23,6 Leach et al.: Hookworm Infestation 471 



in the region of the liver. None of our subjects has become 

 jaundiced after treatment. 



The local effects of the drug upon the intestinal mucosa are 

 often quite marked. They are expressed by the production of 

 variable amounts of mucus and, as in the effects upon the liver, 

 seem to bear no constant relation to the amount of drug given. 

 Even under the lightest doses mucus is present in the stools, 

 in amounts in excess of that encountered in so-called normal 

 stools. From that point, there is every gradation in quantity 

 up to the point where the bowel discharges consist almost 

 wholly of clear, glairy mucus. In some cases the mucus has a 

 flocculent appearance that resembles the pus seen in bacillary 

 dysentery, but microscopic examination shows it to be devoid 

 of an excess of cellular elements. Excessive secretion of mucus 

 bears no constant relation to abdominal pain after treatment. 



In another paper (8) we have mentioned the seeming ill effects 

 brought about by administering a saline purgative immediately 

 before treatment. We suspect that this procedure has a ten- 

 dency to heighten the intestinal irritation produced by the 

 drug. Preliminary purgation is unnecessary, and we advise 

 against its employment immediately before the administration 

 of carbon tetrachloride. Its effect with the drug seems almost 

 synergistic so far as concerns the production of mucus, for the 

 stools consist wholly of thick, tenacious mucus discharged in 

 great volumes. So voluminous and thick is this mucus that it 

 virtually is impossible to screen the stools. If patients are 

 constipated, it is better to clear the bowel over a period of a 

 day or two by milder methods, and allow the intestine to rest 

 for at least eight or ten hours. 



In two instances we have observed the passage of a blood 

 clot from the intestine after treatment. The first case was a 

 young American male with a past history of malaria and bacil- 

 lary dysentery. He was alcoholic and had drunk Scotch whis- 

 key shortly before taking 8 cubic centimeters of carbon tetra- 

 chloride. He slept soundly for about two hours. When he 

 awoke his speech was thick and rambling. In other words he 

 behaved like a man intoxicated with alcohol. He did not feel 

 sick in any way. He was a young man of considerable brag- 

 gadocio and bravado and immediately consumed a hearty meal 

 of tea and toast, fortunately escaping consequences of this un- 

 wise act. Within a few hours he had resumed his normal habits 

 as to alcohol and, except for looseness of the bowels, got along 

 very well until the seventh day, when he passed a small blood 



