was

If rem

degree. Who bas suggested the best is too principles—they need no defense. The ingood? Who intimated we could be too po- dications are that they need only to be untently armed, too competently prepared to derstood to be appreciated and preferred. fight disease ?

None who have understood them and hecome If we are sane we would surely demand familiar with their use has been guilty of certainty and stability and desire celerity, such “adultery”-yes that's the word-as to then the preference must be for the prepara- transfer their affections, or rather confition possessing stability, certainty and celer- dence and preference to

unreliable fluid ity at prices not prohibitive. Variability remedies--none to my knowledge. The defand uncertainty may mean death, and to our inite active principle gives us a therapy utter surprise as well as chargin, when sta- not emasculated of such important features bility and definite dosage would have meant as stability and certainty which is abso. life, and who can appraise its value or when lutely essential to confident and competent once gone, give it back? Only yesterday a therapeutic resources. brother practitioner was lamenting the loss of a patient, the burden of his cry was, "I do not believe the remedy was good or up to FRESH AIR HOMES AND MEDICAL WORK standard." The case one of those in

IN CONNECTION WITH THEM.—Linsly R. Wilwhich effects must be had with "certainty and

liams describes the advantages of a vacation celerity,” or death results; no time to spend

at Sea Breeze. The welfare of the children here or there, or try something else. edial effects are not quickly bad life is gone

is carefully looked after in every detail. The

writer urges all physicians who are engaged --no time to try something else. We feel as

in hospital and clinical work during the sumsured that the brother referred to will see to

mer to have each hospital and clinic supplied it, as best he can, that next time he is sup.

in the spring with a list of all the fresh-air plied with the preparation of his confidence

charities, and to see that list is used. If all and preference. Varying and contradictory

suitable cases were referred to the fresh-air experiences can scarcely be accounted for out

charities the demand would more than exceed side of instabilty and varying strength of the supply. But such a demand in New drug used, it matters not what the prepara

York is never unbeeded. In time it would tion.

result in the formation of a joint application Our plea is for the alkaloid and active

bureau wbich would relieve the hospitals and principle, and our contention is that they are

dispensaries of detailed search for fresh air stable; do not, cannot vary in strength,

for individual cases, and in the building of though they may vary in quantity in differ

more numerous fresh-air homes for the deent specimens. Consequently, the only serving and poor.-Medical Record, June 9, source of uncertai uncertainty and ineffectiveness

1906. must come from adulteration knowingly or through ignorance-through ignorance in not THE STOMACH DOUCHE AND ITS APPLICAunderstanding how to separate and isolate TION.-M. Gross gives as strict indications from associate constituents or added material for the introduction of the stomach tube for necessary in obtaining the desirable and use. therapeutic purposes: Acute toxic inflammaful part.

But when correctly isolated we tions, intoxications, and ileus; old mucous have the greatest power of certain effect, the ponmucous gastric inflammations; smallest bulk, the sniallest dose with which small number of sensitive neuroses, hypereseffects may be had in shortest time at least thesias, chronic ulcerative affections, ereexpense and most pleasantly.

sions; anomalies of secretion, or chyorrhea; Then how eminently superior, these prefer- and disturbances of motility in both atonic ences seems a natural selection, consectary. and mechanical gastrectasia. The tube And this verdict is rapidly rendering, survi- which the writer has used during the last val of the fittest. It is enough to fight cause few years differs from the ordinary tube in and coniagion, dirt and disease, germs and that it is provided with an end opening generalities in infancy and infection without and a number of small, pinhead-sized lateral at last being compelled to conclude from ex. holes which perforate the walls of the tube asperatiog, overwhelming evidence that our in different directions. The action of this fight was a failure on account of inferior, stomach douche is mechanico-chemical, theruncertain remedies.

mio, or both. A loose hard rubber valve is The ratio of capability and desirability of placed at the large end aperture, which it active principles to that of galenics is too tightly closes as the fluid is injected, As evident'to need a mathematical calculation the upper end of the tube is lowered, the to determine or understand. It is unneces- outflowing stream pushes the valve up.sary to say anything in defence of active Medical Record.

or

a

Scientific Communication, Wm. S. Deutsch, 3135 Washington Ave. Executive, A. Ravold, Century Building

Publication, W. E. Sauer, Humboldt Building Entertainment, Frank Hinchey, 4041 Delmar Ave.

