THIS BQPKJS^HECIFTOF Ou- ..' JlPHs^ which by the addition of a weak Fig. 5. — Human muscle with trichinae (Vircliow). Fig. 8.— Cvst magnified 300 diameters, commencing ' situTLeuckaitr" ~ (SSStek ^ " *"" 6Xtr6mities of *»» °^ Fig. 7. — Muscle trichina) in solution of HCL, are dissolved when the bodies lose their opacity. Previous to calcification the capsules cannot be seen by the unaided eye. REPORT ON TRICHINA AND TRICHINOSIS. 17 Under the microscope with a power of 10 to 12 diameters these points appear as oval, or spheroidal cysts, inclosing a small round worm, coiled spirally, whose outlines are more or less distinct according to the degree of calcification (Pig. 6). Leuckart (Mensch. Parasiten). "The capsules found in human muscle are oval, as a ride, with the long Fig. 9. Fig. 9. Sites Fig. 10. Fig. 9.— Calcified human trichina capsules of different forms, 1x200 (Leuckart). Fig. 10. — Sheath of sarcoleinma with recently encysted trichinsB from human muscle, (Ualton). axis lying in the direction of the fasciculi (Pigs. 7, 8); the poles are usually more or less drawn out to a pointed top, which sometimes gradually enlarges in the center to inclose the cyst, and at others butts against the body of the capsule so that the whole takes the form of a citron. By reduction of the pointed ex- tremities, and an increase in the central portions, these oval capsules pass through various intermediate forms to the spherical, which are found mostly in cats and in rats, bat are also found among the oval forms in man -(Fig. 9). These capsules do not lie free in the con- nective tissue, but are contained within the sarcolemma (Fig. 10), which on account of the difference between its diameter and that of the growing capsule exercises more or less pressure on the latter, causing more or less de- viation from the spherical form, as this pressure is exer- cised to a greater or less degree" (L. I. c.) (Fig. 11). " The size of the capsules varies even more than their form. "With a diameter of 0.2 to 0.4= mm there will be a ' difference in length from 0.3 to 0.8 mm . The normal fig. n.-rn china ° capsule ot unusual average may be taken at about 0.4 mm for length, and form from rahMt 0.26 mm for breadth. The difference in form relates more to the external outline than the cavity, which in almost all cases has a S. Ex. 9—2 * ' ' ' J 8 REPORT ON TRICHINA AN© TRICHINOSIS.. simple, more or less, shortened oval form, which gradually decreases in size through thickening of the walls, which latter may reach a thickness of 28/i. "When, as sometimes occurs, the capsule contains more than one worm— two (Bowditch), three .(Farre), and even four and five worms have been observed in the same cyst— it is more or less elongated, according to the number of the contained trichinae, while "the diameter, seldom shows any increase. As a rule they lie behind each other, with more or less space intervening (Fig. 9). " Under higher powers the wall of the capsule has the appearance of a delicate diagonal fibrillation. It is, however, doubtful whether this ap- pearance is due to the presence of real fibres or to the peculiar grouping of the molecular granules which are' distributed through the otherwise perfectly clear and homogeneous basis substance. More distinct, how- ever, is the stratification of the wall, which is seen more particularly in the solid extremities, but can be easily recognized where the wall is of a moderate thickness. "The capsule containing trichinae bears no similarity to the connect- ive tissue envelopes of the cysticercus and other peripheral helminths. On the contrary, it is so similar to a chitinous membrane that we can- not avoid the conclusion that it is a product of secretion of the inclosed worm, and corresponds with the capsules of certain other helminths, particularly the Tetrarhynchice and Trematodes. This view is also supported by its reaction with caustic alkalies, and also that it is changed but little by an increase of temperature." The lime salts deposited, after a time produce a granular condition of the walls; but these lime granules should not be confounded 'with the molecular granules above mentioned, as they are larger and disappear with effervescence on the addition of the stronger acids. They are found most plentiful in the extremities and in the outer layers, and in more complete calcification the whole wall is thoroughly impregnated, when it may lose its transparency ; yet the outlines of the inclosed worm can generally be made out and the true nature of the body be easily determined. " The calcification is not uniform in any case, and, as may be seen by experiment, some capsules will be thoroughly impregnated, while others show scarcely a trace of the deposit. This will be the better understood when we remark that the capsule has an independent vascular system developed from "the interfascicular capillaries. This network has no special relation with the capsule proper:— which is independent of the surrpunding connective tissue — but spreads over the envelope of sarco- lemma, as first observed by Farre (Fig. 12). Sometimes this external envelope is very much increased in thickness, so that the diameter, of the cyst is increased by one-half. At the poles of the capsules when the muscle fasciculi are separated to receive them will be seen numerous fat globules (Figs. 6, 7, 8). At the same' time the vessels will be seen, spreading over the surface of the capsule in the form of a network, which REPORT ON TRICHINA AND TRICHINOSIS. 19 has its greatest development in the equatorial zone. Generally only one vessel is seen at each pole, an afferent and an efferent, corresponding in size to the muscle capillaries, so that they may be con- sidered as artery and vein. When more than one is found their combined caliber rarely exceeds that of a muscle capillary. " The cavity of the cyst contains besides the worm a finely granular, tolerably clear fluid, with numerous ellipsoidal bodies 10 to 15/* in length and 5 to 8/* in diameter, which through the clearness of their outline and the existence of a distinct body, sometimes double, of a cellular appearance, and by its resistance to acetic acid, may berecognized as a nucleus. They are proba- bly the nuclei of the disintegrated muscular fibers. This fluid, on the addition of alcohol or glycerine, coagulates to a jelly-like mass, in which we are some- times so fortunate, after careful section, as to have a complete impression of the inclosed worm. " In capsules taken from fresh, warm muscle there will be more or less motion of the anterior extremity of the worm, and it may even change the position of its whole body. In other cases the worm will be seen in coils oi four or five turns, and motion will be observed, perhaps, only after moistening with warm water or solutions of caustic potash. This condition of rest is that most usually seen and generally depicted by ob- servers. Fig. 12.— Network of vessels surrounding a primitive fasciculus just before encapsula- tion begins. /VKM-EHH.CaH.r. Fig. 13.— Young, trichocepualus dispar 16 days after feeding, Sf (Leuckart). "The inclosed worm (Pig. 3) is 0.8 to 1.0 mm in length.' The anterior half is more slender than the posterior (which measures 33/*), and grad- ually decreases in size to the head, which can readily be distinguished at first sight from the posterior rounded extremity. At either end will be seen a small opening continuous with a delicate tube of chitin, which extends through the whole length of the body. The general external and internal organization' resembles the early forms of the trichocephalus (Pig. 13), excepting that the latter is extended, while the trichina is more or less coiled up, and retains this position even when freed from its cap- sules, which is most readily accomplished by scraping and chopping the trichinous meat and washing out the worms. The position of the jntes- 20 JtEPOKT ON TKICHTN2E AND TBICHINOSIS; tine leaves no doubt that the concave side of the 'curved animal is' the' back, which, as has already been remarked by Bristowe and Bainey, is always- in the same direction as is the case with the full-grown male, trichocephalus (Fig. 14). "The cuticula covering the body is thin (1/i), transparent, and, ex- cepting its delicate annulated appearance,' is of a per- fectly homogeneous nature. The presence of the rings is easily overlooked, excepting where they- are increased in depth by the contraction of the concave back of the worm. Internally the wrinkled cuticula is covered by a layer of tolerably clear substance, which in its deeper portions shows a distinct longitudinal striatioii, and incloses numerous bodies (nuclei 1 ?). I am not pre- OSSt pared to state whether this 'is muscle or not. Pagen- ^>|Sn§IW| stecher (see description- of' intestinal trichina further on) describes another layer of compact oval cells (1.5 to 3.6/i) within the so-called muscular layer^ which serves as a lining to the cavity of the body (abdominal cavity). ; "On the lateral surfaces the muscular coat is inter: ^phafestoparlSk.' rupted by two broad bands (12^ wide) (Z>, Fig. 3), which art >- project into the cavity of the body as flattened tubes (a, Fig. 15), reaching from one extremity of the worm to the other. Bris- towe and Bainey, who first observed them, thought that they were the muscles of the trichina, and Pagenstecher considered them muscular, although well ac- quainted with the true muscular system. But this view is proved to be wrong by anal- ogy with other nematodes, which present the same lateral bodies as the trichinae. Within these bands are observed two rows of oval cells of considerable size, and ar- Fig. 15. — a, transverse section through the posterior portion of a female in- testinal trichina, with intestine ovary, longitudinal hand, and muscles; b, same of female muscle trichina (Leuck- art). ranged alternately, and between the cells, under favorable circumstances, the lumen of a narrow vessel maybe. seen, whose serpentine form can be traced beyond the cellular band to a delicate opening in the ventral side of the body in the vicinity of the neural ring (brain) which surrounds the middle of the oval cavity (Mundrohr). ■ " Besides these bands we may also in the transverse section, on close observation, distinguish a couple of median lines (1> Fig. 15), which sep-; arate the muscular layer through the whole length of the wOrm. ; " The viscera fill the cavity of the body [abdominal cavity] so com-; pletely that their external surfaces are in contact with the inner surface of its wall ; only at the extremities is there any space left, which, be-, sides a few masses of cells lying against the wall, contains a clear^ highly refractive liquid, which may be correctly considered the analogue EEPOKT ON TKICHIN.E AND TRICHINOSIS. 21 of the nutritious fluid of other nematodes. In many cases, also, a thin layer of this fluid, may be seen under the lateral walls of the body. " The intestines and organs of , generation hang free in the cavity of the body* being attached only at their extremities. " The most striking and peculiar part of the intestinal canal is the oesophagus (Pintestine grele, Davaine) (ce. Fig. 3), which extends through more than half the length of the body, and except the posterior third, which incloses the stomach (Chylusmagen) (at. Fig. 3) and genital tube, leaves free only a small portion of the anterior extremity. The oval cavity. (Mundrohr) (o. e. Fig. 3-16) from which this cellular body pro- ceeds, appears as a clear cylinder of small diameter, which sometimes is straight and at others more or less crooked from contractions of the part which contains it, and fills up the space otherwise filled with the nutritious fluid. Within this cylinder is contained a double contoured narrow tube of chitin, which connects the almost punctiform mouth with the oesophageal tube ; the latter, commencing at the anterior ex- tremity of the cellular body and instead of a muscular coating, passes beside.it through its whole length. The muscular nature of the oval cavity (Poesophage, Davaine) is very indistinct j the wall appears clear, and, ex- cept the posterior part, which shows signs of radiating lines, is completely homogeneous. "Near its middle this elongated cavity is surrounded by a clear annular body, contain- ing distinct cells, which are connected with the wall. There can be no doubt that this is the nervous center of the trichinae (B, Fig. 16), as Pagenstecher traced some nerve fila- pig.16 —Anterior ments which passed thence backwards and SStartSS: forwards on the wall. "**• " The peritoneal covering of the first por- tion of the intestinal tube extends over the oesophagus and cell body in the form, of a thin sheath, and on account of the swelling of the in- dividual cells has an irregular, knotty appearance. Farre considered the oesophagus of the trichinae as analogous to the colon. (See sec. A.) The cells are pressed together lengthwise and are about one-half as long as broad (30 /*), and not infrequently are wedge-shaped. " The contents of the cells are distinctly granular, sometimes clear and at other times darker, not only in different individuals, but in dif- ferent cells in the same individual, showing a probability that they are subject to frequent and rapid changes in connection with the conjec- tured absorption of nutritious substances, which are easily seen on ac- count of the thinness of the oesophageal tube. The sac-like nuclei of the cells 25/t in diameter, with their distinct nucleoli appearing as bright specks, are seen through the granular mass. Fig. 17. — Begin- ning ofthe stom- ach (Chylusma- gen) with lower end of ceaopha- gusand cell body (Leuckart). 22 REPORT ON TRICHINA AND TRICHINOSIS. " The posterior end of the oesophagus forms at each side, at the begin- ning of the stomach (Ghylusmagen), a nipple-shaped prominence, which is considered by many observers (Luschka, Kuchenmeister, Pagen- stecher) as a caecal protrusion of the fundus of the stomach, although their solidity and the presence of a sac-like nucleus indicates that, they belong to the cell body, and are nothing more than cells, distinguished from the rest by soparation on account of lack of pressure, and conse- quently more prominent position. " The posterior portion of the, body is filled as completely by the stomach and genital organs as is the anterior part by the oesophagus, without, as might be expected, any considerable increase in the .diam- eter. The stomach (Fig. 17) presents a flask -like enlargement at its an- terior extremity, which is of nearly the same diameter as the oesophagus, and presents a large cavity, while that of the latter appears as a capil- lary tube. " Covering this structure is a structureless tunipa propria, a direct con- tinuation of the peritoneal sheath of the oesophageal apparatus, within which is seen a moderately thick, sharply-outlined layer, containing a greater or less number of yellowish, shining, fat globules, which appear in some localities, especially in the fundus of the stomach, as a layer bf flattened cells, as has been observed by Luschka. u The posterior extremity of the intestine, although differing a little externally from the stomach, is histologically a very different structure. It has, like the oval cavity (Mundrohr), an external thick muscle-like wall, and is lined by a narrow tube of chitin which is continuous through the arms with the external cuticula. It forms the rectum of the tri- china. "The genital organs, which usually in the larval stage of nematodes are only primitive, have in the trichina an unusual developement (Fig. 18). They consist principally of a gland in the form of a broad sac in the convex ventral side, which extends through the whole posterior part of the body and crosses the intestine to the opposite concave side of the body. Although thicker than the intestine and of a different ap- pearance, it has hardly been seen by former observers, except Luschka, and even he gave a very imperfect description of it, because he over- looked the fact that this sac ended anteriorly in a thread like extension which represents the later developed excretory apparatus, and that through the peculiarity of its appearance the sexes might be distin- guished. Yet they are very similar in the male and female. In both it consists of a cylinder of delicate membrane 25/i in diameter, filled with pale uncleated cells 3/x in diameter (Claus, Canstatts Jahresbericht der Med. fur 1865, B. iv, § 178,) and ends in a blind sac or pouch at the be- ginning of the rectum, lying free in the abdominal cavity. The anterior portion, which reaches to the fundus of the stomach, becomes narrower, and in the older muscle trichinse, with calcified capsules contains a con- siderable number of sharply contoured corpuscles of irregular form and REPORT ON TRICHINA AND TRICHINOSIS. 23 strongly refractive, which was observed by Parre and thought by him to be the ovary (Fig. 19). The true nature of this structure is unknown. Even its chemical constitution has not been discovered, and it isuncer- tain whether it is an excretion or whether it is a result of a fatty meta- morphosis of the cellular contents of the getiital gland. Only so much is certain that they have no connection with the future growth of the sexual organs nor with the developement of the ova, and are not reached by the larvae. "The excretory apparatus proceeding from the anterior extremity of the genital gland appears in the female muscle trichina (Fig. 2) as a direct prolongation of the genital sheath, while in the male (Fig. 1), at a short distance from the granular body of Farre, it turns sharply on itself and is connected with the anterior part of the rectum (Fig. 18). This duct in the female not only has another direction, but passes between the cell body and the ventral wall to the anterior part of the body. Its anterior extremity cannot be seen even with a microscope, and I think it is not yet in connection with the abdominal wall. The histological character of this body is not as yet well denned either in the male or female. It consists of a fine row of cells which only in the vicinity of the genital gland shows the traces of a lumen, but otherwise ap- pears as a solid structure." "As long as the trichina remains in the muscle and occupies his cyst his condition remains unchanged." (Leuckart, Mensch, Parasiten, ii, § 546.) Instances are re- corded showing a remarkable tenacity of life in calcified capsulated trichinae. Pro- fessor Leidy found the trichinae alive in most cases observed by him. Virchow (op. eit., p. 39) says, "In almost all cases in man where I have found calcified capsules the trichinae were alive"; and Leuckart I , IG '" 18 _p 08teriore (Untersuchungen, etc., note, p. 63), "We «^a mi ctS taeiiiam seminis have heard of cases of living trichinae «»£ v 5 si .? ula . Be ™; ■withspermaand _ ,, ,. . , ,, , , ,. ... ?t -i « ova (teuokart). where the patient had been attacked 8, 13 J, (Leuckart). and even 18 years previously." (See Arch, fur path. Anat., 1864, B. 29, § 602; B. 30, §447; 1865, B. 32, § 363. Vierteljahreschrift fur ge- richt. und offentlich. Med., 1864, B. 25, § 102.) Damman (Deutsche Zeitschrift, B. 3, § 92) found living encapsulated trichinae 11J years after feeding. - Trichinae have also shown great tenacity of life in de- composed meat. (Beport of Vienna Committee, 1867.) "After re- maining for months in putrified flesh they did not lose their vital- ity." G-oujon (These de Paris, I860) succeeded in infecting with trich- inous meat 80 to 100 days after it became putrid. Klopsch (Virch. Arch., B. xxxv, § 609) reports live trichinae after 25 years. Fig. 19. — Kecep- 24 REPORT ON TRICHINA AND TRICHINOSIS. i This shows a wonderful vitality, for this minute worm, and when its surroundings are considered seems almost incredible. But the question •might arise, ." Are these the same trichinae that were first deposited, or the product of a more recent infection? or is there an epochal develop- ment, as Oohnheim thinks, but reaching through a longer space of time ; and may not the old decayed capsules and trichinae in various stages of degeneration, observed by Bristowe and Bainey, as well as the non- calcified capsules and non-capsulated trichinae found by Leuckart and ■ others, be the result of separate infections or new generations?" (See, also, Renz, op* tit., p. 41, and Oohnheim, Virck. Arch., xxvi, 1866, p. 161.) Muscle thus containing the encapsulated worms reaches the stomach more or less abraded by mastication, and is dissolved by the gastric juice which liberates the non-eapsulated trichinae, as well as the capsules containing trichinae. By experiments outside of the body, Professor Wedl (Report to Med. Soc. of Vienna, 1867) found that the free trichinae were acted on and killed by the gastric juice, while it only served to dissolve the capsules in other casesj and thus set free the contained worm. It may perhaps act in a similar way in the stomach; as Goujon (I. c.) has observed that encysted trichinae are more liable to infect than the non-encysted. According to, Leuckart (Untersuch., p. 61), muscle trichinae must be fully grown before they will be capable of producing infection. Davaine (op. tit., p. 749) says that "the trichina has three phases of existence, and it is only in the cyst that it attains the full development of the second period which renders it capable of entering into the third," or mature sexual period. The irregularity of results in feeding by different observers may thus be due in some cases to the use of undeveloped muscle trichinae. Pagenstecher (op. tit, Tables, pp. 54-58-60) reports seven cases in which he fed animals with meat con- taining such worms without results, excepting in one case. The expe- riments of the committee of the Vienna Medical Society (Vienna, 1867, pp. 23-36) gave negative results after feeding with immature muscle trichinae, and according to Davaine (I. c.) " Drs. Goujon and Legros have v had nearly similar results after feeding rabbits, Indian pigs, and rats. The very small number of trichinae found in these animals proving that a few only of the larvae had attained their maturity." Pagenstecher (p. 81) thinks it possible that the nature and condition of the heat may have an influence in such cases. The liberation of the trichinae corresponds with the time required for the solution by the gastric juice of the albuminous substances of the muscle, which, according to Flint (Text-book of Physiology, p. 250), takes from one and a half to five hours. Renz (op. tit., p>,27) says: " We will not be far out of the way if we say that the trichinae are lib- erated from their capsules in four or five hours." Vircbow (op. tit, p. 43) found free trichinae in a cat six hours after feeding. Leuckart says : (Mensch. Par. II, p. 547) " They are found free in the stomach in considerable numbers three or four hours after feeding." There are REPORT ON TRICHINA AND TRICHINOSIS. 25 Some cases wherein the symptoms commence very early, as in one case in Hadersleben two hours after eating the infected meat, which would lead to the conclusion that the trichinae were liberated much earlier unless, Fig. 20.— Female trichina 24 hours after feeding (Leuckart). as is considered by Friedrich (Deutsches Arch, fur klin. Med., bd. ix, p. 459), who saw evidence of the eyelids on the first day, that these earlier symptoms are due to a poisonous substance liberated from the capsules ; and Fiirstenberg (Wochenblatt, etc., in den Konigl. Preuss. Staaten, 1865, No. 21) thinks that some of the earlier deaths, when there is a small amount of peritonitis, are due to poisonous substances in the lymphatics (see section D, pathology). "After becoming free the trichinae pass into the small intestine. Then commences the rapid increase in the size of the worm by the development of the sexual or- gans, and thus the increase in length is limited principally to its pos- terior portion, while the anterior increases in diameter only (Davaine, Pagenstecher), and in twenty-four hours after feeding (Leuckart, p. 39) they may have increased by one-half their former size (Fig. 20), and for the most part capable of procreation, although immature worms and even capsules may be found in the small intestine after the third day. Virchow (op. cit., p. 10) found completely developed trichinae in the in- testine of a dog which died three and a half days after infection. Leuckart (p. 20, 21) found " no larvae in the intestine of a dog which died on the fourth day after infection, but female trichinae full of eggs and embryos, and (op. cit, p. 70) mature trichinae in a hedgehog on the 26 REPORT ON TRICHINA AND TRICHINOSIS; third day. Cobbold (op. tit., p. 161) found sexually mature trMxijm sixty -nine hours after feeding, while Hun (Trans. U, Y. State Med f Soc., 1869, p. 138) found folly-developed male and female trichinae in the in t testine of a rabbit after four days." The females were full of eggs and embryos, and one gave birth to a brood While under observation. ., Copulation, according to Delpech, " takes place toward the thirdday," Leuckart says (Mensch. Par., bd. ii., p. 548), "When the males have reached a length of 1 .2 to 1.5 mm , and the females 1.5 to 1.8^ m ," and accord* ing to Pagenstecher (p. 81), " after 54 hours, a part and in the course of 90 hoursj the most of the females become pregnant, and in less than . five days some of the embryos are born"; but "males of 0.9™° in length have performed copulation, and females 1.2 to 1.3 mm are impregnated, and at 1.5»™ contain embryos." It thus appears that trichinae are sexu- ually mature before they attain their full growth. Professor Dalton (personal letter May 2, .1880) says that this function may be performed as late as the thirteenth day. INTESTINAL TRICHINAE. The full-grown male intestinal trichinae (Fig. 1) is 1.5 to 1,6" in length, and 0.04™ m (40 micrometers (/*) in diameter. The female (Fig. 2) is 2.5 to 4. mm in length, and from 30 to 60/t in diameter. On account of the difference in size of the two sexes, which in the larval trichinae is insignificant, the growth of the female is very striking, continuing after sexual maturity, and is confined chiefly to the posterior extremity to make room for the immense number of eggs produced. The diameter changes but little. According to Pagenstecher (op. tit., p. 81, et. seq.) its natural history, etc., is as follows : " The body of the intestinal trichinae increases in size from before backwards, but less rapidly beyond the middle, to end- in a blunt rounded extremity, while the anterior extremity narrowing to 10. — 12.5 jj. ends in a constricted lip-like papilla (Figs. 27, 32). " The external covering of the trichina, as of all nematodes, consists of a fine structureless transparent annulated membrane, the so-called chitin membrane. The annular structure becomes more apparent by rapidly drying the worm, or by evacuating its contents, and disappears when it is entirely filled, thus allowing the female to change her form when pregnant. The rings or wrinkles are more readily seen in the muscle trichinaB, The thickness of this layer in intestinal trichinae is nearly 1 jx. Beneath this is a very thin muscular layer which, accoi* ing to Leuckart, is striped longitudinally. Within the latter is a layer of finely nucleated oval cells closely pressed together, and having a diameter of 2.5 /,., and a length of 3.5 p. corresponding to the length of the body. It forms the lining of the abdominal cavity. "In the muscular layer is seen a very peculiar band, which, commenc- ing on one side, apparently near the muscular portion of the oesophagus^ appears to blend with the muscular layer, and, passing backwards, curves EEPORT ON TRICHINA AHD TRICHINOSIS. 27 near the anus and passes forwards on the other side to the opposite side of the omophagias. This band measures on an average one-half to one-fourth the diameter of the body; its borders appear as two well- defined lines. A closer examination reveals that it is composed of closely pressed alternating cells, measuring, when the body is stretched out, about 20 fi in the direction of its long axis, but otherwise may appear smaller and more round and present a very variable form. The cells show a small, very sharply defined nucleus, and are joined together by a very clear connective substance, and usually alternate, but sometimes are more closely pressed together, Within this band is seen the layer of small cells which line the abdominal cavity (Figs. 21, 22), and, run- No. 21. No. 22. No. 23. No. 24, Fig. 21. — The lateral band in the region of the uterus showing ova and terminal elements s i s (Pagen- stecher.) "Fig. 22.— .The lateral hand and cell bodies of the oesophagus. Fig. 23. — Piece of longitudinal band from fore part of trichina isolated in the contracted condition. Kg. 24. — Portion from the middle of a female trichina ^fa; C, posterior extremity of cell body; S, the blind sacs; SA, blood globules ; V, stomach; O, anterior extremity of ovary. (Pagenstecher.) ning through it, sometimes a serpentine line is seen, which appears as an extremely fine canal (Fig. 23). I have as a rule failed to see this line, and never have seen either lumen or contents. This band or trans- verse section (Fig. 15a) appears very thin in proportion to its breadth, and does not give the impression of a vessel ; an aperture has not been observed. On the contrary its contractility and the variable appearance of its elements shows that it is not passive during the changes of form which the worm takes on, and that it bears a close relation to the muscular system, and I am inclined to think that it is of a muscular nature, for it appears to me that the lighter changes of form, seen best in the ordinary motions of the head, in which the wrinkles appear and disappear, are caused by the action of the general muscular tunic ; but on the other hand the sudden and violent bowing and twisting are caused by contraction of the side bands. This view is supported by the fact that it is lacking in those embryos having only a serpentine motion, that it is fully developed by the time the animal becomes fully coiled 28 EEPOKT ON TKICHIN.E AND TBICHINOSIS. previous to encapsulation, and continues in full operation up to the time of copulation, and afterwards, particularly in pregnant females, it takes on a somewhat relaxed appearance and becomes much less promi- nent. In case an aperture should be found, and consequently a canal exist, it might be presumed that its function was connected with encap- sulation and intracapsular life.' 7 [It would seem probable that the contraction of such a lateral band would bend the worm laterally, while, as before noticed^ the animal is always coiled on his back, the belly forming the convex side of the coil; Leuckart (Untersuchungen, etc., p. 76) says: "The opening with which we have lately been made acquainted, more particularly through the beautiful observations of Schneider (Arch, fur Anat. und PhysioL, 1858, § 426, 1860, § 234) on the morphology of the nematodes, leaves no doubt as to the nature of these lateral bands. It is a structure which gener- ally occurs in the round worms (spulwiimen), and contains a canal which opens externally on the ventral surface beneath the brain. The canal is in all probability a form of excretory apparatus — a kind of kidney."] "The cell layer lining the abdominal wall is considerably developed at the caudal extremity ; the cells are larger, gland-like, and form pro- tuberances which project into the cavity. "The,; external covering is continuous through the mouth and anus with the intestine, at the side of which posteriory is left considerable space, occupied for the most part by the sexual organs. A small space is left, however, for the reception of the small amount of nutritious florid or colorless blood, in which are occasionally seen a few elements in the form of granular corpuscles — the so-called colorless blood corpuscles (Fig. 24). "In the male, where the vas deferens, a short distance in front of the anus, empties into the rectum, which latter acts as a cloaca, is developed a network of fine fibers between the muscular layer and the intestine, in which a few distinct bands are seen (Fig. 25), whose function seems to be the withdrawal of the projected cloaca after copulation — the musculi retractores cloacce. Anterior there is no connection between the intestine and the outer wall. Pig. 25. Fle . 2 6. Fig. 25.— Posterior extremity of young male intestinal trichina, »?»: «, hooks; el, oloaca; rr, t8- traotores cloaca); vs, resieula seminalis ; *, extremity of the testicle; i, intestine (Pagenstecher). ' Pig. 26.— External male genital organs (Leuckart.) "At the vagina the external walls are continuous with those of the sexual organs, and naturally the most external layer— the chitin layer- is continued as a lining of the digestive tract and sexual organs. EEPOET ON TKICHIN& AND TRICHINOSIS. 29 ( m^-J .SW&$®i£ m -<'.The mouth is terminal. The body is more or less curved in one di- rection, and taking the female genital opening as a guide for the ventral surface the curve is always towards the back side, and it is in* accord- ance with this that the terminal hooks of the male are found on the op- posite side, and curving towards the convex and consequently ventral Side. The anus is therefore terminal, although in the female on its dorsal side there is a small but distinct prominence. This is the rudimentary tail usually found in the nematodes. As a rule the posterior portion of the male is straighter or is curved in an opposite direction from that of •the middle portion ; especially is this the case during the period of sexual activity. It is then more firm, and displays a motion similar to that of the anterior. " The male intestinal trichinae are distinguished by the earliest ob- servers by a pair of short curved hooks, or beaks, clear and colorless, which are attached by broad round bases on either side of the cloacal opening (anus), having a length some- what less than the diameter of the poste- rior extremity of the body. They have a rotatory motion, yet as a rule their con- vexity is anterior and external, and their points are directed downwards and to the rear. At the inside of the base of each of these hooks there is a ventral and dorsal ce ~ twbercle, so that the cloacal opening is sur- rounded with a line of four tubercles (Figs. 25,26). - ■ " The internal organs consist of the intes- tinal canal, the brain, and the organs of getierationk , tfThe intestinal canal, with the exception of the cloacal portion in the male, is alike in both sexes, and has several divisions. < j.i » . . . oa, line of egg production ;o ««l, n „„„ „i.i _,, . ., muscular elements in its walls (Ptgen- ttie 03SOpnagUS, although Very Similar tO 8techw) - them in size and appearance. I find these as often and as complete as could be possible with such fine Organisms. "The beginning of the third portion of the intestinal tract can be REPORT ON TRICHINAE AND TRICHINOSIS. 31 most properly considered the stomach (st., Fig. 29). It consists of a considerable pear-shaped widening of the canal, with thickened walls, its base towards the oesophagus,' and between which the blind rows above mentioned are wedged. The stomach soon becomes narrowed to the form of an intestine, although its structure remains the same. It is lined throughout with fine nucleated cells, making its walls appear darker than the surrounding tissues (Fig. 30 i). The changes of form of this portion of the alimentary canal, independent of the contractions of the body, leads to the opinion that the epithelial lining is surrounded with a muscular layer, and the lower part sometimes shows the appearance of loose muscular fasciculi with intervening spaces (Fig. 31). While the oesophagus fills nearly the whole breadth of the abdominal cavity, and the first part of the stomach occupies over one-half of its diameter, the posterior part of the intestine of a full-grown female measures only 12.5/*, At the extreme end, whether the cloaca appears as in the male or not, the layer of chitina again becomes apparent, and in the male even to a greater extent. When the worm contracts itself, and the anterior part of the oesophagus takes a zigzag form to accommodate itself to the lessened space, the posterior part of the intes- tine forms a wavy line beside the genital organs. " I have never seen a colored substance in the intestine, and it is probable that the worm feeds on the intestinal se- cretion and not on the remains of food. " Leuckart's views concerning the presence of a brain I can, most decidedly confirm. It appears as a mass of small round nucleated ganglion cells which surrounds the Oesopha- gi . . . j. ii j Fig. 32. — Bram gus where its walls begin to show the presence ot cells, ana with nerves ex- from whose extremities a number of fine fasciculi can be wards S and fc>r- traced a short distance. This body is inclosed in a special ^echer)! PaKen ' envelope (Fig. 32). "The internal sexual organs of the male are completely formed dur- ing his larval life in the muscle, so that in the intestine it is only neces- sary that their contents become mature and the hooks developed inorder that he may be ready for procreation. In the larval female these organs are only partially formed until it reaches the intestines, and thus differ- ent stages of completeness will be found among the intestinal trichina. "The male organs (Figs. 33, 34, 35) consist of a single testicle, the base of which lies a short distance from the posterior extremity of the worm. It is long, cylindrical, somewhat widened at the base, and be- comes narrower as it passes forward, and near the anterior portion of the stomach turns on itself, becomes still' narrower, and passes back- wards. In a full-grown male the testicle is 0.575 mm in length, while its average diameter is 35/*, but reaches O^TS™- 1 in some places, while in the vicinity of the vaB deferens it is only 20/i. This gland in its whole length is lined and filled with small* strongly refracting seminal vesicles, wfcieh, 32 REPORT ON TRICHINA AND TRICHINOSIS. as mother cells, contain a brood of spermatic cell elements with nUcler (Fig. 36, a). The testicle merges into a vas deferens, which, in places, particularly before it empties into the intestine or cloaca, expands, and near its extremity forms the vesicula seminalis, and is filled with sper^ matic elements, which latter have not, as far as observed, been known to undergo any change of form (Fig. 36, ft). The vas deferens, exclusive of vesicula seminalis, is O^"" 11 long, and when not distended is 12.5 to 15/* in diameter, and when empty appears clear and lined with ' cells. Three- fourths of its length is occu- FlG. 34. Fig. 33. Fig. 36. Fig. 35. Fig. 33. — Posterior extremity of a male muscle trichina, *f> : I, longitudinal band ; t, the testicle pass, ing into the fas deferens; el, vas deferens ending in intestine; i, forming the cloaca; el, r r, retractores cloaca; nt, stomach (Pagenstecher). , t • Fig. 34.— The testicle, t; vas deferens, vd; cloaca, el, with its retraotorea. r r; intestire, i. Fig. 35. — Intestinal sexual organs of a young mate intestinal trichina, a $ Q ; t, testicles ; vd, vas defer- ens ; i, intestine ; vs, vesicula seminalis ; cl, cloaca (Pagenstecher). Fig. 36. — a, mother cells, 3 } 2 ; 6, seminal elements, 1 S - ciculus, not only in its immediate vicinity but also as far as the single fiber can be traced, sometimes over 5 mm or 6 mm . This destruction con- sists in a morphological metamor- anram phosis (similar to that found in the so-called parenchymatous my- ositis); the fibrillar substance de- generates to a fine granular detri- tus, and all that can then be Fig. 49— Changed fasciculus showing granules, nu- distinguished is the nuclei (FiffS. olei, and young triehinse (Leuekart). ' , \ o 49, 50), which appear as small oval bladder-like bodies 10 to 16/* long and 4/i in diameter, with a sharply defined wall and with a sometimes single and sometimes double solid nucleolus. When two nucleoli are pres- ent they are generally found at the extremities of the nu- cleus, and the wall will be more or less contracted in the* middle; there can be no doubt that^ this is the beginning of a division into two new nuclei. This ac- Fig. 50. — Normal fasciculus with changed fasciculi, containing worms in different degrees of development, on either side (Leuekart). counts for the fact that the nuclei are always more abundant in the de- generated fasciculi than in the normal. As the transparency of the fasciculus is interfered with by this change in its substance* it ap- pears as a dark thread-like stripe. The changed fasciculus loses its ■•■'•3 Fio, 51. Changed and normal fasciculi. The normal are contracted while the altered ones project on account of their lack of elasticity (Leuekart). contractility, as is shown when the bundle is divided; the granular substance then projects sometimes to the extent of a millimeter (Fig. 44 REPORT ON TRICHINA AND TRICHINOSIS. 51), while the muscle substance is contracted nearly with the sarco- leinma, and it is with this projection (Leuckart says later that the projection is caused by pressure) that muscle trichinae are sometimes carried beyond the limits of the sheath and are then said to be free (Fig. 52). I have found free trichinae often, but they were not developed beyond their embryonal state, and they are not found as often as those freed by chance or by the. dissecting needle. When it is seen that the fasciculus is changed, not only in the immediate neighborhood of the worm, but for a considerable distance beyond, it might easily be con- cluded that the change has been produced by the progress of the worm through it, and this is the opinion of many observers. Zenker (Archiv. fur Patholog. Anat. Bnd., 18, p. 566) says that it consumes the contractile substance of the fasciculus (also Ger- lach, "Die Trichinen," p. 18); but the contents of the alimentary canal are fluid and probably are the result of en- dosmosis and are not swallowed, for I believe that the embryo after reaching , , . .. the muscle falls into a condition of rest Tin. 52.— Unchanged muscle fasciculus with. an embryo escaping from the sarcolemma similar tO that 01 a chrysalis, and. that in spite of his motionless condition the whole contents of the fasciculus degenerates, partly through the con- tinuity of the contractile substance and partly through the continuation of the irritation. When the infection is of a high grade, not seldom two or even three trichinae are found in the same fasciculus ; sometimes the degree of development is so unequal that the younger must have found his home in an already degenerated bundle (Pig. 49). The occurrence of degeneration is in no way a hindrance to a new migration. " Simultaneously with the degeneration of "the fasciculus there com- mences a proliferation of small cells in the surrounding connective tissue, which extends over the whole length of the sheath, and in some cases to the neighboring fasciculi. According to Colberg the nuclei of the capil- lary vessels also partake of this change to such an extent that the dis- tribution of the inflammatory products (as also of the blood)»is interfered with. The blood-vessels themselves are enlarged and elongated, often taking a *' cirsoid " appearance. By many these changes, at least as far as the contents of the fasciculus are concerned, are supposed to bear a direct relation to the activity of the worm. Zenker, as stated above, thinks that the embryo eats its way through the fasciculus, and that it is possible that the oval corpuscles (muscle nuclei) may be masses of ex- crement {Kothballen). This is on the supposition that they retain their previous activity. But the same thing occurs here as with the cestoides and other helminths ; after reaching their future resting place they fall into a condition of repose necessary for the growth of the body and fur- ther differentiation of the organs. The only motion observable after entrance into the muscle bundle is an exploratory vibration of the ante- EEPOET ON TRICHINA AND TRICHINOSIS. 45 rior extremity ; but this is soon lost, perhaps before the above changes are completed. Then begins, with the entrance of complete rest, snch a rapid growth that the worm in the course of 12-14 days : — about three weeks after infection — becomes a fully formed and matured muscle trichina. The body changes its form. While the embryo prior to migration showed a somewhat slender form (1.20), it now takes on a more plump appearance (Fig. 53). In trichinae measuring 0.4 mm in length (Fig. 54), such as are- usually met in fourteen to sixteen days after infection, the relative thickness is nearly double (1.11), in the largest part of the body. The anterior third, however, is more slender in proportion to its former state, and diminishes in size to its extremity similar to the fully developed worm. The "posterior end also begins to show the abrupt rounding of its future form. Similar changes also occur in the in- ternal organs, which now not only become more distinct than before, but separate into oval tube (Munddarm), cell, body, and stomach {Glvylusmagen), and have a more or less complete distinction in histological character. Espe- cially is this the case with the cell body w^iose large cells have a disk shape, 19p in breadth and 1.5/t in thickness), and are ranged one above the other in a tolerably regular column. The thin chitin tube of the anterior extremity, extending through the cell body to the stom- ach, also may be seen, even in worms meas- uring 0.3 mm . The primitive sexual gland is seen in the form of an elongated sac, whose pointed anterior extremity either extends beyond the stomach, as in females, or in the male bends abruptly backwards. The open- ing into the rectum is first seen in worms of about 0.53 mm . The oval tube has a propor- tionate length, and near its middle shows distinctly the first trace of the nervous sys- tem, which in the form of an oval enlarge- Hi ment is distinguished from the cylindrical Sia. 54. -Muscle lnass - Fig. -Muscle trichina i mm length (Leuck- art). trichina having reached a length of 3™* (Leuck- art). " With the more complete differentiation of the internal organs is connected an in- crease in the size of the whole body. The young worm increases more in length than in breadth, and its previous plump form gives place to a more slender appearance; at the same time the body becomes bent and curved until, after a more considerable increase in size, it finally assumes an irregular spiral position, In the larger sarcolemma sheaths the coiling commences soonest, when the worm is scarcely 40/* in length, but is more or less retarded when they are narrower, but it occurs in 46 REPORT ON TRICHINAE AND TRICHINOSIS. the narrowest sheaths, even in those whose lumen scarcely exceeds the diameter of the worm. The sheath enlarges around the trichina, and this occurs in the largest sheaths as well as in the narrow ones. It is apparently due to the outward pressure caused by the worm. The spindle shape of the tube is explained by the elasticity of the sareo- lemma, which has now lost its former delicate appearance. This increase jn size stops when the worm comes to maturity, i. e., two, to two and one- half weeks after the worm has reached the muscular tissue. The bright halo surrounding the worm, and which is now sharply limited by the inclosing muscle, is the. optical expression of the enlargement. The con- tents consist, besides the worm, of the above-described granular ma- terial, which even at this period contains numerous muscle nuclei which are paler and more transparent than at first. " The enlargements of the sarcolemma show many differences in form ,.,™*™,,«*=^ ,„, and size, sometimes slender and extended, sometimes short and bulging; in one*theend abruptly truncated, in others gradually passing into the normal size of the fasciculus. As a rule, the di- ameter of the sheath is scarcely more than a fourth or a fifth of the length, while the remains qf the fasciculus appears as an ap- pendage four times its length (Pig. 55). I have distinguished sex- ual differences in worms measur- ing 0.41 mni by the form of I the genital sac. " The migration of the trichinae during this time has not for one moment ceased, and they may be seen in all stages from those just Fig. 55.-After a preparation from a hnman body dytag arrived in tne tissues to those S^S^i5^^*2g?^ia2^SSaSSS: measnringr 0,7»» in length and ^^^SSJ&^S^'j^^S^S: completely coiled. In these cases the slender end is more closely coiled than the posterior, which lies in the periphery of the coil. "In the rabbit, after the sixth week, I have found no living trichina? in the intestine, and only a few in the fourth and fifth. Fiedler gives 34 days and Pagenstecher 56 days as the last appearance of trichinas in the intestine. I have found them in the hog in the twelfth week. In the Hedersleben epidemic intestinal trichinae were found in the seven- teenth week." Beferring to this epidemic, Cohnheim (Virch. Arch, xxvi, 1866, p. 161) says: "The later-found trichinae showed no essential difference from llSlfllfltt MR! pm Hi ^^PUP^^^^Ii^fcfc H *i?'