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tic waters of this country. I used the process described in another place, by which I determined that it was much impregnated with putrescent matter, which I believe to be much more noxious than the calcareous impregnation; and I doubt not, therefore, that this water had an active share in forming the diseased constitutions of these females.
Without speaking positively on the antecedent causes of this disease, I think the most tenable hypothesis seems to be that which attributes it to the continued operation, with an inferior degree of force, of the causes which excite the intermittent and remittent fever. The village of Home is low and damp, near the banks of the Mole; and formerly agues were common there. The heat and confined moisture of the places where it is endemical, point strongly to causes of this nature. Mr. Marsden says that in the valleys of the mountains of Sumatra, where this disease is common, there is a dense fog every morning which is hardly dissipated by the rays of the sun till the afternoon. It is also affirmed that where this disease is common, the bulk of the inhabitants are indolent in their disposition; and, in consequence, filthy, and having made little progress in civilization; they are said to be extremely wan and livid, and much subject to intermitting fevers. But whatever are the antecedent causes of bronchocele, it is certain that they must be applied for some years before they produce their full effect, and that the effect will remain for a very considerable time, after removing from the situation in which the disease was generated.
Whatever, too, are these causes there can be no doubt that they are local causes, and some modifications of common elementary matter. Other examples of diseases, whose antecedent causes are local, might readily be adduced; but I have said enough for my immediate object. From the facts brought forward, therefore, I shall make, in this place, one or two conclusions, which, though very obvious and conformable to many other facts in the history of disease, are little considered in speculation, and still less acted upon in the conduct of life.
Where bronchocele is common, a species of idiotcy of the worst kind, under the name of Cretinism, is also prevalent, and is obviously the effect of the same local circumstances. These miserable objects are radically defective in their organization; they are bereaved of all the powers, faculties, and privileges of humanity, and hardly preserve the form of human beings. We ^ may therefore conclude, that there is no degree of morbid deviation from the healthy powers and structure of the body
which cannot be produced by the continued operation of local causes.*
But under the very circumstances in which these monstrous deviations from nature are produced, many are equal to all the common offices of life, and enjoy apparent good health. In the human body itself there is a certain degree of resisting power; in some stronger; in others more feeble; the most susceptible are those which most suffer. This adds to the difficulties of the inquiry. Men cannot easily apprehend that the things with which they support themselves, with little or no evident uneasiness, can be the cause of disease or of death in others; and from hence arise contention, caviling, and misplaced ridicule. But to those who consider the wonderful and infinite variety in the human constitution, a corresponding variety in the agencies of the same substances on different constitutions can offer no difficulty; nor is any fact in the history of human nature more firmly established by evidence.
* "The body of these poor creatures is stunted, their height not exceeding four feet. There is a total want of due proportion between it and the other parts, the height of the head with reference to the body being from one fourth to one fifth, instead of one eighth, the natural proportion; the neck is strong, and bent downward; the upper limbs reach below the knees, and the arm is shorter than the fore-arm; the chest narrow, the abdomen hemispherical, and of a length not exceeding the height of the head; the thighs, with the haunches, of greater width than the shoulders, and shorter than the legs, the calves of which are wanting; the feet and toes distorted. In the head, the masticating organs, the lower jaw, and the nose, preponderate considerably over the organs of sense and intelligence; the skull is depressed, and forms a lengthened and angular ellipsis; the receding forehead presents internally large frontal sinuses, to which the brain has yielded part of its place; the top of the head is flattened, instead of being vaulted; the occiput projects but slightly, and runs almost even with the nape of the neck, as in ruminating animals. The face is neither oval nor round, but spread out in width; the eyes are far apart, slightly diverging, small, and deep-seated in their orbits; the pupil contracted, and not very sensitive to light; the eyelids, except when morbidly swollen, are flaccid and pendent. Their look is an unmeaning stare, and turns with indifference from every thing that is not eatable. The elongated'form of the lower jaw, the thick and padded lips, give them a greater resemblance to ruminating creatures than to man. The tongue is rather cylindrical than flat, and the saliva is constantly running from tho angles of their mouth. Enlargement of the thyroid glands generally prevails, sometimes to an enormous extent. Indeed, this appearance is commonly considered as a distinguishing sign of cretinism. The other glands of the throat are also obstructed. Many of these poor wretches are both deaf and dumb; yet do they appear unconscious of their miserable existence. Stretched out or gathered up under the solar rays, their head drooping in idiotic apathy, they ara only roused from their torpor when food is presented to them."—Dr. ilillingen's Curiosities of Medical Experience.—S.
