546 MUSGKAVE, CLEGG, AND POLK. 



CASE REPORTS. 



Case I. — Trichocephaliasis with severe progressive secondary anaemia folloived by 

 death; autopsy. 



L. G. N., male Filipino, 24 years of age, was admitted to St. Paul's Hospital 

 August 9, 1908, died September 16. Family history: Father and mother are both 

 living and in good health; two brothers died of smallpox. Previous illness: As a 

 child the patient had chickenpox, a few mild attacks of "malaria," and five years 

 ago suffered from an abscess of the parotid gland. Present illness: Three weeks 

 before admission the patient began to feel dizziness, weakness, slight fever in the 

 afternoons and ringing in the ears. This condition gradually grew worse and 

 about ten days before admission he noticed beginning oedema of the ankles, hands, 

 and face. 



On admission the patient complained of shortness of breath, great weakness, 

 ringing in the ears, palpitation of the heart, nausea, lack of appetite, dyspeptic 

 symptoms and slight diarrhoea. 



Examination. — The patient is a rather large, well-developed Filipino with 

 marked oedema of the extremeties and face, marked pallor of the mucous membrane 

 and rapid, shallow respiration. The circulatory system appears normal, except 

 for a slight ha^mic murmur heard at the apex of the heart and an increased pulse 

 rate to 110, when the patient is in an upright position. 



Blood examination as follows: Red blood cells, 1,800,000; leucocytes, 10,000; 

 haemoglobin, 20 per cent. Differential count: Mononuclear cells, 65 per cent; 

 polynuclear cells, 30 per cent; transitional, 5 per cent. There are no nucleated 

 red blood cells and but a moderate poikilocytosis. No eosinophile cells are present 

 in a count of 500. 



Respiratory system, negative. Alimentary system shows the following changes: 

 Lips and other mucous membranes extremely pale, tongue large and flabby with 

 a dark, almost black, streak down the center. Nothing abnormal is found in 

 the abdomen, excepting a slight accumulation of fluid; the liver is slightly 

 enlarged; the spleen is not palpable. The examination of the stomach contents 

 shows no abnormality ; examination of the stool after a saline cathartic shows 

 enormous numbers of the ova of Trichuris trichiura. The urine is normal by 

 chemical and microscopic examination. Nervous system : There is no pain, and 

 the reflexes are normal. Locomotor system: ffidema and considerable flabbiness 

 of the muscles are the only abnormalities noted. Cutaneous system : The skin 

 appears normal and there is no enlargement of the superficial lymphatics. The 

 patient's condition grew gradually worse from the time of admission . with 

 accentuation of the following symptoms : CEdema became general and progressed 

 until death; the anaemia was also progressive, and the same general character of 

 blood picture was maintained until the end. A count made a few days before 

 death showed the following: Red cells, 844,000; haemoglobin, 18 per cent. At 

 this time there were still no nucleated red cells and no eosinophile cells to be 

 found. Nausea, from which the patient suffered upon his admission, became more 

 constant and toward the end vomiting was a very distressing and unmanageable 

 symptom. The nervous and mental symptoms became more marked and during 

 the last week of illness there was active delirium. The patient finally died of 

 asthaenia. 



There were no haemorrhages at any time and no severe diarrhoea. Repeated 

 examinations of the stool always demonstrated very large numbers of Trichuris eggs. 

 The temperature was practically normal throughout the course of the disease. 

 Three separate attempts were made to dislodge the parasites, which were the 

 only discoverable cause of the anaemia, the following substances being used for 