^, ■■ Mv-!" m \ l§ I ■ t k£ ^9wwi mmM - i w ^wWfflM&it&F ► ' M pi-l&iii™ * -, x'-'Vi -Mfrnk^Mi 111 ■ HE | ; iff|»l WSm g |||i|| . 1' ?J\ !>' * '7 '4 ' fv:;w4t#|tef i ,; HV.< ; ' i^^^^^HraM^^^^'i^i^^'iBilif/lE^i^^P flK^ilHSff^S B^^Sf'^-'"*^ |^p \W> P^#«tete • % i fcf. : # ;'■' 'M IheI REPORT ON TRICHINA AND TRICHINOSIS. 47 those found earlier, but those found still later, besides the coiled or en- capsulated muscle trichinae, no free ones, or only those very much disin- tegrated, could be found," and thus concludes that there is a periodicity in their birth and distribution. Wagner (Arch, der Heilkunde II, 1864) found no intestinal trichinsB in two cases, one of which died on the twenty-third, the other on the twenty-sixth, day after infection. Dr. Bergen (I. c.) found encysted and free trichinae about the fourth week. Vogel believes that the trichinae die after exhausting their stock of eggs, and also seems to think that they belong to the class of animals that lay their eggs but once. But this is'easily disproved by finding old worms with eggs and somewhat shrunken ovaries. Kramer (Deutsche Klinik 30, 31, 1872) found trichinae free after the seventh week after in- fection ; they lay more between than within the fasciculi, with here and there a trace of a capsule — and part of them were not mature — presuma- bly of a later infection. " In the fifth week, or as late as the sixth, after infection the trichina lies in the above-mentioned tubular sheath, which, on account of the presence of the parasite, has become spindle-shaped, ahd has a double contour. Besides the parasite, the contents consist of a granular mass, with the oval muscle nuclei. Sometimes the enlargement is long and slender, gradu- ally lessening to the original size of the fasciculi, or it may be short and thick, The granular sub- stance may fill the whole space (Fig. 56), or in other cases the enlarge- ment, with a well-defined constriction near either end, has ouly scat- tered masses throughout the tube. I believe this constriction to be the first trace of the capsule, and that it consists of a deposit of a clear sub- FIG. 56. — Spindle-shaped tube before encapsulation commences (Leuokart). Fig. 57. -First trace of capsule. stance in the inside of the sheath in the form of a ring at the capsule, (Fig. 57), and the later capsule of the muscle trichina is produced by a peripheral consolidation of the contents of the changed sarcolemma sheath. This opinion is further strengthened" (see description of ma-, tured capsule in the first part of this section) " by isolation and treat- ment of older cysts with caustic potash, when a line of the same sub- 48 REPORT ON TRICHINAE AND TRICHINOSIS. stance (chitin?) can be traced from one pole, around the periphery office sheath, to the. other. j,' ;•:■.. "After seventeen weeks the trichinae lie in a clear space, 0.4 to 0.5™? m i long, inclosed at the extremities and having a clearly denned outline. The tubular portion of the sheath disappears, and in its place is seen only a line of connective tissue, rich in granules, abutting against the end of the connective tissue inclosure. But without a knowledge of the previous condition nothing abnormal would be suspected. The capsule, by proper and careful treatment with alkalies or acetic acid could be turned out of its sheath. These capsules are still thin, and sometimes of so little firmness that they may be bursted with slight pressure. Their walls consist of a clear, structureless, stratified membrane, with 3TiG. 58. — Capsule formation showing lamination at extremities (Lenckart). numerous molecular granules similar to, but in less number than, those found among the nuclei in the contained space. The proportion of the length to the thickness is, as a rule, 4 : 3, although there are shorter cap- sules of a more bulging form, and they may even be spherical (Figs. ,9-11). Their length is about 0.4 mm ." (Davaine (op cit., p. 735), quoting Bristowe and Eainey, says that the cyst is simple and the product of secretion of the worm. The walls are distinctly laminated, but the lamination is not sufficiently uni- form to warrant the assertion that there are two walls. Generally the layers are partly separated, and the spaces are filled with !FlG. 59. — Encapsulated trichina showing sarcolemma granular matter). sheath and cell proliferation (Lenckart). „,, , . , . . ,-. , . a The lamination is more distinct at the extremities, where the wall is thickest and more condensed, espe- cially in the citron-shaped cysts, whose tap-like, projecting ends are completely solidified, so that the contained space has a simple oval form (Fig. 58). The contained worm (three months after infection) is com- pletely grown, but the granular body of Farre cannot as yet be seen. (See, also, Fig. 63.) "The surrounding sarcolemma still retains its former appearance, and is about lp thick over the lateral walls of the cyst, but projects beyond ; the ends, sometimes in a lengthened tip (Fig. 59), or may be more open, and shorter, as in Fig. 58. The latter is the most usual form. The ends appear as if cut off, but in many cases they can be traced for some REPORT ON TRICHINAE AND TRICHINOSIS. 49 - ^Network of capillary blood-vessels surrounding sarcolemma sheath (Pagenstecher). .distance as delicate, pale tubes, apparently the remains of the original appendages. As a rale, these can be followed only a short distance from the capsule (Fig. 58). Sometimes they are very irregularly ser- pentine or coiled. "After fifteen weeks the side walls of the capsule have a thickness of about 26/jl. The inner sur- face of the capsule presents, in many cases, the appear- ance as if lined with pave- ment epithelium, occasioned by the presence of numer- ous muscle nuclei which are closely pressed against the Rs, wall, some of which also seem to be inclosed in its substance. After injection, the connective tissue envelope shows a rich network of capillary blood-vessels (Fig. 60) de- scribed by Luschka, and .which, according to Colberg's investigation, proceeds from the small proliferative cell seen in the commencement of the new formative connective tissue, &c. Each pole has an independent vascular system with afferent and efferent vessels, which connect with the muscle capillaries" (Leuckarfc, Untersuchungen, &c, and Menschl. Parasiten, ii, 3). CALCIFICATION OF THE CAPSULE. Fiirstenberg saw the beginning of calcification in a rabbit eighteen months after feeding. Pagenstecher (op. tit, p. 96) gives eighty days for the first appearance of calcareous concretions in the rabbit, and al- though it has been denied by Haubner that calcification occurred in the hog (see Pagenstecher, op. tit, p. 9,) he saw traces after one hundred days. [The first case in which trichinae were observed in the hog (Prof. Leidy, I. c.) contained calcified capsules. Dr. Miiller (Virch. Arch., 1866, p. 253) found degenerated capsules in the hog. Delpech (op. eit, p. 72) reports, on the authority of Dr. P. Memeyer, the occurrence of calcified trichinae capsules in the muscles of a hog confiscated in Neustadt in Magdeburg. Leuckart saw (Untersuchungen, &c, p. 67) traces of calcification in a hog five months after infection. See, also, reference from Nathusius Ann. d. Landwirthschaft in den konigl. preuss. Staaten, 1865, Jahrgang, 23, p. 50.] Fiedler saw punctiform calcareous deposits in 17-18 months. Vo- gel found concretions in a dog after five months. Friedrich (Deutsche Arch, fur klin. Med., Bd. ix, p. 454) saw capsules with commencing calci- fications on the one hundred and first day. Warfwinge (Svenska Lakare Sallsk. Forf., p. 182) saw signs of calcifications after six weeks, and E. Wagner (Arch, des Heilkunde ii, 1864,) in two cases, after twenty-three and twenty- six days, respectively, claims to have seen trichina? encapsu- lated and partly calcified. ' Gerlach (Die Trichinen, Hanover, 1873, p. 4) saw trichinae capsules thirteen and a half years old in different degrees S. Ex. 9 4 50 REPORT ON TRICHINAE AND TRICHINOSIS. of calcification; some were completely opaque, some partly transparent, and others having the deposit only at the poles, and says that it is an error to pretend that calcification occurs before the eighteenth month. Damman (Deutsch. Zeitschrift, Bd. 3, 1876, p. 92) found capsules uncal- cified eleven and one-fourth years after feeding. The process of calcification, according to Leuckart (I. c), is as follows: Fig. 61. Fig. 62. Fig. 61.— Commencing calcification, deposit seen only at one extremity of the capsule (Leuckart). Fig. 62.— Progressing deposit of calcareous granules now forming a watchglas disk (i.eucKart). "There is seen beginning at either pole of the capsule a more or less flask-shaped or spread out accumulation of minute calcareous granules? which may remain isolated for some time or soon become a homoge- neous mass, having the form of a disk and lying between the layers of the capsular wall. Sometimes, as in Pig. 61, this process takes place at one pole only. In all cases its margin is well developed, and from its different refracting power is readily distinguished from the surrounding mass. In a hog killed six and a half months after feeding [with trichi- nosed meat], I saw capsules in which there was not a trace of calcifica- tion ; others were found as above, but in the greater number there was an irregular concretion which sometimes, with the adjoining uncalcified layer of the capsule wall, projected like a hump (buckelformig) into the cavity. These occurred mostly in the citron-shaped capsules, but in those more nearly globular the disks were more the shape of a watch glass (Fig. 62). I found the first trace of fat globules in this case. I cannot tell when the process is completed, but probably after fifteen or sixteen months more. In hogs this process commences after six months in most cases. Fiedler says the seventh and eighth, and Pagenstecher the eighteenth, month. Nevertheless, there is great variety and irreg- ularity, perhaps due to idiosyncrasies. Sometimes, capsules will be found without a trace of calcification in bodies, when the rest are com- pletely calcified. The process does not stop with the calcification of the original capsule; the latter becomes thicker at the expense of its con- tents, and after a long time the worm itself may be changed (Leuckart Untersuch., &c). Gerlach (Die Trichinen, Hanover, 1873, p. 22,) says: " The stage of capsule formation begins in the third and ends in the eighteenth month after feeding with trichinosed meat. At first, after the capsule is completed, there occurs a shrinking which lasts two months the capsule becoming somewhat thicker and rounder, after which it re- mains unchanged for four or five months. In about six months, some- REPORT ON TRICHINA AND TRICHINOSIS. 51 times sooner, groups of fat globules are seen in the vicinity of the poles ; after twelve to fifteen months the fat globules appear in the capsular walls. * * * The stage of calcification, beginning in the eighteenth month, in some capsules appears quite distinct in the second year. In the early months of the third year a few capsules are nearly opaque, and can be seen by the naked eye as small bright points about the size of a pin's head in the surrounding muscle." RECAPITULATION OP PROGRESS AND DEVELOPMENT OP TRICHINAE.— GERLACH. " Tenth day. — Completely developed intestinal trichinae and a few embryos migrating towards the muscles. " Twentieth day. — Muscle trichinae about one-half their usual size ; some embryos, none capable of development to muscle trichinae. " Fourth week. — Oldest and most of the tri- chinae fully developed ; traces of capsules ; high grade of myositis. " Sixth week. — Sheaths begin to close up by condensation of nuclei against the wall, and from thence they project towards the middle forming an arch at the end (Fig. 63 a a) ; some trichinae in open sheaths as in fourth week. "Second month. — Capsules fully formed ; some as in sixth week. "Third month. — All the capsules are fully formed; inflammatory, process is ended; sur- rounding muscle regains its normal appearance ; finely granular substance at the poles. " Ninth month. — The capsules become shorter and more round ; greater or less number of fat globules are found particularly at the ends of the capsules, but they are absent in some cases. " One to one and a half years. — Fat globules in the capsules and outside, especially at the ^^SSFS^S S£ poles ; traces of calcification. " After one and one-half years commencing, and after two years distinct, calcification, but not in all capsules." According to Bristowe and Eainey, quoted by Davaine (op. cit., p. 739), the collections of fat are composed of vesicles similar to normal adipose tissue. The vesicles are polyhedric from compression and contain a transparent liquid, soluble in ether, which runs in oily globules when the vesicle is broken. This fat is distinguished from that of normal parts, in that it contains fine acicular crystals in the center of the vesicles, probably consisting of stearin, and also that some of the vesicles show signs of vaeuolation and division. after feeding. The spindle- form cells (6) condensing on the inside of the sarcolemma sheath, and forming arches a a at the extremities (Gerlach). 52 REPORT ON TRICHINA AND TRICHINOSIS. " Sometimes (Leuckart, Menschl. Par. ii, 3, p. 575) the connective tissue surrounding the cyst gradually becomes developed to considerable ex- tent-so that it may be truly said that the trichina has a connective tissue covering— which often increases to such a degree that the capsule may appear as large as a millimeter in diameter, and may be seen with the naked eye. In these cases I have found the contained worm dead, and no doubt this bears a casual relation to the unusual connect- ive tissue development, and the latter may thus be considered a path- ological process. It is probable that these changes— the greater number at least— are the consequence of an unusual severity of the myositis due to individual peculiarities. It generally occurs early in the disease, and ftien the cysts proper fail to appear or are only incompletely developed: Instead of the cyst the fibrous sheath incloses only a clear space with a more or less defined outline containing the usual granular substance and the dead worm (Fig. 64). In recent cases the worm distinctly shows the form and Fig. 64. Fig. C5. Fig. 64.— Pathologically changed trichinae capsules "with thickened connective tissue envelope and dead ^vorms (Leuckart). Fig. 65. — Encapsulated calcareous concretions, the remains of dead trichinae (Leuckart) . characteristics of the muscle trichinae, only that the body is more or less shrunken and assumes either wholly or partially a homogeneous, glittering appearance; they are apparently undergoing a fatty meta- morphosis, which appears later, as does also a deposit of lime salts. The body becomes hard, friable^ and shattered, and breaks under the glass cover and even by the muscular pressure, so that the growing connective tissue capsule is intimately mixed with it. Capsules are also sometimes found which, instead of a worm, contain only irregular, generally angular, calcareous concretions (Fig. 65). These concretions REPORT ON TRICHINAE AND TRICHINOSIS. 53 are probably the remains of cysts, as open spaces and even distinct tri- chinae may be seen in them. This calcareous deposit does not occur 'exclusively in the degenerated capsules, as it may occasionally be seen in normal cysts after ten years, but only after the cyst itself is com- pletely calcined. In such cases the worm retains its characteristic form, although here it occasionally happens that instead of the worm there may be seen a number of sharp-cornered fragments, or one or several amorphous concretions ' of different sizes (Figs. 66, 67, 68, 69). Some- times even empty cysts may be found in which the dead worm, instead of becoming calcified, has been absorbed. This last circumstance shows the possibility that the trichinae may occasionally be absorbed during the excessive development of connective tissue, which opinion is sup- ported by the result of the examination of a rabbit sent to me." (L. "Menschl. Par: ii, 3, p. 578.) Fig. 66. Fig. 68. Fig. 69. Fig 66 — (Bristowe and Eainey) a, cyst, containing a worm, c, very much altered and commencing to reous gTanulesV and the anterior portion tf is swollen with a refractive calcareous deposit (Davaine). Fig 67.— (Bristowe and Eainey) only the angular fragments of the worm are seen (Leuckart). Fig. 68.— (Bristowe and Eainey) if cyst invaded externally and internally by fat vessels. The worm has disappeared (Davaine). Fig. 69'.— (Bristowe and Eainey) the cyst has almost completely disappeared under the mass ot tat glpbuies (Davaine). The question as to the acid of the calcareous salts deposited is thus treated by Davaine (op. cit., p. 737, Note 6). "According to Kiichenmeister the granules are composed of calcic carbonate and an organic substance. Ohlorhydric acid dissolves the salt and renders the presence of the carbonate apparent by the evolu- tion of bubbles of gas. The effervescence observed by Kiichenmeister 54 REPORT ON TRICHINA AND TRICHINOSIS.' does not come from the- granules- contained in the walls bat from the calcic carbonate, which is sometimes found free in the cavity of the cyst, for M. Bristowe says positively that the earthy granules of the * walls are dissolved without effervescence; at least,: they resist the action of acetic acid. However, the absence of effervescence and the preservation of the form of the body observed are not at all absolute characteristics of the non-existence of calcic carbonate. I have shown, in my Becherches sur la generation des hmtres (1852), that the calcic carbonate in a minute quantity cannot produce an effervescence by the action of an acid; the carbonic acid gas is dissolved in the surrounding liquid as soon as it becomes free. In this case, while an insoluble organic substance preserves the form of the body under observation, it might be thought that this lime salt did not occur; but the presence of a carbonate may be recognized by treating with concentrated acid after the substance has been thoroughly dried, or, better still, by treat- ing in water previously saturated with carbonic acid gas." Leuckart says that there is a development of gas on the addition of an acid. (Menschl. Parasiten, ii, 3, p. 536.) Gerlach (Die Trichinen, p. 20) says: "I have never seen air-babbles appear on treating the gran- ules with chlorhydric acid under the microscope. They therefore can- not be formed from the carbonate, but more probably consist of the phosphate." Pagenstecher (op. cit., p. 96) says : " The nature of this substance was clear from the production of gas babbles on the addi- tion of acids." Scoutetten (op. cit, p. 31) says: "The material which forms these deposits is soluble in chlorhydric acid with the evolution of gas." Section C— OEIGIN AKD DISTEIBUTION. In general, the question of the origin of trichinae is perhaps of more importance in a scientific than in a medical or commercial point of view, ^although it is in relation to the latter that I have attempted to obtain information. Several theories have been advanced on this subject: first, in regard to the original "hosts" or bearers; second, in regard to the country from which they originally spread; and, third, the means of distribution. The vegetable (Delpech, op. cit, p. 47) as well as the animal kingdom has been searched for a clue to the first question. Schacht observed what he thought were trichinae in the capsules found on the radieels of the sugar beet, but Virchow (Virch. Arch., Bd. 31, p. 350) has demon- strated that they are not trichinae. This has been confirmed by Kiihu, and also later by Stein, who "has so exactly studied the animals found on the beet that all thought of any relation whatever must be aban- doned. However, the beets diseased by becoming the home of the worm are often the cause of epidemics in cattle fed on them." (Steno- graphischer Bericht d. Verb. it. d. Trichineni'rage, &c, Berlin, 1866.) See, also, Virchow (Lehre von den Trichinen, &c, p. 57.) REPORT ON TRICHINA AND TRICHINOSIS. 55 It is now generally admitted that the muscle trichina is found only in the muscles of the warm-blooded animals, and is mostly limited to the carnivora. Their occurrence or propagation in the cold-blooded vertebrates is denied by Cobbold (Remarks on Dr. Elendenen's paper on "Trichinae in Fish," London Lancet, November 16, 1878; see Cobbold, I. c). Colin (Compt. Bend., lxvi, 1867, p. 31) infected animals with the dejections of fish and reptiles to which he had previously fed trichinous meat, and which could not themselves be infected. Goujon ( Journ. de l'anat. et de la phys., etc., 1867, No. 5, p. 529) gives an account of the trichinization of a salamander — whose body was maintained at a temperature of 30° C. — which Leuckart (Menschl. Parasit., II, 3, p. 513,) says, "this animal prob- ably contained a trichosomum, which is very similar to the trichina. Meissner says (Sch. Jbr., 138, p. 110), " intestinal trichinae do not develop in cold-blooded animals." The occurrence of trichinae in fowls is also de- nied by Leuckart (I. c. and Untersuch., p. 74). Dr. Bryant (Richmond and Louisville Med. Journal, 1865) found entozoa in a hen, which appeared like the trichinae found in human muscle. Bakody (Zeitschrift fur wis- sensch. Zoologie) said he had seen trichinae in the hen, but Gerstacher (Virch. Arch., xxxvi, p. 435) examined specimens sent to Professor Vir- chow and said they were the trichina affinis. Vogel (Path. Anat., etc., Leipzig, 1845) reports having found trichinae in the mole ; also Herbst (op. cit., No. 12, p^ 183). On this subject Scoutetten (p. 43, op. eit.) says: " Vir- chow and Fiedler tried in vain to find trichinae in the mole. They found worms, but these when fed to hogs did not infect the animals. The results of those experimenters who claim to have found trichinae in moles are doubtful." Delpech says (op. cit., p. 47) "The larvae, of flies cannot serve ' for the transmission of trichinae. * * * I eliminate also the mole, of which the parasite's are found in the brain as well as in the muscles, and, as has been determined by Kiihn, differ zoologically from the trichina as found in man and in the hog." Leuckart says (Untersuch- ungen, &c, note (t), p. 31), "What has occasionally been represented as trichina affinis is either identical with the trichina spiralis (as those found by Lei'dy in the hog) or is not a trichina at all. The genuine name 'trichina' has occasionally been applied to the larval condition of different nematodes. The trichina of the mole, for example, is an ascaris ; that of the larvae of insects is a spiro-pteraP (See, also, Leuckart, Menschl. Parasiten, II, 3, p. 513, and Davaine, op. cit., xcix.) In regard to the nomenclature of the trichina found by Professor Leidy in the muscles of the hog, he writes, May 7, 1880 : " Diesing, Systema Helminthum , ii, 114, 1851, refers to my notice of the above from the Ann & Mag. Nat. Hist., 1847, 358, and refers the worm to another species with the name trichina affinis. From the high au- thority of Diesing, 1 accepted this decision in Proc. Ac. Nat. Sc, 1856, 48. It was, however, a mistake, as there can be no question at present that the parasite of the pork was the trichina spiralis." 56 REPORT ON TRICHINA AND TRICHINOSIS. Cobbold {pp. tit., p. 157) says: "Certain nematodes found in earth-worms have been described as trichinae, and consequently pigs, hedge-hogs, and were said to become trichinosed through eating these annelids. The minute flesh- worms, de- scribed by Bowman, from the muscle of the eel are not true trichinae any more than the somewhat similar parasites which Eberth found infest- ing the muscles of the frog. The same may be said of Dr. Salisbury's 'urinary' trichinae (T. cystica), which are the larva? of Filaria Bancrofti (Fig. 88).'' (See also Gobbold, op. tit., p, 180 ; Delpech, op. tiU, p. 53.) "Important errors in connection with the subject of trichinosis- have been committed by the most competent men. These errors consist in confounding animals of essentially different species with trichinae., The parasites of the earth-worm, mole, and the worms found on the beet have been sufficiently studied. Thus far none of these animals found otherwise than in the striated muscular fiber can be compared zoolog- ically with the trichina, although resemblances more or less close might have deceived the first observers. This observation will apply to the ' parasite found several times in the Trito cristatus after ingesting trichi- nosed meat. Legros, quoted by Eodet, considered them as trichinae. Pagenstecher has demonstrated that they are anguillules, and that he has met them as often in animals that have not ingested trichinosed meat as in those to whom it has been fed. Dr. Merland de Chaille (Bull, de l'Acad. de Medicine, 1866,. t. xxxi, p. 485) tried to show, con- trary to the assertion of Virchow and of those authors who deny the presence of trichinae in the herbivora, that the sheep contains them in large numbers. The cysts vary in size from that of a small hazel-nut to that of a pigeon's egg, and, as he gave no description of the worm, 1 believe that they contain young strongyles (strongylus filaria). Also, Professor Tigri, in the same journal (p. 533), tries to prove the similarity of the same nematode with the trichina. I have determined the differ- ence between the two in specimens shown me by Dr. Oornil. In the case where Lebert (Gazette m^dicale, 1866, 1. v., No. 19) mentions the possible connection between the trichina and worms found in the pus of an abscess of the uterus in a woman suffering with cancerous ulcer of that organ there can be no doubt, as their form and appearance is entirely different." In two cases the vinegar eel (see section 26, Angiiillula aceti), (Jahres- bericht der ges. Med., &c, i, 1878, p. 514,) from the acetic acid used in making preparations, was mistaken for trichinae. Davaine (or> tit t> 754) says : "' *" "In a great many cases the observers, not knowing that a number of nematodes live encysted in the organs, or free in the earth or in vegeta- bles, were mistaken in the species of the worm that they saw. It is not sufficient that they should inhabit a cyst to be called trichinae; and those cases reported without a sufficient description of the worm might EEPOET ON TKICHINJ2 AND TRICHINOSIS. 57 also be called in question; as in the case of Vogel, 'trichinae in the owl;' of Herbst, in the mesentery of the strix passerina; of Diesing. in the horse; of Von Siebold, in several birds; of several observers, in the mole; of Bakody, in the intestines of domestic fowls" (Eepert. de Stutt- gart, 1875, et Eecueil, p. 147, 1874). Finally, Virchow (op. tit, pp. 56, 57) says: "Inaccurate observers would certainly find trichinae everywhere. There is a number of small round worms which, in their occurrence, size, and form, are similar to trichinae, but which are not on that account trichinae; e. g., formerly every round worm which occurred anywhere in the meat, or which was small and undeveloped, and perhaps spirally coiled, was called trichinae. In the primitive bundles of the eel (Bow- man, Cyclopoedia of Anatomy, vol. ii, p. 512) and frogs (Kuhn (Virch. Arch., Bd. 36, p. 222) Eberth, Zeitschrift fur wiss. Zoologie, Bd. xii, § 530, Taf. xxx, vij.) occur round worms which are similar to trichinae, yet may be easily distinguished by characteristic peculiarities. Lang- enbeck, of Hanover, supposed that he had discovered trichinae in many of the lower animals, viz, in the greater number of the earth-worms, and that hogs roaming at large became infected by eating them, espe- cially the Hungarian hogs, but I do not find that these are more apt to be infected than others. However, earth-worms do not contain tri- chinae, although microscopic round worms are found in them. The well- known ascaris minutinima is no more a trichina than the later described dieiUs. I have, with Dr. Gerstacher, made observations and determined the intrinsic differences. Other observers (Virch. Arch., 1865, Bd. 32, p. 341) have come to the same conclusions." (See also sections G and H). With such facts before us we might be led to inquire if there is not a possibility that other mistakes less amenable to correction might have occurred. The occurrence of trichinae in the rabbit is explained by that animal sometimes becoming carniverous during the winter, when deprived of its proper food. Meissner (Schmidt's Jrbr., No. 138, p. 110) says that vege- tarian, animals are very likely to develop trichinae. Trichina} have been found in the cat by Voget (Traite d'anat. path, generate, p. 409, note, Paris, 1847), Giielt, in 1849 (Nachtrage, etc., und Lehrbuch, der path. Anat. der Helminthes, Berlin, 1849, p. 144), and Herbst, 1848-50 (Nachrichten, etc., Gottingen, 1854, p. 419). Leuckart (Uhtersuch, p. 71) says Giielt found a natural " host" in the cat, and that he had only lately observed spontaneously trichinosed cats. Bupprechb and Kiihn also found trichinae in cats. In the dog.—W. Erb (Centralblatt fur die med. Wissen, No. 61, 1864), Perroncito (Bern, Zeitschrift, 1877, p. 200) reports having found trichinae in a dog in Turin. This was stoutly denied by Sylvester ( Jahresbericht, etc., i, 1877, p. 601). Gaillard in spaniel in Algiers (Movm. Med., 1866, p. 490). Davaine (op. tit., p. 753) says if the adult dog cannot become trich- inosed he certainly can in his youth, and cites numerous experiments. 58 REPORT ON TRICHINA AND TRICHINOSIS.' A case is reported (see Bost. Med. and Surg. Journal, November 12, 1874, p. 471) where an old woman in Germany became thoroughly in- fected by eating the flesh of a dog. Goose.— Sixty soldiers (see Phil. Med. Times, April 13, 1878), at Thiersville, were taken sick with trichinosis from eating the flesh of a goose. Polecat.— One case in Westphalia (Jahresbericht, i, 1877, p. 601).$ one by Womberg (see Leuckart, Untersuch, p. 72), O. V. Linstow ( Virch. Arch., 44, 1868, p. 579) ; also, Virchow and Wedl, Report to Med. Soc. of Vienna, 1867. Foxes.— Several were shot (Allgem. Med. Cent. Zeitung) which con- tained trichinae in large numbers, also a case reported by Ficinius (Vir- chow, I. c.) and Leuckart (p. 11, note) and Prof. Wedl (I. c). Wild boars were killed in Saxony (Jahresbericht, etc., i, 1875, p. 645) containing numerous trichinae ; also, Erfurt-Staat Esterode Eulenberg (Vierteljahrsschrift f. Ger. Med., 1878, p. 149), and a case of trichinous infection in Leppspringe from eating wild hog. (See Jahresbericht, etc., 1878, p. 574.) Horse. — Trichinae found in a horse's eye (Bost. Med. and Surg. Jour- nal, November 12, 1874, p. 471. See also section G, 6 " differential diagnosis"). Ape. — Panstecki found trichinae like encapsulated round worms in a West African ape (Jbt. der gesammt. Med. i, 1868, 194.) Herbst (I. c.) found trichinae in the crow and badger. Heller (Ziemssen iii, p. 628.) Wedl in the raccoon and marmot, and Ficinius in the marten. (See Leuckart, I. c.) Eats. — Leisering (Sach. Bericht, p. 97) examined 133 rats in Saxony. Of 42 from 7 different flayers, 4 from 3 different yards contained tri- chinae and 11 infected among those from slaughter-houses. The rest were free. (Jbt., etc., i, 1868, p. 505. In Saxony one-half of the rats from flayers contain trichinae; 20 per cent, of all rats caught contained trichinae. Adam (Woch., 1866, p. 65).— Of 13 rats caught in Augsburg none in- fected ; of 5 from flayers 2 were infected. Roll (Oert, 36, p. 88).— Of 175 rats from Vienna and vicinity 4 con- tained trichinae, also 16 out of 20 rats in Moravia, 4 in Bremen, Ji from flayers, and 2 from a house in which a patieut had died of trichinosis. (Jahresbericht, etc., 1866, i, p. 452.) Eektorzek (Wochenbl. der Zeitschrift, etc., Wien, No. 47). Of 105 rats from Lemberg 4 infected, and all but 17 of the remainder contained par- asites of some kind. Op. tit. Stirling ( Journ. d'anat, et de la physiol., May, 1872, p. 425) found one case (Jbr., i, 1872, p. 601). Benz (Wurtemb. Med. Oorr. No. 1, 2, 1866).— Of 31 rats in Wurtem- burg 3 contained trichinae (op. tit. i, 1867, p. 309). Keylow (Deutsch. Zeitschrift, iii, 1876.)— In Jaroslav, in Russia, 2 out of 26 rats, and in Oharkov 3 out of 7, contained trichinae. REPORT ON TRICHINA AND TRICHINOSIS. 59 Goujon (These de Paris, 1866).r-Of 72 rats caught iu the ditches of Paris 5 were full of trichinae. The Vienna committee (Bericht des zur Erforschung der Trichinen— Krankheit von der k. k. Gesellschaft der Aertze Oomites, Nov. 2, 1866, Wien, 1867, pp. 6, 7) report: "In Moravia, in the neighborhood of Ostrau, 9 out of 12 rats were highly trichinosed, and of 8 from the cjty of Ostrau 7 were infected in the highest degree. This is a great market place for hogs in the summer and fall. In Klederling, a suburb of Vienna, 7 out of 47, and in Untermeidling 2 out of 31 were found in- fected. In other places a few rats were examined with negative results. In the meantime 39 hogs of different ages were examined, and only 1— an old and unusually fat one— found iufected. See Meissner (Schmidt's Jahrbucher, No. 130, 1866, p. 118), who quotes N. E. Porssell (Hygiea, xxvii, ii), 4 out of 5 rats caught in Skara were highly trichinosed; also, Kiihn, Adam, E6U, Wedl, et al, and Eenz, op. cit.,U, 45. Besides these, many other cases are reported, and there is no telling how far this list might be extended if examinations were common in rats as in hogs. In Saxony 20 per cent, of all rats are trichinosed, while Eeinhard (Arch. der Heilkunde,xviii,,§ 241) says "about 1 hog in 983 contains tricTiinae." G-erlach (Die Fleischkost, etc., Berlin, 1875), pp. 73-'6) gives a table showing that 664 trichinosed hogs have been found, principally in Ger- many, in eleven years, 1864 to 1874, inclusive. Of these 84 were found in the province of Prussia ; 19 in the province of Brandenburg ; 29 in the province of Pomerania ; 20 iu the province of Posen ; 11 in the prov- ince of Silesia ; 95 in the province of Saxony ; 6 in the province of Westphalia and the Ehine provinces; 44 in Hanover; 27 in Kurhessen and Holstein ; 92 in Brunswick ; 46 in Weimar, Altenburg, Saxony, and Mecklenburg-Schwerin ; 100 in Sweden ; 39 in Denmark ; 2 in Ham- burg, and 1 each in Bremen, Lubeck, Switzerland, and England, 4. Excepting 100 found in Sweden (the whole number secured in the year 1865), and 37 of 39 occurring in Denmark (found in 1866), the largest number in a single year was found in 1867, viz, 170 ; 12 were found in 1864 ; 132, including 100 in Sweden, in 1865 ; 79 in 1866 ; 170 in 1867 ; 55 in 1868 ; 36 in 1869 ; 19 in 1870 ; 59 in 1871 ; 88 in 1872 ; 55 in 1873 ; 59 in 1874. In the Duchy of Brunswick, from January, 1866, to Easter, 1876 (TJhde Vifchow's Archives, Nos. 38, 43, 48, 52, 57, 58, 59, 64, 65, 70), 781,611 hogs were killed; 125 of them contained trichinae — 1 to 6,253— (and 250 were otherwise diseased and unfit for food). Of 6 infected hogs found among 87,111 examined in 186S-'69 (op. cif., No. 52, 1870, p. 439) 5 were found in the city of Brunswick. In every year the proportion of trichinosed hogs in the city far exceeds that of the remainder of the Duchy. In 1871-'72, in the city it was 1 to 4,839; outside of the city, 1 to 13,401 (Virchow's Archives, No. 58, 1873, p. 325). In 1872-'73, in the city it was 1 to 1,502; outside of the city, 1 to 3,807 (Virch. Arch., No. 59, 1873, p. 160). 60 REPORT ON TRIC1IIN.E AND TRICHINOSIS. Id 1873-'74, in the city it was 1 to 1,272 ; outside of the city, 1 to 5,129 (Virch. Arch., No. 64, 1875, p. 570). In 1874-'75, in the city it was 1 to 1,449 ; outside of the city, 1 to 7,004 (Yirch. Arch., No. 65, 1875, p. 548). In 1875-'76, in the city it was 1 to 6,618 ; outside of the city, 1 to 13,182 (Virch. Arch., No. 70, 1877, 157). It would seem from this exhibit that whatever cause operated tp decrease the number and proportion in the city exercised a corresponding influence outside. Berkau (Virch. Arch., Bd. 42, 1868, p. 352) reports that of 60,000 hogs killed in Brunswick in the preceding four years only 7 were infected. In Blankenburg, 8,000' were examined and 9 found infected, and 15 triehinosed hogs were found in the remainder of the duchy. In Eostock, Petri (Virch. Arch., Bds. 44, 45, 49, 52, 54, 57, 59, 62, 66, 70, 72) reports that the whole number of hogs killed in eleven years (1867 to 1877, inclusive) was 67,427. Of these, 42 contained trichinae— 1 to 2,107. The highest proportion was reached in those examined from November 1, 1867, to April 30, 1868 (Bd. 44, 1868, p. 136), 1 to 336. Of 6,555 killed in 1872 (Bd. 57, 1873, p. 296), and 7,165 in 1876 (Bd. 70, p. 156), none contained trichinae. In Gotha, from 1865 to 1876 (Schuchardt, Thur. Corr. Bl., vi, 9, 1877, p. 223), 391,913 hogs were killed, and 46 contained trichinae— 1 to 8,520. Of these, 98,173 were killed in the city of Gotha, and 34 of the 46 infected hogs were found there, a proportion of 1 to 2,887, leaving only 12 to 293,740—1 to 24,479— in the remainder of the province. In the whole of Prussia (Eulenberg, Vierteljahrsschrift, f. ger. Med., etc., xviii, 1, 1878, p. 149), in 1876, 1,728,595 hogs were examined, and 800 — 1 to 2,160 — were found infected; in Guesen, 1 to 141; in Konigs- berg, 1 to 149; in Posen, 1 to 207; in Bromberg, 1 to 323. In 1877 (Eulenberg, quoted by Falck, "Das Fleisch,'' Marburg, 1880, pp. 622, 623), of 2,057,272 hogs examined in Prussia 701 were found triehinosed— 1 to 2,800 (by 12,865 official inspections). Of this number, 997 were killed in Otislin, of which 3 were found infected, 1 to 332; 17,162 in Konigsburg, 46 infected, 1 to 373; 2,043 in Danzig, 5 infected, 1 to 408; 66,692 in Posen, 163 infected, 1 to 409; 37,015 in Marienwerder, 77 infected, 1 to 480; 24,157 in Bromberg, 44 infected, 1 to 544; 36,323 in Frankfort, 52 infected, 1 to 698. On the other hand, in 1871, in Stettin, 2,251 in Stralsund, 3,973 in Oppeln, 37,173 in Stade, 2,743 in Aurich, 19,424 in Miinster, 8 in Wiesbaden, 1,004 in Trier— 68,447 hogs— no trichinae were found. In 1865-'66 the total number (Muller quoted in Jahresbericht, etc., i, 1868, p. 505) of triehinosed hogs reported was 50. In 1875 (Jbt., i, 1876, p. 555), 54 triehinosed hogs were found among 59,230 hogs examined in Cassel — about 1 to 1,100. In the jurisdiction of Breslau (Edward Wolff, "Die Untersuchen des Fleisches," etc., Bres- lau, 1878), 244,840 hogs were examined (by 1,499 official inspectors) in 1876, of which 63 contained trichinae (and 1,710 were measly); 40,904 of this- number were killed in the city of Breslau, and 18 found trichinous — REPORT ON TRICHINA AND TRICHINOSIS. 61 1 to 2,276 — while for the remainder of the district the proportion was 1 to 4,532. In 1877, the whole number was 271,669 ; 54 tricliinous (1,992 measly) ; of these 44,951, including 23 infected with trichinae, were killed in the city — 1 to 1,954 — with a proportion of 1 to 7,378 for the remainder of the district. In Stockholm, from 1865 to 1875 (Warfwinge, "ISTord. Med. Ark., viij 3, No. 18, 1875), 55,200 whole hogs were examined, 111 contained tri- chinae, 2 to 1,000; 6,547 half hogs were examined, 19 contained trichinae, 3 to 1,000 ; 45,788 hams were examined, 47 contained trichinae, 1 to 1,000. • " Of the whole hogs 2,000 were raised in Stockholm, and 58 of the 111 infected hogs were of this number, 2.9 per cent. Ten of the remaining 53 were found among 300 hogs from Tannefors, 3.3 per cent. Among those raised in the villages the proportion was 0.02 per cent. The nativity of 29 of the infected hogs was not known. To divide these proportionately would give for Stockholm 3.9 per cent., and for Tanne- fors 4.3 per cent. It thus appears that Stockholm and other cities really form trichinal centers, while the occurrence of trichinae in the country is purely accidental. Of 74 whose antecedents were known, 22 were raised by butchers, 15 by millers, and 12 by bakers. In 12 cases 2 infected hogs, in one case 4 (raised by a miller), and in another 3 hogs were traced to the same pen." In, 7 cities of Sweden (Key, Virch. Arch. No. 41, 1867, p. 362) Stock- holm, Linkoping, Gothenburg, Norkoping, Falun, Malmo, etc., 39 trich- inosed hogs were found, 1866. . In Copenhagen (H. Krabbe, Zeitschrift fur Vet., bd. xv, Hft. 3, 4, 1867) of 8,174 hogs examined 15 contained trichinae— 1 to 545. Thirty- nine trichinosed hogs were found in different places in Denmark in 1865-'66 ; 28 of these contained prorosperms. In Oharkov, Eussia, Krylow (Deutsch. Zeitschrift fur Thiermed. iii, ■1876, p. 392) reports 3,550 hogs were examined and 5 contained tri- chinae— 1 to 710— and thinks if examinations were obligatory in Eussia that trichinae would be found more numerous tha,n in Germany. The list of cases in section A, where trichinae have been found in the human cadaver, the table of epidemics, and cases in section D, will show to what extent trichinae have occurred in man, although probably many cases have been overlooked. Eeinhard (Ark. der Heilk. viii, 3, 4, 1877, p. 241) gives the number of cases in Saxony at 1,207 for sixteen years, 1860-1875, and thinks many trichinosed hogs are consumed without producing the disease. Delpech (op. tit., p. 81) says: "Waguer as- sured us (D. and Eeynal) that he had met trichinosed corpses in the proportion of 4 to 6 per 100." Leuckart I c, p. 88. In many cities of Germany, Dresden, Berlin, etc., the number of trichinosed corpses is as high as 3 per cent. Virchow (op. tit., p. 29) says : " I found half a dozen corpses in 1859 containing trichinae, and very soon had seen more cases than the whole literature of the world had reported. In three months of 1863 seven new cases had died in charity hospitals ; these were all found 6.2 REPORT ON TRICHINAE AND TRICHINOSIS. post mortem without a suspicion of their presence during life." Zenker found (Arch, fur path. Anat., 1860, 330) trichinae in 4 out of 136 dissec- tions. In Dresden City Hospital 2 to 2 J per cent, of dissections show- encapsulated trichinae, although sometimes found with great difficulty (Meissner Schmidt's Jahrbucher No. 138, p. 103, quoting Fiedler Arch. d. Heilk. vii,1866, p. 448). Wagner of Leipzig (quoted above— Arch, der Heilk. No. II, 1864) saw 30 or 40 cases, according to Am. Jour. Med. Sciences 48, 1864, p. 225, and in the same journal vi, 1865, p. 503, found 1 in 30 to 40 bodies. D. Scheiber (Virch. Arch. No. 55, 1872, p. 462, 463) reports 1 case of trichinosis in Perth and 3 cases in Bucharest in 1868'-69 ; also that trichinae have been found in 1 case in the cadaver every year since 1867 in the dissecting-room in Perth, giving an average of 0.5 per cent. In Vienna 2 cases in 1866; first case of trichinosis oc- curred in 1867. In Eussia-Eudnow 3 cases in 150 dissections (Meissner I. c, Haller I. c). Kroft (Jahresbericht, etc., i, 1867, p. 310) 3 cases in cadaver in Copenhagen, 1 diagnosed during life." Key (Virch. Arch, xli, p. 302. In the universities of Sweden trichinae are often found in the cadaver. G-aillard reported (Gaz. Hebd., 1867, No. 41) 1 case in (in a Spaniard) Algiers. In Scotland 2 per cent, of the dead bodies ex- amined for the five years ended September, 1860, contained trichinae. Haller, in Ziemssen, iii, p. 629. In England 30 or 40 cases had been found post mortem, but no case of trichinosis had been recognized-during life until the report of Dickinson's ease in 1871. Cobbold op. tit., p. 169. The figures given above on the authority of Zenker are very remarkable compared with the results of his later observation. According to Dr. Karl Miiller (Inaug. Dissertation Statistik der menschlichen Entozoen, Erlangen, 1874) they show only 0.95 per cent, of cadavers infected in Dresden and 0.11 per cent, in Erlangen, I. c, in ten years, 1852 to 1862. Two thousand and two cadavers were examined in the Dresden City Hospital, and only 19 found infected from October 1862 to the end of September 1873; in 1,812 dissections in the Institute of Pathological Anatomy in Erlangen only two bodies were found infected (Meissner, Schmidt's Jarhbucher, bd. 168, 1875, p. 297). For reported cases in the United States, see section E. An examination of the results of observation on rats and hogs given above, and consideration of the large percentage of trichinosed rats, would readily lead to the conclusion that the rat was the original host of the parasite. Leisering (quoted by Meissner, I. c.) says, "to extermi- nate the rat is to exterminate trichinae." Leuckart (Untersuchungen &c, p. 119), "the rat is its principal host and the chief cause of infec- tion"; and further (Menschl. Parasiten, ii, 3, p. 605), "many persons struck with the frequency of trichinosed hogs, have claimed that it was the hog and not the rat which was the original host." Gerlach was of this opinion and said (Die Trichiuen, p. 70), "when trichinae occur in rats, trichinosed hogs or other carnivora will be found, but it does not necessarily follow that trichinosed rats will be found where trichinae are REPORT ON TRICHINA AND TRICHINOSIS. 63 found in hogs. The rat may be a means of propagation from hog to hog"; and' says the general spread of trichinae in Germany has some connection with the importation of rats in ships from countries previ- ously infected, but, as a rule, the hog is infected by his own species. But, later (Die Fleischkost, p. 77), "almost every place where trichinosed hogs are found, and the rats have been examined, trichinae are found in them, and even trichinosed rats are found in the flayer's establishments and other places without the occurrence of trichinosis in either man or the hog." Zenker thinks that the hog was the original host, and rats are affected from the offal from slaughter-houses, &c. Prof. A. Key (I. c), says, "trichinosed rats occur wherever trichinae are found in hogs." (See Falck I. c.) Delpech (op. tit, p. 49) and M. E. Heckler (Thier, Corr. BL) found trichinae in the excreta of hogs, and the latter suggests the action of intermediate carriers, and the former says (op.cit., p. 48), "I insist on the spontaneous trichinization of rats and mice, and that they influence the infection of the hog." Fiirstenberg (Landsw. au. Woch., No. 25) thinks that rats become infected from human excrement.. Dr. O. V. Linstow (Virch. Arch., Bd. 44, 1878, p. 349), is of the opinion that hogs, cats, rats, and foxes become infected from man. In the report of the Vienna committee (Bericht, &c, p. 30) it is said: "It is not improbable that in due course of time a chain of animals may be found in which there is a reciprocal infection, and it is possible that foxes and other wild animals may become infected through rats and mice living in the vicinity of men." Of course, the whole question of trichinization has relation to the infec- tion of man through the hog. There does not seem to be much ground for the supposition that hogs are infected from kitchen-slops, as there is nothing essentially different in them from the food eaten by the family. Such infection must presuppose the existence of the parasite in the food prepared for the table, as they cannot exist in the washings of vegeta- bles. In such a case the family would be as liable to primary infec- tion as the hog or even more so, unless, perhaps, that in the washings of highly-trichinosed pork — which cooking rendered innocuous to the family — some trichinae might be added to his food. The exclusive rat theory is less adhered to at present than formerly, and opinions seem to be modified in regard to any exclusive theory. But that in most cases rats do contain a large percentage of trichinae cannot be overlooked. The fact that rats found in flayers' establish- ments are always found trichinosed in the greatest proportion and often in the highest degree when often other rats in the same town contain no trichinae, does not support the theory that they are the original hosts, but it does show that they get them from the offal or carcasses there, otherwise the parasite would not be so closely confined to such places. In Vienna (Bericht, &c, Comite, pp. 5, 6) only one trichinosed rat was found among 162 rats taken from Vienna and suburbs in 18C6. In Klederling, near Vienna, 7 out of 47 rats caught in the flayer's estab- 64 REPORT ON TRICHINA AND TRICHINOSIS. lishment were highly trichinosed. In TJntermeidlung, where large num- bers of hogs are collected from different parts of the country/ only 2 out of 31 rats were found infected. This shows that while trichinosed rats are generally found in cities, and especially where they have access to offal, they do not always occur even in those places, and that they must become infected from what they find to eat in certain places only, for even the presence of a large number of hogs, as in Untermeidlung, does not seem to have had much influence. To the last category belongs, even to a greater degree, the occurrence of large proportions of trichi- nosed hogs in Dearborn and Ohio Counties (Sutton, op. cit.) in Indiana, where the largest known percentage of trichinosed hogs were found ; 42 rats were examined and not a trichina found ; 3 out of 4 cats ex- amined " were found to be swarming with trichinae, and the trichinae from one of them were seen to be in motion." On this subject Virchow (op. cit, p. 61) says : " Should further observations prove that hogs, as a rule, get their tri- chinae from rats and mice, the question will arise where do the latter get their infection? and it will be difficult to explain otherwise than the rats and mice become infected from trichinosed meat which they pick up in their wanderings." Hogs are as apt to meet with dead cats, as with dead rats in some places, and especially, but in less numbers, in those places where the offal of cities is stored, and no other animal is oftener seen lying dead in the streets. See, further, Virchow^ pp. 61, 62; Eenz, 44-46; Kratz., 64 a. It might seem that the way to determine the question of priority would be to find out in what animal the nematode was the most abund- ant, taking it for granted that the animal or class of animals showing the greatest number was the cause of the infection in the others. This would immediately point to the rat as far as the examinations of that animal have been undertaken. But rats, when chosen for examina- tion — excepting, perhaps, only those examined in Vienna in 1866 — have been taken from places most favorable for the dissemination of trichinae. Besides the number examined has- never been large. On the other hand," the number of huma'n corpses found to contain trichinae by Wagner Fiedler, Zenker, and others, would point to man as a probable orginal host. Pagenstecher (op. cit, .note, p. 47): "It seems that man is the creature in which trichinae thrive best." This seems to have been adopted by Piirstenberg, v. Liustow, above quoted, and others. But it seems difficult to support a theory of the origin of trichinae on such statistics, for later observations have shown that all the known cases occurring in man, with a few not very clearly defined exceptions, have resulted from eating trichinosed pork. (See section D, Etiology.) .sl^Cegard to the geographical distribution of trichinae there are widely different opinions, but a large number of observers do not think that it is confined to any particular locality. In regard to their occurrence in REPORT ON TRICHINAE AND TRICHINOSIS. 