ULCERS—Stomach ulcers were clinically described many centuries ago by physicians such as the Arab, Avicenna (903-1037). It is doubtless a fact that men have known "the pain in the stomach" that has been attributed to ulcers down through the ages.

Probably few disorders have received such wide publicity as have ulcers. Commonly associated with high-pressure exec­utives, there has been almost a tradition built up about them. They have been the subject of much research and various treatments have been used.

Now, once again, they are in the news. This time with new facts that are somewhat different from the old beliefs. New studies are focusing new attention and bringing new evalua­tion with respect to ulcers.

Recently the U. S. Public Health Service made an exhaus­tive survey and discovered a 400 per cent rise in ulcer attacks during the last 25 years. There are about 2,400,000 ulcer victims in the country, most of whom are between 35 and 50. The combination of their 12 million lost workdays a year and the estimated medical costs, tallies up to about a $500 million cost per year.

It also has been discovered that ulcer sufferers among women and children have increased 350 per cent in the last 20 years.

"Well, they can't all be pressured businessmen!" exclaimed a harried executive. "I don't understand it."

"A lot of women are competing on jobs with men," ex­plained a doctor. "So they have that pressure. A lot of them are married and worry about taking care of their families— meals, the children, and everything a wife and mother has accepted as her responsibility for years. So a woman worries whether or not she's doing the right thing, and that creates pressures. Middle-income and lower-income people can get on a status-seeking merry-go-round trying to keep up with their neighbors. It can all create tensions. In England a study dis­closed that men's ulcer rate, on the lowest social level, that of unskilled laborers, was 116 per cent of the national average. At the other end of the scale—the highest—it was only 48 per cent."

What are stomach ulcers? What causes them?

There are two types of stomach ulcers. The gastric ulcer attacks the inside of the stomach lining. The duodenal ulcer is found in the short tube that immediately follows the stom­ach. In the ulcer areas, part of the covering membrane of inside tissue breaks down and leaves an open sore that may be tiny or three or four inches in diameter.

As yet doctors are not certain what causes them, but they are convinced that excessive quantities of gastric juices con­tribute to their formation and existence. Duodenal ulcer pa­tients, for instance, sometimes secrete as much as four times the gastric juice (into the empty stomach) secreted by the normal person.

Emotional turmoil, say doctors, may cause oyeractivity of the two vagus nerves that control the flow of juices from the gastric glands.

Other circumstances may contribute to the condition, in­cluding poor circulation and improper diets.

Recently, theories about diets for ulcer patients have under­gone a number of changes. English doctors have reported that the habitually prescribed bland diet apparently is not as effective as once believed. Three doctors of Central Middlesex Hospital in London made a year's study of the bland diet and then reported in a British medical journal: "The results indi­cate that dieting with bland foods does not increase the rate of healing of peptic ulcers."

Drs. Seymour J. Gray of Boston, Max A. Schneider of Buffalo, New York, and Vincent DeLuca, Jr. of Derby, Connecticut, studied the problem of spices and ulcer patients and discovered that the old idea that all spices were bad might not be so factual.

They found that black and chili pepper, mustard seed, and cloves did cause varying degrees of distress, but that other spices caused no bad effects and did not affect the healing time of ulcers. Spices in the latter group include allspice, cinnamon, mace, thyme, paprika, sage, and caraway seed.

Most doctors put their ulcer patients on diets, rest, and medications with the advice to "slow down a little." Drugs may be prescribed to restrict an excessive gastric juice flow and to neutralize stomach acids. Tranquilizers also are being used to keep ulcer patients on a more even emotional level.

Only about 10 per cent of ulcer patients must have surgery for their illness. The operations are usually safe and effective. About 99 per cent will recover and about 97 per cent of these will be cured of ulcer symptoms.

Seldom does duodenal ulcer turn into cancer, but from 7 to 10 per cent of the stomach (gastric) ulcers become malig­nant. Usually surgery is suggested for gastric ulcers when it has not responded to medical management and when X-rays reveal no evidence of healing after two or three months.

