NEMATODA, THREAD-WORMS 559 



the presence of a single trichina may be demonstrated only after a search 

 of hours. 



The PROGNOSIS cannot be determined in the early stages of the disease. 

 Severe, fulminant phenomena, especially on the part of the digestive appa- 

 ratus, are not necessarily followed by a severe course, as the diarrheal dis- 

 charges remove a portion of the infectious material. Cases which appear mild 

 at the onset may subsequently become very severe. After a course of three to 

 four weeks, those cases in which the patient retains a good appetite and the 

 ability to sleep, as well as the integrity of the respiratory organs and of the 

 heart, permit the hope of a favorable outcome. In children the prognosis is 

 more favorable than in adults from the onset. 



During the prevalence of epidemics, the diagnosis is more readily made 

 than in sporadic cases. 



Mild cases may simulate gastric catarrh and muscular rheumatism ; severe 

 cases resemble acute gastro-intestinal catarrh, and in their further course may 

 be looked upon as acute articular rheumatism. The edema, the painfulness 

 of the affected muscle groups, the impairment of respiration, are important 

 in diagnosis. The differentiation from acute progressive polymyositis is not 

 always easy. In doubtful cases it is well to search the dejecta, particularly 

 the intestinal mucus, for intestinal trichinae. In severer infections the tri- 

 chinae may certainly be determined by the excision of sinall portions of mus- 

 cle, which are best taken from the lower end of the biceps. Direct excision is 

 decidedly preferable to the formerly practised harpooning. 



The aim of the prophylaxis should be the prevention of trichinosis in the 

 pig. Stall feeding of swine gives in this respect a certain protection, espe- 

 cially if care is taken never to feed them with uncooked offal. In regions 

 where trichinosis frequently occurs a thorough inspection and radical destruc- 

 tion of meat containing trichinae should be obligatory. The keeping and fat- 

 tening of swine in slaughter-houses should be prohibited. 



Man is best protected from the disease by eating only thoroughly boiled 

 or well-fried pork. The most intense smoking or pickling will kill the para- 

 site, but these precautionary measures are not everywhere taken. There may 

 be exposure to infection, for example, upon a journey. The most important 

 ..preventive measure, therefore, is the erection of slaughter-houses and the 

 introduction of compulsory meat inspection. The microscopic demonstration 

 of muscle trichinae is not difiieult, and this may be carried out by thoroughly 

 competent meat inspectors. Absolute protection, naturally, cannot be con- 

 ferred by meat inspection if only a few muscle trichinae are present. It is 

 well, therefore, to carefully abstain from partaking of any but thoroughly 

 cooked or highly pickled or smoked pork. 



We are very rarely in a position to begin treatment soon after infection has 

 taken place, but, when this is possible, emetics and purgatives are advisable. 

 Theoretically, an attempt should be made to expel the infectious masses by the 

 -administration of castor oil, calomel, etc. Experimentally, it is true, no re- 

 markable results have followed this or any other method of treatment. Neither 

 potassium, nor sodium picronitrate, nor oil of turpentine, camala, extract of 

 male fern, glycerin, etc., has prevented infection. 



