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patient either becomes comatose and dies, or passes into a state of stupor which
may last for days, or even for weeks. In its essential nature the disease is a
rapidly progressing inflammation of the brain and spinal cord, more particularly
of the latter. Spontaneous (or as it is called, idiopathic) inflammation of the
spinal cord is a disease so rare as to be almost unknown. When it is produced
by injury or other accidental causes, it is accompanied with symptoms resembling
those of the epidemic disease, but not so violent.
As regards the local and personal conditions which lead to its prevalence, it
resembles diphtheria much more than any other of the so-called zymotic
diseases. It shews no preference for the over-crowded courts and alleys of
populous towns, but is as often met with in remote villages and lone farm houses.
It has very little tendency to spread by personal intercourse, in consequence of
which the area of its prevalence is usually restricted within narrow limits.
As the disease has already appeared in America, and in every continental
country excepting Russia, it may probably come to England sooner or later.
If it were to appear, the only effectual preventive would be to circulate
the most complete information as to the symptoms by which it may be recognized
at its commencement. For although it is entirely incapable of being
successfully treated in its later stages, there seems good reason for believing
that during the first few hours its progress may be arrested, and that if
the doctor is called in time, life may be saved. In the recent epidemic, children
died by hundreds during the first few weeks, because the disease was not
recognized. Afterwards when it became more familiar, the peasants learnt to
put in practice the necessary remedies, even before medical advice could be
obtained.
That any epidemic disease, and especially typhus fever, should be more fatal
in St. Petersburg than in London can scarcely be matter of surprise to us.
Indeed, if it were otherwise, we should be compelled to admit that the fundamental
notions on which our efforts for sanitary improvement are founded, are
erroneous, and that the sacrifices we have made to render our capital the most
healthy of modern towns, have been useless. In St. Petersburg it seems as if
art and nature had combined to render the place unhealthy. It is situated on a
marsh, and at all times subject to those diseases which are called malarious.
Two hundred years ago London was in a similar condition, but now by the extension
of agriculture, the intermittent fevers, which were so destructive in the days
of the Stuarts, have dwindled into the agues and quotidian neuralgias of our
time. But pernicious intermittents are not the only evils which St. Petersburg
owes to its situation. To drain a town built on a swamp would be exceedingly
difficult, and in fact the Russian capital is without sewers; the foulness of the
town is collected in iron tubs, and conveyed away on trucks, which discharge
their contents into the Neva at a point higher up the stream than the town itself.
To this it is to be added that the common people drink the water of the river
without filtration, that there is much over-crowding, as well as personal and
domestic uncleanliness, and lastly that the diet of the poor is insufficient in
quantity, and is composed principally of black rye bread and potatoes.
In 1860 the salubrity of London induced certain sanguine persons to hope
that fever had disappeared from the metropolis, and that the diseases of zymotic
origin had lost their virulence. Since that time we have had a succession of
unhealthy years, which have shewn us how much they were mistaken. Wherever
over-crowding has been permitted, or the dwellings of the poor have been
allowed to become foul and dilapidated—wherever drainage has been neglected,
and the poisonous air of the sewers has found its way into the houses—there,
fever has shewn itself to be quite as formidable as it was twenty years ago, when
these evils were much less exceptional than they are now.
The reasons why fever-nests exist in London are not difficult to point out.
The districts from which the wards of the fever hospital have been filled, have
been those in which there has been no systematic house to house visitation of the
streets inhabited by the poor, and where the duties of Inspector are limited to
the investigation of such aggravated nuisances, as may happen to be made the
subject of complaint. It may be stated as a fundamental rule of sanitary
administration that every house let in holdings of single rooms ought to be visited
at least once a year, and those which are most apt to be over-crowded,
more frequently. Day by day I become more and more convinced of the