Bleeding ulcers call for surgery, although a new technique that is almost startling in concept and execution recently has made medical news.

A medical team at the University of Minnesota Medical Center has developed a method that has stopped bleeding in some patients by having the patient swallow a deflated balloon to which is attached a slender plastic tube. When the balloon enters the stomach it is gently blown up. A solution of cold water and alcohol is sent through the tube to circulate in the balloon against the bleeding ulcer. Another tube inserted through the nostrils into the stomach removes blood and in­forms the doctors if the hemorrhage is stopping.

"How do I keep away from ulcers?" an advertising execu­tive asked his doctor during an annual physical checkup.

"Don't store up your frustration and emotions. Show your feelings," said the doctor. "If you can't come to terms with some people or situations—try to side step them as much as you can. Don't try to crowd in ten appointments into a five-appointment hour. Start to take your time about everything— eating and sleeping as well as working. Get more time off from the job. Leave your job in the office when you go home at night. Don't eat foods that disagree with you—and watch your drinking."

STROKES—Not long ago a comparatively young man re­ceived an injection of radiopaque substance into his blood stream.

A new, high-speed X-ray machine was then used to obtain X-ray pictures of the blood vessels in the young man's head. The pictures are called cerebral angiograms.

Pictures were also taken down the neck of blood vessels concerned with supplying blood to the brain. The doctors found a narrowing in one of the arteries.

A few days later surgery was performed to clean the artery of a fatty substance that had almost shut off the supply of blood to the brain.

Thus, with one of the newest medical techniques, the young man was delivered from the possibility of a stroke which had been forecast by severe headaches, frequent dizziness, and visual difficulties.

Strokes, medically known as cerebral vascular accidents or "CVAs", are suffered by 200,000 Americans every year. A substantial number of them are young persons. Until tech­niques such as the one described above were evolved, little could be done for stroke victims, or in preventing strokes. Today the outlook is indeed encouraging.

What is a stroke? How does it happen?

So that the brain can work properly, it must have a good supply of blood. This is supplied by a complex network of arteries and veins. About one-fifth of the body's blood circu­lates through the brain every six seconds.

If anything occurs to significantly reduce or stop the blood flow to any part of the brain, that part will not function properly. This may cause weakness, numbness, loss of sensa­tion or of movement in some part of the body. The decrease or loss of function depends upon the extent of the damage.

A stroke occurs—usually suddenly—when an artery to a portion of the brain ruptures, leading to hemorrhage, or is closed by thrombosis, embolism, spasm, or compression.

Some victims recover from a stroke within a few weeks or months. For others, varying degrees of paralysis of an arm or leg, or some difficulty in speech may persist.

Physical therapy has become one of the most important aids in helping to rehabilitate many stroke sufferers so that they can continue to be employed and live fairly normal lives.

The use of the X-ray, as described above, plus new surgical techniques for cleaning out, repairing, and even restoring blood vessels, plus new, safer, more effective anticoagulants, are making the future much rosier for prospective stroke vic­tims, with the possibility that eventually a study to learn if a stroke may be impending will be part of a routine physical examination. Again, prevention may be the important key word in the campaign to reduce the number of victims who succumb to this disease.

PARKINSON'S DISEASE (paralysis agitans)—This affliction usually known as "shaking palsy" was long thought to be an incurable, hopeless disease. New drugs developed within the last ten years or so have changed much of this. Artane, Par-sidol, Disipal, Pagitane, Kemadarin, and Phenoxene are among drugs that relieve the general weakness and tremor of the patients. There is a tendency for the drugs to lose their effectiveness on a patient with the passing of time, however, and a search is on for new compounds to act as replacements.

About one and a half million persons suffer from the dis­ease, which is characterized by tremor, a stooped posture, rigidity, and a quickened gait. Most sufferers are between 50 and 60 years of age.

