III THEORY AND PRACTICE OF MEDICINE.

1. Trichinosis.

The Medical Times and Gazette gives an account from the Deutsche Klinik of an outbreak of this disease at Hedersleben, a town of some 2,000 inhabitants, in Prussian Saxony. Within three weeks after eating of the diseased pork, which came from a single establishment, there were three hundred cases, with forty deaths. (According to another account there were one hundred deaths.) This, however, does not represent the whole number of cases, as many persons, alarmed at what was styled a cholera panic, left the town; of these several died. At the autopsies numerous "parent trichina" were found in the intestinal mucous membrane, the bulk of the animal being in the intramuscular structure. Upwards of one hundred children were attacked, but all recovered. This result was attributed to the more active condition of the alimentary canal in childhood, an observation that was corroborated by the unfavorable results in some of the early cases that were treated with opium. The immediate cause of death seemed to be paralysis of the inspiratory muscles-the most alarming symptoms, besides the loss of motion, being profuse sweating, persistent wakefulness, small and quick pulse, and severe, abdominal pains. The convalescence resembled that of typhus fever. Benzine, as a remedial agent, was largely used, but with no good results, it being ascertained by experiment that the trichina would exist for half an hour when placed in pure benzine.

The same journal also reports that outbreaks of this terrible disease keep occurring from time to time in Germany. One has recently occurred in. Zittau, in Saxony, but unaccompanied by fatal cases, although as many as fifty-seven persons were affected after partaking of ill prepared sausage meat. Dr. Küchenmeister, having no faith in benzine, recommends, in recent cases, equal parts of turpentine and sulphuric ether, with what effect remains to be seen. In two of these cases the trichina were detected by harpooning, and, as in other epidemics, children suffered least, while in several women menstruation was precipitated. In Görlitz, in Silesia, there has also been an outbreak, eighty persons being affected, but only one dying. All over Germany, either through the agency of the butchers themselves, whose trade is threatened with extinction, or more often by decrees of the various Governments, means are everywhere being organized for an effectual microscopical examination of the pork before delivery for sale.

The British Medical Journal, April 7, 1866, says that Professors Delpech and Reynal, who were charged with a mission to study the trichinosis in Germany, have presented a report of their investigations at Huy (Belgium), Hanover, Magdeburg, Berlin, Halle, Dresden, Leipsic and Mayence. They solicited and obtained the co-operation of most of the eminent German physicians who had made the disease in question their especial study. The chief practical facts ascertained are as follows: The epidemic trichinosis lately prevalent in Germany has now almost entirely disappeared. The mortality was everywhere slight, except at Hedersleben. At Zwickau, Seltendorf and Sommerfeld there were eighty-eight patients, not one of whom died. In every case the disease was caused by eating imperfectly cooked

3

pork containing trichinæ. In Hanover, in twenty-one months, out of twentyfive thousand pigs, eleven were found full of trichinæ, sixteen out of fourteen thousand in Brunswick, and four out of seven hundred in Blakenburg. In France no case of the disease has yet been noticed. In Germany the hospitals receive many patients suffering from this affection; during the last year there were thirteen at Madgeburg, of whom only one died. Post mortem examinations have also shown, among persons who died from other diseases, numerous cases of old trichinosis cured by the encystment of the parasites. The proportion of these at Leipsic has been about six per hundred. In places, where the complaint prevails, the rats which infest slaughter houses are found to have it, as proved by Leisering at Dresden, Adam at Augsburg, and Roll at Vienna. Since their return, MM. Delpech and Reynal have examined many of these animals, as well as pigs, without finding a trace of trichinæ. Consequently, there is no reason in France for any person to refrain from eating hog's flesh, especially when thoroughly cooked. In Germany many of the peasantry eat it almost raw, or only smoked. The most timid may safely eat the heart, liver, kidney, brain and fat of pigs, as those parts never contain trichinæ. MM. Delpech and Reynal assert, as an undoubted fact, that a temperature of 167°, Fah., is sufficient to kill trichinæ. Meat thoroughly salted is also perfectly safe. Smoke-dried sausages, which have been kept a long time, are considered free from danger, but the wisest plan is to give them a good boiling. The authors of the report attribute the spread of the disease among pigs to the fact that they are foul feeders and will eat any offal, such as the dead bodies of rats and other animals, which are now known to be liable to trichinosis. Great care ought therefore to be taken to keep such things out of their reach. MM. Delpech and Reynal likewise advise all experimenters never to throw away trichinized flesh, but to burn it as soon as their examination is completed; for a fragment of it carelessly exposed might be eaten by a rat, the rat devoured by a pig, and this last become the cause of fatal accidents. They recommend farmers to be very cautious in feeding their pigs, to avoid giving them offal flesh without first boiling it, to destroy rats and other small carnivorous animals, and never to leave human or other excrements in places where pigs can go.

