Chapter I

The Comparative Mortality of the Human Species, and of the Sexes at every Age, in City, Town, and Country; and in different Kingdoms of Europe: illustrated with a Chart, and with Tables. The Comparative Mortality of the Human Species, by different Diseases and Casualties: exhibiting a Chart, and Tables of all the Mortal Diseases and Casualties in London during Seventy-five Years: illustrated by and contrasted with the united Observations of Medical Authors, with various Hospital Registers; and with a Variety of Materials, Observations, and Comments of the Author.

That learned Physician, Dr. Arbuthnot, in his Preface to Huygen’s “de Ratiociniis in ludo aleæ”, says, There are very few things which we know, which are not capable of being reduced to a mathematical reasoning; and when they cannot, it is a sign the knowledge of them is very small and confused; and, when a mathematical reason can be had, it is as great a folly to make use of any other, as to grope for a thing in the dark when you have a candle standing by you. Medical writers, almost universally, have neglected, or barely skimmed the surface of the following important subjects. The public registers of births, burials, and diseases, are overlooked by all the modern systematick authors: they leave us equally ignorant of the aggregate, or comparative number, or force of those fiends which haunt and ravage the globe. To speak metaphorically, in medical books, the extensive desolation of the most rapacious tyrants and conquerors are confounded with the uninteresting history, and petty depredations of a robber. The detached observations of physicians, or other literary individuals, confined perhaps to a small town or parish, a meagre detail of village remarks, furnish, in innumerable instances, foundations too slight for the erection and stability of general proportions. In order to form useful tables of the ratio of mortality at various ages, to determine upon the absolute and relative havock by different diseases, upon the general effects of climate, season, local situation, diet, drink, luxuries, new customs, and manners, &c. we should extend our views far beyond the narrow bounds of a parish, or even of a province; we should include an interval of many years, collective numbers, and large groups of mankind.

It appears to me, that a great number of the fundamental principles, or of the primary orders of medical architecture, have not yet been established, neither in Pathology, to which this Dissertation is chiefly related; and much less in Therapeuticks. The lumber and mountain of ponderous systems, heaped together from Galen to Stahl, can only be compared to Egyptian pyramids. Except what has been done by a few authors, hereafter to be mentioned, the sciences of Medical Arithmetick and Universal Prognosticks, are new in medicine. In emergencies, the constant appeal has been, with oracular reverence, to aphorisms and opinions of individuals. In a word, no medical author has yet attempted to take the gages of life and death, and of morbid devastation, and, in one general survey, to encircle the horizon of human existence and distempers. I have made some, at least laborious efforts, to rescue a momentous part of active medicine from that conjectural stigma with which the whole profession has been branded in the lump. And, however it may be slighted as an heretical innovation, I would strenuously recommend Medical Arithmetick, as a guide and compass through the labyrinth of Therapeuticks.

We are now to view the human race unexpectedly arrested, and struggling in the tragical and last stages of their terrestrial pilgrimage. The vision of human life is soon at an end: we are ushered into the world with lamentable exclamation; and are too often torn out of it in pain and agony. Bills of Mortality, however defective and inaccurate, yet sufficiently demonstrate this awful truth, that very few of the human species die of old age, or natural decay: by far the greater proportion are prematurely cut off by diseases. Of all the animal tribe, who usually bring forth one at a birth, none die in such numbers, in infancy, as the human race. In London, Vienna, Berlin, and every other overgrown metropolis of Europe, on an average, one half of the children born, die under three years of age. But in country towns and villages, the proportion of infant mortality greatly abates. In some country towns of England, of considerable magnitude and population, as Manchester, half the children die under five; at Norwich, half under six; at Northampton, half under ten years of age. London, therefore, will have lost, out of equal capitals, a number in the intermediate space, between three and ten, more than Northampton.

Attend next to the small proportion of Infant Mortality in open country districts. By Dr. Short’s registers of several small country villages in England, the major part born live to 25, 27, 33, and 40. In many healthy country parishes, half the inhabitants born live to mature age; to 40, 46, and a few even to 50 and 60; and rear large families of children. In some extensive country districts of Switzerland, similar observations have been made by Susmilch and Muret. Here, therefore, is an astonishing disparity between the duration of city and country life: but particularly, let it be engraved upon the memory, in the early stages of puerile exigence. Infants in cities resemble tender delicate plants excluded from fresh air; or fish confined in stagnant putrid water: they perish before acquiring a solidity and seasoning to endure the adulterated quality of the surrounding element; and their thread of life is then suspended by a tender cobweb.

Mortality, universally, during the first year after birth, is the most enormous in the funeral catalogue. A London infant at birth, has but an equal chance of living to three years old; whereas in the country, as before observed, half born survive to maturity. Upon reaching the third year, in cities, infants are somewhat seasoned, and the hurricane of puerile carnage is greatly abated. There is not afterwards such a prodigious disproportion between city and country mortality; and, in a few years after, from seven to ten, they approach nearer to an equality. From the London registers of burials, it appears that more die in the metropolis under two years of age, than from two to upwards of forty; and more under five years of age, than from five to between fifty and sixty: yet under five, there are but an inconsiderable number alive, compared to the latter class above that age: the deaths are greatly disproportioned to the living numbers or capitals. A few more die in the short interval between five and ten years of age, than in the succeeding double interval from ten to twenty. Between eight and sixteen years of age, one of every seventy of the Christ School boys is computed to die. Davenant rates the decrement in these years at only one per cent. After reaching the tenth year, the torrent of mortality in city, town, and country, is subsided; and during the next eight or ten years of adolescence, very few die. From seven to ten, may be termed the highest pinnacle: having surmounted all the dangers and precipices of the early preceding journey, there is no stage wherein the future prospects of existence and longevity are so extensive. From birth to ten, the tide of life continues in annual gradation to increase; and from ten to the ultimate verge of existence, vitality continues gradually to ebb. Between twenty and thirty, more die in London than in the fifteen preceding years; and the burial list continues turgid to sixty; at which latter stage, the mortality is computed between four and five per cent.

One reason, but not the only one, as I shall hereafter prove, of the great surge in the London bills, from twenty up to forty, is, that within this interval of life, the majority of the new settlers or recruits, arrive; and consequently augment the burials, from twenty to forty, beyond their natural proportion. After passing the meridian, and in the evening of life, the seasoned inhabitants of cities are said by Dr. Price, to have the advantage of the country, in health and longevity: that is to say, although the number who have survived in the country to sixty, seventy, and eighty, are greater proportionally than in cities, yet the latter class arrived at those years in London, have, comparatively, surer expectations of life. I do not, however, find this assertion verified in fact; the balance, if any, vibrating alternately on each side. The proportion of inhabitants who reach eighty years of age are computed, in London and Vienna, at one of every forty: but in country parishes, at one of every twenty-two; and in some, even one of every eleven. In both city and country, the few survivors at ninety, out of each thousand cœtaneous births, will have lost almost all their fellow-travellers in the journey, long before reaching that goal; and about three or four only out of each thousand, on an average, will be then left alive.

There are a few instances of extraordinary Longevity, to 150 and 165; such are Jenkins and Par, in this island. In Bacon Lord Verulam’s History of Long Livers, male and female; their climate, diet, mode of life, appetites, exercises, studies, passions, dispositions, habits, and complexions, were exceedingly dissimilar. It is however probable, from observation and analogy, that the indigent and laborious class of mankind do not attain to longevity in the same proportion with the middling and more opulent ranks. The wandering Savages of America are notoriously short-lived. Throughout Europe, Asia, Africa, and America, the rich, the poor, the inhabitants of city and country, with very different complexion, climate, soil, diet, and conveniences, all seldom exceed the usual term of life allotted to man: seventy and eighty is mentioned in holy writ, as the brink of our earthly duration. Since the days of Moses; that is, between three and four thousand years, human existence has been circumscribed within the same narrow bounds. In the London registers of mortality, during a period of thirty years, from 1728 to 1758, the total mortality is 750,332; and of all this number, 242 only reached beyond 100 years of age; one of whom arrived at 138. In some races and families of men, longevity seems to be hereditary; and his age, though little more than a dream, exceeds that of all other living creatures, a few only excepted. Amongst the quadruped creation, the elephant surpasses man in longevity: amongst the birds, the Swan, and a few others, have survived upwards of a century. The age of fishes is determined with more ingenuity than certainty: some seem to rival man in years. Among the numerous vegetable tribes, the Oak, Chestnut, and some other great trees, survive centuries.

On contrasting the mortality of Males and Females, it appears, that, notwithstanding the surplus of male births, the perils of childbearing, the many vexatious diseases peculiar to the fair sex, and that physicians and apothecaries have many more patients of the latter; yet the total aggregate number of living females exceeds that of males, in most European kingdoms. Upon a numerical inquest in Edinburgh, and some other great cities, it was found, that females were to males as 4 to 3: in London, as 13 to 10; and in some other cities and towns, as 9 to 8. But in country districts, Graunt and Susmilch agree, that the two sexes approach nearer to an equality. In the province of Jersey, in North America, the males were found the majority. From 1702 to 1752; that is, during a period of fifty years, I find the proportion of male and female mortality in London as follows: Male deaths, 618,076; Female deaths, 626,692. Whence, therefore, does it happen, that female deaths preponderate over the male, when more of the latter are born, and, as calculators assert, the mortality of males, at all ages, is greater than that of females? As a solution of this difficulty and partial exception, I should suggest a greater exportation and transportation of males to the sea and land service, to nautical commerce, and to unhealthy climates.

Even in the Marriage State, the chance of survivorship seems considerably in favour of the wife. In Breslaw, during eight years, five married men died to three married women. Susmilch, on a scrutiny through several kingdoms and principalities of Germany, found, that three married men died to two married women. Dr. Price estimates the chance in favour of the wife being the survivor in marriage, as 3 to 2: and this calculation is confirmed by the experience of the general Clerical Society in Scotland, who have long established funds to support their widows. From their records, it appears that twenty married clergymen have died to twelve wives; or, as 5 to 3. By an accurate survey of several principalities and cities in Germany, and collected by Susmilch, the widows were to the widowers as 3, and even 4 to 1. At marriage, it should be observed, there is generally a disparity of age; the bridegroom is from six to twelve years older than the bride; and therefore should, in the course of nature, die sooner: and perhaps also more widowers, comparatively with the other sex, enter into a second marriage; which tends to reduce their numbers. Besides, husbands are more exposed to the vicissitudes of the weather and seasons, to excessive labour and noxious trades, and to many other causes of diseases. Dr. Price finds, that the sexes respectively commence to be widowers and widows about 52 and 44; that is, men and women entering into matrimony, on a general average, at the age of 33 and 25, will become widowers and widows at 52 and 44: consequently, that each marriage will be dissolved by the death of one of them, in nineteen years; which is the ultimate term and probability of the husband and wife being both alive. For although some marriages may be protracted forty and fifty years, yet others may be dissolved in one year, or in a shorter time.

