The venereal disease has diminished in intensity, if not in the frequency of its onsets; it is now, certainly, never communicated by the breath, as it is reported to have been in the fifteenth century. A mild treatment suffices to effect the cure of its common forms, and mercury is no longer employed to an enormous and noxious extent. Syphilis was at first confounded with leprosy; and its virulent eruptions on the skin, aggravated, like other skin diseases, by the filth and vitiated health of the people at the time it became exceedingly prevalent, have subsided into milder forms. The skin diseases, designated leprosy in the middle ages, for the reception (not the cure) of which so many hospitals were erected, survive in the itch, and a few, but not very malignant, eruptions. An able writer in the British and Foreign Medical Review* says, "Herpes zoster (shingles) is seldom, in truth, here thought of any importance, although the details of many continental authors abound with descriptions which plainly connect it with formidable constitutional disease. The same, and perhaps a greater degree of violence of character, will be found to prevail in cases of herpes in unhealthy localities, where the people are miserably fed and hardly worked. We see in the description of Alibert, and the author before us, as well as in many others, accounts of almost all diseases of the skin so widely different from any which are observed in the British Islands, that we doubt and occasionally deny their identity." The common acne of the chin, on a part covered with hair, becomes a frightful disease in France. Among the better classes of society in England, if we except lepra, impetigo is more frequently seen than any other skin disease. Scald head and itch are most frequent among the dirty children of paupers.† TABLE showing the principal Diseases among the White Troops in Jamaica. Fatal Diseases, and the Causes of Death. Violent death takes place in a thousand forms: but it may generally be referred to obstructed respiration, as in hanging, drowning, No. 3., Review of M. Rayer on Diseases of the Skin, p. 149. + Med. Jahrbucher, &c., vols. S-10. Austria; observers - Knoltz, Nadherny, Streintz, Slawikowski. Statistical Report of the Sickness, &c., among the Troops, 1838. suffocation; to loss of blood, as in severe wounds, hæmorrhage, rupture of vessels; to destruction of structure, and a shock, as in falls, blows on the head or spinal marrow, contusions, gunshot wounds; and to devitalisation, if the word may be used, by prussic acid, mental emotion, lightning. Death in its most common form is the effect of disease in the brain and spinal marrow, the blood, the lungs, the heart and blood-vessels, the bowels. Fever, inflammation, and various morbid products, infect the whole system, and prove fatal sometimes by the mechanical injury they do, but more frequently by an alteration of the chemical, physical, and vital processes. Persons die of inflammation in the stomach before its structure is disorganised fever is at times fatal without producing any essential lesion of a vital part: cholera, plague, and other epidemics, extinguish existence as rapidly as poison. In presenting a tabular view of fatal diseases, it is desirable on many accounts to arrange them in groups, related as regards their locality, and their essential forms or phenomena. To examine them in these two points of view, we have classified the several observations (1.) according to the organs or systems of organs implicated; and (2.) according to the special nature of the disease. But with the London bills of mortality a different arrangement has been pursued: without following any classification, we have placed infantile diseases, eruptive fevers, plague and fevers, diseases of the bowels, and diseases most resembling each other in their essential phenomena, in the same group. This was necessary, as the nomenclature necessarily varied in the course of two centuries, and the same disease passed under another title. The names of diseases, although derived generally from some very striking feature in the case, are not unfrequently vague and obsolete, so that it is only by a careful study of the contemporary writers that any hope of interpreting them can be entertained. Col. A. in the annexed table is deduced from 65,706 observations made in the 7 years, 1629-1635, the first published: col. B. from 426,253 diseases recorded in the 20 years, 1660–1679, a period made the subject of Sydenham s mortal works: col. C. from 732,873 deaths occurring in the 30 years, 1728-1757: cols. D. and E. are in great part from Mr. Milne's work on Annuities: col. F. presents the results of the five last bills (1831-5), and the actual fatal diseases of London, so far as they are exhibited by the late system of registration. It is calculated on 118,895, the total deaths, exclusive of the still-born. (See Table in next page.) Some of the terms in this table require explanation. The moldshot head, or horse-shoe head, was a chronic form of water on the brain (hydrocephalus); but, under the name of dropsy or sometimes inflammation on the brain, the acute stage of this disease, before deformity supervenes, is now registered. It is really inflammation of the brain in scrofulous children. Livergrown was applied to the swelling of the abdomen, the liver, and spleen, occurring in children after intermittents.