Virchow says that a kind of natural cure of trichinosis is the encysting of the trichinæ. When shut up in a cyst, the wanderings and further develop- ; ment of the animals are arrested. They become imprisoned, and show no signs of existence in their then feeble state of vitality. Art can do nothing here in the cure. The attempt to assist the encysting process by giving phosphates and acetic acids is founded on a false idea; for it is not the calcification of the cyst, but the formation of it, which is essential. If the patient live long enough to allow of the formation of the cyst, in all probability the trichina will not afterwards destroy his life. It is possible, he adds, that some remedy may be found which will kill the trichina without destroying the patient; but assuredly none such has as yet been discovered. The most dangerous guests are the muscular trichinæ, and to find a remedy to kill them would indeed be of the highest benefit. In the meantime, we must remember that the intestinal trichinæ produce the brood of young animals which wander through the body into the muscles. The longer, therefore, these breeding animals are allowed to remain in the intestines, the greater will be the pro

geny set free in the body, and therefore the more destructive the disease. Hence it is of the highest importance to attempt to remove at once the breeding animals from the intestines by emetics and purgatives.

A committee of the Chicago Academy of Sciences have prepared an elaborate report on this subject, in which, after a very accurate and minute account of the natural history of the trichina spiralis, they give an analysis of the specimens submitted to examination. Portions of muscle from one thousand three hundred and ninety-four hogs, from the various packing houses and butcher stalls of Chicago, were examined, and of these twenty-eight, or about one in fifty, were found to contain trichinæ in greater or less numbers. "We must confess," they say, "our surprise at arriving at this result, which indicates, with little doubt, the startling fact that trichiniasis in pork is much more common in this country than in Germany, where it has caused so much suffering and death."

The specimens examined show great variation in the number of worms infesting them. Only three were found to contain over ten thousand to the cubic inch, and "therefore as densely infested as the pork which occasioned the recent disasters in Germany." The observations of the committee as to the muscles of the hog most liable to be infested do not accord with those of the European experimentalists, inasmuch as more than half of the trichinous specimens were taken from the spinal muscles. The means of defense against its ravages, and the advice given in reference to the rearing of hogs so as to avoid this troublesome pest, are essentially the same as those suggested by Professors Delpech and Reynal (vide ante), the degree of heat necessary to destroy the parasite being stated at 160°, F. The report concludes with a review of the economical aspects of the subject, and the opinion is given that as pork is the "kind of meat-diet upon which nine-tenths of our agricultural population, north and south, mainly depend, it would be folly to discard this kind of meat from our list of articles of food, when all possibility of injury attending its use may be avoided by the most simple means.'

Dr. E. M. Smith, of Marion, Iowa, communicates to the Chicago Evening Journal an account of a family of ten persons under his care, nine of whom were attacked with trichinosis. Of this number, three died, and two others were not expected to recover. A microscopical examination revealed the presence of vast numbers of the trichina spiralis in the muscles of those who died. No mention is made of the treament.

2. Functional Nervous Aphonia, Treated by the Direct Application of a Gaivanic Current to the Vocal Cords.

Dr. Mackenzie, of London, in an article published in the Dublin Medical Press and Circular, January 10, 1866, after replying somewhat pointedly to the exceptions which have been taken by Dr. Watson, of Glasgow, to the use of the laryngoscope and laryngeal galvanism, narrates, briefly, six cases where galvanism was used in this complaint with the most satisfactory results. Two of the cases required but a single application. He remarks: "In all of these cases suitable local and general treatment had been previously ineffec tually tried, and in four out of the six external electricity had been employed

in vain. The success which I have met with by treating cases of functional aphonia in the way described has been almost equaled by others who have used this method. Dr. Fauvel, of Paris, has successfully treated a large number of cases in this way, and Dr. Smyly, of Dublin, has not been less fortunate. Dr. George Johnson has also recorded the case of a youth whose voice he restored by the internal application of galvanism. It is of the utmost importance that the pole of the galvanizer should be applied directly to the vocal cords. If it is merely introduced into the upper part of the larynx it generally fails to restore the voice. The application is not at all painful, though rather disagreeable."

