TRIOHOCEPHALIASIS. 553 



time she came under the author's observation the blood examination showed as 

 follows: Marked poikilocytosis and macrocytes were numerous; erythrocytes 

 3,456,000; leucocytes 6,250; haemoglobin 35 per cent. After three week's observa- 

 tion it was : Erythrocytes 3,200,000, leucocytes 6,000, haemoglobin 25 per cent. 

 The differential count of the leueocj'tes showed: Polymorphonuclears 69, lymph- 

 ocytes 26, mononuclears 3, eosinophiles 2. There were no nucleated red cells. 

 Numerous Trichuris eggs were present in the stools. The patient was treated 

 with eight enemas of solutions of benzin. No parasites were found during or 

 after these treatments, but the eggs disappeared from the stools and were not 

 again seen. The patient rapidly recovered after the disappearance of the eggs 

 from the stools. The author's second case was that of a woman 26 years old 

 suffering from chronic progressive anaemia, palpitation of the heart, dizziness, 

 nausea, and diarrhoea. The stool contained numerous Trichuris eggs. The 

 physical examination was negative. The blood examination showed : Erythrocytes, 

 2,852,000; leucocytes, 8,700; haemoglobin, 25 per cent. Normoblasts were numer- 

 ous but megoloblasts were not present. There was some improvement in this 

 case under treatment by arsenic and iron. The patient left the hospital before 

 further observation could be made. Becker believes the Trichuris to be responsible 

 for the condition in both these cases and furthermore compares its action with 

 that of Agchylostoma and the Dibothrioccphalus latus. 



Ward (88) states that since Askanazy has shown the occurrence of haemoglobin 

 in the alimentary canal of these worms, the fact that they nourish themselves on 

 the blood of the host can not be doubted. 



Sandler (74) reports a fatal case in a boy twelve years old. The patient when 

 admitted to the service complained of fainting spells, anaemia weakness, palpita- 

 tion of the heart, fever of an irregular, intermittent type, yellow and brownish 

 spots on the legs, headache, nausea, vomiting, diarrhoea with blood at times, 

 abdominal pains and tinnitus aurium. On examination there was marked anaemia, 

 haemie murmur of the heart, and weak, rapid pulse. The spleen and lymphatics 

 were not enlarged. Blood examination showed : Erythrocytes, 1,200,000; leucocytes, 

 30,600; haemoglobin, 28 per cent. There was poikilocytosis, but no nucleated 

 red cells. The stools contained eggs of Trichuris. After about two weeks of 

 treatment and observation the blood examination was as follows : Erythrocytes, 

 690,000; leucocytes, 14,000; haemoglobin, 20 per cent. The patient's condition 

 grew progressively worse with accentuation of the principal symptoms mentioned, 

 and others also developed. There was bleeding of the nose, the sense of fear 

 became marked, fever became more severe, reaching 39° in the afternoons, and for 

 some time before death which occurred in coma, there was delirium and very 

 frequent vomiting. The diarrhoea improved so that the bowels were practically 

 normal for some time before death. Autopsy could not be obtained, but the 

 author is convinced that Trichuris was the etiologic factor in the condition. 



French and Boycott (28) in reporting upon the prevalence of Trichuris infec- 

 tions in the patients in Guy's Hospital, London, makes the following observations. 

 Stools of 500 patients were examined and Trichuris eggs were found 39 times or 

 7.8 per cent. . The infection was rare in children under 5 years of age and was 

 about equal in the sexes. The authors also compile the statistics as to prevalence 

 from the following sources: Leuckart(52) in Erlangen 11.1 per cent, Erlangen 

 insane 100 per cent, Dresden, 2.5 per cent, Kiel 32.2 per cent; Cobbold(17) in 

 Dublin 90 per cent, Greenwich 69 per cent; Davaine(20) in Paris 50 per cent, 

 Naples 100 per cent; Blanchard(9) in Bale 23.6 per cent; Garrison, Ransom, and 

 Stevenson ( 3 1 ) in 10.8 per cent of insane; Ashford, King, and Igaravidez ( 2 ) 

 6 per cent; Boycott (12) in Cornish Miners 79 per cent. Garrison (30) working 

 in the Philippine Islands found the infection in 59 per cent of adult prisoners. 



