« ForrigeFortsett »
when checked by medication. The cougb increased in severity up to the seventh or
3-16-'06...50% 331% eighth day when it became less anpoging to
3-21-'06:..431% 302% the patient. The pain was constant during
3.25-'06...423% the first eight days, excepting when it was 3-31-'06...409% 362% checked by analgesios. After the eighth day
(300) the pain gradually subsided. , As previously 4. 6-'06...46% 433% stated, there was persistent constipation when 4.22-'06...52 %
37 % 101%
% the patient entered the hospital. Within 5. 4-'06...42% 45 % 121% % twenty-four hours this was relieved and the
BLOOD OF LENA AND KATY K. bowels remained loose-cathartios being given for that purpose.
About one-balf of the cells enumerated as On the second day after entrance to the eosinophiles, in counts 2-13,” “2-24” and hospital, there was incontinence of urine and 3-6,” are not typical eosinophiles. They delirium. The edema of the legs and feet are polymorphonuclear leucocytes containpersisted during this period, that of the eye. ing numerous small granules, wbich gian. lids bad almost disappeared when patient ules are irregular in shape and take a distinct entered the hospital.
In making these counts it is a difficult CASE II.--Lena K.; admitted to the matter to decide which cells shall be classi. hospital at same time as Case I. With very fied as eosinophiles, and whiob as polymorfew exceptions, the history, physical examin. phonuclear neutrophiles, as there are so many ation, laboratory findings, course of disease, grades of cells between the typical forms of etc., of this case, corresponded in every detail each. to that of Case I. Therefore only the differ- In counts *3-11," "3-16," "3-21" and ences will be noted. The first symptoms ap. “3-25" most of the eosinopbiles are typical. peared January 22 (two days earlier than in The granules are large and spherical and the Case I). There were no gastro-intestinal dis- cells appear to be larger than in the former turbances; the cough was not so severe; the counts. perspiration was less profuse; probably there A marked change is noted in the eosino. waslesspain; the muscular weakness and philes, in counts “'3-31.” The granules do prostration were less pronounced. The varia- not stain so brightly and most of the cells tion above normal of the temperature, pulse are vocuolated-apparently they are degener. • and respiration was somewhat less than in ating.
Case I. At no time was there incontinence of But few of the eosinophiles are voouolated urine nor delirium. Improvement began about and the granules stain well with eosin, in . February 14th, about five days earlier than counts “4-6” and “4-13." in Case I.
In counts “4-20” and “5-2" (Katy K.)
and in counts “4.22” and “5-4" (Lena KATY K.-BLOOD COUNT.
K.) the eosinophiles are typical excepting (600) Polym. N. 1. Monon. 1. Eosinop. Mast. c. that some of them are vocuolated. 2.13-'06...864 % 91% 36%
6% All of the blood smears were stained with 2-24-'06...714% 24 % 44% 0 % a reliable preparation of Wright's stain. 3. 6-'06...56% 361% 7% 3.11.'06...513 33° % 153%
FOUR MORE CASES INFECTED FROM THIS SAME (400)
HOG. 3-16.?06...45 41 % 138% 0.% I did not attend these cases and could not 3.21.'06...422 % 38 %
obtain a complete history. These cases are: 3-25-'06...341% 408% 247%
Anton K., age 27 years (husband of case 3-31-'06...321 52%
I), Nick L., age 31 years and Barbara (300)
L., age 25 years (husband and wife, and 4. 6-'06. ...32 % 563% 103%
their daughter, age 4 years. 4-13-'06...28% 531%
One case experienced no gastro-intestinal 4-20-'06...311%
disturbances, the other three cases did. 5. 2-'06...271% 553%
16 % 1% Two had cough, the other two had nọt.
