The Sun.
London, England, 1865-04-14 00:00:00

The Russian Pestilence—lts Interpretation
and Teachings.

•
(From the Lancet.)
For the last fortnight the public mind has been per-
plexed and agitated by a subject of all-absorbing interest.
The bloody battles in America, the fortifications of Canada,
European politics, and the forthcoming budget have for the
time been almost consigned to oblivion by the grim monster
of the "Russian pestilence." Right rev. prelates, Lords and
Commons, have demanded information from Government,
which had little to give; and the excitement in the British
Houses of Parliament has fairly represented that existing
amongst all classes of the community throughout the length
and breadth of the land. Contradictory telegrams have only
served to increase the confusion and alarm. According to
some accounts the " Russian pestilence " was Asiatic
cholera; according to others, Oriental plague, "with car-
buncles and pestilential buboes ;" according to others,
epidemical inflammation of the spleen, or pustula maligna ;
and, according to others, " black death." But the general
impression was that a new disease —" the Siberian plague,"
more malignant and fatal than any fatal malady hitherto
known—had appeared in the world ; and that, taking its
origin in the Ural mountains, it was slowly but surely
working its way westward, so that in due course of time it
might certainly be expected to arrive on our own shores.
Two medical officers have been despatched by Government
to see what could be done to stop it on its march ; and in-
structions been issued by the Lords of the Privy Council
to the commissioners of customs to be on the alert to ward
off the expected invasion.
A letter from Dr. Murchison, published in the Times of
April 7, has tended greatly to dissipate the public alarm.
If, says that gentleman, the details furnished by foreign
physicians are to be relied on, it is not a new pest which
has invaded the world, nor has the disease any relation
whatever to Asiatic cholera ; but the epidemic is composed
of two diseases already well known in this country, viz.,
relapsing fever and typhus.
Relapsing or recurrent fever—the " fievre k rechute " of
French writers—under different designations, has been well
known in Britain and Ireland for nearly two centuries. It
constituted a great part of the Irish epidemic of 1847; and,
about the same time, it was very prevalent in Upper Silesia,
and in other parts of Germany. One peculiarity of relaps-
ing fever is that it prevails in great epidemics, and then
entirely disappears for years. In 1851 more cases of
relapsing fever were admitted into the London Fever Hos-
pital than of any other fever; but for upwards of ten years
not one case has been observed. The intervals between
some of the epidemics have been sufficiently long for a new
generation of medical men to spring up having no experi-
ence of the disease, and who, on the occurrence of a fresh
outbreak, have imagined that they were encountering anew
malady. So it was in Scotland in 1843, and so it is now in
the case of the Russian epidemic. As many of our readers
may never have seen a case of relapsing fever,we transcribe
the following condensed description of it from Dr. Murchi-
son's work on the " Continued Fevers of Great Britain :"
"A contagious disease, which is chiefly met with in the
form of an epidemic during seasons of scarcity and famine.
Its symptoms are—a very abrupt invasion, marked by rigors
or chillness ; quick, full, and often bounding pulse ; white
moist tongue, sometimes becoming dry and brown ; tender-
ness at the epigastrium ; vomiting, and often jaundice;
enlarged liver and spleen; constipation ; skin very hot and
dry ; no characteristic eruption ; high-coloured urine ;
severe headache, and pains in the back and limbs ; restless-
ness, and occasionally acute delirium ; an abrupt cessation
of all these symptoms, with free perspiration, about the
fifth or seventh day. After a complete apyretic interval
(during which the patient may get up and walk about), an
abrttpt relapse on the 14th dayfrom the first commencement,
running a similar course to the first attack, and terminating
on or about the third day of the relapse ; sometimes a
second or even a fifth relapse ; mortality small, but occa-
sionally
.death from sudden syncope, or from suppression of
urine and coma; after death no specific lesion, but usually
enlargement of the liver and spleen."
On comparing this description with that of the Russian
epidemic by Dr. Tillner, physician to the Grand Duchess
Maria of Russia, no doubt can remain as to the identity of
the diseases to which they refer.