The source of trouble is in the basal ganglia of the brain and the brain stem.

Surgery has been very beneficial in selected cases.

YELLOW FEVER—The history of yellow fever and the mosquito is so dramatic that it long has been told in story and pictures. Caused by a virus transmitted by the bite of a mos­quito, yellow fever long plagued peoples living in tropical countries. It is accompanied by jaundice and is very dangerous. The fatality rate may be as high as 85 per cent during an epidemic.

There is an effective vaccination for yellow fever which anyone going into the tropics should have.

PLAGUE ("The Black Death")—The history of plague goes back to antiquity, but it was not until the 6th century that it appeared in Europe. In the 14th century, called "The Black Death," plague spread over European countries with disastrous effect. It killed between two-thirds and three-fourths of the population. Estimates place the death toll from this cycle at 25 million.

London was again visited by the Black Death in 1664-5. Of a population of 460,000, death took 68,596. In 1679, Vienna had 76,000 deaths and in 1681, Prague had 83,000 deaths from the plague.

In 1894, Canton, China lost between 80,000 and 100,000 persons to the killer, but in the following 25 years or so India had the most devastating losses, running into the millions. Calcutta still is reported to be a danger spot.

The plague was first reported in the United States at San Francisco. Between 1900 and 1904 the city reported 121 persons infected, of which 113 died.

The incidence of the disease in this country has been almost negligible in recent years.

There are two forms of the plague. Bubonic attacks the lymphatic glands under the skin. Pneumonic, contracted through inhalation of the bacteria, often results in fatal pneu­monia unless treated in time.

People catch the disease from fleas that come from infected rodents, usually rats. The infected fleas leave the dying or dead rat and while they feed upon a human being they deposit infective material in or on the skin.

There is a vaccine for the disease, but it does not guarantee full protection.

Streptomycin is the drug of choice to check the illness and prevent death. Terramycin also is used.

Sanitation and rat control are high on the list of preventive techniques, and are especially enforced at seaports. Rodent-cides are used to kill rats and usually DDT is quickly sprayed on dead rodents to kill the fleas. Rat guards are placed around hawsers of ships moored at docks to prevent the rodents from traveling from ship to shore.

MALARIA—Malaria is another disease that goes far back into history. It also is a disease for which a treatment was discovered before the cause was found.

Many legends surround the story about Countess Chincon who was suffering the chills and fever of malaria in 1630 and who was treated with medication from the bark of a tree found in Peru. Jesuits were thought to have learned about the treatment from natives.

Eventually the tree was named the chincona tree and from 1700 on its most active principle, quinine, was used univer­sally to treat malaria.

Around the beginning of the 20th century, U.S., British, and Italian scientists raced to discover the method of trans­mission of the disease by mosquitoes. A parasite that causes malaria had been recognized in 1880, but not the method of transmission.

Malaria is distributed by the female anopheles mosquito. When the mosquito feeds upon a patient infected with malaria, it ingests blood containing gametocytes, which are sexual plasmodial cells in malarial blood. These are taken into the intestine of the mosquito and finally emerge as sporozoites and migrate to the mosquito's salivary glands.

When the mosquito delivers the sporozoites into the skin of a susceptible subject, the asexual phase of the parasites' cycles begin as they multiply in the blood. The organisms attack the red blood cells, divide into 12 to 24 spores, swelling the cells and causing them to disintegrate. Released spores then infect other blood cells until billions of cells are de­stroyed. Symptoms usually begin with a shaking chill followed by fever and sweats. After a time fever recurs at regular intervals, usually every three days.

When night temperatures drop below 60 degrees malaria germs are destroyed in the mosquitoes' bodies. Consequently the disease does not occur in cold climates.

Malaria germs in the human body can be destroyed by drugs. Since the discovery of quinine, other drugs have come into prominence. During World War I a shortage of quinine in Germany culminated in the discovery of Plasmochin or pamaquine. Later, Atabrine, quinacrine, was discovered. World War II brought more research which resulted in a new drug called primaquine.

