SUPPLEMENT 679 



[anaemia] from trichocephaliasis, see p. 650). Infection in human 

 beings results from the eggs that have developed outside the body, 

 which probably reach the digestive tract on the hands soiled with dirt 

 or earth, or possibly through drinking water. (Moosbrugger 1 and 

 Kahane 2 mention in their cases that the children had an absolute 

 passion for earth-eating.) Possibly, too, patients reinfect themselves 

 anew, as an intermediate host is not necessary. 



The anterior part of the body of the parasite is usually fixed in the 

 mucous membrane, and according to Askanazy feeds on the blood 

 of its host. Moosbrugger, 1 Schuize, 3 Kahane, 2 Vix, 4 Girard 5 and 

 Blanchard 6 all found changes in the mucous membrane of the gut, 

 showing that the parasites had been in. the gut for a considerable 

 time. Kahane 2 had an opportunity of seeing at the Pasteur 

 Institute Trichocephali with the anterior part of the body penetrating 

 not only the mucosa but also deep into the muscularis of the gut 

 wall. From this mode of attachment to the wall it is easily under- 

 stood how Trichocephali, especially when they are numerous in the 

 gut, cause local irritation and inflammatory conditions consisting of 

 frequent attacks of diarrhoea, sometimes twenty times a day, lasting 

 for months, resisting all remedies, and often accompanied by colicky 

 pains and symptoms of peritonitis. The stools often have blood 

 mixed with the fluid, very glassy, jelly-like mucus, more or less 

 abundantly as in the cases of Moesasca, Moosbrugger, 1 Kahane, 2 

 Girard, 5 Poledne, 7 and Rippe. 8 Nausea and vomiting are rarer 

 symptoms. 



Diagnosis as a rule can only be made by microscopical examina- 

 tion of the stools ; together with the eggs, regular and beautifully 

 formed Charcot-Leyden crystals occur. 



The prognosis is unfavourable in severe infections, in slighter 

 cases, where only a few worms are present, the danger of important 

 symptoms is less. Treatment consists in administration per os of 

 vermicides and in local treatment of the large gut. A remedy which 

 was once much used was calomel, which is much lauded by Gibson 

 and given as follows : calomel o - c6 grm., rheum. 0*3 grm., tinct. ferri 

 sesquichlor. i'2 c.c., aq. dest.9O'o grm., six dessert-spoonfuls three times 

 daily. Rippe appears to have got no result from the use of this pre- 

 scription. Thymol, especially in conjunction with local treatment of 



1 Moosbrugger, Med. Corresp.-Bl. f. Wilrttemburg, 1890. 



2 Kahane, Korrespondenzbl. f. Schweiz. Aezte, 1907, viii. 



3 Schuize, Deutsch. med. Wochenschr., 1905. 



4 Vix, Zeitschr. f. Psychiat., xvii. 5 Girard, Anna!, d. rinst. Pasteur, 1901. 



6 Blanchard, Acad. de M6d., July 3, 1906. 



7 Poledne, Wien. med. Wochenschr : , 1906. 



s Rippe, St. Peter sb. med. Wochenschr., 1907. 