Relapsing fever, however, 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 at-
tacked, whereas the Russian epidemic is said to have num-
bered its victims by hundreds daily, and 40 physicians were
reported to have died from 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 accompanied by an epidemic of
typhus. Now, typhus is at all times a most formidable and
a most fatal disease. Its rate of mortality in this country
is usually nearly 20 per cent., and, in unfavourable circum-
stances, this rate may be greatly surpassed. Of the French
troops in the Crimea, one half of those attacked with
typhus died ; amongst the Russians even this rate of mor-

tality was exceeded. During the siege of Dantzic in 1813,
it is stated that typhus carried off two-thirds of the garri-
son and one-fourth of the population—numbers which in-
dicate 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 of 1813, and who
were afterwards besieged in Torgau, 13,448, or more than
one-half, perished from typhus within the space of four
mouths. Of the 60,000 troops composing the garrison of
Mayence in 1813-14, there died of typhus 25,000. In the
year 1847, it was calculated that no fewer than 500 medical
men in Ireland, or about one-fifth of the total number, suf-
fered from typhus, and that 127 of those attacked died. It
is needless to describe here the character 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 posses-
sion that this is one of the diseases composing the Russian
epidemic, and the facts now mentioned show that an epide-
mic of typhus is amply sufficient to account for the present
mortality amongst the Russian poor. In a mixed epidemic
of typhus and relapsing fever, the aggregate mortality will
of course vary with the proportion of typhus.
If, then, as seems more than probable, the Russian epi-
demic 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 potato 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 a not very uncommon, though a
very formidable, complication of typhus fever such as we
meet with in this country. We find on inquiry that up-
wards 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 inflam-
matory swellings beneath the skin constitute the connect-
ing 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 with observing
that Clot Bey, physician to the Pasha of Egypt, on visiting
the London Fever Hospital some years since, was much
struck with certain cases of typhus complicated with bu-
boes, and declared that in Egypt they would be regarded
as examples of the plague. It would be far from surprising
if such buboes were unusually common among typhus pa-
tients 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. What determines the development of buboes is
the condition of the recipient of the poison and the circum-
stances 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 typhus poison which is indigenous
and at present so very widely distributed in our own
country.

But, after all, the frequency of carbuncles and buboes in
the Russian epidemic has probably been greatly exagge-
rated. This is apparent from the last accounts transmitted
by her Majesty's Ambassador at St. Petersburg, which, by
the way, tend to confirm in a remarkable manner the view
now taken of this epidemic, and to show that it is already
on the decrease. We extract the following from an official
despatch published on April 10 :

"Another physician has confirmed my previous reports
on the fever here. Dilated pupils are a symptom of re-
current fever, but typhus is the more general disease. I
believe there have been no cases with carbuncles or buboes.
The disease is decreasing, and there are vacant beds in the
hospitals."

We must not omit to state that mention has been made
of an epidemic inflammation of the membranes of the brain
and spinal cord in connection with the Russian epidemic.
This malady has been spoken of as prevailing in St. Peters-
burg, 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 so-called
epidemic cerebro-spinal meningitis, 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.
Radcliffe has directed attention to the resemblance between
the epidemic now prevailing on the Vistula and the Ameri-
can 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 epidemics of cerebro-spinal 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 appearance of ordinary British typhus
were ascribed to " cerebro-spinal meningitis."

Like all epidemics of relapsing fever, that of Russia has
supervened during a season of universal privation and suf-
fering amongst the poor. In most of the accounts of Irish
epidemics of relapsing fever, and in that of the Silesian
epidemic, it is stated that the inhabitants wore not only
starving, but that they subsisted on unwhol3some articles
of diet, such as the roots of trees, grass, fungi, &c. Hence
relapsing fever is in this country often designated "famine
fever," and in Germany "hunger-pest." The Russian
poor, we axe told, have been reduced to the necessity of