Antimalarial chemotherapy for the two most common forms of malaria, vivax and falciparum, include quinine, Ata­brine (quinacrine), Aralen (chloroquine), Paludrine (chlor-guanide), Daraprim (pyrimethamine), and primaquine.

The drugs may be used either as curatives to treat malaria, or to prevent the disease. During World War II soldiers in malaria infested areas were given daily doses of antimalarial drugs to safeguard against the disease.

The mosquitoes can be killed by DDT and during the war American planes practically wiped out the disease in Pacific island battle areas by spraying clouds of DDT over the areas.

Victims of vivax malaria are prone to periodic relapses until, eventually, it "burns itself out."

In 1932, health reports to the League of Nations indi­cated 100 million cases of the disease in India alone. It still is so serious that the World Health Organization has an active world-wide malaria campaign in action.

GOITRE—The thyroid gland surrounds the windpipe (tra­chea) in the lower portion of the front of the neck. It is a very important organ in the body because it regulates metabo­lism.

The thyroid gland is the organ that is attacked by goitre. The weight of the normal adult thyroid is around 30 grammes. In simple goitre, according to a description by Dr. Jean De Moerloose of the World Health Organization Editorial and References Services, ". . . the gland may become as large as an orange or even a child's head . . . and may in some cases grow to reach monstrous proportions."

The disease was well known to the ancients. Centuries ago the Chinese used sea products, with their iodine content, to treat the disorder, two or three thousand years before the birth of Christ.

In 1820, Coindent, of Geneva, recommended iodine for the treatment of goitre. The use of iodized salt was first instituted in 1831, but some years later the use of iodine fell into dis­repute because of toxic results following large doses.

After the first world war, iodine again came into its own as a preventive and treatment for goitre. Iodized salt was tested and found to be effective.

Goitre is most common in areas where the iodine content in water and food is low. Consequently, large sections of countries may be afflicted with the problem. Areas where sea food, with its iodine content, has been a routine part of the diet usually have a low incidence of goitre compared with inland areas where sea foods may be more uncommon, or where there is little iodine in the water.

Surgery for goitre is very effective and comparatively safe, but the emphasis long has been on the prevention and treat­ment of goitre through the use of iodine.

For prevention the use of iodized salt has been urged. Sometimes iodine, added to drinking water, is used for the same purpose. Iodine in water is frequently prescribed, also, in carefully regulated dosages, for treatment of simple goitre.

Powerful antithyroid drugs such as thiouracil sometimes makes surgery unnecessary, under certain conditions.

WHO estimates that 200 million human beings suffer from endemic goitre, or, in other words, have goitre mostly because of where they live. This estimate brings out the importance of prevention.

Three international congresses have studied the problem. The conclusions have been simply and effectively stated in a single sentence as quoted in World Health, July-August 1960: "Goitre is an easy disease to treat and will be banished as soon as society decides to try . . . and adds a little iodine to salt."—Fourth International Conference on Endemic Goitre in London, England, from 5 to 8 July 1960.

LEPROSY (Hansen's disease)—A young man and his "date" sat in a beer tavern in a Southern state one evening not long ago. They occupied a booth with another couple and they were animatedly discussing sports.

Suddenly the girl stared at her escort with wide eyes.

"Tom! Your fingers!" she cried.

The man stopped talking to look at her with a puzzled frown.

"What about my fingers?"

"Look! Look what you're doing!"

Everyone at the table looked down at Tom's hands as he stared in a disbelief that turned to fright. The cigarette he held between two fingers was burning into the flesh and he felt no pain. He knew there had been increasing numbness in his fingers, but this—!

The next day the young man went to a doctor. Eventually, the trouble was accurately diagnosed as leprosy, which may show its first symptoms, nerve damage,.through loss of feeling for heat or cold, before skin lesions appear.

