560 MUSGRAVE, CLEGG, AND POLK. 



(1903), United States (Insane), 16.8. Heisig ( 1893), Germany, 45.21. Gubareff 

 (1896), Russia, 43. Boycott (1904), England (Cornwall), 38.78. Grechaninoff 

 (1890), St. Petersburg, 26.41. Sievers (1887), Kiel, 19.81. Roth (1877-1880), 

 Bale, 26.67. Gribbohm (1872-1877), Kiel, 32.20. Heller (1872-1875), Kiel, 

 30.60. Miiller (1862-1873), Erlangen, 11.11. Miiller (1852-1862), Dresden, 

 2.57. Stiles and Garrison (1906), United States (Insane), 7.72. Cima (1S93 

 and 1896), Italy, 37.27. Anaemia Commission (1904), Porto Rico, 7.27. Daniels 

 (1901), Africa, 2.79. Fearnside (1900), India, 6.95. Dobson (1893), India, 

 4.40. Garrison (1908), Philippine Islands,. 59. 



Some of the figures included in the series are from examinations of only 

 a few cases or were compiled under conditions which prevented the findings being 

 properly considered as an index of the prevalence of the infection in the general 

 population of the community in which the examinations were made. 



Garrison's largeNand carefully worked out statistics show the highest percentage 

 of infection among the general population as yet reported for any country. 



The incubation period in this disease would be the time for development of the 

 ingested embryo to maturity which, to judge from the few available data, is 

 more than four weeks. 



Symptoms. — We recognize for convenience in discussion mild and severe intestinal 

 triehocephaliasis and trichocephaliasis of the appendix. In general the symptoms 

 may be said to depend upon the severity and location of the infection. In mild cases 

 of intestinal infection there are no noticeable symptoms and the patient may 

 harbor the parasites in considerable numbers for a long time without inconve- 

 nience. In severe infections the symptom complex is largely that of a severe 

 secondary anaemia, with pronounced nervous symptoms and some gastro-intestinal 

 disturbance. The early symptoms vary somewhat in different cases. Usually 

 there is weakness, shortness of breath, nausea, vomiting, diarrhoea, cramps in the 

 muscles, nervousness, insomnia, and a gradually developing anaemia. The condi- 

 tion is as a rule progressive, with accentuation of the principal symptoms as the 

 disease advances. 



Circulatory system. — Weakness, with shortness of breath and palpitation of the 

 heart are often early symptoms and become more marked as the disease progresses. 

 Evidences of anaemia, such as pallor of the mucous membrane, oedema, and haemic 

 murmur of the heart have been noted in several cases. As a rule the spleen is 

 not enlarged and in fact, it may be smaller than normal. The blood picture is 

 largely that of secondary ana?mia. There is a decrease in the number of red cells, 

 with poikilocytosis, but nucleated cells are not as a rule present. The number 

 of the leucocj'tes remains approximately normal and the differential count usually 

 shows a slight relative increase in mononuclears. Slight eosinophilia has been 

 notedj but most observers agree that the eosin cells are not increased and in our 

 cases eosinophilia was absent. No eosin cells were ever found in our Case No. 1. 

 The haemoglobin is reduced and may be very low before death. 



The symptoms in the respiratory system may consist of some dyspnoea and cough, 

 when severe anaemia is present. 



The alimentary system as a rule suffers rather severely. Nausea and vomiting 

 are frequent and annoying symptoms, anorexia and dyspeptic symptoms are 

 also often encountered, although the appetite may remain good throughout the 

 course of the disease. The mucous membranes are pale, the tongue often large 

 and flabby and in two of our "cases it showed a dark band down the center, similar 

 to that which has been described for uncinariasis. There may, or may not, be 

 tenderness and pain in the gastric region and in the two cases where it has been 

 recorded, examination of the stomach contents showed nothing abnormal. More 

 or less abdominal discomfort or even pain has been a feature of the majority of 



