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into good physical condition, and keep it at that point all the time. It would be
tedious and useless to describe to an intelligent audience all the various kinds of
exercise, and the means of inducing the great variety of patients to utilize them >
there is one plain rule that you may work on, and that is : Never use force to
obtain the end in view; do precisely as you would with a child that you expect to
educate by the humane and reasoning method; persuade, reason, induce by well-
kept promises of reward — anything but lying or force.

Food, combined with enough exercise, are twin influences to supply the brain
with the good blood which is the requisite of every well-working mind. The great
drawback to hospital treatment of insane persons is that they have either too little
food and too much exercise, or— what is more frequently the case in America — too
much food and a lack of suf&clent exercise. Amusements of a kind to give mild
muscular action, free from too great excitemeat, are to be commended. Balls,
concerts, and theatrical entertainments can be indulged in by some to their benefit,
but to the great majority are not well adapted. In the acute stages of certain
forms of insanity, the patient raves, swears and struggles to get up, out and away,
and, as far as may be possible, he should be indulged in his fancy ; a patient with
a red face and congested eyes is the better for being on his feet, thus distributing
the circulation to the extremities, than by struggling to get free from the horizontal
position, in which he must be held by mechanical force ; the exercise and the diet
of such cases, as well as all medication, is of course supposed to be under the direc-
tion of a skillful physiciad.

With the chronic and apathetic insane, the difficulty is to arouse them to ac-
tion, and will tax the ingenuity of the attendant to the utmost. With the chronic
insane, one of the most popular errors is to utterly abandon them to a life of men-
tal neglect. I do not believe there are ten in a hundred of this class who could not
be taught some useful, and to them entertaining, occupation. A man may have
lost his ability to appreciate the society of friends, and hold the most absurd delu-
sions — he may have forgotten all he had learned, and yet be taught some pleasing
and valuable mechanical employment. The former teacher, lawyer or physician
may have lost all remembrance of his profession, and yet he may become a good
workman in the greenhouse, on the farm, or in the shop ; and many a mechanic
may have lost the ability to perform his usual labor, and, I doubt not, might be-
come, under some conditions, quite proficient in law or medicine.

The moral treatment of the insane is one of the most important. It is a kind
of treatment that can not be given in ^^ broken doses," but must be constantly in
force ; it should be administered by every one coming in contact with the patient;
no harsh word, no unkind insinuation, no reference to the sad condition of the in-
dividual should ever be made in his or her presence.

The greatest drawback to the domestic treatment of the insane is the paramount
egotism which usually characterizes them ; and when they are in their own homes,
the extreme and overbearing manner to all who have formerly been under their



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DOMESTIC OARE OF THE INSANE. 255

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control, and the absolute authority they assume, makes home treatment far more

difficult than hospital management. In such cases the best thing for the patient
will be to go OB a journey of some kind, or make a visit to some one much loved
or respected. Frequently we obtain the best results from having the patient sur-
rounded by strangers, before whom most perfect self-control will be used.

As to the influence of religious exercises, or any kind of religious instruction,
1 do not think that in the majority of cases any harm will arise, but, on the con-
trary, some good may be expected. The influence of the religious sentiment in the
human mind is, as a rule, more powerful for good than evil, and should be culti-
vated as a curative measure rather than to be avoided ap. a disturbing element. I
have not been able to find any person who has gone mad because of religion, but
many become religious in a popular sense because they are insane. Such persons,
under what is called religious excitement, give vent to their thoughts in mingled
prayers, blasphemies, ravings, and most obsct-ne utterances. The typical religious
* crank," so well-known in this country, is not a "crank" because he is religious,
neither did religion make him a " crank." You may put it down as a rule that
more mad people become religious (using that term in its phenomenal sense) than
religionists go mad. In selecting the form of religious instruction, I would suggest
that it be of the most gentle, soothing kind, free from the rant and stage effect
which so frequently mars the true spirit of sacred teaching. Music, either vocal
or instrumental, has a most soothing effect, and can be utilized with benefit in most
violent cases of insanity ; reading and story-telling has the same charm on many
of the insane as for children.