Public Health, R. B. H. Grad wohl, 522 Washington Ave

ST. LOUIS.

A REPORT OF TWO CASES OF TRICHIN- symmetrical and well formed. The patient

IASIS AND REFERENCE TO FOUR is well nourished and musoular. The weight OTHER CASES INFECTED FROM THE is about 155 pounds; the height about 5 SAME SOURCE.

feet 4 inches. The chest expansion is good.

The breasts are rather large. The abdomen EDMUND F, TAAKE, M. D.

protrudes somewhat. The surface of the trunk and extremities looks edematous and

there is decided pitting un pressure of legs CASE I.-Katy K.; admitted to

to the and feet. A number of white striae are seen City Hospital, February 10, 1906, 5:25 p.m. on the anterior and upper part of the thighs Age 23 years; married; a native of Austria -probably fat striae. The skin is moist and (in America one year); resides at 1709 S. 10th pale in color. The mucous membrane of street, St. Louis, Mo.

the lips is dry, fissured and scaling. The No intemperate habits. Married about tongue is clear. The patient lies flat upon two and one-half months; husband is 27 her back, she is unable to change her posi. years old and is healthy.

tion. The extremities are flexed at the elbows All of the patient's relatives have been and knees and extension to the normal limit bealthy, well-developed individuals. The is impossible. All parts of the trunk and expatient states positively that she has never tremities are painful to palpation. The pulse been sick before.

is weak and rapid. On auscultation, moist On December 30, 1905, this patient's fam. rales are distinctly heard over the lower part ily and a neighboring family bought a bog of both lungs posteriorly. The knee-jerk is which they divided. On January 1, 1906, absent. Stimulation of the soles of the feet the patient began eating of this meat, some causes but slight movement of the toes. of it raw.

January 20, 1906, the husband Present Condition of Patient.—Temperaand sister-in-law (the other two members of ture 103 deg., pulse 30, respiration 32; severe the patient's family) became sick. Two days pain, great muscular weakness, extreme proslater, January 22, this patient took sick. tration; dyspneic; annoying dry cougb; conAbout the same time the other family re. stipated. ferred to above, sickened. The initial symp- Laboratory Findings. --Urine, negative. toms were severe diarrhea, nausea, profuse Muscle.- A small bit of the gastrocnemius perspiration, edema of the eye-lids, great muscle removed from patient contained a prostration, some fever. In a few days the great number of non-motile trichinae. A diarrhea abated, and the edema extended to piece of muscle was taken from the bam of the legs and feet. At this time there was the bog wbich was supposed to be the source a rather sudden onset of pain, which pain of infection. It contained a large number of has been almost uniform in severity since encapsulated trichinae.

Stool.-Not exam. then. The pain is increased by movement ined. Blood.--See special report. and by palpation of the parts.

Course of Disease During the First Ten The patient describes the pain as a sharp, Days in Hospital. - The temperature was irsticking, pulling pain. Since the pain has

Since the pain has regular. It fluctuated between 98 and 102 begun, walking is impossible, and there is deg. The greater part of the time it was 99 stiffness in all the joints of the body. deg. The respiration varied from 24 to 48

Perspiration has been almost constant and per minute. The average was about 32. The very profuse since it began.

respiratory movements were shallow and reg. A cough which the patient had some time ular. The pulse varied as the temperature, before taking sick, has continued--the pa- ranging from 104 to 136 per minute. The tient thinks it has improved of late.

average was about 125. At times the pulse Physical Examination.-Physical develop- was very weak-bardly, perceptible.

