NEW YORK STATE MEDICAL SOCIETY. 
TRICHINA SPIRALIS: 
BY E. R HOT, M. D. 
Presented to the New York State Medical Society, 
at their Annual Meeting for 1869. 
ALBANY: 
WEED, PARSONS & CO., PRINTERS, 
1869. NEW YORK STATE MEDICAL SOCIETY 
TRICHINA SPIRALIS: 
BY E. R HUY, M. D. 
Presented to the New York State Medical Society, 
at their Annual Meeting for 1869. 
At&Mf': 
WEED, PARSONS & C 0 ., PR I N T E R S , 
1869. New York State Medical Society. 
1 
ARTICLE XII. 
Trichina Spiralis. 
In December, 1868, I was invited by Dr. C. D. Mosher, of this 
city, to visit, with him, a patient who presented a series of symptoms 
which did not correspond with those characteristic of any of the dis- 
eases ordinarily met with in this locality. We found the patient, a 
German boy, ten years of age, lying upon his back, and complaining 
bitterly upon being moved or touched. Face puffy and considerable 
oedema of the legs and feet; tongue red and inclined to be dry; con- 
siderable thirst, with little or no desire for food ; bowels tympanitic, 
but not remarkably tender; frequent, soft, green stools; urine nor- 
mal in quantity and containing no albumen ; constant cough with 
expectoration of a thick, tenacious mucus, sometimes streaked with 
blood, and at others resembling the rusty sputa of pneumonia; loud 
mucous rales over both sides of the thorax with bronchial respiration 
and slight crepitation, with dullness on percussion near the spine oil 
the right side; pulse ranged from 125 to 135 per minute. 
Upon asking the history of the case we found that the illness com- 
menced about six weeks previously with puffiness of the eyelids and 
face, followed by vomiting and general gastric disturbance. Soon 
after the arms and legs became tender and sensitive to the touch and 
muscular movement became difficult and painful; at the same time 
diarrhoea came on ; about the end of the second week a peculiarity 
developed itself in the gait of the patient who walked upon his toes, 
as if unable to rest his heels upon the floor. The symptoms gradu- 
ally increased in severity, and for the past two weeks the suffering 
has been so great as to compel complete confinement to bed, and the 
general soreness and pain have been greatly aggravated by the con- 
stant cough which commenced about ten days ago. 
Upon further inquiry, we discovered that a brother of the patient 
had been attacked at the same time and in the same manner, but the 
symptoms were milder in his case, and had lasted only three weeks. 
We examined him carefully and detected nothing except a slight ten- 
derness on pressure over the right deltoid muscle. 
The diagnosis of trichinosis which I had already formed by exclusion 
was rendered still more probable from the fact that the two boys 
had, a few days previous to their illness, eaten some raw pork which 
they found lying upon the table waiting to be cooked for dinner, 
which pork was afterward boiled and eaten by the whole family (con- 2 
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sisting of five persons), none of whom seem to have experienced any 
ill consequences except the two boys. 
In order to make my diagnosis certain I had an instrument con- 
structed with which to harpoon and remove a small piece of muscle 
and having anaesthetized the skin over the deltoid muscle of the boy 
who had recovered, by means of the rhigolene spray, I tore out a few 
muscular fibres and submitted them to microscopic examination. 
Several trichinae were found coiled up and in a quiescent condition, 
surrounded by a mass of granular and fibrous tissue but without any 
trace of calcareous deposit. 
I continued to visit the patient, with Dr. Mosher, from this time, 
December 24th, until January 15th, when he died. During this period 
the pain and tenderness continued and the diarrhoea resisted all rem- 
edies. The cough was incessant, and he complained at times of noises 
in his ears. 
The autopsy was made 48 hours after death. 
Head. — Not examined. 
Thorax. — No pleuritic effusion. The heart appeared normal. 
The lung tissue upon section presented a very bright, red appearance, 
similar to that observed in the lungs of animals during vivisection. 
Abdomen. — Peritoneum, smooth and shining; no effusion. Liver, 
clay-colored and very much enlarged. Intestines not opened. Spleen 
and other organs appeared normal. 
Microscopic Examination. — Portions of the heart, lungs, liver 
and kidneys were examined, and no trichinae found in them, but in 
the diaphragtn, pectoral, psoas and gastrocnymius muscles great num- 
bers of the parasites were discovered, some of them encysted, and 
others free and full of life and motion. 
I fed some of this muscle to a female rabbit, which died four days 
afterward, and upon opening the stomach and intestines I found a 
great number of fully developed trichinae of both sexes. The females* 
were filled with ova and living young, and one of them gave birth to 
a large family of embryos while under observation with a half-inch 
objective. 