All that I have said pertains to generalities, for the endless variety of cases one
would have to deal with, if special treatment were described, would require the
whole life history of each patient.

I will call your attention to another important point, upon which much of the
saccess of domestic treatment will depend — and that is, to have no manifestation
of fear when dealing with the insane. No class of persons so readily perceive
their power, or so gladly use it. If they observe that you fear them, they are
stimulated to do the most outrageous things, and it is better that they be commit-
ted to an asylum or hospital than to be surrounded by those who manifest fear.

I submit to your consideration a few rules, which are used in most establish-
ments for the treatment of the insane, and which have the same import in the
management of those who are kept at home :

Treat the patient with uniform attention and respect. Greet with friendly
terms and salutifcionp, and exhibit such other marks of kindness and good will as
evince an interest and sympathy. Speak in a mild and persuasive tone of voice,
and never address the patient coarsely or by nickname.

Never speak in a loud or authoritative, scolding voice, nor in w^ excited nor
threatening manner.

Never ridicule, mock, taunt, or otherwise irritate or provoke a patient. Never
stimulate them to manifest the peculiarities of their infirmity to gratify the curi-
osity of others.

Never interrupt a patient who may be making statements regarding yourself to
others, no matter how false or absurd it may be.

Never strike, choke, pinch, or use any unnecessary force in handling such pa-
tients as may require restraint. No sort of punishment can be regarded as an ele-
ment of treatment.



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256 STATE BOARD OF HEALTH.

_

Never put handcafis, anklets, or any kind of restraining apparatus upon a
patient — no matter how vioknt he may be ; it has a tendency to degrade him, and
there is great danger of doing serious injury to the limbs or internal organs.

Verily, " the sense of oppression maketh a man mad." So sayeth the preacher.
In this connection 1 would call your attention to the very common error of trying
to hold or restrain persons who are suffering from epileptic or other convulsions.
It is the greatest cruelty that can be perpetrated upon the afflicted one. To lay
hands upon, or to even touch, a person who is suffering from hydrophobia or pois-
oning by strychnine, is of itself sufficient cause to throw him into most violent
convulsions. This rule holds good in every form of spasmodic action. Remem-
ber, too, that mental spasms, if I may use the expression, may be excited by mus-
cular irritation. It is for this reason that I would abolish every kind of mechan-
ical restraint from every hospital for the insane in America, as I am convinced
that it is of itself a source of excitation of the graver forms of permanent mental
alienation, and retards the recovery of all those subjected to it.

The question as to what class of cases would be better, or as well, taken care of
at home or under domestic treatment, is somewhat an open one, for we have to
consider that it is as yet a matter of experiment. I have no doubt in my own
mind that there are thousands of the chronic, harmless insane kept in the wards
of hospitals who would be happier and, tO some extent, useful at home, or upon
board in the country if their friends do not like to have them seen at their own
domiciles. ' The majority of the hospitals swarm with a variety of inmates who sit
idly against bare walls in dismal wards, year after year, fed and watered like cat-
tle, waiting simply to die. The acute stage of their disease having passed, they are
classed as incurable, and their life ends, so far as any further usefulness goes. I
believe, too, that the inducement held out by a too indulgent State government,* al-
most begging persons to come in and live free upon her bounty, is having a bane-
ful influence upon the American people, and induces a condition akin to that which
pauperizes Europe — that of expecting the State to take care of the citizen at pub-
lic charge. The gradual obliteration of that sensitiveness — once the pride of the
independent — is what causes our free benevolent institutions to be filled to over-
flowing, and causes an apparent increase of insanity, that does not in reality exist.
This I deem largely a matter of culture, and culture of a bad tendency. Fifty
jears ago it was difficult to get even the acute and dangerous class of insane to
come to the hospital, so loath were their friends to partake of public assistance.
Since that period there has been a large emigration of the lower classes of Europe,
who have in their own country been constant recipients of charit^of a public kind.
They have no sensitiveness to overcome, and find but too ready a refuge in our asy-
lums for any that are not quite able to take care of themselves, or are too indolent
to do so — i0is such an easy thing to shift the disagreeable incumbrances upon the
State.