The obild had a cutanoeus eruption, which LENA K.-BLOOD COUNT.
the physician in charge described as being (600) Polym. N. 1. Mono. N. 1. Eosinop. Mast. c. very similar to that of varicella. 2-13-'06...824% 131%
$% All of these four cases presented tbe fol. 2.24.’06... 76%
0 % lowing symptoms and signs: Fever, profuse 3. 6-'06...545% 323%
1% perspiration, edema of the eye-lids, intense 3-11-'06...563% 233% 201% 0°% pulling pains in the muscles, stiffness of the
joints, great muscular weakness and prostra
Dr. D. Arthur Hughes* stated that this Laboratory Findings on Anton K.
was his first experience in coming in contact Urine, negative. Muscle, numermous mo
with patients actually suffering with this tile trichinae. Blood, eosinophilia negative.
disease. Referring to the symptoms disThese laboratory findings are about three
cussed by Dr. Taake, he believed it was weeks after tbe beginning of sickness. For
true that there were no particular symptoms later blood findings see special report below.
that would distinctly diagnose the disease; ANTON K.-BLOOD COUNT.
but that one or another of the symptoms (300)
mentioned usually were found. The point Polym. N. 1. Mono. N. 1. Eosinop. Mast. c.
that impressed him, and which he believed 3. 8-'06...31% 201% 47 % 1 % 3-25-'06...341%
was most important, was the fact that these 3-31-'06...39% 32% 264%
patients not only ate partly cooked pork, but 2 %
also uncooked pork from this pig. This was 4. 6-'06... 413%
a point that should always be borne in mind. 4-13-'06...321%
So many persons were apt to eat pork un4-20-'06...363%
cooked, and after eating uncooked meat in . 5. 2-'06...42% 531% 51%. $%
which this disease was present, there would MRS. L.-BLOOD COUNT.
be found in the patients the intestinal symp(100) Polym. N. 1. Mono. N. 1. Eosinop. Mast. c.
toms that Dr. Taake had given. Dr. Hughes 3-31-'06... 28% 56% 16% 0%
was interested in trying to prevent such dis
eases in man as much as possible. He had 4-22-'06... 30% 55% 15%
been in the service of the Bureau of Animal
Industry, U. S. Department of Agriculture, MR. L.—BLOOD COUNT.
since 1903, a service which has to do with the (100) Polym. N. 1. Mono. N. 1. Eosinop. Mast. c. infection of all animals, before and after 3-31-'06... 36% 43% 21% 0%
death, which are to pass in the channels of (200)
interstate or foreign trade. However, the in. 4-22-'06... 51% 37% 10% 2% spection of pigs for the disease in question,
triohinasis, was made in the case of swine desA differential leucocyte count was made tined for certain countries with which we bave on the blood of Anton K. 2-13-'06, by a a large export trade. These countries were competent pathologist, who reported eosino. Austria, France, Germany, Denmark and philia negative.
Spain. During the official year which closed As far as the examination was made, the the middle of last June, there was inspected blood of Anton K. and Mr. and Mrs. for these countries. L., corresponded very closely to that of From page 16 of the report of the Chief of Katy and Lena K.
the Bureau of Animal Industry the speaker CONVALESCENCE OF THE SIX CASES.
read the following:
Total inspections of pigs for trichinosis The pain, cough and edema gradually sub. 315,015. They were olassified as follows: sided. The pale color was replaced by one Class A, free from the appearance of trich. of health. In fact the convalescence was like ina 307,621, this being 97.64 of the whole. that of any severe wasting disease.
Class B, containing trichina-like bodies, The convalescent period in case I was about by which he said he supposed they meant eight weeks; in case II about six weeks. disintegrating trichina, 4,773, or 1.52%. Anton K. required about four weeks to Class C, containing live trichina 2,015, convalesce and the L. family about three being 0.81%. weeks.
This microscopic work was done by exAt this time, May 1st, Baby L. is in perienced inspectors and as thoroughly as excellent health. The other five cases are should be expected. The pork was really exdoing hard manual labor. They complain of amined three times, and sometimes oftener. being very tired and of having pain in the Under the second class, the trichina-like muscles after a hard day's work.
bodies, the inspectors looked for those tri. In concluding, the writer wishes to call at
china which were encapsulated, having gone tention to the following points in the cases
on to calcification.
The 2,015 in class C on wbicb a differential blood count was made.
were condemned. Eosinophilia did not develop until the pa.