Thinking the subject to be one of interest and importance as 
regards the public health, I have appended the following account of 
the trichina spiralis which I have gathered from the works of several 
French and German authors : 
TRICHINA SPIRALIS. 
The first reliable mention we find of the trichina is that by Mr. 
Hilton, who, in making the autopsy of a man 70 years of age in 
Guy’s hospital, London, found a great number of white corpuscles' 
scattered through the fibres of the pectoral muscles. He considered New York State Medical Society. 
3 
them as being probably small cysticirci, but did not describe their 
organization. This observation of Mr. Hilton was read before the 
Medico-Cliirurgical society, of London, at a meeting held January 
23, 1833, and was published in the Medical Gazette the following 
February. 
About this time Paget noticed a similar appearance in the muscles 
of an Italian who died at St. Bartholomew’s hospital, and carried 
some of the little specks to the celebrated naturalist, Richard Owen, 
by whom they were carefully examined and studied. 
Owen then read a memoir on this subject to the Zoological Society 
of London, which was published in the Medical Gazette in April, 
1835. In this memoir, which was the first work published on the 
subject, the author states that the little white points implanted in the 
muscles are in reality cysts of an ovoid form and containing a micro- 
scopic worm, to which he gave the name of trichina spiralis, from the 
Greek word Vf, because the worm is slender, like a hair, and is usually 
rolled up in a spiral coil. 
During this same year, 1835, Dr. Wood, of Bristol, published a 
case of what he supposed to be acute rheumatism with pulmonary 
and cardiac complications, and in which an autopsy revealed a large 
number of trinchinse in the muscles. 
Soon after this, Harrison published in the Dublin Journal six cases 
of trichinosis. 
Owen himself, then collected all the observations which had been 
published and gave them to M. Bureaud-Riofrey, who, in 1836, pub- 
lished the fourteen cases thus pointed out to him. 
During the next ten years scarcely any mention was made of the 
trichina in medical literature. 
In 1845, Dujardin began to study the origin of the trichina, and in 
a short time all the helminthologists became interested in this research 
•and sought for it in different animals. ILerbst in 1845 and Gurlt in 
1849 found it in the cat, and it was also met with in the mouse, 
badger, and even in the muscles of a sparrow. 
But the most important discovery was made in America by Profes- 
sor Jos. Leidy, in 1847, when he found the parasite in pork. Luschka 
in 1851 gave a correct description of the anatomy of the worm, 
describing the mouth, oesophagus, intestinal canal and anus, but did 
not find any sexual organs. 
This description was followed by the monographs of Ilenle, Kitch- 
en meister, Bristowe and Rainey, and finally by the first works of 
Virchow upon this subject. Kuchenmeister considered the trichina 
to be merely a development of the triehocephalus, in which opinion 
he was opposed by Virchow, who failed to find the genital organs 4 
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characteristic of the latter, and who considered that the trichina 
might possibly be the production of some other entozoon, the strongu- 
lus for example, tiie only thing which appeared to him probable, was 
that the trichina might, like the cysticercus or echinococcus, continue 
its development in the intestine of the carnivora. 
From the above account we see that in 1859 the trichina had fre- 
quently been found in man and other animals, but nothing was as 
yet known as to its origin, or as to its capability of producing any dis- 
ease. 
On the 12th of January, 1860, a servant girl aged 20 years, entered 
the hospital at Dresden, under the care of Dr. Walther. She had 
been sick for about twenty days, and had kept her bed since the 1st 
of January. At the commencement she had great lassitude, thirst, 
anorexia and constipation. To these symptoms, which still persisted, 
were added a burning fever, tympanitis and abdominal pains, in fact, 
an assemblage of severe symptoms which were attributed to typhoid 
fever. Soon, however, the patient developed new symptoms not 
usual in that disease ; such as violent pains, continuing day and night, 
and which were principally located in the extremities; very frequent 
contractions of the arms and legs with flexion of the elbows and 
knees, during which all attempts at extension were very painful. 
Later, there was oedema of the limbs, especially of the legs; finally, 
symptoms of typhoid pneumonia came on, and the patient died the 
27th of January. The nature of the disease was not at all under- 
stood during life. 
Zenker, having studied the case, made the autopsy himself. The 
muscles of the arm were first examined; they were pale, of a grey- 
ish, red color, and appeared speckled. The professor examined a 
small piece of this muscle under the microscope, and saw with aston- 
ishment a large number of free trichinae in the muscular parenchyma, 
assuming all postures and giving the most incontestible evidences of 
vitality. Continuing his examinations, he found all the muscles so 
studded with trichinae, that under a low magnifying power he per- 
ceived as many as twenty in one field of the microscope. lie was 
then sure that the worms had been detected during their passage into 
the muscles. The muscular fasciculi gave evidence of marked degen- 
eration ; they were friable and the fibres were no longer striated nor 
homogeneous. 
