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degree. Who has suggested the best is too good? Who intimated we could be too potently armed, too competently prepared to fight disease?

If we are sane we would surely demand certainty and stability and desire celerity, then the preference must be for the preparation possessing stability, certainty and celerity at prices not prohibitive. Variability and uncertainty may mean death, and to our utter surprise as well as chargin, when stability and definite dosage would have meant life, and who can appraise its value or when once gone, give it back? Only yesterday a brother practitioner was lamenting the loss of a patient, the burden of his cry was, "I do not believe the remedy was good or up to standard." The case was one of those in which effects must be had with "certainty and celerity," or death results; no time to spend here or there, or try something else. If remedial effects are not quickly had life is gone -no time to try something else. We feel assured that the brother referred to will see to it, as best he can, that next time he is sup. plied with the preparation of his confidence and preference. Varying and contradictory experiences can scarcely be accounted for outside of instabilty and varying strength of drug used, it matters not what the preparation.

Our plea is for the alkaloid and active. principle, and our contention is that they are stable; do not, cannot vary in strength, though they may vary in quantity in different specimens. Consequently, the only source of uncertainty and ineffectiveness must come from adulteration knowingly or through ignorance-through ignorance in not understanding how to separate and isolate from associate constituents or added material necessary in obtaining the desirable and useful part. But when correctly isolated we have the greatest power of certain effect, the smallest bulk, the smallest dose with which effects may be had in shortest time at least expense and most pleasantly.

Then how eminently superior, these preferences seems a natural selection, consectary. And this verdict is rapidly rendering, survival of the fittest. It is enough to fight cause and contagion, dirt and disease, germs and generalities in infancy and infection without at last being compelled to conclude from exasperating, overwhelming evidence that our fight was a failure on account of inferior, uncertain remedies.

The ratio of capability and desirability of active principles to that of galenics is too evident to need a mathematical calculation to determine or understand. It is unnecessary to say anything in defence of active

principles-they need no defense. The indications are that they need only to be understood to be appreciated and preferred. None who have understood them and become familiar with their use has been guilty of such "adultery"-yes that's the word-as to transfer their affections, or rather confidence and preference to unreliable fluid remedies-none to my knowledge. The definite active principle gives us a therapy not emasculated of such important features as stability and certainty which is absolutely essential to confident and competent therapeutic resources.

FRESH-AIR HOMES AND MEDICAL WORK IN CONNECTION WITH THEM.-Linsly R. Williams describes the advantages of a vacation at Sea Breeze. The welfare of the children is carefully looked after in every detail. The writer urges all physicians who are engaged in hospital and clinical work during the summer to have each hospital and clinic supplied in the spring with a list of all the fresh-air charities, and to see that list is used. If all suitable cases were referred to the fresh-air charities the demand would more than exceed the supply. But such a demand in New York is never unheeded. In time it would result in the formation of a joint application bureau which would relieve the hospitals and dispensaries of detailed search for fresh air for individual cases, and in the building of more numerous fresh-air homes for the deserving and poor.-Medical Record, June 9,

1906.

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THE STOMACH DOUCHE AND ITS APPLICATION.-M. Gross gives as strict indications for the introduction of the stomach tube for therapeutic purposes: Acute toxic inflammations, intoxications, and ileus; old mucous or nonmucous gastric inflammations; small number of sensitive neuroses, hyperesthesias, chronic ulcerative affections, ercsions; anomalies of secretion, or chyorrhea; and disturbances of motility in both atonic and mechanical gastrectasia. The tube which the writer has used during the last few years differs from the ordinary tube in that it is provided with an end opening and a number of small, pinhead-sized lateral holes which perforate the walls of the tube in different directions. The action of this stomach douche is mechanico-chemical, thermic, or both. A loose hard rubber valve is placed at the large end aperture, which it tightly closes as the fluid is injected. the upper end of the tube is lowered, the outflowing stream pushes the valve up.Medical Record.

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A REPORT OF TWO CASES OF TRICHIN-
IASIS AND REFERENCE TO FOUR
OTHER CASES INFECTED FROM THE
SAME SOURCE.

