SKETCH OF THE MEDICAL TOPOGRAPHY
HUNDRED OF PENWITH,
DISTRICT OF THE LANDSEND,
BY JOHN FORBES, M.D., F.R.S.
[Continued from Vol. II. p. 131]
THE very imperfect account which I am now about to give of the diseases that affect the inhabitants of the Landsend, is derived from the following sources:
1. My own observation and personal inquiries among all classes of persons, during the period of my residence in Cornwall.
2. The answers returned to a series of questions addressed by me to all the medical practitioners in the district. (See Appendix No. V.)
3. Communications from different individuals, chiefly of the medical profession, to more specific inquiries respecting particular diseases, their nature, cause, &c.
4. A series of printed Annual Reports of the Penzance Dispensary, extending over a period of seventeen years.
5. The mortuary registers of certain parishes in which the names of the diseases are partially recorded. 6. The published works on the topography and history of Cornwall.
The plan which I had intended to pursue, in the chapter devoted to the exposition of the results thus obtained, was as follows:—I proposed to divide it into two parts, giving, in the first, a general account of the diseases, under their respective names, as they affect all classes of the community; and, under the second, an account of the diseases of particular classes, more especially of the class of miners, the only one which, in this district, presents any striking peculiarities in the habits of life of the individuals composing it, and in the diseases with which they are affected.
In the first part it was my intentional—
1. To give, in tables, the results obtained from all the sources of information which admitted of this mode of display.
2. Taking these tables as the groundwork of my narrative, to exhibit, in detail, and in their various relations, all the diseases found in the district, and as they affect, generally, all classes, or particular classes of the inhabitants; to trace their locality,—general and local causes,—relative degree of prevalence, as well in regard to the same diseases in other districts, as to other diseases in the same district,—particular forms, and, if modified, the causes of this modification,—modes of treatment, with particular reference to local modes, and the result; &c. &c.
In noticing the various diseases, it would, I conceived, be found most useful to arrange them in groups, having more relation to their etiological than to their pathological characters, with a view to attaining, what I stated, in the beginning of this paper, to be the great object of Medical Topography, viz. "the tracing the causes of diseases, with a view to their prevention." With this view, diseases might be very variously arranged. I had thought of some such order as the following:—
1. Epidemic diseases, divisible into two principal groups, viz. such as seem to depend on a specific contagion; and such as seem to originate in more general causes, whether of known or unknown nature.
2. Climatorial diseases, or such as seem to depend for their origin, degree of prevalence, or modification| of character, on the external influences more or less directly flowing from the peculiar nature of the climate, atmosphere, weather, &c.
3. Endemic diseases, also divisible into two principal groups, viz. such as seem to originate in natural or external causes, known or unknown, and more or less peculiar to the district; and such as can be traced to some circumstances in the habits, manners, customs, or other civil relations of the inhabitants.
4. Contingent or Generic diseases, or diseases of a chronic kind, not coming strictly under any of the foregoing heads, being found more or less in all countries, and among all classes of men; and which may or may not be modified by the circumstances existing in any particular district. This class might also be divided into two groups, viz. such as originate in causes which are either known or supposed to be known, and such as can be traced to no such causes.
It is proficiently obvious that neither the foregoing, nor any other arrangement of diseases, can be very accurate, as many of the diseases may be properly placed in more than one class, according to the point of view in which they are regarded: all that is aimed at or expected, is the establishment of some broad lines whereby the observer or inquirer may have his views somewhat circumscribed and directed, and the great object thus more easily attained.
In the second part of this chapter, I intended to notice, in a more particular manner, the health and diseases of the different classes of inhabitants, as set forth in the first part of this memoir, and particularly of the class of miners. It was my purpose to enter fully into this very important subject, not without hopes of being able to found, on such an exposition of the nature and causes of the diseases of this very intelligent and interesting class of men as it might be in my power to give, a system of hygienic discipline, which, if adopted, might tend, at least, to mitigate, if not effectually to lessen, the frightful suffering and premature decay of which they are the victims.
In conclusion, I contemplated entering upon the examination of the influence of the peculiar climate of the Landsend, on health and disease generally; and, particularly, of its advantages and disadvantages as a winter residence for persons predisposed to, or labouring under, phthisis and other diseases of the chest.
The following pages must be considered as a very rude and imperfect outline of only a part of the plan now sketched out. It is unnecessary to trouble the reader with the reasons why it is presented to him in so unfinished a form: I may, however, be allowed to state that they are of such a nature as at once to justify me in committing my paper to the press in its present shape, and in solicitingthe reader's candid and kind consideration of it.
SECT. I. 0F THE DISEASES OF THE INHABITANTS GENERALLY.
ART. I.—TABULAR VIEWS OF DISEASES.
|Classes of diseases.||Individual diseases.||Three years. 1810 to 1812.||Three years. 1819 to 1821.||Eleven years. 1823 to 1833.||Total diseas. in 17 years.||Total Diseas. in each class.|
|I. Diseases of the brain and nervous system.||Apoplexy||6||4||2||94|
|Obstipatio lateralis (Sauv.)||1||1|
|Delirium and phrenitis||1||11||12|
|Other Diseases of the brain||7||7|
|Determination of blood to the head||34||34|
|Diseases of the spine to the medulla||12||34||46|
|II. Febrile diseases.
A. General fevers.
|Infantile remitting fever||11||15||26|
|B. Eruptive fevers.||Small-pox||6||3||39||48|
|III. Rheumatic and neuralgic diseases.||Rheumatism, acute & chronic||69||29||341||439|
|Neuralgia and nervous pains||8||16|
|Classes of diseases.||Individual diseases.||Three years. 1810 to 1812.||Three years. 1819 to 1821.||Eleven years. 1823 to 1833.||Total diseas. in 17 years.||Total Diseas. in each class.|
|IV. Diseases of the fluids, &c.||Plethora||7||7|
|Dropsical affections, chiefly ascites and anasarca||17||33||102||152|
|Cachexy and chronic debility||41||57||98|
|V. External Scrofula.||External Scrofula, including rockets, enlarged glands, diseased joints, cutaneous ulcers.||28||37||188||253||253|
|VI. Scirrhus and cancer.||Scirrhus and cancer.||6||12||24||42||42|
|VII. Diseases of the head and throat.||Amaurosis and blindness.||18||18|
|Otitis and Otalgia||3||6||9|
|Classes of diseases.||Individual diseases.||Three years. 1810 to 1812.||Three years. 1819 to 1821.||Eleven years. 1823 to 1833.||Total diseas. in 17 years.||Total Diseas. in each class.|
|VIII. Diseases of the thoracic viscera.
A. Respirat. appartus.
|Catarrh and cough||7||267||274|
|Chronic catarrh and chronic bronchitis||60||50||133||327|
|Chronic dyspnœa, and asthma||9||75|
|Acute and chronic pneumonia and pleurisy||123||54||320||497|
|Hæmoptysis and consumption||66||297|
|B. Organs of circulation||Diseases of the heart and sorta||1||4||54||59|
|Palpitation and syncope||17||17|
|IX. Diseases of the abdominal viscera and outlets.||Dysphagia||20||20|
|Stricture of œsophagus||1||4||5|
|Dyspepsia, prim. and second.||143||228||467||838|
|Gastritis and gastric irritation||7||7|
|Hepatis and liver disease||6||14||54||74|
|Colic, constipation and tympanitis||8||8|
|Diarrhœa, dysentery & cholera||27||27|
|Hæmatemesis and hæmorhois||19||19|
|Disease of stomach||3||3||2025
|Classes of diseases.||Individual diseases.||Three years. 1810 to 1812.||Three years. 1819 to 1821.||Eleven years. 1823 to 1833.||Total diseas. in 17 years.||Total Diseas. in each class.|
|X. Diseases of the female genital organs.||Organic disease of the uterus||10||10|
|Amenorrhœa and chlorisis||203||21||174||398|
|XI. Diseases of the urinary organs||Nephralgia, nephritisn, & other diseases of the kidney||6||13||19|
|Dysuria, ischuria, and other diseases of the bladder||1||54||55|
|Diseases of the bladder and kidney||20||20|
|Calculus and gravel||3||3||106|
|XII. Diseases of the skin chronic||Chronic eruptions||107||51||370||528||528|
|XII. Surgical diseases.||External local inflammations, phlegmon, furunculus, anthrax, parnychia||11||300||311|
|Other surgical cases||326||381||707||1181|
|XIV. Anomalous cases.||24||23||7||54||54|
Note.—It will be observed that the arrangement of diseases in this table, is on an entirely different principle from that stated in the observations which precede it. It is not pretended that the plan here adopted is particularly good, but it seems to have some advantages over the simply alphabetical arrangement.
|NAMES (AS GIVEN IN THE REGISTER), AND NUMBER. OF DISEASES.|
|In how many yrs.||No.||In how many yrs.||No.|
|Consumption||9||18||Burn and scald||4||5|
|Dropsy||17||46||Want of natural functions||1||1|
|Mortification||16||35||Pain (of knee, head, stomach)||3||3|
|Fits and convulsions||15||37||Lunacy and mental disorder||2||3|
|Inflammation of bowels||10||22|
|NAMES AS RECORDED IN THE REGISTER.|
|In how many yrs.||No.||In how many yrs.||No.|
|Tussis||5||7||Ditto in mines||8||9|
|Total diseases, 381——Unknown, 544——Total. 875.|
Note.—As the names of the diseases in the two foregoing tables (B and C) are exactly as they are recorded in the parish registers, by the clergymen, who were not of the medical profession, some allowance must be made for incorrect or false nomenclature. In the more common diseases, however, especially contagious and Epidemical disorders, such as fever, small-pox, measles, &c. there seems hardly any grounds for questioning their authenticity, as it is very improbable that the resident clergyman could be mistaken in such well known complaints. In several other instances, it is sufficiently evident that the diseases must be improperly named, as, for example, in the case of "Mortification," in the St. Paul table, and of "Capitis dolor," in the St. Hilary. These authentic records are, nevertheless, very valuable.
ART. II.—0BSERBVATIONS ON PARTICULAR DISEASES.
I. EPIDEMIC DISEASES.
Continued Fever, or Typhus.—A reference to the foregoing tables is sufficient to prove the great prevalence of the common continued epidemic lever of this country, variously-denominated contagious fever, typhus, &c. in the town and immediate vicinity of Penzance, during the period comprehended by them. And I am enabled, by my own observation during part of the same period, and by the communications of the local practitioners, to state, that a degree of prevalence, like in kind, but varying in intensity from time to time, has marked the district for many years past, and nearly in every part of it alike. The testimony of the four oldest practitioners, the duration of whose practice, at the period of my inquiries (in 1819-20), had been thirty-six, forty-eight, forty-nine, and fifty years, respectively, was uniform in this particular, although their accounts varied as to the relative degree of prevalence in more recent and distant years. One of these gentlemen, who resided in Penzance, regarded the disease as less common of late years; while another, resident in the town of Helstone, fourteen miles to the eastward, considered the amount of fever to have been greater during the latter twenty years, than the twenty preceding. The longest period of exemption of the district from this fever, in the epidemic form, admitted by any of them, was ten years; but the general testimony went in favour of an exemption of only one or two years. The disease was considered to have retained the same general character throughout the whole period of my informants experience; but it was admitted by some, to have been more fatal in former years. The existence of this fever, as an almost habitual condition of the district, is also shewn by the register of deaths in the parishes of St. Paul and St. Hilary. In the former parish, which comprehends the large fishing villages of Newlyn and Mousal, there is only one single year (1801), between 1795 and 1814, in which a death from fever is not recorded; while the proportion of deaths, from this cause, was rather more than one-thirteenth of the whole. In the parish of St. Hilary there was an exemption of seven years out of twenty-eight, but the proportion of deaths from fever, to the whole mortality, was greater, being more than one-twelfth. Similar testimony, as to the habitual prevalence of continued fever in the district, is given by the Cornish historians; by Pryce, who wrote about the middle, and by Polwhele, who wrote about the end of the last century. Dr. Montgomery, the present physician of the Penzance Dispensary, informs me that continued fevers have been less prevalent in that town of late years, but that they are still of frequent occurrence in some of the country parishes.