65 Germany Meissner (Schmidt's Jahrbucher, Bd. 130, 1866, p. 118) says: "According to Fuchs, trichinae were imported during the last century by«the nomadic rats, but if Four's observations are to be referred to trichinae, they occurred in Germany before that time." Gerlach says (Die Fleischkost, &c, p. 65) : "Prior to 1830 there were no trichinae in Europe; from 1830 to 1850 there were isolated cases in the human corpse, and they were found once in the hog, the dog, and cat, and it was only after 1860 that they got a firm hold. * * * It is more than probable that trichinae were imported from China or America either in hogs or pork. The hogs in England and ^orth Germany, as well as in the province of Saxony, have since 1820, 1830, been crossed with the small Chinese breed. If now trichinae are frequent in China (see Gerlach, Die Trichinen, p. 74, quoted later) it is the most natural thing in the world that they should emigrate with the Chinese hogs. Trichinae might also have originated in America. * * * From the number of trichinae found in American pork they must be very frequent in American hogs, and it is just as likely that they have been imported in former times in pork as at present. ; The argument used by Gerlach (p. 65) against the early occurrence of trichinae in German hogs, viz, that ham and sausage were eaten raw before the discovery of trichinosis, applies equally to a probability of its non-occurrence in the United States, for it is probable that the large German population of this country have not left any of their habits and. customs at home, and the Germans of America have probably eaten raw pork here as much as they did in their native land, yet but few epidemics* have been recorded here, and those mostly among the Germans who eat. pork raw. But the absence of recorded cases of trichinosis cannot, be taken as a guarantee that hogs were not infected or that cases ox even epidemics did not occur in man, for as will be seen further on, Virchow, Leuckart, Pagenstecher, and others did not consider the dis- ease a new one, but that "the knowledge of it was new." There are only 39 epidemics recorded (Keinhard, I. c.) in 16 years (from 1860 ■ to 1875) in Saxony, which in all probability occurred from 39 hogs.. Yet in the whole of Prussia, in 1876-1877, 1,501 trichinosed hogs were found (see Eulenberg, I. c). These figures show that either, trichinae have always been quite abundant in Germany, or that they are rapidly increasing in numbers. The result of the examinations of hogs in this; country, although showing trichinae in a large proportion of the animals, under observation, have not been extensive enough to. base an opinion, upon as to whether they might be found in a large number of cases if searched for. The assumption that 8 per cent, found infected in the ex- amination of 100 hogs in Chicago (Beport of the Board of Health, Chi- cago, 1878) can be taken as a guide for the whole country is incorrect,, for it probably will apply only so far as a particular, drove, with their mode of life, food, and surroundings, are concerned*. The occurrence of large numbers of trichinosed hogs in Dearborn, and Ohio Counties in. S. Ex. 9 5 v 66 REPORT ON TRICHINA AND TRICHINOSIS. Indiana (Sutton, I. a, and Proc. Ind. State Med; Soc, 1874) would lead to the inference that a trichinae district of large extent had been dis- covered, as was the case reported by the Vienna committee above Re- ferred to; but as these counties border on the Ohio Eiver, and are not a great distance below Cincinnati— a great pork-packing center— it is not surprising when it is considered that' a large amount of offal from slaughter-houses is used for feeding hogs in such neighborhoods. This is mentioned by W. Focke (Berl. Klin. Woch., quoted by Bollinger Jahr- esbericht, &c, Bd. i, 1874, p. 718) who gives it as a probable cause of the large numbers of trichinae found in hams imported into Germany. (See, also, Flitner Anleitung zur Mik Untersuch. des Fleischesj &c.j 3 Aufl. Lippstadt, 1877, p. 10.) - Not being satisfied as to the correctness of this theory as applied to the present time, I wrote to the president of the Chicago Board of Health, and received a letter dated April 15, 1880, from Mr. B. L. Mc- Vicker, the secretary of that body, in which he states that such offal "from all the large establishments is worked up into fertilizers, this being the most profitable use possible. Formerly the material in ques- tion was much used for feed, and in some isolated instances, and from some few of the ham-packing houses, is still sent into the country for pigs." At the same time I made inquiries .as to the practice in Cincinnati, and Dr. Minor, the president of the board of health, sent me the annual ;report (thirteenth) for 1879, which (p. 82) shows " that the refuse of these ■establishments (Slaughter-houses), including bones, pluck, and blood, is largely utilized. The blood is fed to hogs or used for blood puddings i(blutwurst), being shipped for this purpose to Europe, or, when wasted, iis run off in covered sewers into the waters of mill creeks. All extrane- ous waste is turned over to the fertilizing company;" p. 83, "The refuse «o£ some abattoirs is fed to hogs kept for the purpose." It is on this lasfr account that Bocher (Deutsche Vierteljahrssehrift far off. Gesundheits- .pflege, N. J. 2, 1874, p. 255) says : " For in the American slaughter-houses there is a system of propagation scarcely less effective and productive ithan if instituted by design." Probably the cause of infection in Dear- born and Ohio Counties, as may possibly be found in other counties in .the vicinity of Cincinnati, may be found in the offal from the city .slaugMer-houses, which formerly, much more than at present, must have been thrown or wasted into the Ohio Eiver; at least, before the present sanitary laws were enacted, and before fertilizing- companies rendered it innocuous. But it appears that any general estimate based on the ex- amination of one locality must be erroneous^ and more extensive inves- tigations should be made before any reliable figure can be given. For,- .as might lie expected, hogs getting any of the offal from Cincinnati— which would be easy enough in localities below, bordering on the Ohio .Eiver— would be more or less trichiuosed. From the statistics given above it will .be .seen that hogs raised in cities and vicinity are more lia- EEPOKT ON TRICHINA AND TRICHINOSIS. 67 ble to infection than those living in the country. It is not necessary to make any particular charge against the cities on this account, because its explanation is readily found in the aggregation of hogs, with coinci- dent difficulty, in keeping them and their pens clean. The hogs are thus placed in the best possible position for the spread of the disease, and if kept in the same pens with the same number and the same un- sanitary conditions, the infection would spread the same in the country as in the city. Whatever may be said of the influence of rats as car- riers — Gerlach (Die Fleischkost, p. 65) thinks that the trichinae are passed back and forth from rats to hogs, and from hogs to rats — there can be no doubt that hogs thus kept in large numbers may become more or less trichinosed in the course of time from the excreta of trichinosed animals. In regard to. experiments on this subject, Leuckart (p. 36) say® that "the results are not uniform." This may be due to various causes, and in some cases may be due to digestion of the trichinae, as Leisering and Fiedler (Pagenstecher, p. 43) have shown occurs when they are consumed by maggots. Virchow (report of a letter by Profes- sors Mosler and Fiirstenberg to the assembly of the associated butchers of Berlin, December 15, 1865, Berlin, 1866) remarks that the results of such experiments have been variable, but enough of a positive nature has been seen to show that animals may become infected in this manner. Kiihn (Mittheilungen des land. Lut. der Univ. Halle, 1865, p/ 1, 31) denies that animals can be infected in this way. "Professors Gerlach and Gunther (Delpech, op. eit., p. 49) placed two hogs in the same pen ; one of them had recently eaten trichinosed meats, the other was sound. In a short time afterwards the other hog was found to contain trichinae. There can be no doubt as to the manner of infection of the second ani- mal. They also determined the existence of trichinae in excrement in four out of twelve observations." See also, Mqsler (Virch. Arch., Bd. xxx, p. 624), Pagenstecher, op. cit., Kiihn (Virch. Arch., xxvi, 222), Vir- chow (Lebr, &c, pp. 49 and 61), Haubner (Ueber des Trichinen, 1864, p. 20). t : Further, it is actually proved that animals put in pens in which trich- inosed hogs have been kept, will become infected. Gerlach (see Jahres- bericht, &c, i, 1866, p. 451) gives a case where a trichinosed hog was killed ; another hog afterwards kept in the same pen was found infected. This one was destroyed, and after, a time another one was put in,, which also became infected. With such facts before us it will be easy to explain why such large numbers of trichinosed hogs are found in Chicago, for: the filthy condition of the stock-yards in that, city is a matter of -public; comment (see Dr. O. C.JDe Wolf, New Orleans Medical Surg. Journ.,, Jan. 1880, p. 691, and Dr. Eldsha Harris's " Sanitarian," Nov., 1877s). What, may be considered as fairly proven for Chicago,, inlay reasonably bef assumed for Cincinnati and other pork-paeking- cities, > And if one-half is accepted concerning the influence of rats on the spread of trichinae (see especially Gerlach (I. c, 67), who says that "rats spread the infection 68 REPORT ON TRICHINA AND TRICHINOSIS. within narrow limits, while hogs are the cause of their transfer to greater distances," and "where there are trichinosed hogs, trichinosed rats will not fail)," then it must be acknowledged that the infection as found by Dr. Sutton, in Dearborn and Ohio Counties, was of a recent date, as no trichinosed rats were found.. If they are not found there to-day, then the " rat theory " receives a death blow. Of course there is a possi- bility that trichinosed rats might have been found if more extensive ob- servations had been instituted. If the disease was transmitted from hog to hog, then the theory of Euge, who thinks ( Jahresbericht, &c, i, 1874, p. 718) that "a single hog might, in the course of fifteen years, be the cause of infection in 16,384 others, and at this rate, in a few years, all the hogs in America would become infected." But such excessive in- fection does not occur ; and if such a theory were true, Germany would show a larger percentage of trichinosed animals, for even in wild ani- mals there trichinae are often found, and in Hildersheim (Jahresbericht, &c, i, 1876, p. 505) the law governing the examination of pork is made to include the wild boar. Large percentages of trichinosed hogs are found in certain places in Europe as well as in America, as will be seen by examination of the reports from Sweden, above mentioned. In Stock- holm 3.9 per cent. Tannefers 4.3 per cent. Dr. Bine; of Linten (Meissner, Schmidt's Jahrbiicher, No. 130, p. 118), reports "of forty -five hogs three were found infected, and a fourth was known to be infected only after five persons had been poisoned," nearly 9 per cent.; and Warfwinge (Nord. Med. Ark., vii, 3, ~No. 18, 1875) re- ports 3 out of 112 Bavarian hams trichinosed, nearly 3 per cent. This will compare with the average, and is higher than the result obtained from the examination of 800 American pork sides (very much higher when we consider the relative frequency of trichinae in the intercostals and the muscles of the posterior extremity), in which only 18 — 2.25 per cent. — were found infected. It is very probable that the number of trichinosed hogs found in some other special localities in Europe would equal the largest number found in isolated cases in the United States if the former were sepa- rated from the surrounding country, but by taking a number of places or a larger extent of country the general average may be small, although some places or sections may be highly infected, as is stated by von Linstow (Virch. Arch., 44, 1868, p. 379.) In 1867, 23 trichinosed. hogs were found in Holstein. There were none found in the Duchy of Lauen- burg, although in the immediate vicinity, in Lubeck, trichinosis has appeared in man. Also the figures given above for Sweden, with an average of 1 to 22 to 40, the country-raised hogs show only 1 to 5,000. This will also be corroborated by the statistics given above for Prussia by Eulenberg, and in fact nearly all places where examinations have been made. Thus, if the State of Illinois were taken with the city of Chicago, and the remainder of the State of Indiana were included with Dearborn and Ohio Counties, the average would probably compare REPORT ON TRICHINA AND TRICHINOSIS. 69 favorably with the result of examinations in Europe. But the numbers of trichinae reported in Germany are entirely too small. In 1872 Meiss- ner (Schmidt, No. 152, 1872, p. 94) said : ''Although the examination of hogs is obligatory in Saxony, not over one-half of the hogs are ex- amined. This is made more apparent by the number of epidemics occurring in places where all the hogs are supposed to be examined— at Hanover, Diessenhofen, Neugersdorf, Magdeburg, Hasselbach, Kap- endorf, Lissa, Berlin, Grotzingen, Bleidengen, Trebur, Etzalsroda, Patzliingen, Gross-Weehsungen, Forstham, Konigsthal, and Nord- hausen. (See farther particulars in sections D and G). Whatever may be said of the number of trichinosed hogs found in the United States, the epidemics of Germany are almost uniformly traced to the ingestion of freshly-killed German pork. The epidemic in Bremen (Dr. G. W. Freke, Berlin, klin. Woch, x, 36, 1873) was said to be traced to American ham. This ham was not of good quality, as it was sold at auction, and apparently the reporter satisfied himself that the ham was American, that it contained trichinae, and that they were capable of producing infection. He claimed that the trichinae in the center of the hams were still alive. Several children were taken sick in Freiburg (see consular letter, Manheim, No. 86, May 3, 1879), and it was reported that they were infected by eating trichinosed American ham. They all got well, and no positive evidence was offered on the subject. Also (I. c.) "40 soldiers were taken sick in Mayence. Although the disease was laid to American pork, no trichinae could be found in two cases which died. * * *" The consul further states : ■ "In this district cases of trichinosis occur, sometimes resulting in death ; yet, after close inquiry and investigation, in no case can I find that death or even sickness can be traced to American meat." This is more probable when it is considered that as a rule trichinae lose their power to infect after the meat has been properly cured. In view of the discussion of trichina in American hams, in connection with the Bremen epidemic, Professor Roper (Deutsche Vierteljahrss- schrift fur off. Gerundsheitspflege, vi. 2, 1874, p. 280) instituted a series of experiments with American trichinosed ham. He "fed two rabbits with some of the meat, and found a slight redness of the intestines, but neither intestinal nor muscle trichinae;" "two cases have been reported in Offenbach and two in Worms, where trichinae were found in Ameri- can meat" (consular letter). Considering the above observations as to the relative frequency of trichinosed hogs in the United States, it might be asked " How will you explain the large number of infected hams, &c, found in Germany ?" I should not attempt to explain it until I was satisfied that the hams ex- amined were really American. The finding of trichinae in the hams ex- amined cannot be questioned, but the other point is questioned. The American consul at Manheim says (letter of May 3d, No. 86) : " There is an evident disposition on the part of German authorities to discredit 70 REPORT ON TRICHINA AND TRICHINOSIS. American meats. * * * The least appearance of trichinae in Amer- ican hams is taken notice of, published in the newspapers by the au- thorities and those interested in discrediting it." The consul-general at Frankfort says (No. 128, March 31, 1879): " I made explicit written inquiry of various experts and veterinarians as to whether trichinae had at any time been discovered in American pork imported at Frankfort. The responses were unanimous and em- phatic in the negative. One of the gentlemen questioned, a well-known veterinarian, who is commissioned by the army contractor here to ex- amine American hams and sides of bacon, declared that he had never in the course of a long experience of this kind found trichinae in American pork, and that he had not heard of such discovery in such'pork imported here." The consular agent at Mayence, who at my request also made inquiry about this matter, writes as follows : "According to the official statement of Dr. Wollpert, the veterinary surgeon of this district, he examined between the first and twentieth of January last some eighty pieces of American ham, and discovered no trichinae in any of them. Neither has he heard of trichinae being dis- covered in American pork imported at any subsequent time at this place." Further by the same: " Well authenticated cases have come to my knowledge of rumors of the finding of trichinae in American pork, resulting upon examination in proving that the meat infected was not American at all, but German. It is not improbable, however, that in some exceptional cases trichinae have actually been discovered in pork from the United States, and of course the greatest possible use has been made of these cases by the German pork interest. * * * A few days ago the butchers of May- ence requested the burgomaster of that place to caution the public against the use of American refined lard as possibly infected with tri- chinae. They also asked that octroi duties be levied upon American lard admitted within the walls of the city. The burgomaster was obliged to reply that trichinae never appeared in refined lard, and that octroi duties would be illegal; but the petition illustrates the extreme anxiety and jealousy of the butchers. E ven the alleged outbreak of pleuro-pneu- mbnia among American cattle is cited in a precautionary and alarming way." According to a letter from the United States consul at Leeds (No. 19 August 20, 1878), samples of American hams taken promiscuously from wholesale dealers by the sanitary superintendent (Report to the Sani- tary Committee of the Leeds Town Council, August, 1878) were exam- ined by the borough analyst and found free from trichinae. These quotations are not produced to carry the idea that no trichina} are found in American pork abroad, but to show the possibility that the number of diseased swine is over-estimated through the manipulation of REPORT ON TRICHINA AND TRICHINOSIS. 71 persons, perhaps those most interested, the German pork dealers and producers. The opinion that American pork is fearfully trichinosed is so prevalent in Europe that statements unjustifiable by facts are made and eagerly received. They are' made also by men of high ability, whose authority on such subjects should not admit of a suspicion, yet are open to severe criticism, as in the case of Professor Heschl, of Vienna, who, in a letter published in the Wiener med. Wochen- schrift, June 8, 1878 (see letter from consul-general at Vienna (No. 94) June 24, 1878), informed the public that one in every 5 or 10 American hams was infected with trichinae, "and the probability exists that sev- eral epidemics owe their origin to this fact." Professor Heschl after- wards declared that he had no personal knowledge of the subject to which he called public attention, that he had never seen an American ham, and that he relied upon the examinations made in Germany. He was thereupon invited to examine some American hams, and after a careful examination he said there were certainly no trichinae in them, and that they were sound and good. The substance of the first letter was telegraphed to the London Times, and has been quoted in the Euro- pean press generally (see London Lancet, vol. i, 1878, p. 913) in such a manner' that readers would not suspect that its author wrote it before he had seen an American ham. Trichinosis is a terrible disease, and the press of any country would be doing very little of its duty if it failed to warn the people of such a danger. But how often the interest of some particular dealer has been the cause of impositions on the public through the press is a question that presents itself ; and how often mistakes, as above mentioned, have occurred in regard to the nativity of the meat examined is a question that in this country there is no means of determining. We must ac- cept the results obtained in Europe until after proper investigation we can state definitely and officially just how many hogs contain trichinae from year to year, and the disposition that is made of them ; and until that time the American pork interest will be at the mercy of any one who may be induced to give the support of his professional position to any assertion however wild. If adverse legislation is any proof of inferiority of pork products America does not stand alone, for in Kussia it was forbidden (Schmidt's Jahrbiicher, Bd. 138, p. 104) by law to import ham or sausage from Ger- many under a penalty of 100 roubles for the first offense, 200 for the second, and after offending the third time, the dealer's license to be an- nulled. And in 1871 (London Lancet, i, 1871, p. 843) " the importation of German pork sausage into England produced enough cases of trichi- nosis to attract the attention of Mr. Simon, who commissioned Dr. Thu- dichum to investigate." But even if it could be proven that all that has been asserted of Amer- ican swine products were true, it does not solve the question of the origin of trichinae. As to priority, there is every reason to believe that 72 REPORT ON TRICHINAE AND TRICHINOSIS. trichinosis has been more or less common in Europe for a long time. In fact, there is positive evidence of it in the occurrence Of epidemics or single cases, verified by post mortem, examinations in after years, as at Jussen, Wegeleben, Hamburg, and Dresden. (See Virchow, op. cit., pi 36 to 40, who mentions other cases, and section D of this report, 1, His- tory, &c.) And further, this is the opinion of many observers. Kestner says (op. cit., p. 31): " The principal centers have been, for some reason; dimcult to explain, Prussia, Saxony, and recently HahoVer"; and page 46 : " The ancient country of Mansfield, of which Hettstadt forms a part, seems to enjoy the sad privilege of a permanent possession of this par- asite." Eenz (Die Trichinenkrankheit des Menschen, Tubingen, 1867: "In the vicinity of Hedersleben there is. a trichinae nucleus of old date, and if we could have a correct history of trichinae for the whole province of Saxony there would be some interesting developments as regards Magdeburg and Messeburg and the surrounding regions." Dr. O. Y. Linstow (I. c.) says: " It is probable that our land is the natural home of the trichinae." According to a communication from an agriculturist (Bay. arztl. In- tel, bl. Bd. 6; Feb. 1866) quoted by Meissner (op. cit, No. 130, p. 114), trich- inosed hogs were known in Saxony between 40 and 50 years ago. "After a dry season, or when the hogs were kept in a very dry place and the wallowing places became more dry, they seemed to have more, worms, but were cured with hemp-seed. The meat was not generally eaten, but sometimes it was noticed that such meat when eaten gave a sensation of sand between the teeth. No cases of trichinosis occurred in man because the meat was well cooked." Kertuco (op. cit., p. 47): " Competent observers see in the crossing of foreign races the cause of the propagation of trichinae. Hungarian pork, supposed to be the source of trichinae, is not more infected than German pork, and in Bavaria, where this pork is imported on a large scale, trichinosis has never appeared. The English breed, generally raised with a great deal of care, has shown an unhappy aptitude to the introduction of trichinae on the continent, on account, perhaps, of its close relation with the American breeds " (which came from England). " Leuckart thinks that North America is the true source of trichinae, but in Menschl., par. ii, 3, p. 591, says the cause of the first infection in Hettstadt was a hah- blooded English sow. (Note.— In Sweden the proportion of trich- inosed hogs is only equalled by that of some places in North America viz, in Chicago, the so-called Porkopolis)." Pagenstecher (op. cit., p. 38) says : " It cannot be conceived, as Klenke has believed, that trichinae were first imported from England, as Harle found trichinaB in corpses in Ber- lin, as indicating an ancient infection, almost at the same time that they were discovered in England— or that they might have been spread by American meats because they were first tound there in the hog, as they REPORT ON TRICHINJE AN!) .TRICHINOSIS. 73 had been seen in man in numerous places in Europe. This is a hypoth- esis wholly untenable, as there is no indigenous American animal, ex- cept the guinea-pig, which could harbor them." (Leuckart, Menschl Par. ii, 3, Note, p. 591, Pachent.) ' On this subject Delpech {op tit, p. 45) says : "The geographical distribution of the helminths is a fact too well known to be longer insisted on." While the tamia solium is almost exclusively met with in Prance, Eng- land, Prussia, Austria, Spain, and Greece, the bothriocephalus is found with it in Holland and Sweden, and almost exclusively occupies Switzer- land and Eussia. The ascaris lumbriooides, very common in Cayenne, Hayti, Brazil, the French Antilles, Mauritius (Pile de Prance), Eeunion (Pile de Bourbon), Sweden, and certain parts of Prance, is very rare in Paris. There is nothing more curious than the distribution of the human entozoa, fila via Modinensis. The east side of Africa, at Senegal and Guinea, eastern Egypt, the central parts of Asia, Arabia, the shores of the Persian Gulf, Persia, Hindostan, and farther east in Tartary, con- stitute the zone in which it has been observed. It is confined abso- lutely on the south by the equator; in the north it is bounded by the eastern shore of the Caspian Sea, and stops at the forty-seventh degree of north latitude, while in Africa it only attains the thirty- third degree. Iceland is the place of predilection of hydatids, which affect one-fifth of the population. The cysticercus cellulosa of man is frequent in Berlin, according to Eudolphi, Knape and Yirchow, while Brenner could never find it in Aus- tria. That of the hog is universal in France, but occupies certain regions by preference. The trichina spiralis does not escape the peculiar conditions which re- sult from temperature, alimentary habits of the people, regular transmis- sion of the parasite in proportion to its development, and other causes not completely understood. Prussia, especially in the vicinity of Magdeburg and Merseburg, takes the first place as a trichina district. Then come Brunswick and Saxony ; then England, Denmark, Austria, and Bavaria. North America is not exempt, and the cases which occurred in Ham- burg, from an infected hog brought from Valparaiso, show that it oc- curs in South America. "The disease exists in India, and Dr. Gordon (Times, December 14, 1874) describes the habits of the Hindoos, who allow filth and offal of all kinds, dead bodies of domestic animals, and even human corpses to lie on the ground, which are devoured by the swine without hindrance." (In the latter days of 1864 news was received that several cases of trich- inosis had occurred in the English hospital at Calcutta, and that it was quite frequent in the natives. — Pagenstecher, op. dt., p. 28; also, Gerlach, die Tr., note, p. 73.) "Finally, Lebert (Gaz. Med. de Paris 1866) notices the occurrence of the disease in Switzerland, in 1829. 74 REPORT ON. TRICHINA AND TRICHINOSIS.' "France, up to this time (1866),. remains outside of the limits of this distribution." Later reports show that trichina? have been found in rats in Pans (Goujou, I. c), and in Eussia. Krylow {I. ft) reported cases in St. Pe- tersburg, but P. V. Maydell {I. c) denies that they received the infection in that country. Eudnef (see Pageustecher, p. 40) reports trichinae; and, again, Krylow (Deutsch. Zeitschrift, iii, 1876, p. 392) found 5 out of 3,550 hogs infected, and thinks that if the examinations for trichina; were obligatory in Eussia, trichina; would be found to be more numerous than in Germany. Scheiber (Virch. Arch., No. 55, 1872, p. 468) says the same of Eoumania. Gerlach (Die Trichinen, note p. 74) says that according to the statement of a ship captain, who often visits China, trichinosis occurs among the filthy lower classes. They have been found in Africa and Italy (see above reports) and (Heller, I. ft) in Australia. Finally, I will quote Falck (Die Fleisch.,,p. 523): "Trichina; do not belong to those animals which are confined to any particular place; they are cosmopolitan." Pagenstecher (op. cit., p. 38): "Because a place has not suffered from the ravages of trichina; is no guaranty that it will not, for it has become cosmopolitan with man, hogs, rats, and mice"; and Heller (Ziemssen's Encyc, iii, p. 628): "Trichina have been found in all countries where search has been made for them? Section D.— TEICHINOSIS. 1. History. a. History in general. The first hint of a connection between the trichina spiralis and disease in the human body was given by H. Wood in 1835 (Lond. Med. Gaz., May, 1835). In 1860 Professor Zenker, of Dresden (Deutsche Arch, fur Klin. Med., viii, p. 389), treated what was supposed to be a case of typhus fever, With the unusual complication of excessive muscular pain and oedema, etc. He was thus, after the death of the patient, led to make a micro- scopic examination of the muscle and found the whole muscular system swarming with trichina;. He at once inferred that not only the peculiar symptoms but the whole disease was caused by their presence and called it trichiniasis (trichinenkrankheit.) Leuckart (Untersuchungen, etc., p. 34) inaugurated a series of experi- ments which established beyond a doubt the causal relation between the parasite and the disease. "Friedrich (Virch. Arch. 25, 1862, p. 399) in 1862 first diagnosticated the disease and determined experimentally the presence of trichina; dur- ing the life of the patient." (Scoutetten, op. cit,, p. 52.) Closely following the publication of Zenker's case the symptoms of many previous epidemics, hitherto not clearly understood, were ex- REPORT ON TRICHINA AND TRICHINOSIS. 75 amined critically and found to correspond so closely with those of this case— which now was becoming known, as his report was copied far and wide—that the epidemics in question were unhesitatingly referred to trichinae and pronounced trichinosis. The earliest of these cases, pre- viously considered as a result of injection of some poison peculiar to meat (Wurstgift, etc. ; see Diagnosis, p. — ), occurred in . Wurtemburg in 1665, in which four cases, three fatal, occurred.— Fehr. (Miscell. Med. Phys. Gur. Acad. Nat., etc., I Ann. vi, 1677, Obs. 181, p. 269). This is considered by Heller (L c.) as an undoubted epi- demic of trichinosis. In Grobzig, near Dessau, 1818: 7 or 8 cases.— (Dr. Kahler's Hufeland's Journal, vol. v, p. 44.) Adelfingen, 1829.— Lebert (Gaz. Med. de Paris). [See Section 0.] Strasburg, 1831 : 300 cases, 36 deaths.— (HoUstein Deutsche Klinik, 14, 1863.) Neidermittlau: 1834, 34-5 cases called gastro-rheumatic fever. 0. Wagner (Arch, der Heilkunde, 1864, p. 278, and Husemann, Deutsche Elin., 8, 9, 10, 1864). Wurzen, 1837.— (Meissner, op. cit., 1866, p. 117.) Dresden, 1842 : 4 cases, 2 deaths. One of the victims, a lady, moved to Breslau, and was operated upon for cancer, and died 25 years afterwards. At the autopsy numerous trichinae were found in the muscles. Two servants died in 1842, and the butcher who sold the meat was taken sick, all with the same symptoms. Klopsch (Virch. Arch., 35, 1867, p. 609). Halberstadt, 1844. Described by Dr. Abel as influenza or grippe. (See Eenz, op. cit., p. 50.) Quedlinburg, 1844. Dr. Abel (see Eenz, I. c). " JeSsen, 1845: 7 cases, 4 deaths. A. Liicki (Vierteljahresschrift fur ger. u. off". Med. Bd. 25, 1864, p. 102.) Trichinae were found in one of these cases by Langenbeck during an operation. A merchant had in- vited the members of a board of school commissioners to lunch with him; seven of the eight were taken sick and four died. The suspicion of poisoning was so strong that the merchant had to leave the country." (Virchow, op. cit, p. 49.) Leipzig, 1848 : 26 cases, 2 deaths. Wagner, quoted by Delpech, p. 36. Miigeln, 1848, Meissner (I. c). Oschatz, 1848. Wagner (Arch, der Heilkunde, 1864, p. 278), Vir- chow, p. 50. Wegeleben, 1849. Mosler (Virch. Arch., No. 33, 1865, p. 215), Vir- chow, I. c. : 164 cases and 27 deaths, treated by Eudolph, called " En- glish sweat" and "black death," the latter because the bodies became black after lying some time. Eenz (op. cit., p. 4) : " There was a fever and a miliary eruption; cases first observed in the employes of a sugar factory. Eupprecht found trichinae in one of these cases 16 years after." (Meissner, op. cit., "No. 130, p. 109.) 76 REPORT ON TRICHINA AND TRICHINOSIS. Eeichenbach, 1849-50. Meissner (I. c). Quedlinburg, Halberstadt, 1851. Dr. Abel (Preuss. Vereinzeitung, November 15, 1857) described as a peculiar epidemic influenza in the neighborhood between the Harz (Hay Meissner, Eenz^ I. c). Hamburg, 1851: 9 cases, 3 deaths. Tungel says (Virch. Arch., 28, 1863, p. 391) as the judicial examination failed to show the cause of the disease it was called " schinkengift," as the meat was of bad quality and sold cheaply on that account. One of the patients who recovered died in the Hamburg mad-house in 1865, and numerous trichinae were found in the muscles. (Virch. Arch., 32, 1865, p. 363 ; and Pagenstecher, 30, 31.) Celle, Hanover, 1855: 12 cases. (Letter of Dr. Baring to editor of Zeitschrift fur pract. Heilk. Hanover, 1864. 2d Aufl., Gerlach Land- wirthschaftliche Zeitung, No. 381, 4073.) Schweitz, Merschede, 1855. Breslau, 1858. Meissner (I. a). Magdeburg, 1858. Scudlef says (Deutsche Klinik, No. 27, 1862, No. 2, 1863, also Scholz, I. c.) the disease was called "acute epidemic cedema of the subcutaneous cellular tissue and muscles." Blankenburg, 1859: Nearly 150 cases. Scholz (Deutsche Klinik, 17, 1854), " Dr Abel called it rheumatic fever, with acute cedema of the muscles and cellular tissue." (Benz, op. tit., pp. 4-5.) In addition to these epidemics generally accepted as trichinosis, there occurred in Paris in 1828-'29 a severe epidemic called " aorodynia^ "mal des mains et des pieds," " Erythema 6pid6mique," "phlegmaric gastro-cutan^e aigue multiform," etc., and lately has been called trich- inois by Le Eoy de Mericourt. (Arch. g6n. de Med., ii, 1865, p. 620.) [This epidemic has been generally accepted as one of trichinosis, but according to Meissner, I. c, and Med. Times and Gaz. (London), vol. i, 1866, p. 622, Delpech (Report to Acad, de Sc. de Paris) not only denies this, but in the latter is made to say there are no trichinae in France. In a later work (Les trichines et la trichinose, etc., Paris, 1866, p. 80) he does not deny the discovery of trichinae in the cadaver, but says : "We, M. Eaynal and myself, were perfectly correct when we said that no cases of trichinous infection had been known to occur on our soil.] " The symptoms of acrodynia, according to Demos (Nouveau Die. de m6d. et de chirurg. prat., 6d. Jacoud, Paris, 1864, i, p. 375), occur in three series: Disturbances referable (1) to the alimentary canal; (2) to the nervous system ; (3) to the cellular tissue of the external and inter- nal covering— skin, conjunctivae, pharyngeal, bronchial, and urethral mucous membranes. In the beginning there are digestive disorders- loss of appetite, obstinate oedema of the face, at times conjunctivitis and bronchitis, often vomiting and diarrhoea. Then follows stiffness of the joints, with sensation of formication, which gives way to superficial and deep hypercesthesia, painful, often convulsive sensations of various kinds — contraction, twitchings, convulsions, erythematous redness, es- REPORT ON TRICHINA AND TRICHINOSIS. 77 pecially of the hands and feet; later, anaesthesia, weakness, paralysis. The erythema gives place to a yellow, blackish scaling of the skin ; fever usually absent; intelligence clear. The results of post-mortem exam- inations entirely negative. Bascome, in his History of Epidemic Pestilences, London, 1851, al- though giving his descriptions of diseases only in a general way, and for this reason not so available for statistical purposes, yet when simi- larities occur are the, more striking, because he makes no attempt to fol- low any particular theory. He says, p. 1"<6 : "This year (1827) a singular malady, a sort of a rheumatic fever, occa- sioning great agony, broke out in the island of St. Thomas, West Indies, and affected almost every one of a population of 12,000 persons. It obtained from the negroes the cognomen of ' dandy fever.' It was rarely fatal. A similar disease prevailed the year following in Paris * * *. A writer thus describes the malady * * *. It was gen- erally unaccompanied with any great degree of fever, but affected the whole nervous system in a most peculiar manner, especially by a most painful sense of formication of the hands and feet, as well as a degree of numbness which seized first upon the members and thence extended over the whole body. The formication and painful numbness of the extremities were so characteristic of the complaint that at Paris and elsewhere in France it was known by the name of ' mal des pieds et des mains.' The cellular tissues in this disease became affected after a while ; the hands and feet swelled, and cedema attacked the face and several other parts of the frame. Immense numbers suffered from it in France. The sensations were compared to those caused by the punc- tures from the points of a thousand needles or of some such sharp in- strument. An intense degree of heat aggravated the- sufferings, and many could scarcely move their body or extremities- without great agony ; cramps and spasmodic contractions were present in many cases ; the digestive organs were greatly disordered, and symptoms of cholera morbus were sometimes developed in the course of the disease ; erup- tions of various kinds occurred on the body ; sleep was prevented by the excessive pain and general disturbance of the system ; delirium sometimes supervened ; the sight and hearing and the sense of smell were altogether lost in some, but in others only partially impaired. In some, convalescence followed in a few weeks ; in others, not until several months had elapsed. Great numbers fell victims to the malady, and many perished ultimately from its sequelce? This disease "was observed (Heller, Ziemssen's Cyc, iii, p. 619) as a widespread epidemic in Paris in 1828-'29, and afterwards in various other districts of France, as, for instance, in Coulommiers, Pere-Cham- penoise, Montmirail, and Vitry ; in 1846 in Belgium, and in 1854 in the Crimean army. In order to recognize that this view is correct, it is only necessary to read the name and recollect that the prevailing epidemic in Magdeburg and vicinity in the year 1858, and subsequently, was de- 78 REPORT ON TRICHINAE AND TEICHINOSIS. scribed by Scudler " (I. c.) " as acute epidemic oedema of the subcutaneous cellular tissue and muscles. We may thus compare.it -with an epidemic of 'febris desquamatio typboides'in 1863 in Zullichau and vicinity, described by Prank as < epidemic morbid desquamation of the epider- mis,' which -without doubt is to be considered as trichinosis." Virckow, Leuckart> Fagenstecher, and other able observers do not doubt the previous occurrence of this terrible disease, and Zenker very naturally says that (Heller, I. c.) "cases of encapsulated trichinae are to be considered as healed cases of trichinosis." Thus the 50 cases recorded in section A may represent not only 50 cases of trichinosis in man, but 50 epidemics. Some of them might have resulted from very light infection, or, when the number of trichinae was large, from several such infections, no single one of which might have presented more than a passing disturbance of the • digestive organs, or each one may have resulted from infection during a more or less grave and extensive epi- demic, as in the cases from Jessen, from Hamburg, Dresden, and Wege- leben, etc. Thus, as Leuckart says (Untersuchungen, etc., p, 18), "The disease has not failed to appear in former times, only the explanation of the symptoms was different. Typhus, influenza, gastro-rheumatic fever, rheumatism, gout, oedema of the museles, and poisoning were the diag- noses, according to the most prominent symptoms, until the discovery of trichinosis furnished a clue to their nature and etiology." Eeferring again to Bascome (p. 88), it will be seen that the disease called "English sweat" or "sudor anglicus" occurred in England in 1485 (p. 70), and prevailed at the same time in Ireland. It also occurred in 1505 (p. 75), 1517 (p. 77), and the last time in 1551 (p. 86). " The symp- toms (p. 70) were those of a violent inflammatory fever, which, after a short time, caused great prostration of strength. There were also pres- ent oppression at the stomach and violent headache, accompanied by lethargic stupor, and the body was covered with a profuse foetid perspi- ration. The progress of this singular malady was very rapid, a crisis always taking place within the space of a day and a night. The internal heat from which the patient suffered was intolerable, yet everything cold, or even cool, was certain death. No one was exempt. Many of those who recovered ffom the first attack were attacked a second, and some even a third time." There are some points in these symptoms widely different from those of trichinosis. Yet, in regard to the prog- ress, it is possible that some of the earlier symptoms may -have been overlooked, and in regard to the danger from <u cases, and simultaneously in only 11 cases, viz : 2 on the day of infection, 108 REPORT ON TRICHINAE AND TRICHINOSIS. 2 the next day, 2 on the third day, 1 on the fourth, 2 on the fifth, 1 on the ninth, aud 1 on the fourteenth day. Vomiting and diarrhoea were absent in 128 cases, and of these 21 were fatal; 5 of the latter had no oedema of the face or eyelids; another (No. 273) had neither cedema nor muscle symptoms ; one of the former had muscular symptoms on the first day, and cedema of the lower extremities on the nineteenth, and died on the thirty-seventh day; another on the fifth, dying of asphyxia on the thirty-fifth; and 2 on the tenth; No. 70 died on the forty-eighth, and No. 168 on the forty sixth day ; No. 109 had cedema on the fourteenth and died asphyxiated on the thirty-fifth day. In one case vomiting commenced in two hours after ingestion of the trichinosed meat. In another it lasted two weeks, but as a rule passed off after a few days. In one case in Hedersleben, diarrhoea lasted three months, and in Knoll's case (Knoll, I. c.) it lasted from the fifth to the fourteenth week. In Hedersleben, it was mostly uninterrupted during the first four or six weeks; involuntary stools occurred only with delirium or stupor. In Hettstadt, diarrhoea was not one of the prominent symptoms. In Brooklyn, in 1879 (Dr. Maddren, I. c), " the pain, vomiting, and diar- rhoea appeared in 24 hours after eating trichinous meat, the large,' fecu- lent, greenish stools changing later to very thin, clay-colored, or rice- water discharges." Eupprecht (p. 13, op. cit.) reports in his cases: "the stools are yellowish brown, passing without pain." Dr. Gilpin (I. c.) in one case met with diarrhceic stools as in the third week of typhus; all stools like beaten eggs. In Hedersleben there was bloody diarrhoea in three cases, in one of which it lasted four weeks. One of Gilpin's cases had neither vomiting, diarrhoea, nor fever. " Constipation often su- pervened on a previous diarrhoea, and in some cases was one of the initial symptoms." (Kratz, p. 71.) Wunderlich (I. c.) reports one case (No. 2) with constipation, dysuria, and vomiting. "Pain in the abdomen and borborygmus were constant with diarrhoea; occurring also when there was neither vomiting nor diarrhoea." Of the remainder of the 128 cases in which alimentary disturbances were not present (viz, 107) muscle symptoms appeared in the following: On the fifth day, one case, with cedema on , the fourteenth day, and death by asphyxia on the nineteenth day; two cases on the seventh day, both cedematous, death from paraly- sis of lungs occurring on the twenty-second and twenty-eighth days, re- spectively ; five cases on the eighth day, with cedema on the eighth day ; one case on the twelfth day, death from marasmus on the fifty-seventh day; one case on the fifteenth day, death from exhaustion on the fifty-' fourth day; two cases on the sixteenth day, one of which died o'n the twenty-fourth day of paralysis of the muscles of respiration, the other on the forty-ninth day of exhaustion; one case on the twenty-second day, died on thirty -third day, scrofulous; one case on the ninth day with simultaneous cedema, died from exhaustion on the forty-ninth day • REPORT ON TRICHINA AND TRICHINOSIS. 