THE 'LANCET' ON THE EPIDEMIC IN RUSSIA.

Bruce Herald, Volume III, Issue 72, 24 August 1865, Page 5

THE 'LANCET' ON THE EPIDEMIC IN RUSSIA.

Relapsing 1 fever fails to account for the "great mortality occasioned by the Russian epidemic. As a rule, only one person dies from relapsing- fever of every 40 attacked, whereas the Russian epidemic is said to have numbered its victims by hundreds daily, and 40 physicians were reported to have died of it, although in the latest accounts this number has dwindled down to ' four or five.' There is every reason to believe that this mortality has for the most part been due to typhus. Almost every epidemic of relapsing fever has been abcompanied by an epidemic of typhus. Now typhus is at^ all times a formidable and a most fatal disease. Its rate of mor_ tality in this country is usually nearly 20 per cent., and, in unfavorable circumstances, this rate may be greatly surpassed. Of the French troops in the Crimea, one half of those attacked with typihus died ; among the Russians, even this rate of mortality was exceeded. During the siege of Dantzic, in 1813, it is stated that typhus carried off two-thirds of the garrison and one-fourth of the population — numbers which indicate a frightful rate of mortality, as it is not probable that every individual was attacked. Of 25,000 French troops who escaped the disasters of the campaign in 1813, and who were afterwards besieged in Torgau, 13,448, or more than one-half, perished from typhus within the space of four months. Of the 60,00 troops composing- the garrison of Mayence in 1 813-14 there died of typhus 25,000. In the year 1847 it was calculated that no fewer than 500 medical men in Ireland, or about onefifth of the total number, suffered from typhus, and 127 of those attacked died. It is needless to describe here the characters of a disease so well known in this country as typhus. Suffice it to say, that it is clear from the information already in our possession, that this is one of the diseases composing; the Russian epidemic, and the facts now mentioned show that an epidemic of typhus is amply sufficient to account for the present mortality among the Russian poor. In a mixed epidemic of typhus and relapsing fever, the aggrev gate mortality will of course vary with the proportion of typhus. If then, as seems more than probable, the. Russian epidemic is composed of typhus and relapsing fever, it is the precise counterpart of that which devastated Ireland and Britain in 1847, after the failure of the potatoe crop, and which, about the same time and under like circumstances, committed equal havoc in Upper Silesia. But what are we to make of the 'carbuncles and pestilential buboes ' which are usually thought to be pathognomonic of Oriental plague ? It is, perhaps, less generally known than it ought to be, that carbuncles and buboes are not a very uncommon, th.jugh a very formidable complication of typhus fever such as we meet with in this country. We find on enquiry that upwards of 150 cases of typhus thus complicated have been observed at the London Fever Hospital during the last three years. There can be little doubt, in fact, that inflammatory swellings beneath the skin constitute the connecting link between the plague of former days and ordinary typhus, and that typhus is really the plague of modern times. For the present we shall be content by observing that Clot Bey, physician to the Pasha of Egypt, oh visiting the London Fever Hospital some years since, was much struck, with certain cases 1 of typhus complicated with buboes, and declared that in ■Eg'yP* tue y would be regarded as examples of plague. It would be far from surprising if such buboes were unusually common among typhus patients in an overcrowded Russian hospital. The important point, however, for the public to know is, that the poison which gives rise to typhus with buboes in this country is precisely the same as that which causes typhus. without buboes. Wh at determines the development of buboes is the condition of the recipient of the poison, and the » circumstances in which he is placed. Consequently the public have no need to fear that the poison

of typhus imported from St. Petersburg would lead to the development of buboes oftener than the typhns poison which is indigenous, and at present so very widely distributed in our own country. Mention has been made of an epidemic inflamation of the membranes of the brain; and spinal cord in connection wich the Russian epidemic. This malady has been spoken of as prevailing in St. Petersburg, but more .especially in the district of Dantzic, on the Polish frontier of Prussia, and in Brunswick, Hesse, and Hanover. This disease would appear to be the socalled epidemic cerebrospinal meningitis treated of by Dr. Wilks in the present number of the 'Lancet/ and which has been described by different writers as occurring in Ireland, France, India^ Norway, Denmark, Algiers, and America. In the United States of America a very formidable and fatal outbreak of the disease exists at the present time. Mr Radcliffehas directed attention to the resemblances between the epidemic now prevailing on the Vistula and the American epidemic. The latter is as rapid in its course and as deadly as the former, while the evidence of contagion in either is exceedingly slight. But it is certain that many of the descriptions of epidemic of cerebrospinal meningitis refer to typhus with strongly developed cerebro-spinal symptoms. If, therefore, this Prussian meningitis be, as some reports state, ' decidedly infectious/ this is probably its real nature. It is necessary to bear in mind that many years have not elapsed since not only the symptoms, but the post mortem . appearances of ordinary British typhus were ascribed te cerebro-spinal meningitis. Like all epidemics of relapsing ffeverr r that of Russia has supervened durin^ a season of unusual privation and suffering among the poor. In most of the accounts of Irish epidemics of relapsing fever and in that of the Silesian epidemic it is stated the inhabitants were not only starving but that they subsisted on unwholesome articles of diet, such as the roots of trees grass, fungi, &c. Hence relapsing feveris in this country often designated ' famine fever/ and in Germany ' hungerpest.' The Russian poor, we are told, have been reduced to the necessity of eating bread containing a large quantity of horned rye. But the result of famine has usually been that the poor have flocked from the country districts to swell the pauper population of large towns, which become more crowded the longer the famine lasts. As this crowding increases the fever which rtsults from crowding (typhus) is gradually superadded to thatwhich is more immediately the result of destitution (relapsing fever). The same thing has occurred in Russia. • The chief cause of this disease," says Dr. Tilner, 'is supposed to be the arrival in, St. Petersburg of an immense number "of workmen from the neighboring provinces, and even from the more distant towns. It is said there are just now in the capital 43,000. workmen more than the usual number. The consequence is that they cannot work, and are obliged to live in unhealthy localities. In this country, both typhus and relapsing fever are diseases of the poor, except medical men and clergymen, whose avocations bring them into close contact wich infected persons. The accounts of the Russian epidemic state that the diseasecomposing it are also 'exclusively confined to the poorer classes/ From these considerations we are led to conclude that the public need be under little apprehension, as to the importation of the Russian epidemic into England. The more formidable cf the t--vo diseases composing it is here already. During the last, three years typhus fever has been prevailing amonothe poor of London, to an extent rarely if ever before known. It is surprising that while pur government so readily institutes inquiries into- the epidemics of our provincial towns, and even into those of Russia and Germany, comparatively little has hitherto been done by our municipal authorities and medical officers of health towards investigating , or. arresting the epidemic which is at our doors. The lesson to be learnt from the 'Russian pestilence' is, not to create a panic by encouraging the . popular fear as to the invasion of these shores by a new disease, but to endeavor to expel an unwelcome; guest, which for years has been spreading far and wide misery and death, but which\ with proper precautions, ought; ncUangac to exist among us-' ■ _ •■'.■-■