The fever was confined to no particular localities, nor to any class of the inhabitants. It can hardly be said to have prevailed more in the villages, than in detached houses; and, indeed, the former are so common, and the latter so rare in this district, that the disease could hardly find materials but in the towns and villages. As usual, the poor and labouring classes were most obnoxious to it; but during my residence in Cornwall, not a few of the better classes of the inhabitants were affected by it. The contagious nature of the disease appeared to me unquestionable.
The continued fever of the Landsend exhibited nothing peculiar in its character. It was often very severe, long-protracted, and frequently fatal. Death occurred rarely from sudden collapse; sometimes from intestinal hemorrhage; commonly by the typhoid or comatose state, indicating an affection of the brain of an unknown quality; never by the supervention of anything like putridity.
The most beneficial treatment appeared to be general and local bleeding in the early stage, and leeching in all stages when the affection of any one organ was predominant, with mild aperients and common refrigerants: but I am bound to confess, that the result of no practice adopted by me, was sufficiently successful to satisfy myself, or to justify me to recommend it with any confidence.
During the period of my residence at Penzance, a few cases of fever occurred, which seemed to me, at the time, to be, and probably were, unconnected with contagion, or any influence either of an epidemic or endemic kind. They were most distinguished by disorder of the digestive organs, and as they occurred in the warmer season, they were, no doubt, members of that family which has at different times borne the name of bilious, mucous, gastric, &c. In no case did they put on any semblance of remittent; and neither in this, nor any other case of fever, was I ever led to employ bark, during my stay in Cornwall. According to the testimony of the older practitioners, sporadic fevers of a continued or imperfectly remittent character, and of a more contagious nature, were more frequently met with in former years, more particularly in the lowest and dampest localities, and on the more uncultivated moors.
In explanation of the cause of the continued prevalence of epidemic fever in this district, it will, I apprehend, be considered sufficient, by most persons, to refer to the economical details in the former part of this paper. In the close, ill-ventilated, and dirty tenements, in the poverty and deficiency of food and clothing, and in the mental depression consequent thereon, we may find ample causes of fever, although scarcely any of the usual sources of malarious influence are to be traced in the district,—a fact still more strikingly demonstrated by the almost total absence of intermitting and remitting fevers. This is a circumstance deserving the attention of those who are disposed, with the late Dr. Armstrong, to look to terrestrial miasmata for the cause of all our fevers.
Small-pox.—The tables in the preceding section, my own observation, and the concurrent testimony of the medical practitioners and old inhabitants of the district generally, demonstrate the gratifying fact, that in spite of the still existing prejudices against vaccination, and the numerous failures of its protecting influence, the immortal discovery of Jenner has been productive here, as elsewhere, of a great diminution of the prevalence, and consequent mortality, of small-pox. During the period of my residence in Cornwall, the disease was several times epidemic. It was propagated partly by casual infection, partly by the evil activity of some rustic inoculators; but the sphere of its influence and fatality was greatly contracted by vaccination, which had been generally practised by the surgeons for many years previously. The prejudice against vaccination is still strong among the common people here as elsewhere, and continues to be strengthened by the occasional occurrence of cases of secondary small-pox. In weak compliance with this prejudice, the surgeons in several parts of the district, during my residence, had returned, to a considerable extent, to the practice of variolous inoculation, although they all practised vaccination at the same time. Several cases of second attacks of small-pox in the same person came under my observation, as well as a good many cases subsequent to vaccination.
According to the testimony of the older practitioners, the disease is incomparably less frequent than in their early experience. Although the district, taken as a whole, could never be said to have been entirely free from it, yet it could not be said to have been generally prevalent, in anything like its former violence, for the twenty years preceding the date of my inquiries. When existing, it was also found to be less fatal than in former years, probably owing to the improved method of treatment. All the older practitioners had met with cases of second attacks of small-pox in the same individual.
The greater frequency and fatality of small-pox in the district, previously to the introduction or general prevalence of vaccination, are shewn by the registers of St. Paul and St. Hilary. In the former, in a population of about 3000, the total deaths from small-pox, in the nineteen years anterior to 1814, were 89, or nearly one-tenth of the whole mortality; while in three years only, previously to the introduction, or at least general protecting influence of vaccination, viz. in 1795, 1802, and 1803, the deaths were 49, being more than during the remaining period. In the parish of St. Hilary, having a population under 1000, we find the number of deaths, in the twenty-eight years preceding 1805, to be 56, or about one-fifteenth of the whole—a considerably smaller proportion than in the former case, probably to be accounted for by this parish being without any large villages, while St. Paul's, on account of its large fishing villages, is in a very crowded state both as regards houses and inhabitants. In St. Hilary, however, we find that the whole deaths from small-pox, took place in eight years out of the twenty-eight, a characteristic indicative at once of the epidemic nature and fatality of the disease.
Chicken-pox.—To judge from the tables, this should be a comparatively rare disease in the Landsend district: it is, however, to be recollected, that the malady is of an epidemic character, and that the period included in the tabular view is comparatively short. I have no reason to believe that its habitudes, both as to prevalence and individual character, are in any way remarkable. The only point of importance to be noticed in its history, is the fact of its being occasionally confounded with small-pox after vaccination. I have no reason to believe that it prevailed more among one class of persons than another: it was regarded by some practitioners as more prevalent in the summer season.
Scarlatina. Cynanche maligna.—The tables represent this disease as of comparatively infrequent occurrence at Penzance. During my stay there it certainly was so, as only a single case is recorded in the dispensary registers. It appears, however, by the same register, that in the years preceding and subsequent to my abode there, the disease was more prevalent. In other parts of the district there was the same variation as to prevalence, both in place and time; it being occasionally absent from the practice of different practitioners, in different parts of the district, for several years at a time. The uniform testimony of the older practitioners was in favour of its much greater prevalence and severity in former years. Their recent experience was only conversant with the simple scarlatina with slight affection of the throat; while in their early practice the disease in a putrid form, as they describe it, the true cynanche maligna, was rife and very fatal. The same fact is illustrated by the register of the deaths in the two parishes already referred to. In St. Paul's, which does not extend further back than the year 1795, we have only one death from "throat disorder" while in that of St. Hilary, which comprehends the time from 1777 to 1805, we have 11 from the same cause, being one in 79 of the whole mortality. I think it probable, however, that in the register of the former parish, some of the cases included under the general name of Mortification, were in reality the putrid sore throat, a disease which was early signalised as of fatal prevalence in Cornwall.
In the 46th vol. of the Philosophical Transactions, for the year 1750, there is a very interesting account of a fatal epidemic of this kind at Liskeard, (twenty miles to the eastward of the hundred of Penwith) given by Dr. John Starr, under the name of Morbus strangulatorius. It appears to have been unaccompanied with any cutaneous eruption, and to have proved fatal in general, by the extension of the inflammatory affection of the fauces into the trachea, producing the peculiar form of secondary croup, the nature of which has been well understood since the publication of Dr. Bretonneau's work on Diphterite. Nothing can be clearer or more accurate than Dr. Starr's account, as far as regards the phenomena of the disease, which was precisely that described by the French physician, viz. a peculiar inflammation of the mucous membrane of the fauces and air passages, throwing out a continuous fibrinous membranous exudation on the surface of the affected parts; although Dr. Starr regarded the exuded membrane as an actual separation of the natural mucous tunic of the affected parts, produced by gangrene. The old practitioners had formerly met with cases of this sort in the Landsend district, though none of them described it with the same precision and horror as Dr. Starr, who regarded it as, "in its consequences, frightful, even shocking to the imagination."
Measles.—This disease, like the last, would appear, from the tables, to have been rather less common in Penzance, than in other parts of the country; but being an epidemic affection of uncertain recurrence, such results can hardly be admitted as satisfactory evidence of the general fact. During the period of my abode there, it prevailed frequently over the whole district, in different places at different times; and the testimony of the older practitioners was decidedly in favour of the opinion that measles had become more prevalent and more fatal of late years. One of my informants assured me, that he had not lost a patient from this disease during the first forty years of his practice; but the same strong evidence of this fact, was not afforded by gentlemen of equally long experience. Its great fatality of late years was, however, generally admitted; and one of the country surgeons assured me, that no less than seventy persons had died of it in one year in one parish. Out of the 27 deaths from measles, recorded in the register of St. Paul, 21 occurred in two years, viz. in 1811, 6, and in 1812, 15. In the parish of St. Hilary (much smaller than St. Paul's, it is true) the register of which does not come below 1805, only 8 deaths from the same disease took place in twenty-eight years. In the year 1819, the disease proved fatal in a considerable proportion of the cases which occurred at Penzance; but there was nothing particular either in the result, or the history or phenomena of the affection.
Nettle-rash.—This affection was hardly observed by me, or in so slight a degree as to be undeserving of notice. l believe this is the character in other situations.
Erysipelas.—I have no remark to make on this disease. It would appear, from the tables, to be of rather frequent occurrence.
Hooping cough.—Hooping cough, in this district, presents nothing peculiar either in its relative prevalence or individual character. It is, and always has been prevalent after uncertain intervals. Some of the practitioners considered it as more common in spring and autumn, than at other times. Although no one had confidence in any one of the many remedies prescribed in this disease, yet it was regarded as hardly ever fatal in its uncomplicated state. It, however, became so occasionally, by passing into, or being superseded by, other diseases, particularly of the lungs. In the register of St. Paul, we find eleven deaths, and in that of St. Hilary five deaths, from this disease; the former occurring in seven different years, the latter in two.
Croup.—Mr. Polwhele, in his history of Cornwall, states this to be a frequent and most fatal disease in that county. Of its fatality, I believe there is only one opinion; but it may be doubted if it is more frequent in Cornwall than elsewhere. I am, however, disposed to regard it as being fully as frequent as in any place which I have had an opportunity of observing. In the register of St. Paul, we have fifteen deaths recorded in nineteen years, being one in sixty-one of the whole mortality. In the practice of the surgeons of the district, it was found of general, but by no means of frequent occurrence: yet seldom more than two years would elapse without the occurrence of some cases; and when they did occur, they were extremely fatal. I could not ascertain that the disease was more prevalent in any one place than another. It was confined to children. All my four cases occurred in the same year, and two out of four died.
Mumps.—I met with no case of this disease while in Cornwall: it however appears on the books of the dispensary both previously and subsequently to the period of my residence. This fact shews its epidemic character; and I was assured by the surgeons of the district, that it occasionally appeared in this manner, in different parts of the district.
II. CLIMATORIAL DISEASES.
Catarrh.—It would result from table A VIII. that the common catarrh was less prevalent at Penzance, than in either London or Plymouth. Judging from general observation, however, I should say, that in the slight form in which it is usually observed, when it hardly claims medical interference, it was as frequent there as elsewhere. It was also common in the chronic form, as a sequela of the acute disease.