109 two cases, first seen on the ninth day, (Edematous, one died on the twenty-seventh day of collapse, the other on the thirty-ninth, of paraly- se of muscles of respiration; two cases on the tenth day, one (edema- tous when first seen on the eleventh day, died of paralysis of respiratory muscles, and the other (Edematous when first seen on the nineteenth day, died on the thirty-seventh day, of paralysis of the brain; one case on the eleventh day, with oedema on the twenty-fifth day, died on the forty-fifth day; and one case, first seen on the twenty-first day, with cedema on the twenty-fifth day, died on the one hundred and thirty-first day. "The second stage in a diagnostic point is the most important, and in light cases is the only one present." * * * "Its advent is marked by a swelling of the eyelids, face, etc., which in typical cases occurs with the beginning of the second week. If the number of migrating trichina} is small, these, symptoms may not appear until the first two (3, Rupprecht) weeks have passed., or even later." (Leuckart, Mensch., par. ii, 3, p. 587.) Delpech (p. 28 op. cit.) says : " (Edema is an indication of the presence of the parasites in the facial muscles. In severe cases it may appear on the seventh day, in lighter ones on the eleventh, or even as late as the twenty-second. It is sometimes very fleeting, especially when not prominent, and probably it is owing to this circumstance that it was not seen in the only two cases (Friedrich and Behren's) in which it was reported absent. All observers that I have consulted consider it characteristic. In one of Friedrich's cases cedema of the face, hands, and feet appeared on the first day. Pressure and burning in the eyes and swelling of the lids and face were among the first symptoms observed by Fiedler, and one of his cases was marked by great subcutaneous extravasations in the extremities, which came on shortly after the disappearance of the oedema of the face." Renz (I. c.) reports cases in which the oedema was very light. Sungel (Virch. Arch. Bd., xxix) says : " The most characteristic signs are those exhibited as the different groups of muscles become successively attacked. When they are situated under a fascia the cedema is felt deep-seated before exhibiting itself under the skin. When the muscles of the face are affected, it at once appears there. (Edema may, however, be entirely absent. It failed in the face in one case out of every 5 J in Hedersleben (18 per cent.). It failed entirely in 28 cases, viz, in all the light ones and in the severest ones where death occurred early." It failed in the eyelids and face-68 times (and 72 times in the extremities). " It commenced oftenest on the ninth and tenth days, and disappeared in a few days. In four cases it reappeared after four or six weeks," and " in severest cases returned in the lower extremities, reaching even to the scrotum, and sometimes remaining for weeks or months." ( Meissner, 1. c.) In St. Petersburg (Veh, I. c.) " cedema was not always present, and when it occurred, there was loss of hair on the part affected. The 110 REPORT ON TRICHINA AND TRICHINOSIS. sailors from the Valparaiso ship, treated in Hamburg, had no oedema." (Scoutetten, p. 64, op. cit.) . Perspiration, which Meissner says is a constant symptom, was absent in Dr. Gilpin's cases, and " the skin became moist only as convalescence progressed." Kratz does not give this symptom a place in his table of symptoms. . Pain, soreness, or muscular weakness appeared m 258 cases in He- dersleben, showing that it was the most constant symptom (it occurred on the day of infection in 1 case, No. 62), but it failed in one out of every 13 cases. Fullness or tension of the limbs present m 214 cases, and in No. 74 it was the only symptom present. In No. 51 there were neither muscle symptoms nor oedema, but diarrhoea, headache, and swelling of the lips, and tongue. In No. 106 diarrhoea and oedema, and in No. 131 vomiting, were the only symptoms present. One of the Ham- burg cases had no pain. Dyspnoea comes on in the second week through the formation of bron- chial catarrh. It increases to asthma-like attacks, which may recur every 3, 6, or 24 hours, often continuing 8 days. It occurred in 95 cases, while the catarrh continued a week very severe, with profuse expectora- tion, in 111 cases. (Meissner, I. c.) 6.— Differential diagnosis. Next to the discovery of what a disease is, is the finding out what it is not. "In the different degrees of intensity of trichinosis, according to the number of migrating trichinae, it presents similarities to rheuma- tism; a light nervous fever, and in severest cases begins like cholera, and afterwards appears like nervous fever." Many epidemics of this disease have been wrongly interpreted and called by various names, as influenza, rheumatism, gastric fever, etc. It will therefore be necessary, when epidemics or even single cases occur with the leading symptoms of these diseases, to study them carefully and compare their symptoms with those of trichinosis. Influenza — Would not be apt to be accompanied by severe stomach or intestinal symptoms, while its own peculiar symptoms would be the most prominent ones present. "The cough in this disease is severe, and sputa, profuse and yellow, most troublesome at night, and accom- panied with a severe headache. The inflammation generally commences in the ocular and nasal mucous membranes and extends downwards, and when lung symptoms occur they are marked by well-defined physi- cal signs" (which is not the case in trichinosis), "and it may terminate in diarrhcea, while trichinosis is more apt to commence with diarrhoea, or vomiting, or both." (Aitken, Pract. Med. i., p. 706.) Rheumatism. — " The parts affected by acute rheumatism are for the most part the joints and such textures as are composed of white fibrous tissue." Fever often precedes by twenty-four or forty-eight hours the "inflammation of the joints, but the local and general symptoms may REPORT ON TRICHINA AND TRICHINOSIS. Ill be contemporaneous." (Aitken, Flint.) "In a certain proportion of cases only fever is present." It may be "preceded by chilliness, which soon passes away ; perspiration may be copious, but only partial " (A., F.). "The urine is scanty and high-colored, and deposits, on cooling, deep-colored sediments of urate." In trichinosis the urine may be ab- sent or small in quantity, is dense and high colored. Albumen may be present in rheumatism, while it very rarely occurs (Eupprecht says never) in trichinosis. Albumen occurred in one case by Warfwinge (I. a), one by Maddren (I. c). Eheumatism pursues no particular course after invasion. Extreme cases, however, may simulate trichinosis in general characters ; but in the former only a few joints will be found to be affected, while the latter affects the bodies of the muscles (the pain when it appears is diffused, as a rule, Kratz), and pain on passive mo- tion is due to motion of the inflamed muscles on each other. The sub- fascial oedema, will not be present in rheumatism, while the joints will be hot, red, and swollen. Pain is not usual in prsecordium, and when present in rheumatism other signs of cardiac inflammation will appear. Eheumatism will not occur as an epidemic. a Gout — Does not often attack any joint but the first one of the great toe ; in other words, it is rare for the first attack instead of being a podagra to be a ckiragra, gonagra, or omagra" (Niemeyer.) " The pre- vious history of a case would have a strong influence on the diagnosis, yet a previous history of gout should not necessarily preclude the pos- sibility or even probability of trichinosis, as high livers are apt to lunch often, and raw or underdone ham is frequently used in public places for lunches. In trichinosis the pain commences centrally and presses towards the extremities." Sudor Anglicus, or sweating disease (Xiemeyer), with which the en- demic at Wegeleben (and probably in other places) was confounded, has many symptoms in common with trichinosis, but they seem to commence in a regular order— commencing on the " sides of the, neck and upper and front part of the chest, thence spreading to the belly and back and limbs » In a few instances the disease is preceded by languor, head- ache, soreness of the limbs, loss of appetite, indigestion, etc. Much more commonly it breaks out suddenly without precursory signs. The patient awakes at night bathed in a profuse perspiration, which may have been preceded by a slight chill. There is a painful constriction about the praecordium, and an indescribable terror and restlessness. The countenance is reddened, the skin is hot, pulse frequent, and urine scanty and concentrated, thirst is not always much augmented. In 1st cases there is headache and a feeling of stiffness about the nucha; there may be mental confusion, dizziness, roaring in the e«M*lp£ tion and painful spasms in the extremities, as in cholera. These cases ro L^anted by a more characteristic symptom, a sense of numb- TessTd pSng of the skin, particularly in the fingers and ^over ttie regions where the eruption afterwards breaks out most profusely. The 112 REPORT ON TRICHINAE AND TRICHINOSIS. sweating is so copious as to saturate the clothing and bedding, and sometimes the mattress. A peculiar odor has been ascribed to this per- spiration by some, who compare it to the smell of rotten straw or musty vinegar; but most probably the odor proceeds from decomposition of the sweat which soaks the bedding. At the end of the third or fourth day the eruption appears, preceded by an aggravation of all the above symptoms, but particularly by an increase of the sweating and the prickling of the skin. Scattered here and there among the spots of the eruption, solitary sudamina appear, limpid vesicles filled with sweat, beneath which the skin appears so natural that one might mistake them for drops of water. The vesicles soon become pearly and turbid. The bowels are generally confined throughout the disease. This disease is limited to certain parts of Europe, and rarely, if ever, occurs in isolated cases. When its presence may be suspected, a thorough examination of food and a close study of the history of the cases would lead to a correct diagnosis ; but the existence- of the premonitory symptoms, with those conditions of the muscles and skin most characteristic of trichinosis, would be the most reliable guide, as an epidemiq of any magnitude would hardly occur without some of these symptoms being present. " Post mortem : the spleen is enlarged, the liver full of blood, and rarely pneumonic infiltrations are found in the lungs." Cholera. — The similarity of trichinosis to cholera was so great in the Hedersleben epidemic that it led to a false diagnosis in many cases, and cholera morbus, having for its cause an irritation of the mucous membrane of the alimentary canal, and which generally shows its effects in the night, might easily be mistaken for the former disease. In cholera morbus the treatment would necessarily be very different from that of trichinosis, as may also be said of true cholera, as the use of astringents in any form of trichinosis would tend to make the prognosis more unfavorable, as was the case in some of the early instances in Hedersleben. In all such attacks it would be well to give due consideration to a possibility of trichinosis, with especial inquiry regarding the ingesta of the previous day. A possibility of cholera invasion would be increased by its pre- vious occurrence in other, especially neighboring localities. The pain on pressure occurs in cases where there is no diarrhoea or vomiting. The peculiar stitching pains and feeling of tension in trichinosis develop later. The remission of pain and tension in cases of cholera, after per- spiration occurs and absence of pain in epigastrium, would then settle the question. (See Eupprecht.) Typhus fever.— This disease materially differs from trichinosis, besides the most apparent symptom of the former, is the rash, which appears, from the third to the fifth, or as late as the seventh day. (But the rash is absent in 25 per cent, of cases below 15 years, 14 per cent, from 18 to 22 years. In cases above 25 years it is always present. Aitken). In " the cough of typhus the sputa is of tough mucous, occasionally mixed with blood" (Memeyer), while that of trichinosis will be negative, as it • REPORT ON TRICHINA AND TRICHINOSIS. 113 is due to irritation of the larynx. The temperature in typhus is high during the first weeks, whereas in trichinosis it is not much elevated until after the first week. In typhus the spleen early shows signs of en- largement, but there are only two or three cases of such an enlargement in trichinosis ; but in the latter the liver may exceptionally be very much enlarged. (One case at Hedersleben, Kratz). (Edema, muscular ten- sion, and contraction is absent in typhus, while in trichinosis the arms are generally flexed. " In typhus the arms lie beside the body helpless." (Memeyer, Pract. Med.) "The only important symptom of typhoid fever said to be absent in this disease" (trichinosis) "is enlargement of the spleen, and it is very probable that some of the so-called epidemics of typhoid fever in former days were caused by the propagation of trichinae in the human body. But the epistaxis, the pain and gurgling on pressure in the right iliac region, the rose-colored eruption of typhoid fever, cannot exist in trich- inous diseases, while the earlier irritation of the stomach and bowels, with oedema of the face and severe muscular pain, especially on motion, with breathlessness, increasing to dyspnoea or almost asphyxia, ought to render the parasitic disease easy of diagnosis from enteric fever." (Aitken.) Although all of the symptoms of enteric fever may not be present at the same time, one or more of its characteristic symptoms may be of sufficient prominence to mislead the practitioner unless the ensemble of the symptoms of trichinosis is firmly fixed in his mind. Warfwinge (l. c.) found enlargement of the spleen. Hun found the spleen smaller, darker, and firmer than normal — a condition which was probably pre- ceded by enlargement. Epistaxis was observed by Ehoda (Centralblatt f. Med. Wissen, No. 17), who gave ergot where it occurred, and by Kratz shortly before the death of the patient (see Friedrich below). Pains in the ileocecal region observed by Wolff (I. c.) ; also by Kratz and Eupprecht in the lower part of the belly, but they diminished as the trichina} reached the limbs. There have been various symptoms seen in trichinosis (Meissner, I. c), but none perhaps like the eruption of typhoid, but in the latter it may be absent. It has been seen that the only symptoms referred to the stomach and bowels may be wholly or partly absent, as also the oedema and even the pain. Friedrich (Deutsch Arch. f. Kl. Med. Bd. ix, 1872, p. 459) reports a case admitted to hospital for typhoid fever in which trichinosis was sus- pected only when the severe pain and profuse perspiration came on. In the height of the disease there was epistaxis and spitting of bloody mucus. , ,. Knoll (Prager Vierteljahresschrift, Bd. Hi, p. 144) reports the case in Prague Hospital of a woman aged 52 years from fifth to fourteenth week of the disease. There was a diarrhoea of long duration. Pulse high to tenth week, alwaysabove 100 and often reached 120. Temper, S. Ex. 9 8 114 EEPOET ON TRICHINA AND TRICHINOSIS. ' ature in first seven weeks showed a regular morning remission and even- ing exacerbation. Urine scanty ; convalescence tedious. In four cases reported by Fiedler (I. c.) the evening exacerbation of- temperature agreed with those of a light case of typhoid fever. Kestner (I. c, p. 41) speaking of the case of a soldier at Quedlinburg reported by Behrens (Deutsche Klinik, No. 30, 1863) says : " The symp- toms at the beginning of the disease assumed a typhoid character to such an extent that an error would have been excusable. Independent of the early pain in the ileoaecal fossa, the dryness of the tongue, fever, loss of appetite, a severe diarrhoea, which was followed, after several days, by constipation, would be sufficient to mislead the most expert physician. In Pankom (Mendel, I. c.) in the severe cases the temperature rose to 40.5° 0., with delirium, sleeplessness, and great prostration. Warfwinge (Hygiea xxxviii) reports a case of trichinosis in a woman, dying, after delivery, of what was at first supposed to be puerperal fever and later was called typhoid fever. There were no rose-colored spots, cough, or digestive troubles ; 45 trichinae were found in one gram of flesh (Annales d'hygiene publique, &c, Dec, 1879, p. 508). Coupland (Path. Soc. London, June 6, 1874) reports a case in Middle- sex hospital dying of "chronic phthisis and acute bronchitis when numerous trichinae were found. Infection probably nine years previously in New York, when he suffered a nearly fatal case of enteric fever with constipation." In one of Boehler's cases (case viii, Kestner, p. 32, op. cit.) the symp- toms, on the eleventh day, took on a light typhoid character. In Marengo, 111. (S. T. Med. Journal xi, 1870, p. 107), the symptoms were like typhoid fever, excepting swelling and pain in the muscles. In three of the cases reported by Sutton (op. tit., pp. 6, 7) the patients had been treated two weeks for typhoid fever. One of them, H. T., was taken, a few hours after eating trichinosed meat, with vomiting and diarrhoea. When first seen by Dr. S., 14 days after infection, face pale, countenance shrunken, great emaciation, diarrhceal discharges serous and yellow every three hours, unrestrained by astringents, occasional nausea and vomiting, loss of appetite, thirst, tongue red but not re- markably dry, pulse feeble, 110 to 120, temperature 98° to 100° F., mind clear, apathetic, complaint of feeling tired, tendernessof abdomen, slight hyperaesthesia, but no oedema or eruption; died after four weeks. The fever curves as presented in Figs. 70 and 71 show some similarity between trichinosis and typhoid fever, as also how easy it might be to mistake one for the other. In Fig. 70, from Hillar (in Ziemssen Cyclo- pcedia, &c), the first observation was taken on the tenth day of the disease ; but this really corresponds more nearly to the temperature of trichinosis than if taken on the day of infection ; for in the latter case ' it should be compared to that of the incubation period of typhoid fever, REPORT ON TRICHINA AND TRICHINOSIS. 115 for the earlier gastro-intestinal symptoms do not really occur in the characteristic period of trichinosis, and as stated above by several iert 28 : !9 3DJ$ B 3 4. K fi % 8 9. 14 B. 1Z. ft ft W1IB.17 18. 58)20, Zl ?Z 23/24 25/26 77 Z8 29 30 31' t£me m£iffl£. l ft^&B\ff,ttlE.we;^nfi.ratf■■.tt\£.^^B.me.^lB.1^£_w\e.TOE..me 1 mE.WE.me-'mcmE , . me. me. meJmejpie.^me.inpiyTie.-mE.me.tfie i p r r r - *"". ft K* 3j«_E-- h ^S-w zz* g_ i" 5;X is •* ;-«. . .:.-.. ?m -38--i/-ga.!- - -U-2 L 11 .a;- „-»• _• ,.- - !S -C g:L :: g-,* --y «-jy -*t :Zi.-."m «," 8 . r :~_" _ :x .X - __" C2-S5-,"„ 3:2*::; z: _« . ..: ::-.: x X : :____ ^.,2:6 _:t5:: j s "»_>,: J?o :::::: :± ± : :: c :::: -h 1- *f- -5 ri ^ _: IS ;;~: ;_ _x .z^zzzzzzzt- .X _ *.s ~--_^_- 7 W v . ■ . ::*: -:~...± .±-_ „ ...11,,...- 1 y ss: . .,,. v ,.:,:_...,. j. .±.--* In .. , , f « ■* "i HOt> Fig. 70. — Fever curve of a caae of trichinosis beginning about the 10th day of the disease (after Fried- reich in Ziemssen, iii, p. 631.) authors — Kestner, Kratz, and others — do not differ from those caused by the irritation of any other foreign substance in the alimentary canal. k«*Ibl'* 3*5 6TB3WHHB »•» T6 VJ\L WJZO/W Zl. 23 W 25 26 27/28 29'30 S\ ^° S-nie me mf me, mrme. me m e. mer-rae. mp..mg THJ.TCTf.tnfc m,c, nie.-mEme. at bb k w.: me. ma. mt. to. im. me-. toiutm. -mn-ij. ■ ' i ' I I ' ' ' ' I I* ' ft I I I I I ' I I I I M I ' I -I 1 I 1 I I 1 I I I I I I S I FIG. 71.— Range of temperature in a severe and prolonged case of enteric /«>«•-?»• "■ morning and evening temperature (Wiinderlich from Aitken Pract. Med. l, p. 530). In light cases it is probable that the characteristic curves would show less similarities, as there are decided intermissions in such cases of trichinosis in place of the usual morning remis- sion. Fig. 72 shows the fever curve for a mild, case of trichinosis. In one case reported by Wiinderlich (Arch, der Heilkunde, ii, 3, 1861, page 269) the fever was of an irregular remittent type. There was DmoIOis A f. 8 7' t ! « " ll m to, Si. .e.M«'«.M«-'«tM -IIS p$fi n RMS VI CKO V/J- **■«- iii^b"-"™ " ■*■ I i i i i i ! i ■■■■■■■■■■■ — oppression and bloody sputa, which continued m-f™™^^ for some time with no corresponding pathologi- ziemssen, ui, 632). cal condition discoverable by auscultation or percussion. In one of the sailors from the Valparaiso vessel, dying at Hamburg, there was no oedema. Trichinae were not looked for. At the autopsy broncho-pneumonia and ulcers of the intestines were found. See ' Mr. Power," mentioned by Dr. Bradbury, 48th An.'Meeting Brit. Md., April 2d day. "Parasites resembling trichina in the voluntary muscles ot tvphoid fever patients." '(N. Y. Med. Eecord, vol. xvm, p. 353.) From the appellation « nervous fever," used to designate the epidemic at Planen, and diagnostication of one case as such in Gratzungen re- ported by Grasenick (Thtir. Corr. BL, iii, 9, September 15, 1874, p. 170), there is still further evidence of a tendency to confound trichinosis with typhoid fever, in these instances with the abortive form. (See Eiemeyer, Pract. Med., N. Y., 1875, vol. ii, p. 591.) The staring condition of the eyes reported by Kittle m Libau might provoke a suspicion of some nervous disorder. Eing (l e.) "f**-™ case of a cooper in whom the disease was very threatening at first un 116 REPORT ON TRICHINA AND TRICHINOSIS. account of the stiffness and contractions of the muscles it was thought to be tetanus. (Edema was very slight ; there was fever, but no pain in the abdomen, and no difficulty in breathing. The patient was better in one month, but too weak to work at the expiration of two months, Cerebro-spinal meningitis might under some circumstances be sus- pected from the headache and pain in the nape of the neck, opisthoto- nus, trismus, etc. But in that disease the pupils are contracted, the belly sunk in, and the bowels obstinately constipated, and although there may be vomiting, it is followed sooner by other characteristic symp- toms, and coma soon supervenes. (Niemeyer, Pract. Med., ii, 221, 222.) A case of cerebro-spinal meningitis reported by Dr. P. G. Clark (Bost. Med. Surg. Journal, January 8, 1880, p. 37) had many symptoms in com- mon with trichinosis. The patient was attacked with rheumatism March 8, 1873; with swelling and pain in the knees on the 21st; had a "ner- vous attack" on the 22d; was seized with vomiting, convulsions, rest- lessness, hyperaesthesia, soreness of abdomen, injection of conjunctivae, photophobia, and profuse perspiration on the morning of the 25th; on the 27th had one slimy discharge from the bowels, takes nourishment with difficulty ; on the 28th rales heard on the right side of the chest, a trifling dullness on percussion, cough, and a slight bloody expecto- ration; April 1, eyelids somewhat swollen, abdomen tumid, but not tender, gurgling in the right iliac region; April 3, sore throat, diffi- culty of swallowing ; April 8, great prostration returned, profuse sweat- ing; 10th, relieved constipation with calomel, followed by magnes. sulph. Swelling of the face again on the 12th ; disappears on the 13th ; urine of a brick-red color ; gave another purge ; swelling of the face again, with vomiting and purging. The opisthotonus and epistaxis often repeated, contracted pupil. The course of the symptoms, etc., pre- clude a diagnosis of trichinosis, while most of the other symptoms, the condition of the bowels, and especially the condition of the abdomen, considering the age of the patient (ae. 12 years), would lead to a diag- nosis of trichinosis in an epidemic of that disease. PECULIAR CASES. In one of Boehler's cases, previously referred to, the patient was sick five weeks, and it was thought that the disease was the result of a cold taken during menstruation. The patient had had swelling of the feet for seven days, had passed lumbricoides, and a few fragments of taenia. This case was diagnosed " rheumatic fever," and on the third day after admission the symptoms assumed a light typhoid character; on the twenty-second day there was an abundant effusion into the left pleura. The hair fell off, but commenced to grow again before she left the hos- pital (Kestner, p. 35 ; Scoutetten, p. 54, op. cit.). { In Plauen in 1863 (Behrens) the general characteristics of the disease were those of a gastro-rheumatic fever ; in most cases constipation was a prominent symptom. The whole course of the disease was very be- REPORT ON TRICHINA AND TRICHINOSIS. 117 nign, lasting on an average about three -weeks. A few complained of pain and tension in the fingers, and one had small ecchymoses under the nails. Palpebral oedema occurred in every case, but general oedema was not present in any. The palpebral cedema was so constant and characteristic a symptom that the people were in the habit of calling those afflicted " swelled heads " (grosses tetes, Dicklcopf). Eupprecht so frankly states the source of his error (previously referred to) that I have inserted that portion of his remarks describing the symp- toms of his epidemic to show when failures may occur. He says (Die Trichinen Krankheit, etc., p. 1, 2) : " In the latter part of October, 1863, there occurred suddenly several peculiar cases of vomiting and diarrhoea. The sickness began generally in the night without apparent cause, and did not yield as usual to opi- ates, sinapism, etc. Besides unusual weakness, there was more or less restlessness, anxiety, nausea, cardialgia, and meteorism. The evacua- tions were greenish, thin and slimy, and painless. There was loss of appetite, increase of thirst, sleep troubled or failed entirely, and a more or less febrile condition was developed. In another series there was nausea without vomiting, with great oppression and restlessness, neu- ralgic pains in the vicinity of the cceliac, mesenteric, hypogastric, and sacral plexures ; also a greenish, slimy, or clay -like diarrhoea, without tenesmus. In still other cases there was constipation with dysuria; there was also exhaustion, decrease of appetite, great thirst, sleepless- ness, with the appearance of gastric fever, without severe headache, dizziness, delirium, appreciable elevation of temperature, or enlarge- ment of the spleen. The unusually warm weather in the early part of October— 32° E. (40° C, 104° F.) at noon, and 13° E. (16.250 C, 61^° F.) at midnight— seemed to have had an etiological relation to the disease., I was induced to believe that it was an epidemic of acute gastric catarrh, and treated it accordingly. At the end of the first week there was de- veloped suddenly in the cases first attacked an cedematous swelling of the eyelids, with catarrh of the conjunctivae and simultaneous muscular pains, difficult motion of the somewhat swollen limbs, and a tendency to profuse diaphoresis." In the case of the soldier at Quedlinburg before mentioned, there was absence of cedema of the lids. CEdenia of the feet appeared only in the fourth week. The respiratory symptoms resembled those described by "Wunderlieh, haemoptysis, with no appreciable affection of the heart or lungs, but which he referred to anaemia, and was attributed by Behrens in a great measure to general debility, which persisted a long time after recovery from the disease. "In December, 1860, Professor Wunderlieh met with a case of pro- longed fever, which did not correspond in its course with any of the well-known specific fevers. ' The patient was a butcher. He eventually got well, and so far negatived the diagnosis of acute tuberculosis which had been made. This was undoubtedly a case of trichinosis." (Aitken, op. cit., i, 158.) 118 REPORT ON TRICHINA AND TRICHINOSIS. A case in Wiirzburg (Kolliker, Wiirzburger med. Zeiturig, ii, 1861, p. 12) died of general purulent bronchitis. Otto (Memorabilien, No. 10) reports a case of trichinosis which simu- lated pleurisy. All other symptoms of trichinosis present. The diag- nosis was made by means of a "harpoon." The autopsy revealed Old adhesions in the left lung. Pleura contained effusion of bloody serum. There was hypostasis. The pyramids of the right kidney and its pelvis contained a purulent effusion. Wood's case (1835, I. c.) showed pneumonia in the first stage, and ex- tensive pericarditis. The symptoms were attributed to a cold. In Hettstadt, of four miners, three had pneumonic complications after the third or fourth week * the other died of pneumonia on the fifth day. In Bovenden (Kraemer, D. Klinik, 30, 31, 1872) there was an endemic of twenty-eight cases, the first one of which was diagnosed catarrhal rheumatic affection, with angina. There soon occurred another case in which a trichinous infection seemed probable, and on examination of the remains of the food eaten, trichinae were found in great numbers. Most of the patients showed the first symptoms at the end of the second or the beginning of the third week after eating the infected meat. Bronchitis and hoarseness occurred only in the severest cases. In Neugersdorf (Lond. Lancet, vol. ii, 1877) the usual symptoms re- curred after twenty-five days. Forty-five cases occurred. The butcher was imprisoned for selling infected meat. In two cases in Cheektowaga, N. Y., reported by Dr. Kronbein (1, c), were diagnosed " at first to be acute muscular rheumatism of a peculiar type." In one case reported by Baring (Zeitscht. f. prakt. Heilk, 2, 1864) was diagnosed erysipelas. No desquamation, followed. In the epidemic in Keustadt in 1874 (Munzel, I. c.) the first symp- toms — muscular pains, with oedema of the face concurrent or following in a few dars — occurred on the fourteenth to the twentieth day. The cases were mostly lighter as the first symptoms were postponed. Hun (Trans. K. Y. State Med. Soc. 1869, p. 157) reports that in one case puffiness of the face was noticed first ; this was followed by vomit- ing and general gastric disturbances; soon after the arms and legs be- came tender and sensitive to the touch, muscular movements difficult and painful ; about the same time diarrhoea came on ; about the end of the second week the patient walked on tiptoe, other symptoms in- creased ; cough was apparent after thirty days. This patient was first seen by Dr. H. six weeks after the first symptoms appeared. He was then lying on his back, complaining when moved or touched; face puffy, considerable cedema of legs and feet, tongue red and inclined to be dry ; considerable thirst and little or no desire for food; bowels tympanitic, but not remarkably tender ; frequent soft, green stools ; urine normal ; constant cough, with expectoration of a thick, tenacious mucus, some- times streaked with blood, at others resembling the rusty sputa of pneu- EEPORT ON TRICHINA AND TRICHINOSIS. 119 monia ; loud mucous rales on both sides of the thorax, with bronchial respiration and slight crepitation, and dullness ou percussion. Martinsville, N. J., Dr. E. J. Bergen (communication to the Surgeon- General M. H. S.) reports four cases of trichinosis. The symptoms, as reported by the physician who first saw them, were those of cholera. Dr. B. saw them two weeks after the attack, when all but the father of the family were bejter. He (the father) was suffering with symptoms similar to those of arsenical poisoning, viz : Foetid state of the mouth ; sensation of the teeth being on edge ; hic- cough; burning pain in prsecordia; inflammation of the lips (see Kratz, case No. 51); irritable stomach; vomiting of matters brown in color; black, foetid stool; small, frequent, and irregular pulse; partial suppression of urine ; livid spots over the abdomen ; delirium ; great prostration of strength; profuse perspiration; inability to move without great pain in the voluntary muscles ; oedema in the arms and legs. The patient was better on the second day of my treatment (salycilic acid in ten-grain doses), and on the third day he died while being helped from the bed. Trichinae encysted and free were found in a piece of muscle taken from the deltoid twenty-four hours after death. Fifty were counted in a space, perhaps, of one-half an inch square. The following cases were reported by 0. Frommann (Virch. Arch., Vol. 53, p. 501): On the 21st of December, 1865, 1 was called to see Theresa M., aged 22, who lived in Weimar, suffering from an cedeinatous swelling of the eyelids, and also, but to a less degree, of the cheeks, a painful feeling in the limbs. The oedema had lasted eight days, but weakness was felt only in the last three days. She felt exhausted and restless. These symptoms, as well as a pain in the back, had been very much increased. by hard work. There were no disturbances of digestion, and the bowels and appetite were normal. The patient had an anaemic appearance, moist skin, temperature to the touch slightly increased, pulse quick and small. Examination of the chest, except a few coarse rales, was nega- tive; voice unchanged; upper and lower lid somewhat cedematous, less towards the back part of the cheek; conjunctivae not markedly red- dened but were slightly swollen. When lying tranquil the patient com- plained only of headache, a feeling of stiffness in the neck and pains in the back; on the other hand motion caused pains in the limbs, viz, in the calves of the legs, the flexors of the fore-arm and legs, notwith- standing which she would not lie still in bed, and complained of a feel- ing of great discomfort and restlessness, which made it necessary to change her position often. She could neither walk nor stand alone be- cause she felt so undone (so caput.) ; pinching the above-mentioned muscles increased the pain besides developing pain in other muscles previously free from it, even on motion. Acute and sometimes reflex pains were occasionally called forth by pinching theserratus ant. maj., coracobrachial, deltoid, flexors of the hand and fingers, the small 120 REPORT ON TRICHINA AND TRICHINOSIS; muscles of the ball of the thumb and little finger, rectus and obliquus abdominis, the flexors of the legs, gastrocnemius, &c. &•> S T ' 2 s morphia in aqua laur. every three hours. On the 22d pain in the muscles markedly decreased ; on the 23d complained of loss of sleep, from pain in the nape of the neck; her head can be turned only slightly, slowly, and painfully on account of stiffness and pain in neck ; muscular pains and sensibility increased ; the flexors of the hands and figures are tense ; the skin about the elbow joint is cedematous as well as on the back of the hand; oedema of the eyelids increased; pulse 100, small ; skin moist. On the 25th a piece of muscle was taken from the forearm ; it contained neither trichinae nor degen- erated muscle fasciculi, but was cedematous. On the 26th cedema of the eyelids and pain in the muscles considerably decreased, but- com- plaint of pain in the region of the diaphragm on taking a deep breath or on yawning ; skin moist ; 27th, the wound in the forearm has sup- purated a great deal ; the tension of the flexors and cedema of the skin of the forearm has abated. January 1, 1866, patient much better; 6th, pain only in the calves of the legs on walking or being pinched, wound on forearm healed, pulse 88, some cough during the whole of the dis- ease. !Nb disturbance of the appetite or digestion ; the skin was moist, but no sweating appeared. The infection dated from the 26th of Novem- ber, 1865, when she had eaten some cracker sausages, some of which she gave to her brother Bernard M., who in turn shared his part with Franz H. "Bernard M. was taken sick about the 25th of December; slight trouble in swallowing, reddening and swelling of the mucous mem- brane of the mouth and pharynx. These symptoms improved rapidly and gave place to those characteristic of trichinosis. I first saw the patient on the 28th of December. He was complaining of great weak- ness and exhaustion, and was unusually quiet. The patient was some- what small of his age, and undeveloped. He had suffered with frontal headache since the 26th, with pain in the back and nape of the neck, shoulders, flexors, and calves of the legs, increased by pinching; the muscles were elastic and tense; neither oedema of the face or eyelids present ; appetite and digestion undisturbed ; skin moist ; temperature to the touch seemed somewhat raised ; pulse, 120, small ; considerable sweating during the night. Ordered morphia, &c, as before. Janu- ary 1, 1866, pulse 116. January 6, oedema of the upper third of the forearm and lower third of the leg, some oedema of'the cheeks, contrac- tions in right arm. " Third case.— Franz H., who ate a small part of the brother's share of the meat above mentioned, showed, on the 22d of December, a slight cedema of the eyelidsj- weakness and exhaustion, pain and stiffness in the limbs and neck, pain in the region of the diaphragm on deep inspira- tion. The oedema disappeared after two days, and after a week the patient resumed his work. REPORT ON TRICHINA AND TRICHINOSIS. 121 " The first two cases offer symptoms of a light form of trichinosis, viz, pain in a great number of muscles, oedema of the skin, increased fre- quency of the pulse, &c, while gastric symptoms were absent. Muscu- lar pain commenced in the first case (Theresa M.) on the twenty-second, and in the second (Pranz M.) on the thirty-firgt day after infection, and in the first case five days after the appearance of oedema. In the first case the pain lasted twenty-three days, and in the second it lasted thirty- two days. Excessive sweating was absent in the first and noticed only once in the second case. With the former it was not the extensiveness and severity of the muscular pain which aroused the suspicion of trichi- nous infection, but the cedematous swelling of the eyelids. In the sec- ond case there could be no doubt in regard to the diagnosis, as the mus- cular pains so often noticed in the fourth week were present, besides the weakness and the difficulty of motion in the limbs, &c. Mollendorf (Berliner Klin. Wochenschrift i, 37) relates a case in which, a few days after the oedema of the eyelids appeared, there was a sensation as if electric shocks were passing through the body, followed by some pain in the loins and calves of the legs, and later by intense contraction of the muscles of the left leg. This condition was observed in Bernard M. The absence of trichinae in the specimens of flesh examined is not sur- prising, as I found them only once in four cases examined in the epi- demic of Weimar, in which 100 cases occurred." In a case reported by Professor Navrateil (Pester med.-chir. Presse xi, 19, 1875, p. 295) there was paralysis of the left side of the larynx, for which no cause could be assigned during the life of the patient. Tost mortem, trichinae were found in the muscles and in the heart (?). Dr. I. Hirschberg (Deutsche Zeitschr. f. prakt. Med. 49, 1875, p. 421) reports a case of what was supposed to be trichinse or other nematode in the eye. Dr. Boull (Virch. Arch. 65, 1875, p. 421) reports a similar case in a raven. Referred by Virchow (see Beimer, Schmidt's Jahrbttcher, No. 178, 1878, p. 180) to "Jilaria sanguinis hominis" of Lewis (see Cobbold, I c, p. 180, P. Bancrofti (Fig. 87). A case is reported in the Galveston Medical Journal, 1866 (f), of tri- chinae having been found in the eye of a horse. In large epidemics or small ones in families, even if not more than two persons are affected, and especially when similar symptoms appear in several persons after partaking of the same meal, particularly when pork has been eaten, suspicion of trichinosis should be entertained early, and as many cases of sudden diarrhoea depend on offensive matters in the intestines, the desirability of an immediate administration of a non- irritating cathartic, as calomel, will present itself. In reviewing symptoms and cases in reference to the diagnosis of trich- inosis particular'stress has been laid on those cases which might mislead' by certain prominent symptoms, and on light ones, in which mistakes will be most liable to occur. Every case, therefore, of cholera morbus 122 REPORT QN TRICHINiE AND TRICHINOSIS.. may be looked upon with suspicion, only to be removed by a negative result of a thorough examination of the food eaten or th^ short duration of the symptoms. It has been seen that the symptoms of trichinosis are not so uniform, but that if the disease is suspected, the physician will be warranted in searching for trichinae, although Leiiekart (Untersueh., etc., p. 81) says " as long as muscular pains fail with other connecting circumstances, exclude trichinosis." This symptom, however, may fail (as in 6 cases in Hedersleben and 17 doubtful ones). " Besides the earlier gastric symptoms" (which do not always occur), " the microscopic examination of the vomited food and the diarrhoea! discharge will assist in the diagnosis." Many cases are on record where trichinae have been found in the stools. (Pagenstecher, op. cit., pp. 41, 43, also p. 39 ; Eupprecht, Edblk., p. 30, two cases after a purge of calomel in the third week; G-erlach, Die Trichiuen, p. 10 ; Virchow, op. cit, p. 59 ; Leuckart, p. 90.) But in many other cases where examinations have been made,- no trichinae were found, and therefore it would not be safe to exclude trichinosis because they could not be discovered. Dr. B. Wagner (Arch, der Heilkunde, ii, 1804) found no trichinae in the intestines in two cases, dying respectively on the twenty-third and twenty sixth days, " after hours of careful search." Gerlach (Die Trichinen, p. 10) says '■ the more severe the diarrhoea, and the more mucus contaiued in the evacuations, the more trichinae will be found, and the most in cases where the mucus is tinged with blood. Later, in doubtful cases, the examination of a piece of muscle taken from the arm by incision or by means of a har- poon, is recommended by Mitteldorf and Kuchenmeister. This is rec- ommended by most authors, but with varying amount of reliance in its diagnostic value." Frommann (Virch. Arch., No. 53, p. 508) says " the absence of trichinae in the muscles of the arm is no evidence against trichinosis, even in severe cases, as was shown in Weimar." Kratz says (op. cit, p. 106), "by this means only a positive result is obtained, never a negative certainty"; and Leuckart (Mensch. Par., ii., 3, p. 590) "a pos- itive result is not always attainable, because in the doubtful cases the trichinae are only sparsely distributed in the muscles." Even up to the fourth week Kratz (I. c.) found the, microscopic examination of the mus- cles to give a negative result; and P. Memeyersays (Catachismus, etc.), " There is nothing peculiar in the muscles in the first three weeks, but in the fourth there is an appearance of whitish streaks in the red mus- cular tissue." The oedema of the face and eyelids without albuminuria, one of the characteristic symptoms of trichinosis which may be occasionally absent, may occur in other diseases. " Neither Pagenstecher's method of examining portions of the gums for trichinae, nor Welpker's of examining the under sides of the tongue near the fraenum with a magnifying glass has been found to be reliable and up to this time there is no way of determining with certainty the presence of trichinse in animals during life " (Scoutetten, op. cit., p. 75). REPORT ON TRICHINAE AND TRICHINOSIS. 123 One great difficulty in the way of recognizing the presence of trichinosis is the assumption that it is a disease without variable symptoms. Wag- ner (Arch, der Heilk., ii, 1866), after mentioning several cases, says: " The symptoms of trichinosis are so well marked that there is no neces- sity for using the harpoon or trochar." It was because Eupprecht re- lied on these " well-marked" symptoms that he failed to recognize the disease. He found a whole epidemic in which the symptoms were not well marked according to the type given in the first case recorded as such. [To assume that this was the first case that occurred would be to assume that Professor Zenker was the first one to make a mistake in his diagnosis. He had called it by the name of the disease which most closely resembled it in its symptoms, but it seems he was not satisfied. There was something beyond the usual symptoms of the diseases with which he was familiar ; a comparison had failed to explain the case, so he resorted to investigation to learn what was beyond the existing knowledge, and happily for the world he found it.]* Tanner (Pract. Med., 1875, p. 173) says the diagnosis is not difficult, especially if the symp- toms occur after eating raw pork. Kratz, after the observation of 280 eases, says (op. cit., p. 57), "The first symptoms occur in so many widely different ways that one is led to suspect totally different causes for them." I have thus given at some length the opinions of observers to show the probability of errors in diagnosis from erroneous notions in regard to the symptoms or course of trichinosis, particularly as one gentleman — of whom I had made inquiries regarding some cases, etc.— wrote me " I do not see how trichinosis could become epidemic." "Fried- rich distinguished a case' of trichinosis among 12 cases of typhoid " (Rupprecht). 7.— Prognosis. " The mortality in different epidemics of trichinosis is widely differ- ent, and depends on the degree of infection and severity of the disease, but children suffer less than adults." Of 67 children under 14 years attacked in Hedersleben (Kratz. pp. 53 54) 1 died— 1.5 per cent.; of 100 women 17 died, 17 per cent.; of 170 men 83 died, 48.8 per cent., or nearly 30 per cent, of all cases. In Plauen in 1862 the mortality was 6 per cent.; in Oalbe, 20 per cent.; m Burg 22 per cent. In Hedersleben (Kratz I. c. and Cohnheim Virch. Arch., 136, 1866, p. 161, etc.) the mortality was very irregular m the different periods. Two died during the first week, a few in the second. The mortality increased towards the third week, and three-fourths of the deaths occurred during the fourth, fifth, and sixth weeks, alter which the death rate decreased and none died after the tenth week. Oi 8 fatal cases in Plauen 1 died on the fourth, eighth, fourteenth and forty- second day, and 4 on t he twenty-first day. Eupprecht, E u ndbhck, p. 10. "NOTE.-Cobbold states that the first person m England to observe recognize and treat the trichina disorder, in the living snhject, was Dr. W. Lindow Dickinson m 1870. 124 REPORT ON TRICHINA AND TRICHINOSIS. In Hettstadt (Bupprecht, Eundblick, etc., p. 26; Die Trlch., p. 20), "The greatest mortality occurred in the fourth and fifth -Weeks, i.e., during 'the time that myositis was most severe. A few died earlier, some later, the last through marasmus, in consequence of a purulent breaking up of. atelectatic nuclei or from follicular disease of the intestines, or from muscular atrophy." Also, p. 27 : " The more extensive an endemic the more intense will be the disease. The earlier the disease supervenes on the infection and the more complete and severe the symptoms are developed— swelling and tension of the muscles, formication, prone po- sition, stiffness of the body, trismus, dysphagia, severe diarrhoea, tem- perature 410 o., pulse over 120, respiration over 32, dyspnoea, embolism of the lung — the more unfavorable the prognosis." - Eenz (op. tit., p. 98) says : " The first cases of an endemic are usually the most severe." Schenck, of Halle (I. c), divides the symptoms into three sets for prognosis. " 1st. Where there was severe diarrhoea after one or two days, lasting several weeks, the prognosis is most favorable. 2d. Where there was a slight diarrhoea after six or eight days, with sudden cessation, the patient most frequently dies. 3d. The lightest cases are those in which the symptoms appeared after two or three weeks. According to Meissner (Schmidt's Jahrbiicher, No. 138, p. 92), these observations were not confirmed in the Hedersleben epidemic, for severe stomach symp- toms appeared early in some cases, later in others, and in another set not at all, without influencing the prognosis." One of the last category was, in Hedersleben, very severe. Death occurs most frequently in the fourth or sixth week after infection. Implication of the muscles of res- piration is the most frequent cause of death, but it seldom reaches a fatal condition before the fourth week, or comes on later than the fifth. In the gravest cases typhoid symptoms set in during the fourth week (Jackson, I. c). In some cases in Hedersleben, as in Hettstadt (Kratz I. e.), there would occur an entire remission of symptoms, which might be followed by a sudden significant exacerbation, speedily ending in death. Sometimes death follows from gastro enteritis before any signs of peritonitis or migrating trichinae were observed (Kratz, I. c, und Berl. Klin. Wochenschrift; see other cases quoted under diagnosis). "A good appetite, undisturbed sleep, easy respiration in the third week, late appearance of first symptoms, favorable age of the patient, escape in the first eight weeks, are indications for a favorable prognosis" (Meissner, I. c). According to Virchow (op. tit, p. 41) diarrhoea is more favorable than constipation. "In regard to the organs of respiration the hoarseness and intense dyspnoea are due to the presence of trichinae in the larynx and muscles of respiration in the early weeks, which not seldom is the cause of death' without the early symptoms of the disease having been noticed.'