TRICHOCEPHALIASIS. 561 



cases which have been described and diarrhoea has been present in most of them. 

 The character and number of the intestinal discharges varies, ranging from only 

 one or two stiff, pasty stools in twenty-four hours, to the severest form of 

 diarrhoea, even with bloody discharges. Again, the bowel movements may appear 

 normal for considerable periods of time. Whatever the number and character of 

 the bowel movements, tenesmus and other symptoms indicating involvement of the 

 lower bowel are rare. Stool examinations demonstrate the eggs of the Trichuris : 

 at times but few, and again large numbers may be seen in a single field of the 

 microscope. The urinary, reproductive, and locomotor systems do not, as a rule, 

 show any characteristic symptoms. Muscular cramps, particularly in the calves 

 of the legs, have been repeatedly observed. The urine is usually normal. The 

 cutaneous system shows the changes due to anaemia. There may be more or less 

 oedema of dependent parts and even anasarca may develop. The superficial lym- 

 phatics are not enlarged. 



The nervous symptoms are usually quite noticeable and consist of mental and 

 nervous depression which may be melancholic in character ; there is often great 

 restlessness, headache, and sometimes insomnia. Objectively nothing of impor- 

 tance is found. 



Among the symptoms of the special senses aphasia is frequent and it is difficult 

 to explain. Tinnitus aurium and even partial deafness have also been noted by 

 several observers. 



Appendiceal trichocephaliasis has not heretofore received much attention. 

 Metchinkoff urged its importance and reported a convincing ease in detail. Very 

 little is given about the clinical findings, but a priori there is no reason to assume 

 that they would be materially different from appendicitis of other etiology. 



Trichocephaliasis of animals has been observed by several authors. 



Analysis of symptoms. — As pointed out by Becker, the symptoms in the major- 

 ity of cases of this disease fall into three groups: 



( 1 ) Those of the blood, ( 2 ) nervous and ( 3 ) gastro-intestinal symptoms. 



These are present to a greater or less extent in all cases of severe infection. 

 The blood changes and the anaemia point positively to what we recognize as a 

 secondary type of the latter. The absence of eosinophilia is quite generally 

 recognized and is to be noted. French and Boycott paid particular attention to 

 this condition and failed to find eosinophilia in 26 cases which they examined. 

 In ours, eosinophilipaenia was the rule, and in Case No. 1 no eosinophile cells 

 were ever found after repeated blood examinations. 



The nervous symptoms are difficult to explain, particularly the mental and 

 nervous depression and the aphasia which has been so frequently noted, and it 

 is probable that the nausea and vomiting are to a considerable extent of nervous 

 origin. 



Even the intestinal symptoms are difficult to explain as a result of the patho- 

 logic findings, certainly they are not to be considered as being due to the direct 

 loss of blood caused by the mechanical action of the worms. Marsasca and others 

 believe that the latter secrete a special toxin, and although the entire clinical 

 picture supports such a view, it has not been demonstrated. Bacteria and other 

 secondary invaders entering through the injured mucosa probably account for 

 some of the symptoms and explain those cases having septicaemia. However, the 

 manner of the production of the symptoms remains unexplained. 



Diagnosis. — While the clinical picture in some of these cases is quite suggestive, 

 diagnosis can only be determined by finding the eggs of the parasite in the stools. 

 Not every patient having eggs in the stools will show symptoms of the infection, and 

 for clinical purposes only a combination of some of the clinical phenomena and 



