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THE EPIDEMIC IN DUBLIN. The following is an abstract of a communication to the Epidemiological Society by Dr. Mapother, medical officer of health for Dublin, giving complete details of the epidemic which, it will be seen, are on the whole of a character to re- assure the public mind:— The author first detailed the history of the outbreak from March 18, 1866, to the present date, and stated that 63 cases had been recorded in the Dublin district, and about 13 over the rest of Ireland, as it had appeared in Tullamore, Birr, Mitchelstown, Rathcoole, and Clondalkin. The topography of the disease was illustrated by maps. In Dublin the greatest mortality, namely, 15, had occurred in April. In Chelsea the disease had destroyed one life, As "febris scorbutica4 the malady had probably been known for centuries. If it be determined that the disease be essentially a lesion of the vaso-motor and cerebro-spinal systems, Dr. Mapother suggested the term "neuro-purpuric fever." He described two types, the more grave being a lesion of the vaso-motor system, the milder being scarcely different from sporadic cerebro-spinal arachnitis. The first was indicated by chillness, vomit- ing (owing to stimulation of the vagus nerve), con- stipation but in one case melsena had been seen by him, and especially purple blotches of dissolved hsematin in and under the skin, averaging in size that of a pea. Thermometric observations had shown that the heat of surface differed slightly from that of health. He detailed One case in which a healthy woman, aged fifty- nine, had sunk in twenty hours. Prostration and extensive appearance of blotches, with some stupor, were early perceived. In this case there was the dietetic peculiarity that she would never eat vege- tables. In these sudden cases congestion of the cere- bro-spinal membranes and lungs with tarry blood was the only post-mortem condition. To illustrate the second form of the disease, a case from the report of the surgeon of the 52nd Regiment was quoted, in which the symptoms and morbid appearances were those of inflammation of the cerebro-spinal membranes. Death occurred on the fifteenth day. Violent cerebro-spinal pain, increased sensitiveness and tetanoid contrac- tions, in some instances greater than that of tetanus, had characterised other cases. Paralysis, defective nutrition, and low inflammation in the eye tunics had been frequent during recovery. In such cases the cerebro-spinal membranes had shown every trace of inflammatory action. The most rapidly fatal case of the first form had destroyed life in 4i hours from perfect health but in 41 cases the average duration was 42 hours. The mortality had exceeded 50 per cent. Of 41 cases, 6, 6, 6 and 8 had occurred in the quinquennial periods from 5 to 20, which proneness the dominant action of the sympathetic and the abun- dance of fibrin from the removal of temporary organs would explain. Twenty-one of the deaths were in females, 20 in males. No rank of life was exempt, and the only cases in which contagiousness could be believed in were two in which the sanitary circum- stances were of the worst kind. The promoting causes of purple fever and cholera are similar, for all the towns in which the former had appeared had suffered last year from cholera. If the morbid poison of purple fever was that of typhus, the lesser contagiousness would be due to the rapid death, for it is during the eliminative stages that the latter most readily spread. Mental anxiety, such as wakefulness. that among the troops who pursued the Fenian rebels, the regrets of recruits, and the anxiety of soldiers in the American war appeared to have been exciting causes. The unparalleled coldness and prevailing east wind of March, April, and May promoted the disease. Fever had been notably less, but measles was most prevalent and fata1. For the past eighteen months" purples" had been most fatal to pigs, and Dr. Mapother detailed many of the phenomena of the epidemic to show its analogy to the human malady. It had been prevalent in 1846, when the former attack of cerebro-spinal disease was present. Having alluded to other zymotic diseases now rife among cattle, he expressed regret that there were no facilities for the study of epizootics. Previous epidemics of cerebro-spinal a,rachni1is were then con- trasted those in 1839 in French garrisons, in the Dublin Workhouse in 1846, and in Dantzic in 1865, being shown to be purely cerebro-spinal,' whereas the outbreaks in the United States were, just as in the present Irish disease, of two forms, malignant pur- puric and cerebro-spinal. With regard to the nature of the disease Dr. Mapother urged that all the pheno- mena of the rapid blood poisoning form might be ex- plianed by depression or arrest of the vaso-motor nerves which especially abound in and under the arach- noid, and superior activity of this system in children might explain their great proclivity. That want of vegetable food, the cause of scurvy, may be a main promoting cause of this disease would appear from its occurrence during the potato famine, and now, when that most antiscorbutic food was so high-priced that the poor fed on bread and Indian meal principally. Purpura and scurvy were more frequent now than for many years. The spring and early summer months were the prevailing periods of the present and former epidemics, and then the potato was scarce and bad. The rich were occasionally victims to the disease, but among them the habit of abstaining from fresh vege- tables was not infrequent. Typhus implanted upon a scrobutic person would kill at once, and Dr. Mapother thought that the appearance of purple blotches in the present and not in the epidemics of meningitis in other countries may be due to dietetic peculiarities. To aid recovery vaso-motor stimulants, such as ergot, belladonna, or cantharides, were worth trial, as were also stimulants and digestible nutrients like solution of beef in dilute hydrochloric acid. Although he re- garded the disease as slightly, if at all, communicable, he had directed disinfection and isolation, but if the dietetic point he had touched on were proven by his further investigations the disease would be one of tho most preventible which we encounter.





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