? "Pneumonia is a complication of extreme gravity;" while pleurisy is only exceptionally followed by serious consequences. In Hettstadt, of KEPORT ON TKICHIN^ AND TEICHINOSIS. 125 27 fatal cases, 8 succumbed to a typhoid form of the disease, 5 died from paralysis of the lungs, 3 from pressure caused by a serous infiltration of the cellular tissue of the muscles of the neck (and in one case oedema of * the glottis), 6 died of embolic pneumonia, 1 from effusion into the peri- toneum from puerperal peritonitis; other cases, more chronic, from col- liquative diarrhoea, marasmus, etc. (Kestner, I. c, p. 46). Meissner (I. c.) says: "There were constant signs of tuberculosis in cases after 4£ months." Other complications affecting the prognosis in some cases : Abortion, Klob. (I. c), Kronbien {I. c); precocious menstruation (Rupprecht-Boch- ler) ; thirty-three cases in Hedersleben had trouble in menstruation (Kratz, 1) ; one case of suppression of milk (Ring, I. c.) ; intermittent pal- pitation of the heart (Rupprecht) ; oedema of the larynx, Kestner (Rupp- recht) ; haemoptysis with phthisis (Meissner) ; bloody diarrhoea (Meiss- ner, Kratz, Renz, Dithusen, Krabbe, in Jahresbericht, etc., 1878, p. 195); anaemia, hydrsemia, and leucocythaemia (Meissner). "Most patients can resume their work on the eighth week" (Leuckart, p. 87), but after lung complications not until the tenth week, and some- times a painful sensation in the soles of the feet prevents the patient from walking for one or two weeks after convalescence. There is abund- ant desquamation, and the epidermis may be detached in large flakes, and the hair, and even the nails, may fall off. The pupils remain inert and dilated for a long time. The catarrh of the palpsebral conjunctivae and more or less difficulty in accommodation remain generally until the eighth or tenth week. 8. Sequels. It has been remarked that convalescents from trichinosis have a very pronounced tendency to obesity. This is due to a fatty transformation which commences in the interior of the primitive fasciculi, and plays an important role during the destruction of the fibrillae. It extends to the extremities of the capsules and to the intermuscular connective tissue. The weight increases more rapidly than the strength (Kestner, op. eit., pp. 67, 68). According to Leuckart (Mensch., Parasiten, ii, 3, p. 584), Davame, and others, after the trichinae have become encysted there is no further trouble from them; but Simon, quoted by Kestner {op. tit, p. 73), men- tions the probability of encysted trichinae affecting the general health of the patient and becoming the cause of muscular weakness, and the lat- ter says, "In robust persons there is little to fear from this cause, but to persons of advanced age, and those of feeble health, it may be a source of future trouble. Grave cases show a tendency to become chronic." All cases of profuse perspiration, if attended with nauseating or strong odor, or more or less oedema after slight exertion, dating from a given sickness, or often recurring peculiar pains or weakness, might be 126 REPORT ON TRICHINE AND TRICHINOSIS. looked on with suspicion. Muscular pains occurred in the Dresden case operated on by Langenbeck, in the case infected, in Davenport in 1856 (Timm, Virch., Arch., 30, p. 447), in a butcher reported by, B,uj)precht, also a case by Groth (Virch. Arch., vol. 29, 1864, p, 604). Besides these cases, Dr. Wendt (Am. Jour. Med. Sciences, April,, 1878, p. 434) reports several cases in New York where muscular pains occurred five years after recovery from trichinosis. He says, " These attacks do not depend on changes in the weather. There are painful spots commencing sud- denly at all times of the year, and disappearing as suddenly, or some- times declining gradually, the latter the most frequent; or it may de- velop slowly as an irksome tension, like l growing pains.'" Disorders of hearing may also result from" an attack of trichinosis, as the auditory muscles are often affected (Henle, Coupland,' Kestner, Meissner, and others). From the -large number of cases of trichinosis reported as showing* lung or pleural complications, and the large number of cases where evi- dences of lung troubles appear post mortem in those showing trichinae in the muscular tissue, there is reason for connecting the two conditions, and for the suspicion that some, if not many cases of lung disease of a chronic character may have their origin in a light form of trichinous in- fection, or may be the remains of a somewhat severe case of trichinosis. Virchow says (op. tit., p. 34) : " In a few cases I have examined the' bodies of those said to have died of consumption, and found, besides marked lung disease, extensive trichinftation and extreme emaciation. Harri- son's cases showed (three out of six) luag disease, also Bowditch's, and Coupland's cases died of an acute bronchitis added to a chronic phthisis, and Wood's case had chest troubles. 9. — Pathology. The pathological conditions and changes in the different parts of the body are known by well-marked changes in the symptoms.. The latter, according to Rupprecht, follow in three distinct stages (see Section I, 2 Symptoms), 1. Stadium ingressionis ; 2. Stadium digressionis ; 3. Sta- dium regressionis. Delpech (op. cit, p. 27) asserts that '" the first symptoms appear when the birth of the young trichinae commences ;" and according to Kestner (op. tit, p. 59) " the symptoms of the first stage are declared as soon as the females have commenced to deposit their young." This could hardly be possible, as it has been seen that the embryos are not deposited be- fore the fourth or sixth day. The first as well as the earliest case seen , is where Hun (I. e.) saw a female give birth to young on the fourth day ; 'but the first symptoms may commence in a few hours after the inges- tion of trichinosed meat. Kratz (op. tit, p. 107") mentions " a few hours "to forty-three days" as the "period of incubation." Gerlach (l. c.) says: f " Nausea and andrexia occur after twelve hours, when infection is severe, with diarrhoea and vomiting." Sutton's cases commenced in a few hours REPORT ON TRICHINA AND TRICHINOSIS. 127 after infection. In one case in Hedersleben the first symptoms com- menced after twd hours, and in two others— one in Calbe (Eenz, p, 29) • and one in Hedersleben* (Kratz, p. 4)— the patient died on the fifth day; and further (p. -8, et seq.), it will be seen that of the 280 cases reported in Hedersleben, 12 showed the first symptoms on the day of infection, of which 7 had diarrhoea alone, 3 had vomiting, and 2 had both ; 22 were at- tacked on the day following, and 20 on the third day. Whatever else • might have been the cause of these early symptoms, it could not have- been the presence of a brood of embryos. In the above epidemic there were 26 cases commencing on the fourth, fifth, sixth, and seventh days, and 11 others were attacked on the eighth. Unfortunately, the date of the first appearance of symptoms is not given in hours in the first 12 cases. The appearance of the early symptoms in these' cases would perhaps , . correspond more nearly to the liberation of the muscle trichinae by the digestion of the surrounding muscle and capsule, which, according to Flint (who gives the time required for the digestion of albuminous sub- stances at 1£ to 5£ hours, raw pork taking 3 hours — Text Book of Physiol., p. 250), would be completed in that time, and have also time for the commencement of the irritation iu the intestines produced by their motion. Eenz (op. cit., p. 27) considers it probable that the muscle trichinae are liberated in 4 or 5 hours after reaching the stomach. Vir- chow (op. cit, p. 43) found the trichinae free, in 6 hours after feeding. After they are set free the muscle trichinae increase in size very rapidly, and in a mouse fed by Leuckart (p; 39) they had increased one-half of their former size in 24 hours. Virchow found intestinal trichinae com- pletely developed in 3£ days. Leuckart (pp. 20, 21) found intestinal trichinae full of eggs and embryos on the fourth day after feeding, but no free larval trichinae. Gerlach (Die Trichinerf, p. 29) says : "The first symptoms are caused by the liberated muscle trichinae. The irritation increases the secretion and peristaltic motion of the intes- tines, and may even amount to an inflammation of its walls. In 24 hours after feeding large quantities of trichinosed meat, I have found irritation of the upper pact of the small intestine, and later, of the whole intestinal wall. In young dogs I have found the greatest degree of irri- tation in the rectum. This irritation begins with the liberation of the muscle trichinae, and reaches its highest grade as sexual maturity of the worms is reached, and lasts until after a majority of the embryos have left the intestines. From the fact that the-highest grade of irritation does not always coincide with the passage of the greatest number of trichinae through the intestinal walls, it follows that the early symptoms are not due to migration of the embryos,.or at least not to that alone. _ It will thus appear ^that the first gastrointestinal symptoms can un- ' 'ddubtedly be referred to'the irritation produced by the liberated trichina rather than to the presence of the new brood in *^e mtestoes, and later by 'their passage through the intestinal walls. Fnedrich (Deutsche Arch. fur. Klin. Med., Bd.'ix, p. 459) reports a case in which oedema at 128 REPORT ON TRICHINA AND TRICHINOSIS. the face, hands, and feet occurred on the first day. He does not consider this early cedema as collateral, but as due to blood-poisoning on account of the setting free by the capsule, after solution of its walls, of its poisouous contents, probably the secretion of the animal from which the trichinosed meat was obtained. (See, also, Meissner, op. cit., No. 165, 1875, p. 285, and Jahresbericht, etc., i, 1872, p. 2570 Kenz says {op. cit, p. 163): "The question as to the cause of early death in trjohinosis has been answered, although hypothetically, yet in a manner worthy of consid- eration, by Fiirstenburg (Wochenblatt, etc., du. K. P. S,taaten, 1865, p. 191), who says 'the inflammation in some animals dying in consequence of migration [of trichinae] is often not so well marked that it can be said that they died of inflammation. It seems more probable that there is some other cause of death. It is not improbable that substances may be absorbed by the lymphatics of the intestinal wall, pass into the blood, and thus cause death.' I am glad to see my opinion of a toxic substance vindicated, although in a later time and on different grounds." The muscle symptoms noticed by Kratz, as a feeling of lameness or soreness of the muscles, occurred very early, and in some cases was one of the first, and in one (No. 35) the only, symptom noticed. " It appears before the young brood could possibly reach the muscles, and was con- stant in the Hedersleben cases. I have considered this as a sympathetic affection of the muscles." (Kratz, op. cit, p. 763.) Wolff also (I. c.) re- ports a case in which these muscle symptoms appeared a few days after infection, and it is said to be the first one in which this symptom had been observed before the young brood; could possibly have reached the muscles. Eenz (op. Cit, p. 92) says: -'- ,- .. " If we cannot accord to the trichina a peculiar muscle poison which, during their rapid development to sexual maturity, is distributed by means of the intestinal secretion and, blood .to the muscles, there is no other way of explaining these muscle phenomena than by calling them reflex." According to Leuckart (Untersuch, etc., p. 87), "the muscular weakness is due to blood poison, and perhaps to certain changes in the liver, as lately shown by Oohnheim." "The second stage is ushered in with oedema. The explanation of the genesis of oedema varies according to different authors. Those who, as Virchow, regard the* act of generation accomplished in a week, ex- plain the tumefaction of the cellular tissues by the presence of the para- sites in the muscles of the face; the observations of Leuckart, who found them in the muscles of rabbits on the seventh day, have confirmed this opinion. Pagenstecher has found trichinae in the diaphragm in rabbits after 7 or<8 days,also in the diaphragm and tongue of a pig after 9 days. » Fiedler* wirongly thought that the embryos did not quit the intestine until- the tenth day. Kestnernas found larvae trichinae in the muscles of the larynxand jaws on the seventh day. * Hennas made in this connection the judicious remark, ' according to all probability a REPORT ON TRICHINAE AND TRICHINOSIS. 129 few of the experiments in which oedema appears late, have been made with larvse which have not attained the degree of maturity necessary to a rapid development which may be followed by copulation.' It will be understood by this that they must pass through the different stages in the intestine that otherwise they would have experienced in the muscles." (Delpech, op. cit., p. 28.) Kramer (Deutsche, Klinitz, 30, 31, 1872) loots upon the myositis as a direct consequence of the irritation produced by the pressure of the trichina?. E. T. Bruen (Phil. Med. Times, Dec. 20, 1879, p. 37) considers oedema. (not especially of trichinosis) the symptoms of deficient vaso- motor tone, and with this view in mind it might appear likely that the reflex — or perhaps direct — disturbance of the vasomotor centers caused by the movements of the trichinaB through the muscular tissue will ac- count for the cedemapresent in trichinosis (for the effect of traumatism on the vasomotor centers and nerves ; see Vaulais and Marius in Oompt. Eend. Cong. Sciences MMicale, Bruxelles, 1875). Schaun (Thier de Paris, 168, May 17, 1872) says, " The eminent professor, Jaecuud, has, on several occasions, dwelt on the law of Stokes, which is as follows :" '? The muscles adjacent to inflamed serous or mucous tissue are rap- idly affected with inertia. ' There is at first/ says Stokes, ' an augmen- tation of the muscular innervation, which is shown by the pain and spasmodic movements ; to this condition a state of more or less complete paralysis succeeds.' I go further than Stokes, and say that the recipro- cal is also true; that serous, mucous, or subcutaneous tissue in the vicinity of inflamed muscles are, on account of their proximity, them- selves the seat of inflammatory processes." • Eenz (p. 93, op. cit), " The oedema is at first collateral, similar to that of phlegmatia alba dolens, and does not retain the impressions made with the fingers ; later, it takes on the character of an anseniic hydropsy, in which the finger marks remain." " Myositis coincides with the oedema in most cases. Appearing in the beginning of the second week, it increases with the migrations of the trichina} and until their encapsulation has commenced, which takes place towards the fourth week. Thus, during the second, third, and part of the fourth week the symptoms of muscular traumatism super- sede all, others. (Kestner, p. 65.) This condition— inability to move the muscles without pain— depends on the number of trichina} in the muscles. It is often absent in light cases." « A certain degree of trismus indicates invasion of the masseter. (Delpech, op. eit., p. 31.) " Dyspnoea and hiccough are due to invasion of the intercostal muscles. Loss of voice is due to invasion of those ot the larynx." (Kestner, p. 31.) . "The destruction of the muscular tissue is not merely anatomical , it is also chemical. The muscles and blood are overladen with the products of disintegration, which interferes more or less with their normal function. (Oolberg found that the muscle of a recently tncni- S. Ex. 9 9 130 REPORT ON TRICHINA AND TRICHINOSIS. nose"d animal gave an alkaline reaction, and Neubauer found the creatin yery much increased after 14 days, with only an insignificant decrease of the sarcine.) It is probably on this account that many cases show such great similarity to certain typhoid conditions.'? (Leuckart, Mensch. Parasiten, ii, 3, pp. 583, 584.) " Trichinosis lasts only during the continuation of irritation and de- struction of the muscular tissue produced by the motion of the parasite. As motion is impossible after the commencement of encapsulation the cause of this condition no longer exists. The changes then are the same as those occurring in a wound which interfered with the integrity Of the parts." (Leuckart, op. cit, p. 584.) " From the encapsulation of the last trichina, and the repair of the last fasciculus, the cure com- mences, and in spite of the large number of trichinae (in some cases over 30,000,000), the patient will return to his former health." (Leuckart, Untersuch, etc., p. 84 and I. c. 1.) " The muscle convalescence commences with fatty degeneration and absorption of the detritus of the primitive bundles ; the cure is in almost all cases complete, although it may last through many months." (Rup- precht, Rundblick, etc., p. 27. See prognosis.) " The severe sweating cannot be explained by the relaxation of res- piratory activity caused by the painful state of the thoracic muscles, neither by the diminished secretion of urine, which is more likely an eifect than a cause. The true cause of the perspiration and the oedema is the inflammatory irritation of the peripheric muscles, which determines a hyperaemia of the sudorific glands in their neighborhood. Local mani- festations are due to circumscribed areas of infection." (Kestner, op. cit.) p. 64.) The irregularity of the appearance and duration of the disease (see Kratz, pp. 78, 79) is probably due to the irregularity in the duration of the productiveness of the female intestinal trichinae, which, according to Virchow (I: c), is four to six weeks. Eenz (p. 31), from the fifth or eighth day until the twelfth week, or even longer. One case in Pan- kow .(Mendel, I. c.) : in the fourth week the intestinal trichinae contained numerous eggs and embryos, showing that emigration was not yet com- plete. "In Hedersleben living intestinal trichinae were found in the seventh week. 1 found them in the twelfth week after feeding." (Leuckart, Untermelung, etc., p. 62.) Wagner (I. c.) "reports two cases dying on the twenty-fifth and twenty-sixth days, respectively, in which no intestinal trichinae were found," showing that the disease is not always kept up by the presence of living trichinae in the intestines, which might be inferred from Leuckart, who says : "As soon as the number of intestinal trichinae has notably decreased, causing a reduction n the number of migrating worms; there is a minimum of the symp- toms." •" The presence of trichinae in the pus of a furuncle (Friedrich, Virch. Arch., xxVj 1862, p. 397) confirms the fact already mentioned by Kal- Report on trichina and trichinosis. 131 liker that trichinae may stray into fhe subcutaneous cellular tissue, pro- voking pustular inflammation, which may end in a partial mortification ' or gangrene of the skin." (Kestner, op. cit., p. 28. See, also, Virch., ?. c.) The occurrence of pericarditis in Wood's case is not surprising when it is considered that one of the most common causes of cardiac inflam- mation, and even of pleurisy and lung diseases, is the presence of dele- terious substances in the blood, as in Bright's disease, etc. " The origin of the pneumonia of trichinosis, which must be considered embolic, is to be sought for in the muscles invaded by the parasites. The capillary vessels are destroyed in part. The detritus of the fibrillaB furnishes the first elements of a thrombus, of which the volume is aug- mented under the influences of the inflammatory processes. The throm- bus forms then a prominence in the lumen of a large capillary ; it then softens and is washed into the current of the blood, which carries it from vein to. vein, and, reaching the right ventricle through the vena cava, is propelled into the smaller capillaries of the pulmonary artery, where on its arrest by the small size of the vessel it becomes the nucleus of an infection." (Eupprecht, I, c.) ■ The clay-colored stools mentioned by authors indicate that the func- tion of the liver is interfered with, the beginning of fatty degeneration. (Edema of the meninges— as also of the glottis and pharynx— when it occurs, is produced, according to Eupprecht, by an extensive immigra- tion into the superficial and deep muscles of the neck causing pressure on the veins (Kestner, op. eit., p. 63). 10. — Treatment. « The therapeutics of trichinosis deserves no great praise. Means by which the muscle or intestinal trichinae can be destroyed have not after the most careful search, been found. Calomel has been prescribed to evacuate the intestines by way of the rectum. I would recommend a one-half per cent, solution of chloride of sodium, at 37° C. A blood- warm solution of salicylic acid would probably serve a better purpose" (Falck, Das Fleisch, Marburg, 1880, p. 518). ( Pagenstecher says (op. cU, p. 78) : "In the first period give « omel and jalap p. aa.1.0 to 1.5 grams, and, later, oleaginous emulsions and sulphur made into pills with glycyrrhiza radix." Virchow says (op cit, pp. 53, 54): "As a rule, when there is a proba- billy Section, powerful evacuants, with or without previous anthel- M K^Zl^pXl *> recommends calomel, "not only because of unSa ng q uiiities,but also on account of its P«^^^ as demonstrated in its effect on the anchylostomum duodenale m Africa^ Other anthelmintics are of little use. Castor rod it ,1» energetic than calomel as a cathartic;" further, p. 98 "one o^^.^fj^ titioners of our province has expressed the <^***£^£»ioa. called to treat trichinosis he would commence with inunctions ot mer 132 REPORT ON TRICHINA AND TRICHINOSIS. rial ointment and keep them up every hour until salivation was pro- duced. But the trichinae, when brought into contapt with particles of mercury, do not seem to be affected. And the weakening influence of severe salivation, with the accompanying fever, is greatly to be feared in some cases and in light ones would not be necessary." Yet it would seem that a fair trial would be desirable. Kratz says (op. cit., p. 116) : "Eupprecht warmly recommends scruple doses of calomel, and, as long as we have no real anthelmintic against trichina?, I look upon it as a very useful remedy on account of its bene- ficial action on the mucous membrane of the alimentary canal. I have occasionally combined it with santonine. I have, however, seen saliva- tion follow after the use of one scruple of calomel ; certainly a very un- fortunate complication in such a disease (see Nos. 174, 262). The anthel- mintic effect of calomel is, to £ay the least, very doubtful." Infusion of quassia, so destructive to ascarides, might on trial be found to destroy the trichinae in the intestine. The solid extract would be the best form, administered in pills and perhaps combined with sulphur. Tanner (Pract. Med. vol. ii, 1875) suggests the use of sulpho-carbolate of soda. Drs. Bitter and Von Brenner (Meissner, op. cit, 130) used IJ. Cupri acet., 3i; aqua cinnamoni, mucil. gum arabic, aa fi; aqua font., §vj, in teaspoonful doses, and found it very useful in connection with salt- water baths. Dr. Dirke (Inaug. Dissert. Berlin, 1874, p. 31) found the hydrarg. cum creta recommended by Traube to have the best effect as an anthelmintic and antiphlogistic in the cases treated in charity hospitals. Bohde (Berlin Klin., Wochenschrift, No. 43, 187&) found morphia and ergotine useful antipyretics, but according to Levy (Ann. d'hygiene Dec. '79, p. 504) ergotine has not been sufficiently tested to warrant an opinion. The use of salicylic acid seemed to make the patient restless. Friedrich (Virch. Arch., 25, 1862, p. 399) used picro-nitrate of potash with good results, while Fiedler (ibid., No. 26, p. 573) found the picro- nitrate of potash and soda entirely useless. "One case in Plauen" (Kestner, op. cit, p. 33) "treated with iron got well rapidly." Veh. (St. Petersburg Med. Wochenschrift, Jarz. ii, 1874) says: "Iron was useless against the oedema of the lower extremities, but digitalis and increased diaphoresis by means of hot bottles did good service, as also did cold sea baths. Warm baths did little good." Kramer (I. c.) found that warm baths decreased the pain. Mosler (Helminthologische Studiren, etc., pp. 27, 28) concludes that the lack of any symptoms of trichinosis during life or of intestinal trichinse after death in a steer fed by him was due to the use of benzine, as a calf that had been fed by Leuckart with trichinons meat died of enteritis irichinosa. ' Ad. v. Dirke (I. c.) found benzine (Mosler), picro- REPORT ON TRICHINA AND TRICHINOSIS. 133 nitrate of soda (Friedrich), oil of turpentine (Behrens), ext. felix mas. seth. (Ktichenmeister), of little use. Flogel (Weiner Med. Presse, xv, 21, p. 490, 1874) used turpentine. Owing to its known irritating effect on the stomach and kidneys, gives, it in small doses often repeated, rubs it on the swollen parts, and ad- ministers it by inhalation. He treated successfully a filaria in the eye of a horse with turpentine. " Benzine was administered by Kratz to the extent of one fluid dram daily with no other effect than that fewer trichinae were found after death in the intestines than after the use of opium." (Because it did not have the same constipating effect 1 ?) Meissner (Sch. Jhr. 138, p. 96) recommends thalium or lithium carbonate with sulphur pnecipitatum. Behrens (I. c.) suggests the salts of lime to favor calcification. (See, also, Hanen, Berl. Klin. AVochenschrift, vii, 25, 1870.) In cases where patients drop off suddenly while apparently feeling well, as in Maddren or Bergen's cases, artificial respiration should be resorted to. The effects of amyi-nitritis and electricity should be tried. "There were several cases in Hettstadt in males who drank notable quantities of brandy and escaped infection, while their families, par- taking of the same meat, became seriously ill. Another man who drank two bottles of red wine experienced no inconvenience after eating trich- inosed meat. Alcohol, according to Bupprecht, kills trichinae in a few hours." (Kestner, op. cit, p. 74.) Schonenberg (Vierteljahreschrift fur Gericht, etc.,) reports the infec- tion of three in one family, viz, a man, his wife, and wife's mother; the two women died; the husband, who drank freely of whisky (Korntraut- wein) during several days after infection, recovered. But in Bo vender (Kramer, I. a), several who had been drinking had about the same symp- toms as the others (Schmidt's Jahrbucher., 165, 1875), "and one of Friedrich's cases had been drinking hard, so that his sickness was at first considered the result of his debauch." Virchow {op. cit, p. 55) says "stimulants give no security against infection, and much less a promise of a cure." "In conclusion (Delpech, op. cit., p. 102), it maybe said that there are no medical preventives, i. e., medicines, which protect against trichinosis when trichinosed meat has been eaten. Anything thus rec- ommended is based on charlatanism or personal illusion. It may be that in a great many cases such or such a remedy might apparently have prevented the development of the disease, or rendered it insignifi- cant. In such cases the meat has contained but few trichina}, or the subject had a strong constitution. If there is a substance which wiU kill the parasite in the stomach or intestines it has not been found yet. If such an agent can be found, of which there can be no doubt, it cer- tainly wiU not be an ordinary remedy, as wine or brandy, spices, etc., but a true medical substance. Such a remedy can never be used as a prophylactic." 134 EEPOET ON TRICHINA AND TKICHINOSIS. Section E— TEICHINOSIS IS ANIMALS. The symptoms of trichinosis in animals have never been studied under the conditions natural to epidemics. It has been seen that there are certain circumstances under which human beings— and there is no rea- son why the same should not apply to animals— are not usually infected after the ingestion of trichinosed meat. Among these are the small quantity of meat eaten and the la,ck of susceptibility of the patient to any quantity as well as a high state of that irritability which is excited by the presence of deleterious substances in the alimentary canal, and which may result in the immediate expulsion of the parasites, as in one case in Kratz's table (So. 131); also cases cited by Leuckart (Uniter- sueh, p. 3 a) and others. In other cases this irritability is at a minimum, and small quantities of trichinosed meat produce no symptoms (see Leuckart, op. cit., p. 62, et seq.), but undergo the same changes as larger quantities, the number of trichinae being so small that no great disturb- ance is produced, as is remarked by Leuckart (op. cit, note 3, p. 63), who says, "It will thus appear, as has also been confirmed by other later observers, that neither in all cases nor in all hogs are such marked symptoms observed as in my first case," and (p. 70) " single cases are found where a complete immunity exists, but whether due to age, sex, or race is not known"; (p. 73) " because we have a negative result after feeding in a single case, it does not follow that in that class of animals there is immunity to trichinosis." Some of these negative results may be due to the use, in feeding, of unripe trichinae, which, according to Leuckart and others (see section B), are not susceptible to further devel- opment in the alimentary canal. The symptoms of trichinosis in hogs, as given by Gerlach (Die Trichi- nosis, Hanover, 1873, p. 35, et seq.) in 40 cases, after feeding, 12 of which were under his own observation, were very light or imperceptible in about 41.5 per cent. "These were mostly over six months of age. Pigs from three to six months old became infected more readily and completely than older ones. The symptoms in the light cases had nothing characteristic; they consisted merely in slight gastric disturbances, which appear gen- erally on the third or fourth day, seldom later, and in a few days en- tirely disappear. There is diminished appetite, lessened vivacity, droop- ing of the tail, and a tendency to constantly lie at rest. "The more complete and severe cases present, as in man, two differ- ent stages (?), as the gastro-intestinal or muscular symptoms are most prominent. "1. Symptoms of intestinal irritation and inflammation. In a few or several days — five to ten as a rule — the following symptoms appear: The appetite is lessened or disappears entirely, sometimes vomiting (one case observed by Furstenberg and one by myself) ; vivacity de- stroyed, back hollowed, tail hangs loose and limp, constant lying down, REPORT ON TRICHINAE AND TRICHINOSIS.- 135 posterior portion of body stretched out, often bodily pain shown by restlessness and pawing with fore feet. Diarrhoea appears soon, and, with irregular exacerbations, may last a few days or longer and even several weeks. Fever appears with the diarrhoea, or may come on at first; weakness, erection of the bristles, pale skin, irregularly distributed, and diminished cutaneous temperature. "The termination of this iatestinal affection differs greatly in differ- ent cases; sometimes it disappears in six to eight days, sometimes a few days later, or within this time may end in death. In my researches death resulted from the intestinal affection only in young pigs, which were always weaker, and would lie on their belly because they had not strength to stand up. ^ich ™* estimated to contain 3,000,000 trichinae, and was attacked with a severe, persistent diarrhoea on the third day, and at the autopsy showed numerous intestinal tri- chinae m the small and large intestines, and embryonal muscle trichinae In both cases the mucous membrane of the intestine was in a condition of inflammatory irritation (Kiihn). The 8 weeks old pig before men- tioned died on the nineteenth day. The one dying on the thirty-fifth day was a young hog, age not given. A 5 months old pig died on the forty-second day apparently from paralysis of the lungs. (Claus, Ma^ von Guslt und Hertwig, Bd. 31, Heft., 1, 2). " "A yearling boar died on the forty-ninth day, not having been able to stand up for the last fourteen days, and presenting emaciation in the highest degree (Berlin). Some reporters speak of a typhoid disease as the cause of death. I have not found this view confirmed, and therefore believe that an error has arisen on account of a diffuse reddening of the skin presented by the cadaver ; but this reddening of the skin is merely a hypostasis, and is always present in the bodies of hogs dying of disease and is apparent if the skin is not pigmented. ■ According to my observations, trichinization was always moderate after a light sickness ; on an average 2 to 10 trichinae were found in 5 preparations. In severe cases I found in those recovering 15 to 20 trichinae in every preparation of less than one-quarter of a grain. Thus, a recovered hog may have 15,000 to 20,000 trichinae in every half ounce of muscle. Hogs may become highly trichinosed with small and repeated feedings, and may not show marked symptoms of disease. The absence of severe diarrhoea, which as a rule follows after feeding of a considerable amount of highly trichinosed meat, seems to promote the reception of muscle trichinae, which, after successive movements, are more readily tolerated. Of this, one of Kuben's cases furnishes the strongest proof. A six weeks'-old pig was ted daily for 4 days with 20 grams of highly - trichinosed meat, then after 4 days more the same was repeated, and in the course of 15 feedings about 10 ounces of this meat were taken. There was no important sickness noticed, but finally a high degree of emaciation appeared. The pig was killed, and in 60 preparations 3,052 trichinae were found, viz : 1,021 in 15 from the diaphragm, 787 in 15 from the larynx, 474 in 15 from the shoulder, 770 in 15 from the psoas ; an unusually large number, which never could Ape been reached by one feeding. In one case, dying during the migration of the trichinae in the muscles, after strong trichinization by a single feeding, I did not find half so many. The difference in susceptibility does not depend on sex or race ; only age was not without influence, although not to such a degree as in other parasites which leave the intestinal canal to penetrate other organs. Early age seems to favor the migration of the embryos. This is most apparent in dogs, but is noticeable in other animals. In hogs there is a 138 REPORT ON TRICHINA AND TRICHINOSIS. lessened disposition in the second year. The researches in the second year of life in the veterinary school in Berlin, and by Kiihu in Halle, with 2 yearling hogs, one hog of 1£ years and one 1J years old, showed no decrease of susceptibility, while my own investigations with 2 hogs of 2 and 2£ years showed it distinctly. "A two-year-old hog (which had been trichinosed in early life, and showed numerous encapsulated trichinae when weighing 10 pounds, but showed very few when reaching 200 pounds) was ted with a dressed rabbit tolerably trichinosed, so that in every preparation some trichinae at least were found. From the eighth to the eleventh day there was slight indisposition, fever, temperature of 38° to 40° 0.; disturbed ap- petite, moderate diarrhoea ; vomiting on the ninth day, and no sickness after the twelfth day. On the fortieth day he was killed, and after a careful search only a few from the last feeding could be found, and in most preparations none were present. "A further confirmation is found in the result of feeding a 2 J-y ear-old sow. She received one pound of moderately trichinosed hog's muscle. On the third day there was a feverish condition present ; from the eighth to the eleventh there was decided sickness; the appetite decreased, bristles erected ; unequal distribution of heat ; one ear hot and the other cold. The faeces were soft and pulpy ; the animal laid mostly on its side, and resented disturbance. From the eleventh again appeared well; from the nineteenth to the twenty-third light febrile attacks, inactivity, lying down most of the time, then again entirely welL "After \\ months this sow was fed with the carcass of a rabbit which had died of trichinosis, and whose body contained numerous trichinae about 28 days old. Diarrhoea appeared on the third day, which con- tinued actively until the eighth day, and gradually disappeared by the thirteenth day. At the same time there was a well-defined fever, almost entire loss of appetite, and appreciable emaciation. After this the ani- mal recovered and ate its food, but on the sixteenth day began again to appear sick ; motion weak and uncertain ; lying a great deal, and some- times flat on the side ; could hardly stand without support ; urinated freely, and became emaciated. On the twentieth day the animal com- menced to appear lively, and was then killed. There was found only a few muscle trichinae from either feeding, so that in the muscles usually most iufested (diaphragm, masticating, and shoulder muscles) there was on an average in eaqjfc>reparation scarcely 2 from the first and still less from the second feeding. In both experiments the animals had received an unusually large number of trichinae, in consequence of which the in- testinal symptoms were tolerably severe. It will be apparent that the small number of muscle trichinae would cause very slight muscular symp- toms. * * * " Trichinization does not depend on age in any other class of animals or in man to such a degree, as is shown by the occurrence of the disease in old persons and by many researches with animals. In order to de- REPORT ON TRICHINA AND TRICHINOSIS. 139 S m a ine ^? the V er ! ° ld animalS COuld be 8 «<*essfully trichinosed, I fed an old horse (aged 25 to 30 years) from time to time with a quantity amounting in the aggregate to 2J pounds of tolerably trichinosed meat. He was killed after six weeks. Trichina were found in all muscles more numerous than in the hogs above. e£s-0m£— (Gerlach). " 1. About two-fifths of the hogs fed were either not affected or only slightly disturbed ; the remainder, three-fifths, became sick. "2. The light cases offered nothing characteristic, as is the case in many other diseases of hogs. The severe ones, on the contrary, are characteristic enough to enable us to recognize trichinosis, at least when the scalpel and microscope are used to determine the presence of trichinae in the muscles. " 3. After an attack of trichinosis the hog becomes again sound and can be raised, and will become as fat or even fatter than other hogs. "4. In' cases where no symptoms appear or the health is only slightly disturbed after feeding, the infection is sufficient to render the meat a dangerous article of food. After severe sickness the infection in recov- ered cases is always considerable, so that a small quantity, J ounce or less, of the meat may cause infection in man. "5. In early age hogs are most susceptible to trichinosis; after 2 years they will bear a considerable number, and even after eating a large quantity of highly trichinosed meat they show a comparatively small number of muscle trichinae. " 6. Death follows in hogs in over one-half of the completely devel- oped cases. "7. Death occurs through intestinal irritation as well as through myositis ; 41 per cent, die in the former stage and 59 per cent, die from myositis," etc. Prom the description of the disease by Gerlach, as given above, it would seem that the symptoms in a true animal epidemic of trichinosis should present the same variations as in man; but a majority of the earlier writers on trichinosis do not seem to think the symptoms in ani- mals are sufficiently well marked to depend on their absence as an evi- dence of the absence of trichinosis. Leuchart says (Untersuchungen, etc., p. 103) : "The first case observed by me (p. 32 op. cit.) showed the same symp- toms as in man ; the next two showed no particular symptoms to dis- tinguish trichinosis. Also Haubner, Gtirlt, and Kiihn report cases in which the symptoms would not warrant a diagnosis of trichinosis. In most of my 12 cases in hogs the symptoms commenced, in 5 to 8 days after feeding, with a feverish diarrhoea, to which after a few days the other symptoms were added. In one case the animal died after 12 days with inflammation of the intestines. Giirlt also reported cases in which the animal died." 140 EEPOET ON TRICHINA AND TRICHINOSIS. Beferring to the case mentioned above, he says : "The next day after feeding'a young hog with the intestines and con- tents of a trichinosed dog, which was eaten greedily, there was loss of appetite, drooping of the head and tail, grinding of the teeth, and con- traction of the abdominal muscles, showing colicky pains. The next day the symptoms increased so much that the animal maintained the recumbent position ; the head was hot and quite feverish. He recov- ered his appetite on the eighth day, but there was an insecurity of mo- tion, particularly when the hind legs were brought into play. This was increased on the ninth day, and on the nineteenth amounted to com- plete paralysis. On the twenty-fifth day the animal was stiff, cold, and extended ; motion caused pain ; there was involuntary evacuation of the bladder and bowels. The voice, becoming hoarse in the first week, now lost all resemblance to a squeal, and sounded like the bleat of a sheep. In spite of all this the vegetative (trophic) functions seemed normal, and the appetite was very little disturbed. Although I could entertain no doubt as to the cause of the sickness in this animal, yet at the onset I was disposed to consider the suffering as due to an affection of the central nervous system, and hourly expected to see him die. But, with unremitting care, keeping him in a warm place, with milk diet, he rap- idly recovered and was soon able to stand up." Haubner (Bericht fiber das Veterinarwesen im K. Sachsen, 1862-^63, p. 117) fed a young hog with tfjchinosed meat on the 26th of Mas', an d again after 27 days (July 22). The last time the animal ate in addition the intestines of a trichinosed hog. For four days he was feverish and presented the appearance of erysipelas (Bothlauf), but was found free from trichinae on the 27th of December (158 days), while others fed at the same time had many trichinae. The above hog was constipated dur- ing the sickness, so that there was no ground for the opinion that the trichinae were passed off in the excreta. Other observers have presented their views in regard to the symptoms of trichinosis in animals. But a majority of them, while giving individ- ual cases in which the symptoms are severe (Leuckart, Virchow, Pagen- stecher) and some in which the animals have died in various stages of the disease, say that there are no characteristic symptoms (Piirsten- berg, Kfihn, Scoutetten, pp. 80, 81, Virchow, p. 30). Gerlach has shown that there is a vast difference between cases in which the hogs were fed small quantities of trichinosed meat and those in which large quantities have been ingested. The latter always have " characteristic" symptoms and show numerous trichinae in the muscles, while the former, with slight symptoms, always show a small number, but he has also proved that the results of one feeding may be added to those of another, and after numer- ous light infections the animal may become intensely trichinosed with- out showing any characteristic symptoms unless ttie observers were looking for this disease. In an epidemic of trichinosis in hogs, if they ever occur, it seems very probable that some cases would present the REPORT ON TRICHINA AND TRICHINOSIS. 141 symptoms in such intensity that there could be no mistake in the diag- nosis. It is possible that the small number of observations made by each investigator will account for the lack of conclusiveness in regard to ani- nials, but the whole number taken together by Gerlach have given a dif . ferent result. The Vienna committee (Bericht des zur Erferschung der Trichinenkrankheit von der K. K. Gesellschaft der ^Erzte ernanntec Comity's, &c, Wien, 1867) report, while giving the symptoms observed by others after artificial infection, that there are no symptoms charac- teristic of the disease, while they show that the symptoms, as in man, are more or less complete, according to the amount of trichinosed meat consumed. "In the first case (p. 10), after feeding with a small quantity of trichi- nosed meat, there occurred very insignificant disturbance of the healtb, shown by decrease of appetite, soft stools, often hoarseness; later, stag- gering, weakness of the posterior portions of the body, symptoms which disappeared after the fifth or sixth week, while a larger quantity of the same meat or often repeated feeding of small quantities was followed, as reported by Gerlach above, by severe symptoms or even death. But these symptoms had nothing characteristic, and no one not knowing that trichinosis had been produced would have the least excuse for saying that the animals were suffering from that disease. " In the first case there was a hoarse cough after 6 days, decrease of appetite on the 7th, lasting until the 14th day ; there was occasional diarrhoea and a disposition by the hog to rub himself over the whole body; great emaciation, but absence of staggering or weakness. No trichinae were found in the stools. After 2 months the animal had re- covered, but showed traces of hoarseness. Numerous encapsulated trichinsB were found, especially in the diaparagm. " The second case showed only a hoarse cough, itching of the surface, decrease of appetite, and continuing emaciation after the ingestion of 6 ounces of trichinosed meat, taken at several feedings during a period of 3 months. " In the third case the pig ate about 4 ounces of trichinosed meat at intervals during a period of 2 months ; there was hoarseness, itching, decrease of appetite, and finally emaciation ensued. " In the fourth case the symptoms were the same as in the other cases. In none of these cases, however, was there diarrhoea, pain in the bowels, nor weakness, much less a paralysis of the lumbar muscles. "With a moderate amount of trichinosed meat the animal seemed to increase in fat, but when it was fed repeatedly there was always a progressive emaciation. The hoarseness and cough occurring with every motion, especially on eating, raises a suspicion of trichinosis, but even that symptom may be explained on other grounds. The itching of the skin is due to the irritation of the cutaneous nerves by the migration of the trichina} in the cutaneous muscles and neighboring connective tissues." 142 REPORT ON TRICHINA AND TRICHINOSIS. Emaciation, which seems to have been pretty uniformly present in the above cases, as also in those mentioned by Gerlach, may occur in other diseases, but unless otherwise explained should lead to investigation. In some cases muscular weakness (Steh. Bericht, etc., Berlin, 1865), loss of appetite, dragging of the hind legs constitute the principal symp- toms. Of 4 cases fed all became sick and 2 died. Scoutetten says (p. 81) : " When hogs show symptoms they resemble more or less those of a rheumatic affection ; * * * oedema which is common in man has never been observed in hogs." This may be due to the thick cover- ing of fat, but is contrary to Gerlach's observations. The above symptoms, though not uniform, as reported by different observers, are perhaps as much so as the same number of cases in man would be under the same circumstances. While Gerlach's description of the disease in hogs corresponds to cases of human infection, the dragging of the hind legs (Berlin), its absence, but the peculiar hoarse- ness and itching of the skin (Vienna), and the rheumatic symptoms (Scoutetten) point to varieties of the disease due perhaps to the amount of trichinosed mea't ingested, the condition of health, or other peculiar- ities of the animal, which may be determined by future observations, and if the symptoms in a possible epidemic, if following any of the above varieties, are not such as to lead a person who is entirely unfamiliar with trichinosis to suspect that disease, they would be sufficient to one who was familiar with them, or had read them, to lead to the use of more certain and conclusive means of diagnosis, i. e. the use of the microscope. The symptoms of epidemic diseases occurring in droves of hogs are often so similar to those of trichinosis that it would seem very possible that in many of such cases they might be due to trichinous infection. In the Agricultural Beport for 1863, p. 205, is found a description of the symptoms of hog cholera prepared by Dr. George Sutton, of Aurora, Ind., and furnished to the Medico-Ohirurgioal Beview, asibllows : " The hog at first appears weak ; his head droops, and sometimes in a few hours after these symptoms diarrhoea commences; there is fre- quently vomiting. In some cases the discharges were serous and clay- colored, sometimes dark, also bloody and mucous, resembling those of dysentery. The urine at first was generally small in quantity and high colored, but as the animal recovered it became abundant and clear. This was one of the symptoms by which the men attending the hogs at the distillery ascertained that they were recovering. In a large number of cases the respiratory organs appeared to be principally affected, and there was coughing, wheezing, and difficult respiration. In some in- stances the animal lost the power of squealing, and the larynx was dis- eased. There was frequently swelling of the tongue and bleeding from the nose. In those cases where the respiratory organs were the princi- pal seat of the disease there was generally no diarrhoea or dysentery. In many instances the ear or the side of the head were very much in- flamed, the ear swollen to twice its usual thickness. This inflammation REPORT ON TRICHINAE AND TRICHINOSIS. 