368 TRICHINOSIS 



patellar tendon reflex ma}' be absent. The patients are 

 usually conscious, except in cases of very intense infestion in 

 which delirium, dry tongue, and tremors give a picture similar 

 to that of typhoid fever. In addition to the dyspnea present 

 in most cases, there may be bronchitis, and in the fatal cases 

 pneumonia or pleurisy. In some epidemics polyuria has been 

 a common symptom. Albuminuria is frequent. 



The intensity and duration of the symptoms depend en- 

 tirely upon the grade of infestion. In mild cases recovery is 

 complete in from ten to fourteen days. In severe forms con- 

 valescence is not established for from six to eight weeks, and 

 it ma}' be months before the patient recovers the muscular 

 strength. One case in the Hedersleben epidemic was weak 

 eight years after the attack. 



Of 72 fatal cases in the Hedersleben epidemic the greatest 

 mortality occurred in the fourth, fifth and sixth weeks ; namel}?, 

 52 cases. Two died in the second week with severe choleraic 

 symptoms. The mortality has ranged in different outbreaks 

 from one or two per cent to thirty per cent. 



The anatomical changes are said to be chiefly in the 

 voluntary muscles. In the early stages the muscles look 

 normal, but in the fourth or fifth week grayish-white areas 

 appear in which the muscle fibers are extensivel}' degenerated 

 Bnd in the neighborhood of the trichinella there is an acute 

 interstitial myositosis. Cohnheim has described a fatty degen- 

 eration of the liver and enlargement of the mesenteric glands. 

 At the time of death in the fourth or fifth week or later the 

 adult trichinella are still found in the intestines. 



The prognosis depends upon the quantit}' of infested meat 

 which has been eaten and the number of trichinella which 

 mature in the intestines. In children the outlook is more 

 favorable. Earl}' diarrhoea and moderately intense gastro- 

 intestinal symptoms are, as a rule, more favorable than con- 

 stipation. 



§ 298. Diagnosis. The disease should always be sus- 

 pected when a large birthday party or Fest among Germans is 

 followed by cases of apparent typhoid fever. The parasites may 

 be found in the remnants of the ham or sausages used on that 



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