We have not yet sufficient information to determine the comparative chances of Female Longevity in the married and single state. At Berlin, indeed, calculators have remarked, that there were more married women alive at great ages, than of those who remained single. But such result might naturally be expected from a greater proportion in the decline of life of widows and wives, compared to antiquated virgins. From the ages of fifteen to twenty-five, married women likewise are said to have the advantage of the single, in whom the dictates of nature are frustrated and violated.

Comparing the mortality of the Seasons, Dr. Short found, from a variety of country-registers, that mortality generally begins its reign in December; that at March it is in its zenith; and at May in its declension. In twenty-five country towns and parishes, he found the winter to the summer mortality as 50 to 41. At Manchester, a country town of England, Dr. Percival found the winter to the summer mortality as 11 to 8. At Vevey, in Switzerland, during sixty years, Mr. Muret found the burials, during the four winter months, as 5 to 4 to those of the summer. Another proof of this is recorded in the Recherches sur la Population, par Messance: The total sick admitted into the Hotel Dieu hospital in Paris, from 1724 to 1763 (forty years) were, in the four winter months, December, January, February, and March, 314,824; and in the four summer months, June, July, August, September, 238,522; or as 4 to 3. In London too, the undertaker’s, harvest is in winter. There is one obvious reason why, in every metropolis, the winter mortality should exceed that of summer, from the greater concourse of inhabitants of all ranks: but, independent of additional population in winter, the same law seems to prevail in country places. In a subsequent part I shall attempt to throw some collateral illustration upon the subject.

Let us close this humiliating scene with a general abstract of human carnage. If we scan the dolorous mansions of disease, we find, on an average, 1 death, annually, out of every 5 families in cities: but in country towns, and open districts, 1 of 7, 8, 9; and in a few healthy places, 1 of every 10 families. Including the whole assemblage of inhabitants in city, town, and country, from birth to the extreme of existence, they are computed to die in the following annual proportion to the living: In London, 1 of 21; Dublin, 1 of 22; Edinburgh, 1 of 21; Vienna, 1 of 20; Amsterdam, 1 of 22; Berlin, 1 of 26. This is nearly Dr. Price’s calculation; but Halley and Susmilch compute only 1 of 22 to 29 to die annually in cities. In smaller cities and towns, such as Norwich and Northampton, the general average of deaths is 1 of 24 to 26; but in several provinces and healthy country villages, 1 of 32 and 33, up to 45, 50, and even 60, is the annual drain: 1 of 43 to 50 was the average in upwards of a thousand country parishes on the continent; and recorded in Susmilch. Within the above short intervals of time, there will have died in the respective cities and country places enumerated, a number equal to the whole inhabitants. But the annual decrease of the oppressed Negroes, in the West India islands, is estimated at 1 of 7.

The ancient Egyptians allotted 3 generations to a century, which is bordering upon the truth; at this day, 1 of 32 and 33 up to 35, is near the measure of a generation, and to the general decrease of a community throughout Europe, comprehending all the inhabitants in city, village, and country: that is, mankind share amongst them from about 32 and 33 to 35 years each of existence: and within this fugitive interval of time, a number equal to all the present inhabitants of this island, or of the whole earth, will be exterminated. If we extend this estimate to the whole human race, eight hundred million will die in 33 years; about twenty-eight million annually; seventy or eighty thousand daily; about three thousand hourly; and from fifty to sixty every minute. It is perhaps superfluous to add, that, in the same intervals, an equal or superior number will be born.

According to De Moivre and Dr. Price, “the probabilities or expectation of life, decrease as we advance from childhood to old age, in an arithmetical progression; that is, in such a manner that the difference is always the same between the number of persons living at the beginning of any one year, and the number living at the beginning of the following year.” Or, in other words, less enveloped in mathematical obscurity, out of any specified number, an hundred or a thousand, the same proportion will continue to die every year until near 80 years of age and upwards: consequently, the probabilities of life are constantly decreasing; because notwithstanding the progressive annual drain from the capitals, yet the deaths continue throughout equal. But this proportion is certainly erroneous in the first stages of life, and until about 10. View the above proposition in another light.

From any given number there will be an equal drain annually, until what De Moivre terms the complement or maximum, or utmost probable extreme of life, which he fixes at 86, all are dead. The probability, therefore, that the whole of any limited number whatsoever, or age, will all be exterminated is the number of years between 86 and the year such a number are all alive. Of 56 persons alive at 30, they should all be dead in 56 years, because 56 added to 30 amounts to 86, the maximum: of 46 persons alive at 40 years of age, they should all be dead in 46 years: and 36 persons alive at 50 years of age, should be dead in 36 years; for 50 and 36 complete the maximum. Again, the expectation of any single life is only half the maximum or complement, or half the space between that age and the ultimate term of existence: but here we must repeat the former exception, and draw the line after 10 years of age. The expectation of two equal joint lives, according to De Moivre, is one third of the complement of life. Example: two lives, aged 40, have an even chance or probable prospect of continuing together in exigence only 15 years; which is the third of the complement, reckoning from 40 to 86: the expectation of the survivor is also 15. Or, suppose a lot of marriages of persons at 40 years of age, they will, on an average, continue together 15½ years; and the survivors the same time after. This expectation, therefore, is the probable duration of each marriage, and the share of each person’s life. But it may be proper to add, that the duration of marriages, and the value of single and joint lives, will, on a promiscuous calculation, be different from the registers of annuitant and insurance offices; because they are scrupulously vigilant to exclude all diseased and unhealthy persons from becoming members.

The following Chart and Tables, present a distinct prospect of the fates clipping the mortal thread, from birth to old age, in city and country. But we are not to suppose that in every instance there will be annually a regular arithmetical diminution, as marked in the different tables: some years will be more fatal than others; and we are to form estimates from an average of several years. The first column points out the age, the second the number living at that age, the third the number who die during the year; and so on to the end of the table. But observe, that the number of infants, at the beginning of the second column, are supposed to be all born together on the first day of that year; and this rule applies throughout all the remaining ages. The two short tables of 15 and 30 years mortality in London, demonstrate the gradations at longer intervals than a single year. From these different tables may be estimated the annual waste, out of any specified number, at all ages, the ultimate prospects of existence, and the odds or probability of a person in health surviving a stated number of years.

A GENERAL CHART, with different Tables, Exhibiting the Gradations of Mortality in City and Country.

Shewing the Probability of the Duration of Life in London, deduced by Mr. Simpson, from Observations on the Bills of Mortality in London for Ten Years, from 1728 to 1737. The total Number of Inhabitants, probably, about 650,000 in Winter. One Half born died under Three Years of Age.

Ages.Persons living.Decr. of life.

01000320

1680133

254751

349627

446917

545212

644010

74308

84227

94155

104105

114055

124005

133955

143905

153855

163805

173755

183705

193655

203605

213555

223505

233456

243396

253336

263276

273216

283157

293087

303017

312947

322877

332807

342737

352667

362597

372527

382458

392378

402297

412228

422148

432067

441997

451927

461857

471787

481716

491656

501596

511536

521476

531416

541356

551296

561236

571175

581125

591075

601025

61975

62925

63875

64825

65775

66725

67675

68624

69584

70544

71504

72464

73423

74393

75363

76333

77303

78272

7925

Shewing the Probabilities of Life in London for all Ages. Formed from the Bills for Ten Years, from 1759 to 1768. By Dr. Price.

Ages.Persons living.Decr. of life.

01518486

11032200

283285

374759

468842

564623

662320

760314

858912

957710

105679

115589

125498

135417

145346

155286

165227

175157

185087

195017

204947

214878

224798

234718

244638

254558

264478

274398

284319

294229

304139

314049

323959

333869

343779

353689

363599

373509

383419

3933210

4032210

4131210

4230210

4329210

4428210

4527210

4626210

4725210

482429

492339

502249

512159

522068

531988

541907

551837

561767

571697

581627

591558

601478

611397

621327

631257

641187

651117

661047

67977

68907

69837

70766

71706

72646

73585

74535

75485

76435

77385

78334

79294

80253

81223

82193

83163

84132

85112

8692

8772

8851

8941

9031

Shewing the Probabilities of Life at Vienna. Formed from the Bills for Eight Years, as given by Mr. Susmilch, in his Gottliche Ordnung. Contains upwards of 200,000 Inhabitants. One Half born died under Three Years of Age.

Ages.Persons living.Decr. of life.

01495682

1813107

270661

364546

459933

556630

653620

751611

85059

94967

104896

114835

124785

134736

144676

154616

164557

174486

184426

194366

204305

214255

224205

234156

244096

254036

263976

273917

283847

293777

303706

313646

323585

333536

343477

353408

363328

373248

383169

393079

402988

412907

422836

432776

442717

452648

462569

472479

482389

492299

502208

512127

522057

531987

541917

551848

561768

571689

581598

591518

601437

611367

621296

631237

641167

651098

661018

67938

68857

69787

70716

71655

72605

73554

74514

75475

76425

77375

78325

79274

80233

81202

82182

83162

84142

85122

86102

8782

8862

8941

9031

9121

9211

Shewing the Probabilities of Life at Berlin. Formed from the Bills from Four Years, from 1752 to 1755. Given by Mr. Susmilch, in his Gottliche Ordnung. Contains 134,000 Inhabitants. Half die under Three Years of Age.

Ages.Persons living.Decr. of life.

01427524

1903151

275261

369173

461845

557321

655216

753613

85239

95147

105075

115024

124984

134944

144904

154864

164825

174775

184725

194676

204616

214556

224496

234437

244368

254287

264219

274129

284039

293949

303859

313768

323687

333617

343547

353478

363399

3733010

3332010

3931010

4030010

412909

422818

432737

442667

452597

462527

472457

482387

492317

502247

512177

522107

532038

541958

551878

561798

571718

581639

591549

601458

611377

621306

631246

641186

651126

661067

67997

68926

69866

70806

71746

72686

73625

74575

75525

76475

77425

78375

79324

80284

81243

82212

83192

84172

85152

86132

87112

8892

8971

9061

9151

9241

Dr. Short’s Table, from January 1st, 1728, to 1743; a Period of Fifteen Years. Died by the London Bills, at all Ages, taken at an Annual Medium, in the following Proportions.

Years of Age.Died.

Under———29910

{ 2to52411

{ 5———10980

{10———20851

{20———302060

{30———402471

From{40———502510

{50———602231

{60———701675

{70———801200

{80———90634

{90———100117

———

Total Annual Medium of Deaths in this Period }—27,058

A Table of Thirty Years, taken from the London Bills, beginning with 1728, and ending with 1757; shewing the Total Number of Deaths and Decrease in this Period, at every Age.

Years of Age.Died.

Under———2272903

{ 2to564745

{ 5———1025912

{ 10———2022891

{ 20———3058474

{ 30———4071502

From{ 40———5073258

{ 50———6059872

{ 60———7047269

{ 70———8033679

{ 80———9016948

{ 90———1002496

{100———138242

———

Total Deaths in this Period, at all Ages }750,191

Shewing the Probabilities of Life in a Country Parish in Brandenburg. Formed from the Bills for Fifty Years, from 1710 to 1759, as given by Mr. Susmilch, in his Gottliche Ordnung. One Half born lived to 25 Years of Age.