143 would spread along the skin, sometimes over the eye, producing com- plete blindness. Sometimes one or more legs were inflamed and swollen, and the inflammation also extended along the body. The skin where it was inflamed was red and swollen. Some had large sores on their flanks or sides from 3 to 6 inches in diameter. In one instance the foot became ulcerated and sloughed oif, and the animal recovered. Some appeared delirious, as if there was inflammation of the brain. Sudden changes of the weather, particularly from warm to cold, appeared to increase the fatality of the disease." And on page 207 of the same report the disease is described as fol- lows : " The first thing to be noticed in the diseased hog is weakness in the eyes, the water flowing from them, together with the forming of dark spots under the eyes. In the second stage there is discoverable a slight shrinkage of the shoulders, something like that of the shoulder of a horse in case of swinney, connected with slight coughing. In the third stage there is great thirst, a drawing up of the hind quarters, a sign of great weakness, and a refusal of food." In the latter case there is sufficient similarity to the above symptoms of trichinosis, as developed by experiment, to warrant a suspicion of that disease. The former outline presented by Dr. Sutton, the diarrhoea, vomiting, clay-colored stools, the decreased diuresis, its augmentation as convalescence progresses, cough, wheezing, and loss of voice, &c, show a more marked similarity to the symptoms as they occurred in Leuckart's first case, given above, and as they occur in man. The descriptions of hog cholera, as quoted in the Agricultural Report for 1877 from that of 1861, as also the exhaustive article by Professor Law, give some symptoms in common, and others which, although not so common in trichinosis, yet do occasionally occur, as Haubner's case, where the skin assumes the appearance of erysipelas, and in one of Veh's cases, where there were bluish suggillations under the skin. On page 386 of the same report will be found other series of symptoms which correspond in many respects to those of trichinosis. In thus presenting these similarities and comparing so closely the symptoms of trichinosis with those of well-established and defined dis- eases, it is not my intention to try to prove that such diseases are due to the presence of trichina?. It has been thought that hog cholera was due to trichinous infection, but Dr. Sutton has proved that it is not. While the opinions of observers on this subject cannot be called into question, and accepting as fully proven that what is called hog cholera is not trichinosis, it will at the same time be found just as easy to prove that rheumatism, gastric fever, typhoid fever, &c, are not produced by tri- chinee, yet the presence of this parasite in large numbers has given rise to a diagnosis of those diseases by observers well able to distinguish any known disease, and it is just as possible that cases of trichinosis m animals have been pronounced hog cholera, especially as the diagnosis 144; REPORT ON TRICHINA AND TRICHINOSIS. of diseases in animals is often left to those who have no knowledge of disease, and it seems very probable that one or more of the prominent symptoms may have given an erroneous idea of a whole epidemic in ani- mals as in man. I have tried to show by these remarks that among epidemics of what is called hog cholera, trichina} may possibly in some cases be the cause of the symptoms, and when such epidemics occur, trichina should always be searched for. Further, in those places where epidemic diseases have appeared, among hogs, particular attention should be given to the examination of rats as well as of hogs that have suffered during the epidemic, and if any trichinae are found, a more general search should be made, SECTION F.— PEOPHYLAXIS, ETC. Prophylaxis may be directed (1) to the prevention of infection from the use of trichinosed meat ; (2) to the prevention of the use of trichin- osed meat ; (3) against the production of trichinosed hogs ; (4) to the eradication of trichinae from hogs and other natural bearers. Leuckart says (Untersuch., etc., p. 91) : " It has been clearly determined that trichinae possess a very unusual power of resistance. Not only may they remain alive in their cyst for many years, and during putrefaction of the meat containing them " (see section C), " but they show a high state of indifference to the effects of changes of temperature. I succeeded in producing a high degree of in- • fection when trichinosed meat had been kept for 3 days at a temperature of— 16° to— 20° E. Similar observations have been made by Eupprecht, Fiedler, and Kiihn, yet Fiedler believes that the trichkise expire at a temperature of 11° — E. Kiihn found the trichinae from frozen meat which . had been kept in an ice-house 1£ months capable of infection, but after 2 months the trichinae were all dead, pale, and motionless. They also undergo a temperature of 40° to 42° E. without showing much change. Eaising the heat to 40° E. seemed to affect them, but not until it reached 50° to 55° E. did it seem to produce a change in them (Fiedler, Haub- ner), when the albuminous substances became coagulated. Then the dead trichinae presented, under the microscope, a uniformly clear, almost opalescent, appearance, as I had observed in undeveloped trichinae found, dead in the alimentary canal (op. tit, p. 61). In order to be secure against trichinous infection by means of boiling or roasting, it is neces- sary that the whole mass of meat be subjected to a temperature of at least 51° to 55° E. (65° to 70° C). Meat may be subjected to a high tern-, perature, yet not be cooked unless time be given, for the whole mass to become heated (Eupprecht, Kiichenmeister). Further, meat may be- cooked, but underdone, and trichinosis be caused by its consumption (Eupprecht), so that cooking is no guaranty that the trichinae are all dead. Salt will kill trichinae, but not all salted meat is innocuous (Filrst- REPORT ON TRICHINA AND TRICHINOSIS. 145 enburg, Fiedler, Rupprecht, Leuckart), but the same meat may be made innocuous by sufficient cooking (Kiihn). A temperature of 52o R w m prevent infection (Haubner). Kiihn found that hams were innocuous after 31 days' pickling. Gerlach (Die Fleischkost, etc., p. 68) says : " It is a matter of fact that man, wherever trichinse are found, without particular care is liable to an infection every time he eats pork. Hogs appear sick only after severe infection ; they recover and appear well, and even become fat," and thus present no signs during life by which the presence of trichinse may be suspected. Falck (Das Fleisch., p. 520) says : " The best way is not to eat pork; but, if you must eat it, do not eat raw pork." Cobbold (op. tit, 173) : " There is no need to be in the slightest degree nervous about flesh food, provided it is properly cooked." This is the opinion of all authorities on the subject, and the experimental question of the exact amount of heat necessary to destroy the vitality of trichinse is of less importance. Thorough cooking implies that the meat shall be done en- tirely through — down to the bone ; and that there shall be no appear- ance of blood; as Niemeyer (Catechismus, etc., p. 5) says, "Meat must be cooked until gray." According to Kestner (op. cit., p. 55) : " The vital substance of the trichinse succumbs to heat that coagulates albu- men and boils water." Besides the above witnesses there is further evi- dence in the effect of heat in the case in Halberstadt (Schmidt's Jahr- biicher 138, p. 101), where highly-trichinosed pork was well cooked and afterwards eaten with safety ; also in Marion, Iowa, the meat from the same hog which produced the infection was eaten without bad result after thorough cooking. Falck (I. c.) says that drying meat destroys the vitality of the contained trichinse. Thorough salting or smoking, or both, will destroy trichinse. Virchow deplores the modern dishonest way of sprinkling hams, bacon, etc., with creosote or pyroligneous acid, instead of curing them after the old-fashioned method of smoking. Ac- cording to the Agricultural Eeport for 1863, salt does not penetrate pork from hogs fed in distilleries, because the meat is softer. Perhaps this may account for cases in which the effects of the preservative measures are found only on the surface of the hams, etc. The use of trichinosed meat can only be prevented by a thorough microscopic examination of all pork offered for sale as well as that slaughtered for private use. A judicious use of the knowledge thus ob- tained, and the destruction of all trichinse thus found by means that will admit no doubt as to their efficiency— e. g., by boiling or burning the infected carcass— will, by preventing the distribution of the contained trichinse, lessen the cause of infection and thus the number of trichi- nosed hogs. The fourth proposition can only be carried out by a thor- ough examination of the sources of infection, and thus perhaps deter- mine the original bearers, or at least the most dangerous source of infec- tion in hogs. "It is of great interest (Bericht, etc., Wien, Co., p. 5) in a scientific as well as a sanitary point to know what animals contain S. Ex. 9 10 146 REPORT ON TRICHINJE AND TRICHINOSIS. trichinse, and from whence hogs derive their infection." As has been seen in Section of this report the rat has had, a large share of atten- tion in this respect, and while large numbers of rats have been examined in Europe, very meager notices of such investigations have appeared in American medical literature. According to the report above mentioned (p; 29) — "Large centers of infection have been found among rats, and in some places, as Klederling, where the rats were found infected, trichi- nosed hogs, not previously observed, were found, and in Briinri, after the occurrence of a case of trichinosis in man, the infecting pork was found, and trichinosed rats were found in the houses as well as in the neigh- boring flayers' establishments. Another remarkable circumstance is that trichinosed foxes are not seldom found in lower Austria, and it is not improbable that a series of animals may be discovered in the course of time in which a reciprocal infection occurs. * * * If we accept the proposition that hogs get trichinse from rats, then the first and most important thing will be to investigate the subject in that connection, and in places where rats are found to be infected, to make a special search for .trichinae in hogs." In addition to the scientific interest and sanitary necessity of a thor- ough investigation of the subject of trichinosis in the United States, its importance in a commercial point cannot be overrated. In 1862, 1863, and 1864 the exportation of American pork products to Bremen, Ham- burg, and the German Zollverein amounted to over four millions of dol- lars. Since the figures have been given for a few observations iu places in the United States where trichinosed hogs had been found in large numbers, a feeling of distrust has grown up in regard to American pork, ham, bacon, etc., and no doubt exaggerated reports have arisen in regard to the danger of infection from salted and smoked pork, etc., from the United States (and various laws have been made in many parts of Eu- rope relating especially to the importation and sale of such meats), which, as the home products are very much higher in price, it is to the interest of dealers to magnify. The best way to allay these fears and suspicions is to provide that no meat shall be allowed to leave our ports without a guaranty that it is fit for human food ; and this can only be done by a thorough and systematic microscopic inspection in our own country made by microscopists who can have no interest in shirking their work or in giving false or sensational results, and when ham, bacon, and pork sides are put up for export, they should, for a time at least, be so marked by the inspector who makes the examination that they may be easily recognized by him as having passed through his hands, and authority should be given if any shall be found unsound in foreign ports to have them returned immediately. lf ' ! It is possible that something more 1 ni ay be learned from the artificial in- fection of animals, but Pagenstecher, Leuckart,Virchow, and others have apparently exhausted this subject, and have arrived at nearly uniform EEPOET ON TRICHINA AND TRICHINOSIS. 147 conclusions. Our first object should be to find out where they already exist. The able discussion by Leuckart (Untersuchungen, etc., p. 96) of the origin of trichinous infection gives a key to the direction the inves- tigations ought to take in this country. The question is not now in what animals can trichinae be propagated, but where do they occur naturally. To this end extensive investigations should be made, particularly as to the surroundings and habits of hogs kept together in large numbers, as in the West. What we wish to know, after it has been determined where trichinae are oftenest found in the United States, is what can be done to prevent their propagation and extension, the procedure which will in time exterminate or at least lessen their areas of infection. Where they originally came from is of remoter interest. We should learn first if they occur in any wild animals. Do they exist in the rat here in as large numbers as in Germany I Do they extend along our water courses, or only over land, and what influences their extension ? Have we trichina centers ? Then let all pork be carefully examined, and by this means trace the parasite to its original infection center, if such exist ; determine the average of trichinosed animals among large numbers of hogs, and if possible find out where the infected animal was born and raised, and the various conditions under which he was kept and fed, the kind of food used, and especially trace the formation of droves which are made up in remote places. Also it should be ascertained if the hogs have been allowed to run loose or were kept in pens, and in all cases to learn if there has been any possible access to carcasses of any kind. Special attention should also be directed to animals raised in villages, particu- larly when they are allowed to roam at will and become public scaven- gers — and often the only ones for large areas. The known habit of hogs to root in their own excrement makes it extremely likely that if one hog in a drove becomes infected the rest will (at least in part) become so sooner or later, and any small drove might thus be thoroughly trichinosed in the course of a year or two, and when added to a large one in picking up a drove in different places by collectors or buyers, might constitute all the diseased animals in that drove. Animals, may be sick in a drove without being noticed by an ordinary observer. The droves should thus be carefully and regularly inspected by persons competent to judge of any change from the normal. That trichinae may pass with the excreta of hogs there can be no doubt, as it has been observed by Pagenstecher (p. 41, 2 op. cit), Bupprecht (Trichinenkrankheit, etc., Eundblick, 30), Cohnheim (Pagenstecher, p. 39), Gerlach (Die Tr., p. 10), Virch. {op. tit, p. 59), Leuckart (Note, p. 90, Untersuch., etc.). That trichinae may spread from hog to hog, and that their pens may become infested sufficiently to propagate trichinosed hogs, is shown, by Warfwinge, quoted by Eiemer (Schmidt's Jahrbucher, 178, 1878, p. 205), who found two infected hogs in the same pen twice, and in one case he found 3; in another, 4 trichinosed hogs in the same 148 REPORT ON TRICHINA AND TRICHINOSIS. pen, and one man brought trichinosed hogs in a drove who, the previous year, had sold a drove in which many infected animals were found; the infection of the first mentioned dating from the killing of the latter, and probably caused by the excreta from the first. (This author does not think' it probable that hogs are infected by rats ; 1st, because they are not quick enough to catch them ; 2d, hogs do not often have access to dead rats. See also Heller in Ziemssen, iii, p. 653.) Schuchardt (Thuring. Corresp. Bl. Par. vi, 9, 1877, p. 232) remarks that there is more trichinous meat found in the cities than in the country. Levy (Ann. d'hygiene, December, 1879, p. 506) thinks that this is due to less care in the examinations in the country. Eulenberg (Vrtljrscht. f. ger. Med., etc., Bd. 28, 1878, p. 149) thinks that the occurrence of relatively large numbers of trichinosed hogs in Bromberg is because they are allowed to roam over the wild lands, and thus have an opportunity to get the bodies of dead animals. This, however, is contrary to the statistics given in section C, which show that hogs raised in cities give the largest per cent, of infection ; but for all this the original infection may have come from the wildest possible places, and the more rapid spread of the parasites in the city be due to the special surroundings. That legislation with appropriations will be necessary to determine these points must be apparent, because the disease if it does exist in this country to such an extent as would seem possible after a careful exami- nation of the facts presented in sections C and D, is not sufficiently rec- ognized to arouse the fears of the people, and as the expense is consid- erable, and the subject one that interests commerce, it should, be com- menced by the government, under direction of the Commissioner of Agriculture. The question may arise, can a law be made to govern the examination and sale of meats which will be beneficial in proportion to the inconven- ience it entails t Even if the action of such a law must of necessity be continuous, the protection to life and health would more than compensate for the ex- pense and trouble, which latter at first no doubt would be considerable, and perhaps cause some annoyance, but if there is a possibility of erad- icating, in a few years, the disease from our midst it should be attempted at any price. At first this examination should be made a general one, and the fact concerning the existence of trichinae be. fully settled for the whole country, while the systematic examination of all pork should be commenced as early as possible. Heller says (Ziemssen, iii, p. 654) : " The experience of several cities shows that the difficulties of a thorough microscopic inspection are by no means insurmountable.? " The micro- scopic examination of hogs has been practiced in the Duchy of Bruns- wick since 1863 with excellent results, and ifc has resulted similarly in other localities " {op. tit., p. 655). Muller ( Jahresbericht, etc., i, 1870) says : "As a result of microscopic examinations of pork, trichina are not EEPOET ON TRICHINA AND TRICHINOSIS. 149 so often found, and consequently trichinosis does not so often occur in Prussia." The statistics of other places show that there are fewer tri- chinse found than formerly, perhaps on account of the removal by de- struction of all trichinse in slaughtered hogs of one of the sources of infection. Zenker in Dresden, Wagner, Fiedler, and others (see section 0) found over three per cent, of cadavers to contain trichinse in the early part of the seventh decade of this century. In examinations of over 4,000 cadavers in Dresden and Erlangen by Zenker for the ten years ending in 1872 there was only 0.95 per cent, found in Dresden and 0.11 per cent, in Erlangen. Whether this is also due to prevention by the official examinations is a question which although possible seems less likely when we consider the probability, as before mentioned, of human infection lasting through a period of years by small accretions. There are those, however, who seem to be opposed to the general microscopic examination of pork, or do not believe in its efficiency. Dr. Liman (Vierteljahrsschrift f. gericht Med. ST. S. Bd. xvii, p. 281) says: " The use of the microscope in the examination of pork does not estab- lish a certainty against, but lessens the danger of, infection." Meissner (op. cit, 138, p. 101) says : "In spite of the optional examination of pork since 1862, Simon reports three home epidemics in Oalbe." Berkan (Virch. Arch., No. 42, p. 354, 355) says : " Trichinosed hogs have infected persons, yet only after the most careful examinations could a single tri- china be found. There may, therefore, be light cases of trichinosis with- out trichinse being found in the hog of which the patient partook," and " it is not safe to say after an examination that there are no trichinse, but that none were found in the specimens examined, as they may occur in other parts of the body" (P. Niemeyer, op. cit., p. 12). Such experience should not be brought forward to discourage the ex- amination of pork, but should rather lead to a more thorough search. Dr. Eulenberg (Vierteljahrsschrift fur ger. Med., etc., 1878, p. 149), to show the necessity of great thoroughness in examinations, mentions that in three of the trichinosed hogs found in Prussia in 1876 one showed only 40 trichinse in 30 preparations, another showed 40 in 35, and a third only one trichina in 40 preparations. The editor of the journal last mentioned, in commenting on cases ot trichinosis in Magdeburg, says "by the eating of raw pork there will always be cases of trichinosis in spite of microscopic examinations. Wasserfuhr (Deutsche Vtljr. f. off. Gesndhtspflg ix, 4, 1877, p. 82o) does not believe in the microscopic examination of pork as a general meas- ure, as the largest proportion of trichinosed hogs are raised and con- sumed by their proprietors. He thinks it sufficient to give a careful examination with the naked eye, by which means not only tachmosis but other diseases-may be discovered, and thinks it better to get the people to understand the danger of Heating pork not ^ughty cooked. P. Niemeyer (op. cit, p. 5) says that "raw meat should not be eaten even if free from trichinae, as there will be danger from cysticercus." 150 REPORT ON TRICHINA AND TRICHINOSIS. The opinion of Wasserfuhr is not sustained by the evidence given by all observers, viz, that trichimsB if present would be visible to the naked eye. . If pork has been found free from trichinae after microscopic exam- ination, any cysticerci present will have been seen, and on that account the meat declared unfit for food (see Gerlach quoted later on this sub- ject). '■ Even admitting that the microscopic examination of hogs or pork wifl. not be a perfect protection against trichinous infection, as asserted above, it will be apparent that the intelligent use of the results of such examinations, if carefully followed to the source of the trichinae when- ever possible, will have a tendency to prevent the spread of infectioQfto other swine, and thus lessen the number of infected hogs and assist in the more general work which should be instituted immediately by the national government. The necessity of early action in this direction will be apparent if °we accept the opinion -of Dr. Eoper (Deutsche Vrtljlrsohr;, etc., £ off. G-es. vi 2, 1874, p. 280), who estimates that a drove of 10,000 hogs may be- come trichinosed through the addition of one trichinosed hog* He says : " When it is considered that one trichinosed hog may infect two oth- ers — even if only one occurs in every 10,000 — through his dejections, we have as a result of geometrical progression 2 in the second year, 4 in the third, 8 in the fourth, etc.; so that after fifteen years 16,384 trichinosed hogs will result, and in this manner, by a continuation of the feeding with offal from trichinosed hogs there is a certainty that in a few years all the hogs in America will become infected. The neces- sity for microscopic inspection of American pork increases every year, for in the American slaughter-houses there is apparently a system for propagation of trichinae scarcely less effective in its consequences than if it had been instituted by design." This extreme view would seem to be corroborated by a comparison of the results of examinations in Chicago in 1866 and those of 1878. In the former series only 2 per cent, were found trichinosed,. in the latter 8 per cent, of trichinosed hogs were founds (See Chicago Med. Ex- aminer, April, 1866, and Eeport Health Dept. Chicago, 1878.) Kraemer and Puge (quoted by Eoper, I. c.) found 3 per cent, of Amer- ican pork trichinosed. Fuge claims to have found sugar-cured hams (Eoberzuckerschinken) infected oftener than others-^-5 per cent, of the former and only 2J per cent, of the latter. This could be true only (1) on the assumption that the method of curing increases the number of trichinae, the absurdity, of which must be apparent to the most super- ficial observer, or (2) that in places where trichinae are most abundant in hogs that method of preservation is practiced. < This paper is quoted in the Medical Times and Gazette (Lond., Dec. 12, 1874; p. 667), with'a warning against American pork. J Petri (Virch. Arch., B. 57, p. 296) in Eostock found 12 out of 622 (2 per cent*) Amer- ican hams infected. Jacobi (Vierteljhrsch f. ger. Med., etc.) found 5 per REPORT ON TRICHINiE AND TRICHINOSIS. 151 cent, in Ebling (21 in 415 pieces). A. Key (Jahresbericht, etc., 1, 1875, p. 650) found 18 out of 800 pork sides (half hogs), or 2.25 per cent., in- fected ; also 9 samples in Cassel were found infected; no statement given as to the number examined. Christiania, Sweden, 24 out of 1,000 pork sides were found trichinosed (consular letter, June 6, 1879). Gerlach (Die Fleischkost, p. 76) gives the following results of exam- inations of "American" pork, etc. : " In the municipality of Cassel, Hafgeismar, Marburg, Esch wege, and other places in three years 140 pork sides were found trichinosed. " In Hildesheim in 1872, '73, '74, many trichinosed hams were found; three trichinosed hams were found in Gottingen. " In Hanover in 1872 trichinae were found many times in American pork ; in 1873-74 they were found in 54 sides and hams. " In Erfurt, 1873, trichinae found in American pork. " In Magdeburg and Aschersleben in American hams, 1874. " In Stettin, 1874, trichinae found in American pork. " Iu Danzig, 1872, trichinae found in American pork. •" In Solden, in Brandenburg, 1872, trichinse found in American pork. " In Leignitz, in Silesia, 1872, trichinse found in American pork. . u Trichinae were also found in American pork in "Westphalia. " Also in Hamburg, according to a verbal report by Professor Kohne, trichinse have been found several times in American pork." Warfwinge (Nord. Med. Ark., vii, 3, Nov. 18, 1875) reports: "Of 112 Bavarian hams 3 were trichinosed ; of 800 American pork sides (see A. Key, above) 18 were infected, and in Galeburg 8 in 210 (3.8 per cent.) were trichinosed." Beimer, quoting this article in Schmidt's Jahrbucher, No. 178, 1878, p. 204-5, notices the remarkable number of American hams found infested, but says nothing of the 3 per cent, in Bavarian hams ; and Levy (annalis d'hygiene public, Dec, 1879) fails to say any- thing about the large per cent, found among the European samples, while he remarks particularly in regard to the infected samples from the United States. Dr. Wallpert, " V. S., Mayence, examined 80 specimens of American pork and found no trichinae, and the American consul-general at Frank- fort (see consular letter, March 15, 1879) says: " Well-authenticated cases have come to my knowledge of rumors of the finding of trichinae in American pork, resulting on examination in proving that the infected meat was not American but German." * * * Further, "I made inquiries of experts and veterinarians if trichinae had been discovered in American pork imported into Frank- fort. The responses were unanimous and emphatic in the negative. One of them, a well-known veterinarian, who is commissioned by the army contractor to examine American ham and bacon, declared that he had never in the course of a long experience of this kind found trichinae in American pork, and that he had not heard of such discovery." It has been thought by several of the American consular officers that 152 EEPOKT ON TRICHINA AND TRICHINOSIS. the laws which had been made concerning the examination of meats in various places, viz, Borne, Manheim, Vienna, Berlny Frankfort, Chris- tiauia, Hanover, Lisbon, Barmen, discriminated unjustly against Ameri- can swine products, and examples are cited which give color to such an opinion; e. g., "in Mayence the butchers requested the burgomaster to caution the people against the use of American refined lard, and asked that active duty be levied on the same. In Manheim the law in regard to examinations refers only to American hams, &c. ; other meats are sold without examination." In Freiburg (consular letter ) the city papers reported cases of trichinosis occurring from the use of American ham. Several children were taken ill, but it could not be ascertained what was the cause of the disease. Forty soldiers were taken sick in Mayence with what was reported as trichinosis, and although some of" them died, there was no positive evidence of trichinosis, as no trichinae could be found. The consul at Freiburg further states: "In this dis- trict cases of trichinosis occur, sometimes resulting in death, yet after close inquiry and investigation in no case can I find that death or even sickness could be traced to American meat. * * * Great exaggera- tions have been accepted as authorized statements." Bumors of t J he prevalence of trichinosis in American hogs having reached Portugal, were rife in Lisbon, and the introduction, storage, and sale" of American pork products were forbidden "so long as said disease continued." (Consular letter, April 21, 1879.) This order was afterwards so modi- fied as to allow the sale of such pork, after due inspection, as was in stock. Not only the authorities and dealers, but the press has been ac- cused of unjust assaults on the American pork interest. Of course the press of any country would neglect its duty if it did not warn the peo- ple of what might be considered a great public danger; but the question arises, How much of private interest exists as the cause of these reports? Even scientific men have been led carelessly to make statements which are not founded on observation, and are not corroboratedby facts. For example : "Professor Heschl, of Vienna, wrote a very authoritative statement to the Wiener Med. Wochenschrift, June 8, 1878, to the effect that there was great danger from the use of American hams, etc. ; that one hog in every 5 or 10 in America was infected; that several epidemics of trichinosis had occurred, probably from the use of American hams, and warning the people against the further use of the same. [This was telegraphed to the London Times, and has been quoted by the European press generally, and has been accepted by the American medical press as a matter of fact.] The city council of Vienna requested the govern- ment to prohibit the sale of American pork in Austria. * * * The professor was requested to state the reports on which his statement was based. He referred to the article by Dr. Eoeper and that by Dr. Jacobi [already mentioned in this report], and declared that he had no personal knowledge of the subject, * * * and had never seen an American EEPORT ON TRICHINA AND TRICHINOSIS. I53 ham. After the examination of some American hams he said there were carton y no trichinae in them, and that they were sound and good » The consul, Mr. Post, blames the professor for giving the weight of Ins name to a statement not founded on personal observation. The article appeared in the London Lancet (vol. i, 1*78). The impression made by it is probably stronger and more lasting than any retraction or denial could possibly be, and will be noticed quicker, and still the American pork interest has no way of denying such statements, however exaggerated they may be. The government correspondents have been strongly impressed with the idea that facts have been greatly exaggerated and used against the sale of American swine products, and it may, perhaps, be considered somewhat significant that the reports concerning the occurrence of trichinae in American products have been mostly made by men who seem to have been very thorough in their work, while the official ex- aminations in Germany are often made by persons who are careless or incompetent. Even under ordinary circumstances mistakes may be made, as competent authorities assert. Scoutetten (op. cit, p. 85) says, "Some discover trichinae where they do not exist, and others fail to find them where they do exist." Dr. Thorn, of Konigsberg (Virch. Arch., No. 50, p. 461), sent what he asserted were the charred remains of calci- fied trichinae — over which there had been some discussion— to Professor Virchow, who pronounced them accidental foreign bodies. In two cases the anguillula aceti (vinegar eels) (Jahresbericht, etc., i, 1878, p, 514) from the acetic acid used in makiug the preparations was mistaken for trichinae (Pig. — ). Delpech (op. cit, p. 53) says, "Many mistakes are made in regard to trichinae; other nematodes or their larvae being mistaken for them." (See section C.) The comparative statements in regard to trichinous hogs in America and Germany have always favored the latter country, partly because all the examinations on which they were based were made there. The numbers given for American pork are the more readily accepted, be- cause the isolated examinations in this country having been made in places where a higher degree of infection might be expected, large numbers of trichinosed hogs have been found. On the other hand it is more than probable that many cases in German hogs have been over- looked through lack of thoroughness, or from pure carelessness. For example, in the municipality of Erfurt (Riemer Sch. Jrbr. 178, 1878, p. 195) Dr. Krahmer, the physician having charge of the examination of hogs, was in the habit of marking " sound" on each line of a whole page in the book kept for records, before the examinations were made. Oases of trichinosis having occurred from eating pork that had passed through his hands, he was prosecuted and condemned to 6 months' confinement. Other cases are on record where trichinosis has occurred when it was discovered that the butcher did not submit all his pork to inspection. Meissner says (op. cit. 152, p. 24), " although the examination of hogs is 154 REPORT ON TRICHINAE AND TRICHINOSIS. obligatory in Saxony, not over one-half of the hogs are examined." He also refers (op. cit., 138, p. 101) to the occurrence of cases in Oalbe show- ing that the optional examination as practiced there is not thorough enough. Also an instance near Hanover where 400 cases occurred, 50 of which were fatal. (Brit. Med. Journal, ii, 1875, p. 75) ; and at Died- enhofen where 121 soldiers were attacked (B. M. J., i, 1877, p. 820); in Neugersdorf 45 cases ; butcher was imprisoned one month (Lond. Lancet, ii, 1877) ; and Magdeburg there were 100 cases where the vic- tims had all patronized the same butcher (B. M. Journal, i, 1873, p. 316) ; 9 cases in Hanelbach ; several children in Biipendorf ; 5 eases in Lissa (B. M. Jour., i, 1874, p. 494.) Berlin several cases, one fetal, in Chem- nitz Hospital; cases at Gratzungen, Bleidengen, Trebra, Etzalsroda, Pulzliingen, Grors-Nechsungen, Forstham, Konigsthal, and 45 cases in Nordhausen (Brit. Med. Journ., ii, 1874, p. 182). The trichinosed hogs causing these epidemics were not included in the statistics, and they would increase the percentages considerably if added to the number al- ready reported. Numerous laws have been framed and put in force to protect the people against the sale of bad or diseased meats. Such laws stipulate that the butcher shall use due diligence, but can hardly be effective against the sale of trichinous meat, as there is no way known at present by which trichinae in meat can be recognized except by the use of the microscope. Prosecutions are not rarely commenced against butchers on account of the sale of meat which has proven to be infected. Cases of this kind have occurred within the past year, one in Brooklyn, N. Y., and one in Newark, ST. J. In Germany there have been three in- stances of such prosecutions. In one case Professor Kiichenmeister was called to testify as an expert, and gave as his opinion (Oertel, Zeitschr. f. prakt. Heilk, xix, 48, 49, Nov. and Dec, 1873) that the butcher could not be in a position to know whether the meat in ques- tion contained trichinae, as he was unfamiliar with the microscope and the appearance of trichinae ; and, further, as long as there was not a cheap and general obligatory inspection of meats, any laws, such as the one under which this butcher was prosecuted, would be an illusion. (Also see Dr. Maeder in Thur. Corr. Bd., hi, 9, 15, September, 1874, and Berlin Klin. Wochenschrift, xi, 22, 1874.) The necessity of microscopic inspection of meats, is recognized by all prominent investigators. Meissner— often quoted in this report— who has given a great deal of attention to the subject of trichinosis, etc., for many years (see Zeitschr. fur rationelle Med., 1855, and Schmidt's Jahr- biicher, 1868 to 1875), speaking of the epidemics reported by Schauen- berg in the Harz, Grasenick in Gratzuugen, and Kraemer in Bovenden, says (op. cit, 165, 1875, p. 285) : « These epidemics show again the neces- sity for a thorough meat inspection. In Gottingen, where there has been an obligatory examination of meat for the last 6 J years, seven trichinosed hogs have been found. No cases have occurredin man." REPORT ON TRICHINA AND TRICHINOSIS. 155 • Professor Gerlach, of Berlin, whose authority on this subject cannot be doubted, says (Die Fleischkost, pp. 69, 70) : " The microscopic examination of hogs after killing in connection with other means of protection is always a necessity, especially in all places where trichinse have been previously found. The experience of ten years proves its usefulness, its security, and the possibility of its execution. All the earlier objections have been refuted by the success of the prac- tice. Yet the objection that it is very difficult to find trichinae when they exist in small numbers still retains its force. But the usefulness of such investigations loses nothing on this account, because when the examina- tion is skillfully performed no fears of trichinous infection need be enter- tained after a negative result. Isolated trichinse do not produce disease, and when the meat is sufficiently infected to produce even light cases of trichinosis the trichinse will be readily discovered in the regular exami- nations. Thus far only one instance has come to my knowledge in which trichinosis occurred after microscopic examination had been instituted. In this instance (in Hanover) it was ascertained that the butcher had not submitted all his hogs to the inspector ;" and further (p. 79), "dur- ing eleven years 744 hogs were found infected, and of this number there was only a small number determined after the development of trichinosis among the people, and we can assume that more than 600 trichinosed swine have been withdrawn from consumption by microscopic examina- tion, and when we consider that one hog may be the cause of hundreds of cases of disease, especially in the cities, it must be plain that many thousands of cases of trichinosis have been averted by such examina- tions. No measure for the protection of the public health can show a more brilliant success. Let us take, for instance, the city of Hanover. "Previous to the microscopic inspection of hogs in this city there oc- curred (in 1864-'65) three epidemics, in which over 300 persons were in- fected. Since its introduction in 1866 until now (1875) only one epi- demic, with 54 cases, has occurred, and these cases were all traced to the meat of one butcher, who, according to his own confession, had killed a hog in the beginning of the year 1870-at which time the epidemic oc- curred—and sold the meat without its having been subjected to micro- scopic examination. How often the city of Hanover might have been Visited by epidemics of trichinosis is shown by the fact that in the in- tervening 9 years trichinse have been found in 9 hogs. In Linden (a suburb of Hanover, with an independent city government), where the inspection was introduced at the same time that it was ordained in Han- over and shortly afterwards given up, an epidemic* occurred in 18/4, in which 400 persons were infected and 40 died of tnchmosis. " The application of the microscope is not at all difficult, and onl in large cities where large numbers of hogs are slaughtered » tta» «* inconvenience encountered, and this can be readily overcome by theem- ployment of men and women without any special knowledge , of the ^med Ll sciences. The greatest difficulty is to bring all hogs under control, 156 REPORT ON TRICHIN2E AND TRICHINOSIS. and to this end it will be necessary in large cities that all hogs be killed in public abattoirs, and of those found infected nothing but the lard should be used, and that only after sufficient boiling. The meat should be burned or otherwise destroyed, or deeply buried. [As trichinae will withstand so many changes and even putrefaction of the meat (see sec- tion B) burying should not be thought of until after boiling at a high temperature. This will secure the destruction of the trichinae.] Rejec- tion should not depend on the number of trichinae found to be present, but the discovery of a single worm should be sufficient ground for de- claring the whole hog unfit for food, because if one muscle trichina is present, one female trichina — capable of giving birth to 1 to 2,000 em- bryos — may be set free in the intestine, although from a sanitary point of view it cannot be said that trichinosis will occur from the presence of a solitary intestinal trichina. " Trichinae belong to that dangerous class of parasites which always increase in numbers, and thus afford increasing danger, unless all pos- sible measures are used against them. While measures are taken, at great expense, against the parasites which destroy our forests, vine- yards, and vegetables, the destruction of trichinae, which may infect our bodies and even destroy our lives, should be the objects of particular at- tention. Of the means to attain this end the microscopic examination of all slaughtered hogs in trichinae districts, and in places where even a trace of infection is suspected is the groundwork. When all hogs are subjected to inspection, when rats are kept from places where trichinosis occurs in man or trichinae are found in hogs, and when the carcasses of trichinosed rats, etc., are rendered harmless to pigs by burning, then will there be a prospect of exterminating trichinae. On the other hand, if measures are not taken against them the danger of infection from trichinae will increase from day to day."- On the subject of sanitation and prophylaxis, in connection with tri- chinae, etc., Professor Virchow says (Lehre, etc., p. 64, et seq.): "As the infection of hogs comes through the food, especial care is necessary to prevent the consumption of suspicious animal substances. Of these we have on one hand trichinous meat, on the other the excreta of trichinosed animals, and especially of man. Clean food and clean stables give the greatest security. Eats and mice should be caught and destroyed; * * * but trichinosed hogs are found where — asatSchon- rade, in East Prussia — no trichinosed rats and mice are found, so that the hogs should be kept as much as possible from the excreta of men and dogs. * * * Thus far most of the epidemics of trichinosis have occurred in the Saxo*n districts where stable-feeding is the rule, * * * where, according to my own investigations, the poorer classes make the pigs eat human excreta. " The endemic centers must le carefully determined and watched. I have previously explained my views concerning the existence of such centers, of which there can scarcely be a doubt entertained. Private individuals REPORT ON TRICHINA AND TRICHINOSIS. 157 cannot control the sale and transfer of trichinosed meat and animals. The public authorities should therefore, first of all, make registers of all places where trichina; occur or have been found, and publish them at proper times. By this means special care could be given to animals from such places; but public preservation should not be limited to this alone. In small places (and this should be especially observed in breeders and breeding places) all pigs living during the occurrence of an epidemic among the people should be marked, and should not be allowed to be sold, and when killed should be thoroughly inspected. Finally, asso- ciations should be formed to insure against individual losses, with a par- ticipation by the district or even of the government — such as already exists in Brunswick. [In some places, Nordhausen, Mtihlhausen, etc., in Prussia, premiums are paid for the discovery of trichinosed hogs. Eulenberg, Vierteljahreschrift f. gerichtt Med., etc., 1878, p. 149.] This is more especially necessary in the interest of many poor people who raise hogs. * * * The sooner such measures are undertaken the sooner will the propagation of trichinae and the occurrence of trichinosis be brought within narrow limits. This subject is of sufficient importance for especial legislation, without which such regulations cannot be enforced. "As there are no certain signs by which trichinous infection can be discovered, and as the capsules cannot be seen with the unassisted eye unless calcified, a microscopic examination of the meat becomes essen- tial. * * * In every place where such examinations have been prac- ticed for even a short time, the results have been eminently practical. In Altenburg, where it was ordained December 22, 1865, a trichinosed hog was found on the 2d day of January, 1866, showing that it is only necessary to introduce it in order to test its efficacy." Thus it will be seen that the only way to insure success in the eradi- cation of trichina} is to establish complete methods, and then make them thorough in their execution. This, according to Gerlach, can only be accomplished by the establishment of public abattoirs. I have taken the liberty to quote complete (from Die Flieschkost, p. 134, et seq.) his remarks on the subject, and although they are so worded in some parts as to apply particularly to Germany, they may be equally applied to any other country. Exceptions might be taken in regard to the large estab- lishments already in running order in several American cities, where many other precautions are no doubt observed, and which may only need the addition of the trichinae inspector. The object of his remarks, it will be apparent, is to bring the smaller dealers under control. PUBLIC SLAUGHTER-HOUSES, AND OBLIGATORY USB OF THEM, UN- DER CONTROL OP VETERINARY SURGEONS. HISTORICAL. « The ancient Eomans built slaughter-houses-Laniense-and ^market- places-Macelli-which in size and luxury were not surpassed by other public buddings, baths, arenas, etc. There were also in thelarger cities 158 REPORT ON TRICHINA AND TRICHINOSIS. common places for the slaughter of animals, in the middle ages — e. g., one in Breslau in the fifteenth century (Brandes), and in many European cities, viz, in Germany, particularly in the seventeenth and eighteenth centuries, the so-called Kuttelhofe and Kuttelhauser. Abattoirs were erected in Berlin during the past century, which were demolished in 1811 and 1842 (Feit). " The ancient abattoirs were often demolished and rebuilt as they failed to answer to the necessities of the changed ideas and increased population. They were not properly arranged ; were situated within the cities and annoyed the people who lived near them, and finally, be- coming inadequate to the wants of the increasing population, private slaughter-houses had to be allowed. These public slaughter-houses were not looked upou as a sanitary necessity. Such a necessity could not be recognized, because the butchers as well as the public in general looked upon the meat from sick animals with horror ; but in later times, on the contrary, it came to be considered harmless. In early times the people without exception rejected meat from sick animals, and no butcher even thought of killing one that was diseased. But this preju- dice was somewhat overcome at the first development of veterinary science in the second half of the eighteenth century without discriminat- ing between those which were dangerous and those which were harmless. As the crude empiric veterinary science of that time proved only that harmless meat was sometimes excluded, some authors assumed that all meat was harmless. It was thus that a ground was laid for a careless- ness in the slaughtering of animals which has now increased to such an overwhelming magnitude. "The modern slaughter-house, which answers to all the demands of the times — in which butchering is done in the most careful way, where the greatest cleanliness is observed, and which is under veterinary su- pervision—first appeared in the early part of the present century in France. Napoleon I, in 1810, ordered that all private slaughter-houses be demolished and the erection of public establishments in all the me- dium sized and large cities in France. The first five were opened in Paris in 1818. At the present time there are about twelve abattoirs in Paris, which have become the models of all establishments of the kind. 1 This proclamation of Napoleon should be adopted by every civilized na- tion. According to the imperial decree of October 15, 1810, and the royal ordinance of January 14, 1815, and April 15, 1838, the slaughter- houses in France belonged to the first class of those establishments which were called ; dangerous, unwholesome, or inconvenient, and not to be erected in the vicinity of dwelling-houses.' The last ordinance (1833, article 2) provides that after,,the opening of the public slaughter- houses all private ones in the< vicinity ^ shall fee closed*. „-'■ rM " The impulse thus originating in;Erance was next shown in Belgium) where at the present time slaughteu-houses exist in all the large cities (Brussels, Ghent, Antwerp, Louvain, Mechlin) and some of the smaller ones. REPORT ON TRICHINA AND TRICHINOSIS. 