Ho lesion elsewhere was found which would justify the idea of 
typhoid fever; no splenic enlargement nor alteration of the mesen- 
teric ganglia; the left lung was collapsed with points of infiltration; 
the bronchi were inflamed, and the mucous membrane of the ileum 
very hy perse mic. New York State Medical Society. 
5 
The penetration of the trichinae into the muscles was then not only 
the cause of the violent muscular pains, but also the true cause of death. 
As the patient had been brought to the hospital from the country, 
Zenker made some researches, and found that about four weeks pre- 
viously a hog had been slaughtered at the house from which this girl 
had come. He also found that the ham and sausages made with the 
flesh of this animal contained a large number of trichinae, and that 
the butcher who had dressed the hog and had eaten raw sausages, as 
well as several others, had, like them, presented more or less severe 
rheumatismal and typhoid symptoms, but the patient who had been 
sent to Dresden was the only one who had died from eating the pork. 
Zenker sent to Virchow a portion of the muscles of the dead girl, 
and by a series of experiments upon rabbits several doubtful points 
were elucidated and definitely settled. It was found that when a 
rabbit was fed upon the flesh containing trichinae the animal became 
emaciated and feeble during the succeeding three or four weeks, and 
died toward the fifth or sixth week, with its muscles filled with the 
entozoa. In this manner Virchow obtained five generations of 
trichinae. 
Since 1860 numerous wTorks upon this subject have been published 
by different authors, as Davaine, Pietra Santa, Kestner, Rodet, Vir- 
chow and Leuckart. But of all the works which have yet appeared, 
that of Pagenstecher seems the most complete, in which are given the 
results of a number of experiments made upon various animals at the 
Zoological Institute, of Heidelberg, by the author and J. Fuchs. 
We now come to the consideration of the successive transformations 
which the trichina passes through during its existence. 
When an animal contains trichinae in its muscles, they are usually 
found enveloped in a little capsule, which is formed in its interior, of a 
smooth, transparent membrane, and externally, of a calcareous deposit. 
If the flesh containing these trichinae is eaten by a carnivorous ani- 
mal the gastric and intestinal juices dissolve this envelope and the 
worms are set free, and soon arrive at a complete stage of develop- 
ment. The females are fecundated by the males, and the embryos 
are soon born. 
When the generative function has been accomplished by the tri- 
chinae, the}7 die, and are expelled from the intestine with the fecal mat- 
ter. The young embryos, whose number is immense, perforate the 
walls of the intestine, penetrate into the abdominal cavity and pass 
from thence into all the muscles of the body. When they have fin- 
ished their immigration, they lodge in one of the fibres of the muscle, 
become encysted and remain quiescent for an indefinite period of 
time; they die in this condition, unless the animal containing them 6 
is eaten in his turn, when the trichinae pass through a cycle of exist- 
ence similar to that of those worms which engendered them. 
We will now review each of these stages in detail. 
1st. The Formation of the Cyst. — The cysts of the trichina are 
formed of a double envelope. First, an external one which is 
formed from the sarcolemma of the muscular fibre in which 
the worm is lodged, and which is terminated at both its extrem- 
ities by an elongated fibre. Second, an internal one of ovate 
form, and with very thin, transparent walls, which is consid- 
ered to be the production of the trichina itself. After a time cal- 
careous matter is deposited in these cysts, and this cretification grad- 
ually advances until the parasite is entirely concealed from view. 
The cavity contained in the cyst is sufficiently large to allow its 
occupant a slight degree of motion. The great majority of the cysts 
contain only one worm, but sometimes we find two, or even three in 
the same envelope. 
How long the trichina is capable of living inclosed in this manner 
is as yet undecided, but many observers have found them alive after 
several years of inclusion. However, they do finally die, and their 
death *is accompanied by the deposition of earthy matter in the body 
of the worm and in the cavity containing it, so that at last we have 
a solid mass of calcareous matter, which afterward undergoes seg- 
mentation and then breaks up. 
The habitual location of the encysted trichina is in the muscles of 
the trunk and limbs, especially near the insertion of tendons and apon- 
euroses ; they are even found in the muscles of the eye and internal ear, 
but they accumulate in large numbers in the diaphragm, the posterior 
muscles of the neck, the biceps, deltoid, etc., etc. Thus far the 
encysted trichina has not been found in the muscles of the heart, but 
they have been met with in this organ in an embryonic condition. 