Ages.Persons living.Decr. of life.

01000225

177557

271831

368723

466422

564220

662215

760712

859510

95858

105777

115706

125645

135595

145545

155495

165445

175394

185354

195314

205275

215225

225175

235125

245075

255024

264983

274953

284923

294893

304864

314825

324775

334725

344675

354626

364566

374506

384446

394386

404325

414275

424225

434175

444126

454066

464006

473946

483887

493817

503747

513678

523598

533518

543439

5533410

5632410

5731410

5830411

5929311

6028211

6127111

6226012

6324812

6423612

6522411

6621311

6720212

6819012

6917812

7016613

7115315

7213816

7312215

7410714

759313

768012

77689

78598

79517

80446

81386

82326

83266

84205

85154

86113

8782

8862

8941

9031

9121

9211

Shewing the Probabilities of Life in the Parish of Holy Cross, near Shrewsbury, in England. Formed from a Register kept by the Rev. Mr. Gorsuch for Twenty Years, from 1750 to 1770. One Half born lived to 27 Years of Age.

Ages.Persons living.Decr. of life.

01000189

181149

276245

371735

468223

565923

663618

761814

86049

95956

105894

115854

125814

135774

145734

155694

165655

175605

185555

195505

205456

215397

225327

235257

245186

255126

265065

275015

284965

294915

304865

314815

324765

334715

344666

354606

364547

374477

384407

394337

404268

414188

424109

434018

443937

453867

463797

473727

483656

493596

503536

513477

523407

533337

543268

553188

563109

573019

582929

5928310

6027310

6126310

6225310

6324310

6423310

6522310

6621310

6720310

6819311

6918211

7017110

7116110

721519

731428

741348

751267

761197

771127

781057

79988

80909

818110

827110

836110

845110

85419

86328

87247

88176

89114

9072

9151

9241

Shewing the Probabilities of Life in the Country District of Vaud, in Switzerland, from the Registers of Forty-three Parishes. Given by Mr. Muret, in the First Part of the Bern Memoirs for the Year 1766. In this Country Province were 112,951 Inhabitants; and one Half born lived to the Age of 41.

Ages.Persons living.Decr. of life.

01000189

181146

276530

373520

471514

570113

668811

767710

86678

96596

106535

116485

126434

136394

146354

156315

166264

176224

186184

196144

206104

216064

226025

235975

245925

255875

265825

275775

285725

295674

305635

315585

325535

335484

345445

355396

365336

375277

385207

395137

405066

415006

424946

434886

444826

454767

464698

4746110

4845110

4944110

504319

514228

524148

534069

543979

5538811

5637713

5736416

5834817

5933117

6031415

6129913

6228612

6327412

6426212

6525014

6623616

6722018

6820218

6918416

7016815

7115313

7214011

7312910

7411910

7510911

769813

778514

787113

795812

804610

81367

82295

83244

84203

85173

86143

87112

8892

8972

9051

The two following Tables are taken from Dr. Price. I have however omitted the fractions, for reasons which shall be explained when treating of the inaccuracy of the public registers. The expectations of life are here rated a few years inferior to the standard of most other authors.

The probable Expectations or Prospects of Life in

Ages.London.Vienna.Berlin. Country parish of Brandenburg.Holy Cross, near Shrewsbury.Pais de Vaud, in Switzerland.

At birth18yrs.17yrs.18yrs.33yrs.33yrs.37yrs.

Age12343636444444

25262827363535

30242625323231

35222324262828

40202121252624

45181819222321

50161616182018

55141414151715

60131213121512

65111011101210

709998108

75777686

80566555

The Odds or Probability of living ONE Year in

Ages.London.Vienna.Berlin. Country parish of Brandenburg.Holy Cross, near Shrewsbury.Pais de Vaud, in Switzerland.

At birth2to 12to 12to 14to 15to 15to 1

Age1275to 184to 1123to 1112to 1144to 1160to 1

2556to 166to 150to 1110to 1100to 1117to 1

3045to 156to 144to 1107to 196to 1111to 1

4031to 136to 132to 178to 155to 183to 1

5024to 127to 130to 150to 150to 149to 1

6018to 119to 118to 125to 126to 123to 1

7012to 111to 112to 111to 116to 110to 1

807to 17to 17to 16to 18to 14to 1

Having in the preceding part endeavoured to establish the mortality of the human species at different ages, I am now to attempt a more arduous task; to ascertain the mortality by different diseases. I propose therefore, in imitation of the geographers, to spread out and to review, in one general Chart, the enormous host of diseases which disgorge their virulence over the earth, and, with frightful rapacity, wage incessant hostilities with mankind. By this means, we shall, to use a military phrase, reconnoitre more distinctly our enemies arranged in hostile front; and be warned to make the best disposition and preparation for defence where the greatest danger is apprehended, and the most formidable assaults to be sustained. Armed with diseases, the grim King of Terrors appears in the most hideous aspect. Under all these predatory disguises and morbifick forms, I shall track him grappling with mankind, and with his tremendous scythe mowing down generations. The learned Sauvages thus expresses himself: “Utinam numerus respectivus diversorum morborum a nostratibus inquirarentur.” It is, in some measure, from ignorance in this subject, that the streams of medical inquiries, of academick rudiments, and of charitable donations to poverty in disease, have not yet been pointedly directed to publick utility.

I could easily have exhibited tables of the Diseases and Casualties in London during the greater part of the last century. But, compared to its present magnitude, the British metropolis was then insignificant in size: 23 new parishes have been since gradually added to the London bills: there is also a chasm of 10 years in which the registers are lost. Again, until 1665 and 6, London was infested with the plague; which disease, previous to that date, seems to have been one primary object of the registers: and to adopt Graunt and Short’s sentiments, these records, from various political and religious obstacles, were then very negligently managed. During the early part of this interval, the kingdom was distracted with civil war; and after the great pestilence in 1665, London must have required some years to recruit. Besides, had I attempted to form tables for even the latter part of the last century, the reader would have been fruitlesly embarrassed; and such an attempt must ever prove abortive. For example, under one and the same title, in the annual bills of mortality, are often confounded flox, small pox, and measles: consumptions and tissick: cancer, canker, and thrush: wolf, cancer, gangrene, and fistula: cancer, gangrene, fistula, and mortification: gout and sciatica: vapours and water in the head: quinsey and thrush: teeth and worms: sores, ulcers, bruised and broken limbs: cough, cold, and chincough, &c. These are a few specimens of Nosological absurdity in the superintendents of the publick registers.

Notwithstanding this rabble of diseases in commenting upon the London bills and diseases of the present century, I constantly refer back, and contrast them with the bills of the last thirty years of the preceding century; so that, as near as the imperfection of the materials will admit, the mortality and diseases of 105 years in London is presented at one view; and comprehends the various acute and chronic diseases, by which about two million and a half of the human species have been destroyed. The few authors who have written on bills of mortality, have obscured their works in a cloud of figures and calculation: the reader must have no small portion of phlegm and resolution to follow them throughout with attention: they often tax the memory and patience with a numerical superfluity, even to a nuisance.

For the above, and many other reasons, I have compressed into one chart, the London Diseases and Casualties of seventy-five years in the present century: each disease and casualty arranged in a progressive series of fifteen years mortality; in a fifth column is added together the mortality of the preceding five divisions. During this period, London has been more populous and stationary in numbers: and by this means, the actual and comparative magnitude, rise, and declension of different diseases, will be more conspicuous in each period or interval: and by measuring the mortality with the population, we are enabled, with certain precautions and exceptions, to make the diseases and casualties of London serve as a morbid barometer to the whole nation. The important reason which determined me in forming an arrangement of fifteen years, in preference to any other number or period, was, that the annual havock by similar diseases and casualties, throughout this and the neighbouring island, might be computed with some probability by each fifteen years of the London bills; and thereby to elicite a new, curious, and comprehensive proportion in medicine. For instance, if we suppose the standing number, on an average, of the London inhabitants at six hundred thousand; and the total inhabitants in Britain and Ireland at nine million; and if the same diseases and casualties were equally diffused and fatal to this whole community, then, in such case, the London bills would serve as a scale or index of mortality to both kingdoms: as many would die annually of every disease and casualty throughout nine million, as are cut off in fifteen years in London; for six hundred thousand multiplied by fifteen, amounts to nine million.

But to supply the probable deficiency in the annual mortality of London by different diseases and casualties, we must make an addition to each of one third or fourth. To the mortality of Small-Pox, in London, during fifteen years, and rated at thirty thousand, we should add one third or fourth more to raise it to its just standard; that is, to about thirty-eight thousand; which would be the annual mortality amongst nine million in Britain and Ireland, supposing small-pox equally universal, one time or other, and destructive. By the same hypothesis, amongst two hundred million in Europe Variolous mortality annually, would amount to four hundred thousand; and, amongst eight hundred million; that is, the whole human race would exceed three million annually. On this simple principle, a gross estimate may be formed of the annual havock by every other disease and casualty; taking the precaution, however, to attend to the subsequent criticisms on the London bills.

Another curious corollary may be grounded on the above hypothesis; which is, to form a probable conjecture of the numbers who are annually Sick, or afflicted with different diseases. Example: if one of every seven die of the Small Pox, and the variolous deaths throughout Britain and Ireland are rated at thirty-eight thousand annually, this number, multiplied by seven, amounts to two hundred and sixty-six thousand annually, infected with variolous contagion. Apply the same rule to Childbed mortality; rate the annual havock by parturition in the two islands at four thousand: it will hereafter be shewn, that in London one of seventy-four women die in childbed: multiply therefore 4,000 by 74, the product is 296,000, which, in reality, cannot be very distant from the total annual procreation in both islands. And in these two examples, I have suggested what may be termed an inverse proof of both propositions. From these tables and commentaries, we are likewise furnished with a key to the comparative mortality of each disease amongst a community: whether its devastation is in the proportion of a fifth, tenth, twentieth, or hundredth. Gentlemen who have not particularly attended to the subject of morbid calculations (and very few of the medical profession have) will, on better information, be astonished at the flagrant errors daily committed by authors when treating of these topicks. Out of the many examples which might be enumerated, I shall merely select one in proof. Baron Dimsdale, in a Treatise on Inoculation, dedicated to the present Empress of Russia, calculated that, at least, two million were annually destroyed by Small Pox alone in the Russian empire; and it was not until after the publication of my Observations on his different Inoculating Essays, that this error and others were erased.

I would request the reader’s particular attention to another circumstance: which is, that on comparing the gradations of mortality in the following chart, we are not to estimate the relative number, frequency, or proportion of certain diseases, compared to others by the absolute mortality of each. For instance, Apoplexy kills rather more annually in London than Measles; but yet the latter disease is infinitely more universal and diffused amongst the community, and consequently less dangerous to life: Cancerous and Venereal cases are widely different in the annual number afflicted with each, although the deaths are not far distant from an equality. The same observations will apply to Rheumatism, compared to the Dropsy, and to many other diseases.