This is going to the other extceme, and foists useless burdens on the tax-payers,
and breeds a dependtnce in the hearts of the people that is unworthy the high
standing we have held as a free and independent nation.

There is about as much reason for the State to take charge of and treat the
chronic consumptive as it has the chronic insane who are of the harmless kind-
When the day comes that we have a better understanding of this matter, and quit
building palaces, and offering inducements for persons to fill them free of charge,
we will behold a wonderful decrease of insanity. Then, instead of having a little
more than one in five hundred, we will see the ratio fall back to the old standard
^ one in about twelve hundred.



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DOMESTIC CARE OF THE IISSANE. 257

While I thus think that the harmless chronic lunatic may be easily kept, and
to an advantage to himself, it is quite uncertain as to the acute cases. With the
acute, the chances are that they will be much better off if sent early to a place
where such cases are constantly being treated. This is particularly the case if the
one is of violent disposition, or inclined to escape. This class may be cared for
•quite well, if their financial standing is such that they can command the constant
•attention of well qualified nurses without being sent to hospital or retreat.

In conclusion, let me assure you that the good work to be done in this special
•field is new and vast; the same good rules and principles that have been taught you
pertaining to the general care of the sick, will stand you in good stead in the do-
mestic care of the insane. I do assure you that no more interesting "study will ever
be presented to our inyestigation.

There is something sacred about insanity — the traditions of every country agree
in flinging a halo of mysterious distinction around the unhappy mortal, stricken
with so sad and lonely disease. The poet who has most studied from nature — the
immortal Shakespere — has never made our souls thrill with more intense sympathy
ithan when the personages brought before us were bereft of reason. The gray hairs
•of King Lear are silvered o'er with additional veneration when he raves, and the
•wild flower of insanity is the tenderest that decks th^ pure garland of Ophelia.
To contemplate what was once great and resplendent in the eyes of man, slowly
anouldering in decay, has never been an unprofitable exercise of thought, and to
muse on reason itself prostrate, can not fail to teach us our complete dependency.

With all the fastidiotis pride of fancied superiority, and in the full plenitude
•of our undimmed reason, we can not face the breathing ruin of a noble intellect un-
•dismayed. The broken sounds, the vague intensity of that gaze, those whisperings
Jthat seem to commune with the world of spirits, the play of those features still im-
pressed with the signet of immortality — though illegible to our eyes — strikes us
•with that awe which the obelisk of the desert, with its insculptured riddles, in-
Hspires into the Arab shepherd.

If to dwell among ruins and amid sepulchers, to explore the pillared grandeur
•of the tenantless Palmyra, or the crumbling wreck of a Roman Amphitheater once
manned with applauding thousands and rife with joy, now overgrown with shrubs
and haunted by the owl — if to soliloquise in the valley where autumnal leaves are
thickly strewn, ever reminding us by their rustle as we tread the path " that all
that's bright must fade " — if these things beget the mode of soul in which the sug-
gestions of Heaven find radical adoption — how forcibly must the wreck of mind
itself, and the mournful aberration of that faculty by which most we assimilate
to our Maker, humble our self-sufficiency and bend down our spirit in adoration.



17— Bd. Health.



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258 STATE BOARD OF HEALTH.



Newcastle, Ind., January, 1885.
E, S. Elder J M. D., Secretary of Indiana State Board of Health :

Dear Sir — In pursuance of the request of the State Board of Health, commu-
nicated to me by you, I undertook, on the 15th of October last, the examination of
five hundred Indiana hogs, with a view to determine how extensively they might
be infected with trichinae, and to prepare a report upon the subject of trichinae
and trichinosis.

I have been able to give only evenings and odd moments to the work, being-
engaged in the active duties of my profession ; hence, the labor has been performed
under pressure for want of time, but has been as thoroughly performed as possible
within the limited time given to me.

I herewith present to you my report, which embraces not only the work done-
since the time I entered upon this work for the State Board, but also much previous
study and investigation in the same direction.