A case of hysterical aphonia at Guy's Hospital, under the service of Dr. Pavy, is described in the Medical Times and Gazette of February 17, 1866, where a patient, who, after a severe fright, had not spoken a word for seven months, recovered her voice under the intimidating effects of galvanism. An instrument in use by a paralytic patient was set to work, and the girl was made to grasp the handles. "The battery was not strong enough to yield any powerful shock, and she did not utter any sound, although she cried and moved her mouth as though attempting to speak. She was told that a more powerful battery would be used another time, if she did not find her voice, and that she was meanwhile to make every effort to speak. The next day she had a fit of hysterics, and afterwards uttered some sounds. She now began to speak, and in the course of a few days talked as freely as any patient in the ward."

3. Diphtheria, Treatment of, by Lime Inhalations.

Dr. H. McElderry details, in the Medical and Surgical Reporter, the history of a well marked case of diphtheria which had resisted other treatment, but yielded promptly to inhalations of the fumes of lime, after the method advised by Dr. Geiger, of Ohio. This is simply by pouring boiling water upon lime, and allowing the patient to freely inhale the fumes. The instantaneous relief afforded by the inhalations, after the failure of other remedies, led him to attribute the very fortunate and successful issue of the case entirely to their influence.

4. Hydrophobia, Treated by Mercurial Salivation.

The British Medical Journal for June 2, 1866, records a case of this disease which occurred at Wolverhampton. The patient, a servant girl, while tying up a dog that had manifested signs of rabies, was bitten on her right thumb. She experienced no serious results until about a month after the mishap, when her thumb, arm and chest became considerably swollen, accompanied with great heat, pain, redness, stiffness and numbness. The second day after the occurrence of these symptoms a surgeon was summoned, who found her evidently suffering from hydrophobia, the result of the bite of the dog. The following night she became very ill, biting and tearing at every thing near her, and suffering much from convulsions, and manifested every symptom of this dreaded disease. The treatment was that of inducing "profuse salivation, with a view of neutralizing the poisonous character of the saliva of hydrophobia. This is a course of procedure not often pursued, but its bene

ficial effects were soon apparent." The convulsions ceased, and at the date of the report there was every prospect of her ultimate recovery. The Lancet, in commenting on the above case, says: "This method of treatment has been largely employed, and without any success. It was at one time much trusted to, but constant failures have caused it to be laid aside."

(To be continued.)

VARIA.

It is not to be

THE WAR IN EUROPE.—Before this number of the JOURNAL reaches our readers the war between Prussia and Italy on the one side and Austria on the other will doubtless have commenced. expected that many new lessons will be taught by it in medical or surgical science, for since the Crimean war and our own great struggle no inventions in arms or other military appliances have been made calculated to overturn the experience already gained by military sur, geons. So far as obtaining transportation or in providing accommodations for the sick and wounded are concerned, the difficulties to be encountered will be small, compared to those we had to contend with in our early campaigns. Europe is always ready for war; we have always been unprepared for it, and even now, if hostilities were to break out between us and any other power we should be almost as badly straitened for surgeons, hospitals, and comforts for our invalid soldiers, as we were immediately after the first battle of Bull Run and the year subsequently. Whether the evils consequent upon the maintenance of a large army, with all its paraphernalia, would not be greater than those arising from our unpreparedness, is a question which we in this country have settled for ourselves with our eyes open.

Aside, moreover, from the fact that ample provision-so far, at least, as governments can make it has already been made by the contending powers, for their future sick and wounded soldiers, the face of the country, its network of railways, its good roads and dense population, will greatly tend to mitigate the horrors which even at the best must be endured by those so unfortunate as to be placed hors du combat from disease or wounds. "Sanitary Commissions" will also doubtless be inaugurated, but it is notable that thus far Austria has declined to come into the treaty stipulations recognizing the neutrality of the medical service, which have been adopted by the other parties.