There are between eighty and ninety diseases and casualties enumerated in the London bills, which, in the subsequent comments, I have disentangled into their separate genera. But, to prevent the possibility of aberration, after the chart of London diseases, I have added a correct Medical Chart of all the principal diseases and casualties with which mankind, in every part of the earth and ocean, are afflicted or harrassed. This will operate as a check and correction to the public registers; and by this, the defects and errors in the London bills will be apparent; and it will serve as an index to our future commentaries. But objections and difficulties occur in our researches for collateral information and illustration from hospital records. The reasons are glaring, why, in the latter, diseases should be less fatal; and in this respect, cities should have the advantage of the country. We cannot therefore apply hospital registers as a general criterion to a nation. Whenever authentic and systematic records of diseases, recovery, and mortality, are kept in hospitals, domestick as well as military, and annually published, whatever may be alledged respecting the importance and demerits of such institutions, the community, at all events, will derive much useful information.

A CHART of all the Fatal Diseases and Casualties in London, during 75 Years; Beginning from 1701, and ending with 1776.

Collected from the London Bills of Mortality, and arranged into Five separate progressive Periods of Fifteen Years each.

The Total Amount of the Five Periods, or Seventy-five Years Mortality, is added together in the Sixth Column.

DISEASES AND CASUALTIES.Fifteen Years, from 1701 to 1717.From 1717 to 1732.From 1732 to 1747.From 1747 to 1762.From 1762 to 1777.Total Amount of Seventy-five Years Mortality, from 1701 to 1777.

Ague801988299109574

Fevers. Malignant, Spotted, Scarlet, and Purple50,95553,33057,99545,62148,594256,085

Small Pox22,21934,44829,46229,16536,276151,570

Measles1,9722,6182,8583,0993,31913,866

Quincy, Sore Throat2261692873063091,297

Pleurisy3846028114073213,525

Rheumatism3684473101751281,468

Gout3136457698031,0103,236

Consumption42,54149,68066,00961,74968,949288,928

Chin Cough, Hooping Cough, Cough1166321,6922,7554,2529,573

Asthma and Tissick5,0907,9389,4605,6996,15434,341

Apoplexy and Suddenly2,2283,0133,2873,2713,35315,152

Palsy3325506211,0211,0203,544

Lethargy10512611610574526

Meagrims1310———23

Headach2132618—77

Lunatick4125137771,1261,0483,876

Spleen and Vapours535220——125

Rising of the Lights1,2191,23919730102,074

Stoppage of the Stomach4,1392,5572,2863041799,465

Vomiting and Looseness8206822481341202,004

Cholic, Gripes, and Twisting of the Guts13,66811,0323,7391,47579629,710

Flux178200—252341971

Bloody Flux1332481679493745

Worms697662161115561,691

Jaundice1,2611,7982,0321,7292,0898,909

Gravel, Stone, and Strangury7898687004214293,205

Diabetes374819165125

Dropsy and Tympany11,62615,43016,03613,41014,03870,506

Livergrown76957523—269

French Pox9171,3721,6639971,0165,965

Scurvy6328145942226

Evil1,0205194261971982,360

Leprosy19536939151,915

Rash77128475924341

Itch——42311184

Childbed3,5603,8943,4123,0053,18617,057

Abortion, and Stillborn8,74610,2318,7938,82010,24146,831

Chrisoms and Infants850315606——1,771

Miscarriage——475649152

Convulsions91,660114,718111,96685,19689,221492,761

Headmold-shot, and Water in the Head6092,3742,0131,0223376,355

Teeth18,47825,19920,27413,97811,91889,847

Thrush8391,1911,5121,3911,1016,034

Scald Head9152922—75

Rickets3,9161,3839541121046,569

Inflammation8676988941,3943,061

Imposthume790694387191842,130

St. Anthony’s Fire—73366369241

Gangrene and Mortification1,0712,8573,3623,0833,02313,438

Canker1381811237761580

Cancer1,0411,0597746827192,475

Sores and Ulcers6954854022532362,071

Fistula3602022101341191,025

Bursten and Ruptures3103093041631401,226

Swelling and Wen6—474937139

Killed by Falls, Bruises, Fractures, and other Accidents8289179261,0841,0654,820

Self-Murder4456676935555092,869

Murdered1351091477177539

Stabbed, Killed, Wounded, Shot, &c.153213——60

Executed——4954951,020

Drowned9071,1931,4441,7181,7817,043

Burnt905490127132493

Scalded1936455140191

Stifled, Suffocated, and Smothered1334629068276

Overlaid8171,1801,293414953,799

Found dead3885576683361332,082

Grief—267—8777421

Frightened814813245

Surfeits685131593127933

Starved—17965357223

Excessive Drinking19267678189691,222

Bleeding87695770114397

Poisoned277241040

Bit by Mad Dogs and Cats—31415638

Bedridden—104—56105265

Aged27,34134,70830,05825,10922,032139,248

A MEDICAL CATALOGUE of all the principal Diseases and Casualties by which the Human Species are destroyed or annoyed.

Fevers. Intermittent, quotidian, tertian, quartan, species and varieties.

—— Remittent, Continued, and Eruptive; remittent, and the species, nervous and putrid, miliary, inflammatory, small pox natural and inoculated, measles, scarlet fever, some cutaneous eruptions, mixed and anomalous fevers, plague, sweating sickness.

Fevers with topical inflammation of the brain, of the fauces, including angina inflammatory and putrid, pleurisy, and peripneumony, inflammations of the heart, diaphragm, liver, spleen, stomach, intestines, kidneys and ureters, bladder, peritoneum, erysipelas, acute and chronic rheumatism, regular and irregular gout. Internal suppuration and gangrene.

Injured respiration and coughs, catarrh, pulmonary hæmorrhage, pulmonary consumption, hectick, atrophy and tabes, asthma, hooping cough, croup.

Natal hemorrhage, headach, nightmare, lethargy, vertigo, apoplexy, epilepsy, fainting, resemblance of death from drowning, foul air, &c. palpitation of the heart, internal polypus and aneurism, tetanus and locked jaw, catalepsy, spasm, cramp, Saint Vitus’s dance, tremor, palsy, berbiers, insanity furious and melancholy, hypochondriasm.

Diseases of the sight, hearing, smell, taste, voice, and speech, sterility of the sexes, morbid irritability of the genitals, diseases of the teeth, deglutition obstructed.

Diseases of the stomach, and of the complex organization, subservient to appetite and digestion, gall-stones, jaundice, cholera, dysentery, diarrhœa, cholick, worms, tenesmus, costiveness, hemorrhage from the stomach and anus.

Morbid symptoms and diseases from various poisons, canine madness, venomous bites and stings.

Obstruction and suppression of urine, stone in the bladder, diabetes and incontinence of urine, ulcers of the kidney and bladder, bloody urine.

Watery effusions, or dropsies of the head, spine, chest, pericardium, external cellular membrane, abdomen, ovarium, fallopian tubes, womb, scrotum, tympany, corpulency, and excess of fat.

Venereal disease, scurvy, scrophula, leprosy, yaws, itch; several chronic cutaneous defedations, morb. pedicul.

Female Diseases. Obstruct. mens. chlorosis, excessive menstr. fluor alb. hystericks, pregnancy, parturition, natural, laborious, preternatural, and complex, some diseases during pregnancy, abortion and miscarriage, uterine hemorrhage, fainting, convulsions, lochial excess and suppression, uterine inflammation, puerperal fever, after-pains, weed, milk fever, inflammation of the breast, excess and defect of milk.

Infant Diseases. Convulsions internal spasms, dentition, rickets, thrush.

N. B. Vomiting, diarrhœa and watery gripes, hectick and atrophy, small pox, measles, rash, hooping cough and worms, dropsy of the head and spine, are before described, under their respective titles.

Internal schirrus affecting various parts, the lungs, stomach, intestines, liver, spleen, kidneys, ovaria, womb, testicles; also internal cancer, external scirrhus and cancer.

External inflammation, suppuration, gangrene, burns, wounds, and contusions, fractures simple and compound, luxations and sprains, herniæ, or ruptures, abscess and ulcers, white swelling, spina ventosa, external aneurism and varix, polypus of the nose, fauces, vagina, womb, wens, bronchocele, corns, warts, chilblains.

An abstract of the general causes of diseases and mortality, of the seasons and elements, food and drink, excretions and secretions, exercise and rest, sleep and waking, passions of mind, venery.

An abstract of mortality in various domestic and military hospitals.

The Poet has, in just and emphatical language, stiled health the vital principle of bliss. In the rude state of science and medicine, and in the ages of superstition and credulity, it was usual to ascribe diseases to the immediate resentment of some invisible demon, or to divine displeasure and chastisement; on which account, in barbarous nations, their physicians have been a set of stupid conjurors. Two centuries have barely elapsed, since the people of England could, with difficulty, be persuaded that the jail distemper, communicated at the Oxford assizes, from the prisoners to the spectators, was not kindled up by witchcraft and necromancy: but learning and philosophy have now discarded such supernatural agents. Others again equally err, in supposing diseases to be unsteady motions of the human machine, excited by something hurtful. This popular error seems to originate from confounding diseases themselves with the versatility of medical remedies and practice. Beyond a doubt, diseases are presented to us, over and over again, in nearly the same form and shape: the diseases delineated two thousand years ago by Hippocrates, at this day retain the same essential marks and prominent features; tho’ in degree and violence, there are many gradations and shades to vary the picture.

A disease, in the pathological language, is when one or more of the various corporeal or mental functions, cannot be performed as in usual health. The symptoms of all diseases are indicated by few or many derangements of the corporeal functions, of the excretions, and of the sensible qualities: such are pain, disagreeable sensation, anxiety, irritation internal or external; the exercise of some of the external or internal senses impeded; of sleep and waking; of the muscular or moving fibres; of the digestive and intestinal functions: of the lacteal, lymphatic, or absorbent system; of the respiration, sanguiferous circulation, and arterial pulsation; of the different excretions and secretions, the feces, urine, perspiration, bile, pancreatic fluid, saliva, milk, menses, semen, mucus, oil, lymph, by extravasated blood: by the countenance, actions, gestures, debility, strength, heat, colour, smell, taste, magnitude, hardness, softness, the nature and appearance of the excretions, &c. I studiously avoid all minute pathological discrimination of symptoms; as symptoms of the disease, of the cause, of symptoms, of reacting nature; of primary, pathognomic, accidental, and accessary symptoms. Nor in briefly enumerating the various causes of diseases, shall I waste time in the explanation of what may be learned from pathological systems and vocabularies: such as the technical distinction of causes into external and internal, predisponent, exciting and occasional, remote and proximate.