The acute disease did not appear to be more frequent among any one class of persons than another; not even among miners, who, as we have already seen, are especially obnoxious to the common causes of it, variety of temperature and exposure to wet, and among whom, as we shall shew hereafter, the idiopathic chronic catarrh, the effect of their peculiar habits, is so much more prevalent than among the other classes of the community. The Landsend district has been visited with the epidemic influenza equally with other parts of the kingdom.
Ophtlalmia.—Common catarrhal ophthalmia, and also strumous ophthalmia, appeared to me more than commonly prevalent at Penzance, one-thirty-ninth part of the total diseases seeming to be a very large proportion for ophthalmia. And it is to be observed, that nearly all the cases included in the tables were unconnected with the mining population, among whom the disease is very common from surgical causes. I am not aware that common acute idiopathic ophthalmia is more common among miners than the other classes of labourers.
Otitis and Otalgia.—A few cases of this affection were met with, but they presented nothing remarkable in their history or character.
Cynanche tonsillaris et pharyngea.—Inflamnatory sore throat was regarded by the surgeons as a rather common disease; and I think I noticed it as frequently as I have done elsewhere. It affected no locality, or class of persons, more than others. I may notice a remark made by one of the old surgeons, which I have often seen verified elsewhere, that the disease as affected particular families more than others.
Rheumatism.—From my own observation, and the result of my inquiries while in Cornwall, I was led to regard the acute rheumatism as comparatively of rare occurrence among any class of the community in this district. At least, I may safely say, that it was, during my residence, considerably less frequent than in the more northern parts of the island. One of the older practitioners assured me, that he had met with a few cases only, in a practice of forty years. The whole cases seen by me, in four years and a half, were four in number, viz. two in 1817, and two in 1821, not one case having been met with in the three intermediate years. In the Dispensary Report for 1821, I stated, "During the whole of the last two years, not one case of acute rheumatism has been entered in the books; and I cannot help thinking that the total absence of the disease among so large a body of individuals, for so long a period, is a circumstance that would be reckoned very singular in the northern, or even central parts of our island. It is, at all events, I think, sufficient to render doubtful the truth of a common notion, that a moist climate is favourable to the production of rheumatism." It would, nevertheless, appear, from some of the Dispensary Reports in subsequent years, and from the observations of the present physician of the institution, Dr. Montgomery, that the comparative absence of rheumatism observed by me, was rather a temporary incident, than the habitual condition of the district; unless, indeed, it should be found, by still more extensive experience, that the state observed by Dr. Montgomery, is an exception to the general law. In the reports of this gentleman, for the five years from 1829 to 1833, we find no less than 194 cases recorded, being an average of 39 annually; and although, for want of any detailed classification of the cases, we cannot form any accurate estimate of their nature, still we are justified in inferring, from Dr. Montgomery's remarks, that the cases were frequently of an acute nature, and much more severe than had occurred there during my residence. Indeed, this seems to have been the case with diseases generally. In 1829, he observes, "A large proportion of inflammatory diseases have come under treatment. The variable and severe weather during part of the late winter, had assuredly much influence in the production of these diseases." In 1830, he says, "Inflammatory affections, especially of the chest, were exceedingly prevalent during the late winter, and more particularly soon after the very cold weather. Rheumatism was also of frequent occurrence, and in numerous examples proved a tedious and intractable disease." In 1831—"Rheumatism has likewise been of frequent occurrence, and occasionally proved peculiarly painful and intractable." And, finally, in 1832—"Some cases of Rheumatism were of great severity, and appeared to take their origin in the early occupation of newly-erected houses. Although this disease did not, in any instance, prove fatal, I have reason to fear that, in some patients, organic disease of the heart has been established."
The chronic disease, however, including under this head all local pains of the joints not depending on diseased bones or cartilages, must, I think, be regarded as of not infrequent occurrence. In table A III. I have been obliged to unite, under one head, the acute and chronic forms of the disease, because they are so confounded in the reports of the majority of the years. In my own reports, and in the two years subsequent to my leaving the Dispensary, the distinction between the acute and chronic affection is noticed, and the proportion is 5 of the former to 69 of the latter—or 1 case of acute for every 14 of chronic rheumatism. This is a much greater disproportion between the two species, than is shewn by the Plymouth and London tables, or by Dr. Haygarth's reports; the following being the relative proportion of the two forms in reference to the total diseases observed:
|Acute rheumatism||1 in 50||1 in 50||1 in 62||54.0|
|Chronic rheumatism||1 in 20||1 in 27||1 in 35||27.3|
The degree of prevalence of both forms of the disease, relatively with that observed in other places, is considerably less than at London and Plymouth, but more than that recorded in the tables of Dr. Haygarth, who practised in the North of England. The relative proportions are the following:
|Acute and chronic rheumatism||1 in 14.7||17.0||22.0||20.0|
The evidence supplied by the practitioners of the district, as to the relative prevalence of rheumatism among the different classes of the community, is somewhat contradictory, but the weight of testimony is decidedly in favour of the opinion that the disease is not more prevalent among miners, than among other labourers; and this is the conclusion to which my own observation leads. It must be owned that this is rather a singular circumstance, according to the commonly received etiology of the disease, when we refer to what was stated in a former part of this paper respecting the extreme dampness, or rather wetness, of some of the mines. Would it, therefore seem probable that the effect of the moisture was counteracted by the warmth of the locality, and the immunity from currents of air in the bottom of the mines?
Pneumonia and Pleurisy.—I class these two diseases together, because it was impossible to separate them in drawing out the tables, and because they so commonly recognise similar causes. I trust that henceforward there will be found less difficulty in distinguishing these two diseases in practice and treatment, however much they may continue to acknowledge like causes. It will appear, from table A VIII., that inflammatory affections of the chest are of uncommon frequency at Penzance; much more frequent, indeed, than either at Plymouth month or London. In London the relative prevalence of pleuritis and pneumonia, as deduced from the Reports of Drs. Willan and Bateman, is 1 in 47; at Plymouth, according to Dr. Woolcombe, 1 in 31; whereas, at Penzance it is 1 in 17.7. What makes this result (if, indeed, it may safely be received as a general one) more striking, is the fact that Penzance is not in the immediate vicinity of the great mines, among the population of which, as we shall shew more particularly hereafter, such pectoral affections are extremely frequent. It is, nevertheless, true that a good many chronic affections of the chest, in old miners, did find their way to the Dispensary, and, no doubt, contributed to swell the list of diseases included under the present head; still such cases were more frequently classed under the head of chronic catarrh, asthma, dyspnœa, or simple cough. If, then, we may be allowed to assume the results of the Penzance tables as affording a fair view of the relative prevalence of diseases in the district, we must admit the conclusion, that inflammatory affections of the chest are of very frequent occurrence among the inhabitants of the Landsend. The general testimony of the country practitioners, likewise, established the great prevalence of pneumonia; and all those connected with mines, regarded it as more common among miners than among the labourers on the soil. It was also a general observation of the more experienced practitioners, that the disease was more prevalent formerly than of late years.
The registers do not admit of classifying the cases into acute and chronic, for the whole space of time; but I can state this for the diseases included in the second column of table A VIII. during a period of three years, viz. 11 acute, and 43 chronic.
One class of the community, viz. miners, are much more obnoxious to chronic inflammations of the thoracic organs than the other inhabitants, as will be shewn in a subsequent part of this paper; but if it is admitted that the whole population is more liable to such diseases than in other districts, the extreme degree of prevalence among miners will excite less surprise.
The same remarks apply exactly to most of the other diseases included in table A VIII. under the general head of thoracic diseases; and if we exclude hooping cough and croup, and phthisis pulmonalis, we may safely include all the remaining affections under one head, as all partially of the same inflammatory nature, and all probably acknowledging the same general causes. These affections are catarrh and bronchitis, cough, chronic asthma and dyspnœa, pneumonia and pleurisy. Taking all these under one view, we find they constitute, within a fraction, one-eighth of the whole diseases; and if to these we add the remaining pectoral affections, hooping cough, croup, hæmoptysis, and phthisis, we find the whole sum of diseases of the chest amounting to one-sixth: an enormous proportion, certainly, and considerably, I apprehend, beyond the average of such diseases in other parts of the kingdom?
Diarrhœa and Dysentery.—These diseases appear to prevail in the ordinary proportion observed elsewhere in this country. Actual severe dysentery is very rare, a case not being seen in the practice of one surgeon for many consecutive years. In the Dispensary tables 16 cases are recorded in fourteen years, being about 1 in 393 of the whole diseases of the period. Diarrhœa is far more common, but rarely becomes epidemic. All the surgeons agree in stating that these complaints are not more prevalent among miners, than among other classes of the inhabitants. The total number of cases of diarrhœa during fourteen years, in the Dispensary Reports, are 236, being 1 in 37 of the total diseases. It will be observed in the reports, that the proportion of cases of diarrhœa is much greater during the latter years of the period. This is accounted for by the fact, of the year 1833 being comprehended in the latter period. In this year the cholera made its appearance at Penzance, and, as usual in other places, was preceded and accompanied by an epidemic diarrhœa. In that year 105 cases of diarrhœa are entered on the Dispensary list, while only six more were recorded during the whole of the four preceding years. This must be kept in view, in estimating the general prevalence of diarrhœa, from the results given in the tables.
Cholera.—If this disease is not less frequent in this district than elsewhere, it certainly is not more so. My own opinion is, that it is rather less frequent. I only saw four cases of it during my residence at Penzance, among the dispensary patients, and only one or two more in private practice. Of the 67 cases recorded in the dispensary lists, from 1823 to 1833, no less than 33 occurred in the last mentioned year, and were instances of the epidemic spasmodic cholera. Deducting these, we find the remaining cases to bear nearly the same proportion to the total diseases, as the cases of cholera did in the former periods; and it is obvious that we should exclude these cases of the new form of disease, in making an estimate of the general prevalence of English cholera in this district. On this principle, the proportional number of cases of cholera at Penzance, during the seventeen years, in place of being 1 in 118 cases of disease generally, as might be deduced from table A, ought to be only 1 in 210 cases, a proportion which is less than that recorded in Dr. Bateman's London tables (1 in 187), and considerably less than that in Dr. Woolcomb's, at Plymouth (1 in 107).
The disease does not appear to prevail more among miners than among other classes of the people; and the results of my observation and inquiries afford me nothing peculiar to state, either as to the character or treatment of the disease.
The visitation of the epidemic spasmodic cholera in this district, in 1832, presented, I believe, nothing peculiar in its features or history. It first made its appearance in the fishing village of Newlyn, in the parish of St. Paul, and subsequently visited Penzance, and the adjoining parish of Gulval. The following extract from the Penzance Dispensary Report, for the year ending April, 1833, drawn up by Dr. Montgomery, physician to the dispensary, contains a brief summary of the epidemic: "The cholera, at Penzance, as elsewhere, was preceded as well as accompanied by numerous cases of diarrhœa, and this diarrhœa, when neglected, was found to pass into cholera. With a few impressive exceptions, the disease observed its usual character, in seizing upon the aged and exhausted, in preference to the young and robust. Some of its first invasions were also found to be completely beyond the power of all remedial measures, and to hurry the sufferer with appalling rapidity to the grave; while many of its later attacks were more easily controlled. I am not in possession of documents to enable me to enter upon detailed statements, but so far as my own personal experience went, I am of opinion that not more than one in three of the cases ended fatally: the intensity of the disease had begun to abate in a fortnight, and its duration did not extend beyond one month. The funerals at St. Paul amounted to 96; at Penzance, to 64; and at Gulval, to 8; making a total of 163, in a population of about 12,000."
