NEMATODA, THREAD-WORMS 557 



mal is extraordinarily slow. This is markedly different from the temperature 

 course of enteric fever. In mild cases, even during the third week, the temper- 

 ature falls to normal, while severe cases continue to show a febrile range from 

 four to seven weeks. The pulse frequency corresponds to the height of the 

 fever. 



In the course of the second week, edema of the face, particularly of the 

 eyelids, is characteristic. After several days this may disappear, but it often 

 returns in the later stages. The affection of the muscles is accompanied by 

 marked edema; the genital region often remains free. 



Usually from the ninth or tenth day — sometimes earlier or later — with the 

 entrance of the embryo into the muscles, symptoms occur there. The affected 

 muscles are tensely swollen, as hard as wood, and very sensitive to touch or 

 pressure. In mild cases only the sensation of painful tension is felt, and the 

 patients are still able to walk about. In severe cases the slightest movement 

 is accompanied by the most intense pain; locomotion and standing are im- 

 ■ possible. As a rule, the muscles of the extremities and particularly the flexors 

 are the most painful. Injorder to relax their muscles as much as possible the 

 severe cases assume a characteristic position : Permanent dorsal decubitus with 

 an acute angle contracture in the shoulder, elbow and wrist joint; stiffness 

 and muscular rigidity are observed in the masseters, in the muscles of the 

 neck and of the upper extremities. Implication of the muscles of deglutition 

 and of the tongue often causes great difficulty in swallowing. Hoarseness and 

 aphonia result from the involvement of the muscles of the larynx; and in 

 severe cases pain in the muscles of the eye is rarely absent. The mobility of 

 the eye-balls is affected, and this gives to the face a conspicuously rigid appear- 

 ance. In severe cases, the masses of trichinae cause difficulty in respiration; 

 extreme dyspneic conditions may develop with very severe asthmatic attacks, 

 and may be a direct cause of death. 



Even at the beginning of the second week Kratz noted inactivity of the 

 diaphragm upon inspiration. The condition noted by Askanazy is very inter- 

 .esting. This author found under the pleura pulmonalis and in the lung sev- 

 eral disseminated red flakes or points which closely resembled the punctiform 

 ecchymoses upon the human pleura. These were demonstrated to be young 

 trichinee which had formed emboli. 



Changes in the skin are not rare. Besides edema, pruritus, measle-like 

 exanthems, and in the later stages acne, furunculosis, herpes, etc., appear. 

 The sweats which occur in the mild as well as the severe cases are particularly 

 .annoying. Desquamation of the skin takes place in convalescence. Formica- 

 -tion and cutaneous anesthesia have been observed in isolated cases. 



Stubborn bronchial catarrh develops early. In the later stages hypostatic 

 -and catarrhal pulmonary inflammations occur. In debilitated patients these 

 not infrequently cause death. 



In general there are no characteristic changes in the cardiac activity. In 

 severe cases and in the later course of the affection thromboses develop, par- 

 ticularly in the lower extremities. The appearance of decided leukocytosis with 

 a conspicuous increase of the eosinophiles, which show an increase of from 

 30 per cent, to 60 per cent., is interesting. This demonstration has repeatedly 