There is both fiction and much truth in the warbling melody of the Roman poet: “Post ignem etherea domo subductum macies, et nova febrium cohors incubuit terris.” Consumptions and Fevers we see, by arithmetical demonstration, are amongst the most universal and fatal maladies of our metropolis and Island. I begin this morbid survey with the latter. The principal and most general febrile epidemicks which infested England during two intire centuries, are enumerated in a short abstract, by Dr. Short; and consist of plagues, agues, remittent fevers, summer and autumnal dysenteries, spotted putrid fevers, slow fevers, small pox, measles, putrid and contagious peripneumonies, fatal spring pleurisies, and peripneumonies, and epidemical catarrhs. Throughout all countries, in epidemical diseases, there are years when they are more or less prevalent. Great national calamities, from this source, are rare: none ever inundate a whole kingdom (catarrh in some instances excepted): they sometimes indeed spread from one province to another, but all the community are never attacked at once; nor are large populous kingdoms, or even cities, totally exempt from them. Fevers of various generic forms, as intermittent, remittent, nervous and putrid, scarlet, small-pox, measles, &c. may be local and circumscribed to one city or district, whilst others in the vicinity, continue at the same time healthy; the disease dissipating its virulence within a small boundary. From a comparison of 150 different parish registers, Dr. Short calculates, that within a certain period, some have had 8 to 14 sickly years, and others, in the same interval, only one. He estimates 5, 6, and 8 years interval, as a common rotine of irruption by some epidemical distemper, even in remote country parishes: and a few of them have been so fortunate as to escape any uncommon or remarkable mortality during 11, 12, or even 20 and 30 years. In all the seasons denominated sickly in the country parishes, the burials exceeded the christenings; and according to the nature of the epidemick, the morbid state of the seasons, the medical treatment, and many other circumstances, the gradations of mortality, even by the same disease, were extremely various.

Collating the annual average of deaths in a sickly year of London, and other great cities, with sickly years in the country parishes, Dr. Short found, that cities and towns, in this respect, have the advantage of the country. In spacious open country districts where fatal epidemicks burst out, according to this author, more died in one year than during 6, 10, 12, or sometimes 15 healthy years: whereas, says he, in London, and such other cities, not above one third, fourth, or fifth beyond the ordinary consumption are swept away. Pestilential mortality is a solitary exception to this proportion. In the London bills we may frequently observe, that in different months, the deaths are double or treble above equal periods of the same year: but during the present century, I find no instance of triple, very rarely of double excess in the annual London burials. Dr. Short adds, that mortality is more constant and regular in cities, and not so many destroyed “per saltum” from raging epidemicks, as in the country. In pure open air, he suggests, that contagion and infection, or other adulterated effluvia, are more virulent. Or perhaps he should have said, or at least have added, that in cities where the atmosphere is charged with a load of smoke, and other heterogeneous vapours, epidemical poisons may be blunted, decompounded, or annihilated; that likewise in cities, human bodies are more early seasoned and habituated to such noxious external impressions, and, like doctors and nurses, are in some degree fortified by habit: that besides, in every large metropolis, small-pox, measles, and, some other febrile epidemicks, are almost constant residents; and consequently the devaluation from these diseases is more regular and equal than in the country, where several years intervene between their invasions.

The absolute mortality by fevers in the London bills, without including the small pox and measles, amounts to nearly one seventh of the whole funeral catalogue. In the London dispensaries, the Aldersgate and Westminster, and in the Newcastle hospital, fevers were a fourth and sixth to all other diseases. De Haen computes, that out of two thousand sick, admitted into the hospitals in Vienna, seven hundred of them laboured under acute and febrile diseases. Dr. Cleghorn estimates the summer fevers in that warm Mediterranean island Minorca, as constituting three-fourths of all the diseases in that island. Dr. Lind calculates, that nineteen out of twenty of all the numerous Europeans who visit the sultry climates of Africa, America, and of the East and West Indies, are destroyed by intermittent, remittent fevers, and fluxes; and probably he also should have added, or by chronic diseases and broken constitutions, the consequence of those fevers. In the London bills of mortality, many different genera of fevers are crammed into one indiscriminate heap, from which it is impossible to extricate the specific nature or genus of febrile carnage. I was anxious to determine with some probability, the ratio of desolation in London, by each of the different febrile genera: because it would be an important guide to the prevention and cure. I knew that most of our hospital registers were in this particularly defective; on that account I was favoured by a medical friend, with the perusal of the books of the Aldersgate dispensary. But although no gentlemen are better qualified to discriminate diseases, I perceived, on inspection, that too often the genus of fevers was not marked, only by the general outlines of the class. However, I converted this scrutiny to some other use, as will hereafter appear.

We shall first trace the prominent features of the general febrile Class, descending progressively through the different Orders and Genera. In most fevers, of whatsoever genus, one or more of the following symptoms occur: shivering, chilliness, and heat of the skin alternating: the circulation of the blood, and consequently of the pulse, as felt at the wrist, accelerated more than in the natural state; in adults, to upwards of 96 strokes every minute; and in infants, is considerably more increased in velocity: also general languor, lassitude, and debility of the nerves and muscles; dryness of the mouth and tongue, thirst; little or no sleep, or disturbed and not refreshing, and generally headach: in most of the continued and remittent fevers, there is total suspension of appetite, sickness at the stomach, nausea and vomiting; increased heat of the skin, at least burning sensation; aversion to motion; the sick are mostly confined to bed, unable to walk, or frequently even to sit erect; and this is commonly the case, even in the intermittent genera during the febrile paroxism: the remittent and continued have usually an evening or nocturnal febrile exacerbation: the voice and countenance frequently express condolence: and in the genera of topical inflammations, there is fixed pain in the different parts affected.

Intermittent Fevers,

or Agues, notwithstanding their febrile type, fall under the Chronic class. They are usually distinguished into different genera, or types; into Quotidian, Tertian, Quartan, with their separate species and varieties. It would seem, by the London registers, that very few die of agues, from which no age is exempted, but to which adults are much more obnoxious. Intermittent havock, if not immediately, yet in its chronic effects, is far more fatal than the London bills represent. Towns in general, it is true, are less harrassed with agues than country places. Pringle remarks, that during the campaigns of the British troops in the marshy countries of Holland and Flanders, where, in all such climates, and in damp soils and situations, agues and remittent fevers are epidemick, that the soldiers quartered in towns were less afflicted than those stationed in country cantonments: that in the former, the fires, sewers, drains, and paved streets, prevented an exuberance of moisture: and that, if the men slept in the upper floors of the house, they were still more secure from damp and intermittent sickness.

The invasion of Intermittent Paroxisms, is during certain periods only, and generally consists of a successive series of shivering and cold, burning heat, and profuse sweats: and exhibits the fundamental outlines of all fevers. Intermittent paroxisms, and consequently the genera and species, vary in duration, in recurrence, and in the symptoms. Quotidians, Tertians, and Quartans, consist of paroxisms, at the respective intervals of 24, 48, and 72 hours. An interval denotes the length of time from the beginning of one paroxism to the next succeeding: an intermission the vacation between paroxisms. Other distinctions, perhaps too refined, are made of intermittents, as Quintanæ, Septiminæ, Decimanæ, Erraticæ, Vagæ. Each of the three primary intermittent genera, are likewise subdivided into duplex and triplex. The double tertian is a very universal form, but may be referred to remittents: it implies that every other or second day the paroxisms are similar, but different in the intermediate days. Again, the type of intermittents is often obscured under a cloud of irregular and adventitious symptoms; and from one predominant symptom, or from similarity to various other diseases, these three fundamental genera are split by Nosologists into other species and varieties; the Quotidiana or intermittens, into simplex, cephalalgia, ophthalmica, nephralgica, stranguriosa, ischiadica, sputatoria, catarrhalis, anginosa, epileptica, hysterica, partialis: the Tertiana into simplex, hemitritæa, duplex, triplex, pleuritica, asthmatica, arthritica, emetica, hysterica, apoplectica, urticata, and other species of double tertian enumerated under the remittent type: the Quartana into cataleptica, epileptica, hysterica, maniaca, comatosa, nephralgica, splenetica, arthritica.

The three stages of intermittent fevers, during their periodical revolution, affect, more or less, the brain and nerves, the inherent muscular power, the heart and arteries, the stomach and intestines, and the sensible qualities of the body; the symptoms usually succeeding in the following progressive order: languor, sluggishness, debility, impaired sensibility, sometimes drowsiness and coma, oscitation, sensation of coldness in the back and spine, overspreading the body and extremities; accelerated and weak pulse; laborious respiration with anxiety; impaired appetite, and often sickness, nausea, and vomiting of bile; thirst; limpid urine; pale face, extremities, and trunk, and cutaneous collapse; rigor and trembling of the extremities and trunk, and gnashing of the teeth, as if cold water was poured on the body. This stage is various in duration in different persons, and in the different intermittent types. Nature at length rallies its powers with success, and with the expulsion of the cold, the second or hot stage is kindled up with undulating flushes of heat, and its preternatural increase over the body; the cutaneous blood vessels are dilated with suffusion of the countenance, redness, and burning heat; the pulse becomes strong, full, and more regular; the respiration continues oppressed, and is accelerated; with headach, throbbing of the temporal arteries, and sometimes delirium. After some continuance of this febrile struggle, and tumultuary rage of the re-acting organs of sensation and motion, the third stage of sweat is introduced by some moisture oozing throughout all the cutaneous pores, and poured out often in profuse streams: with this the heat of the body, the pulse, respiration and appetite become more natural; the urine less transparent deposits a sediment; the febrile tempest abates to a calm; and the body recovers the exercise of all its usual functions. Sometimes indeed there are varieties; such as little or no cold stage, or sweat.

Intermittent paroxisms are always terminated in less than twenty-four hours. Quotidians have the least cold stage, but the longest paroxism: tertians are in the intermediate degree in both respects; quartans have the most violent, or at least the longest cold stage, but the shortest paroxism: their cold stage may be two hours, or longer. The hot and sweating stages therefore constitute the greatest portion of intermittent conflict. Quotidian paroxisms rarely exceed eighteen hours: tertians are from six to twelve: quartans somewhat shorter. Quotidians generally assault in the morning; tertians and quartans in the noon and afternoon. Vernal are said not to be so refractory as autumnal intermittents. But in young sound constitutions, agues, if not inveterate, are frequently cured after a few paroxisms. When death happens in them, it is generally during the cold stage. More frequently their fatality is by transition into some other chronic diseases: such as maladies of the stomach, digestive organs, liver, and intestinal tube; bilious cachexy, jaundice, consumptions, dropsy. Some inveterate corporeal infirmities have been relieved by intermittents. During their revolution the type is frequently changed: quartan and tertian into quotidian: the latter into remittent; and these into continued fever.