It was believed, at Penzance, that the cholera "was brought to Newlyn, from the North of Ireland, by fishermen who annually visit that coast;" but must say, that I think the suddenness of the inroad, rapid spread, and total disappearance of it, within the brief period of a single month, is very little characteristic of a contagious disease. If disposed to follow the ordinary laws of contagion, how came it, after having established so many foci whence the contagious atoms might be diffused, to depart, as it were, at once, leaving the vast majority of the population uncontaminated? Surely such results are much more explicable on the theory of some more general and exterior influence, than by the laws which, in all other cases, seem to regulate the transmission of diseases from one individual to another.
III. ENDEMIC DISEASES.
Agua.—Of all diseases usually classed under the head Endemic, there is no one more truly so, or of which the habitudes have been so accurately ascertained, as ague. Although ignorant of the nature of the actual agent that produces this disease, we are well acquainted with the principal circumstances amid which it originates, insomuch that we can always predicate, with considerable certainty, upon examining any locality, whether or not the inhabitants there residing are subject to this affection. It is hardly necessary to state, that the particular situations liable to ague, are those which contain marshes, or are, at least, low and flat, containing much stagnant water in pools or ditches, &c.
The topographical account of the Landsend, in the former part of this paper, which characterises the whole district as hilly, dry, and almost devoid of any thing like marshy lands or stagnant waters, will lead any one to predicate its comparative immunity from ague: and this prediction is proved to be correct by the actual history of the district. In the Penzance Dispensary Reports, only three cases are recorded in a period of seventeen years, and among upwards of 8800 patients. During my residence, only one case occurred at the Dispensary; and this is the only one witnessed or heard of by me during that period. In the eleven years subsequent to my residence, not a single case was entered on the Dispensary books. The oldest practitioner in the district had never known a single case to occur in the town of Penzance, in a practice of fifty years. The case witnessed by me, occurred in the person of a fisherman from the parish of St. Paul. I am ignorant of the circumstances connected with the two cases that are recorded on the Dispensary books, before my connexion with it.
The same almost complete exemption from intermitting fever, not only during the period of my residence in Cornwall, but for many years previously, was confirmed to me by the testimony of all the practitioners in the district. Hardly a case had been witnessed by them for a dozen years, and very few indeed for twenty years: scarcely any of the younger practitioners had seen a case of the disease.
And yet this immunity from ague is only a comparatively recent feature in the medical history of the district. All the older surgeons were familiar with the disease in their earlier practice. Forty years before the period of my inquiries, each practitioner saw many cases every year: one, "about thirty in a twelve month;" another "five or six every spring and fall;" and a third "a great many;" and the uniform testimony of medical tradition, throughout the district, went to establish the general prevalence of the disease in the days of their fathers. The same evidence goes to prove that the disappearance of the disease has been progressive; a fact also illustrated by the official registers of the Dispensary. In the three years from 1810 to 1813, two cases occurred; in the three years from 1819 to 1822, one case occurred; in the eleven years from 1823 to 1833, not one case occurred.
There seems every reason to believe that the causes commonly assigned for the decrease of ague in England, during the last and the present centuries, for the decrease is general, viz. the draining of marshes and wet grounds, the cultivation of wastelands, the improved cleanliness of the habitations of the poor, &c. are correct; and no doubt all these have operated, more or less, in this district; still there seems something else wanting for the complete elucidation of the change that has so universally taken place in this respect. At no period could there have existed marshes to any extent, or stagnant ditches or ponds, or even wet lands, in any part of this district. Certainly, causes of this kind could not, at any time, have existed in a greater degree than they now exist in Scotland, where ague is, and always has been, totally unknown. None of the practitioners, old or young, had ever met with a case of ague in a miner, or streamer, which could, with any degree of probability, be attributed to causes immediately connected with the occupation of such persons. And this is a curious and important fact, as proving, in a very decided manner, that neither impure air simply, nor wet, nor the alternation of cold and heat, nor all these combined, can give rise to fevers of this type.
Hepatitis and Scirrhous Liver.—These diseases appear to be rather more frequent than I should have supposed a priori, although certainly not more frequent than in other parts of the kingdom. I have been so much accustomed to consider organic diseases of the liver and spleen as so much more prevalent in malarious districts than elsewhere, that I should have predicated of the Landsend district a comparative immunity from them. The fact, however, is by no means such as regards Penzance and its immediate neighbourhood, as is shewn by the Dispensary table; and the same results are afforded by my inquiries among the resident practitioners in Penzance. One of these had met with several cases of chronic hepatitis which proved fatal by suppuration, and some others in which recovery had taken place on the abscess being discharged externally. Several of the practitioners in the country to the eastward of Penzance, considered the disease as very rare, meeting with no more than a single case in seven or eight years, during a long practice. Judging from my own limited experience, and the results of the Penzance table, I should say that organic affections of the liver were of moderate frequency in the district.
Jaundice.—This disease, which the Dispensary tables shew to have been comparatively infrequent at Penzance, at least much less so than hepatitis and scirrhous liver, was regarded as of frequent occurrence by the same country practitioners who reported liver cases as rare. Several of them who had only met with two or three cases of diseased liver in seven or eight years, met with as many cases of jaundice annually. Some of the older practitioners also considered the disease as rarer now than in their early practice. They noticed a fact, which most practitioners must have observed of this and of many other diseases, that it had a tendency to run in families: some had met with three cases in one family.
Diseases of the Spleen.—The connexion between disease of the spleen and ague is much better supported by the medical statistics of this district, than the connexion between the latter class of diseases and affections of the liver. While, as we have seen, hepatic cases are far from uncommon in the hundred of Penwith, it will be observed that not a single case of splenic disease is recorded in the Dispensary lists; and I may had, that I neither saw nor heard of any case of the kind during my residence there. By way of contrast to this fact, I may state that at Chichester, which is only in a very slight degree a malarious district, I meet with more than one case of enlarged spleen every year, among my Infirmary patients.
Bronchocele.—This is another disease of a strictly local character, although its causes, or the particular circumstances under which it occurs, are much more obscure than in the case of ague. I did not meet with a single case of it during my residence in Cornwall, and all my inquiries lead to the conclusion that it is of comparatively rare occurrence in the Landsend district. It appears that only seven cases were admitted at the Penzance Dispensary during a period of fourteen years; and none of the surgeons of the district had met with many cases in the course of their practice: all, however, had met with a few. Although, therefore, when compared with many districts in the kingdom, the Landsend presents a very small proportion of cases of bronchocele, still, I apprehend, there are many districts which exhibit even fewer. This seems to be the case with Plymouth and London; unless, indeed, there should arise a doubt that bronchocele might have been usually transferred to the surgeons of the institutions, from which the statements are made, and did not, therefore, appear on the lists of Drs. Willan, Bateman, or Woolcombe. I can, however, refer to a more recent instance respecting which there can be no doubt, as the list includes the medical and surgical cases indiscriminately—I allude to the admirable Reports of the Birmingham Infirmary, published in the Transactions of the Association, by Mr. Parsons. In the Reports for the years 1832-3-4, in a list of 10824 cases, not a single case of bronchocele is recorded.
Nyctalopia.—This disease is markedly endemical in many countries. It is an extremely rare affection in Great Britain: I only met with a single case during my residence in Cornwall, and I heard of no other. The case of nyctalopia occurred in the person of a fisherman, aged 52, in the summer season. It was accompanied by, and apparently dependent on, gastric and intestinal disorder, as the man had been for some time affected with dyspepsia to a great degree, and also diarrhœa. It was irregularly intermittent, coming, on after intervals of some weeks, and lasting from four to eight days.
Colica pictonum.—From the great prevalence of this disease in the adjoining county, in former times, so great as to obtain for it, as is well known, the name of Devonshire cholic, we should not have been surprised to have met with it in this district. It will be seen, however, that no case of the kind is recorded on the Dispensary lists; I myself never met with a case, nor could hear of more than one as having been met with by any of the resident practitioners, except such rare spasmodic cases as are met with everywhere among painters.
Although not, strictly speaking, endemic diseases, yet as possessing some points analogous to these, particularly in the obscurity of their causes, and the variety of the degree of local prevalence, I shall notice, in the present section, two or three of the more important diseases to which mankind are liable, viz. scrofula, (including consumption, hydrocephalus, and epilepsy,) scirrhus, calculus and scorbutus.
Scrofula.—Under this head I propose to notice only those affections of an external kind, the nature of which is unequivocal, and which are commonly marked among surgical diseases, such as enlargement of the external glands, diseases of the joints, scrofulous ulcers, rickets, angular curvature of the spine, &c.
I am disposed to regard scrofulous diseases as of more frequent occurrence in this district, than in England generally: I am not, sure, however, if I am in possession of positive evidence sufficient to establish this position. Such an impression was made on my mind, during my residence in Cornwall, by the numerous cases that came under my notice in the Penzance Dispensary, and by the observations I had opportunities of making in private practice, and among the population generally; still, as I have just hinted, this general impression may not be in accordance with the actual facts. The point is one extremely difficult to be decided, and I am not sure that we at present. possess documents of sufficient extent and authenticity to determine it.
In the Dispensary table the affections classed under the present head amount to about one-thirty-fifth part of the whole diseases; and the proportion might be considerably increased if we include cases of ophthalmic of a scrofulous nature, the great proportional prevalence of which disease I have already noticed. As, however, the disease termed strumous ophthalmia may originate in children having no original scrofulous taint, under circumstances of insufficient and unwholesome food, air, and exercise, and may readily disappear under proper management, without leaving behind it any fixed constitutional lesion or even predisposition, I have not thought it proper to class these cases of ocular inflammation under the present head. Their great prevalence, nevertheless, I regard as unequivocal evidence of much strumous predisposition in the locality where they prevail.
It appeared to me that the common external indications of the scrofulous constitution, visible in the complexion, texture of the hair, configuration of the body generally, and of the features of the face more particularly, were more marked among the inhabitants generally, and especially among the better classes, than in other parts of England, where I have had opportunities of observing the condition of the people; and I thought I could discover a larger proportional number of white swellings, incurvations of the spine, hip cases, and glandular tumours there than elsewhere. Of the very general and great prevalence of these diseases throughout the district, the answers of the resident practitioners, under the heads scrofula, rickets, white swelling, hip disease, spine disease, are sufficient evidence; but their absolute proportional superiority in point of frequency, relatively to other districts, cannot be considered as established on the present evidence. Most of the surgeons had, at the period of my inquiries, some patients rendered lame by scrofulous disease of the hip and knee joints; some partially recovered; some still under treatment.
If it should be satisfactorily proved that scrofulous diseases are really more common in this district, some circumstances might be mentioned as possibly helping to explain the fact, and particularly two, viz. first, the very relaxing nature of the climate, from its great humidity and the singular equability of its temperature; and, second, the frequent intermarriage of families, from the confined and isolated position of the district. This latter circumstance is likely to operate in two ways,—first, by generating the strumous diathesis in healthy subjects, on the well known principle of breeding in-and-in; and, secondly, by tending to develope and strengthen the predisposition when already existing. There is no fact better established in physiological pathology, than that the offspring of parents, both of whom are touched with any hereditary malady or morbid predisposition, are likely to exhibit the same malady or morbid predisposition in a greater degree than either of the parents.
Consumption.—It will not be denied by any experienced pathologist, that the disease strictly termed phthisis, or consumption, or tuberculous consumption, is, in reality, one of the forms of scrofula; neither will it be doubted, although other diseases of the chest are frequently classed under the name of consumption, that the great majority of cases classed under the head of phthisis in any of our public institutions, are really genuine examples of the true tuberculous consumption. It does not, however, follow, from this, that there is any necessary proportion in the degree of prevalence of scrofulous phthisis and the other forms of scrofula; on the contrary, it is possible that where the morbid diathesis manifests itself strongly in one form, it may do so feebly in the others. It would not follow, therefore, as a matter of course, that consumption must he a very prevalent disease in this district, even if it were fully established that external scrofula were so.
