Trichinosis : a clinical study of fifty-two sporadic cases / by W. Gilman Thompson.

  • Thompson, W. Gilman (William Gilman), 1856-1927.
Date:
1910
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Licence: In copyright

Credit: Trichinosis : a clinical study of fifty-two sporadic cases / by W. Gilman Thompson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the course of the fever. The question is obscure and experimental evidence is much needed to elucidate it. Some of the tapeworms, notably Dibothriocephalus latus are known to generate specific toxins causing anemia, yet their eosinophilic response is much less than that of trichinosis. In a case of this sort which I have else- where reported,10 the eosinophilia never exceeded 9 per cent., although a condition of pernicious anemia was produced, of extraordinary degree. Von Leube17 states that it is impossible to distinguish polymyositis from trichinosis in many cases without examination of excised muscle, and Hepp,18 in an early account of polymyositis, referred to it as “ Pseudo-trichinose,” but in the light of recent study the diag- nosis ought not to be so difficult even without excision of muscle, for in polymyositis eosinophilia is lacking, as well as the eye pains, marked headache, puffiness of the eyelids, vomiting and peculiar dyspnoea, which characterize all the more severe cases of trichinosis. Apart from polymyositis, those diseases for which trichinosis is most often mistaken are typhoid fever, paratyphoid fever, septicemia, acute rheumatic fever, estivo-autumnal fever, multiple neuritis, and acute poliomyelitis. The temperature charts of cases of trichinosis very often closely resemble typical charts of typhoid fever in the third and fourth week, and the headache and occasional epistaxis may be confusing, but in trichinosis the patient is usually proportionately less ill and lacks the nervous phenomena of typhoid fever. Moreover, the onset of trichinosis is more acute, with vomiting and muscular pains and cramps. The two diseases may, however, co-exist, as they did in the original case of Zenker, which led him to discover the trichinae in a routine examination for degenerated muscle fibers in a patient who had died from typhoid fever. Fischer19 and MacCrae20 have each reported a case of combined trichinosis and typhoid infection. Exceptionally, the trichinosis charts may resemble the markedly remittent temperature curve of septicemia or of a estivo-autumnal fever with chills and sweats, but a thorough examination of the blood in all such cases ought to resolve all doubt. Occasionally, in trichinosis there is swelling about such major joints as the knees and ankles, and this, with the pain caused by voluntary movement and sweating, may give rise to an erroneous diagnosis of rheumatism. I have lately seen a case which had been mistaken for rheumatism for a week, owing to such symptoms, and the fact that the patient a year before had had a typical acute artic- ular rheumatism. The hemorrhages into the cornea led me to suspect the presence of trichinosis, and the latter diagnosis was 18 Med. News, April 8, 1905. 17 Medical Diagnosis. 18 Berl. kin. Woch., 1887, xxiv, 297-322. 19 Deut. med. Woch., 1898, xxiv, 821. 10 Amer. Jour. Med. Sci., 1902, cxxiv, 56.