The number of trichinae contained in the muscles varies according 
to the quantity of infested meat ingested. It has been estimated 
that many millions may be contained in a single individual. A single 
mouthful of meat may, therefore, easily contain two or three thousand. 
2d. Intestinal Trichina. — When a portion of meat containing tri- 
chinae reaches the stomach, it rapidly undergoes certain changes which 
are due to the digestive powei of that organ. The meat being 
reduced to a pultaceous mass, exposes the capsules of the entozoon 
to the action of the gastric and intestinal secretions, and the acids 
contained in these fluids dissolve the calcareous matter and set the 
trichinae free. At the moment when the animal escapes from the 
cyst it measures from to of an inch in length, and at this 
period no sexual organs can be distinctly observed. 
Transactions of the New York State Medical Society. 
7 
Twenty-four hours after being set at liberty in the intestine, the 
trichinae have already acquired a considerable degree of development, 
the sexual organs are now apparent; by the third or the fourth day 
the ova can be distinguished in the ovary of the female and spermatic 
cells in the male. The male has now a length of about T\ of an 
inch, and can be distinguished from the female b}r two projections, 
constituting a kind of forked appearance at the extremity of the tail, 
and which represents the genital organs. 
The females assume larger proportions, and rapidly reach from -i 
to } of an inch in length, and look like very fine white threads, -which 
are perceptible to the naked eye. 
Copulation soon takes place, and the ova can be seen to swell 
in the ovary of the female, and five or six days later, minute, living 
young make their exit from the uterus. These little ones are of 
extremely small size, measuring only from to of an inch; 
their number is prodigious ; a single female being capable of pro- 
ducing as many as one thousand young. 
When the processes of fecundation and reproduction are termin- 
ated the old trichinae die and are expelled with the faeces. Usually 
all the above functions are performed within from twelve to fifteen 
days; but Pagenstecher has found female trichinae, still living, two 
months after the introduction of the encysted worms into the stomach, 
and this fact makes it possible that the same individual may give 
birth to more than one brood of young.' 
The number of females is always greater than of males, and the 
difference has been variously estimated between two to one and forty 
to one. 
3d. Migration of the Embryos. — When we consider how very pro- 
lific this parasite is, we might, at first, be astonished that in one 
instance only have the trichinae been found in an embryonic state in 
the intestinal canal. The fact is that these embryos are scarcely 
born before they bore into the walls of the intestine, and according 
to Virchow penetrate into the epithelial cells of the mucous mem- 
brane. 
Some authors consider that the embryos reach the muscular tissue 
by being carried along in the circulation, but this opinion is refuted 
by Virchow and Pagenstecher, who have never been able to discover 
them in the blood or in the vessels. 
When the young trichinae have perforated the intestine they are 
found in large numbers in the serous cavities, especially in the peri- 
toneum aud pericardium ; they make their way into the mesenteric 
glands, the spleen and above all into the diaphragm, where they 
remain permanently and become encysted. 8 
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The trichinae, continuing their emigration, finally reach the primi- 
tive muscular fibrils, and it is during this period, while they are 
moving, that the patients complain of pain. The trichinae never 
locate themselves in the cellular tissue, hut traverse it so rapidly that 
they have never been discovered in it. 
The embryos, which, at the time of their birth, measured only 
about jij of an inch, gradually increase in size for six or seven 
weeks, deriving their nutriment at the expense of the muscular fibre 
in which they are lodged, until they are simply inclosed in a tube 
formed by the myolemma. By this time they have attained between 
— and of an inch in length, and their growth is arrested. They 
now become surrounded by a capsule, which is in due time enveloped 
in a deposit of calcareous matter. When thus encysted, they may 
live for a number of years, and there are cases on record where they 
survived thirteen years in an encysted condition, after which they 
were capable of producing trichinosis in rabbits. 
We see from the above that the trichinae pass through a cycle of 
existence which may be divided into three distinct periods, viz.: 
First, the period when they exist as encysted larvae ; second, the 
period of development and procreation ; third, the embryonic stage. 
The anatomy of the trichina is much more complicated than its 
diminutive size would lead us to suppose. The adult trichina is a 
cylindrical, transparent worm, scarcely perceptible to the naked eye. 
The anterior extremity is very pointed, while the posterior extrem- 
ity is rounded and obtuse, presenting a terminal anus which looks 
like a little depression. All along the body, but, especially, toward its 
posterior portion, small transverse striae may be seen, which are the 
folds formed of the dermis by the action of the logitudinal muscle. 
The intestinal canal extends from the mouth to the anus, and is 
divisible into three portions : The oesophagus, stomach and intestine. 