EDMUND F. TAAKE, M. D.

symmetrical and well formed. The patient is well nourished and muscular. The weight is about 155 pounds; the height about 5 feet 4 inches. The chest expansion is good. The breasts are rather large. The abdomen protrudes somewhat. The surface of the trunk and extremities looks edematous and there is decided pitting on pressure of legs CASE I.-Katy K.; admitted admitted to the and feet. A number of white striae are seen City Hospital, February 10, 1906, 5:25 p.m. on the anterior and upper part of the thighs Age 23 years; married; a native of Austria-probably fat striae. The skin is moist and (in America one year); resides at 1709 S. 10th street, St. Louis, Mo.

ST. LOUIS.

No intemperate habits. Married about two and one-half months; husband is 27 years old and is healthy.

All of the patient's relatives have been healthy, well-developed individuals. The patient states positively that she has never been sick before.

On December 30, 1905, this patient's family and a neighboring family bought a hog which they divided. On January 1, 1906, the patient began eating of this meat, some of it raw. January 20, 1906, the husband and sister-in-law (the other two members of the patient's family) became sick. Two days later, January 22, this patient took sick. About the same time the other family referred to above, sickened. The initial symptoms were severe diarrhea, nausea, profuse perspiration, edema of the eye-lids, great prostration, some fever. In a few days the diarrhea abated, and the edema extended to the legs and feet. At this time there was a rather sudden onset of pain, which pain has been almost uniform in severity since then. The pain is increased by movement and by palpation of the parts.

The patient describes the pain as a sharp, sticking, pulling pain. Since the pain has begun, walking is impossible, and there is stiffness in all the joints of the body.

Perspiration has been almost constant and very profuse since it began.

A cough which the patient had some time before taking sick, has continued-the patient thinks it has improved of late.

Physical Examination.-Physical development is excellent; all parts of the body are

pale in color. The mucous membrane of the lips is dry, fissured and scaling. The tongue is clear. The patient lies flat upon her back, she is unable to change her position. The extremities are flexed at the elbows and knees and extension to the normal limit is impossible. All parts of the trunk and extremities are painful to palpation. The pulse is weak and rapid. On auscultation, moist rales are distinctly heard over the lower part of both lungs posteriorly. The knee-jerk is absent. Stimulation of the soles of the feet causes but slight movement of the toes.

Present Condition of Patient.-Temperature 103 deg., pulse 30, respiration 32; severe pain, great muscular weakness, extreme prostration; dyspneic; annoying dry cough; constipated.

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Laboratory Findings.-Urine, negative. Muscle. A small bit of the gastrocnemius muscle removed from patient contained a great number of non-motile trichinae. piece of muscle was taken from the bam of the hog which was supposed to be the source of infection. It contained a large number of encapsulated trichinae. Stool. Not examined. Blood.-See special report.

Course of Disease During the First Ten Days in Hospital.-The temperature was ir regular. It fluctuated between 98 and 102 deg. The greater part of the time it was 99 deg. The respiration varied from 24 to 48 per minute. The average was about 32. The respiratory movements were shallow and regular. The pulse varied as the temperature, ranging from 104 to 136 per minute. The average was about 125. At times the pulse was very weak-hardly, perceptible. Perspiration was continuous and profuse, except

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when checked by medication.
The cough
increased in severity up to the seventh or
eighth day when it became less annoying to
the patient. The pain was constant during
the first eight days, excepting when it was
checked by analgesics. After the eighth day
the pain gradually subsided. As previously
stated, there was persistent constipation when
the patient entered the hospital. Within
twenty-four hours this was relieved and the
bowels remained loose-cathartics being given
for that purpose.

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On the second day after entrance to the hospital, there was incontinence of urine and delirium. The edema of the legs and feet persisted during this period, that of the eyelids had almost disappeared when patient entered the hospital.

CASE II.-Lena K.; admitted to the hospital at same time as Case I. With very few exceptions, the history, physical examination, laboratory findings, course of disease, etc., of this case, corresponded in every detail to that of Case I. Therefore only the differences will be noted. The first symptoms appeared January 22 (two days earlier than in Case I). There were no gastro-intestinal disturbances; the cough was not so severe; the perspiration was less profuse; probably there waslesspain; the muscular weakness and prostration were less pronounced. The variation above normal of the temperature, pulse and respiration was somewhat less than in Case 1. At no time was there incontinence of urine nor delirium. Improvement began about February 14th, about five days earlier than in Case I.