159 " In 1850 the Austrian Government ordered that each community- should build abattoirs, and since that time in nearly all of the large and middling-sized cities such buildings have been erected, In 1872 a slaughter-house was built at Pesth, which is the best one on the conti- nent. "South Germany also excels in the number and completeness of the arrangement of her slaughter-houses. The arrangements of the meat markets in Baden and Bavaria are considered the best. In North Ger- many, on the contrary, these establishments are very much neglected. They exist only in Hamburg, Bostock, Giistrow, and Wismar, but under deficient control. " In Hanover the necessity for an abattoir became urgent more than ten years ago, but against the strenuous opposition of the corporate butchers, the medical society, the often-appointed commissioners, the indefatigable exertions of the medical counselor Dr. Brandes, even with the knowledge that there were 300 stricken men and women and 40 corpses, have not succeeded in attaining this end. In Magdeburg the same opposition occurs. But in Berlin the best example of the ob- stinacy of butchers is shown. Under the patronage of Stromberg a company has built a large slaughter-house, with stables attached, at an expense of about 1,000,000 thalers ($400,000), but only a few of the 780 butchers have availed themselves of its privileges. By this is proven that nothing can be expected from the free will of the butchers ; that without compulsory laws nothing can be done, for they seek and find profit in that on which the necessity of a strenuous control is founded. "A laudable exception is the corporate Butchers' Association of Dres- den, which built an excellent abattoir in 1872. "THE NECESSITY AND USEFULNESS OF PUBLIC ABATTOIRS. "The necessity can no longer be disputed. This arises first from the possibility of infection of meat used for human food ; and, secondly, the butchers have not the necessary knowledge, and much less the good-will, to consider the health of the people against a possible increase of profits. Butchers as a rule do not believe in the danger from diseased meats. They do not wish to believe it, and therefore cannot be convinced of what is so clear to us concerning trichinae. In spite of direct proot-tne many sick and dead-they for the most part persevere in their opposi- tion without scruple., ,,.,5.,. " The necessity has become greater of late on account of the abolition of the butchers' tax, which, as it was levied L par capita or ' the jecies and was not affected by the weight and discrimina ted only bet ^een calves and full-grown cattle, caused the butchers to look . oat ta the heavv weights, as light lean catttethns paid a higher tariff per pound. BlLrSrrestriionhas disappeared with the dutf which thus pre- vented the slaughter of sick, lean cattle. «The compulsory slaughtering in public abattoirs offers other advan- 1 -■ - ] 160 REPORT ON TRICHINA AND. TRICHINOSIS. tages which in themselves are sufficient to make it desirable, as fol- lows : " (1) It will put an end to the driving of cattle through the streets of our larger cities. This inconvenience is overcome in Berlin, Where according to the street regulations, cattle moved in the day-time must he trans- ported in closed wagons. But in other cities no such law exists, and it has been repeatedly and vainly proposed by the police authorities in Hanover. " (2) Prevention of cruelty in butchering. It is 1 not necessary to prove how much cruelty may be practiced in the slaughter of animals. In pri- vate slaughter-houses it is not seldom in consequence of insufficient room, deficient arrangements for holding the victim firmly, and espe- cially in consequence of lack of firmness in handling the instrument of death, which can alter the best methods of killing animals to a system of torture. In the large abattoirs the work is divided ; every man at- tains the greatest possible dexterity in his particular work, and thus only can the greatest possible certainty of a rapid death be secured. The international congress for the prevention of cruelty to animals, held in Zurich in 1869, saw correctly, in the erection of abattoirs, an effective expedient to prevent unnecessary pain to animals. " (3) Greater cleanliness on account of the more judicious arrangements and cleansing with water. The most careful cleanliness in private slaugh- ter-houses cannot compete with the properly arranged abattoirs, because the space, especially in the larger cities, is always very limited, but even in ordinary cases is generally insufficient, and filth is the rule; and it only exceptionally occurs that the accumulations do not become unbear- able. In public slaughter-houses the care for the best possible state of cleanliness is increased by its publicity. " (4) With the closing of private slaughter-houses in cities abundant sources of air poisoning are removed. Those living in the vicinity of slaughter- houses know best how often in summer the air becomes foul, particularly near open water courses. The question here not only concerns the foul- ness and unpleasantness of the air, but from the putrefaction of blood very often arise peculiarly dangerous substances, which are directly in- fectious, and therefore in denselypopulated cities the greatest care should be taken to prevent such decomposition. This is recognized in the ordi- nance concerning the trades. "(5) * * * * * * # " (6) Real progress in the control and extermination of infectious and contagious diseases among domestic animals. It is a fact that the public in general is inclined to hide contagious diseases,- and on this account it is very difficult to check and especially to exterminate them. Obliga- tory inspections of slaughtering is by far the surest means of accom- plishing this end. The discoveryof contagious diseases in the abattoirs is so important that for this reason alone the compulsory use of the pub- lic building should be inaugurated in every city. When the enormity of the danger to the public health on account of the diseases of our do- REPORT ON TRICHINA AND TRICHINOSIS. 161 mestic animals in the present conditions of commercial intercourse is considered, and when it is seen that we can seldom prevent tSntro ££"£ T' "^ Tl ° Ur eff0ltS mUSt be S-cted to "Cd destruction-that we can do little to prevent but must act to reoresL it may be safely said that a successfal exercise of the dutLs of the it^ inary pohce without legal control of the slaughter-houses can by no means be accomplished. * " With all these great advantages to the States and cities the butch- ers wdl lose nothmg. On the contrary, they have the greater advantage . m the expenses, that butchering together is handier and cheaper, and the scraps and offal can be more readily utilized. In former times the slaughter-houses, as the bakeries, were erected solely for the profit to the trade. No supervision was necessary in those days. The butchers know this very well, and when they (as in North Germany) nevertheless oppose the obligatory use of public slaughter-houses bv bringing for- ward all possible difficulties and the cost, they must have some ulterior object-which probably is that they do not wish to be interfered within their business, which indicates still more the necessity of supervision. The profits made must certainly be great when the butchers reject the very apparent advantages and conveniences of public slaughter-houses. " It may thus be seen that in the most cultivated cities in Europe the necessity of compulsory use of public abattoirs has become apparent, but it seems inexplicable that such measures have not succeeded in North Germany, where the consumption of meat is greatest, and where pork and beef are often eaten in a raw or half-cooked condition, and where therefore the. danger of infection is much greater than in other countries. "STABLING IN CONNECTION WITH SLAUGHTER-HOUSES. " In order that these abattoirs may attain completely the object in view there should be sufficient space left for stabling and the storage of hay. To keep the cattle, etc., near the place of killing is necessary for the following reasons : " ( 1) The cattle can be bought at any time and killed when needed. The butchers, etc., can thus become independent of the brokers. " (S3) The animals should be well rested before slaughter, as only after a long bodily rest can animals furnish normal and healthy meat. Mus- cular activity changes the blood and muscle. Nourishment is disturbed during exercise or labor. There is a consumption of the elements of nutrition, the products of which accumulate in the muscles and blood in proportion to the amount of activity, which in extreme cases may be- come fatal. Fat cattle may easily be driven to death, and fat hogs suc- cumb much more readily. Even work animals can be brought to a fatal exhaustion, and wild animals may be chased to death. "According to my experiments on horses, the blood after muscular ac- tivity becomes at first of a bright red, but changes after a time to a dark red, and alter extraordinary exertion becomes of a blackish red color, S. Ex. 9 11 162 REPORT ON TRICHINA AND TRICHINOSIS. and loses its coagulability. Animals killed under such circumstances bleed little. The muscular tissue contains more blood than usual; is moister and softer ; the secretion is acid instead of alkaline ; it breaks down easily, and putrefaction rapidly supervenes. After the highest degree of muscular labor the muscular tissue, especially in those parts of the body where the muscles were subjected to the highest degree of activity for a long time, appeared soft, more or less discolored, and under the microscope showed a more or less complete granular degeneration of the transverse striae. " There is a decided loss on account of muscular labor before killing, which is augmented by the rapidly occurring putrefaction, and, as before remarked (Fleischkost, etc., p. 12), the meat itself may become dangerous to life. A rest of at least 12 hours after even the lightest exercise, and twice or four times as long after severe exertion, is necessary beibre the animal will be fit to be slaughtered for human food. " The present way of transporting cattle affects the animals as much •as driving. After .long journeys by rail they arrive in a feverish and nearly exhausted condition, and need a rest of several days. " VETERINARY SUPERVISION OF PUBLIC ABATTOIRS. "Such a supervision should be exercised both before and after slaugh- ter. An examination of the live animals requires a rapid glance as to the quality in general (or individual), of which a closer examination after killing will be necessary. A general ambulatory inspection of cattle in i large establishments is not sufficient to properly bring the health of the animals under control, yet through the necessary observation of animals before killing it is possible to determine the condition of the health in general. It is not necessary that every animal should undergo a special and methodical examination. A general but thorough inspection, fol- lowed by a thorough examination in doubtful cases, will be sufficient. " The examination of slaughtered animals must necessarily, on account of the large numbers to be examined, be executed in a rapid and prac- tical manner. The thoracic and abdominal organs especially should be examined, as also the meat independent of trichinae and cysticerci. The intestines should be glanced at, and the portions that have a suspicious appearance should always be subjected to a closer examination. In regard to the cysticercus the examination becomes comparatively easy, , as they usually occur under the tongue and in the muscular substance of the heart. The difficulty in regard to the microscopic examination of pork for trichinae is that it takes so much time. A veterinary surgeon can supervise the microscopic examinations in a large establishment. About 20 hogs can bo reckoned daily for each inspector, for which a spe- cial room should be provided. Nonprofessional persons may be in- structed, and with practice will be able to do this work." For small towns where there is no veterinary surgeon, persons should be instructed by official veterinary surgeons, to whom all doubtful ques- tions should be referred. REPORT ON TRICHINA AND TRICHINOSIS. 163 » Section G.— MICEOSCOPIC EXAMINATION OP MEAT. "The recognition of trichinae in swine during life is of grave impor- tance. The, symptoms in many cases, after artificial infection, are not characteristic, but this cannot be said of all cases. The appearance of trichina; capsules has been pointed out as a diagnostic sign, but even if present their color is not so distinct from the surrounding tissues as to make them appreciable unless calcified;" but "if the muscle is unusually red,.look out for trichinae" (Leuckart, Untersuch., etc., p. 104 and note). Only a few cases of calcified trichina? capsules in hogs have been ob- served (see Section B of this report— Calcification). "The use of the microscope is the only means by which we can deter, •mine the presence of trichinse without a doubt. During life the investi- gation may be made by cutting a piece of muscle, or, better, by with- drawing a piece of muscle by means of the harpoon, but such measures would not be fitting to animals unless infection were suspected, as in the healing of the wound a sore might be left or an abscess might form, and besides it might prove very unsatisfactory unless often repeated ; but this, according to Kiihn, can be done at the pleasure of the operator without inconvenience or danger to the animal. He sometimes operated 16 times at one sitting without inconvenience to the animal. Caution must be used not to pierce the periosteum, while the puncture must be deep enough to pass through the layers of fat which lie under the skin. The regions of the neck aud shoulders and fore limbs have the prefer- ence. Kiihn not only determined the presence of trichinae, but their relative abundance." (Leuckart, op. cit, p. 105.) "However, the examination of the slaughtered animals, when either the harpoon or scalpel or both may be resorted to, is the most certain, as all parts are thus exposed, and especially the diaphragm, which, ac- cording to Leuckart, should, in the earlier stages, contain the trichina in the greatest abundance; but the youngest embryos will be found first between the layers of the mesentery." In 741 specimens taken from 15 different places, Kiihn found 1,628 trichinae. Of these 25.3 per cent, were found in the diaphragm; 7 per cent, in flexors of hind legs; 14 per cent, in scapular muscles; 4.3 per cent, in muscles of neck; 11.3 per cent, in lumbar muscles; 4.7 per cent, in muscles of tongue; 8.5 per cent, in laryngeal muscles; 4.4 per cent, in masseters; 3.6 per cent, in orbital and abdominal muscles; 3.1 percent, in extensors of fore leg; 1.7 per cent, in intercostals; 0.3 per cent, in dorsal muscles. These figures varied somewhat with the degree of infection. Prom this table it will be seen that the diaphragm, as well as the muscles of the shoulders and loins, are particularly liable to infection (Kiihn), with the pectoral and those of the neck (Leuckart). The orbital muscles are less infected than those of the latter. Kestner (of. cit.) found the to- 164 KEPOET ON TRICHINAE AND TRICHINOSIS. • chinse most numerous in the masseter, temporal, and pharyngeal muscles of a rabbit fed by him. Delpech '(op. tit., p. 51) says : "Professor Gerlach informs me that in Hanover the meat inspectors choose the diaphragm, the intercostals, and the masseters. Professor Miiller, of Berlin, who has carefully studied the subject of distribution of trichinae, has given us a table of results obtained by him by the fol- lowing method. He raised at the point of examination a sufficient amount of muscular tissue to weigh exactly a grain, and then carefully counted the number of trichinee contained therein, with the following results : "From the psoas muscle one grain of tissue contained 161 trichinae. u u -u a a a a u u u a u a a a a a a u u u diaphragm " « " " ....129 laryngeal muscles one grain of tissue contained . 126 " lingual « " " " » .105 « orbital " " " " " 64 " abdominal " " " " " . 54 " masseter " " " " . 45 " lips near the snout "- " " " . 43 M serratus magnus '" " " " . 39 " pectoralis major " " " " . 33 " O3sophagus in front of the diaphragm, one grain contained 31 " u " oesophagus close to the stomach, one grain con- tained 1 " " " pelvi-femoral muscle, one grain contained 26 " " " tibial muscle, one grain contained 26 ■ " " " longissimus dorsi muscle, one grain contained . . 20 " " " scapulo-humeral muscle, one grain contained . . 18 " " " radio ulnar muscle, one grain contained 17 " " " metatarsal muscle, one grain contained 9 " il u intercostal muscle, one grain contained 8 " ■" " small muscles of the ear one grain contained . . 2 u a u u u of the tail " " " 1 " *' Neither the heart nor muscular tissue of the stomach contained tri- «hinse. " Prom the above table it would appear that the psoas, the diaphragm, the larynx, and tongue can be the most usefully reached in cases where the infection is light. " The official instructions published at Magdeburg order inspection of the muscular portion of the diaphragm, the muscles of the eyes, of the jaws, of the neck, and the intercostals. This does not accord with the results we have given, in which the intercostals do not have an impor- tant place. Si The above figures have reference to an animal in which the trichinse have their usual distribution. It is very certain that if a recently trich- iiiosed hog were examined in which the embryos were still in the stage REPORT ON TRICHIN2E AND TRICHINOSIS. 165 of migration the results obtained would be very different. While the diaphragm and the neighboring muscles would contain a large quantity, those of the other parts would show very few." Kramer (Deutsch Klinik, 30 : 31. July, August; 1872) obtained results different from those quoted above. He examined one gram (gr. xv) of muscular tissue from various muscles, with the following results : In one gram (gr. xv) of muscle from the biceps 420 '^>"V $#wgjj»|e?{gBj g£<£S w* lajaBfe SifaraB Stf?* K*f Paps 1 IS j i s8S JX> WB^^" Ik ^W *a No. 77. No. 78. Tig. 77. — Single psorosperm, showing the unchanged muscle fasciculi on its periphery (Virchow). Pig. 78. — Reniform sausage and irregular granules (navicular) from the sac of the psorosperm (Virchow). .perfectly free from foreign substances. Dr. Thorn (Virch. Arch*, Fo. 50, p. 451) sent a specimen of what he called calcified and charred tri- chinae capsules, over which, it seems, there had been some discussion, to Professor Virchow for examination, who wrote that he found no such bodies, and thought that Dr. T. saw some accidental foreign bodies. Fibers of linen, cotton, or silk from the cloths used to wipe the slips might be mistaken by those unfamiliar with the microscope for trichinae; detached muscle fasciculi might also be mistaken for them. "Other objects may be seen, as foreign bodies in the muscles, which may be mistaken for trichinae. The most common of these are the so-called psorosperms'' (Fig. 76), discovered by Bainey in the hog (Trans. Phil. Soc, 1857, p. 114), and at one time considered as the embryonal form of the cysticercus cellulosa; they are identical with those found in the muscles of the mouse by Miescher, and by Huling in the heart of the sheep, ox, and deer. Nearly one-half of the hogs examined contained them in greater or less quantities, and in some places they are found in nearly every hog (see Gerlach, p. 450, and Berkan, p. 451, Jahres- bericht, etc., 1866). They have been found in the muscles of the sheep, and Ktihn found them in the hen (see Kuchenmeister, Die Parasiten des Menschen, 2d, Aufl., Leipzig Lief., 1, p. 10, and Davaine, op. cit., p. 261; Bupprecht Bundbleck, etc., p. 39, 40) : " The psorosperm (Fig. 77) is a more or less elongated body of a gran- ular nature 0.3 mm to almost 1.0 mm in length, slender, or worm-like. Ten or, fifteen may be found in a small slip of muscle, and they give it a REPORT ON TRICHINA AND TRICHINOSIS. 169 striped appearance. The stripes lie in the direction of the fasciculi, and are of a d]rty-white color, and might almost be taken for trichina cap- sules if not too slender. The-microscope reveals that, like the trichina capsules, they lie within the sarcolemma, but that the normal appear- ance of the muscle substance is not changed, as the transverse stria can be seen in the periphery. "The granular contents (Pig. 78) of the sac like envelop consist of numerous reniform bodies which have a great similarity to the spores of certain fungi. The outer wall consists of a clear cuticular layer of tol- erable thickness, and is pierced by numerous porous canals, at least in many cases, while in others the cuticular wall is covered with stiff bristles." , "Psorosperms found by me in dogs appear as pustules of an oval form, with a sharp contour, an almost shell-like capsule, and a few granular bodies. The granular substance was collected into a mass, which did not by any means fill the capsule. The remaining contents consisted of a clear albu- minous substance, which was sometimes drawn together in a stringy or sausage-like mass, so that I was reminded of the egg of a nematode. [Berkan (Virch. Arch. 35, p. 1), says: " Psorosperms are found in FlG - ra.-Tyrosin crjMsj^hnm from Westphalia all hogs, but in smaller number in summer, owing perhaps to green food being plentiful at that season. In some cases where hogs were fed on milk he found immense numbers."] "Although these bodies are often found in animals, the subject does not seem to be inconven- ienced by their presence. Eating of the flesh in which they are found does not cause disease in man or other ani- mals." (See, also, Gerlach, g§^ op. cit, p. 84.) The occurrence in smoked hams of microscopic crystals of tyrosin (Fig. 79), which appear as whitish flakes with uneven borders or roundish or oval masses of needle-shaped crystals, scattered more or less thickly through the muscle, might without fur- ther investigation be taken for trichina. They disappear without ef- fervescence on the addition of hydrochloric acid. " Other bodies also now and then appear as small sharply defined nodules about the size of a pin's head or larger, with usually a compact connective-tissue investment, and consisting of a more or less calcified FIG. 80. — Calcified granules (cysticerci?) from hog's muscle also streaked with fat (Virchow). 170 REPORT ON TRICHINA AND TRICHINOSIS. friable substance. Similar bodies, but larger (4 mm in length), have been found by Drs. Wiederhold and Rupprecht in fresh meat, which contain^ besides the calcareous concretions, numerous fat globules, distinct cells and cell remains, a part of the cells corresponding in their size and gran- ular condition to pus globules. The whole has a caseous appearance, cor- responding to a condition of retro- grade metamorphosis." (Leuckart, Untersuch., etc., pp. 112-114. See, also, de- generated capsules, in latter part of section B of this report.) The cysticercus cel- lulosse found in measly is?fc Fig. 81. Tig. 82. Tig. 81.— Cyat of the eysticfrcnscellulosa magnified 120 diameters. Fig. 82. — Tree Jarva of tenia solium (free cvsticercus cellnlosa) enlarged (Eiiffert). Tig. 83.— Vinegar eel (anguillula aoeti) (Ehffert), sometimes mistaken for triohina spiralis. pork are small white cysts (Figs. 80 and 81) from the size of a millet seed to that of a pea, containing the armed head of the tenia solium Tig. 84. Tig. 85. Tig. 84.— A, embryo of etrongylus Maria; B, embryo of ascaris lumbricoides (Leuckart) dig. 85.— A, new-born embryo of ascaris lumbricoides ; B, appearance in ovum just before birth (Fig. 82). The cysts are mostly visible to the uaked eye (Flitner I. c. and Eiiffert op. cit, p. 71). In two cases the vinegar eel (anguillula aceti,Fig. 83),-from the acetic acid used in making the preparation, was mistaken for the trichina. KEPOET ON TRICHINA AND TRICHINOSIS. 171 Finally, many mistakes arise by miscalling other nematodes or their larvae, as Dr. Merland de ChaiHe" and Professor Tigri found nematodes in the lungs of sheep, which, as Delpech (op. cit., p. 35) demonstrates, were the young of the strongylus (Fig. A 84). He also shows that the organization of the worms found by Lebert (Gaz. MMicale, 1866, ftnro-£ha.eo,/t'*i Via. 86.— Young of trichocephalus dispar (Leuckart). !Nb. 19) in an abscess of the uterus of a woman dying of cancer did not correspond to larval trichinae of the same length. The larva found in the water newt, and called trichina spiralis, «^\ 1 1 J' l-tsSS-™"' is a trichosoma (T. tri- 'V v%»»^^* Ssa J^'> (Pagenstecher, op. cit., p. 99). The last author (p. 100) mentions also another nematode found in the intestines of hogs, having a short tail and double sexual organs. The young of the ascaris lumbricoides (Fig. 84 B and 85 A) may also be mistaken for trichinae. Those of the trichocephalus dis- par (Fig. 86) have been mistaken for them also. j^. 8 7._;Filaria sanguinis hominis (Lewis), from Leuckart, some- Dr. J. H. Salisbury times mistaken for a form of tnchina. (American Journal Med. Sciences, 1868, p. 376) mistook, according to Cobbold {op. cit., pp. 157, 198), the fllaria sanguinis hominis (Fig. 87) for a trichina, and called it t. cysUci. (See Leuckart, Mensch. Par p. 382,ii, a fllaria cystica, young strongylus.) Meissner, in Schmidt s Jahr- bucner, m. 135, 1875, p. 289, gives the following table to distinguish the above, aswellastheeinbryoof the dracunculus^romth^muscletochinae. Muscle trichina? . . . . Dracunculus embryo Filaria sanguinis Diameter. Otm. 0. 0030 0. 0025 0. 00073 Length. Ctm. 0. 1008 0. 0787 0. 0338 Proportion of length to breadth. lto28 lto31 lto46 Head. Sharp. Hound. ..do.. Tail. Blunt. Sharp. ..do.. Proportion- teiength of tail. lto3i lto8 172 REPORT ON TRICHINA AND TRICHINOSIS. ( See section C, p. 104, of this report. Other worms taken for the trichina spiralis.) "I. The so-called trichina affinis was found in nearly every mole ex- amined by Gerlach (Die Trichinen, p. 4'J), and occur principally in the thick parts of the flesh as well as in the liver and braiu ; they are mostly free and in various shapes, but seldom rolled into a spiral. (1) This nematode is scarcely one-half tbe size of the trichina spiralis ; (2) the head is sharper and the cell body is of a different form; (3) it is found in the liver and brain as well as in the muscle; (4) it remains free for a greater length of time, reaching its full size before a trace of a capsule becomes apparent; a bulging of the sarcolemma sheath is not present; ( ■">) irritation in its immediate vicinity and prolifera of cells, etc., as well as the intense hyperemia, was absent; (C) feeding gave no results. "II. A small round worm has been found in the muscles of the frog. The delineation by Kiihn (Virch. Arch., 20, p. 222) shows that they are essentially different from the trichina. "III. Bound worms found in earth worms. IV, in beets." "The trichina spiralis always shows the same form, no matter where it may be found" (Gerlach, op. eit., p. 52). SECTION H. —TRICHINOSIS IN THE UNITED STATES. The history of trichinosis in the United States should commence with the cases occurring in Iow*a in 1856, related by Virchow (Lehr., &c, pp. 39-40) as follows: A German family living in Davenpoit, Iowa, was at- tacked in 1856. The mother returned to Germany and was admitted to the Altona Hospital in 1861, where the resident physician extirpated a cancer of the breast, in which Dr. Tiinin (Virch. Arch., Bd., xxx, p. 447) found numerous encapsulated trichinae. The woman died in 18i>4, and calcified live trichinje in large numbers were found in the muscles (Groth Virch. Arch., Bd., xxix, [or xxxix?] ) The next cases in this country were reported as follows : Locality. Reporter. S3 £=2 Reference. 1864 1864 1864 18C4 1864 1865 1865 1865 1866 1867 1807 1869 New York ...do ...do Cheektowaga, N. Y Manila, N. Y Schnetter Professor Dalton . Dr. Voss Dr. Kronbein. Massichu setts New York (in hos- pital). Linn Co-antv Marion, Linn County Iowa. New York Hospital Massachusetts Albany, N. Y. Dr. Dwyler A. Sawyer Dr. H. Coupland.. Dr. H. Wilson . . . Dr. H. Restine Dr. E. C. Seguin. Dr. Hun . Am. Med. Jour., February 20, 1861. Trans. N. Y. Acad. Med.,' 1864, N. Y. Times. Aitken Prac. Med., vol. i, p. 160. Buffalo Med. & Surg, jour., June, 1864. Am. Jour. Med. Sci., July-Septem- ber, 1864. Boat. Med. & Surg. Jour., 1865, p. 16. From Path. Soc, Lond., 1874; case diagnosed enteric fever. St. Louis Med. Rep., 1866, Chicago Med. Jour., 1866. N. Y. Med. Rec, August, 1863, Flint's Prac, p. 487. N. Y. Med. .lour., vol.iii, 1868, p. 116. Med. Times, April 20, 1867, p. 431, Davaine, Cobbold, p. 109. Trans. N. Y. State Med. Soc, 1869 p. 157. REPORT OF TRICHINAE AND TRICHINOSIS. 173 J Locality. Keporter. & S3 s ~ O u 2 St A si %*3 Reference. 1870 Saxonvillp, Mass 1 1 Lond. Lancet, 1871, p. 515. Do. IT. X. Med. Jour., xi, 1870, p. 107. A_ report on trichinosis as observed in Dearborn County, Indiana, in 1874; reprint from Trans. Ind. State Med. Soc, 1875. 1870 Lowell, Mass 1870 Marengo, De Kalb County, 111. •jf Detroit, Mich Port Huron, Mich . . Brooklyn, N. Y Martinville, "S.J Milford, Ind 8 3 1874 Dr. Sutton 1874 Dr. Keifer 1 4 5 4 5 4 1 1 2 1 3 1874 1879 1879 1879 Dr. Northup Dr. William Maddren Dr. E. J. Bergen E. P. Gilpin Mich. Bd. Health Rep., 1875. Proceedings Med. Soc, county of Kings, 1879. Letter to Surg. General M. H. S. American Practitioner, September, 1879, p. 135. N. T. paper. Number of cases a long time ago. Epidemic in German family a long time ago. Diagnosis not confirmed by post mor- tem. Microscopist. !N. A. Jour. Homceop., No. viii, p. 317, N. Y. Free I'ress. 1880 (*) Bridgeport. Conn . . . Newark, IT. J Prof. E. L. Sanford, Yale College. Dr. A. Boll... (*) 4 (*) (?) Specimen shown to Dr. Thayer. *Date uncertain. In regard to the discovery of trichinae in the cadaver, the first re- corded cases are those by Dr. Bowditch in the Boston Med. & Surg. Journal, 1842-'43-'44. Professor Chazal, dean of the South Carolina Medical College at Charleston, told me in the summer of 1879 that he had seen trichinae in The cadaver 1841-'42, while demonstrator of anat- omy in South Carolina Medical College. Asking for further particulars, he wrote, March 8, 1880: "All that I can recollect is that I noticed at least three cases at the time I was demonstrator during the session l841-'42. I think all thi se were colored ; one was a mulatto woman with much disorganization of the liver, the nature of which I do not recollect. I made drawings of the interesting little colonists, and had the drawings in my possession a few years ago. I state this to show that I did see them. At that period I only knew of Owen's article, which the late Dr. E. Geddings gave me to read after telling me what I had before my eyes. I infer irom that circumstance that he himself had met them .before." I have attempted to ascertain what had been done in the way of searching for trichin a? in the cadaver iu the United States. In response to my inquiries to professors of anatomy and pathologists in colleges and hospitals I have received many letters showing that trichina? are occasionally found in the cadaver. In some of these cases trichina? were not searched for— in fact, there are very few in which an especial search had been made. 174 REPORT ON TRICHINA AND TRICHINOSIS. CONDENSED REPORTS FROM PATHOLOGISTS AND OTHERS. NEW ENGLAND STATES. Maine.— Prof. C. W. Bray, Portland, Me., from 100 to 12Q cases exam- ined, no trichinae; Prof. S. H. Weeks, Brunswick, Me., knows of no cases of trichinae in the State ; H. M. Haslam, Augusta, Me*, no post mortems. 3H New Hampshire.— Dr. J. P. Bancroft, N. H. Asylum for Insane, but f3w autopsies, no trichinae. Massachusetts. — J. Gr. Park, superintendent Worcester Lunatic Hos- pital, no trichinae in last eight years; E. S. Boland, M. D., assistant superintendent Boston Lunatic Hospital, eighteen autopsies in last two years, no trichinae ; Professor Bowditch, of Boston, two cases, one age 36, one age 70 (Bost. Med. & Surg. Jour., vol. xxvi, 1842, pp. 117, 222) ; 1 case (Bost. Med. & Surg. Jour., vol. xxvii, 1842, p. 241); 1 case (Bost. Med. & Surg. Jour., vol. xxx, 1844) ; Prof. H. A. Beach, politeness of Professor Holmes, Boston, February 23, 1880, "in past twelve years five bodies contained trichinae; no- record except in two cases; no history sufficient to account for death." Connecticut. — Hospital Hartford, Conn., few post mortems, no trichinae ; H. Y. Stewart, Retreat for the Insane, Hartford, Conn., no trichinae ; Prof. Leonard J. Sanford, Yale College : u In the course of twenty years no trichinae observed. About two hundred cadavers examined in that time. Some of our old doctors have known of fatal cases of trichinosis." (Letter May 31, 1880.) MIDDLE STATES. New YorTc. — Prof. William Darling, M. D., LL. D., Professor of Anat- omy, University of New York, New York City, and at Burlington, Vt., reports eight cases that he has met, the discovery of which were acci- dental. They occurred in dissecting-room subjects. Prof. Mary A. Wattles, Woman's Medical College, New York Infirmary, about 150 ca- davers examined in last twelve years; two trichinae subjects in 1870 and one in 1879. Dr. E. A. Maxwell, Charity Hospital and elsewhere, 100 to 150 autopsies annually. " Have seen trichinae, always dead, how many times I cannot say." Prof. Corydon L. Ford, Long Island College Hospital, reports one case, and states that the number of bodies dis- sected in different colleges under his direction would probably amount to 1,500 to 2,000. No special attention given, but thinks he would have been notified. Prof. Wm. Hailes, Albany Medical College : No trichinas in cadavers in dissecting room. Found them in muscles of rat, in bacon, and in rab- bits to which trichinosed human flesh was fed. Cases dying in hospital. Prof. E. Y. Stoddard, Rochester City (N. Y.) Hospital : No trichinae found, but cases have occurred in the city. T. M. Franklin, New York City Lunatic Asylum, Black well's Island: No cases recorded. E. H. REPORT ON TRICHINA AND TRICHINOSIS: 175 Sordek M jYolr ^f ^ H08piM ' ^hkeepsie, N. Y. : No cases recorded. J M Cleaveland, superintendent Hudson River State Asylum Sed^ So 60 «£? ^ J ' H&m l8laDd H ° S P ital: Ninety-two deaths ^L TT P . Tw mS; n ° trichiD8e - Dr - Geo - Ford > S ^e Emigrant ^n g SE*? 7 ardS l8laDd ' ^ 6W York: Some P««t mortems^ tri -£ TiH / or - Professor Van Vuyer ' S ^~ <*• Y -) ™— sity, boMmonstrator and professor, microscopist : No trichina found ■ number of cadavers not given. Dr. 0. O. McBeth, Buffalo General Hos- pital: Interested in the subject; no cases in hospital; was prosector two years in Buffalo Medical College; no cases there. Prof. Charles Cary, secretary Medical Department University, Buffalo, N. Y. : Fifteen to twenty cadavers dissected annually; no trichinae found. Prof. J. D. Bryant: Trichinae often observed in the dissecting room of Bellevue Hospital Medical College. New Jersey.— Dr. A. Mercer, Saint Barnabas Hospital, Newark, N. J.; average ten post mortems a year for ten years; found oue cadaver con- taining trichinae. Dr. A. Boll, German Hospital, Newark, N. J.; twenty- five post mortems annually for last two years ; no trichinae found. Dr. Thomas W. Harvey, Memorial Hospital, Orange, N. J. ; autopsies, five per annum ; no trichinae found in hospital or in his private practice. Pennsylvania.— Professor Leidy, of University of Pennsylvania, of Philadelphia, in a personal letter writes that he " has seen trichinae repeatedly, but has never kept account of them. I have repeatedly met with trichinse spiralis at the university. / One case of a woman used last winter to show the vascular system; the muscles were filled everywhere. All cases under my observation encysted, and in most cases alive. It was the observation of a case of trichinosis in the uni- versity which subsequently led me to its discovery in the hog." (Pro- ceedings Academy of Natural Sciences of Philadelphia, 1846, p. 107.) Dr. Morris Longstreet, Philadelphia, Pa.: No case in hospital tor thirteen or fourteen years; about that time a fatal case ; found trichinae in many specimens of flesh of man and animals sent for diagnosis ; few post mortems in hospital. Dr. J. Berens, pathologist, Philadelphia Hos- pital : Pour to five hundred autopsies for past five years ; forty of them conducted in such a manner that trichinae could not have escaped^letec- tion ; found one case in University of Pennsylvania, 1878-'79. Dr. S. S. Schultz, State Hospital for Insane, Danville, Pa. : No examination for trichinaB ; post mortem, one case per month ; no trichinae found at the Homoeopath. Hospital, Pittsburgh, Pa. Prof. Mary J. Scarlett Dixon, Woman's College Hospital, Philadel- phia : Few deaths in hospital ; no suspicion of trichinae. Thirty-three cadavers in dissecting-room of college past two years; no trichinae found. Dr. H. Schrapinger, Jewish Hospital, Philadelphia : Six autop- sies per annum for the last three years; no trichinae observed. Dr. G. Alder Blusner, German Hospital, Philadelphia : But few post mortems; 176 EEPOET ON TRICHINAE AND TRICHINOSIS. no trichinae. Dr. W. Evans Cassellberry : Eight to ten autopsies annu- ally for last three years ; no trichinae. Prof. J. G. Eichardson, Philadel- phia Pathological Society, May 9, 1878, found trichinae in a man, age 40 to 50, a victim of an accident. (Philadelphia Med. Times, Aug. 31, 1878.) Dr. Stockton Hough, Philadelphia Hospital, reports 2 cases in 1867 and 2 in 1869 (Amer. Jour. Med. Sciences, ii, 1867 and 1869.) He also reports two later cases ; one, Mrs. M. L. Irish, age 28, dftutted for phthisis-pain; no account of (edema; another, T. McC, age 5(pl m itted first for rheumatism, second time for necrosis of superior maxillary, third time for chronic diarrhea. SOUTHERN STATES. Maryland.— Prof. J. Edson Michael, University of Maryland : Average fifty autopsies yearly in college hospital; no trichinae found; not looked for particularly during past six years. Prof. 0. F. Bevan, College of Physicians and Surgeons, Baltimore, Md. : Sixty to eighty cadavers per annum ; no trichinae found. Virginia. — Prof. J. S. David, University of Virginia : Average about ten autopsies every winter since 1805 ; saw one case about seven years ago, in which the trichinae were /lead and encysted. Dr. John Clapton, Eastern Lunatic Asylum, Williamsburg, Va. : Only two post mortems in twelve years ; no trichinae. North Carolina. — Dr. Eugene Grissom, North Carolina Insane Asylum, Ealeigh : No post mortems held. South Carolina. — Professor Parker, Medical College, State of South Carolina: Twenty cadavers annually ; no Trichinae found. He sends a brief abstract of a case reported by Dr. E. W. Gibbs, of Columbia, S. C, in Transactions of Medical Society of South Carolina, 1871, as fol- lows : " Negro man, age 50, suddenly fell dead ; numerous cellular bodies found in muscular tissue of abdominal and thoracic walls and in the heart; cysticerci in ventricular walls, one of which near the apex of the right ventricle was ruptured, and blood had exuded from the opening." Was it cysticercus ? Georgia. — Dr. John M. Mell, Georgia Infirmary, Savannah : Forty cases of autopsy per annum ; trichinae never suspected, neither looked for n»r found. Dr. W. Duncan, Savannah Hospital : No trichinae in twelve years, and not looked for. Alabama. — O. Bryce, superintendent Alabama Insane Hospital, Tus- caloosa, Ala. : No trichinae found. Mississippi. — T. J. Mitchell, superintendent Lunatic Asylum, Jackson, Miss. : Post mortems not allowed. Louisiana. — Prof. Samuel Logan, New Orleans, Feb. 22, 1880, has not had experience; is under the impression that they are rarely found there. Dr. A. W. Smyth has made a number of nice preparations of those found in the dissecting room of the University of Louisiana. Kentucky.— Prof. J. M. Bodine, University of Louisville, Medical De- REPORT ON TRICHINA AND TRICHINOSIS. 177 partment :, Thirty to forty post mortems a year; no trichinsB found; has heard of none in post mortems there for some years. Tennessee. — Prof. Frank Gleason, Medical Department University of Tennessee, at Nashville: Twenty to thirty bodies dissected annually; no trichinae found. WESTERN STATES. MissomM— -Prof. H. H. Mudd, Saint Louis, Mo., found trichinae in one case inT»77; has seen others, bat has only indistinct recollections of individual cases. Prof. N. B. Carson, professor of surgery, Saint Louis Hospital, has examined many bodies with trichinse; some of them died in their hospital; found them all encapsulated; signs of life in only one. One or more found in city hospital; some from subjects in dissecting room of Saint Louis Medical College, and others were sent him from dif- ferent parts of the country ; all notes ha\e been lost. IS". 1. 2ST. Howard, superintendent Saint Louis Hospital : Trichinae never searched for. T. E. H. Smith, superintendent State Lunatic Asylum, Fulton, Mo.: But few post mortems and no trichinse. Indiana.— Pvof. W. A.Wheeler, Medical College, Evansville, Ind.: Twenty-five post mortems per annum; no trichinae found, Prof. J. Chambers, Medical College of Indiana, Indianapolis: Thirty-five bodies per annum; trichinse not looked for. Illinois.— Prof. D. W. Graham, Woman's Medical College, Chicago, HI. : Eight cadavers per annum during last six years; no trichinae found. Prof. Chas. T. Parkes, of Eush Medical College, has seen no cadavers containing trichina spiralis in Chicago, 111. Michigan.— Prof. Corydon L. Ford, University of Michigan, found one case of trichinse twenty years ago, but they had no sign of vitality. Minnesota.— Dr. C. A. Wheaton, Saint Paul,Minnesota, Medical School, Saint Paul, Minn : In operation one year ; no trichinae found. Dr. Joseph E. Eogers, superintendent Hospital of Saint Paul, Minn.: No autopsies until 1879; trichinse not looked for, and not found. Dr. C. K. Bart- lett, Saint Peter, Minn. : Made post mortems for the last twenty years in Massachusetts and Minnesota; averaged ten per annum; trichinae not suspected and not looked for. m . , . Jwa—Prof. E. M. Clapp, University of Iowa, Iowa City: Trichinse found in one case, in which the flesh was examined for another purpose. Calif ornia.-Vr. Henry C. Kerber, German Hospital, San Francisco, Gal. : 72 post mortems since March 1, 1878; no attention given to tri- china. He examined 13 consecutive cadavers in 1878 for **%£* no result. G. Shurtleff, superintendent Insane Asylum of 0*^ a t Stockton, Cal.: Few post mortems, and not conducte d so as o beapt to find trichina, Dr. George H. Jenks, supenntendent Saint Luk e s Hospital, San Francisco: But few post mortems ^ n « t ™ hin ^Sus oL.^Prof. J. M. Wheaton, Starling Medical College, Columbus, Ohio has been connected with the college for the past fifteen years and there has been an average of twenty-five dissections per year, and as 178 REPORT ON TRICHINA AND TRICHINOSIS. many post-mortem examinations in hospital, but has never seen or heard of the occurrence of trichinae in any stage. Prof. J. F. Baldwin, Colum- bus Medical College for five years: Thirty cadavers per annum ; no tri- chinae found or looked for. Prof. Charles Van Pelt, Toledo School of Medicine: Six cadavers in past years; no trichinae. Prof.N. W. Kitchen, Medical Department University of Wooster, Cleveland, Ohio: 16 bodies a year; no trichinae looked for. Dr. C. A. Miller, Layvie^Asylum, Carthage, Ohio : Trichinae never found. ^ft District of Columbia. — Prof. D. L. Lamb, Medical Department How- ard University: Thirty post mortems annually; no trichinae found. Martinville, Somerset County, New Jersey, April 24:,- 1879. Sir : Yours of the 20th received. In reply I send you, as requested, the following : About February 1, 1879, Mr. Low, of Bound Brook, in this State, bought in the city of New Brunswick a quantity of pork (a ham), bring- ing it home, and there being more than could be eaten fresh, Mrs. Low cut the meat in slices and salted it, one layer on top of the other, on an earthen dish (a common pie-plate.) The meat was bought on Saturday. The following Saturday the family were all taken sick — Mr. and Mrs. Low and their two children, aged one and three years — Mrs. Low being much the worst, while the youngest child, who had eaten but little of the meat, was but slightly affected. Before the meat was entirely con- sumed Mrs. Low noticed an unusual taste and smell to the meat, so much so that the last cooking was thrown away. As I get it from the ^physician who attended them when first taken, the symptoms were like those of cholera. When they came under my charge at the township farm, about two weeks after first taken, all but Mrs. Low were better, and have at this writing got comparatively well. Mr. Low presented the following symptoms, which it will be noticed are similar to arsenical poisoning: Foetid state of the mouth; sensation of the teeth being on edge; hiccough; burning pain; praecordia; inflammation of lips; irritable stomach; vomiting of matters brown in color; black, foetid stools; small, frequent, and irregular pulse ; partial suppression of urine ; livid spots .over the abdomen; delirium; great prostration of strength; profuse perspiration ; inability to move Without great pain any of the volun- tary muscles. On seeing him I proposed to take from him a piece of muscle and settle the question of diagnosis ; but he objecting to being cut, I delayed the matter till the next day. At my visit the next day he seemed so much better that I again deferred the operation. The next day, the third of my treatment, Mr. Low, while "being helped from the bed, suddenly died. Twenty-four hours after death I took from the .left deltoid muscle a small piece. Dr. Berg, of North Branch, N. J., cut REPORT ON TRICHINA AND TRICHINOSIS. « 179 it in thin sections, placed one under his microscope, when numerous capsules were seen. (It is said trichinae do not become encapsulated till after some months.) On tearing the capsules apart with the point of a needle a trichina was found in each. Trichinae were also found not encapsulated. Fifty were counted in a space perhaps half an inch square. They were in various positions, and were seen to change, their position. „ Some were in size ^ of an inch in length by T ^ of an inch in width of thickness. My treatment was salicylic acid in ten-grain doses, without, however, expecting to do him any good, which proved to be so. The rest of the family took no medicine and got well. Mr. Low had oedema of the arms and legs. Any other information you wish will be cheerfully supplied by Tours, respectfully, E. J. BERGEN, M.D. J. B. Hamilton, Surgeon-General, M. H. S. APPENDIX. 