It is hardly necessary to remark, that my own observation, and the testimony of the local practitioners, go to establish the existence of consumption as a disease of very frequent occurrence; because it will be universally admitted that it is so in every part of England, and, indeed, it may be said, in every part of Europe, if not in the world. Without referring to statistical documents, l should say, as a general observation, that consumption is as prevalent in the Landsend district as in Sussex; and that it is more prevalent in both than in Scotland. I found it affecting all classes of persons, but in an especial manner miners, I shall have occasion, in a subsequent section, to enter more particularly into the nature of the consumptive diseases of the Cornish miners; it may suffice here to remark, that the opinion is universal among the medical practitioners of the district, that the genuine phthisis, slightly modified indeed in many cases, is of vastly more frequent occurrence among miners, than in other classes of the community. The proportion of miners affected with this disease, and that die of it, for they all die, was variously calculated as 1 in 10, 15, 20, 30, 40, by the local practitioners. It is sufficient to observe here, that if the disease exists among the other classes of the community in the same proportion as elsewhere, it follows, as a matter of course, the nature of their mode of life being considered, that it must be more prevalent among miners, inasmuch as they have many additional causes of pulmonary disease to which the rest of the people are not obnoxious.
It will be observed that, in the Dispensary Report, I have classed hæmoptysis and consumption together; and although the former disease unquestionably may, and does exist independently of the latter, still the proportion of cases of pure hæmoptysis is so small as not greatly to vitiate the conclusions deduced from such a document. These give the proportion of consumptive cases to other diseases, as one in 29.7, a considerably smaller proportion, than was observed at London or Plymouth, at both of which places the proportion was nearly the same, viz. 1 in 19.7 in London, and 1 in 19.6 at Plymouth. Unfortunately, I am deprived of the surer test of prevalence on the large scale, namely, that of the relative mortality from the disease; but, as far as can be gathered from the obituary of the two parishes of St. Paul and St. Hilary, we may infer that although very considerable, still the proportion of deaths from consumption does not differ much from the mean of Carlisle, London, and Plymouth. In the case of the parish of St. Paul, indeed, if we include the deaths from decline with those from consumption (179 of the former and 18 of the latter, and there can be little doubt that the majority of the cases marked decline were, in fact, consumption) we have the proportion of deaths from this disease very nearly the same as at London and Plymouth, viz. 1 in 4.6. In the parish of St. Hilary, supposing the cases of tussis (7) and tabes (70) to have been instances of pulmonary consumption, the proportion of deaths from this cause, upon the whole number of diseases, is 1 in 11.3; but rejecting those which are marked unknown, many of which must have been owing to tuberculous phthisis, the proportion is then 1 in 4.3. This, it will be observed, is less than the proportion usually given of mortality from consumption in recent investigations, Dr. Clark making the proportion, both in France and England, no less than one-third. I own I cannot bring my mind to admit so large a proportion for this country as one-third, fearfully prevalent and fatal as l know this disease to be; and the result of my general observation respecting the causes of death in my public and private practice, and among my friends and neighbours, during the last twenty years, is in some degree corroborated by the statistical results. The mean proportion of deaths from phthisis at Carlisle, London, Plymouth, and the Landsend, is 1 in 5.6.
It is the opinion of some of the older practitioners of the district, that consumption is more prevalent now than formerly; but no causes were given for the supposed increase.
In a subsequent part of this paper I shall have occasion to return to the subject of consumption, when noticing, more particularly, the diseases of miners, and examining the eligibility of the Landsend district as a place of residence for consumptive patients.
Hydrocephalus.—The propriety of placing this disease among scrofulous affections will probably be contested by many; but, I apprehend, the majority of experienced practitioners will agree with me in thinking, that by far the greater number of the hydro cephalic affections of infancy and childhood do occur in families of a decided strumous constitution. Although, then, it may be true that the subjects of these affections present no other morbid indication of scrofula, the constitutional predisposition suffices, in an inquiry like the present, to justify the present classification of hydrocephalus.
Hydrocephalus, like external scrofula, appeared to me to be of rather frequent occurrence in this district; but this was not the prevailing opinion of the resident practitioners. My Dispensary table makes the proportional prevalence of this disease not very different from that recorded in Dr. Willan and Dr. Bateman's tables for London. The degree of prevalence, by the Plymouth tables, is so very much less, that I am led to doubt their accuracy in this point. Certainly, during the period of my residence at Penzance, I met with a greater proportion of hydro cephalic cases than I have done since.
Epilepsy.—My own experience leads me to consider epilepsy as a disease, if not peculiar to scrofulous constitutions, yet of decidedly more frequent occurrence in them than in other persons; and were this otherwise, the following very strong opinion of a most observant and experienced practitioner, would be to me sufficient reason for placing the disease in its present position: "I conceive (says Dr. Cheyne) that epilepsy is as certain a manifestation of the strumous diathesis as tubercular consumption, psoas abscess, hereditary insanity, or certain congenital malformations or defects of organization which are inherited only from scrofulous parents. I have no recollection of a case of cerebral epilepsy in a patient who, when due inquiry was made, did not appear to inherit a strong disposition to scrofula." Be this as it may, I think I am justified by the tables, as well as by the result of my own observation and inquiries, to regard epilepsy as of very frequent occurrence in the Landsend district. Ninety-seven cases in seventeen years, or upwards of five annually, in a list of patients averaging between 500 and 600, is certainly a larger proportion of cases than I have been accustomed to observe elsewhere; and if the reports before referred to can be admitted as authentic evidence of the proportional prevalence of diseases at the places mentioned, epilepsy is less frequent, by one-half, at least, both at London and Plymouth.
Tubes mesenterica.—If the diagnosis of this disease were always unequivocally established, there could be no question as to the propriety of its classification among strumous affections. It is, no doubt, however, true, that many cases have been so designated in which the mucous membrane of the bowels alone was the diseased part. I think, however, that if not all, certainly the greater number of the twelve cases ranged under this head in the Dispensary table, were, in reality, affections of the glands of the mesentery; and I am, therefore, disposed to regard this disease as more than usually common among the children of Penzance. At least, I can safely say that I have not met with it in so great a proportion since l left that place.
Scirrhus and Cancer.—I am unable to form a guess as to the comparative frequency of this disease in this district. The Dispensary tables, my own observation, and the testimony of the resident practitioners, all prove that the affection is of common occurrence. Most of the older practitioners had had from eight to twelve cases, at different times, under their care. The relative proportion of prevalence, in the Dispensary table, is, during my connexion with the charity, 1 in 91.5, and during the whole seventeen years, 1 in 210; and the relative proportion of fatal cases, in the St. Paul's obituary register, is 1 in 130. The number of cases of internal cancer appeared to me greater at Penzance than I have noticed elsewhere. The following is the analysis of the twelve cases recorded in the Dispensary books, during my administration: 1 of the lip; 1, eye; 1, uterus; 1, cardia; 4, pylorus; 4, mamma. The disease affected no class of the community in particular. None of the practitioners ever knew a case of genuine cancer cured by medical means.
Calculus.—This disease must, I think, be regarded as of very rare occurrence in the Landsend. During my residence there I did not meet with a single case; and only three cases are recorded in the Dispensary register in seventeen years, being in the proportion of only 1 in 3000 patients nearly. Similar evidence of the comparative infrequency of the disease was afforded by all the resident surgeons. The older practitioners had met with only one, two, or three cases in the course of a practice of forty or fifty years; none had performed the operation of lithotomy, and I could only hear of one case in which the operation had been performed in the district. Dr. Montgomery, who has resided in this district many years, informs me that he has only met with one case of stone in the bladder, and had been informed of two others; the former patient was a miner, the latter were not. This infrequency of cases becomes the more remarkable, when we consider the isolation of the district, and its remoteness from London or other large towns, whither patients might be transferred for operation. If cases originated here, many of them, at least, would still be found in their native localities, especially among the poorer classes.
In the excellent papers on the Statistics of Calculus, by Mr. Smith, of Bristol, and Dr. Yelloly, of Norwich, much interesting information is given respecting the relative prevalence of calculous disorders in various parts of the kingdom, but little light is thrown on the causes of the difference. If bad sour bread were a cause, this, as we have seen in the former part of this paper, exists in abundance in the district of the Landsend; and if dyspepsia or disordered digestion, however produced, gave rise to it, as others imagine, we shall find hereafter how plentiful a source of this kind is found among the poorer population: its supposed connexion with scrofula, also, seems disproved by the frequency of this latter affection in the district. If pure air and water free from saline or earthy impregnation, tend to give an immunity from calculus depositions in the bladder, it must be allowed that this district possesses these advantages in great perfection.
Scorbutus.—I never saw a case of this disease, and it was equally unknown to the oldest practitioners: a very few cases of purpura were met with.
IV. GENERIC OR CONTINGENT DISEASES.
Diseases of the Brain and Nervous System.—I notice under one head the several diseases thus classified together in table A I. because I have little to offer respecting them in general, and still less individually. Epilepsy and hydrocephalus I have already noticed. It will be seen, on referring to the tables, and comparing them with the reports of Drs. Bateman and Woolcombe, that the proportion of cases of apoplexy and palsy, on the Dispensary books, came very near to that observed at London and Plymouth. I certainly was disposed to regard palsy as very frequent, and the obituary of St. Paul, which gives the proportion of deaths from the two diseases as 1 in 40, would seem to establish the great prevalence of both palsy and apoplexy. Chorea appeared to me unusually rare, and this was the general opinion of the surgeons of the district, the oldest practitioners having only met with three or four cases in all their experience. No case was entered on the Dispensary books in my time. The proportion of such cases was, however, even less in London, though considerably greater at Plymouth. Hysteria was of frequent occurrence: hypochondriasis less so. The case of tetanus seen by me originated in, a wound. Neuralgic affections were of moderate frequency. I met with none of an intermitting character, or rather none which could be regarded as originating in malarious influence.
Hydrophobia.—Judging from my own observation, I should regard cases of this disease as everywhere of extreme rarity. In all my experience I never met with a single case. In this district, none of the practitioners had ever met with a case, though they had known of dogs reported- mad, and heard of hydrophobia cases in the human subject in other parts of the country.
Dropsy.—The number of cases of dropsy in all its forms (excluding, of course, hydrocephalus) which are registered in the Dispensary table, appeals to bear nearly the same proportion to the remaining diseases, as in the London tables of Drs. Willan and Bateman. I have omitted to compare the numbers of the different forms of dropsy with one another in the different lists, and cannot, therefore, speak as to their relative prevalence, but it struck me at the time, and the same impression is conveyed now by an inspection of the Dispensary records, that the number of cases of anasarca was unusually large. The distinction of the forms of dropsy is only given for eight years of the seventeen included in the list, and the following are the actual numbers of each kind:—Anasarca, 62; ascites, 22; hydrothorax, 3. In the three years from 1819 to 1821, out of 1096 medical cases, there were 33 cases of dropsy, and of these no fewer than 26 were of anasarca. In the answers returned to me by the resident practitioners of the district, the great frequency of dropsy, particularly of anasarca, was generally recorded. It seemed doubtful, from the evidence afforded, which of the three diseases, dropsy (particularly anasarca), pulmonic inflammation, or acute rheumatism, was of most frequent occurrence. Dropsy appeared not to affect miners, or any one class of personas more than another; unless, undeed, we reckon drunkards as a class, and as the chief of them the landlords of public houses, the greater number of whom here, as elsewhere, fall victims to their intemperance, of which some form of dropsy is the most obvious result, although itself generally a consequence of some other disease. The frequency of dropsy in this district, seems also established by the mortuary registers both of St. Paul and St. Hilary, particularly of the former, in which it bears a proportion of no less than one in twenty of the total deaths.
