VIII, B, 3 Crowell and Hammack: Intestinal Parasites 167 



The establishment of direct etiological relationship seems rather 

 arbitrary, and the pathological changes described by them do not 

 seem pathognomonic of trichuriasis. 



Among the very large number of appendices received from 

 the surgical clinic, 2 have been examined v^hich contained 

 Trichuris. The total number of cases examined is not given 

 for the reason that not all were opened before fixation. How- 

 ever, microscopic sections of none of the appendices showed 

 anything which led to the suspicion of the presence of Trichuris, 

 and in the two cases mentioned the presence of Trichuris would 

 not have been suspected from the sections made. 



CASE 1 



Trichuris in the vermiform appendix. — A 21-year-old Filipino was 

 admitted to the hospital v/ith symptoms pointing to disease of the appendix 

 and giving a history of two previous similar attacks within four months. 

 The symptoms were some pain over the region of the appendix, tenderness 

 on slight pressure, nausea, some vomiting, and slight rigidity. The tem- 

 perature was not above 38°. 6 C. before operation. He was in the hospital 

 for twenty-six days before operation; his leucocytes, which had ranged 

 from 12,600 to 14,800 per cubic millimeter of blood previous to this, 

 numbered 28,000 on the day of operation. At the operation the appendix 

 was removed, and it was noted that there were adhesions about the 

 intestines. The examination of the faeces previous to operation was un- 

 satisfactory, but 3 examinations at varying periods after operation showed 

 the presence of the ova of hookworm but none of Trichuris. 



When received at the laboratory the following record was made of 

 the appendix: "The specimen consists of an appendix which is 6 centi- 

 meters long and has some attached mesenteric fat. It is about 7 milli- 

 meters in diameter, and the vessels of the serosa are prominent. On 

 opening the appendix, it is found to contain a small amount of soft brown 

 faecal material, and the mucosa is somewhat swollen and moist, and shows 

 a few injected areas. Two trichurides are found in the lumen, rather 

 closely attached to the mucosa. Microscopically there is seen some loss 

 of epithelium with the passage of lymphocytes into the lumen, and the 

 epithelium of the glandular tubules shows a well-marked catarrhal state. 

 There is active proliferation of the lymph follicles and some fibrosis 

 of the submucosa. Marked round-celled infiltration of the submucosa 

 is seen as well as of the outer muscular and serous coats. The outer 

 muscular coat is very cedematous, and the vessels just beneath the serosa 

 are much dilated and surrounded by dense masses of round cells. Eosino- 

 philes in large numbers are present throughout all parts of the sections." 



CASE 2 



Trichuris in the vermiform appendix. — In the course of a gynecological 

 operation on a 38-year-old Filipina the appendix was removed. It was 

 a small, somewhat distorted appendix, from the cut proximal end of 

 which an intact Trichuris protruded. Microscopic examination of this 

 appendix shows a very thin muscular tunic and an intact serosa. The 

 lymphoid tissue is scanty. . In the mucosa there is some congestion and 



