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the colon, which extends over toward the right side to the cecum. The rectum is large and spacious, and the transverse colon is below the umbilicus. The arrows in both cuts show outline of the sigmoid flexure. Treatment.

Patient was put in bed, placed temporarily on a diet of milk and broths. Rectal enemata of two quarts of warm plain water were given once a day to empty the lower bowel and relieve it of its weight. An abdominal belt, just a plain strip of heavy muslin 10 inches wide, was applied around the lower abdomen to support the abdominal organs and aid in increasing intraabdominal pressure. The lower border of the belt extended down to the symphysis pubes and passed around the pelvis down to the great trochanters of the femurs. The object is to apply the pressure and support from below upwards and in this way to prevent, if possible, a recurrence of the twist or falling of the sigmoid colon,

and by keeping the lower bowel empty lessen the weight of this organ.

His diet was increased, as there was no contra-indication to a full diet. For the circulatory condition he was given two fluid drachms of the infusion of digitalis three times a day, and strychnin sulphat. gr. 1/30 as a tonic three times a day. He remained in the hospital only ten days, gaining markedly in strength. Later he visited my office once a week for several weeks. Then I saw him at intervals of two or three months. The last time he consulted me was in February, 1913. After leaving the hospital he took the enemata only once every three or four days. He had gained in strength and was able to do light farm work, going to market, driving, doing light chores, etc., and has not had any trouble since. In July of 1914 I passed through, in my machine, the country where his farm is located and happened to meet him. He continued in good health and free from attacks.

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Bubonic Plague in New Orleans, 1914-15.

By GEO. H. TICHENOR, JR., A.B., M.D., 4007 Magnolia St.,

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In justice to all parties concerned, it should be known that New Orleans is the only city in the State which employs a whole-time health officer; the total amount available for the work of the city is an appropriation of $56,683.13, additional revenue, $45,664.24; total, $102,347.37. (Report 1913.)

There is no sanitary protection, nor sanitary progress in Louisiana at large; therefore, the State was not prepared to fight the plague. In 46 per cent. of the 195 incorporated communities no systematic work is done, no accurate records are kept, and no reports made to the State Department. Only 38 have sanitary inspection.

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vaded every precinct, will prove ineffective so long as garbage remains uncovered, stables, granaries, warehouses, markets, etc., remain unratproofed. It would need the great fire of London to clean up some of the rookeries; sixteen miles of wooden wharfage serves as a harbor for these pests, hence advantage should be taken of the high stage of the river to institute a vigorous campaign when the waters force them inland. * Rats must be starved into submission before they can be induced to enter traps and eat poisoned bait, so it is a question of educating the public. * * * I fear it will require, in the future as in the past, an epidemic visitation to arouse the people to their duty in the premises.

"San Francisco expended millions of State and Federal money, and still the bacillus pestis lingers in the ground squirrels of the rural districts.

In order to meet the demands of the

times, the Louisiana State Legislature enacted a law authorizing the Governor to raise $150,000, as the State contribution to this fight. this fight. But the State is not unwilling, the Governor is quoted as saying, to do her full share, as has been demonstrated by his contributing $10,000.

"Whether funds will be secured depends upon conditions, and those are that the State is not going to contribute money to create any new jobs or keep political henchmen employed."Daily States, August 22, 1914.

Public Opposition.

Dr. Rucker, or his Federal associates, did the employing, as the State and city subordinated their authority to these gentlemen.

This seems to have been the first visible evidence of the shaking of the foundation of the people's faith in the United States Public Health Service.

In commenting, the Pan-American Journal states:

"The immediate effect of this form of 'policy' is to create the impression in the minds of our sister States that we are trifling, by the injection of politics, with a situation which affects them vitally as it does ourselves."