Per. ment is excellent; all parts of the body are spiration was continuous and profuse, except

0 % 0 %

30 %

(300)

45 %

With very

when checked by medication. The cough

(400) increased in severity up to the seventh or

3-16-'06...50% 331% 164% eighth day when it became less annoying to

3-21-'06:..431% 302% 261% the patient. The pain was constant during

3.25-'06...423%

271% 1%

3-31-'06...409%
the first eight days, excepting when it was

36%% 224% á %
checked by analgesios. After the eighth day
the pain gradually subsided. , As previously

4. 6-'06. ..463% 433% 103 %

1 %

4.22-'06...52 % 37 % 101% 3%
stated, there was persistent constipation when
the patient entered the hospital. Within

5. 4-'06...42%

12% *%
twenty-four hours this was relieved and the

BLOOD OF LENA AND KATY K.
bowels remained loose-catharties being given
for that purpose.

About one-balf of the cells enumerated as
On the second day after entrance to the eosinophiles, in counts “2-13,” “2-24” and
hospital, there was incontinence of urine and “3-6," are not typical eosinophiles. They
delirium. The edema of the legs and feet are polymorphonuclear leucocytes contain-
persisted during this period, that of the eye. ing numerous small granules, which gran.
lids had almost disappeared when patient ules are irregular in shape and take a distinct
entered the hospital.

eosin stain.

In waking these counts it is a difficult
CASE II.--Lena K.; admitted to the matter to decide which cells shall be classi.
hospital at same time as Case I.

fied as eosinophiles, and which as polymor-
few exceptions, the bistory, physical examin. phonuclear neutrophiles, as there are so many
ation, laboratory findings, course of disease, grades of cells between the typical forms of
etc., of this case, corresponded in every detail each.
to that of Case I. Therefore only the differ- In counts "3.11," "3-16,” “3-21" and
ences will be noted. The first symptoms ap. “3-25” most of the eosinopbiles are typical.
peared January 22 (two days earlier than in The granules are large and spherical and the
Case I). There were no gastro-intestinal dis- cells appear to be larger than in the former
turbances; the cough was not so severe; the counts.
perspiration was less profuse; probably there A marked change is noted in the eosino.
waslesspain; the muscular weakness and philes, in counts "3-31.". The granules do
prostration were less pronounced. The varia- not stain so brightly and most of the cells
tion above normal of the temperature, pulse are vocuolated-apparently they are degener-
• and respiration was somewhat less than in ating.
Case I. At no time was there incontinence of But few of the eosinophiles are vocuolated
urine nor delirium. Improvement began about and the granules stain well with eosin, in
February 14th, about five days earlier than counts “4.6” and “4-13."
in Case I.

In counts "4-20" and "5-2" (Katy K.)

and in counts “4-22” and “5.4" (Lena KATY K. -BLOOD COUNT.

K.) the eosinophiles are typical excepting (600) Polym. N. 1.

Eosinop. Mast. c. that some of them are vocuolated.
2-13-'06...864% 91% 35% *%

All of the blood smears were stained with
2-24-'06...714% 24 % 43% 0 % a reliable preparation of Wright's stain.
3. 6-'06...566 % 361% 7 %
3.11.'06 ..51%% 33 % 15%% *%

FOUR MORE CASES INFECTED FROM THIS SAME

HOG.
(100)
3-16-'00...454%

138%
0 %

I did not attend these cases and could not
3-21.'06...423 %

% obtain a complete history. These cases are : 3-25-'06...344% 404% 244%

3% Anton K., age 27 years (husband of case 3-31-'06...321%

154%

%
I), Nick L., age 31 years

and Barbara
(300)

L., age 25 years (husband and wife, and 4. 6-'06...32% 56% 103%

3%

their daughter, age 4 years. 4.13-'06...283 % 53% 161%

% One case experienced no gastro-intestinal 4-20-'06...313% 443 % 233%

% disturbances, the other three cases did. 5. 2-'06...271% 553 %

1 % Two had cough, the other two had not.

The child had a cutanoeus eruption, wbich
LENA K.—BLOOD COUNT.

the physician in charge described as being
(600) Polym. N. 1,

Eosinop.

very similar to that of varicella.
2-13-'06...82% 131% 33% *% All of these four cases presented the fol.
2.24.06...766% 206% 23%

lowing symptoms and signs: Fever, profuse
3. 6-'06...546% 323%

12%%

perspiration, edema of the eye-lids, intense 3-11-'06...56% 23%% 201%

0 % pulling pains in the muscles, stiffness of the

Monon. 1.