The mouth is not easily seen, it is round, and not furnished with 
hooks, or any prehensile apparatus. The oesophagus is very long, 
occupying two-thirds of the whole length of the body and termin- 
ates by a constricted opening into the stomach, which is a very small, 
oval cavity, about one-tliirtieth of the length of the digestive canal. 
The intestine goes directly to the anus, and is of nearly uniform 
diameter. 
Pagenstecher claims to have discovered the brain of the trichina, 
and represents it as located behind the mouth, and in front of the 
oesophagus. 
No blood vessels have been discovered, but blood globules have 
been recognized in the connective tissue. 
The lower portion of the body of the trichina is traversed longi- New York State Medical Society. 
9 
tudinally by muscular fibres which seem to form bands. Posteriorly 
and entirely underneath, are two other muscles, called retractors of 
the cloaca. 
When the trichina reaches the adult stage, the generative organs, 
which, previousl}', were only rudimentary and entirely invisible, 
become rapidly developed, and acquire a size equal to one-half the 
body of the male, and four-fifths that of the female. In the male, 
at each side of the anus, are two oval appendices, convex outward, 
and concave inward, and pointed at their free extremity; these are 
the vesicular seminales, and are terminated above by a vas deferens 
which carries the semen into the cloaca. Between these two vesicles 
the penis projects at the moment of copulation. 
The female trichina is viviparous. The vulva is situated at the 
anterior and inferior fifth of the body, so that the embryos escape 
from the uterus from behind forwards. The ovary is situated imme- 
diately above the uterus ; it forms a closed sac above, and contracts 
below before opening into the uterus. 
Many observations have been made upon animals to see which of 
them are naturally infected with trichinae. 
At first, the earth worm was said to contain them, but Virchow, 
Gerstaecher, and, especially, Kuhn, who made special investigations 
into the subject, declared that the conformation of the head and tail 
of the parasite found in the earth-worm bore no analogy to the same 
parts in the trichina. Besides which, the latter can only be devel- 
oped in the muscles of warm-blooded animals. 
Several observers claim to have observed the trichina in moles, but, 
according to Virchow, the results of their investigations appear to 
be at least doubtful. 
The rats and mice infesting houses frequently are infected, so that 
cats are exposed to the disease, and, as hogs, also, are knowm to eat 
rats and mice, they may become trichinosed in this manner. 
The most complete study with regard to the artificial trichinisation 
of animals, is that by MM. Fuchs and Pagenstecher, who made 
various experiments upon animals of all classes, from the mammals 
to the molluscs. 
1st. Mammals. — The dog, after eating infected meat, does not 
become trichi nosed. The trichinae, it is true, undergo their usual 
development in the intestines, and propagate young, but the latter do 
not find their way into the muscles, from some unknown cause; the 
old and young passing off together with the intestinal evacuations 
This is also true of the fox. 
The cat undergoes trichinisation easily and completely, and so does 
the rabbit. Experiments made upon the goat show that the male 10 
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can never, and the female but seldom, become infected. It is hardly 
necessary to state that swine become trichinosed with extreme facility. 
The calf is susceptible of artificial infection, but attempts upon 
the bull, ox and cow have been unsuccessful. The sheep can be tri- 
chinosed, but only with great difficulty. 
The Guinea-pig, rat and mouse are easily infected, so are, also, the 
hare and wild boar. 
The birds cannot be trichinosed, at least, MM. Fuchs and Pagen- 
stecher found it so in their investigations, thus differing from some 
other authors. Experiments were made upon the cock, hen, goose, 
turkey and pigeon, and afterward upon the rook, starling, magpie, 
jackdaw, peacock, buzzard, and several birds of prey. In all of 
these the trichinae grew, and, in some instances, propagated in the 
intestines, but were soon carried off with the alvine evacuations. 
Fish readily eat the meat, but the trichinae perishes without devel- 
opment. The same is the case with frogs, and several varieties of 
salamanders. 
Among the Crustacea, the lobster only was experimented upon; 
the result was nil. 
As a result of these researches, we find, that among the animals 
used for food, the hog is the only one which presents any danger. 
Historical researches, and especially the observation of individual 
cases of trichinosis, have enabled us to arrange a complete tableau of 
the disease. The results produced by the ingestion of infected meat 
necessarily vary, according to the number of worms swallowed, the 
impressionability of the patient, and the time which has elapsed since 
the invasion. The disease may, therefore, be divided into four stages. 
First Period. — It lasts from eight to ten days ; trichinous meat, 
introduced into the stomach, passes into the intestines; the cysts are 
ruptured and the larvae grow and arrive at a complete stage of 
development. 