"This can be treated at home," the doctor decided.

The young man's fright, when he learned about his afflic­tion, took time for the doctor to calm. He explained the dis­ease and how drugs could help him.

Several days later the young man brought his "date" to the doctor's office.

"Please tell Doris," he pleaded. "Tell her she's all right."

The girl stared at the doctor with wide eyes. There were circles under her eyes from worry and lack of sleep.

"Have I got it, Doctor?" she whispered. "Have I got leprosy, too? I've been out with Tom several times and it's so contagious. Am I going to die now?"

She was beginning to weep, tears running down her cheeks.

"I doubt it very much," the doctor explained. "Leprosy— or Hansen's disease as we like to call it now—is much less infectious than tuberculosis, for example. Actually, it is one of the least contagious of all diseases. And you'd probably have to have long or frequent contact with an open case to get it. You just mustn't believe all the old tales about it, or the misconceptions we've had through the ages. Like those in the Bible, which we now realize came from translators' errors."

The doctor went on to explain more about the disease to allay her fears. He told her about the many workers who cared for the victims in hospitals all over the world without contracting the disease. Finally she was calmed down.

As they were about to leave, Tom said quietly, "Look, Doris—while the doctor's here and everything. I just want to say that we'd better not have any more dates. It never was serious, anyhow—but I don't want you frightened, nor feeling kind of funny about seeing me. And I don't want you to be embarrassed about saying no."

She looked at him gently. "Thanks, Tom. I mean . . . well, I guess it would be better that way."

The doctor watched them leave his office. He wondered if

it would be easier for Tom if he suggested the national hos­pital in Louisiana, maintained for victims of the disease.

Fortunately, such problems of decision are not frequently demanded in this nation but, as indicated in the above statis­tics, the problems brought about by leprosy are manifold.

Leprosy is believed to be caused by an acid-fast rod, Myco-bacterium leprae, discovered by the Norwegian physician, Gerhard Armauer Hansen, hi 1874.

The disease is marked by lesions of the skin, ranging from small, pale, flat patches to thickened welts, lumps, or masses of nodules. There is a sensory loss for cold and heat, followed by loss of the sense of touch, or pressure, and of pain. Partial paralysis may result. Blindness may be a complication.

Leprosy affects between 10 and 12 million persons hi more than 100 countries. Estimates say there probably are 2 million victims in Africa, a million hi India and another million in Communist China. There are about 1000 known cases in the continental United States, most of them in the South and Southwest.

One of the world's leading experts on the disease, Dr. Paul W. Brand, says, "Leprosy is no longer incurable. It can be rendered completely noninfectious by treatment."

Again the new drugs of the era have come to the rescue: the sulfones and certain antibiotics.

Sulfones have been a treatment of choice. Three have been used at the National Leprosarium in Louisiana: Promin (glucosulfone sodium), Promizole {thiasolsulfone) and Di-ason {sodium sulfozone). Streptomycin and, especially, di-hydrostreptomycin also have been used.

Prognosis depends upon the character and extent of lesions. Spontaneous remissions frequently are encountered in case predominantly marked by neural lesions. The outlook is non-encouraging for cases with nodular lesions. In a reported 15 per cent of nodular lesion cases—and a higher percentage of neural lesion cases—sulfone drugs arrest the disease after 3 to 5 years of treatment.

New drugs are under study and may soon be in use. Tapa-zole, a drug long used for hyperthyroidism, is said to be more rapid in clearing up leprosy lesions than sulfones, according to reports from Dr. Arturo O'Byrne of Cali, Colombia. An­other drug called Ciba 1906 and an ointment called Etisul show encouraging effects.

Rehabilitation through surgery on hands crippled by leprosy has been very successful. Dr. Brand has pioneered the work and over ten years he and his associates have performed about 5000 reconstructive operations.

One problem in fighting the disease is the difficulty and de­lay in diagnosis. This is especially true in this country or other areas where the disease is uncommon. Fortunately, in Tom's case, the doctor had served overseas in countries where the affliction was common.

