548 MUSGRAVE, CLEGG, AND POLK. 



Stomach: Mucous membrane extremely pale with small, hemorrhagic areas 

 near the pyloric end; otherwise the organ appears normal. 



Small intestine: Contents, greenish mucus. The mucosa shows the same pale 

 condition. Peyer's patches and solitary follicles prominent, but not congested. 

 Numerous Trichuris trichiura are present, the greater number being found in the 

 lower part of the ileum. 



Large intestine: On opening the ileocecal valve two hundred trichiuris are 

 counted. These parasites extend the entire length of the gut. The mucosa of 

 the descending colon shows a few healed amoebic ulcers. With the exception of 

 the extremely pale condition of the mucosa, the organ appears normal. 



Anatomic diagnosis. — Severe grade of secondar}' anasmia. 



Specimens of the worms were submitted to Mr. G. F. Bichmond, chief 

 of the chemical laboratory, for determination as to the presence of pig- 

 ments of blood origin and he reports that no such pigments are found. 



Dr. Philip E. Garrison, medical zoologist, Biological Laboratory, 

 Bureait of Science, reports as follows: 



"The whip-worms received on September 16 have been carefully exam- 

 ined and compared with specimens identified in Dr. Stiles' laboratory in 

 Washington. They appear to agree in every material character with 

 Trichuris trichiura (Linnaeus l r iQ>l)=Trichoceplialus dispar Eudolphi, 

 1801. The specimens are Fo. 258 in the Bureau of Science Hel- 

 minthological Collection." 



Case II. — Severe infection with whip-worms, with diarrhoea, muscular cramps, 



dizziness, oedema and indigestion; patient left hospital after 



ten days observation. 



F. E., male Filipino, age 22, was admitted to St. Paul's Hospital March 10, 

 1906, and left March 21. His family history and the history of previous diseases 

 give no data of importance. Present illness: For about six months previous to 

 admission the patient has suffered from diarrhoea of a somewhat intermittent 

 character. The stools were only one or two on some days, but generally they 

 were from five to ten or more in twenty-four hours, being soft and pasty. Other 

 symptoms during this time were dizziness, weakness, palpition of the heart, 

 tinnitus aurium, cramps in muscles of the legs and chest, anorexia and indigestion. 



On admission the patient complained of weakness, shortness of breath, palpita- 

 tion of the heart, nausea, diarrhoea, ringing in the ears, partial loss of voice and 

 melancholic tendencies. 



Examination shows a pale, somewhat emaciated Filipino with moderate oedema 

 of the feet and legs. Examination of the circulatory system demonstrates a weak 

 pulse of 110 in the upright position: the arteries are soft and there is a soft 

 murmur at the apex of the heart. The spleen not palpable, and blood examination 

 is as follows: Erythrocytes, 2,400,000; leucocytes, 9,000; hemoglobin 23 per cent. 



There are no nucleated red cells and the differential leucocyte count shows a 

 slight relative increase in large mononuclears. There is no eosinophilia. The 

 respiratory system appears normal. Examination of the alimentary system gives 

 the following details : Tongue, large and flabby with teeth marks on the edges, 

 but no dark streak in the center. The abdominal examination is negative and 

 the stool contains very many ova of Trichuris trichiura. The urinary system 

 (including urine examination), the reproductive, cutaneous, and locomotor systems 

 appear normal, except for moderate cedema of the lower extremeties. The reflexes 



