736 ACUTE INFECTIOUS DISEASES. 



characteristic position of the patient is as follows : " He lies on the 

 back with the shoulder and elbow-joints sharply bent, and the hands 

 slightly flexed ; on the other hand, the knee and hip joints are but 

 slightly bent, or nearly straight ; so that the patient is unable to lift 

 the arm, extend the forearm, sit up, or bend the knees." Cohnheim 

 explains this position correctly, by ascribing it to the patient's attempt 

 to assume a position where the different groups of muscles are the lease 

 extended ; with the swelling of the muscles there is cederna extending 

 from the arms toward the hands, from the thighs toward the feet, but 

 not affecting the scrotum or labia. Besides the above symptoms, from 

 the third to the fifth week of the disease, there are frequently attacks 

 of severe dyspnoea, which subside again in the sixth week ; they doubt- 

 less depend on trichinous disease of the respiratory muscles. Where 

 the disease attacks the muscles of the glottis, the voice is sometimes 

 lost ; sometimes affection of the masticatory muscles causes trismus ; 

 participation of the glossal and pharyngeal muscles induces impaired 

 movement of the tongue and dysphagia. Trichinosis is accompanied 

 by high fever, with slight morning remissions. Although this fever is 

 unmistakably not of zymotic origin, but depends on the extensive dis- 

 ease of the muscles, and is to be regarded as a symptomatic inflamma- 

 tory fever, it very closely resembles the fever observed in the course 

 of typhus and other infectious diseases, and occasionally the tempera- 

 ture curves can scarcely be distinguished from those of typhus. The 

 evening temperature sometimes reaches 106, that of the morning re- 

 mains somewhat lower. The bodily temperature does not become 

 normal for a long time, often not till the sixth or seventh week. The 

 frequency of the pulse corresponds with the temperature, and in severe 

 cases reaches 120 to 140 beats a minute. Copious perspiration, with 

 a miliary eruption, is somewhat characteristic of the fever accompany- 

 ing trichinosis. The constitutional influence of trichinous fever, the 

 effect that it has on the sensorium and other functions, is just the same 

 as that from great elevation of the bodily temperature in other dis- 

 eases. The pulse becomes small and weak, the thirst painful, the 

 tongue dry, the patients sink into apathy, or become delirious ; occa- 

 sionally there are twitching and trembling of small groups of muscles, 

 bed-sores over the sacrum, and with these symptoms the patients may 

 die of exhaustion. The usual symptoms of trichinosis are more or less 

 modified by the occurrence of extensive bronchitis, hypostasis, or 

 pneumonic infiltration; but the pneumonic infiltrations alone (which 

 are frequent) betray their presence by subjective as well as objective 

 symptoms, by piercing pain in the side, cough, dyspnoea, etc. If the 

 disease takes a favorable course, as not unfrequently happens in severe 

 cases, the muscles gradually become less rigid and painful, the bodih 