* Rickets, a form of scrofula, is now exceedingly * Sydenham's Works, vol. i. p. 102–10. TABLE of the Fatal Diseases of London for the last Two Centuries; showing, in 1,000 Deaths, the Proportion by each particular Disease. * *Column C. was calculated by Mr. Corbyn Morris; it includes, as well as col. B., the still-born: to compare these columns, therefore, strictly, with cols. A., D., E., F., from which the still-born were excluded, the items of col. B. must be raised 1-36th, of col. C. 1-42d. Col. E. is from Mr. Milne's work on Anuuities; who, it will be perceived, did not calculate the minor items. + Perhaps cough and cold should come in this place. Under" Various." rare. Sydenham acutely remarks, that the true rickets rarely happen, except in those years when autumnal intermittents prevail*: livergrown and rickets, apparently confounded at first, disappeared from the bills with the reign of intermittent fevers. Croup and hooping-cough are increasing rapidly, if they were not formerly mixed up with convulsions, which took the place of the chrisomes, in expressing the undefined diseases of infancy. The common diseases of childhood are irritation of the mucous membranes, inflammation, and scrofula. Tubercles are rare in the first year; between the fourth and the ninth year of age, M. Papavoine found tubercles in 70 per cent. of the children that died in the Hôpital des Enfans Malades in Paris. They were, doubtless, equally frequent in London. Scarlet fever was at first confounded with measles; it was joined, in 1731, with fever, and only made a separate item in 1831. Griping, twisting of the guts, bloody flux, and plague in the guts, were the homely Saxon synonyms of dysentery. Surfeit, with respect to its symptoms, resembled cholera morbus, which, raging epidemically in August, was attributed by the vulgar to eating too much fruit. Stopping of the stomach is the iliac or coeliac passion, "which," says Sydenham, "deserves to be enumerated among the symptoms consequent upon fevers." Its great frequency (1629-79) was probably owing to contraction of the bowel after fever and dysentery. No commentator on the bills of mortality has been able to explain the great mortality attributed to rising of the lights; Sydenham, however, solves the question, in treating of this distemper under hysteria, which, as it simulates, was confounded in females with almost every other disease. Diseases of childbed, often accompanied with hysterical symptoms, were evidently reported under this title. The fol The preceding table, founded on the deaths, only indicates the relative mortality produced by different classes of disease. lowing table expresses the liability of the living to death by all the Sydenham's Works, vol. i. p. 104. + Traité des Maladies des Enfans. Par C. Billard. great classes of diseases during 6 periods of the last two centuries. The first and most difficult step here was to determine the absolute rate of mortality in the 6 periods. The population in the liberties of London, enumerated in 1631, was 130,178; the deaths in the liberties during the 8 years, 1628-35, were 54,299, of which 1-24th were stillborn: excluding these, the annual mortality was 5 per cent. This represents the mortality of years free from pestilence, but not the absolute mortality of the period, which, for the 24 years, 1620-43, was 7 per cent. Column A. shows, therefore, the fatality of diseases in years intercurrent between epidemic years. Column B. is an approximation to the mortality and diseases of London in the middle ages, although it includes 14 years subsequent to the great fire, and to the last epidemic.* The mortality of London in the 17th century did not differ very sensibly, before the French revolution, from the mortality in the current years, 1629-35: the mean expectation of life at birth, 1728-37, was calculated by Mr. Simpson to be 19-2 years; while in the 10 years, 1771-80, it was 19.6 by Dr. Price's 16th table. Nearly 5.2 and 5.1 deaths happened annually out of 100 persons living. The mortality of London in 1801-10 had considerably diminished, and was estimated by Mr. Milne to be 1-34·19 annually -2.92 per cent.† The annual deaths in the 18 years, 1813-30, are stated by Mr. Edmonds at 2.82 per cent.; and as the deaths reported in the bills, 1831-5, were 1-8th more than the deaths in the 5 years preceding, the mortality has been assumed to be 3-2 per cent. in this period, including an epidemic year. III. TABLE showing the mean Annual Number of Deaths in London produced by 20 Classes of Disease out of 100,000 living. The enumeration of 1631 was published by Graunt, in the Appendix to his Observations, under the title " Anno 1631, ann. 7 Caroli I.: The Number of Men, Women, and Children, in the several Wards of London, and Liberties, taken in August, 1631, by special Command from the Right Honourable the Lords of his Majesty's Privy Council." The results agree remarkably with the later enumera Treatise on Annuities, &c., by Mr. Milne, vol. ii. p. 428. |