TRICHINOSIS. 735 



ach, or remained there, and that consequently the development of the 

 intestinal trichinae and their passage through the walls have only slightly 

 interfered with the functions of the stomach and intestines, while suc- 

 cessive broods and repeated emigrations of young trichinae have filled 

 the muscles with the parasites. It is difficult to explain the occasional 

 sudden change of insidious trichinosis into dangerous forms, unless it 

 be due to an extensive emigration of a new generation of trichinae into 

 the respiratory muscles. 



This insidious commencement of the disease, with its total absence 

 of gastric disturbance, is in striking contrast with the very trouble- 

 some intestinal symptoms observed at the commencement of some 

 cases. The first cases in the famous Hederleben epidemic were re- 

 garded as cholera, because the patients were attacked with severe 

 vomiting and purging, which could not be checked. Three of them 

 died on the sixth day of the disease, with the symptoms of paralysis 

 and thickening of the blood. For the diagnosis between " trichinous 

 cholera " and Asiatic cholera, and cholera morbus, Kratz and Ruprecht 

 lay particular stress on the peculiar stretching, muscular pain, which is 

 located chiefly in the flexors of the extremities, and is increased both 

 by movement and pressure. The commencement of trichinosis with 

 cholera symptoms, which is not frequent, shows that an unusually 

 large number of living trichinae have reached the stomach, and that 

 consequently the gastric and intestinal walls have suffered more than 

 usually. This idea is supported by the fact that cholera symptoms 

 have hitherto been observed only in cases of poisoning with raw meat. 



The absence of all intestinal symptoms, as well as severe attacks 

 of vomiting and purging, is only exceptionally observed after the use 

 of trichinous flesh. Far the greater number of patients complain in a 

 few hours, or not till a few days after the poisoning, when the young 

 brood has been hatched, of severe pressure in the stomach, of eructa- 

 tion and nausea, combined with a feeling of great heaviness and de- 

 pression. There is almost always diarrhoea, the passages being at first 

 brownish, subsequently yellow, thin, and accompanied by more or less 

 severe colicky pain. These gastric symptoms are soon accompanied by 

 those of the entrance of the trichinae into the muscles, vague pains, and 

 a feeling of stiffness, as well as a peculiar oedema of the face affecting 

 chiefly the eyelids, in which the conjunctiva also participates occasion- 

 ally, so that there is chemosis. The movements of the patient are 

 now sometimes very much impaired, partly because their muscles be- 

 come more rigid and less supple, partly because every attempt to 

 stretch them is very painful. The different muscles swell considerably, 

 become tense and as hard as caoutchouc, just as in the rigor mortis. 

 According to Cohnheirrfs description, in severe cases the constant and 