The diseases to which we have now particularly adverted, or at kast the contagions, and those obviously originating in locality, form no inconsiderable portion of the whole number which infest society, and occasion such an immense mortality. The small-pox alone has often been the occasion of one fourth part of the annual mortality; and it is not improbable that, now that it has been in a great degree suppressed by vaccination, the other contagions and the diseases which seem to arise spontaneously in the system will, in a great measure, supply its place. Now I would not dwell too strongly upon an argument merely analogical; nor say that because this large class of diseases is evidently artificial, all others must be so likewise. Analogy is but a fallacious guide; nor ought it ever to be confided in when it is possible to arrive at direct evidence. But so much may be said with perfect fairness. As a large portion of the diseases which cut men off in civil society are proved to be artificial, and there is reason to suspect the same thing of others in which so direct a proof cannot be obtained, there can be nothing extravagant or absurd in the supposition that they all are artificial, and to be traced to some morbific causes either of circumstances or manners. And should this hypotheis, after due investigation, prove correct, there can be nothing absurd, extravagant, or enthusiastic in the hope that, finally, successful methods may be discovered, either of treating them when formed, or, at least, of preventing their formation.
Mortality subject to fixed laws.—Erroneous opinions on this subject.— The artificial nature and identity of constitutional diseaso.
If these facts render it highly probable that locality, and other accidents of life, foreign to the body itself, are the circumstances which chiefly influence the health, the same truth is placed beyond controversy by the observations that have been made, in the mass, upon the human species. Bills of mortality, surveys, or parochial registers, have afforded the materials of these observations. To illustrate this position, I shall make use of the statements and inferences contained in the essays which form a part of Dr. Price's " Observations on Reversionary Payments," etc. I cannot follow a safer guide.
From these it appears, that in every particular place there is an invariable law which governs the waste of human life. In single years, owing to the seasons, to the absence or prevalence of epidemics, or other accidental circumstances, the quantity of disease may vary, and the number of deaths be less or greater. But taking the average of a series of years together, the same total numbers have been found to die in the same situations, in the equal successive periods of time. These facts are established by observations taken from the bills of London, of Northampton, of Norwich, in England, and of many other places in various parts of Europe. In situations moderately healthy, as in moderate-sized towns, the rates of decrease have been found to coincide very nearly with the hypothesis of Mr. de Moivre, who, assuming 80 years to be the utmost extent of life, supposed an equal decrement of life through all its stages, till it was finally extinguished. For example, of 56 persons alive at 30 years of age, one will die every year till, in 56 years, they will be all dead. The same will happen to 46 persons at 40, in 46 years, and so on, for all other ages. At most ages between 30 and 70 or 75, the results of this hypothesis are very nearly conformable to actual observations. But both in the earlier and in the later stages of life, the law of decrease is very different. In London also, and in large cities, in general the current of life flows with greater rapidity. In the country, on the other hand, communities are more healthy, and, in consequence, life is expended more slowly.
As life at all ages wastes according to invariable laws, so likewise does it at a given age. In consequence, the expectation of life either at birth, or at any given age, that is to say, the mean continuance of any given, single, joint, or surviving lives, may, from tables properly constructed, be calculated with mathematical certainty.
The proportions between the whole numbers living at any age and upward, and the whole number of the community, is a fixed proportion. This fact is established by observation, and is indeed a consequence of the invariable laws according to which human life is expended.
.From these documents the havoc made in human life, by collecting multitudes of men together in great cities, is fully demonstrated. There is no stage of life in which this pernicious influence is not evident, but it is most remarkable in the earliest stages. In London, according to the most moderate computation, half the number born die under three years of age; in Vienna and Stockholm, under two. And other things being equal, the insalubrity of towns appears to be in proportion to their size.
The proportion of persons who die annually in great towns, is found to be one nineteenth or one twentieth of the whole population. In moderate towns, it is from one twenty-third to one twenty-eighth. In the country, the proportion has been found to be from one thirty-fifth or- one fortieth to one fiftieth or one sixtieth. In London, the number of years which a child at birth has been found, upon an average, to reach, is rather less than twenty. In Norwich; half die under five years; in Northampton, under ten. In the parish of Holy Cross, near Salop, the expectation of a child at birth is thirty-three years: one half the inhabitants live to thirty years of age'. At Ackworth, in Yorkshire, half the inhabitants live to the age of fortysix. In the town of Manchester, one twenty-eighth part of the inhabitants die annually; in the country, in its immediate vicinity, the number is not more than one fifty-sixth part.
Large cities are as unfavorable to longevity as they are destructive of infant life, and unfriendly to health at every period. In country places it is the reverse. At Holy Cross, one in eleven and a half of the whole population die at upward of eighty years of age. At Ackworth, one fourteenth of the inhabitants reach the same age. At Northampton, the proportion is one twentysecond part; at Norwich, one twenty-seventh. But in London only one in forty arrives at this age; whereas, if other things were equal, the proportion in London ought to be greater than in other places, since at least one fourth of its inhabitants are persons who come into London from the country, in the most robust period of life, at which the probability of living to old age is the greatest. Of the natives of London, not more than one in sixty attains the age of four-score.
Though villages and country places are more healthy than towns, and that in a degree to excite astonishment in those who are imperfectly acquainted with the facts, yet there is a great diversity in the healthiness of different villages and country places. This demonstrates and exemplifies the important influence of locality in the production of disease, and on the length of human life. Marshy situations, conformably to what has been already said of their general insalubrity, are the most unfavorable to the health, insomuch that they are as destructive of life as large cities. Dr. Price has, in the following paragraph, strikingly contrasted the different salubrity of different parishes in the small district of Vaud, in the county of Berae.