However no danger was to be feared from tients were convalescing; and that the per
the consumption of infected pork, providing centage of eosinophilia varied inversely to the *D, Arthur Hughes, Ph. D., M. D., Cornell University, now severity of infection.
inspector of Food Supplies, Cemmissary Dapartment, U. S. Army, 82 Live Stock Exchange, Chicago.
it was cooked; this was the first way of get. open; they did not eat rats and mice, which ting rid of the disease in the meat. Second, communicate the disease to them. if the pork was heavily salted, that would There were sporadio cases in this country, destroy the live trichina and pass the meat but when they occurred they were traceable, over to class A. Moreover if the pigs were as in this case, to the eating of pork that was pickled for an extensive period, there was no uncooked. danger whatever; nor if they were cooked How common the disease was in St. Louis, and put up in canded form. As a general the speaker was unable to say, and was also thing, these animals were not allowed to be upprepared to go into a discussion from the returned to the owners, but were tanked, by standpoint of the human medical literature, which be meant to say that they were put into but he believed that but few cases were spoken great heaters and made into fertilizer for the of in American medical literature that were soil.
due to causes other than eating uncooked The millions of swine slaughtered for the food containing the larval form of trichina interstate trade and not for the export trade spiralis. these were not examined for triobinosis. The doctor thought they should be, but believed
Dr. Soper inquired what the inspectors the reason this was not done was that so little looked for in swine. of the disease seenied to be found in the To this Dr. Hughes replied that the attencountry at large, that the government had tion of the inspectors was ohiefly directed to not deemed it advisable to examine the pork wards the detection of tuberculosis and for this disease, where the meat was to pass other communicable diseases, where the cominto the interstate trade. No alarm need be
municability came from bacteria rather than felt, the doctor said, on this account. Wbile
from parasitic origin. The parasitio diseases some countries required the examination, that were communicable to man were found there were other great countries which do not
to be so rare that the inspection was not so require the examination, as they had come to
striot on that point as it was with reference the conclusion that there was little danger
to bacterial diseases. Tuberculosis was found from American meat. Those countries which
to be very common in pork, and a great deal did not require the examination included all
was condemned for that, great quantities of those not mentioned as requiring it; for in swine being full of tuberculosis lesions. stance, Great Britain. These countries took When the animals were large and fat, it thirty-five million tons of American meat,
would hardly be thought that they were tumeat products, and dairy products last year, berculous, but this was frequently found to a large portion of which was pork.
be true. These were condemned, and deposTo lead into an explanation of the fact that ited in the tank. The speaker stated that there was so little of this disease in Amer.
the inspectors were not satisfied, with putican swine, attention was called to the fact ting the animals into the tank with the ex. that in Germany there was a great deal of it
pectation that they would be treated so as to in the swine, the statement having been made
produce fertilizer, but that the government that one in every five hundred pigs have the
seal was also placed upon the tank, and the disease in Prussia, in Saxony more, and in
steam is turned on. All of this was done West Germany less, the reason being that in
under rigid supervision. Packing house Germany the swine did not run at large, as owners had found to their sorrow, when tryon our great American plains; they were ing to get anything out of a tank sealed by a penned up, and likely to devour many rats
government official, that Uncle Sam was a and mice, and these were the great means of
very hard customer to deal with. communicating trichinae to the swine. This Besides tuberculosis, hogs were inspected is true, though the fact is known to the Ger- for swine plague, hog cholera and the like. mans that 10 to 20 per cent of the rats and
It was not thought that these diseases, as inice have the disease. It was probable also
such, were communicable to man, but if meat that the disease was more common and prev
was eaten from a hog having hog cholera, it alent in Germany for the reasons that the
would produce chronic diarrhea. Pigs were Germans not only eat the animals that we eat
also examined for injuries of all kinds and in America, but also eat dogs, horses, don- local diseases, for pregnancy, etc., and all of keys, etc. Persons in Germany therefore got those things which make the flesh upeatable, the disease not only from trichinous swine, unpalatable or disagreeable because of senti. but also from dogs. Dogs are notoriously in
ment or effect. fected with trichina. Swine in this country were comparatively free from the disease, be. Dr. Deutsch inquired whether the disease cause they were not penned so much: they in the animal resembled the disease as we see followed the cattle, ate grain, and were in the it in man.
JOHN MCHALE DEAN, Surgery.
