562 MUSGKAVB, CLEGG, AND POLK. 



the presence of eggs should be considered as a diagnosis from a practical therapeu- 

 tic standpoint. The differentiation from most of the other recognized types of 

 anaemia is readily made by the blood picture; Severe infections are only differen- 

 tiated clinically from similar cases of uncinariasis by stool examinations and by 

 the greater prevalence of eosinophilia in the hook-worm infections. 



Prognosis. — Certain light infections do not appear to do recognizable harm, even 

 when the parasites remain for a long time in the bowel. The prognosis in severe 

 infections is grave, largely because of the difficulty with which the parasites are 

 destroyed. Barth, Pascal, Sandler, Moosbrugger and others have reported fatal 

 cases. The disease may continue for a long time, and, on the other hand, as in 

 our Case No. 1, the course may be fairly acute and its duration from the development 

 of clinical symptoms short. 



Prophylaxis. — The prevention of this disease consists in personal hygiene and 

 in public health measures. Because of the simple life cycle of the parasite and 

 the long viability of the eggs under outside influences, personal hygiene, by avoiding 

 the introduction of unsterilized substances into the mouth, makes protection fairly 

 safe even in infected zones. 



The hygienic side of the problem requires a safe and practical method for the 

 disposal of faeces. This is very important, not only because of the presence of 

 whip- worms, but of others as well. This subject has been covered by Garrison ( 30 ) . 



Treatment. — Whip-worms are exceedingly difficult to destroy in the intestine. 

 In this respect out experiences have been in conformity with the general literature of 

 the subject. However, several authors have had more or less success with various 

 anthelmintics, and in most cases where it has been possible to destroy the worms, 

 rapid and complete recovery of the patient has followed. Enemas of solutions of 

 benzine have been the most successful in the hands of several observers, while 

 others have reported success by the use of calomel, thymol, naphthol, santonin, or 

 garlic. We have used thymol, the eucaliptus oil, chloroform, and the castor' oil 

 mixtures employed for uncinariasis, but without very much success. The benzine 

 treatment has only just come to our notice, but to judge from the reports in the 

 literature it deserves a more extended trial. Schiller (quoted by Sandler (74)) 

 used thymol by mouth and benzine solutions as enemas and secured 2,000 worms 

 from one case. This is remarkable because of the fact that the worms were 

 passed. The killed worms in the experience of most authors do not pass from 

 the bowel and their destruction is only made evident by the disappearance of the 

 eggs from the stools. Other treatment of the disease consists in general hygienic 

 measures with attempts to improve the nutrition of the patient. 



BIBLIOGRAPHY. 8 



Andrikidis. * ( 1 ) lDtude des troubles morbides attribuables au triehocephale de 

 l'homme, Paris, (1906), 119 pp. 



Ashford, B. K., King, W. W., and Igaravidez, P. G. '" ( 2 ) Report of the Com- 

 mission for the study and treatment of anemia in Porto Rico. Authorized 

 by act of the Legislative Assembly. San Juan, (1904), 311 pp., 7 pi. 



Askanazy, M. (3) Der Peitschenwurm ein blutsaugender Parasit. Deutsches 

 Arch. f. klin. Med., (1896), 57, 104-117, 1 pi. 



Barth. *(4) Ref. : von Valleix, Guide de mgdicin practieien, Paris, (1845), 

 6, 98. 



3 Unmarked references have been verified in the library of the Bureau of Science. 

 References marked f have been partially verified — in most cases the original 

 article has not been available, but reviews and abstracts have been verified as 

 cited. References marked * have not been verified. 