In the great majority of persons no effect is produced the first day, 
a few, however, feel a malaise, vomit and experience slight symp- 
toms of indigestion. If the meat, only partially smoked, or salted, 
was undergoing putrefaction, serious accidents may be produced, con- 
stituting a form of poisoning called in Germany wurstgift (sausage 
poison), which sometimes terminated fatally. Usually it is not until 
the third or fourth day that the following symptoms are manifested: 
loss of appetite, nausea, general malaise, fatigue, thirst, frequent 
alvine evacuations, and then diarrhoea and fever. 
This period offers no special characteristic by which it can be dis- 
tinguished from an ordinary irritation of the stomach and intestines 
produced by some accidental cause, but it corresponds perfectly to New York State Medical Society. 
11 
the phenomena of the evolution of the trichinae ; in fact, these worms, 
whose number is often prodigious, irritate the mucous membrane and 
determine all the symptoms of a commencing gastro-intestinal 
inflammation. 
Second Period. — It corresponds to the birth of the embryos, which, 
in millions, perforate the intestinal walls and provoke an aggravation 
of all the symptoms ; the fever increases, the pulse beats from 120 to 
130 per minute, the capillary circulation is disturbed, oedema of the 
face commences, often first observed in the eyelids; the thirst is 
intense, the lips and tongue become dry and brown, the perspiration 
is abundant, and there are alternations of diarrhoea and constipation. 
The mind remains clear through all this disorder. This second period 
has a duration of from eight to twelve days. 
Third Period. — The embryos having pierced the intestines, are 
scattered over the abdominal and thoracic serous membranes, and 
thence penetrate into the muscles. Then commence the muscular 
pains, which rapidly increase in severity and become atrocious; the 
muscles of the upper extremities contract, the arms are semi-flexed, 
and every effort to extend them calls forth cries of distress; the 
patient walks upon his toes, as if unable to let his heels down to the 
floor ;* the movement of the pectoral muscles being impeded, render 
respiration difficult; the trichinae which penetrate into the tongue 
and larynx embarrass deglutition and occasion enfeeblement of voice; 
the patient remains motionless in bed. and bed-sores form upon the 
points compressed; the oedema increases, ascites comes on, and the 
inferior extremities sometimes acquire an enormous size ; the pains 
are incessant; the urine is scanty; there is profuse perspiration, and 
the wakefulness is- persistent; the intelligence remains unimpaired, 
notwithstanding the constant torture of the patient; the muscles of 
the extremities swell up, offering an elasticity like that of india rub- 
ber ; at times the patient experiences a transitory desire for food. 
Soon all the symptoms become aggravated, the diarrhoea augments, 
the thirst is unquenchable and delirium comes on, and is sometimes 
permanent; finally, after six weeks, two months, or even longer, 
exhaustion draws the sad scene to a close. 
Fourth Period. — The symptoms of the third stage, although often 
very severe, do not always reach a fatal termination : they commence 
to subside, either under the influence of the strong constitution of the 
* This symptom I have not met with in any account of the disease which I have 
seen, although it was very marked in the two cases which fell under my own obser- 
vation, and constituted one of the principal features in an epidemic of trichinosis 
which occurred at one of our orphan asylums, under the care of my father, Dr. 
Thomas Hun. Transactions of the 
patient, or because the number of trichinae injested has not been very 
large. The gastric phenomena become ameliorated, the appetite 
reappears, and the diarrhoea ceases; the fever, muscular pains and 
oedema diminish. These happy symptoms appear after one and a 
half or two months, which correspond to the period when the tri- 
chinae became encysted. When this phenomenon is accomplished, the 
trichinae are no longer in direct contact with the muscles, being 
inclosed in capsules, which increase in thickness, become incrusted 
with calcareous salts, and remain indefinitely as foreign bodies with- 
out occasioning any defect in movement. 
During the convalescence, which is long, the hair falls and the nails 
often become detached, sometimes, also, large flakes of epidermis are 
cast off. 
The complications which may arise during the course of the dis- 
ease are numerous, and it is not uncommon to meet with pleuritic 
effusions, pneumonia, cutaneous eruptions, furuncles and sloughs 
which take place about the trochanters and the sacrum. 
When death terminates the sufferings of the patient, we find, at the 
autopsy, evidences of the disorders observed during life. The intes- 
tines are inflamed, red and sometimes ulcerated; the mucus which 
they contain is viscous and abundant; occasionally, but rarely, adult 
trichinae are found in them, but usually they have been expelled in 
the stools. The liver and spleen preserve their normal appearance. 
