240 GOMEZ. 



and nitric acid methods, l)ecaiise the Anosmia Commission of Porto 

 Eico(5) fomid that in man}^ cases of liookworm infection albumin is 

 present in tlie urine. 



In a few cases the hookworms were collected and counted. It has 

 been my procedure to collect the stools in every case. The patients 

 were directed to pass all the stools in a vessel for twenty-four hours 

 following the last purgative in the treatment, but considerable difficulty 

 was experienced in making them comply with the instructions. Inas- 

 much as some worms may still be passed later than twenty-four hours 

 after treatment, the number which I obtained may not represent the 

 total number of parasites in every case, but the error can not l)e ver}' 

 great, as the number of hookworms recovered bears a very close relation- 

 ship to the number of eggs found in a cover-glass preparation ; it usualljr 

 being about one to three. 



Ten cases without hookworms but with other intestinal parasites were 

 selected for study as controls. 



DISCUSSION OF FINDINGS. 



As is shown in the table, five cases out of twentj^-six complained of 

 a certain amount of pain in the stomach. The other symptoms, such as 

 emaciation, a feeling of dizziness, pain in the Joints, difficulty in urina- 

 tion, a sensation of oppression on the chest, tympanitis, neuralgic in- 

 tercostal pains, or debility, can be attributed to other diseases such as 

 malaria, tuberculosis, deng-ue fever, cystitis, and nephritis. 



The vague pains in the stomach suggest the presence of hookworms, 

 either alone or associated with other intestinal parasites, as their removal 

 is followed by immediate relief. Pain in the gastric region as a symptom 

 accompanying hookworm infection has been frequently observed by Doctor 

 Eissler and me in our work in Eizal and Cavite Provinces and the Cagayan 

 Valley. One particular instance was that of our own assistant in. Las 

 Pinas, Eizal, who complained of poor appetite and vague abdominal 

 pains, and who was promptly relieved on the expulsion of hookworms. 

 The occurrence of vague digestive and abdominal symptoms is also men- 

 tioned by Bass(') in connection with mild infections with hookworm 

 in the southern United States. The reference of the pain to the stomach 

 and abdominal region may be explained by the anatomic arrangement of 

 the sympathetic inervation of the duodenum which is connected, through 

 the solar plexus, with the remainder of the abdominal organs, and par- 

 ticularly Avith the stomach. 



As compared with the control cases, eosinophilia is generally present 

 in the patients harboring hookworms. Five out of 10, or 50 per cent, 

 of the control cases gave an eosinophile count above 4 per cent. In 

 patients infected with hookworm, 20 out of 26, or 76 per cent, had 

 eosinophiles above 4 per cent. Only 3 of the controls had over 5 per 