W. H. VOGT, Obstetrics and Gynecology.
T. A. HOPKINS, Genito-Urinary Diseases.
To tbis, Dr. Hughes replied that the simil. arity was not a similarity, but that there was an exact reproduction in swine of the pathological appearances. The lesions of the dis Issued Tenth and Twenty-Fifth of Every Month. ease in swine closely resemble the post-mor
Under the Editorial Direction of tem findings in cases of tuberculosis in man.
FRANK PARSONS NORBURY. Dr. Hughes, in connection with the sub
THOS. A. HOPKINS,
CARL E. BLACK. ject of tuberculosis in swine stated that there
With the following staff of Department Editors was no question that there was a great deal of 0. E. LADEMANN, Internal Medicine. it in swine and in oattle. Recent investiga
R. B. H. GRADWOHL, Pathology and Bacteriology. tions made since Robert Koch's famous
WALDEMAR FISCHER, Ophthalmology. speech before the International Tuberoulosis
A. LEVY, Pediatrics. Congress, beld in London, 1901, tended to
W. T. HIRSCHI, Therapeutics.
A. F. KOETTER, Otology. disprove many of his tenets, among them his HERMAN STOLTE, Laryngology and Rhinology.
F. P. NORBURY, Nervous and Mental Diseases. belief that human tuberculosis is not com. municable to animals, not that of animals to
ROBERT H. DAVIS, Dermatology. man. The above report merely epitomizes the ex
EDITORIAL temporaneous address made by Dr. Hughes, and summarizes the answers to a few of the
In the space at our comamnd it will be im. questions put to him after the address. At
possible to do justice to the long-to-be-re. the close of the evening Dr. Hughes was
membered Boston meet. given a rousing upanimous vote of tbanks.
ing of the American The hope was expressed by many that he The Boston
Medical Association, would soon again address the City Hospital Meeting of
which was from all Alumni on some phase of the government the A.M, A.
view-points an ocoasion work.
of profit and pleasure. In closing the discussion Dr. Taake stated The opening session (and all the general that the treatment had been entirely symp sessions) was held in Mechanios Hall, a hall tomatic. The pain was relieved by morphine admirably suited to the association's pursulphate. A cough mixture was given to poses. The body of the hall was reserved for check the cough. The perspiration was so members of the association, in the balconies profuse that it was thought best to reduce it were ladies and friends. Seated on the platto some extent, which was done by the ad. form at the opening session were the presidministration of tincture of belladonna. Pur. ing officer, the special guests and the ex-pres. gatives were given when he took charge of idents of the association, all in the front row. the patients. Upon investigation it was They were President Lewis S. McMurtry, found that the pork was still hanging in the with Governor Guild on one side and Rev. smoke house. This was about one month Dr. Hale on the other; Mayor Fitzgerald, after the patients took siok. The pork was President Elliot of Harvard University, Pres. purchased from a near-by meat market, the ident-elect William J. Mayo of the associa. proprietor of which secures bis meat from a tion, Dr. Arthur T. Cabot, president of the small packing house located in this city.
Massachusetts Medical Society; Dr. Herbert Dr. Taake thought that there were many L. Burrell, chairman of the local committee cases of trichinosis which were not diagnosed. of arrangements; and these ex-presidents of He substantiated the latter statement by the A. M. A.: Dr. Wyeth, Dr. Keen, Dr. citing several cases discovered in the operat. Reed, Dr. Billings, Dr. Mathews, Dr. Musser ing room and a post-mortem. He believed and Dr. Henry O. Marcy. that if the government officials knew of all After a few brief exchanges of courtesies the cases, a system of inspection would be Dr. Lewis S. McMurtry, the retiring presi. enforced.
dent of the association, stepped to the front and extended a cordial welcome to the assuciation and its friends. Then he introduced
Dr. Hale who pronounced the invocation. Severe localized pain after traumatism, es Addresses of welcome followed by Goverpecially in children, may be due to subperi. nor Guild of Massachusetts, who welcomed osteal fracture, e. g., near the bead of the hu. the association to the comioonwealth, and exmerus or the femur. Extreme localized ten pressed the bigh appreciate of his people in derness is the cbief sign; abnormal mobility the work of our association; President Eliot, and deformity are absent, and crepitus may of Harvard, and Mayor Fitzgerald, of Boston, not be elicited.
