SUPPLEMENT 647 



is furnished by the blood changes recorded by Zappert, 1 Miiller and 

 Rieder, 2 Bucklers, 3 and Neusser, 4 which must be regarded as the 

 expression of toxic action, especially with reference to eosinophilia. 

 The striking increase in proteid destruction in ancylostomiasis 

 observed by Bohland, 5 and which ceased after the parasites had been 

 expelled, also gives additional support to the assumption of toxic 

 action. The observation of Daniels 6 also deserves consideration in 

 this connection, according to which the presence of yellow pigment 

 in the liver and kidney cells is to be attributed to blood destruction 

 by a verminous toxin absorbed from the gut. Looss 7 considers it 

 not at all improbable in fact, almost certain that Ancylostoma, in 

 addition to withdrawing blood, exert a kind of toxic action on their 

 host. 



Scheube 8 attributes almost equal importance to the loss of blood, 

 the digestive disturbances, and the intoxication induced by certain 

 metabolic products of the parasites. According to v. Jaksch 9 ancy- 

 lostorne anaemia is not- induced solely by loss of blood, but by the 

 fact that the parasites produce a ferment which has a toxic action 

 and produces stimulation in those organs in which the eosinophile 

 cells arise. The haemolytic action of ancylostomes has frequently 

 been observed by Galvagno 10 in men employed in sulphur mines. 

 According to Loeb and Smith 11 the anterior half of the body of 

 ancylostomes contains a substance which probably causes anaemia. 

 Bauer 12 found in the urine of ancylostome patients glycuronic acid, 

 which he considers to be a sign of metabolic disturbance due to 

 parasitic toxins. As has been demonstrated by Allessandrini, 13 the 

 secretio n of glands in the anterior part of the body has a distinct 

 haemolytic effect on the erythrocytes. While the worm attaches 

 itself to the mucosa by means of its teeth, these glands discharge 

 their secretion, producing hyperaemia. The extravasated blood is 

 acted on by this secretion, so that it can serve as food for the 

 parasites. Hynek 14 attributes eosinophilia (up to 20 per cent.) to 

 a toxic action. Goldmann 15 expresses a similar opinion, though he 



1 Zappert, Wien. klin. Wochenschr., 1892. 



2 Miiller and Rieder, Dettlsch. Arch. f. klin. Med., xcviii. 



3 Eiicklers, Munch, ined. Wochenschr., 1894. 



4 Neusser, Wien. klin. Wochenschr., 1892. 



5 Bohland, Milnch. med. Wochenschr., 1894. 



6 Daniels, Lancet, No. 3,725. ~ Looss, Cenlralvl.f. Bakt., 1897. 

 s Scheube, " Die Krankh. der warm. Lander,'' 1896. 



3 v. Jaksch, Milnch. ined. Wochenschr., 1902. 



10 Galvagno, Arch, di Patol. e Clin. inf., 1902-1904. 



" Loeb and Smith, Centralbl.f Bakt., xxxvii. 



12 Bauer, Wien. klin. Wochenschr., 1904. 



13 Allessandrini, Policlinica, 1904. ll Hynek, Klin. Chron., 1904. 

 15 Goldmann, Wien. klin. Rundschau, 1905. 



