TRICHOCEPHALIASIS. 555 



Braun(13) considers Trichuris to be pathogenic. Seifevt(78) states that from 

 the evidence of recent years it is necessary to remove Trichuris from the list of 

 commensal parasites and place it among those pathogenic for man, and that the 

 prognosis is grave in some severe infections. 



TEICHOCEPHALIASIS. 



Synonyms. — Whip-worm infection. Trichuriasis. 



Definition". — An infection with whip-worms, usually confined to the large 

 intestine, less frequently to the appendix and ileum and occasionally by perforation 

 invading other parts of the body. In light infections there are no pathologic 

 changes or symptoms of importance, but the heavier infections are characterized 

 by anaemia, which may be very severe and even fatal and by nervous and gastro- 

 intestinal symptoms. 



Etiology. — Contributing causes: The ordinary causes which usually are con- 

 sidered as influencing infections probably play a less important role here than 

 with many other diseases. 



The geographic distribution of the infection is cosmopolitan. It is particularly 

 prevalent in the 'Philippine Islands. 



Seae. — Practically all authors recognize the much more frequent infection in 

 females. Stiles and Garrison (83) in 3,457 cases found 12.13 per cent of infections 

 in females and 10.08 in males. 



Age. — It is generally recognized that infections are most prevalent during 

 childhood and gradually grow less with advancing age. 



Garrison, Ransom, and Stevenson (31) in 500 examinations noted this gradual 

 decrease of infection with age, and Stiles and Garrison ( 83 ) found the following 

 percentages of infection according to age: Under 15 years 13.01; from 15 to 30 

 years 10.09; from 31 to 50 years 8.65 and over 50 years 4.65. Garrison's (30) 

 statistics in the Philippines were based entirely upon examination of specimens 

 from adults and in our service the number of recorded examinations for children 

 is too small to make statistics of value. However, we have seen several instances 

 of infections in breast-fed infants, in one case the child being less than 3 

 months old. 



Race and nationality. — In general it may be stated that the infection is more 

 frequent among the colored races than it is in the Caucasian. Stiles and Garrison 

 noted particularly the preponderance of infections in the American negro over 

 that of the white races of the same country. Our records show a much higher 

 percentage of infection in native Filipinos than is found in the foreign residents 

 of the Caucasian race resident in Manila. In Stiles and Garrison's statistics, Irish 

 born patients showed a higher percentage of infection than did any other nation- 

 ality resident in the United States. 



Residence. — The infection is more common in rural districts than it is in cities, 

 no doubt largely because of the better methods of disposal of faeces in cities. 



Occupation. — The infection is more frequent among soldiers, laborers and others 

 whose manner of life and occupation brings them into contact with faecal infected 

 substances. 



Overcrowding with its usual insanitarj' surroundings may readily be inferred 

 to be a factor in incidence. 



Climate. — It is generally stated that the infection is more frequent in warm 

 climates. 



Gastrointestinal condition. — There are no statistics available, but it is probable 

 that it is not a factor in the incidence of this infection. 



Environment and mode of life. — After all is said regarding the influence of 

 race, sex, etc., upon the prevalence of this infection, it is probable that the question 



