The British Medical Journal
BMJ (Clinical Research Edition)
Members of Branches are requested to pay the same to their respective Secretaries. Members of the Association not belonging to Branches, are requested to forward their remittances to Mr. FRANCIS FOWKE, General Secretary, i6i, Strand, London. Post Office Orders should be made payable at the West Central District Office, High Holborn. Tlyc #3ritizl ¢Jtebiga1 3journal+ SATURDAY, MAY 8TH, I880. DIPHTHERIA IN SOUTHERN RUSSIA. UNDER the above heading, there appeared a few days ago in the Timzes a
... er from the correspondent of that paper at Odessa, which certainly must have attracted the attention of all their medical readers. For some years past, we have seen in English, French, and German medical and lay papers, occasional short notices of the ravages which diphtheria made amongst the population of Southern Russia, but their want of authenticity caused them to be placed more or less in the class of sensational news, which is eagerly collected concerning the inner state of Russia. Moreover, other apparently more urgent political news, such as the Russo-Turkish war; the development of Nihilism, its outrages; the appearance of the plague at Wetlianka, the measures taken to stuppress this imminent danger, their discussion, and many other things, for a time so completely diverted attention, that a recent telegram, stating that in one single department of that Empire no fewer than twelve thousand children had succumbed during the last few years to diphtheria, was again met with some incredulity. Unfortunately, however, it appears that all these reports were only too well founded, if the statistics of the Timtes correspondent are to be trusted. These, even according to his own statement, by no means represent the true extent of the evil. It is easy to see that, if'the number of qualified medical men in that part of the country be so exceedingly small as represented in his letter, it will be an utter impossibility for them, not only to watch the progress of the disease in every individual case, but simply to keep reports of the numbers and results of all the cases under their care; and that most likely a very considerable proportion of cases exist in which during the whole progress of the disease no medical man is called in at all, and which never come to the knowledge of the authorities. But, even if we omit all speculations on this subject, it is evident that an epidemic of so great extent and malignancy as are described in the Times letter is a very serious national disaster. At present, there are not fewer than fifteen districts or provinces infected with diphtheria, which, in accordance with most of the other recent experiences, instead of abating, increases during its progress in malignancy up to a mortality of as much as 73 per cent. in some places. There are two points in the letter which seem to call for some comment, viz.: (I) the etiological statistics; and (2) the measures which have been at last adopted in order to eradicate the evil. Whilst giving accurate details in the former respect, the writer does not mention anything about the proportion of pharyngeal and laryngeal diphtheria, nor regarding the results of tracheotomy in the latter subdivision. Possibly this may be accounted for by the fact that the letter, which is intended for the instruction of the public, is evidently written more from the point of view of a social economist and a statesman than from that of a medical man. With respect to the etiological statistics, we may say at once that the tremendous number of cases which form their material should render them a valuable addition to our knowledge; in matters of fact, however, they bring very little, if anything, new. That children before the age of ten years aremoreliable, and succumb much more readily to the disease than adults, we all know; that, as a rule, if only for a time, the intensity and malignancy of the disease increases with its progress is an experience which has been made in Vienna, New York, Paris, and many other capitals in which diphtheria is more or less endemic; and that even the mortality up to the present is not extremely high in comparison with other epidemics-e.g., the Florentine, in 1872 and 1873, in which more than 50 per cent. died-is shown by the statement that the percentage of death in the Russian epidemics in 1876 was 36, and in I877 about 40,though certainly the increase in the rate of mortality is alarming. As to the influence of the seasons, it is stated that, in one district, that of Meergorod, in which the development of the disease has been studied with greatest attention, it has been observed that, whilst in the months of June in the three consecutive years of 1876, 1877, and 1878, the number of sick greatly increased, and went on increasing till the following October or November, at the same time the lowest rate of mortality invariably occurred in June, August, and September, in which months no more than a third of the stricken died, whilst in the first and last months of the year nearly one-half of all who were attacked died. This is certainly a curious fact, which, if we may for a moment indulge in theoretical speculations, would seem to point out that the driest months of the year favour most the development of the diphtheritic poison, whilst the coldest and wettest ones promulgate its virulence. But it must be confessed that at least the latter part of this speculation is a rather idle one; for the mere fact of the further development of the poison might go hand in hand with the development of greater virulence. At the same time, the reports of the most careful observers on former epidemics as to the influence of seasons are so'widely discrepant from each other, and there are so many well observed facts proving that in many severe epidemics the disease raged steadiPy throughout the year in spite of changes of weather and temperature, that we still must believe in the comparative independence of the affection from such influences.