554 MUSGRAVE, CLEGG, AND POLK. 



Osier (65) states that "The Trichocephalus rarely causes symptoms." He notes 

 without comment the recent observations in which severe anaemia has occurred 

 in connection with infections with this parasite. Allen J. Smith (80) considers 

 the parasite to be of little pathologic importance, stating that apparently it 

 does but little damage and practically never gives rise to appreciable symptoms of 

 its presence. Emerson (23) states that "This parasite is harmless as a rule, 

 but may cause enteritis and the severest and even fatal anaemia." 



Poledne(G8, 69) reports one case. The patient was a sailor who was admitted 

 to the hospital suffering from fever and severe diarrhoea. The fever was typhoid 

 in character, but careful examination by modern laboratory methods gave negative 

 results for typhoid, paratyphoid, Malta fever, and tuberculosis. Anaemia, ema- 

 ciation, and nervous symptoms were present. The blood showed a slight leucoey- 

 tosis and a relative eosinophilia. There were numerous ova of Trichuris triehiura 

 in the stools. The fever and diarrhoea subsided after treatment by thymol and 

 by benzine enemas, the eggs disappeared from the stools and a rapid and per- 

 manent cure followed. 



Vix ( 86 ) considers the parasite to be pathogenic and states that it may produce 

 ulceration of the intestinal mucosa. Rippe(T2) reviews the literature of Trichuris 

 infections and reports two eases occurring in Russia. His first patient was a 

 woman who had been ill for three years. The important symptoms were nausea 

 and vomiting, anorexia, weakness, dizziness, muscular pains particularly in 

 the legs, slight diarrhoea, and melancholia. On examination there was emaciation, 

 marked pallor of the mucous membrane and some abdominal distension with 

 tenderness over the caecum. The stools contained mucus and numerous eggs 

 of Trichuris. After treatment by thymol the eggs disappeared from the stools 

 and the patient made a rapid and permanent recovery. The second ease was in a 

 man who was suffering from a purulent pleuritis. with frequent epileptoid seizures, 

 diarrhoea, muscular cramps, nausea, and restlessness. There were numerous eggs 

 of Trichuris in the stools. The patient died and at autopsy the brain was normal, 

 except for slight oedema of the meninges ; the mucous membrane of the ca'cum 

 and lower portion of the small intestine was hyperaemic and contained Trichuris 

 triehiura. Rippe considers Trichuris to be a pathogenic parasite and that infec- 

 tion with it must be considered in making diagnoses in conditions showing 

 intestinal and nervous symptoms. The author found the eggs in 42.93 per cent 

 of 184 cases of parasitic infection of the intestine in Russia. 



Stiles (82) treats the pathogenicity of this parasite in a conservative manner. 

 He recognizes a lack of symptoms in the majority of light infections, but on 

 the other hand this author makes the statement "that severe infections do not 

 produce injury is not in accordance either with probability or with recorded 

 observations." Again he states that "several cases of severe anaemia have been 

 recorded within recent years which were, apparently justly, attributed to heavy 

 infections with whip-worms." Kahane(48) considers the parasite to be patho- 

 genic. He states that it can cause ulceration of the intestinal mucosa and that 

 the head may penetrate the walls of the bowel to the muscular coat. 



Sir Patrick Manson(54) considers Trichuris infestation of no practical moment 

 and that, so far as known, the parasites give rise to no serious pathologic lesions, 

 ilanson and Shipley (55) state that so far as is known Trichuris lias very little 

 pathologic significance, except when it perforates the intestine. These authors 

 call attention to reports in which nervous symptoms have been associated with 

 a high degree of infection. According to the same authors "several cases of 

 anaemia ( some fatal ) are reported as caused by the presence of this parasite, 

 the blood showing a fall in the number of red cells, marked poikilocytosis, and 

 the appearance of nucleated red cells principally of the normoblastic type."' 

 Eosinophilia has been noted, but is not the rule. 