0 %

41 % 38 %

19 %

52 %

16 %

Mono. N. 1.

Mast. c.

0 %

Mono. N. 1.

Mast. c.

40 %

25 %

423 % 42 % 50 %

233%

3

Mono. N. 1.

Mast. c.

Mono. N. 1.

Mast. c.

37%

joints, great muscular weakness and prostra

DISCUSSION. tion.

Dr. D. Arthur Hughes* stated that this Laboratory Findings on Anton K.

was his first experience in coming in contact Urine, negative. Muscle, numermous mo

with patients actually suffering with this tile trichinae. Blood, eosinophilia negative.

disease. Referring to the symptoms disThese laboratory findings are about three

cussed by Dr. Taake, he believed it was weeks after tbe beginning of sickness. For

true that there were no particular symptoms later blood findings see special report below.

that would distinctly diagnose the disease;

but that one or another of the symptoms ANTON K.-BLOOD COUNT.

mentioned usually were found. The point (300) Polym. N. 1.

Eosinop. 3- 8-'06...313%

201%
47 %

1 %

that impressed him, and which he believed 3-25-'06...343%

3%

was most important, was the fact tbat these 3-31.'06...39% 32% 264% 2 %

patients not only ate partly cooked pork, but 4. 6-'06...41%

131%

23 %

also uncooked pork from this pig. This was 4.13-'06...321%

a point that should always be borne in mind.

2 % 4.20-'06...363%

121% 1 %

So many persons were apt to eat pork un

cooked, and after eating uncooked meat in 5. 2-'06...42 % 531% 51%. 3%

which this disease was present, there would MRS. L.--BLOOD COUNT.

be found in the patients the intestinal symp.

toms that Dr. Taake had given. Dr. Hugbes (100) Polym. N. 1.

Eosinop. 3-31-'06... 28% 56% 16% 0%

was interested in trying to prevent such dis

eases in man as much as possible. He bad (200) 4-22-'06... 30% 55% 15%

0%

been in the service of the Bureau of Animal

Industry, U. S. Department of Agriculture, MR. L.- -BLOOD COUNT.

ince 1903, a service which has to do with the (100) Polym. N. 1.

Eosinop.

infection of all animals, before and after 3-31-'06... 36% 43% 21% 0% death, which are to pass in the channels of (200)

interstate or foreign trade. However, the in. 4-22-'06... 51%

10%

2% spection of pigs for the disease in question,

trichinasis, was made in the case of swine des. A differential leucocyte count was made tined for certain countries with which we bave on the blood of Anton K. 2-13-'06, by a

a large export trade. These countries were competent pathologist, who reported eosino- Austria, France, Germany, Denmark and philia negative.

Spain. During the official year which closed As far as the examination was made, the the middle of last June, there was inspected blood of Anton K. and Mr. and Mrs. for these countries. L., corresponded very closely to that of

From page 16 of the report of the Chief of Katy and Lena K.

the Bureau of Animal Industry the speaker

read the following: CONVALESCENCE OF THE SIX CASES.

Total inspections of pigs for triobinosis The pain, cough and edema gradually sub. 315,015. They were classified as follows: sided. The pale color was replaced by one Class A, free from the appearance of trich. of health. In fact the convalescence was like ina 307,621, this being 97.64 of the wbole. that of any severe wasting disease.

Class B, containing trichina-like bodies, The convalescent period in case I was about by which he said he supposed they meant eight weeks; in case II about six weeks. disintegrating trichina, 4,773, or 1.52%. Anton K. required about four weeks to Class C, containing live trichina 2,015,

convalesce and the L. family about three being 0.81%. • weeks.

This microscopic work was done by exAt this time, May 1st, Baby L. is in perienced inspectors and as thoroughly as excellent health. The other five cases are should be expected. The pork was really exdoing hard manual labor. They complain of amined three times, and sometimes oftener. being very tired and of having pain in the Under the second class, the trichina-like muscles after a hard day's work.

bodies, the inspeotors looked for those tri. In concluding, the writer wishes to call at

china which were encapsulated, having gone tention to the following points in the cases

on to calcification. The 2,015 in class C on which a differential blood count was made.

were condemned. Eosinophilia did not develop until the pa

However no danger was to be feared from tients were convalescing; and that the per

it was cooked; this was the first way of get. open; they did not eat rats and mice, which
ting rid of the disease in the meat. Second, communicate the disease to them.
if the pork was heavily salted, that would There were sporadio cases in this sountry,
destroy the live trichina and pass the meat but when they occurred they were traceable,
over to class A.