This policy, together with the very few cases of plague, the general filthy condition of the city, and the prompt disappearance of the plague in human subjects, when no large appropriation was forthcoming, are the causes which I consider leading to the organization of the Citizen's and Taxpayers' Association, which opposed what it considered unnecessarily stringent regula

tions.

notices, which would cause continual reThe stringent and probably indefinite. pairs, sent to property holders, and disregard to city filth, probably caused the re

marks of its attorney, Mr. H. P. Dart, Sr.: "New Orleans is circled by huge dump piles of trash and filth, an admitted breeding place for rats. If otherwise innocent and inoffensive citizens of this city are sent to jail for failure, through financial inability or other good reasons, to comply with the stringent ratproofing regulations, then the city administration is just as culpable and should be jailed for their failure to keep the municipal house clean."

The death of thirty people, who are supposed to have died of bubonic plague, eighteen males and twelve females, seems to have made little impression on the local public, as well as the felicitations at the banquet of the United States Public Health and city officials on cleaning up the city, if we accept newspapers as an authority on the subject: "Of course, no one can fail to see how much cleaner the city is now." The Author's Views.

I have attempted, so far, my dear reader, to be impartial and give you both sides of this question, and will now give you the author's views. Remember, that it has not been many "moons" passed that we observed in New Orleans the ridiculous situation of the United States Public Health Service insisting that the "Belgian Girl" had trachoma, and local physicians of repute denying same with equal unanimity of opinion.

Continual observations up to the present in regard to the extensive dumping grounds in the heart of the city, where refuse of all descriptions are hauled during the day and piled in great heaps, while negroes, buzzards and beggars regale themselves in looking for desire's treasures, lends a brilliant scene of contrast to the stupidity of the numerous rat-proof dwellings of workingmen closely surrounding this beautiful spot. It is doubtful that the beggar of Bagdad ever viewed such filth. or subjected himself to such criminal insanitary surroundings. I am told (by irresponsible persons) that the refuse is burned at night. If it is, it has made the same impression on appearances as Simple Simon made when he bailed out the ocean with a teaspoon. I suppose I should not visit such forbidden places so frequently and adapt the Golden Rule of Confucius: "I see no evil, hear no evil, and speak no evil." "Stop knocking and boost the town." So I must pass on to dwellings most pleasantly located with cement business floors and sleeping apartments a few feet above the marshy ground, always below the zone of excessive moisture (my experiments showed same to be from 10 to 12 feet from

surface level), where I find consumption, rheumatism, catarrh, etc., always la grippe, as frequent as unpaid bills and invalidism. Is this a casual observation? Can you prove same by applying the accepted facts. of modern sanitary science? Yes, even by old theories; in fact, I know of no authority who would advocate such stupidity in regard to dwellings and cement floors for business places. Already I have found a general complaint, on inquiry all over the city, in regard to cement floors.

Authorities.

What do some of accepted authorities say concerning favorable conditions for germ activity, purity of air, foundations. for buildings, soil conditions, and effects of dust and filth?

Burdon Sanderson avers that the influence of environment on bacteria is so great that it seems as if it were paramount ("Lectures on the Relation of Microorganisms to Disease," 1883.) "The air supply desirable may be put there at 32 cubic feet per head per minute, or 28 cubic feet per second for the whole. The evil effects of insufficient ventilation are manifested in diseases of the respiratory organs acute and chronic."-Billings. What chances with cement floors and four walls with insufficient openings?

Legality:-Decision of Mansfield, in the case of Rex vs. White: It is not necessary the smell

be unwholesome. It is enough that if it renders the enjoyment of life unwholesome," often quoted approvingly by jurists. This decision certainly covers the ground regarding the public and private dumps.

Influence of climate in causing disease well known for over two thousand years: "Residence on a damp soil has a tendency to produce diseases of the lungs, especially phthisis. Soil moisture is also an important factor in the development of periodical fevers."-Pepper, "System of, Medicine."