Remittent Fevers:

fevers with remissions and exacerbations, or which have not a temporary and total cessation, are the most universal febrile form in all parts of the globe. Throughout the equatorial oven, or middle regions of the earth, from Cancer to Capricorn, intermittents, but, above all, remittents and dysenteries are the most universal type of fever. They are the locusts which devour whole crops of mankind. During the periodical rainy seasons of the tropical zones; particularly where they are choaked up with woods and morasses, and in uncultivated new settlements, these fevers often ravage with the desolation of an Egyptian pestilence; and are sometimes so precipitate as to kill in one or two paroxisms, if not sooner repulsed; the doctor, lawyer, and priest quickly succeeding each other in their visits. They destroy not only multitudes immediately, especially of the new European settlers; but when improperly treated, or when convalescents from irregularity, fall back into relapses, they often terminate in fatal chronic diseases, similar to those recently enumerated under the intermittent train.

Not only within the tropicks, but likewise through the northern hemisphere, to the verge nearly of the polar circles, we can descry this remittent febrile host. In the sultry summer and autumnal seasons of Europe, in low marshy countries, soils and situations such as Italy and Hungary, where the summers are long and intense; and in that northern morass, Holland, these are the epidemical tyrants. Armies encamped are often at that season grievously infested with them, and with dysenteric fluxes. In Britain and Ireland also, they are frequent and fatal epidemicks; and are not confined to the summer season only. Even in most dry countries and situations without the tropicks, after an unusual close sultry summer, with long protracted heats, we often see, or read of, such fevers and fluxes. The humours then, says Pringle, are corrupted, the solids relaxed; and in such a disposition of body, irregularities in diet, wet cloaths, and damp air, may give activity to such latent indisposition. In that small southern Mediterranean island, as described by Cleghorn, where the soil is rocky, but the summer heats excessive, such fevers have raged with atrocious severity.

Fevers intermittent and remittent, and those strictly simple inflammatory, are greatly regulated, not only by the climate, latitude, soil, local elevation or depression, but also in the same country by the different seasons of the year. In summer and autumn, fevers tend in various degrees to affect the stomach and intestines with sickness; they are then, more or less remittent, and participate less of the inflammatory. “In Holland,” continues Pringle, “towards June, a healthy month, the inflammatory fevers begin to recede; and the remittent, bilious, and putrid often succeed throughout the summer and autumn, until the return of winter, when the inflammatory again recommence; the seasons and diseases insensibly interchanging and running into each other.” We may also add, that in all warm climates there is a copious and superabundant secretion of bile; and that none of the animal fluids so soon turn putrid. They are more obnoxious to remittent fevers who are constantly exercised in labour and fatigue, and exposed to the external air, than other ranks who are comfortably accommodated, cloathed, and fed. Pringle remarks, that the peasants of Holland were always greater sufferers by the summer, autumnal, and remittent fevers, than those of the more opulent class; and also, that during summer and winter, in the field and in garrison, the private soldiers were more sickly than the officers, and liable to fevers.

Remittent fevers seem to consist of a repetition of protracted diurnal paroxisms, or periodical aggravated exacerbations, nearly similar to the intermittent or primitive type; but without the latter’s complete intermission. Authors have described them under a variety of apellations; but they may be all comprehended as ramifications of one great trunk, or integral genus: they appear in essence the same disease, and are cured by similar remedies. In the medical nomenclature, they are denominated remittent, semitertian, hemitritea, tritophyea, double and triple tertian, putrid remittent, marsh, camp, ardent, bilious fevers, gall sickness: tertian fever obscured under a mist of one or more dangerous and prominent symptoms; hence named tertiana lethargica, vertiginosa, soporosa, apoplectica, paralytica, cataleptica, epileptica, convulsiva, phrenitica, hysterica, syncopalis, asthmatica, arthritica, cardialgica, singultuosa, rheumatica, pleuritica, dysenterica, atrabilaria, cholerica, emetica, diaphoretica, pituitosa, miliaris, scorbutica.

Exclusive of the symptoms common to such fevers, and partly delineated under the intermittent paroxism, remittent fevers are variously diversified by a rotine and medley of nervous, putrid, and inflammatory symptoms; but infinitely more of the two former. The climate, season of the year, remissions, and the notorious epidemick or endemick of that region or place, all contribute to their unerring detection. Sometimes they attack very suddenly and violently with delirium and inflammatory simulation; but soon afterwards, and at the interval of a few days, remissions are evident. Sometimes their approach is in appearance mild, but not less alarming. In general there are great lassitude, debility, anxiety, restlessness, severe headach, frequently delirium, especially at the exacerbations; disturbed sleep, and not refreshing; sickness at the stomach, nausea, bilious vomiting, or efforts to evacuate the ventricular contents; fecal excretion bilious with gripes; inextinguishable thirst; tongue dry and parched; quick hot respiration; skin sometimes dry. When bile is redundant, the intestinal excretion is often putrid and offensive, with bilious diarrhœa or dysentery, in repetition and quantity profuse, exciting tenesmus, and sometimes excoriation of the anus; to these may be added pain in the stomach and intestines, tension and elevation of the belly. According to Lind, the tropical remittents are the most virulent, yet are not contagious, unless accompanied with dysentery, or the sick crowded together; which, if an irrefragable fact, distinguishes this fever from the nervous and putrid: and besides, in those febrile epidemicks and endemicks, from marshy effluvia, the remissions are more perceptible and synchronous than in these from animal contagion. From the air, season, and medical treatment, the remittent may be converted into the intermittent or continued type; in the intermittent there is more security. In warm climates putrescency and death may ensue in a few paroxisms; in others, in all the intervals during three weeks: and usually the crisis is by some of the larger excretories.

Nervous and Putrid Fevers.

This febrile host are also widely dispersed over the earth; and probably are not so much governed or influenced as the preceding remittents by the climate, season, and sensible qualities of the atmosphere; but may originate in all countries, climates, seasons, and situations; and when extremely virulent, may, like the plague or small pox, be communicated by imperceptible emanation or contagion from one infected person to another; by personal intercourse, by the medium of polluted goods, furniture, apparel, cloaths, and houses; in all which the noxious miasma may be concentrated and lodged. Sometimes they harrass a nation or city in detachment only; and sometimes in formidable phalanx. Such fevers are frequently engendered in jails, crowded with filth and animal steams, and excluded from free ventilation: also in military hospitals, crammed with sick, with dysenteries, putrid sores, and mortifications: also in ships and large fleets, when hastened out in the hurry and spur of approaching hostilities: also in wet and stormy weather at sea, when the hatches are closed.

In cities, contagious fevers may be traced to prisons, perhaps sometimes to hospitals; certainly often to narrow courts and alleys, and small crowded apartments; to the houses of the indigent; to filth, rags, and squalid poverty, co-operating with foul unventilated air: and in the open perflated streets, are much less frequent. Cities, therefore, should be more infested with them than the country; and the poor more than the affluent. Children with adults are subject to them, but more of the latter. In London, perhaps, nine-tenths of the fevers, are of the remittent, nervous, and putrid type, and not of the simple inflammatory. But I exclude from this calculation the exanthematous order, and the topical inflammations. Some, not without argument, alledge, that slow nervous fevers are in general derived from the same origin; and that they differ from the putrid in degree only. Petechial spots are by no means constant symptoms of the putrid type; but when they occur, they point out the disease more unerringly, and its greater malignity. In many instances, their differences may be rationally imputed to climate, season, constitution, miasma, and medical treatment.

I meet with inextricable embarrassment, in endeavouring to draw the exact limits, not only between nervous and putrid fevers, but also between them and what some authors have termed the universal remittent of this island; and which is not limited to any season of the year. I take this opportunity, therefore, to avow, that in what proportion these very general fevers with remissions originate from marshy effluvia, from climate, and constitutional indisposition, from animal contagion, or from other occult causes, I am unable to decide: Their precise relation as to lineage and consanguinity, is beyond my penetration. Nervous and putrid fevers have been described under the following different names: slow nervous fevers, febricula, maligna lenta insidiose mitis, nervous and putrid fevers, putrid remittents, typhus castrensis, jail, hospital, infectious, putrid, malignant, continued, putrid, spotted, purple, petechial fevers; yellow fever of the West Indies, or typhus Icterodes.

Slow nervous fever frequently steals on with treacherous mildness; the sick are rendered unfit for business, but yet not confined to bed, and except to sagacious judges, the fever is not apparently alarming; and too often the sick and their friends are lulled into fatal security. The symptoms slight alternate chills and fugacious heats, especially in the evenings; heaviness, giddiness, and headach, particularly in the posterior and superior part, and the pain often descending down the spine; great debility and prostration of strength; and in both nervous and putrid, the functions of the brain, and of muscular motion, considerably weakened, and interrupted; also depression of spirits, sighing, restlessness, very little sleep and not refreshing; accelerated, weak, and small pulse; nausea, total inappetency; inconsiderable heat of the skin or thirst; dry tongue, a little yellow at the sides; pale urine, and without sediment; irregular sweats; sometimes pains resembling rheumatick. After a few days, the fever, stupor, delirium, and headach increase, with low muttering delirium, chiefly during the nocturnal exacerbation, and with noise in the ears, and universal debility of the corporeal and mental organs. The remissions are generally more distinct in the beginning, and, by degrees, more obscure.

Putrid fever sometimes creeps on with deceitful approach under the nervous cloak; and sometimes, with furious onset, counterfeits the inflammatory. The symptoms when radicated and inveterate are, unremitting headach, pain in the back and loins, and course of the spine; vertigo, throbbing of the temporal and carotid arteries, noise in the ears; delirium, extreme diminution of strength and despondency of mind, trembling of the hands and tongue when thrust out; anxiety, restlessness, or no refreshing sleep; intense burning heat of the skin, especially in the evenings; nausea, bitter taste in the mouth, vomiting of green or black bile: sometimes insatiable thirst; at other times the sick are insensible to thirst and heat, and only complain of universal languor and weariness; the tongue, teeth, and lips covered with a brown or black tenacious crust, with thrush and ulcers; the fecal excretion black, and fetid; the breath and perspiration offensive to the smell; the pulse progressively small, irregular, and quick, often 130 to 140 pulsations, even in adults, every minute; the eyes glazy, the vessels of the tunica albugina turgid with blood, and what is called blood-shot: in stages of still more virulency, petechial eruption sprinkled on the skin, with hemorrhages from the gums and nose, and hemorrhagick subcutaneous extravasations. In the yellow fever of the West Indies, there is a jaundice-colour of the eyes.

In the duration, crisis, and termination of nervous and putrid fevers, there is considerable diversity. Some may be suddenly stifled before they burst into a flame: some of inveterate malignity may prove fatal in a few days; others may terminate in all the intervals within three weeks, or even later. Some terminate auspiciously without any sensible crisis or evacuation: in others, there is more or less sensible defecation by some of the excretories, by perspiration and sweat; diarrhœa and fetid stools; turbid urine; exspuition and salivation; vomiting; tumor of the parotid glands; eruption about the mouth.