Moreover if the pigs were as in this case, to the eating of pork that was
pickled for an extensive period, there was no uncooked.
danger whatever; nor if they were cooked How common the disease was in St. Louis,
and put up in canned form. As a general the speaker was unable to say, and was also
thing, these animals were not allowed to be unprepared to go into a discussion from the
returned to the owners, but were tanked, by standpoint of the human medical literature,
which he meant to say that they were put into but he believed that but few cases were spoken
great heaters and made into fertilizer for the of in American medical literature that were
soil.

due to causes other than eating uncooked The millions of swine slaughtered for the food containing the larval form of trichina interstate trade and not for the export trade spiralis. these were not examined for tricbinosis. The doctor thought they should be, but believed Dr. Soper inquired what the inspectors the reason this was not done was that so little looked for in swine. of the disease seenied to be found in the

To this Dr. Hughes replied that the attencountry at large, that the government had not deemed it advisable to examine the pork wards the detection of tuberculosis and

tion of the inspectors was chiefly directed tofor this disease, where the meat was to pass other communicable diseases, where the cominto the interstate trade. No alarm need be

municability came from bacteria rather than felt, the doctor said, on this account. Wbile

from parasitic origin. The parasitic diseases some countries required the examination,

that were communicable to man were found there were other great countries which do not

to be so rare that the inspection was not so require the examination, as they had come to

strict on that point as it was with reference the conolusion that there was little danger to bacterial diseases. Tuberculosis was found from American meat. Those countries which

to be very common in pork, and a great deal did not require the examination included all

was condemned for that, great quantities of those not mentioned as requiring it; for in

swine being full of tuberculosis lesions. stance, Great Britain. These countries took

When the animals were large and fat, it thirty-five million tons of American meat,

would hardly be thought that they were tumeat products, and dairy products last year, berculous, but this was frequently found to a large portion of which was pork.

be true. These were condemned, and deposTo lead into an explanation of the fact that

ited in the tank. The speaker stated that there was so little of this disease in Amer

the inspectors were not satisfied, with putican swine, attention was called to the fact

ting the animals into the tank with the exthat in Germany there was a great deal of it pectation that they would be treated so as to in the swine, the statement having been made produce fertilizer, but that the government that one in every five hundred pigs have the seal was also placed upon the tank, and the disease in Prussia, in Saxony more, and in steam is turned on. All of this was done West Germany less, the reason being that in

under rigid supervision. Packing house Germany the swine did not run at lurge, as

owners had found to their sorrow, when tryour great American plains; they were

ing to get anything out of a tank sealed by a penned up, and likely to devour many rats

government official, that Uncle Sam was a and mice, and these were the great means of

very bard customer to deal with. communicating trichinae to the swine. This

Besides tuberculosis, hogs were inspected is true, though the fact is known to the Ger.

for swine plague, hog cholera and the like. mans that 10 to 20 per cent of the rats and

It was not thought that these diseases, as inice have the disease. It was probable also such, were communicable to man, but if meat that the disease was more common and prev

was eaten from a hog having hog cholera, it alent in Germany for the reasons that the

would produce chronic diarrhea. Pigs were Germans not only eat the animals that we eat

also examined for injuries of all kinds and in America, but also eat dogs, horses, don

local diseases, for pregnancy, etc., and all of keys, etc. Persons in Germany therefore got those things whicb make the flesh uneatable, the disease not only from trichinous swine,

unpalatable, or disagreeable because of sentibut also from dogs. Dogs are notoriously in

ment or effect. fected with trichina. Swine in this country were comparatively free from the disease, be- Dr. Deutsch inquired whether the disease cause they were not penned so much: they in the animal resembled the disease as we see followed the cattle, ate grain, and were in the

on