23,6 Leach et al.: Hookworm Infestation 51 1 



mentioned. On this basis, we have administered doses ranging 

 up to 12.5, and even 15 cubic centimeters, without observing 

 untoward effects of a serious nature. 



We do not, however, maintain that this should be the standard 

 dose. Our studies have yielded us abundant evidence that 

 smaller proportions are equally efficient in the removal of hook- 

 worms and a certain proportion of other intestinal helminths. 



Existing infection with Entamoeba histolytica, provided there 

 is no active dysenteric process, or previous infectious disease 

 of the intestinal tract is not a contraindication provided no 

 active process is present. 



Several men showing definite pathology of one kind or another 

 were treated on the same basis as the other men. Their de- 

 fects included tuberculosis ; splenic and liver enlargement, prob- 

 ably of malarial origin; slight renal disturbance; and valvular 

 heart lesions. There was a total lack of significance in the 

 reactions to the drug shown by these men. Their behavior as 

 a group, and individually, in no way differed from that of the 

 group of men in whom we found no physical defects. 



Moderate alcoholism is not a contraindication to the adminis- 

 tration of carbon tetrachloride, provided liquor is withheld from 

 the men two or three days before and after treatment. Un- 

 toward effects in alcoholic subjects usually can be attributed to 

 disregard of this rule. Statistically, the men in this series 

 who admitted the use of alcohol showed less abnormal reaction 

 to the drug than did those who denied the use of alcohol. 



Saline purgatives should not be given immediately before 

 treatment, for they apparently reenforce the irritative prop- 

 erties of the drug on the intestinal mucosa. 



We consider that the administration of the drug in divided 

 doses is both unnecessary and undesirable. 



Carbon tetrachloride is without effect upon any of the common 

 intestinal protozoa. Its administration in protozoal infections 

 of the intestinal tract, therefore, is irrational. 



Although observations have not been made on this in the 

 work recorded here, we consider it opportune to voice our opinion 

 that the drug should not be given during the course of any in- 

 fectious disease where the heart and liver are already over- 

 burdened by a toxaemia. This applies with particular force to 

 acute intestinal affections, and to infectious abdominal (sur- 

 gical) conditions such as peritonitis. Cases may arise where it 

 is desirable to rid a surgical patient of a hookworm infestation. 

 In such cases, the circumstances should be made the subject of 