Miliary fever, febris purpurata, rubra and alba, is never epidemick, and is denied to be a primary disease; but is spurious, symptomatick, accessary, or fortuitous; it is very rare, and may be complicated with the nervous and putrid, and with small pox and measles. The miliaris alba is more frequent amongst the female sex, especially during the puerperal state, and in other females debilitated by fluor albus, and hemorrhages, of weak constitutions, delicate, prolifick. It sometimes exhibits previous symptoms of angina, pleurisy, catarrh, rheumatism, erysipelas. Its peculiar diagnosticks are extreme languor, anxiety, despondency, terror, sighing, prostration of strength, headach, delirium, restlessness, quick weak pulse, oppression of the breast and stomach, dry cough without expectoration; sometimes profuse sweats towards the third day or later, and the sooner the worse; inextinguishable thirst; urine and stools various. In different stages of the fever, after a few days, a cutaneous efflorescence is perceivable, from which the disease takes its name, preceded by and accompanied with itching and pricking heat of the skin, and eruption of diminutive pustules, the size of millet seed, and, by the fingers, may be felt prominent: they are rarely seen on the face; commonly on the neck, back, breast, and extremities; some of them change into small serous vesications, distinct or clustered, and emitting a peculiar sour odour: of these there is often a retrocession and new eruption, variously protracting the fever to a few days, or even weeks. It is distinguishable from measles by the pruriency and sour smell, and the absence of morbillous sternutation.

Inflammatory Fevers,

synochus continua non putris of Boerhaave. To this we may add the febris diaria. A different genus of fever, both in its nature and cure, from the remittent, nervous, and putrid, is the simple inflammatory. The frequency and the fatality of this fever, is infinitely inferior to the preceding groups; and in comparison, is as a wasp to a tyger; or a babe to Hercules. The false lights hung out successively by multitudes of authors, and transmitted, in some degree, through the Boerhaavean school, to steer with the antiphlogistick compass and lancet in each hand, in the generality of fevers, have been the cause of numerous shipwrecks. Inflammatory fever is frequently complicated with some local inflammation, and then is distinguished under a different name, and hereafter described. Pringle observes, that in military camps, pleurisies, and peripneumonies are the most frequent form of fever with inflammation; and next to these acute rheumatisms.

The predominancy and reign of inflammatory fever in northern latitudes, is in winter and spring, in cold climates and rigorous seasons, and where cold and moisture are combined. It commonly attacks the robust, strong, athletick, and those in the vigour of life: it is not contagious; and neither its remission nor exacerbation are conspicuous. Its assault is sudden and violent, with severe headach, quick laborious respiration, interrupted sleep and restlessness, or sometimes somnolency; sometimes delirium; but in general the mental functions are not greatly disordered, nor the muscular debility so great as in the nervous and putrid fevers: pulse accelerated, strong, full, and tense; commotion and throbbing of the temporal and carotid arteries; intense heat of the skin, dryness of the mouth, fauces, tongue, and nose; ingurgitation of drink with avidity; the urine somewhat crimson in tincture, and in small quantity; the belly generally costive; the blood drawn, forming a buffy incrustation on the contracted coagulum, complete its portrait. The natural crisis is various by nasal hemorrhage, by sweats, turbid urine, diarrhœa; and the duration of the fever from four to eleven days. The Febris Diaria of a few days continuance, is a sort of minor or infant species, an appendix of the inflammatory: it begins suddenly with nausea, vomiting, shivering, cold, headach, lassitude, heat of the skin, flushed face, restlessness, or disturbed sleep, strong quick pulse: and is rarely dangerous.

With respect to all the preceding confederate genera of fevers, we shall make the following general observation. In the preceding century, during the last thirty years, febrile mortality, by the London bills, is rated at 87,645: and the mortality of the present century is seen in the Chart. Formerly, in this metropolis and island, and probably throughout Europe, fevers seem to have been much more prevalent and fatal than at present: their essential nature and cure is now much better understood by physicians; and we are provided with far more powerful auxiliary remedies, and are more expert in their application. In this particular instance, modern medicine, especially of the century in which we live, is signalized, and may, without arrogance, claim triumphal honours. The supposed innumerable varieties of fevers, and from which perplexity Sydenham could not altogether extricate himself, is now disproved by repeated experience, and by the infallible efficacy of general remedies. It is, however, as yet impossible to fix any definite medium or average of mortality in the above genera of fevers, whether remittent, nervous, putrid, or inflammatory. We have modern authentick records, wherein, under judicious and skilful treatment, of 200 sick in remittent fevers only one died; and even in the nervous and putrid, the blanks were trifling compared to the prizes; whereas, under different and erroneous management, one half, and often the greatest part of the sick perished. The corroboration of these assertions may be seen in those learned authors, Lind, Millar, Robinson, Clarke, Lettsom, Sims, and others.

Throughout the intire morbid host of human foes, there is probably no such flagrant variation in the therapeutick barometer, or scale of mortality, as in that of the fevers hitherto described. Different curatory processes and remedies soon change the natural genus, symptoms, crisis, prognosticks, and event. No dangerous diseases almost whatsoever, are more successfully oppugnable under discreet medical regimen; and when entrusted to nature, from the days of Hippocrates to the present time, they have ever been extremely fatal. Sorry I am to add, that, perhaps in many instances, the errors and fatality of nature, have been less destructive than those of artificial and therapeutick mismanagement. Since the discovery of antimonials and Peruvian bark, few now, under skilful medical pilots, die, compared to the multitudes of sick: but still in the aggregate list of funerals, except perhaps pulmonary Consumptions, it may be doubted whether any other of the belligerent morbid foes commit such ravages amongst mankind.

Small Pox,

natural and inoculated. We have no vestiges, neither in history nor tradition, of this loathsome disease, nor of the measles, before the irruption of Mahomet and his followers from the Arabian deserts, about 1,300 years ago; and from whom this extraneous contagion was first transplanted into Europe. It is little more than 200 years since the exportation of this exotic poison to the American continent, where it had never before been seen nor heard of. The havock by this scourge of the human race, amounts, in London, to nearly a decimation of the inhabitants; or to about one tenth, or one twelfth. It is equally or oftener much more fatal throughout the torrid and frigid zones; and in the adult age is more violent than in childhood. It attacks the same person but once in life: had this not been the case, the human race must long since have been extinct. On a promiscuous average, one of every seven infected die of the natural disease; but under inoculation only 1 of 500. Besides, to the former deadly catalogue may be superadded a frightful train of mangled constitutions and countenances, of consumptions, abscesses, ulcers, opthalmias, blindness.

In every large metropolis, small pox is an annual epidemick. In country towns and open districts, its invasions are more distant; at uncertain intervals of some years, when numbers contiguous are attacked at the same time. In our climate, it is alledged to be most prevalent in spring and autumn. Very few of the human species escape the small pox, especially in populous cities and towns, wherein there is always lasting variolous fuel, or, lurking embers: a wooden horse with ferocious foes in ambuscade, tolerated within their walls, rioting in human slaughter, and infantile immolation. It might easily be demonstrated, that in London, and probably in all other large cities, variolous ravages are principally amongst children under five years of age. Without entering into any elaborate argumentation, or proofs of this assertion, the reader may, in some degree, be convinced, by only turning his eye to the first Chart, and to a small table of London mortality during ten years; wherein he will observe the trifling annual mortality in the interval between 5 and 20 years; before which last period, a mere handful of the native progeny of the metropolis can be supposed to have escaped an infection with which they are constantly enveloped. It is obvious that the total annual mortality by all diseases, inclusively, in London during this adolescent period of life of 15 years, is not equal to variolous carnage singly. As to inoculation, or artificial engrafting of the contagion, it is throughout the greatest part of Europe a modern practice of the present century, and is yet in its cradle. Even in the London small pox hospital, since its first institution, forty years ago, there have not been inoculated altogether 25,000.

The cruel carnage perpetrated by small pox throughout the earth; the rooted prejudices, and the insinuations urged to shackle the universal benefits of inoculation, and which pervade not only the ignorant mass of the community, but also the generality of the medical profession throughout Europe, would abundantly excuse and urge me to be more diffuse on this interesting and litigated topick. But having, some years ago, published a small Essay on Inoculation, and having now nearly finished a general treatise on the natural and inoculated small pox, I shall postpone the result of much reading and reflection to that republication. An acquiescence in neutrality or indifference, where it can be proved to mathematical demonstration that myriads of lives might be preserved, which are now sacrificed, would, at least in a moral sense, constitute an accessary in criminality.

Small pox, or variolæ, have been properly discriminated into several species: the distinct and confluent, or benign and malign; the crystalline, lymphatick, warty, petechial, and hemorrhagick; the inoculated; the spurious. The principal differences between small pox consist in the period of eruption, the number and form of the pustules, the quantity and state of the fluid contained in them, and the contumacious perseverance of the fever. The progress of variolous fever has been divided into four stages, that preceding the eruption; the eruption; the suppuration; and the exsiccation of the pustules. The first visible effects of the contagion and fever are nausea, vomiting, soreness at the stomach, drowsiness: before the eruption infants are prone to startings, and some even to epileptic fits; adults to sweats. The second stage of eruption is, from three to four days, from the first attack, of small red spots or pimples on the skin, resembling flea-bites, in number and quantity extremely various; from one or more, multiplied to many hundreds. The eruption is commonly first on the face, spreading gradually over the body and extremities, and is compleated about the fifth or sixth day from the febrile commencement: and on this eruption, the fever abates or subsides. In the third stage of maturation the pimples increase daily in size; are elevated into prominences inflamed at the base; and the suppuration is compleated between the eighth and eleventh day from the first attack: the pustules then detached from each other, have risen into small boils, the size of peas or larger, turgid with pus, gradually becoming opake, yellowish, and tenacious. In the fourth stage the pustules shrivel or burst, oozing out part of their contents, and a superficial incrustation is formed, which, after some days, together with the shrivelled pustules, scales off, leaving the subjacent skin of a brown red colour. This is the mild form of the disease; but we are next to describe it under more dangerous and fatal forms.

In the Confluent small pox, the revolutions are the same, but the symptoms more exasperated; the vomiting and the eruptive fever violent, frequently with coma, or delirium. The eruption protrudes earlier; on the second or third day, in congregated clusters, like measles, and more numerous on the face; the fever does not then subside, but increases towards the fifth or sixth day, and continues throughout the disease. The swelling of the face is commonly earlier and more severe: and both in confluent and distinct, when the pustules are numerous on the face and fauces, there is soreness and inflammation of the throat, hoarseness, and difficulty of swallowing; and about the eighth day, the eye-lids are closed up with temporary blindness. On the face, especially, the pustules are small, less elevated, coalescent; and it is often covered with a universal flat vesicle: the fluid is whitish or brownish, not yellow and tenacious, or of due maturation and concocted purulency. The pustular interstices, if any, are pale and flaccid. The facial intumescence subsides about the tenth or eleventh day: and during these stages of fermentation and depuration, a salivation commonly ensues, especially in adults; and in infants a diarrhœa. About the fourth stage the fever, called secondary, is often renewed with considerable vehemence, and with various duration and event. In the latter stages the pustules excite intolerable itching of the skin, and, if not prevented, incessant scratching and cutaneous denudation: the breath, exhalations and excretions are then offensive to the smell. In the mild distinct, the pustules commonly begin to dry on the ninth day, and continue to the fourteenth in a process of exsiccation; but in the confluent, this stage begins about the eleventh day.

