1760 



HELMINTH INFECTIONS 



anthelmintics. They do not appear to be blood-suckers, nor is 

 there any evidence that they produce toxins — -at all events, in 

 sufficient quantity to affect man. On the other hand, it is beheved 

 that micro-organisms can gain entrance to the blood through the 

 wounds produced by the head, and this secondary infection may be 

 the cause of the appendicitis and other pathological phenomena. 



Morbid Anatomy. — A post-mortem simply reveals anaemia and 

 dropsy, with at times appendicitis. The most marked feature is 

 the presence of large numbers of Trichuris trichiura. 



Symptomatology.— The symptomatology may be subdivided into 

 the intestinal and appendicular varieties. 



Intestinal Variety. — The illness begins with dizziness, tinnitus 

 aurium, and a sensation of weakness, which may be followed by 

 slight daily fever and later by oedema of the face and extremities, 

 while anaemia appears and gradually progresses. Seen at this stage 

 of the illness, the mucosa of the lips and tongue appear pale, the 

 appetite is poor, and dyspepsia, followed later by nausea and 

 vomiting, with or without slight diarrhoea, occurs. 



The liver and spleen are normal, but a haemic murmur may be 

 heard at the apex of the heart, while the blood examination reveals 

 a great decrease in the number of red cells and the presence of 

 poikilocytes, but as a rule no nucleated elements. The haemoglobin 

 is also reduced, while the leucocytes are increased, and also in most 

 cases there is an absence of an eosinophilia. The urine is normal. 

 There is mental depression, restlessness, headache, and at times 

 insomnia. As the disease progresses the anaemia becomes more 

 and more marked, and death may eventually ensue. 



Appendicular Variety. — The symptoms of this variety are the 

 same as those for appendicitis arising from other causes. Operative 

 treatment reveals the nature of the malady. The symptoms are 

 the same as those for appendicitis due tq other causes — viz., severe 

 pain in the region of the appendix, tenderness on pressure, with 

 often vomiting and fever. 



Diagnosis. — The disease closely resembles ankylostomiasis, from 

 which it may be differentiated by finding trichuris ova and no 

 ancylostome ova in the faeces, and also by the absence of marked 

 eosinophiha. 



Prognosis. — The ordinary slight infection which is frequently met 

 with may be considered to be harmless, but the prognosis is grave 

 in those rare cases of very heavy infection presenting the symptoms 

 described above. 



Treatment. — ^The treatment at present advised is the administra- 

 tion of thymol by the mouth in the manner presently to be de- 

 scribed for ankylostomiasis, and enemata of solutions of benzine. 



Prophylaxis. — Good sanitation and proper disposal of sewage, 

 associated with cleanliness in the preparation of food, as well as 

 with personal cleanliness, constitute important prophylactic 

 measures. Uncooked vegetables and skins of fruits should not be 

 eaten. 