Among the cases of anasarca observed by me at Penzance, were several of the acute idiopathic kind, coming on in persons of unbroken constitutions, and passing off entirely under the use of bleeding and purging. In Dr. Montgomery's Report for 1833, he says, "A greater proportion than ordinary of dropsical affections have presented themselves [anasarca 16, ascites 3, among 670 cases], in a few examples arising from inflammatory action, but for the most part originating in debility."
Hydrocele was also regarded by the resident surgeons as a disease of rather frequent occurrence; and some of the older practitioners were of opinion that it had been still more prevalent formerly. It will be seen that 17 cases are recorded in the Dispensary tables, being on the average of one annually, or 1 in 500 cases of disease, including both the medical and surgical cases.
Diabetes.—This disease (the piss-pot dropsy, as it was called by the older authors—hydrops ad matulam) rare everywhere, I must regard as not more frequent in this district, although the numbers given under this head in the Dispensary list, and also in the table, of the relative prevalence of the diseases, would seem to indicate the contrary. During my residence at Penzance, I only met with a single case; and it appears that only one other occurred at the Dispensary during the eleven years subsequent to my leaving it. I must, therefore, regard the number of six cases, entered upon the Dispensary books in three previous years, as including some, at least, of the more common cases of diabetes insipid us, an affection of a totally different kind, and generally of only temporary prevalence. All the surgeons regarded the disease as extremely rare, and equally so among miners as others.
Gout.—Here, as elsewhere, this disease is nearly confined to the classes of society not depending on bodily labour for subsistence. I have only one observation to make respecting its prevalence in this district, which struck me at the time as remarkable, and, if really true, is certainly deserving attention. Two of the oldest practitioners in the district, each resident in a small country town, assured me that, in their earlier practice, that is forty or fifty years before, gout was much more frequent than at present—in the proportion, they said, of a hundred to one! Has this remark been made elsewhere? If true, generally or partially, is the fact a consequence and a proof of the more general prevalence of temperate habits?
Diseases of the Heart.—I have no remark to make on this class of diseases, except to express my belief, founded partly on reasoning and partly on my own observation, that miners are more subject to organic changes of this organ, particularly dilatation, than most other classes of workmen. The causes of such a morbid state, in this class of persons, stand out prominently, both in their habits and diseases. The extreme strain on the respiratory and circulatory organs produced in the ascent from mines, described in the first part of this paper, and the chronic obstructions to the transmission of blood through the lungs, so frequent a form of disease in this class of persons, as will be shewn more particularly hereafter, are strikingly calculated to produce these affections. Palpitation is returned, by the medical gentlemen in the mining district, as a very common complaint among miners. Here, as in other instances, I have to lament the want of a more discriminating diagnosis, and still more of cadaveric confirmation.
Diseases of the Chest.—I have already noticed the principal diseases of this class under the heads of catarrh, inflammation of the lungs, and phthisis pulmonalis. The only remaining affections of this cavity, that remain to be noticed are chronic bronchitis and asthma. And as these possess no peculiar interest, except as they occur among miners, I shall refer my notice of them to the section which is more particularly devoted to the diseases of this class of persons.
Chronic diseases of the Alimentary Canal.—I have already noticed most of the diseases of the intestinal tube, and the collatitious viscera, which seemed likely to be the result of endemic, epidemic, or atmospheric influence. I now proceed to make a few remarks on such as remain, and which, if attributable to any appreciable cause, must be regarded as more owing to circumstances in the constitution and mode of living of the individuals, than to any peculiarities of soil or climate.
Dysphagia.—The number of cases of this disease, entered upon the Dispensary lists, is, I apprehend, above the ordinary proportion; and I certainly was myself struck with the frequency of the complaint during my residence at Penzance. The same remark was made by one of my successors in the Dispensary. In the Report for 1832, Dr. Montgomery observes—"A few examples of obstruction of the gullet occurred. This disease almost always ends fatally. From some inquiries I have made on this subject, there is reason for believing that it is of more comparative frequency in this than in the neighbouring counties." In a communication of later date, with which the same gentleman favoured me, he further observes on this complaint—"I have not observed this disease in young persons, but have seen it both in the temperate and intemperate. It has invariably ended fatally. I have examined some of the bodies after death, and found the upper part of the gullet filled, to the extent of two inches or more, with a firm semi-cartilaginous substance, with the remains of a passage not larger than a crow-quill winding in a spiral direction through it." I have not the means of verifying the exact nature of the greater number of the cases, but from what I observed myself, and from what is known of the general character of such cases, I think myself authorised to conclude, that the greater number, or sixteen cases, were examples either of chronic inflammation and thickening of the part, or of actual scirrhus. It is, indeed, so difficult, if not impossible, in many cases, to separate these two affections from each other, that it might, probably, be a preferable arrangement to comprehend them under one head, and extend the classification to the whole extent of the alimentary canal; thus including, under one head, stricture of the œsophagus and rectum, and scirrhus of the cardia and pylorus. I have, however, already noticed, under the general head of scirrhus and cancer, the affections of the cardia and pylorus of this description; it, therefore, only remains to advert to the obstructions of the œsophagus: no cases of stricture of the rectum are noticed in our reports. The four cases of dysphagia that came under my own care, were all, probably, instances of the scirrhous stricture of the œsophagus; some of them were proved to be so by dissection; and the probability of the cancerous nature of these affections, is certainly increased by the fact that, during the same period of three years, I met with one case of scirrhous cardia, and four of scirrhous pylorus, among the same patients, 1096 in number. This makes the proportions of scirrhous affections of the œsophagus and stomach 1 in 120 nearly. If we reckon the whole cases of dysphagia recorded, as of a scirrhous character, and reckon only three of the cancerous cases included in the report from 1823 to 1833, as having their site in the stomach, (there are only three so named in the report of the physicians, although, possibly, others also included under the general name cancer may have had their site in the same part) we have no less than 33 cases of scirrhous affections of the œsophagus during the seventeen years, being 1 in 231 of the whole medical cases.
It is singular that dysphagia should be regarded, by the old practitioners of the district, as a disease of comparatively recent origin. The three oldest surgeons had each met with a few cases (all fatal) within the last ten years, and they did not remember to have met with any previously. May this fact, for I believe it to be such, be accounted for by the greater prevalence of dyspepsia, consequent on the distress and poverty produced by an increased population and bad times, and the change of the more solid diet of former times (particularly among women) for the sloppy meals of these tea-drinking days?
Dyspepsia.—During my residence at Penzance, the proportion of cases of dyspepsia among the poor, that came under my notice, was much greater than I have met with in any other situation. The proportion of cases in three years, as recorded in the second column of the Dispensary table, was more than 1 in 5 of the whole diseases, viz. 1 in 4.8; and the proportion during the remaining two years of my residence was not inferior. It seems certain, however, that this proportion is beyond the average of what is observed in the district, since we find that the numbers received into the Dispensary, both previously and subsequently to my visit, bore a considerably less proportion to the other cases of disease. Indeed, it will be seen by the results of table A, that the average proportion of dyspeptic to other cases, during the whole seventeen years, is only 1 in 9—a proportion which is as much below that of the London tables as mine was above it. The marked increase of dyspepsia, in recent times, was corroborated by the testimony of the old practitioners, and they did not consider the increase as produced only by the recent distresses of the people, but as having progressively increased through the change of habits since the days of their early practice. All the resident practitioners considered dyspepsia to be habitually more prevalent among miners, than among the males of the other classes of the labouring population. Some attributed it to long fasting while under ground; others to the impure air they breathed while there: both, probably, co-operated to produce the result.
The following extracts from my official Reports, printed annually with the Dispensary accounts, illustrate the causes of dyspepsia:—"The most prevalent disease, by far, during this and the preceding year (1819-20) has been chronic derangement of the digestive organs, or indigestion, in its various forms and degrees. This prevails chiefly among the female patients, and is in a great measure, perhaps, attributable to their sedentary habits, and scanty and improper diet." In the Report for 1821, it is stated—"The great majority of the disorders have been of a chronic character. Of these, by far the most numerous and important are the distressing complaints which are either immediately or remotely referrible to functional derangement of the stomach and other digestive organs. In the table I have classed them chiefly under the two heads of dyspepsia and marasmus, and they will be found to constitute nearly one-fifth of the whole of the medical cases. The great majority of these occurred in the persons of women, and some in children: in the former they can, in most cases, be traced to the effect of imperfect and improper nutriment. The daily food of many of these consists, almost entirety, of imperfectly baked barley bread and warm water (misnamed tea), a sort of diet. which can hardly be expected to be long persisted in consistently with health, and which, in very many instances, I have ascertained to be directly the cause of the diseases above mentioned."
It is not difficult to account for the increased proportion of dyspeptic complaints during the years referred to. Distress, during the greater part of that time, prevailed throughout the kingdom, partly from failure of the crops, and partly from the state of our trade and financial relations; and this was aggravated in a ten-fold degree in the Landsend district, by the total failure of the pilchard fishery, on which the great majority of the poorer classes almost entirely depended. These general and local causes did not exist, at least in anything near the same degree, in the previous or subsequent years.
It seems probable that the very humid and relaxing climate has some effect in giving rise to this complaint, even among the native inhabitants. I am informed, by Dr. Montgomery, that the wet relaxing weather so prevalent in winter, at Penzance, is very apt to induce dyspepsia among the strangers who resort thither during that season.
The causes occasioning increased frequency of the disease, seemed also to produce greater intensity in the individual cases. At least, I never witnessed, either before or since, such extreme derangement of the digestive and assimilative functions, as among my patients at the Penzance Dispensary. It may give some idea of the general character of the cases included under this head, to state that of the 228 cases in the second column, 74 only were examples of what is more properly called dyspepsia, viz. primary derangement of the digestive functions, while 119 were cases of what may be called secondary dyspepsia, or what has been sometimes named bilious disorder exhibiting a much more extensive and profound affection of the whole chylopoietic viscera and organs of assimilation: the 35 remaining cases were examples of inflammatory affections of the stomach, duodenum, or liver, consequences of this state, and sufficiently characterised by their local intensity to be in some manner segregated from it. It is proper also to state, that among the 143 cases in the first column are included the cases of infantile remittent (termed by the physician, Dr. Borlase, worm-fever), as well as others ranged under cardialgia. The foulness of tongue, thirst, depraved or abolished appetite, foul and fetid and discoloured dejections, and alteration, both as to quality and quantity, of the urinary secretion, were extreme and most remarkable. I was particularly struck with the immense flow of urine, which often amounted to a true diabetes insipidus, and was of very common occurrence. All these symptoms, and with these, feverish restlessness at night, and nervous agitation amounting almost to insanity, were often relieved in the most striking manner, and almost instantaneously, by a few doses of calomel. This remedy, in such cases, had often a more unequivocal and, indeed, astonishing effect than I have witnessed by almost any treatment in other diseases, if I except, perhaps, quinine in ague, steel in chlorosis, and tartar emetic in pneumonia. I regret, however, to add, that the relief was in general also very temporary, partly because the exciting causes of the disease were immediately re-applied, indeed, had never been removed, and partly, because I do not think I had recourse to the best means for securing the benefit I had obtained by such preliminary treatment. I fancy that if I had now to treat such cases, and I now hardly ever see such, I could produce results much more satisfactory, by the better regulation of even the bad diet then in my power, and by the cautious and regulated use of medicines having a tonic effect on the digestive organs and the system at large. I was then more skilled in subduing the enemy by a coup de main, than in expelling him by systematic manoeuvres, and keeping him at bay when expelled: like that of most young physicians, my practice was more of the heroic than philosophic cast.