The outlook for the plight of those who get the disease, and for the fight against it, becomes more encouraging every year. The World Health Organization has been active in pro­moting a gradual shift from permanent to home and dispens­ary treatment.

All who are engaged in the medical problem and its rami­fications deplore the stigma that has been attached to the words "leprosy" and "leper."

Dr. Brand further lamented the history of the disease in writing for Rehabilitation Literature recently: "It is terrible to realize that millions of men and women have for years been condemned to isolation and misery when means for their restoration to family and home and a job have been available."

The comparatively large number of diseases that are con­trolled or cured effectively by the new drugs seems to become more spectacular each year as more and more drugs make their appearances.

Many of the diseases have already been mentioned. Some diseases have not been because they do not constitute com­mon or serious problems, or they have become very rare.

Some other diseases for which there are effective remedies in the sulfas or antibiotics, include psittacosis (parrot fever), against which achromycin and terramycin are effective; ba-cillary dysentary, which yields to Paludrine, sulfonamide, achromycin, and terramycin; enteritis, streptococcal infec­tions, pneumonoccal infections, and in treatment of other rickettsial diseases such as Rocky Mountain spotted fever, trench fever, and Q fever.

TYPHUS, confused on occasion with typhoid, is a very con­tagious fever marked by congested lungs, prostration, and dark blood. It is caused by a rickettsial virus that is trans­mitted by the bite of lice.

The disease usually begins with a headache, chills, malaise, dark flushing of the skin, pains in muscles, and a rapidly rising fever. Later, comes the dry blackness of skin. Delirium and coma are accompanying symptoms. In this country the disease is believed to be transmitted by rodents.

There is a vaccine against it. Achromycin or terramycin are used for treatment.

It might be noted that rickettsial disease such as typhus and others mentioned above are in a group of diseases caused by minute microorganisms called rickettsias, which are trans­mitted to many by a biting insect such as a louse, mite, tick or fly. The insect can only transmit a rickettsial disease if it has first dined on blood from an infected human being, or— more frequently—a sick rabbit, mouse, deer, or other animal. Rocky Mountain spotted fever is another example of such diseases, as are the others listed with it above.

Usually they yield to treatment similar to that used for typhus.

TYPHOID is an infection conveyed by water or food. The source of infection is always the excreta of infected persons. From this the typhoid gets into drinking water, milk, pota­toes, lettuce and other vegetables, either through poor sanita­tion, or handling by infected persons, or contamination by flies. Family contacts can be transient carriers. It is estimated that two to five per cent of patients become chronic carriers.

The organism enters the body with food or water. An in­cubation period of 10 to 14 days ensues. The onset of the disease is gradual, with a rise in temperature that may reach 102 degrees in a week. Usually there is constipation at the beginning, but occasionally there is diarrhea and vomiting. Particularly noticeable is the patient's mental confusion. There may be backache. Stools are either constipated or thin and bright yellow. Delirium and stupor are frequent. Pneu­monia or bronchitis may occur. During the second week, when the temperature is high, "rose spots" come out in crops on the skin.

Chloramphenicol is used to destroy the germs and, in time, to cure the illness.

Typhoid vaccination is of proven value. Those who have had the disease usually are immune to it for the remainder of their lives.

Typhoid "carriers"—those who do not get completely over the disease—are dangerous to others. Food handlers should be screened about their past medical histories. In some places, "carriers" are forbidden to work in food stores or shops unless they have had their gall bladders removed, for this is where the typhoid bacilli keep on living.

Great care should be taken about drinking water, especially in foreign countries or where there is doubt about the purity of the water. Where there is doubt, as in a foreign community, it usually is advisable to drink bottled water or other bottled beverages. This has been found to be especially true in some parts of Mexico.

The disease is almost unknown in communities where there are proper sanitary facilities. Typhoid usually is found in the backward areas.

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