EPIDEMIC CEREBRAL MENINGITIS is a disease which has been noticed and described by many American physicians since the year 1811, when Dr. North specially drew the attention of the profession to it. In 1838-40, it appeared in France, and com mitted great ravages in Versailles, where the mortality was 28 per cent; in Strasburg, where the mortality was 42 per cent; in Lyons, Nancy, and other garrison towns. The patients, in these cases, were almost entirely young conscripts; and the disease was regarded as non'-infectious. In the spring of 1846, it appeared in the Dublin and Belfast workhouses, boys under 12 years of age being the only victims, while girls under similar circumstances escaped; it likewise appeared in the constabulary depot, in the same year, amongst the recruits. In 1863, it was very fatal in the United States. In 1865, it rav aged West Prussia: of 2,000 cases recorded, half died; and of 347 cases, 330 were under 14 years of age. In this epidemic, no mention is made of the purple spots which excited such alarm in Ireland; and in the United States, two forms of the disease are recognized —one marked by shock, weak pulse, purpled limbs, and coma, death happening within the first day; the other presenting signs of cerebro-spinal mischief, such as tetanoid spasms, and death here occurring in three days. Purple spots were present in 27 out of 44 cases.
We now pass to the consideration of the so-called black death, which, during the two years 1866 and 1867, caused such intense alarm in Ireland, and especially in Dublin. The history of this disease is as follows: A healthy medical student, aged 19, residing in Dublin, fell ill with chilliness and malaise about noon on Mar. 18, 1866. When he was visited in the evening, it was found that lie had vomited frequently and was very prostrate; purple blotches appeared on his skin during the night, and about noon next (lay, he suddenly fell into stupor, and was dead at two, or about 26 hours from the apparent commencement of the symptoms. Drs. Stokes and Benson, who, with Mr. Croly, saw the case, at once recognized it as presenting a novel type of disease. A girl, aged 18, presented similar symptoms on April 2, but recovered. Fatal cases were recorded on May 12, 13, and 17. According to Dr. Mapother—from whose excellent report "On the malignant purple fever epidemic in Ireland," read before the epidemio logical society in July, 1867, the materials of this article are almost entirely drawn—it appears that 63 fatal cases had been registered (up to July) in the Dublin district, exclu sive of eight deaths amongst soldiers. This able physician gives the following descrip
tion of the symptoms, which include two types of very different severity, and in this respect lie agrees with the American observers. In the graver, life is rapidly extin guished as if by a blood-poison; in the milder, the symptoms are those of inflammation of the cerebro-spinal axis, or its membranes. Dr. Stokes, however, regards these latter phenomena as secondary to the essential disease, and believes that they will always appear, if the patient lives long enough for their development. The earliest symptoms are chilliness and a sense of impending danger, and vomiting of a persistent character soon follows, There is constipation till shortly before death, when the evacuations are involuntarily discharged. The tongue is dry; the pulse abnormally compressible, and usually over 100. The dark purple blotches, caused by the escape of dissolved hematine (coloring matter of the blood) from the smaller vessels, are situated in and under the true skin of the legs, hands, face, back, and neck. These patches vary in size from that of a pin's head to that of a walnut, and are often sufficiently raised to be detected by the touch. The skin is dusky and moist, sometimes even bathed in sweat. In some cases, stupor, and in others, delirium and intense restlessness, are the forerunners of death. The rapidity with which this disease runs its course is appalling. A healthy boy, aged 10+ years, sank in less than 5 hours from the time of his seizure; and of 41 investi gated fatal cases, 14 terminated within 24 hours. Of these cases, 21 were females, and 20 males. Youth predisposes very strongly to the disease. No position in life affords exemption ; one young nobleman, three medical students, two undergraduates, and sev eral inhabitants of the lowest hovels—the seats of typhus and cholera—were amongst the victims.
With regard to treatment, almost every kind has been tried, and each has been found equally unavailing. The external application of cold to the spine and head, as advo cated in various forms of disease by Dr. Chapman, deserves a trial. Dr. Mapother sug gests that the disease is due, like scurvy, to the want of fresh vegetables as an article food; and if this view is correct, it is satisfactory to feel that if this terrible malady is incurable, it is at all events preventable. A few cases of this disease have been recorded as occurring quite recently in various parts of England. They would probably have passed unnoticed but for the Dublin epidemic.