I consider the cases marked in the Dispensary list, under the heads of gastritis and gastric irritation, gastrodynia, pyrosis, constipation and vomiting, as coming essentially under the same class of observations, and, indeed, all these, except the two last, have been included under this head, in estimating the relative prevalence of diseases.
During my residence at Penzance, I met with numerous cases of pyrosis, but never recorded it as a distinct disease. It, however, seems to have more attracted the notice of my very intelligent successor, Dr. Barham. In one of his reports (for 1825) I find the following striking remark:—"Another complaint which makes some figure on the list, and which we suspect to be of more than usually frequent occurrence in this part of the kingdom, is pyrosis or water-brash. This complaint, which destroys the comfort and debilitates the constitutions of many of our poor neighbours, especially among females, is commonly attributed to the effects of poor watery diet. If that be, indeed, the true explanation, it is one which harmonises but too well with the situation of the poorer classes of this county. but which refers the evil to a cause which we behold with concern, but have little power to remove."
Female diseases.—The only diseases of this class in the Dispensary tables, that require notice, are those comprehended under the head of chlorosis and amenorrhœa. It will be observed that the proportion of cases so denominated is extremely great, being, in fact, nearly three times as great as in London, and more than one-half more than in Plymouth. It will also be observed, that the disproportion is entirely owing to the very great number of cases thus distributed in the first column of the table. Taking the two last columns only, we find that the proportion of such cases (even when those classed under dysmenorrhœa are included) to the total diseases, during the same period, instead of being 1 in 21, is only 1 in 25, or, excluding dysmenorrhœa, in 30. Still, even this is a very large proportion, and I can only account for it by supposing that every case presenting any deficiency in the catamenial discharge was arranged under this head, without considering how frequently the amenorrhœa is a mere symptom of other diseases. I am borne out in this supposition by the result furnished by the second column, which gives the proportion only as 1 in 52. I do not doubt, but that if as rigid analyses had been instituted during the other years, as was done by myself in classifying the cases during these three years, the general result would have approached nearer to that last stated. It is, however, not improbable that these affections are more prevalent in this district, although not to the extent alleged; and that this increased prevalence may be owing to the greater amount of dyspeptic affections, of the more inveterate forms of which, amenorrhoea is often a consequence.
The same remark, I believe, will apply to the class of affections next to be noticed, marasmus, infantile remitting fever, intestinal irritation, and worms. As I have nothing particular to state on these affections, I shall conclude with a few remarks on worms and chronic eruptions.
Worms.—Dr. Paris, who resided at Penzance for a few years, considered worms as of very frequent occurrence in this district, and attributed the circumstance to an impoverished diet and the use of unsalted fish. Whatever the cause may be, and I apprehend we may look no farther than the ordinary causes of dyspepsia, which we have found so prevalent, the fact seems fully established by the results of the Dispensary tables, which make the proportion of worm cases to the total diseases as 1 in 48, while in the London tables of Dr. Willau and Dr. Bateman it is only 1 in 141. I am unable to specify the kind of worms of which the list is composed, except for column second:—the 16 cases therein given were—lumbricus, 9; tænia, 5; ascaris, 2. This is an unusually large proportion of tænia, and a small one of ascarides.
Cutaneous eruptions.—I should have regarded the number of these complaints mentioned in the Dispensary table as uncommonly great, were it not that I find precisely the same proportion given in the London tables. Judging however, from my own experience in other country towns, I should still say that the proportion of cases in Penzance was disproportioned to the size of the place, regarded as a country district. I have nothing to advance respecting their nature or history. Only in two years out of the whole seventeen comprehended in the Dispensary tables, are they arranged under distinct heads: they are as follows:—acne rosacea, 2; herpes, 1; lepra vulgaris, 16; impetigo, 3; porrigo, 2; pityriasis rubra, 4; psora. 13; psoriasis, 2; tinea capitis, 17; anomalous, 22; total, 82. They seemed to affect no particular class more than another. Admitting their frequency, we, perhaps, need to look no farther for the causes of this than to the poverty and consequent defective nutriment and clothing of the inhabitants, and to a general want of cleanliness among the lower classes, which is not altogether dependent on poverty. The following remarks on this subject, from the Dispensary Reports, are pertinent:—"The frequent occurrence of one disease (itch) which appears on the list, and which one cause alone can keep alive, gives us occasion to notice the importance of inculcating on our poorer neighbours the benefits of cleanliness. The more than ordinary neglect of this duty among the lower classes of Cornwall is matter of general observation, and the evils it entails on them are obvious. The connexion of cutaneous disease with this cause requires no comment."—Rep. 1827.—"It is gratifying to observe, that since our last meeting the important subject of cleanliness among the lower orders has obtained increased attention. Still, however, much remains to be done. The numerous cases of scald-head, ringworm, and other still more offensive cutaneous complaints, which appear in the list, bear witness to the operation of the want of cleanliness"—Rep. 1828.
SEC. II.—OF THE DISEASES OF PARTICULAR CLASSES OF INHABITANTS.
1. DISEASES OF MINERS.
The statistical details contained in the first chapter of the second part of this paper, exhibit an extraordinary superiority in the rate of mortality in the mining parishes over the agricultural, and even those containing towns and crowded villages. It now remains to consider, in a more particular manner, the remote and predisposing causes, and the particular nature of the diseases, which occasion this increased mortality.
It may, however, be desirable previously to ascertain how far the results recorded, as deduced from the parish registers of the ages at which persons die, and from the parliamentary population returns of the numbers alive at each different age, are borne out and corroborated by the general and particular observations of medical men and others resident in the district, and by the results of my own experience and inquiries directed to this particular object.
1. It may be stated then, in the first place, that the opinion is universally prevalent in the district, that mining is a very unhealthy occupation, and that miners are subject to a particular disease which affects great numbers of them and shortens their lives. This disease is generally known by the name of the miner's consumption; and its existence and great fatality are readily acknowledged by the miners themselves.
2. The examination of a body of miners, when assembled on any public occasion. cleaned from their ochry defilement and in the dress of the common labourer, impresses the observer with the belief that they are not healthy, and that they are much older than is really the case. It is stated by one of my medical correspondents, resident in a mining district, that an agricultural labourer at forty-five is almost as good as a miner at twenty-five, and the relative appearance of the two justifies this opinion.
3. My own inquiries among miners, and my repeated examination of this class of men, both individually and when collected within and about mines, under ground and at grass, have demonstrated the existence of diseases in a considerable proportion of them, which there was reason to believe would prove eventually fatal to all of them before the ordinary period of natural decay, and which diseases were almost all notoriously the consequence of their peculiar habits and mode of life.
The following table gives a view of the actual state of health of the men employed in a mine, from a personal examination made on the spot by myself, in the year 1821:
|Respective age of the men.||Number of year a miner.||Age when commenced mining.||Past and present health.|
|45||30||15||Occasional gastrodynia—otherwise well.|
|55||40||15||Subject to slight cough, and slight dyspnœa.|
|36||27||9||Occasional gastrodynia—otherwise well.|
|41||25||16||Formerly subject to dyspnœa—not so ate present. good health.|
|32||12||20||Subject to slight pain in the shoulder.|
|30||20||10||Subject to pain of chest, but has not dyspnœa.|
|41||25||16||Subject to bowel complaints last two years.|
|50||45||5||Has had slight dyspnœa for eight years.|
|32||20||12||Dyspnœa and occasional hæmoptysis for 8 yrs.|
|60||50||10||Dyspnœa during present and last year.|
|38||25||13||Good at present; may he had liver disease last yr.|
|24||10||14||Good, but subject to pain in left shoulder.|
|24||10||14||Subject to pain of stomach.|
|36||24||12||Subject to pain of bowels for last six month; no dyspnœa.|
|22||6||16||Liable to fits last two years.|
|37||20||17||Scrofulous swellings of the glands. Health good.|
|25||13||12||Affected with dyspnœa a year and a half.|
|27||8||19||Subject to lumbago four years.|
|43||26||17||Dyspnœa (not severe) for fourteen|
|37||20||17||Subject to pain of bowels for six years.|
|34||14||20||Has pain on the left side of the chest|
|52||32||16||Subject to dyspnœa for seven years.|
|35||9||26||Dyspnœa for two years|
|21||10||11||Pain of chest (from previous inflammation) for two years.|
|53||30||23||Dyspnœa for seven years.|
|49||32||17||Dyspnœa for three years; also subject to fits.|
|29||14||15||Had dyspnœa for some year years, but not for last 5.|
|29||14||15||Had dyspnœa for some years, but not for last 5.|
|27||8||19||Pain in the chest for last 5 years; no dyspnœa.|
|24||9||15||Subject to occasional pain in the chest.|
|22||11||11||Subject to pain of chest, uneasiness or anxious feelings about he heart, for years.
|Respective age of the men.||Number of year a miner.||Age when commenced mining.||Past and present health.|
|28||12||16||Palpitation of the heart for several yrs. Breath good.|
|20||2||18||Occasional pain in the bowels for five years.|
|32||16||16||Occasional dyspnœa for five years.|
|25||8||17||Pain of chest, last five months.|
|46||27||19||Subject to to dyspnœa for the last six years.|
|19||3||16||Pain in the chest for some years.|
|50||1||19||Dispnœa for two years. Has not worked for 20 years.|
|33||18||15||Subject to dyspnœa (slight) for eight years.|
|26||12||14||Subject to pain of chest and dyspnœa.|
|26||8||18||Subject to pain of chest, no dyspnœa.|
|30||16||14||Subject to pain of stomach; health otherwise good.|
|54||20||14||Subject to occasional pain of chest. Health good.|
|40||20||20||Subject to dyspnœa eight years eight years since. Health now good.|
|19||5||14||Subject to pain in the chest for twelve months.|
|35||20||15||Subject to dyspnœa for three years.—slight at present.|
|33||16||17||Severe dyspnœa with hæmoptysis for 14 years; the latter produced, he thinks, by carrying loads of ore.|
|18||5||13||Subject to dyspnœa before coming under ground, but the complaint aggravated since.|
|Respective age of the men.||Number of year a miner.||Age when commenced mining.||Past and present health.|
|35||19||16||Subject to pain of stomach; health otherwise good.|
|27||9||18||Subject to catarrh and dyspnœa ever since he remembers.|
|26||7||19||Subject to pain of stomach for 3 years. Health good.|
|18||2||16||Pain of chest and stomach.|
|49||35||14||Subject to dyspnœa|
|30||17||13||Lumbago for four years; health otherwise good.|
|46||30||16||Subject to slight dyspnœa.|
|45||30||15||Pain in the chest for five years.|
|42||28||14||Dyspnœa and pain of chest eight years.|
|25||1||24||Dyspnœa, present before working underground.|
|24||13||11||Affected with pain of chest two years.|
|29||20||9||Affected with dyspnœa four years.|
The following results are deducible from the preceding table:—
A. Among 120 labouring miners, the state of health is as follows:—
|Affected with dyspnœa||26||40|
|pain of chest||14|
|Pain of stomach and bowels||10|
|Pain of shoulder||2|
B. Of those in good health—
|The average age is||25|
|The average number of years of under-ground labour||13|
Of those affected with dyspnasa and pain of chest—
|The average age is||32|
|The average number of years under ground||18|
C. The actual distribution of the ages through the different periods of life, among 120 working miners, is as follows:-
|From||10 to 15||15 to 20||20 to 25||25 to 30||30 to 35||35 to 40||40 to 45||45 to 50||50 to 55||55 to 60||60 to 65||65 to 70|
Thus, out of 120 men, 5 only, or 1-24th part, are found capable of active labour beyond the 50th year, and 40, or 1-3rd, are already affected with a disease which will, in all likelihood, carry them to a premature grave; corroborating, in a striking manner, the statistical results in the former part of this paper, viz. how small is the proportion of this class of men found beyond the middle periods of life.
