Treatment.—Keep the bowels freely but gently opened by taking cascara regularly; if the piles come down they should be returned, and an ointment of galls and opium or an injection of hazeline (one tablespoonful mixed with seven of water) used. Tannin, five grains to the ounce, or sulphate of iron, three to five grains to the ounce, may be used instead of hazeline. Hazeline suppositories are often of great use for internal piles, but ordinary suppositories do not keep well in very hot countries; if they are taken to the tropics they should therefore be specially made and packed. If the piles bleed profusely or cause great pain, an operation will be necessary.
External piles do not bleed, but from time to time they become inflamed and swollen, causing great agony.
Treatment.—The bowels should be kept well opened; the sufferer should lie with his hips raised; hot fomentations should be frequently applied, and the piles should be well greased. Glycerine of belladonna, smeared on a pad of lint, is a valuable application, as is dry calomel powder.
Some sedative, such as Dover’s powder, may be necessary to procure rest and sleep.
Plague.
There are two chief varieties of plague, the bubonic and the pneumonic.
Causes.—Bubonic plague, which is due to a small vegetable organism, the Bacillus pestis, exists primarily as a disease in rats and other rodents, such as the Manchurian marmot and the Californian brown squirrel, and is transmitted from these animals to man by means of the flea. It is the rat flea that is chiefly concerned in the spread of plague. Both the brown and the black rat are affected and, speaking generally, the black rat is the more dangerous, as it lives in closer association with man. It is now known that certain forms of merchandise, especially grain and, to a lesser extent, raw cotton, are more to be dreaded as vehicles of the bubonic plague infection than the infected human being.
The flea does not inoculate the bacillus by its bite. It sucks up blood containing plague bacilli. The latter multiply in the insect to such an extent that they block the entrance of the flea’s stomach and prevent it from feeding. The starved flea makes violent efforts to obtain more blood and, as a result, the contents of its gullet are discharged, together with the plague bacilli, upon the skin of the healthy person on whom it is trying to feed. If there is any little wound in this skin the bacilli gain an entrance and they set up the disease. Infection may also occur from the bacilli-containing excreta of the flea being voided on the skin and rubbed into wounds. When rats become ill or die the fleas leave them and attack man. It should be noted that the rat flea may remain infective for 43 days.
Pneumonic plague, although due to the same bacillus, is quite a different kind of disease, and is transmitted from the sick to the sound by droplets of sputum expelled in coughing, and probably also by the invisible spray which pneumonia patients discharge from the mouth. When the disease is epidemic domestic animals may suffer from it and become sources of infection.