who spoke felicitously and assured the asso.
the rangementspan of the 13. Dr. Her ben
he State of in the late usces, 27,876 perso all
State of Minnested being iminury, a per
ciation that every endeavor to the scientific disappear from the army and country, a perand social success of the meeting was ours son properly protected being immune. In to command, a matter which all already felt. the State of Minnesota inability to enforce
The retiring President, Dr. McMurtry, then vaccination in the late smallpox epidemio introduced President Mayo.
permitted, from a few sources, 27,876 persons · The presidential address was quite what to become infected with this disorder; all one would expect from Dr. Mayo, dealing due to a small but vociferous band of antilargely with practical facts and existing con- vaccination agitators. ditions. He urged unity as a means to “Contagious disease in any place is not a achievement; in this connection he said: "'The matter of local or State interest alone, as present organization of the American Medi. the ease and freedom of transportation cal Association is but a beginning; we must render local control impracticable and prop. further the interests of this body unselfisbly, erly place it in the hands of the General Gov. not for ourselves alone, but that we may bet. ernment. The keenness with which the ter fulfil our sacred obligations to mankind. American people are watching the affairs of The people must be educated up to a point Panama argues well for the future. The were they can understand the broad humani. communication of Dr. Charles A. L. Reed tarianism of modern medicine. Society ap. awakened publio interest. His portrayal of preciates the saving of a sick person's life by red tape and obstruction to sanitation in the the skilled physician, but fails to see the Canal Zone has resulted in obtaining for that priceless gifts to the human race made by most able army medical officer, Colonel Gorpreventive medicine and sanitary science. It gas, power to carry out the necessary reforms views everything in detail and misses the per. and has made the Canal Zone the most sanispective. We have failed to secure the sup-' tary place in Latin America. port of the masses of the people to much. “The army and navy niedical departments needed sanitary reforms, because we have have worked intelligently against overwhelmappealed to them as one individual to another ing odds. Their individual members have without the weight of an authoritative organ international reputations honestly achieved. ization."
Their schools for the special training of their He also urged the education of the masses men are in the highest degree efficient and in the matter of infectious diseases, espeoially deserving of every praise; but the depart. emphasizing tuberculosis. He held that ments have been so small as to be unable to there is no reason why a man who bas be- act even as nuclei about which in time of come infected with typhoid from a city's neg. war competent forces could be gathered and lect should not sue for damages as he would the militia of our country enter into conflict for personal injury sustained from falling fearfully handicapped. The indications, howthrougb a defective sidewalk. Unavoidable ever, are that these matters will now be recsickness is bad enough, but when we stop to tified, and if so it will guarantee to the patri. consider that the life of the individual is otic American that should be again be called worth $5000 to the State, and that those who on to serve his country his enemies will be recover under great disability and expense, in front and he will not be destroyed by his the continuance of unsanitary conditions is own side through neglect of sanitary laws. criminal. The experience of Vienna, which Contract practice, fee division, commission was converted from a typhoid center to one giving, lodge practice and other evils were of freedom from suob outbreaks by bring. mentioned in condemnation. He urged the ing in a pure water supply, has now been re- broadening of medical education that our peated over and over again in every civilized schools may constantly graduate stronger land. Yet hundreds of deaths from this pre- men, and further, that graduates may not rentable source yearly attest that the lesson leave college to at once embark as specialists. has not yet been learned.
“Graduation from a college, he said, is merely In the patter of governmental interfer- a commencement of a life study of medicine. ence and control, in the presence of con. Therefore, young men without special traintagious disease he said: "One of the few ing under competent teachers should not be misfortunes of the individual freedom af. encouraged in wanton assaults on major surgi. forded by a republican form of government cal diseases unless justified by necessity. The is that it enables the most ignorant man, future will demand schools for advanced train. througb prejudice, to interfere with and de- ing for those who desire to do special work. lay needed legislation, with the result that In the practice of medicine the student days by the time the law can be passed the im. are never over. There is so much to be learned mediate object to be obtained has often dis- that a long and industrious life leaves one appeared. In Germany compulsory vaccin- with the feeling that he is but a beginner. ation has practically caused smallpox to The most important babit a young physician