TKICHOCEPHALIASIS. 549 



are present and nothing abnormal is found upon examination of the nervous 

 system. 



During the patient's ten days' stay in the hospital, two unsuccessful attempts 

 were made to remove the Trichuris. Both thymol in 6 gram and santonin and 

 calomel in 0.250 gram doses were used. The patient left the hospital in a worse 

 condition than when he entered. 



In this case repeated and careful examinations were made and the data 

 obtained could only be explained by assuming the cause of disease to be Trichuris 



Case III. — Trichocephaliasis with severe secondary anwmia; under observation and 

 treatment for one month without improvement. 



D. V., a male Eurasian from Singapore came under our observation in Septem- 

 ber, 1904, and left the Philippine Islands in October of the same year. The 

 family history and history of previous illnesses of this patient are unimportant. 



Present illness. — About one year after arrival in the Philippine Islands the 

 patient began to notice that he was becoming "anaemic," with shortness of breath 

 and palpitation of the heart. About one month before he consulted us, diarrhoea 

 developed and there was some cedema of the legs. At the time he came under 

 our observation the principal subjective symptoms were dizziness, with shortness 

 of breath and palpitation of the heart upon exertion, indifferent appetite, with 

 nausea more marked in the morning occasional vomiting, and moderate diarrhoea. 

 There was a general feeling of "nervousness" and tendency toward melancholia. 



Examination. — A rather severe secondary anaemia was present which could not 

 be explained, except by the presence of a rather severe Trichuris infection. The 

 stools after a saline cathartic often contained as many as 20 eggs in one field of 

 the microscope, an AA objective and No. 4 ocular being used. 



The blood examination was as follows: Erythrocytes, 2,800,000; leucocytes, 

 6,400; haemoglobin, 36 per cent. 



There were no nucleated red cells and the differential leucocyte count was 

 approximately normal. 



One unsuccessful attempt was made to dislodge the parasites by thymol. Good 

 food, tonics, and general hygiene were prescribed, but the patient did not improve 

 and he left the Philippine Islands about one month after we first saw him. 



Case IV. — Embolism of the left coronary artery caused by an adult Trichuris 

 trichiura. 1 



It has not been possible to obtain a clinical history of very much importance 

 in this case. The patient was a Filipino boy, 17 years old, and had been ill for 

 about a week. For approximately the first five days he complained of pain in 

 the chest, cough, shortness of breath, and he vomited once or twice. Slight 

 diarrhoea developed and continued throughout the trouble. Pulse 130, temperature 

 at first from 38° to 39°. Two days before death the symptoms became very 

 much aggravated; vomiting more frequent, temperature 40°. 5. Death occurred 

 suddenly. 



Autopsy (twenty-three hours after death). — Petechial haemorrhages in skin of 

 shoulders and occasional ones over the rest of the body. No glandular enlarge- 

 ments. 



Lungs: Lower lobes much congested, dark, grayish-red in color. Center of 



1 This case is not reported as one of importance in elucidating the question of 

 the pathogenicity of whip-worms, but it is mentioned as being a very curious 

 finding for which we have no explanation to offer. 