And again: "The influence of the rise and fall of the soil water in typhoid fever upon which so much stress is laid by Pettenkofer and others, no doubt, exists. Level of sub-soil water should be at least 5 feet below the foundations." (Usually my observations here, 3 feet, increased with drainage. Do not forget cement absorbs moisture. Furthermore, our drainage system is not complete). [Some quotations omitted.-ED.]

You perceive, kind reader, that conditions here are not the same as in other places. If New Orleans had been raised by the early colonists, as was Chicago, fifteen feet, some of the accepted regulations might be applicable to this locality, and if filth was buried in order to elevate marshy places, the public would have no objections. Then, again, if the authorities had presented the matter, as in Philadelphia, in the present financial stringency, there probably would have been less antagonism. The text of their circular on rat-proofing was conservative.

Then, too, there seems to be a prevalent notion that other cities have exaggerated and profited by New Orleans' misfortune, which does not appear to me to be the case. The Disease Itself.

All observers at present agree that the plague in some manner is not infrequently transported by rats. It seems probable that the fleas, which are commonly on the rats, aid in spreading the disease. “In a few cases proof has been forthcoming that persons have contracted plague from bites of rats." Progressive Medicine, 1900 series.

The disease is classified among specific diseases, owing to the finding of the bacillus in 1894 by Yersin, etc. Liebermeister classified it as a contagious-miasmic disease. Whilst present views as to the causation of the specific diseases compels us to assume a specific infecting principle as the real cause of every outbreak of the plague, there are certain circumstances which are recognized as so favoring the development and action of that principle that they have come to be looked upon as indirect or auxiliary causes-rather, strictly speaking, predisposing influences.

All observers of recent epidemics unite in ascribing poverty the foremost rank; neglect of sanitary laws; over-crowding and ill-ventilation; personal filthiness, improper or insufficient diet; indifference as to location of dwellings and their surroundings; accumulation of filth in or around houses; imperfectly buried corpses.

Diagnosis.

"The difficulties attending the recognition of the plague at the beginning of an outbreak speedily subside, the rapid spread of the disease, its frightful mortality, the overwhelming intensity of the symptoms, the prompt occurrence of cases characterized by buboes, carbuncles, or petechiæ are collectively considered diagnostic of this disease and no other disease whatever." (Wilson.) However, it has been mistaken for lymphadenitis, syphilitic buboes, parotitis,

etc.

It happened that an old case of syphilis on a steamer from South Africa, at the time the disease was prevalent there, was diagnosed plague at quarantine in this State not so many years ago, to my personal knowledge.

I do not consider this such an unpardonable sin, although disastrous in its results, as concerning its clinical course little is accurately known, and of the complications

still less. The mortality rate being greater than any other epidemic disease, it naturally causes popular commotion. "Dampness, and particularly a thoroughly wet soil, are favorable to the development and spread of the disease." (Pepper.)

The New Orleans 1914-15 epidemic differs from all others in that it has had every advantage accepted by authorities for its spread from the beginning to the end. of human infection, and even at present, considering that rat-proofing has only been partially done, and yet it was wiped out.

Immunity.

Probably you may say every one is immune. No, this is one serum which is not popular. Neither Yersin serum nor any other serum is now used for prevention of plague.

No sufficiently extensive observations have been made upon man immunized against plague by vaccination to determine absolutely the duration of immunity that results from vaccination; it is not practical. Extensive experiments upon rats, by the Indian Plague Commission, have been made. by vaccination and subsequently inoculated with living plague germs.

The Lessons of the Epidemic.

What are, then, the lessons we may learn from this epidemic?

First, the need of specially qualified health officers in every State, not boards of medical politicians. Other States have seen this necessity.

In "Public Health Work as a Career," J. A. Ferrell states that there are already more positions open for trained health officers than can be satisfactorily filled.