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About one-half of the cells enumerated as eosinophiles, in counts "2-13," "2-24" and "3-6," are not typical eosinophiles. They are polymorphonuclear leucocytes containing numerous small granules, which granules are irregular in shape and take a distinct eosin stain.

In making these counts it is a difficult matter to decide which cells shall be classified as eosinophiles, and which as polymorphonuclear neutrophiles, as there are so many grades of cells between the typical forms of each.

In counts 3-11," "3-16," "3-21" and "3-25" most of the eosinophiles are typical. The granules are large and spherical and the cells appear to be larger than in the former counts.

A marked change is noted in the eosinophiles, in counts "3-31." The granules do not stain so brightly and most of the cells are vocuolated-apparently they are degenerating.

But few of the eosinophiles are vocuolated and the granules stain well with eosin, in counts "4-6" and "4-13."

In counts "4-20" and "5-2" (Katy K.) and in counts "4-22" and "5-4" (Lena K.) the eosinophiles are typical excepting that some of them are vocuolated.

All of the blood smears were stained with a reliable preparation of Wright's stain.

FOUR MORE CASES INFECTED FROM THIS SAME
HOG.

0.% I did not attend these cases and could not
3% obtain a complete history. These cases are:
Anton K., age 27 years (husband of case
I), Nick L., age 31 years and Barbara
L., age 25 years (husband and wife, and
their daughter, age 4 years.

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Monon. 1.

Eosinop.

2-13-'06...86%

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2-24-'06...714%

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3- 6-'06...56% %

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A differential leucocyte count was made on the blood of Anton K. 2-13-'06, by a competent pathologist, who reported eosinophilia negative.

As far as the examination was made, the blood of Anton K. and Mr. and Mrs. L., corresponded very closely to that of Katy and Lena K.

CONVALESCENCE OF THE SIX CASES.

The pain, cough and edema gradually sub. sided. The pale color was replaced by one of health. In fact the convalescence was like that of any severe wasting disease.

The convalescent period in case I was about eight weeks; in case II about six weeks. Anton K. required about four weeks to convalesce and the L. family about three ⚫ weeks.

At this time, May 1st, Baby L. is in excellent health. The other five cases are doing hard manual labor. They complain of being very tired and of having pain in the muscles after a hard day's work.

In concluding, the writer wishes to call attention to the following points in the cases on which a differential blood count was made. Eosinophilia did not develop until the patients were convalescing; and that the percentage of eosinophilia varied inversely to the severity of infection.

DISCUSSION.

Dr. D. Arthur Hughes* stated that this was his first experience in coming in contact with patients actually suffering with this disease. Referring to the symptoms discussed by Dr. Taake, he believed it was true that there were no particular symptoms that would distinctly diagnose the disease; but that one or another of the symptoms mentioned usually were found. The point that impressed him, and which he believed was most important, was the fact that these patients not only ate partly cooked pork, but also uncooked pork from this pig. This was a point that should always be borne in mind.

So many persons were apt to eat pork uncooked, and after eating uncooked meat in which this disease was present, there would be found in the patients the intestinal symp. toms that Dr. Taake had given. Dr. Hughes was interested in trying to prevent such diseases in man as much as possible. He had been in the service of the Bureau of Animal Industry, U. S. Department of Agriculture, since 1903, a service which has to do with the infection of all animals, before and after death, which are to pass in the channels of interstate or foreign trade. However, the inspection of pigs for the disease in question, trichinasis, was made in the case of swine destined for certain countries with which we have a large export trade. These countries were Austria, France, Germany, Denmark and Spain. During the official year which closed the middle of last June, there was inspected for these countries.

From page 16 of the report of the Chief of the Bureau of Animal Industry the speaker read the following:

Total inspections of pigs for trichinosis. 315,015. They were classified as follows: Class A, free from the appearance of trichina 307,621, this being 97.64 of the whole.

Class B, containing trichina-like bodies. by which he said he supposed they meant disintegrating trichina, 4,773, or 1.52%.

Class C, containing live trichina 2,015, being 0.81%.

