SYMPTOMS 367 



§297. Symptoms. The ingestion of trichiiious flesh is 

 not necessarily followed by disease. When a limited number 

 of the encysted larvae are eaten, only a few embryos pass to 

 the muscles and may cause no symptoms. Well characterized 

 cases in the human subject present two groups of symptoms, 

 one referable to gastro-intestinal disturbances and the other to 

 the general infesting of the muscles. 



The following symptoms are described by Osier. In the 

 course of a few days after eating the infested meat there are 

 signs of gastro-intestinal disturbance, pain in the abdomen, 

 loss of appetite, vomiting and sometimes diarrhoea. The pre- 

 liminary symptoms, however, are by no means constant, and 

 in some of the large epidemics, cases have been observed in 

 which they have been absent. In other cases the gastro- 

 intestinal features have been marked from the outset, and the 

 attack has resembled cholera nostras. Pains in different parts 

 of the body, general debility and weakness have been noted 

 in some of the epidemic cases. 



The invasion symptoms develop between the seventh and 

 twelfth day, sometimes not until the end of the second week. 

 There is fever except in very mild cases. Chills are not com- 

 mon. The thermometer may register 102 or 104° F. and the 

 fever is usually remittent or intermittent. The migration of 

 the parasites in the muscles excites a more or less intense my- 

 ositis, which is characterized by pain on pressure and move- 

 ment and by swelling and tension of the muscles. The limbs 

 are placed in the position in which the muscles are in the least 

 tension. The involvment of the muscles of mastication and of 

 the larynx may cause difficulty in chewing and swallowing. 

 In severe cases the involvment of the diaphragm and intercos- 

 tal muscles may lead to intense dyspnea which sometimes 

 proves fatal. Oedema, a feature of great importance, may 

 appear early in the face. Later it develops in the extremeties 

 when the swelling and stiffness of the muscles are at their 

 height. Profuse sweats, tingling and itching of the skin, and 

 in some instances urticaria, have been described. The general 

 nutrition is much disturbed and the patient becomes emaciated 

 and often anaemic, particularly in protracted cases. The 



