Parasites of Muscular and Connective Tissue. 427 



with alternate chills and flashes of heat, perspiration and thirst. 

 Friedreich suggests that this is due to a poison elaborated by the 

 worm and set free by the removal of its capsule. 



These early symptoms have often been mi.staken for those of 

 typhoid fever, which is the more probable if red spots appear on 

 the skin. The number of victims, the history of the case, and 

 above all the presence of trichinga in the stools should correct 

 this mistake. 



The migration or muscular symptoms are noted from the 

 tenth to the fortieth day, and have been often mistaken for rheu- 

 matism. A rigidity of the abdominal muscles may be felt as early 

 as the eighth day, but that of the jaws, back and limbs beginning 

 about the thirteenth day is much more diagnostic. The muscles 

 are swollen, tender to movement or pressure, stiff, or rigid even 

 to a wooden hardness. There may be persistent tonic contraction 

 which clinches the jaws, holds the limbs rigidly semi-flexed, or 

 renders the breathing short and catching. The condition is to be 

 distinguished from rheumatism, by the fact that the joints and 

 tendinous sheaths escape, as well as by the history, the consump- 

 tion of raw pork, the early bowel symptoms, and the numbers 

 attacked . 



CEdema is a very common symptom beginning with the eyelids, 

 and affecting the face, extremities, scrotum, prepuce and other 

 parts. It may be slight or excessive, appearing as soon as the 

 seventh day and remitting on the twelfth to reappear later. It 

 may lead to chemosis, and may be attended by choked disc, or ex- 

 ophthalmos. Bleeding may occur from the nose, prepuce or 

 vulva. 



Hoarseness, and dyspnoea are not uncommon in connection 

 with invasion of the laryngeal muscles, oedema glottidis, or bron- 

 chial catarrh. Hypostatic pneumonia is occasionally seen. 



Skin eruptions, acne, boils or urticaria are frequent, and also 

 hypersesthesia, or itching as a sequel of the dropsy. 



The temperature usually rises (104° to 106°) but it may be 

 normal or subnormal. It is highest at night and the elevation 

 may last from four to seven weeks. 



Urine may be albuminous, and may be tinged by red blood 

 globules, or contain hyaline casts. 



Insomnia and headache attend on severe cases, and death may 

 be preceded by delirium, coma or collapse. 