This microscopic work was done by experienced inspectors and as thoroughly as should be expected. The pork was really examined three times, and sometimes oftener. Under the second class, the trichina-like bodies, the inspectors looked for those trichina which were encapsulated, having gone on to calcification. The 2,015 in class C were condemned.

However no danger was to be feared from the consumption of infected pork, providing

D. Arthur Hughes, Ph. D., M. D., Cornell University, now inspector of Food Supplies, Cemmissary Department, U. S. Army, 82 Live Stock Exchange, Chicago.

it was cooked; this was the first way of getting rid of the disease in the meat. Second, if the pork was heavily salted, that would destroy the live trichina and pass the meat over to class A. Moreover if the pigs were pickled for an extensive period, there was no danger whatever; nor if they were cooked and put up in canned form. As a general thing, these animals were not allowed, to be returned to the owners, but were tanked, by which he meant to say that they were put into great heaters and made into fertilizer for the soil.

The millions of swine slaughtered for the interstate trade and not for the export trade these were not examined for trichinosis. The doctor thought they should be, but believed the reason this was not done was that so little of the disease seemed to be found in the country at large, that the government had not deemed it advisable to examine the pork for this disease, where the meat was to pass into the interstate trade. No alarm need be felt, the doctor said, on this account. While some countries required the examination, there were other great countries which do not require the examination, as they had come to the conclusion that there was little danger from American meat. Those countries which did not require the examination included all those not mentioned as requiring it; for instance, Great Britain. These countries took thirty-five million tons of American meat, meat products, and dairy products last year, a large portion of which was pork.

To lead into an explanation of the fact that there was so little of this disease in American swine, attention was called to the fact that in Germany there was a great deal of it in the swine, the statement having been made that one in every five hundred pigs have the disease in Prussia, in Saxony more, and in West Germany less, the reason being that in Germany the swine did not run at large, as

on

our great American plains; they were penned up, and likely to devour many rats and mice, and these were the great means of communicating trichinae to the swine. This is true, though the fact is known to the Germans that 10 to 20 per cent of the rats and mice have the disease. It was probable also that the disease was more common and prevalent in Germany for the reasons that the Germans not only eat the animals that we eat in America, but also eat dogs, horses, donkeys, etc. Persons in Germany therefore got the disease not only from trichinous swine, but also from dogs. Dogs are notoriously infected with trichina. Swine in this country. were comparatively free from the disease, because they were not penned so much: they followed the cattle, ate grain, and were in the

open; they did not eat rats and mice, which communicate the disease to them.

There were sporadic cases in this country, but when they occurred they were traceable, as in this case, to the eating of pork that was uncooked.

How common the disease was in St. Louis, the speaker was unable to say, and was also unprepared to go into a discussion from the standpoint of the human medical literature, but he believed that but few cases were spoken of in American medical literature that were due to causes other than eating uncooked food containing the larval form of trichina spiralis.

Dr. Soper inquired what the inspectors looked for in swine.

To this Dr. Hughes replied that the attention of the inspectors was chiefly directed towards the detection of tuberculosis and other communicable diseases, where the communicability came from bacteria rather than from parasitic origin. The parasitic diseases that were communicable to man were found to be so rare that the inspection was not so strict on that point as it was with reference to bacterial diseases. Tuberculosis was found to be very common in pork, and a great deal was condemned for that, great quantities of swine being full of tuberculosis lesions.

When the animals were large and fat, it would hardly be thought that they were tuberculous, but this was frequently found to be true. These were condemned, and deposited in the tank. The speaker stated that the inspectors were not satisfied, with putting the animals into the tank with the expectation that they would be treated so as to produce fertilizer, but that the government seal was also placed upon the tank, and the steam is turned on. All of this was done under rigid supervision. Packing house owners had found to their sorrow, when trying to get anything out of a tank sealed by a government official, that Uncle Sam was a very hard customer to deal with.

Besides tuberculosis, hogs were inspected for swine plague, hog cholera and the like. It was not thought that these diseases, as such, were communicable to man, but if meat was eaten from a hog having hog cholera, it would produce chronic diarrhea. Pigs were also examined for injuries of all kinds and local diseases, for pregnancy, etc., and all of those things which make the flesh uneatable, unpalatable, or disagreeable because of sentiment or effect.

Dr. Deutsch inquired whether the disease in the animal resembled the disease as we see it in man.

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