181 LETTERS FROM UNITED STATES CONSULS TO THE STATE DEPARTMENT. No- 9*-] "United States Consulate-General, Vienna, June 24, 1878. Sir: I have the honor to state that a letter from Prof. Eichard Heschl, professor of anatomy at the Vienna University, was published in the Wiener Medicinisohe Wochenschrift, dated June 8, of which the following is a translation : " We have received the following letter, which we recommend to the attention of the city physician : '"To the Editor: u i Allow me to say a few words concerning a matter of sanitary inter- est, which may not be undeserving a space in your paper. It is in regard to the American hams which are offered for sale in Vienna since sev- eral weeks or months, and which are recommended by the salesmen to be superior to the Westphalia hams. While of the latter out of 2,000 to 2,500 one contains trichinae and is rejected, the American hams ex- amined in Germany show that of every five to ten, one has trichinae, and the probability exists that several epidemics owe their origin to this fact. The city physician should not permit the sale of American hams that have not passed examination, and the public should be warned, and if you need my name, it is at your disposition. u i v er y respectfully yours, '"Prof. EIOHAED HESCHL.'" In several of the Vienna morning papers of June 22 the following notice appeared : "ABOUT THE SUPPLY OP PROVISIONS. " The conviction having gained ground that the hams and the sau- sages imported from America, via Hamburg, contain for the greater part, trichinae, the proper section of the city council has concluded in its ses- sion of to-day to forward a petition to the government asking the same to issue a decree prohibiting the further import of such goods from America into Austria." I inclose the extract from the Medieinische Wochenschrift and the notice which appeared in the Neue Freie Presse above quoted. Soon after HeschPs letter appeared I requested him to specify the German reports upon which his statement was founded. In comply- 183 184 REPORT ON TRICHINA AND TRICHINOSIS. ing with this request he mentioned two German works, both published in 1874, and which do not appear to have any reference to the Mud of hams recently imported into Austria-Hungary. The works mentioned are: IVierteljahrschrift fur offentleiche Gesundheitspflege von Wanentrapp, 6 -Band, 2s, Hft., 1874. Ecepper, Trichinae der Americanischen Schinken. Published by Vie- weg, Braunschweig. 2. Eulenberg, Vierteljahrschrift fiir Gerichtliche Medizine, xx r Seite 103,1874. . Zur Trichinae frage von Dr. Jacobi. Published by Hirschwald, Berlin. Professor Heschl declared that he had no personal knowledge of the subject to which he called public attention, that he had never seen an American ham, and that he relied upon the examinations made in Ger- many. He was thereupon invited to examine some American hams, and after a careful examination he said there were certainly no trichinae in them, and that they were sound and good. If Professor Heschl had made his examination before he wrote his letter, he might have written *more definitely and satisfactorily, and would have authorized his name to be used to endorse the truth as as- certained by investigation; but it is unlikely that any such report would have been given such widespread publicity as has been • given to the letter he wrote. The substance of the letter was telegraphed to the London Times, and has been quoted in the European press generally in such a manner that readers would not suspect that its author wrote it before he had seen an American ham. It is not the facts stated nor the suggestion which Professor Heschl made which gives the letter importance. The importers of American hams would.be quite willing to have the government adopt his sugges- tion, not only as applicable to American but also to German and all other hams offered for sale. They feel confident that such examination would prove the superiority of those imported from America. But this course would not satisfy those interested in preventing competition in the food supply, and therefore his suggestion is rejected, while his name is used to create prejudice against American products. It is not proposed to petition the government- to cause examination of all hams offered for sale, but to prohibit the importation of American hams because " the conviction is gaining ground " that they are not good. This conviction is not gaining ground among those who have used them, for they unite in warmly recommending them, and therefore the demand for them is constantly increasing. The conviction may be gaining ground among those who have never used them, and who will believe a learned theory from men equally ignorant rather than the tes- timony of those who know by actual experience. Ignorant theory dis- guised in learned phrase so often represses and defeats practical expe- rience that it cannot be predicted howthe government will decide this REPORT ON TRICHINA AND TRICHINOSIS, 185 question, but it is to be hoped that the competent medical authorities of .Austria-Hungary will make independent investigation for themselves, uninfluenced by the German reports. I have also received from Professor Heschl a paper herewith inclosed, which was printed at the imperial printing office, and purports to be in- structions issued for the information of the sanitary council at the re- quest of the government of Lower Austria. There are two paragraphs only concerning America, to which I direct attention, translated as fol- lows: Equal precaution must be observed in regard, to the disposition made of the refuse of slaughtered animals since the frequency of trichina in America is principally due to the fact that hogs there are fed with the refuse of the great slaughtering houses, whereby, so to speak, trichinae are propagated. ******* Particularly must be noted the fact that bacon and hams have re- cently been imported from America which contain more trichinae than ours. In Germany one hog in 10,000 has trichinae, while of the hams and bacon brought from America from 2£ to 5 per cent, contain trichinae. In calling the attention of the Department to these several statements I beg to suggest that some proper means should be taken to contradict erroneous reports concerning our products, in order that responsible men may not indorse and give currency to them as unchallenged scien- tific facts. The attempt to create a prejudice against exports from America by misrepresentation and to cut off that source of food supply from the consumers in Europe is an injury to the poor, a crime against humanity; but there are those who are ready to use any prejudice or report, however unfounded, to prevent such competition in the markets Of Europe, and it is not only necessary to avoid furnishing material for evil reports, but to see that false reports are promptly and author- itatively contradicted. I am, sir, your obedient servant, ' ' PHILIP SIDNEY POST, United States Gonsul-Oencral. Hon. F. W. Seward, Assistant Secretary cf State, Washington, Z>. C. [Inclosures.] 1. Extract containing letter of Professor Heschl. 2. Extract from Neue Freie Presse. 3. Instructions at request of Government of Lower Austria. 186 REPORT ON TRICHINA AND TRICHINOSIS: Kb. 335.] United States Consulate-General, Berlin, July 9, 1878. Sir: I have the honor to report that it has been decided by the Prussian authorities hereafter to dispense with a microscopical exam- ination of all American fat pork, provided the same consists of salted and cured sides of hogs without any muscles or flesh attaching. Heretofore the import into Prussia of these products has been largely 1 interfered with, if not altogether inhibited, by the local authorities on the ground of their being infested with trichinae. Thorough investiga- tions have resulted in*establishing the fact that no trichinae ever exist in the purely fat portions of pork, and that whenever any trichinae have been discovered it has been in the meat or the muscle attaching to the fat. American pork packers and exporters will, therefore, do well to so dress their fat pork sides as to bring them within the above regulations now established for the whole Prussian monarchy, and thereby secure iioT themselves additional markets. I inclose a copy of the decree published in the premises under date of the 21st ultimo, jointly by the minister of the interior and of the church and medicinal affairs, marked Inclosure 1; also a copy marked Inclosure 2 of the royal scientific commission for medical matters, upon which the ministerial decree is based. I am, sir, your obedient servant, H. KEEISMAK, Consul- General. Hon. Assistant Secretary of State, Washington, D. C. [Inclostues.] Copy of decree of the Prussian ministers of the interior, &c., June 21, 1878. Copy of decree of the Prussian scientific commission for medical mat- ters, April 24, 1878. Mb. 19.] ; United States Consulate, Leeds, August 20, 1878. Sir : It is a gratifying duty to be able to send you herewith a copy of a report by the health officer of the borough of Leeds on the subject of trichinae in American hams. ; As no little detriment has been caused to the trade in this article by a wide and mischievous circulation of the idea of the prevalence of tri- chinae, I respectfully suggest that the report herewith is of great im- portance to our exporters. I have the honor to be, your obedient servant, A. V. DOCKEEY, United States Consul. Hon. Assistant Secretary of State, *, D. C. REPORT ON TRICHINAE AND TRICHINOSIS, 187 [Inclosure.] PARASITES IN AMERICAN HAMS. The following report by Superintendent Newhouse was read before the sanitary committee of the Leeds Town Council at a meeting held on Monday : "I have to report that in consequence of a paragraph in the Sanitary Eecord and other papers, stating that a large number of the American hams imported into England were infested with a deadly parasite called trichinae, I obtained from the wholesale merchants in Leeds ten samples of American hams and submitted the same to the borough analyst for analysis- The following is a copy of his report: " 'I have carefully examined microscopically these samples for tri- chinse, comparing them with trichinae obtained elsewhere, and find that none of the samples are so infested. 'THOMAS FAIELET, P. E. S. E., P. I. C."» ut' No. 135.] United States Consulate, Barmen, August 27, 1878. Sib: During the past four months the notices of the discovery of tri- chinae in American hams and bacons have been so very frequent that I have been inclined to consider them the result of jealousy and spite. The consumption of American hams and bacon even here in West- phalia has increased so much that it seemed not improbable that inter- ested parties systematically circulated these reports for the purpose of bringing American wares into discredit. The report, however, a few days ago, that trichinae had once more been discovered in American bacon in Dartmund, led me to address, in the interests of truth, a few lines to the circuit physician, Kreisphysikus, of that place, inquiring whether the report is true, whether he knew the bacon to be American, and whether trichinae were found oftener in Amer- ican than in German bacon. As will be seen in the copy of his reply, herewith inclosed, it is stated that two different examiners have at various dates found trichinae in sides of American bacon, whilst it is alleged that since the introduction of meat examination in Dortmund trichinae have been discovered but twice in swine slaughtered here. Now as these reports are of almost daily occurrence, and, whether true or false, by inculcating fear or suspicion of American hams and bacon are likely to be most prejudicial to one of the most important articles of the American export trade, and as the newspapers are con^ tinually warning the public of the danger they run in purchasing Ameri- can hams and bacon, since they do not receive the protection of a micro- scopical examination, I venture to suggest that American curers, if they 18& report on TRickiNJi A.TX& TmcnistdsW: desire to retain the foothold they have' obtained in the German market, take such measures as will enable them to guarantee their hams and bacon to be free from trichinae. , Many of these reports may be unfounded, but manj^ are but foo true, and this constant agitation must ultimately be injurious to the trade.. Hence it cannot be too strongly impressed upon al} American merchants that a uniform and unvarying excellence is the first essential to a lucra- tive European trade. I am, sir, your obedient servant, EDGAE STANTOlf, > United States Consul. '■ Hon. Assistant Secretary oe State, Washington, D. G, [Inclosure.] Copy of Dr. Cassaltfs letter to Mr. Stanton. [Inclosure.— Translation.] : Dortmund, August 24, 1878. . Sir: In reply to your esteemed favor of yesterday,; I confirm the re- port that trichinae were discovered in three sides of American bacon by Mr, L. Schmid, of Ostenhellirig, Dortmund, the, city meat examiner, whilst another examiner but a shprt time ago discovered trichinae like- wise in American hams. ; Their appearance has also been noticed in other districts. Since the examination of meats was introduced into Dortmund trichi- nae ha"ve been discovered but twice in swine slaughtered here. I am, sir, respectfully, yours, Dr. CASSEL, Circuit Physician (Kreisglvysikus)* jSo. 80.] United States Consulate, Manheim, February 11, 1879. Sib: In a dispatch sent to the De^rl;ment June 5, 1878, I called at- tention to the inclination exhibited by the local authorities of Germany to embarrass the exportation of pork 4n any shape from the United ■States. .,,,,. I have now to report that the following police regulation was issued from the grand ducal district, court, Manheim, December 27. 1878 : "American pork sold in the market-place, butcher-shops, or public streets, or to be u$ed for the manufacture of sausages, inust previously be microscopically examined for trichinae ; after this examination each piece must be marked by the inspector." REPORT ON TRICHINA AND TRICHINOSIS. 189 This regulation only exists in regard to American pork— native pork and pork imported from any other country than America is sold with- out examination. ,_ I remain, your obedient servant, EDWAED M. SMITH, United States, Consul. Hon. Frederick W. Seward, Assistant Secretary of State, Washington, D. C. No,. 115.] Consulate-General oe the United States, Home, March 1, 1879. Sir : I beg you will find herewith inclosed an ordinance of the Italian Government, with translation, forbidding, until further orders, the im- portation into Italy of swine, their meat, or any preparation or article made from their bodies, from the ports or landing places of the United States of America. It is believed that this ordinance does injury to our commerce by its general and indiscriminate application to the whole territory of the United States, and it may be hoped that timely notice may serve to restore to uninfected districts the trade so essential to their prosperity. I may add that the ordinance was received at the consulate-general last evening, being transmitted through our legation from the ministry of the interior of the Kingdom of Italy, I am, sir, your obedient servant. CHAS. MCMILLAN", Consul-Qeneral. Hon. Wm, Hunter, 'Second Assistant Secretary of State, Washington, JD. C. [Inolosure.] 1. Marine Health Order, No. 5 (with translation), dated Eome, Feb- ruary 20, 1879. ■ [Translation.] > Marine Health Order, No. 5. The minister of the interior, by virtue of the law of March 20, 186J on public health, supplement 0, and the regulations of December 26, 1871, having verified the arrival within the kingdom of pork affected Vith trichinaj spiralis from Cincinnati and other points m the American Union, which proves the existence there of trichinae in swine, decrees^ That until further orders the importation into the kingdom of swine 190 REPORT ON TRICHIN2E AND TRICHINOSIS. animals, their meat, and remains, whether prepared or preserved, com- ing from ports and landing places of the United States of America, is prohibited. The prefects of the maritime provinces are chslrged with the execu- tion of this order. ( •Given at Eome February 20, 1879. For the minister. G. B. MOBANA* [Scott & Co., commission house, and manufacturers' agents, No. 10 Pasajie de la Paz.] Barcelona, March 24, 1879. Hon. William M. Evarts, Secretary of State, Washington, D. C. : We hand you herewith a clipping from the leading daily paper of this city relating to the existence of trichinae in the hog products of the United States, which, if not true, should be officially denied, as else it will result in a great injury to a new and growing trade in that line 'with Spain and Portugal : En vista de la propagacion de la trichinae en los ganados de cerda de los Estados Unidos de America, el gobierno portugues, de acuerdo con la junta consultiva de sanidad, ha prohibido la introduccion en el feiUo e" islas adyacentes de las carnes y embritidos de aquella procedencia. We have recently established an American agency here for the, pur- pose of developing a new market for our products, and such statements uncontradicted will go far to undo all we have accomplished. Hoping that this matter may not escape your attention, we remain', respectfully, &c. ,,,,.., -* , SCQT0? & TOO. [Translation.] In view of the prevalence of trichinae among hogs in the United States of America, the Portuguese Government, in accordance with the opinion of the board of health, has prohibited the importation into the kingdom and the adjacent islands of meat and other hog products coming from that country. No; 128.] United States Consulate-General^ , « ^rflnkfort-onthe-Mmni March 31, 1879. i Sir: As a matter seriously affecting an important branch ©f Amer- ican trade in this part of Germany, I have to advise the Department th%t -the following official notice appeared, with others, a few days ago in the REPORT ON TRICHINA AND TRICHINOSIS. 191 daily newspapers of this city, * * * which may be translated as fol- lows : 681. (Warning.) In the course of trade a large amount of ham is imported from Amer- ica at this place. As is known, the trichina pest prevails among swine in America, and therefore the purchasers of such hams should, in order to protect themselves against sickness, only use such meat in a thor- oughly cooked condition, or, before use in a raw state, assure themselves beyond doubt by careful investigation and inquiry that the ham is not infected with trichinae. HUGENHAHN, President of Police. Frankfort-on-the-Main, March 15, 1879. .Immediately after this publication appeared I made explicit written inquiry of various experts and veterinarians as to whether trichinae had at any time been discovered in American pork imported at Frankfort. The responses were unanimous' and emphatic in the negative. One of the persons questioned, a well-known veterinarian, who is commissioned by the army contractor here to examine American ham and sides of bacon, declared that he had never, in the course of a long experience of this kind, found trichinae in American pork, and that he had not heard of such discovery in such pork imported here. The consular agent at Mayence, who at my request also made inquiry about this matter, writes as follows: ■ According to the official statement of Dr. Wollpert, the veterinary surgeon of this district, he examined between the 1st and 20th of Jan- 'uary last some 80 pieces of American ham, and discovered no trichinae in any of them, neither has he heard of trichinae being discovered in American pork imported at any subsequent time at this place. He has, however, been informed of trichinae being discovered in American pork- ham— in two cases at Offenbach and in two cases at Worms, all meats j said to have been imported by the firm of Kiebicher & Co., at Mannheim. The examination of American meat imported at this place was discon- tinued, partly on the ground that parties were unwilling to go to the expense and partly for the reason that no appropriation being made by the government for the expense, the authorities were not willing to in- eur the same, and as a precautionary measure they recommended the public to use American pork and ham only in a well-cooked condition. To this statement of the consular agent at Mayence may be supple- mented the opinion that the official notice above quoted is intended merely as a precaution, and not as a measure to injure the trade In American pork. Similar notices have been published in other places, as for instance at Freiburg, as will be seen by the following dispatch:. 192 REPORT ON TRICHINAE A«0 TRICHINOSIS. /[Translation.] ■•'•' •'<:?;:,< • ; •:, "Freebtjkg, March 13* ,; " Cases of trichinosis have occurred here also in consequence of the consumption of American hams. An examination by the police revealed the existence of many trichinae in the American raw hams. The grand ducal authorities caution the public, through the newspapers, against the use of American pork before it has been thoroughly cooked or sub- jected to a microscopic examination by specialists." I have requested the consul at Mannheim to make inquiry as to the correctness of the statement in this dispatch that trichinae have been found in American hams at Freiburg, but as yet I have no report "from him. Well-authenticated cases have come to my knowledge of rumors of the finding of trichina in American pork, resulting, upon examina- tion, in proving that the meat infected was not American at all, but German. It is not improbable, however, that in some exceptional cases trichina have actually been discovered in pork imported from the United States, and of course the greatest possible use has been made of these cases by the German pork interest. There is no ordinary article of food which is so expensive in this country, or in the production and sale of which a larger profit is made, than that of meat. It is a common saying here that butchers all get rich. Meats of all kinds are so expensive that they are used very sparingly by the laboring classes. The large and growing imports of American pork and canned meats are therefore viewed by the dealers in German meats with extreme jealousy, and no pretext is unemployed for prejudicing consumers against the American article. A few days ago the butchers of Mayence requested the burgo- master of that place to caution the public against the use of American refined lard as possibly infected with trichinae. They also asked that octroi duties be levied upon American lard admitted within the walls of the city. The burgomaster was obliged to reply that trichinae never appeared in refined lard, and that octroi duties would be illegal, but the petition illustrated the extreme anxiety and jealousy of the butchers. Even the alleged outbreak of pleuro-pneumonia among American cattle is cited in a precautionary and alarming way. These facts show the extreme importance that every possible precau- tion should be taken by American exporters against the sending of any kind of diseased or infected meats to the German market. The trade in such meats promises to be very large and very lucrative, if the quality of the articles imported and sold here can be protected against any just grounds of complaint. But one well-authenticated case of trichinated pork or diseased beef may do vast damage to the American meat- importing interest. I have also to suggest that it might be well for the American pork trade in Germany if reliable statistics could be collected as to the actual extent to which the trichina pest prevails among American "swlne^ arid REPORT ON TRICHINA AND TRICHINOSIS. 193 the facts published in some legitimate way. The truth might be very useful in combatting the effect of exaggerated and pernicious rumors. I am, sir, your obedient servant, ALPEED E. LEE, • _ ,„ Consul- General. Hon. P. W. Seward, Assistant Secretary of State. No - 4&] Consulate op the United States, Lisbon, April 7, 1879. Sir: I have the honor herewith to inclose an extract from the Diario do Governo of Lisbon, of March 14, with a translation of the same, containing a decree recently issued by the minister of the interior pro- hibiting, until further notice, the importation from the United States of all descriptions of swine's flesh in consequence of the sanitary author- ities having received official information of the prevalence in that coun- try of the disease among hogs known as trichinosis. I am not aware of the extent of this disease in the United States, having seen nothing in the papers concerning it, and I am not aware that any other European nation has put on a similar prohibition to the importation of pork and hams from that country. The trade in this article between our country and Portugal, while not large, has recently commenced to increase, especially in respect to hams, the quality and price making them very popular in this market. This decree is a virtual prohibition of the trade, and is enforced without inspection of the articles offered for import to ascertain whether or not they may be affected. Within a few days two shipments, one of pork and one of hams, have been received here from America, but in both cases the importation was not only prohibited, but the consignees were obliged to reship the same to some other country for sale, of course at loss and inconvenience. I hear also of a similar case in the island of Madeira. I should like to be informed to what extent this disease prevails in the United States, if any other nations have prohibited the importation of pork and hams from the United States, and any other facts which might be useful to me in making such a representation as may bring about a revocation or modification of this order. I am, sir, your obedient servant, HENEY W. DIMAN, Consul. Hon. F. W. Seward, Assistant Secretary of State, Washington. [Inolosure.] < Extract from Diario do Governo with translation. S. Ex. 9 13 ^ 194 REPORT ON TRICHINAE AND TRJCHINO^IS.. [Inclosure.— Extract from Diaij.0 do Go,verno.— Trarala^io^i,]^ ( , h a . j , Sanitary Marine JBulletin^No. 62. ' l - ■•" '- "^ Ministry of the Interior, ;J „j Lisbon, March 14, 1879. Having been officially informed that the trichinose hag manifested itself in the United States of America, and* in concurrence with the re- port of the consulting board of public health, it is hereby decreed that from and after this date, and until further notice, the importation into this kingdom and the adjacent islands of all descriptions of swine's flesh coming from that country is prohibited. Ministry of the interior, March 13, 1879. LOUIS ANTONIO NOGUEIKA. No. 252.] Legation op the United States, Lisbon, April 21, 1879. Sir : On the 14th March ultimo an official publication was made in the Diario do Governo by the minister of the interior, stating that in consequence of the existence of "trichinosis" in the United States of America, and as a measure taken in protection of the public health, all importations of the flesh of swine into Portugal and the adjacent islands had been forbidden by the "consulting board of public health." This note was followed on the 20th of the same month in the Gazeta dos Alfondegas, or custom-house journal, an official ptfper issued under the authority of the secretary of the treasury, by a portaria or royal order issued on the 17th, which prohibited not only the importation for con- sumption into Portuguese territory of such of the products of swine as are used for human food when coming from the United States, but re- fusing also permission for them to be warehoused or temporarily de- posited on shore. I understand that several small parcels have, under this order, been transferred to vessels lying in the Tagus bound for for- eign ports. I am credibly informed also that the public health authorities have refused to allow American pork to be taken on board of vessels for con- sumption while lying in Portuguese waters. However, this exclusion was modified on the 5th instant by the publication of a letter from the director-general of customs, dated the 26th of March, admitting for con- sumption "pork lard" from the United States; and further allowing the entry of such pork as was actually in custom-house stores at the moment of the issue of the first order, and after due inspection. No official communication whatever has been made to me of these new regulations, and I now forward them for the information of the depart- ment. I have not seen fit to write to Mr. Oorvo on the subject, because no REPORT ON TRICHINA AND TRICHINOSIS. 195 and ?I 6 in *f e8ted in the teade has t>™gW; these rules to my notice, tWflT T - b r fai ^ di8ea8 - 6 Prevail8 in the United states, and TZT* ™ h t0 C ° mmit mySelf in the dark " But I tMnk there ougnt to be an inspection before exclusion. I have the honor to be, sir, your obedient servant, CT w BENJAMIN MOKAN. Hon. William M. Evarts, Secretary of State, Washington, D. 0. [Extract fromDiario do Governo, March 14, 1879.— Translation.] Bulletin of Maritime Health, So. 62. It being officially shown that trichinosis has appeared in the United States of America, it has been declared, in accordance with the decision of the " Consulting Board of Public Health," that after this date, and until further notice, the admission into the continent and adjacent islands of the flesh and fatty tissues of swine is forbidden. Secretaria of State of the Interior, this 13th March, 1879. LUIZ A. NOGUEIRA. [Extract from Gazeta dos Alfondegas of March 20, 1879.— Translation.] A prohibition having been issued in the " Bulletin of Marine Health," published in the Diario do Governo of the 14th instant, against the ad- mission into the continent and adjacent islands of the flesh and fatty tissues of swine coming from the United States of America, on account of the trichinosis having appeared there, His Majesty, the King, deter- mines that in the several maritime custom-houses no entry be permitted either for consumption or deposit to the said flesh and fatty tissues so long as said disease continues, and no order be given to the contrary. Palace, 17th of March, 1879. ANTONIO DE SUEPA PIMNTEL. [Extract from Gazeta das Alfondegas of March 20, 1879.— Translation.] Illustrious, &c, Sir : To solve the doubts which the chief of the first section of the second department has raised in his representations attached to your official order of the 22d instant, I have to declare : 1st. That by the official letter of the said date it has been already communicated that "pork lard" coming from the United States of America can be admitted for consumption ; and 2d. That meat and fatty tissues coming from the country aforesaid, being already warehoused in the custom-houses previously to the pub- lication of the portaria forbidding its importation, will only obtain admis- 196 BEPOET ON TRICHINA MD' TRICHINOSIS* sion for consumption when the respective health inspector, whose fluty it is to examine it, declares in writiqg that it is not affected* with'triea* inosis. JOSE DIAS DE OLIVEIRAy< To the Dieectob oe the Ctjstom-Hotjse in Lisbon* No. 86.] United States Consulate, Mannheim, May 3,, 1879. Sie : In a dispatch dated February 11, 1879, 1 called attention to regulations made by the authorities of Mannheim regarding trichinae in American hams and pork. I now report the following correspondence regarding action in the same direction at Freiburg : [Copy of notice appearing in Freiburg papers March 12, 1879, concerning trichinae.] " Many trichinae were found in a raw American ham sold in this city; it cannot be certainly stated yet whether there are in this ham trichina? still alive. We again call the attention of people to the danger result- ing in the use of American pork, ham, long and short sides, tongues, etc., and recommend, in order to be protected against such a danger, a thorough boiling of such pork or a microscopical examination by an expert. " Grand Ducal District Court. «De. GROOS." [Copy of a reply to a letter of inquiry written March 27 to Dr. Groos by the consul a Mannheim concerning trichinae.] " In reply to your letter of March 27 we have the honor to inclose herewith a copy of the advertisement, of this court informing you that several children of a family of this city who had eaten of such ham were affected with symptoms of illness, yet it could not be certainly stated whether they were a consequence of the use of such ham. These cases of illness had a favorable conclusion. "De. GEOOS.» There is an evident disposition on the part of German authorities to discredit American meats, and unless some action is taken by our gov- ernment calling the attention of the Government of Germany to this fact, our importers will be subject to so many petty annoyances and extra charges that they will abandon what should be a most important trade to the United States and a general blessing to Germany. The physical condition of the German nations is weakening for the want of meat at such prices as will enable the common people to make a daily instead of a weekly meal of it. They are a patient people, who eat their bread with little complaint, but it is observed by their own physiologists that as a nation they are growing physically weaker. They REPORT ON TRICHINA AND TRICHINOSIS. 197 mol1j?I- 8t ^f theni ?. g f °° d - ° Ur extensive ***** ««»™* and flS^ K Q fleWs enaWe US to fl « nd8h meat t0 them a * lower prices at ,S? n P u° S8ibly Pr ° duce ifc Nothin ^ but ignorance and preju- dice can delay their obtaining it from the United States. A large importer in Mannheim informs me that' the annoyances and hinderances are such that he shall abandon German sales and sell in England from whence the Germans would buy the same hams and pork at a much larger price than they now pay. He has just filled a large order tor hams to Westphalia, which will be sold in Germany as West- phalia hams, restrictions regarding examinations for trichina* not being so stringent toward any other than American hams. It is evident that trichinae exist more or less in all hams or pork sold consequently the only complaint we can make is that meat from the United States should be so critically examined and condemned,, while that of Germany and other European nations is allowed to pass compar- atively free; no complaint could be made if the pork of Germany was in a like manner treated. The least appearance of trichina in American meat is taken notice of, published in the newspapers by the authorities and those interested in discrediting it, warning the people against it, while the meat of Germany is sold without criticism. In Mayence forty soldiers were taken ill after eating pork for dinner; at once the newspapers announced trichinae as the cause. After the post mortem of some who died, it was stated that no trichinae could be found in them. Similar notices in other places could be stated. Other countries, more or less influenced by the opinions of Germany, make absurd regulations in this direction. In Venice the city authorities passed an ordinance that all American meat could be admitted for sale after it had been cooked four hours. It is thought by some of the best authorities here that the sharp salting, smoking, and drying of Amer- ican pork, combined with the long voyage, usually three months between the killing and selling, make the danger of trichinae much less than that in freshly -killed German pork. In this district cases of trichinae occur, causing sickness and death; yet, after close inquiry and investigation, in no case can I find that death or even sickness can be traced to American meat. On the contrary, it is stated by observers that all cases that have occurred can be traced to other than that. Within a few weeks a family of four persons died at Schriesheim from trichinae in German pork. It is the opinion of Professor Gerlach, medical counsel of Berlin, that through thorough salting, smoking, and drying, pork is rendered com- paratively harmless from trichinae, and if cooked entirely so, while the habit indulged in by some Germans of eating freshly-killed pork, es- pecially if raw, is productive of disease to an alarming extent. No American exporter should venture to send pork abroad that is not thoroughly cured. The recently imposed tax, raising the duty on American pork from three to twelve marks, and on American lard to ten marks on the one 198 REPORT ON TRICHINA AND TRICHINOSIS. hundred kilos* amounting to nearly 25 per cent, of the value of "the pork, guards the interests of the few at the expense of the many. A large proportion of imported pork is consumed by the poorer classes, who will yet continue to eat American pork if they are nbt deprived of it by false statements. Even with the increased tariff it can be sold, at a profit, cheaper than Germany can raise it. Lard will not be so much affected, as it is used by all classes and it is not subject to the same inspection, and at the low prices sustained in America can compete with German lard, notwithstanding the additional tariff. The difficulties of the importer are not so much with the increase of tariff as with the unjust examination and discrimination between American and other meats. That this should be changed is very important, not only for our own people, but for the poorer classes of Germans, who are already deprived of enough of what Americans consider the absolute necessities of life, without in addition depriving them of cheap food, especially cheap meat, strong good food, 40 per cent, cheaper than they can raise it. German pork sells here for 80 pfgs. to 130 marks. American pork sells here for 30 pfgs. to .65 marks. It is well known to all who have investigated this subject that a small worm, born in flesh, maturing in muscles of other flesh after it has been eaten, and from there deriving life, afterwards incloses itself in a chalky sac, which sac when taken into the human stomach is dis- solved, freeing the animal to make its way out through the intestines or coatings of the stomach, causing pain, sickness, and death, but it is not known to how great- an extent the danger from eating pork exists. Great exaggerations have been accepted as authorized statements, atad people have been prevented from eating a food that under certain con- ditions is harmless from disease. Eminent acknowledged authorities state " that 2 \ per cent, of Ameri- can imported pork contains trichinae, yet it is probable that trichina? in such pork in general are dead. It is possible that they are always dead and not dangerous ; at least the percentage of dangerous pork is in- ferior to the microscopic-examined pork infected with trichina}." Much has been done in scientific investigations of this subject and much is being done. In the ordinary investigation of science it is not important that facts should be immediately produced, but in this case, one of so great interest to all exporters of pork in the United States, it is important that the opinions of acknowledged authorities should be at once obtained. I would suggest that the subject should be made a matter of scientific investigation in Germany and the United States, and that an appropriation of at least $1,000 shall be made by the United States Government to pay the expenses of such an investigation, to be made under the control of the United States Minister at Berlin, with the cooperation of the German State authorities, and that acknowl- edged investigators and authorities on this subject shall be asked to REPORT ON TRICHINA AND TRICHINOSIS. 199 give their opinion whether there is generally danger from eating Ameri- can pork, and to what exteiit, and whether the danger from trichinae is greater in American pork than that of any other nation ; and also the best and quickest mode of inspection for large importations. I would suggest the names of Professor Pagenstecher, of Heidelberg, and Pro- fessor Yirchow, of Berlin. The earlier investigations of the gentlemen named have been accepted as authority. Their later discoveries are not well known outside of scientific circles. Their opinion would be accepted throughout the world, and the German Government would not maintain the present strict regulations towards American meat alone, even if they did not modify them or discontinue them altogether. The rapid introduction of American products in the markets of my district have not only aroused the jealousy of the authorities but alarmed the producers and manufacturers, so as to create a reaction, Which for the time injures the sales of all kinds of American products. Many who first received them with favor, and know well their superior- ity and low cost, persist in discrediting them and buy poorer articles at a greater cost. Nothing but the fostering care of our government and the persistent sending of our best products at reasonable prices will overcome these prejudices and false statements. If they are once over- come among the people the trade is secure; but if our government neglects to aid in every way the exporter, not only at home but abroad, then the position already gained will be lost. I remain your obedient servant, EDWAED M. SMITH, United States Consul. ' Hon. Frederick W. Seward, Assistant Secretary of State, Washington, D. G. ■^ 104 i United States Consulate, Hamburg, June 3, 1879. Sir • I have the honor to transmit herewith copies of two letters, with translation, received at this consulate, regarding certain hams said .to have been received from Messrs. Armour & Co, of Chicago and winch have been confiscated by the Hamburg authorities as containing tri- china, with my answer thereto. Mr. F. H. Kirsten now desires to return thesXms to Messrs. Armour & Co. in Chicago. The Hamburg au- nties, however, will not permit this unless he first procures £ oert fi- eate from the American consul giving his permission, and to the effect th7t the Government of the United States makes no objection to the retoulng of diseased meats. Mr. Kirsten was verbally informed Jtta* the consul « personally * had no objection to his making such disposition ofthThTms a" was to Ms best interest, officially, however ■£> tfheojj* sul could not give his permission to their return, or a certificate that the 200 . REPORT ON TRICHINA AND TRICHINOSIS. Government of the United States had no objection thereto, for the rea- sons given in my letter in answer to that of Senator Kimhardt. In view of the fact that frequent confiscations of American hams are now being made in Germany upon the ground of their containing tri- chinae, and as in most cases of this class the parties receiving the hams desire to return the same to the United States, I would respectfully ask that instructions be given as to what action it is desired the consul should take in the premises. A rigid and thorough microscopic inspection is now made in all parts of Germany by government inspectors of hams, pork, etc., exposed or intended for sale, and if in the least infected the same is confiscated. In this connection I would again call the attention of our merchants and business men engaged in exporting produce,, meats, etc., to Europe to the importance and necessity of sending none but the best, and in meats especially to be certain that the same is not in any manner in- fected. A more thorough inspection of meats of all kinds either by the government or by those engaged in that business would tend in a great measure to enhance the value of our products, increase our trade, and do away with the general distrust now prevailing in Europe against American meats, hams, etc. I am, sir, your obedient servant, JOHN M. WILSOF, Consul, Hon. P. W. Seward, Assistant Secretary of State, Washington, D. G. [Inclosures.J i. Copy of letter of H. F. Kirsten to John M. Wilson. 2. Copy of letter of Senator Kunhardt to John M. Wilson, with trans- lation. 3. Copy of letter of John M. Wilson to Senator Kunhardt. [Translation.] Hamburg, May 21, 1879. To the Consulate op the United States: The authorities of this place confiscated up to this time all hams which had been declared to contain trichinae; whereas now Messrs. Armour & Co., of Chicago, desire that I should return to America the hams con- , taining trichinae; and whereas the authorities of this place have directed me to obtain the consent of the American consul thereto, I herewith re- spectfully request the permission that I may send hams which have been imported here by Messrs. Armour & Co., and found here to contain trichinae, back to the same firm. Eespectfully, H. F. KIRSTEN. KEPORT ON TRICHINA AND TRICHINOSIS. • 201 [Translation.] The Police Authorities of the Free and Hanseatic City op Hamburg. Ho. 2125.] Hamburg, May 31, 1879. To the Consulate of the United States of America: The merchant H. F. Kirsten, of this city, has requested the permis- sion to return to the* shipper certain meats which have been imported into this place and found to contain trichinae. Kirsten asserts that upon his inquiry at the consulate he received the verbal information that there was no objection to the returning of the same. As probably other importers of such meats will ask for the same per- mission, the undersigned authorities deem it proper respectfully to ask whether the statement of said Kirsten, that the Government of the United States of America does not object to the returning of meats con- taining trichinae, is correct. The senator, chief of police, T. KUNHARDT. [Inclosure.] United States Consulate, Hamburg, June 3, 1879. Sir: I have the honor to acknowledge the receipt of your communi- tion No. 2125, under date of May 31, 1879. In answer thereto I have to say: On the 21st instant I received a letter from H. F. Kirsten, of this city, in which he informs me that certain hams imported by the firm of Armour & Co., of Chicago, had upon examination here been found to contain trichinae, and that the same had been confiscated by the Ham- burg authorities. Second, that he desired to return these hams to the United btates, and that in order to do so he must furnish the authorities of this city the official permission and consent, and a certificate to the effect of the American consul. In answer thereto Mr. Kirsten was verbally in- formed that "personally" the consul had no objection to his making such disposition of the hams in question as was to his best interest but that no official certificate or permission could be given to the effect "that the Government of the United States of America does not object to the introduction of meats containing trichina;,'' as the consul neither desSes to place the government he represents or himself in the positum of adding the introduction into the United States of artacles declared by the Hamburg authorities to be deleterious, and confiscated as being furious to puke health and safety, without first having obtamed 202 ' REPORT ON TRICHIN2E AND TRICHINOSIS. special instructions from his government authorizing him so to do, upon receipt of which you will be duly notified. Availing myself of this opportunity of renewing to you the assurance of my distinguished consideration, I am, sir, your obedient servant, JOHN M. WILSON, Consul.' Senator Dr. Kunhardt, ' Chief of Police, Hamburg. j, No. 213.] United States Consulate, .,,.,, Christiania, May 24, 1879,,, Sir: With reference to my dispatch No. 212 of May 3, 1 have now the honor to communicate that v the board of health of this city has issued a decree to the following effect : "From the 1st of June next, and until further notice, sides, ham.s, and spare-ribs of pork imported over sea into this country may not be sold until after examination by officers authorized by the board of health, and having received the ..mark. 'free from trichinae.' " The above measure, called forth by the repeated discovery of trichinae in American hams, establishes a compulsory examination of all kinds of pork imported from the United States. Importers of this article, some of whom handle up to four thousand boxes of salt pork every year, complain much of the severity of the enactment, which must raise the price of American pork through the expenses of examination, which likewise subjects them to great inconvenience. However, American pork has gradually become an article of primary importance, and will continue to be imported here in considerable quan- tities. From other cities in Norway we also receive the report that trichinae have been found in American hams. I am, sir, your obedient servant, GERH. GADE, Consul. Hon. F. W. Seward, Assistant Secretary of State, Washington, D. G. [Extract.] No. 44. J Consulate oe the United States of America, Bristol, May 29, 1879. Sir : * * * I beg to direct the attention of the Department to the reply given to the inquiry of the Earl of Belmore, in yesterday's sitting of Parliament, by the Duke of Eichmond. The stock-raisers of England as well as of the Continent have circu- lated reports to the effect that a very large portion of the American REPORT ON TRICHINA AND TRICHINOSIS. 203 buXrArn b ! COn ^ ! nfected 7 ith trichinosis, thus to keep people from thT coutrT 11 P ° rk m pref T QCe t0 the native - Th <> Pork-raisers of number t? ^^T IT mU ° h alaPmed in conse