D. It appears that a very considerable proportion of these men, viz. 10 (or 1-12th), are subject habitually to pains in the stomach or bowels; a circumstance well worthy of notice relatively to what we shall find the general opinion of the medical men of this district, as to the character of the pectoral diseases of miners, viz. its marked complication with dyspeptic symptoms.
4. The unanimous testimony of the whole profession, in the west of Cornwall, goes to establish the great comparative unhealthiness of miners, and the premature death of a great proportion of them from diseases occasioned by their mode of life. Perhaps the most satisfactory as well as the most authentic mode of presenting this testimony to the reader, will be by giving a few extracts from the letters of some of my medical friends, in reply to some queries I submitted to them, bearing in a more exclusive manner on the health and diseases of the miners. If the remarks in some of these anticipate, in some degree, inquiries hereafter to be gone into respecting the nature of the pulmonary diseases of miners, it will, I conceive, be better to run the risk of repetition, than to weaken the impression conveyed by these documents. In regard to these, I think it but justice to the authors to state, that the letters were not written under the expectation of being published: being all, however, the productions of men of education and long experience, they will not be considered less valuable on that account.
From Dr. Wise, of Helston.—The first of the two following extracts is from a letter written so long back as 1824, and addressed to me from Edinburgh, to which place Dr. Wise had proceeded for the purpose of taking a degree in medicine, after having practised long and very extensively in the centre of the mining district of Cornwall. The second is from a letter dated in 1833, from Helston, in the west of Cornwall, in which place Dr. Wise has practised as a physician, since his graduation at Edinburgh. I make no apology to or for Dr. Wise, for the repetition, in the second letter, of several of the statements in the first, because this very repetition (of which, after so long an interval, the writer was unconscious) is a satisfactory proof of the strength of the writer's convictions, and of the accuracy of his statements.
First extract.—"The cases of phthisis pulmonalis which came under my notice during my practice in Cornwall, were very numerous. I have, indeed, witnessed this malady in, I believe, almost every variety both of shade and stage, and in every age from 15 to 60.
"With respect to that chronic form of the disease, or what in Cornwall has been called the miners consumption, I should think that full three fourths of those who continued to work under ground to the age of 50, are, more or less, affected with it, and a great number die of it between the ages of 40 and 55. It seldom proves fatal in a shorter period than two or three years, in some instances going on to five or even to eight or ten years. During this time, there will be numerous aggravations of the disease, particularly in the winter season, and especially marked by increase of dyspnœa, always aggravated by bodily exertion, and more or less expectoration and some degree of emaciation These are, nevertheless, unaccompanied by the usual hectic symptoms, the pulse, for the most part, not exceeding 70, and being sometimes even as low as 50. The hectic symptoms, however, invariably came on for some months before death, the pulse at last reaching, and more frequently exceeding, 120, and the emaciation becoming extreme.
"This form of phthisis, however, I have witnessed in persons who never worked under ground, but much more rarely than in miners. It is not wholly confined to persons advanced in life, though I conceive the more rapid character of the true tubercular consumption is by far more frequently observed in younger patients.
"Very much, I am aware, has been said in regard to the vitiated air from noxious gases, gunpowder smoke, &c. so often encountered by miners in their subterraneous employ, as giving rise to pulmonary diseases; yet I have long thought that there is another cause which operates still more powerfully, not only in inducing chronic consumption, but also hæmoptysis, and, in the young scrofulous subject, tuberculous phthisis, namely, the mode of ascent from the deeper mines by the ladder—a practice which, under the most favourable circumstances, is, I conceive, highly prejudicial to health. I scarcely need inform you that the miners work two, three, four or five together, for six or eight hours at one time, when they are relieved by another set; though, perhaps, you may not be fully aware of the very imprudent way in which they climb their way up to the surface. I have frequently conversed with miners on this subject, and they have all given me the following account as that which is generally true:— Each miner having taken his portion of the blunted tools on his back, amounting in weight, perhaps to from fifteen to twenty pounds, the most active generally takes the lead, and, at whatever pace, is closely followed, along the horizontal galleries and up the perpendicular ascent of the ladders, by the rest of the party, not only from their desire to keep together, but to avoid a certain slur which would attach to any one falling in the rear. The rapid pace at which they usually set off soon hurries the circulation and respiration, and frequently to such a degree as to give rise to the most distressing feelings. At this time each would slacken his course, although none dare propose to do so; and thus they go on till they reach "grass," when they find themselves completely overpowered by the excessive action of the heart and lungs, so as to be wholly unable for some time to speak. Is it surprising, then, that the miner, of all men, should be the most subject to hæmoptysis, and to pleuritic and pulmonic stitches, so constantly. in them, demanding the use of the lancet and blisters?
"That the heart, and the great blood-vessels thereunto appended, are often the seat of disease in the miner, the numerous examples of their irregular and disordered functions, so often terminating in hydro-thorax, and the frequent rupture of blood-vessels, too probably indicate. It would, indeed, seem to me altogether impossible that the whole circulating and respiratory systems within the chest, could long suffer such inordinate and preternatural actions with impunity. I conceive, also, that when the lungs have been thus over-excited, the full and quickly repeated inspirations of cold air, during the winter season, which the men are obliged to take immediately on reaching the surface, and to continue for some time, must act inimically on the delicate network of blood-vessels of the bronchial tubes. Such sudden changes must give rise to, and keep up, a degree of subacute inflammation, and consequent thickening of the mucous membrane of the bronchia, frequently obstructing their cavities, and that of the air cells, producing dyspnœa and expectoration, and ultimately terminating in the disease which I have termed chronic consumption.
"The mining district of Cornwall would, I conceive, afford an ample field for a Laennec farther to illustrate and confirm his opinions, provided leave could generally be obtained for post-mortem investigations. I am sorry, however, to say, that on this point the common people are extremely prejudiced, insomuch that I have found it almost impossible to obtain permission to open a body."
Second extract.—"Miners are, unquestionably, more liable to disease than the agricultural labourers of the same district. Their appearance is more unhealthy, and they are also shorter lived. They are very subject to diseases of the chest, much more so than other labourers; and I may say, to every variety of disease of the chest, both acute and chronic, but especially the latter. I can hardly say they are subject to any peculiar disease of the chest, and which we do not witness in others. The prevalent affection is chronic bronchitis, attended with different degrees of dyspnœa, and more or less expectoration of a decidedly short, purulent character, and frequently offensive. The patient lingers on from one to four or five years, or even longer, and at last sinks, worn down to skin and bone. The pulse, during the first two-thirds of the illness, is slow, and often irregular, and invariably quickens some months before death. This chronic bronchitis may be called the miners' consumption, inasmuch as miners are more liable to it than others; but it differs much from the tubercular disease frequently termed consumption. In this last the progress is more rapid— the hectic more decided the pulse more quick from the first-the expectoration more muco-purulent, more tenacious and less offensive. Miners often die of the true tubercular phthisis, but, in this case, almost always before the age of 25. We occasionally observe chronic bronchitis in the young miner, but by far—far more frequently between the ages of 36 and 50.
"Miners are subject to every degree of dyspnœa up to the most confirmed asthma, to spitting of blood, hydro thorax, general dropsy, valvular and other disease of the heart and great vessels, &c. The last-named class of diseases are often the cause of the others, by deranging and obstructing the pulmonary circulation, occasioning extreme congestion, and even regurgitation of the blood, and thereby giving rise to organic lesion of the pulmonary tissue with all its consequences—inflammation, effusion, thickening, adhesion, rupture, &c. &c.
"The more than ordinary frequency of diseases of the heart and its great vessels, and of the whole pulmonary organs, in miners, I am, from long observation, convinced, may be fairly attributed to their occupation; but not so much to their actual labour, or to the impure air in which they sometimes work, as to the hasty and imprudent manner in which they too often climb the ladders in ascending from the mines. On these occasions so distressed are they who have been so inconsiderate, on reaching the surface, from the inordinate action of the heart, and consequent hurried and crowded circulation of blood through the lungs, as to be unable for some minutes to speak. It is very true they are not necessarily compelled to ascend so rapidly; but still, such is the force of emulation, as I have learnt from frequent conversations with captains of mines, and the men Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/329 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/330 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/331 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/332 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/333 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/334 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/335 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/336 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/337 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/338 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/339 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/340 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/341 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/342 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/343 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/344 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/345 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/346 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/347 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/348 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/349 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/350 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/351 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/352 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/353 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/354 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/355 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/356 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/357 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/358 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/359 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/360 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/361 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/362 Page:Transactions of the Provincial Medical and Surgical Association, volume 4.djvu/363
- A vulnere.
- In column two, are included general dropsy or anasarca 26; ascites, 4; hydro thorax, 3. In column three, the distinction is only made during the last live years, during which the total cases are 54, viz. anasarca, 36; ascites, 18.
- No doubt the greater number of the cases included in column one, were not the proper diabetes, D. mellitus.
- In column two, the cases were the following:—cancer of the uterus, 1; mamma, 4; eye, 1; lip, 1; cardia, 1; pylorus, 4.
- Of these, in column two, the distribution was—acute, 11; chronic, 43.
- This disease is thus subdivided in the reports, whence the third column is constructed:—dyspepsia primary, 74; secondary dyspepsia, or biliary disorder, 119; abdominal inflammation consecutive, 35; total, 228.—This title in column one, includes cardialgia and worm fever.
- Tænia, 5; ascarides, 2; lumbricus, 9.
- In 1797 there were 16 cases; in 1802, 16; in 1803, 17.
- 1801 was clear.
- In 1811 there were 6 cases; 1812, 15.
- Pryce's Mineralogia Cornubiensis.—Polwhele's History of Cornwall.
- The relative proportion to other diseases, as deduced from the Dispensary Reports, is 1 in 164; whereas, in Plymouth it was 1 in 62; and in London, according to Willan and Bateman's Reports, 1 in 76.
- The proportion at Penzance is about 1 in 15; at Plymouth, 1 in 103; at London, 1 in 4.5.
- A streamer is a surface-miner, who searches for tin ore in the alluvial soil in the vallies, and on the banks and in the channels of the numerous stream; of the district. His employment necessarily exposes him to much wet.
- The relative mortality from consumption, at Carlisle, is 1 in 7.5; at London, 1 in 4.2; at Plymouth, 1 in 4.1; mean of the three, 1 in 5.3.
- Cyclopedia of Pract. Med., vol. II. p. 90.
- Med. Chir. Trans. vol. 10; Philos. Trans. 1829-30.
- The etiology of this disease seems strikingly modified by climate and national character. I was recently informed by a very intelligent medical friend, who had spent many years in Mexico, that hysteria is totally unknown among the better classes of females in that country, though their mode of life is such as would seem calculated to induce it. The Mexican ladies live almost entirely within doors, and eat enormously.
- Treatise on Diet, 4th Ed. p. 159.