The following are all unfavourable omens in small pox: Sudden and premature eruption of pustules. In this first stage, infants, especially before dentition, are sometimes snatched off in epileptick fits. The more small pox appear in the confluent, or in the distinct form, they are more or less perilous. It is only where the distinct are crowded with pustules on the face; or accompanied with fever and putrescency; or with pustules warty and lymphatick, that they are dangerous. Or, a natural mild small pox may be rendered malignant from confined air, heated room, and regimen. In the catalogue of unfavourable symptoms, are the fever continuing pertinaceous; and with putrescency it is still more dangerous: the pustules not sufficiently filled and distended, hard, or warty, or not filled with maturated pus; the top of the pustules depressed; pale interstices at their base; sudden retrocession or subsidence of the pustules during the stage of maturation: severe inflammation of the fauces; difficult deglutition; severe pain at the stomach. The secondary fever arising commonly about the recession and exsiccation of the pustules, or ebb of maturation, is the most dangerous period of small pox. The variolous crisis then is generally by diarrhœa, or turbid urine, or both conjointly, or by salivation. It is evident that, as the cutaneous pores are blocked up, the absorbed, and other floating pus, must be defecated by some grosser excretory. Additional symptoms of alarm, especially in the confluent, are, if the suppurating stage of the fever continues severe, the salivation ceases, and the hands do not then swell. When the putrescency is virulent, the disease sometimes proves fatal in a few days; but in most cases on the eleventh, and sometimes not until the fourteenth or seventeenth. Fatal symptoms of putrescency are petechiæ, and bloody pustules; putrid urine and stools; tumid emphysematous abdomen.

Inoculated Small Pox. Between seven and nine days, some slight fever succeeded by an eruption of pustules; in general not numerous, and the patients are very seldom confined to bed, or indisposed. In ninety-nine cases out of an hundred, inoculation produces a distinct small pox, void of danger. After inoculation from the maturated pustules of real small pox, and the usual symptoms of impregnation, mankind are ever after invulnerable by this contagion.

Chicken Pox. Bastard or spurious; and distinguished under the apellation of petite verole volante, stein pox, and swain pox. They are sometimes epidemick, but inoffensive; and have given rise to the supposition of a person’s undergoing the natural small pox a second time. The eruption forms very quickly into pustules, of which the pus is not concocted, nor tenacious; and after three or four days, incrustations.

Measles.

Morbilli rubeola. From 100 to 120th part of the community seem to be destroyed by measles. Morbillous mortality is to that of small pox in the ratio of one to ten or twelve; and consequently may be estimated at one of seventy-seven whom it attacks. Sydenham, long ago observed, that measles, if judiciously treated, are attended with very little danger; but he should at least have qualified the expression, by adding immediate and considerable danger; for both immediately, and in their future consequences, they are by no means so innocuous. Few escape this exotick contagion, especially in childhood and in cities. It attacks the same persons but once in life; and, with us, is said to be most epidemick in winter.

Morbillous symptoms are fever, impaired appetite, heaviness of the head and eyes, somnolency, catarrh, acrid defluxion from the fauces, nose, and eyes, with hoarseness, sneezing, and lachrymation; short dry cough, and some difficulty in respiration. Prior to the eruption, there is generally anxiety about the breast, palpitation of the heart, itching of the face, peevishness, and considerable fever. On the third or fourth day there is an eruption of small red spots first on the face, resembling the bites of ants or fleas, generally confluent and entangled, and broad on the trunk and extremities; but not elevated above the skin, nor rising into pustules, nor suppurating: the size and shape various and irregular. About the sixth day the eruption on the face begins to dry, and on the ninth, is totally obliterated with desquamation of the cuticle. With the eruption the fever frequently does not cease; and the cough and difficulty in respiration often continue beyond the eruptive limits and cuticular desquamation. The usual crisis is by scaling of the cuticle, turbid urine, or diarrhœa. Unfavourable symptoms are, too sudden or too tardy eruption; pale or yellow eruption; great debility; and above all, pulmonick inflammation. The last in the train of morbillous evils and consequences are, consumption, anasarca, ophthalmy. Sometimes, though rarely, measles have been seen in accompanyment with other eruptive fevers, as small pox, and gangrenous angina.

Scarlet fever.

Febris scarlatina, ignis facer, scarlatina anginosa. Its mortality in the London bills is added to the general febrile heap. This contagious epidemick is most frequent in the infant and adolescent age; it attacks families and schools about one time; and the same person but once in life; and is said to be most frequent in winter. It is generally accompanied with an anginous or ulcerous sore throat, but not putrid. That genus or species of scarlet fever which usually accompanies angina gangrenosa, and is extremely dangerous, is hereafter described. The symptoms of simple scarlet are the usual febrile precursors; on the second, third, or fourth day, an eruption of broad irregular redness and spots; general or partial only over the face, trunk, and extremities, and not elevated above the surface: sometimes overspreading the face with a crimson colour. Concomitant symptoms are, difficulty of swallowing, and uneasiness in the throat, redness, tension, and sloughs: commonly also nausea, sickness at the stomach, vomiting, vertigo, drowsiness, headach, difficulty of breathing, anxiety. After three or four days more; that is, between the sixth and ninth, the cutaneous eruption and redness disappears, with desquamation of the cuticle, and harrassing pruriency. The usual crisis is by sweats, urine, fetid stools, and exscreation of sloughs. Sometimes, a few days after the cuticular desquamation, an anasarcous swelling suddenly appears; and during the convalescent state, from exposure to cold air, or neglect of cutaneous and other expurgation, anasarca, hydrothorax or ascites have ensued.

There are two or three other febrile eruptions to which authors have appropriated distinct names, but by which very few of the human race are destroyed. These are febris urticata, bullosa, and pemphigodes. In general, they consist of red spots and serous vesicles on different parts of the skin, exciting heat and itching; the urticata resembling blisters from the burning of nettles. Some of these are mobile, receding and re-appearing, and prone to relapse. After a few days, however, or at the utmost a few weeks, they vanish: and are not contagious nor epidemick.

Plague.

Pestis. This febrile demon cannot now be called one of the mortal epidemicks of Europe, except in the south-east extremity, inhabited by the Turks. The two greatest pestilences on record, happened in the sixth and fourteenth centuries of our era; which, with more barbarous havock than that of Goths or Saracens, overwhelmed millions in three quarters of the globe in one indiscriminate massacre. In London, before the general conflagration in 1666, of one half nearly of the old city, the plague was very frequent: but since that event, or at the most two or three years after, it has been exterminated and banished from us. That fortunate disaster which consumed a magazine of putrefaction; together with widened streets, ventilation, cleanliness, and many other causes, have all contributed to the extinction of this exotick incendiary. For it is well known, that pestilential miasma has been preserved dormant many years in porous materials. From 1592 to 1665, the plague appears to have had annually more or less share in the mortality of the British metropolis; and adding together the different periods of its duration, amounts to twenty-five years. In 1665, which is the most furious pestilence in the London annals, the deaths amounted to 100,000; but in the eight preceding years, to only 113. Registers, in other parts of Europe, prove, that this disease has committed direful carnage since our emancipation. At Marseilles they can enumerate twenty general plagues, which have successively laid waste that populous city. Many other European cities and towns, during the last and present century, and especially those bordering on the Mediterranean, have, in a very short space of time, severely smarted by pestilence, and have been nearly depopulated.

At present, in all the Mediterranean ports they are, from fatal experience, scrupulously vigilant to guard, by a circumvallation of alarm posts, against the pestilential infection, and the clandestine entry of infected goods or merchandize. It rarely now gains admittance, by stealth into any of the European ports; (Constantinople excepted) or even if imported to our shores, the wise precautions and regulations, enacted by Quarantines, soon check its irruption and progress. This is a most interesting epoch and improvement in the police of modern states; for the original institution and rough draft of which, about 300 years ago, we are indebted to the Venetians. The political ordinances, however, enacted for the exclusion and suppression of pestilential contagion, were, until the present century, extremely erroneous and impolitick. Formerly, the plague in London, and in most other European cities, where it was permitted to sojourn, was rendered infinitely more terrifick and destructive by injudicious legislative regulations; especially by the barbarous sacrifice, and absurd policy of sick and sound immured together, with a forlorn motto on their doors, until all were dead or recovered. This was an effectual discouragement against an early alarm which, as in cases of fire, is of the utmost importance. It is evident, by the London bills, that a mere handful, at any time, died in the publick pest-house; consequently, every corner of the city was polluted with infection.

True plague is now chiefly chained down to Constantinople, and to Grand Cairo in Egypt, the two original, or at least one of the hotbeds and volcanos of pestilence; to several of the maritime towns of Asia and Africa situated on the Archipelago and Mediterranean; as Smyrna, Aleppo, Tripoli, Tunis, Algiers, &c. In many of these cities the pestilential miasma is hatched and accumulated into venomous malignity: it is in some nearly an annual, or triennial epidemick. At this day, plague almost solely wreaks its venom on the Mahometan nations, whose prejudices and ignorance, rivetted by religious and predestinarian absurdities, give licence and activity to its imperious domination. From such implicit and enthusiastick submission to the tenets of the Alcoran, joined to gross stupidity in science and philosophy, the Mahometans are encouraged, defenceless and rash, to brave this most malignant and terrible of the febrile host.

Fortunately for mankind, the pestilential contagion spreads to a very small distance through the air, without some contact or adhesion to infected goods and porous materials; or by personal communication and intercourse of the sound with the diseased. The atmosphere is not tainted to any considerable distance. A neighbour barricading himself within his house, at a few yards distance from infection, may escape unhurt. If pestilential contagion could be so suddenly and widely scattered over a kingdom as epidemical influenza, the earth, in a few months, would be converted into an enormous church-yard. It is not like some other exotick poisons of the exanthematous order, after enduring which once, mankind are rendered invulnerable: the plague, as well as putrid fever, may attack the same person repeatedly. What proportion die or recover, I cannot ascertain; and indeed the prophylactic or preventitive, is infinitely the most important indication. Its invariable characteristic features are buboes, carbuncles, and petechiæ. The general progress of the symptoms are, great abasement of strength and of spirits, apprehension of death, dejected countenance, and wildness of the eyes; nausea, vomiting of bile; headach, giddiness, delirium; weak irregular pulse; petechiæ, hæmorrhages; fetid breath and excretions; buboes or boils in the inguinal, axillary, or jugular lymphatick glands; and appearing early, or in the progress of the disease; besides gangrenous carbuncles in different parts. According to the virulence of the contagion, and other co-operating causes, the disease may be fatal in a few hours, a few days, or in one, two, or three weeks. The poison arrested in the lymphatic glands and suppurating, is a favourable presage. Domestick animals, as quadrupeds and fowls, are liable to the infection, and to be changed into carrion.