23,1 Leach et al.: Hookworm Disease 119 



and loss of strength; she attended school for only one year and was 

 obliged to leave school because she was easily fatigued by the journey to 

 and from school ; for the last four months she has suffered from persistent 

 constipation, her bowels moving on an average only once a week; on ad- 

 mission she was afebrile and appeared normal except as noted; appetite is 

 fair, sleep normal, bowel movements constipated; her general development 

 and nourishment are fair. 



Special senses. — Normal. 



Skin and mucous membranes.— Conjunctivae markedly pale; lips, gums, 

 and buccal mucous membranes anaemic; no haemorrhage; marked pallor of 

 Bkin of extremities. 



Pulse. — Not taken. 



Heart. — A.C.D., normal; sounds normal; no murmurs. 



Lungs. — Normal. 



Genito-urinary system. — Not examined. 



Neck.— No adenitis; bruit du diable heard over right side. 



Abdomen.— *No tenderness; no masses. 



Spleen and liver. — Not palpable. 



Nervous system. — Normal. 



Blood findings: 



Total erythrocytes, 2,700,000. 

 Haemoglobin, 45 per cent. 

 Differential count not made. 



Treatment with 4.4 cubic centimeters of carbon tetrachloride. 



Worms were destroyed by maceration, only three being recovered, as 

 follows : 



Ancylostoma duodenale, male, 1. 

 Necator americanus, female, 2. 



Bowel movements following treatment were few in number and very 

 scanty in quantity. The patient showed no ill effects from the treatment, 

 however. 



Pedro Sabay, male, aged 37 years; residence, San Nicolas, Cebu; oc- 

 cupation, laborer; weight, 49.5 kilograms. 



Narcotics.— Alcohol in moderation. 



Family history.— Mother and father dead, cause unknown; one brother 

 drowned; two sisters dead, one of cholera, one of bubonic plague. 



Personal history.— Mild smallpox at 8 years; unknown illness at 12 



Special senses. — Normal. 



Skin and mucous me mbranes.— Conjunctivae and buccal mucous mem- 

 branes extremely pale; palms and finger tips show extreme anaemia ; 

 ashen gray appearance of face, hookworm pallor; irregular white scars 

 over shins, due to accident. 



Glandular system.— Inguinal glands palpable. 



Pulse.— 68 ; regular in rate and rhythm. 



Heart.— A.C.D., normal; pronounced haemic murmur. 



Lungs.— Impaired resonance, right posterior upper; respiratory sounds 

 slightly prolonged over right upper; no rales. 



Genito-urinary system. — Normal. 