Secondly, we must earnestly work for the day when we shall have arrived at that point in science where the chemist can trace with equal facility the chemical action in fermentation, putrefaction, suppuration, infection and contagion, as will the microscopist when he shall have discovered the causative and indispensable minute organisms to all these processes. In other words, we must be able to explain Sternberg's observations with the inoculation of animals with the saliva, proving that even when taken from perfectly healthy men, this may be fatally poisonous to animals.

Then, and only then, will medical jurisprudence be what it should be. That we are progressing along a line at an incommensurable ratio, no scientist doubts.

Finally, if plague is to be prevented

from entering this country, there must be first, a most careful search made for modified cases of plague for some considerable time after the disease has apparently died out in places that have been attacked by it; second, rigid inspection of vessels and passengers coming from infected places, disinfection with sulphur (which had formerly protected this State for years) "Holt System"; third, a sharp lookout kept for increased mortality among rats and extermi

nation of same.

In closing, the reader must remember that New Orleans is blessed with soil im

pregnated with salt from the Gulf, and even its waters sometimes extend up the Mississippi as far as the city, which chemical, we all know, is a purifier; therefore, the generally good health. As even the levee protecting the city has been known to slide into the river, rat-proofing of the extensive wharf will try the skill of the most expert sanitary engineers.

We are going to make the city clean: it's healthy notwithstanding its disadvantages.

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Every now and again a new disease appears under the sun, not only a new ailment in man, but in animals and trees likewise. Dr. O'Gara has just discovered a new fruit plague, which is a ruse due to an entirely new plant parasite. Dr. Strong, of the Harvard Medical School, returned from South America with a new human malady to report. As for animal distempers, there are so many new ones that you cannot keep track of them.

How, then, are such sudden and unpleasant dispensations visited upon the earth? How are these disturbers of the bodily economy evolved?

Parasitic Origin of Disease.

Plainly, most maladies are parasitic. That is to say, ailments are as a rule the outcome of microbic invasion of living tissues. Just as Charles I had his Cromwell, so each infectious disease has its invading parasite. After all, most ailments are the outgrowth of a smaller creature preying upon a larger one.

Parasitic animals are the ones which derive their peace, comfort, food and growth

from others. The nourishing host may be either animals or plants, and the parasites or little mites which live and have their being may be internal or external.

Varying Parasitism.

These may be fixed or be able to move from place to place. There are, of course, various degreees of parasitism, from temporary to permanent abode in the victim.

is temporary; the thyphoid bacillus abides Pneumonia has a parasitic microbe which with its sufferer a litle longer. The parasitic bacterium of tuberculosis belongs to ultra-miscroscopic parasites and a chronic type, and perchance if certain others which cause permanent joint troubles and kidney disorders were discovered, the list would be nearly complete.

Absolutely no animal or plant can forever escape the onslaught by some sort of a parasite. Man has upwards of two hundred parasites, with new ones constantly appearing. The dog, the ox, the frog, the potato, the pear, the chestnut and other living things have from a few to several dozen parasites.

New Parasites.

New diseases, therefore, really depend upon the creation of new parasites. There are two schools of science, the scholastic and the evolutionary. Each explains the origin of new instances of parasitism-that is disease-in a different fashion.

One group maintains that the change is a slow, gradual one. Another holds that these new varieties of germs, molds, microbes, bacteria, and other parasites appear abruptly and unexpectedly.

Professor S. O. Mast, of the Johns Hopkins Zoological Department, has observed that certain so-called hybrids breed a new and different race exactly like themselves.

These new races, if they happen to appear among germs of, say, typhoid fever, appendicitis, tuberculosis, dysentery, or any long-known malady, may in the next victim attacked evolve a new disorder. Thus, either a sudden or a gradual appearance of a new type of small creature, if the latter happens to be parasitic, makes a new dis

ease.

New Hosts and New Diseases.

There are also other ways for new maladies to show themselves on earth. The eggs, embryos or adults of some small animals or microscopic plants may never have been parasitic, but they are accidentally swallowed or wander into the tissues of

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