I hope the work may result in good to the cause of public sanitation.
With respect, I am yours, truly,

T. B Redding.



TRICHINA SPIRALIS AND TRICHINOSIS, INCLUDING AN EXAMINA-
TION OF INDIANA HOGS.



PREPARED UNDER THE DIRECTION OF THE INDIANA STATE BOARD OF HEALTH

BY THOMAS B. REDDING, A. M., PH. D., FELLOW OF THE

ROYAL MICROSCOPICAL SOCIETY, ETC..



1884—1885.

In presenting this report, I have the pleasure of acknowledging my indebted-
ness, for many of the facts and thoughts contained therein, to the valuable and
exhaustive report of the late W. C. W. Glazier, M. D., Assistant Surgeon, Marine
Hospital Service, on " Tricbnae and Trichinosis." — 1881, prepared under the direc-
tion of the United States Marine Hospital Service ; and also the excellent work of
M. Joannes Chatin, entitled " La Trichine et la Trichinose,"— 1883, J. B. BailliSre-
et Filfl, Paris ; Also to the works of Leuckart, Cobbold, Pagenstecher, Gerlach
and others.

I also tender thanks to Messrs. Kingan & Co., of Indianapolis ; Messrs. Baldwin
& Roberts, of Newcastle, and Messrs. Collins and Welch, of the same place, for
favors shown in furnishing specimens of pork ; also to Dr. E. S. Elder, and others^
for use of valuable books.

INPORTANCE OF SUBJECT — INTRODUCTION.

" My people are destroyed for lack of knowledge." — [Hosea iv, 6.

"Therefore shall the land mourn and every one that dwelleth therein shall
languish with the beasts of the field, and with the fowls of Heaven ; yea, even the
fishes of the sea shall be taken away."— [Hosea iv, 2.



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TRICHINA SPIRALIS AND TRICHINOSIS. 259



These prophetic words of Rosea, though spoken of a different subject, are as
true to-day, when applied to the lack of the peoples' knowledge of sanitary laws, as
when uttered by Hosea more than two thousand five hundred years ago. The cat-
tle are dying of anthrax, tuberculosis, Texas fever and other preventable diseases ;
hogs are dying of cholera and trichinae ; sheep are infected with strongylus and
numerous parasites, that proper knowledge, rightly applied, would prevent; our
chickens and turkeys are dying of cholera and other diseases ; even the fish of our
rivers and seas are being poisoned by the filth poured into them by men, while men
are dying of small-pox, malaria, cholera, trichinosis and many other "preventable
diseases; and the children are being slaughtered by the millions, while they ought
to live to be old men and women, so that it might be said of our land :

"There shall yet old men and old women dwell in Jerusalem, and ^very man
with his staff in his hand for very age, and the streets of the city shall be full of
boys and girls playing in the streets thereof." — [Zech. viii, 4, 5.

That the people are destroyed for lack of knowledge is alarmingly true! Many
thousand perish every year for the want of knowledge within easy reach, yet the
mass of humanity lives on in willing ignorance, without an effort to know how to
live well and long.

A large per cent, of diseases come to man through the use of poisonous, diseased
and parasite-infected foods, and from poisonous, disease-infected water and drinks.

It is part of the work of sanitarians and Boards of Health to awaken people out
of this sleep of death ; to stimulate them to know themselves and their food ; to
choose the good and reject the bad.

One of the most distressing and fatal diseases, resulting from the use of un-
healthy food, is trichinosis, infection with trichinae^ a disease that can be infallibly
guarded against, if we have the knowledge to do so, and fortunately that knowl-
edge is easily obtained. This disease has swept its thousands into the grave pre-
maturely through intense agony and suffering, all for the lack of knowledge and
inspection. There need never be another case of trichinosis, if the world will only
look and see, or know and do. The rejection of all trichina-infected meats, or their
thorough cooking will absolutely protect from and prevent trichinosis; but the
thorough cooking, while it will kill the parasite, will not render the food as healthy
as it should be for human use.

The attitude of Germany, France, Italy, and other foreign nations toward the
American hog, and their refusal to give him a passport lo their markets and the
stomachs of their people, has touched our American people in a very tender place —
the pocketbook — and far more interest has been awakened in the subject of trichinae
by this unfavorable action of foreign governments than from interests of health or
sanitation.