If pulmonary symptoms have been present during the illness, we will 
find evidences of disease in the lungs or pleurae, but these pathologi- 
cal changes present nothing special or characteristic, and microscopic 
investigation is necessary, in order to find the lesion peculiar to tri- 
chinosis. A few fibres taken from the diaphragm or muscles of the 
neck will, when placed under the microscope, demonstrate the exist- 
ence of the parasite. 
It may here be stated that the trichinae have never been discovered 
in the blood vessels, nor in the blood itself, and that the kidneys, 
bladder and brain are habitually in a condition of perfect integrity. 
It cannot be denied that trichinosis is a very severe and dangerous 
disease, but still its mortality is usually overestimated, as will be 
seen from the following statistics, gathered from some of the epi- 
demics of this malady: 
At Plauen, there were 3 deaths in 30 cases, T\\. 
“ Calbe, “ 8 “ 38 “ TV*. 
“ Ilettstcedt, “ 27 “ 158 “ TyT. 
“ Bourg, “ 11 “ 50 “ Ty*. 
“ Hedersleben, “ 80 “ 300 “ 
The danger of the disease evidently depends upon the number of New York State Medical Society. 
13 
entozoa introduced into tlie stomach, and the age and constitution 
of the patient will, also, greatly influence the prognosis. From the 
present statistics, it appears that the mortality is greater among 
women and children than among men. 
The diagnosis of trichinosis is by no means easy, at least if we 
rely only upon the symptoms presented by the patient. According 
to the period in which we see it, we may mistake it for gastric fever, 
typhoid fever, renal disease, or rheumatism. There is, however, one 
infallible means of confirming our diagnosis in cases where we sus- 
pect the disease, which consists in removing a small portion of the 
biceps or deltoid muscle and submitting it to a microscopic examina- 
tion. Welker, of Halle, thought an examination of the under sur- 
face of the tongue, with a convex lens, would reveal the presence of 
the parasite, and Kiiclienmeister hoped to be able to see them under 
the mucous membrane covering the gums, but their attempts to do 
away with the more painful, but more certain, proceeding of removing 
a small portion of the muscle for examination, have not been attended 
with success.* 
The medical treatment of trichinosis presents two indications: 
First, the prevention of the infection of the muscular system; and, 
second, the cure of the disease after attempts to avert it have not been 
successful. 
Circumstances rarely afford an opportunity to act immediately 
after the ingestion of the infecced meat, for, usually, the patient him- 
self does not know his own danger. If, however, we should discover 
that such meat had been swallowed, and had reason to think, from 
the lapse of time, that it still remained in the stomach, a free 
recourse to emetics should at once be made. 
If the trichinae are in the intestines, we must resort to purgatives, 
and, probably, the best agent would be castor oil, which serves the 
double purpose of destroying the parasite by closing its pores and 
evacuating the alimentary canal. 
Many physicians associate vermifuges with purgatives, and san- 
tonine, etherial extract of male fern, pomegranate rind, kousso, etc., 
have been used. Kiiclienmeister recommends calomel and jalap, fol- 
* This is done by means of a peculiarly formed trocar and canula. The trocar has 
a piece filed out near the point in such a manner as to form a barb, and the canula is 
cut short, so as to be drawn far enough back to expose this notch in the trocar. The 
instrument when used is introduced through the skin into the muscle to be examined, 
and then the canula is drawn back sufficiently to expose the barbed point. A rotary 
movement being given to the trocar, a small portion of the muscle is torn off and 
drawn back into the canula, and after withdrawing the instrument a few muscular 
fibres will be found retained in the notch cut in the trocar, which may be submitted 
to microscopic examination. 14 
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lowed the next day by powder of jalap and powder of male fern, 
until the patient has at least six or seven liquid stools. Many other 
remedies have been tried, as camphor, bichloride of mercury, sulphur, 
phosphorus, arsenic, chloroform, alcohol, salt, etc., etc., and all of 
them have failed. Finally, MM. Leuckart and Mosler called medi- 
cal attention to benzine, which they considered to be really efficacious. 
Rodet repeated their experiments, obtaining, as he thought, a 
remarkably good result, but he afterward failed, in repeating his 
experiments upon a rabbit. 
Dr. Friedreich claimed that the picronitrate of potassa was a 
certain remedy against trichinosis, but in direct experiments upon 
animals, he found that this remedy, even in large doses, neither killed 
the .trichinae in the intestines nor in the muscles, and besides it 
exerted a poisonous influence upon the animals to whom it was 
administered. 
Notwithstanding the various remedies employed, we must acknowl- 
edge that as yet no very marked success has been obtained, and this 
fact may be due to the remarkable vitality of the trichina as well as 
to its extreme tenuity, which enables it to avoid direct contact with 
the medicines by concealing itself in the folds of the mucous mem- 
brane. The immense fecundity of this entozoon will also explain 
how the escape of a few adults from destruction in the intestine may 
allow of the birth of thousands of embryos. 