It has been repeatedly charged by many foreign scientists and investigators,
that American hogs are more generally infected with trichinae than those of any
other country. Our American investigators and scientists are not able to confirm or
deny this charge for lack of suflScient observation. Very few examinations have
been made in this country, and before this question can be settled there must be
systematic inspection, embracing our entire country and a large number of hogs.

Not only do the interests of health and the preservation of human life demand
this, but the vast commercial interests involved in our pork raising makes it less,
but forcibly imperative.

Not far from forty million hogs are annually produced in our country, of which
about three and a quarter millions are produced in Indiana. If these forty million
hogs average two hundred pounds each, we shall have a total of eight thousand



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260 STATE BOARD OF HEALTH.



million pounds. If 2 per cent, of these, probably a very low estimate, be infected
with trichinae, we shall have one hundred and sixty million pounds of infected
pork, every pound of which is capable of producing death in the consumer.

if it be true that our meats are thus infected, we have no right to complain of
our uninspected pork being excluded from foreign markets. It will be wiser, far
more humane, and honorable, to provide that poison meats shall neither be shipped
to foreign ports, nor sold to our own citizens in. our home markets; that every hog^
shall be inspected before going upon the market. The extreme limit of cost for a
thorough inspection for trichinie need not, in any case, exceed the one-tenth of one
cent per pound, or twenty cents per hog, and can probably be done for less than
one-fouiUh of this sum — a very small expense compared with the safety secured at
home and the advantage of the freedom of foreign markets*

But the advantage of proper inspection, investigation and oversight, in this di-
rection, will not only conduce to the health and safety of our own people, and open
to us the 'markets of the world, but will increase largely the demand for American,
inspected meatn, and, at the same time, will enable and stimulate our farmers and
all persons interested in pork raising, to so feed, manage and handle their hogs as-
to reduce the infection to its lowest limit and, probably, ultimately to entirely
stamp it out of existence among us.

In order to present the subject of trichina and trichinosis so as to lead to a full
comprehension of its importance in every relation, I shall give, not only the results
of my examinations of Indiana hogs for trichinse, under direction of the State
Board of Health, but, also, a brief history of the discovery of the parasite; its-
natural history; a description of the proce ses of infection of men and animals;,
symptoms of the disease called trichinosis ; methods of prevention ; statistics of
epidemics, and of examinations ; methods of inspection and study, and a list of the
principal authorities upon the subject,

EXAMINATION OF INDIANA HOGS.

About ten years ago my attention was directed to the necessity for the examin-
ation of all pork used as food. Since that time I have not allowed any pork to be
used in my own family that was not first submitted to microscopical examination
for trichina spiralis. During that time, and up to October 15, 1884, I examined ia
all, probably as many as two hundred diflferent animals, but of most of these exam-
inations I kept no record. In this report I shall only include such examinations
as I made records of at the time. Since October 15, 1884, 1 have examined the
flesh of five hundred and fifty hogs.

I shall not give details of the several examinations made, further than is nec-
essary to present.the results, but can furnish them, if desired, at any time,

" In 1881 I examined twenty hogs and found trichinae in two, one of them ex-
ceedingly full; in 1882 I examined twenty-five and found but one that contained
any of the parasites. Last year I examined, at various times during the year,,
fifteen, and found one that contained trichinae; these were hogs that had been killed
and were sold on our market. I also, during the past winter, examined the mus-
cles of three hogs that had died and were left on the street a few days, and found
trichinae in each of them in great abundance ; they were fed in very dirty pens and
where rats greatly abounded." (216 p. 45.)

In nearly all cases I examined five sections from each hog. The section^ would
"average nearly three-quarters of an inch square, ai\d from the 1-100 of an inch to
1-150 of an inch in thickness. Many times I examined more than five sections to
the hog. The methods of examination are given elsewhere more fully.



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TRICHINA SPIRALIS AND TRICHINOSIS. 261

From October 15, 1884, to December 31, 1884, 1 examined the flesh of fifty-two*



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