In the present state of our knowledge, we can therefore consider 
the preventative measures as the only efficacious means to be em- 
ployed against the disease. 
We cannot judge from the appearance or the history of a living 
hog, whether it contains trichinae or not, for many cases are on 
record where these animals have been carefully raised upon good food 
and under strict surveillance and have never been observed to be 
sick, and yet their muscles have been found studded with trichinae. 
In December, 1863, the authorities of the city of Brunswick made 
the microscopic examination of pork obligatory, and appointed cer- 
tain physicians to attend to it. Between December, 1863, and 
December, 1865, 30,000 hogs were examined, and only two cases of 
the disease were found among them. In the city of Blankenbourg, 
however, four cases were found among seven hundred hogs examined. 
In Saxony the proportion was still greater, and in a little village near 
Iledersleben three cases of trichinous hogs were discovered within a 
very short space of time. 
Many persons are now of the opinion that they must abstain 
entirely from pork in order to avoid danger, but this is an exaggera- 
tion, and the only thing which it is necessary to proscribe is raw pork. New York State Medical Society. 
15 
By experiment it has been found that a temperature of 212° is 
fatal to the trichina, but in order that the interior of a large piece of 
meat should attain this degree of heat, it must be submitted to a 
thorough process of boiling, roasting or frying as the case may be, 
since it very often happens that the meat appears externally well 
cooked while the interior is almost raw. 
Salting or smoking pork, unless very complete, do not destroy the 
entozoa, and Leuckart has observed the trichina to resist exposure to 
cold as low as 13° F. 
From the above it is evident that as a rule it is not entirely safe to 
depend simply upon curing or cooking pork to prevent danger in 
eating it, and the butchers in Germany, seeing that their business 
wras liable to suffer, began themselves to take measures to calm 
public inquietude. In several cities, the butchers formed associations 
for the purpose of examining the pork and insuring one another 
against losses. In order to avoid all attempts at fraud, they fixed 
the value of the animal according to its weight, and added about one 
cent a pound to the current market price, and if any butcher found 
that he had a trichinous hog in his possession, he received from the 
association the full value of the animal, besides a premium of fifty 
thalers. 
In other parts of Germany, where the examination of each hog 
was enforced by the authorities, the butchers formed companies for 
the purpose of insuring one another against losses. 
The following official communication will serve as an example of 
the manner in which they should be worded, and the strictness with 
which they should be enforced. 
OuDINANCES AND PUBLICATIONS OF THE AUTHORITIES OF THE 
Province of Magdebourg. 
Police Ordinances. 
In order to avoid the injurious effects resulting from eating trichin- 
ous pork, uporl human life and health, we order, in virtue of the law 
regulating the police administration, dated March 11, 1850, through- 
out our jurisdiction, as follows : 
1. Whoever slaughters a hog, or causes one to be slaughtered, is 
obliged to have it microscopically examined by an expert appointed 
by the authorities for this purpose; and it will only be after a cer- 
tificate shall have been given by the expert that he has found that 
the pork contains no trichinae, that the flesh can be sold or pre- 
pared for human food. Whoever disobeys this law is liable to a fine 
of from five to ten thalers. 16 
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2. When a hog is found to be trichinous, the expert should at once 
inform the local police. 
Every part of a trichinous hog should at once he destroyed, under 
penalty of a fine of ten thalers; and, for this purpose, should be 
delivered to the Knacker (equarrisseur), who is obliged to bury them 
according to the law, in default of which he is fined ten thalers. 
Besides, those who not having obeyed the orders above mentioned, 
shall have been the cause of the trichinous meat being sold, and of 
its use as food having injured the health of a human being, or even 
produced his death, will be prosecuted before the tribunals and 
punished according to the penal code. 
Explanation of Plate. 
Fig. 1.— The anterior third of an adult female trichina, with embryos. Obtained 
from the small intestine of a rabit four days after the ingestion of a piece of 
trichinous human flesh. 
Fig. 2.— A portion of human muscle, containing a number of recently encysted tri- 
chinae. 
Fig. 3.— A muscular trichina, preparatory to its becoming encysted. 
Fig. 4.— An old .encysted trichina. The cyst undergoing calcareous degeneration. 
Fig. 5.— An old cyst, which, having undergone complete calcareous degeneration, is 
now breaking up, preparatory to its final destruction. 
Note.— The above figures are lithographed from microscopic photographs of speci- 
mens which are now in my possession. 
E. R. HUN.