09 
Blotting paper text . — In al)out 8 out of 10 modiuin and severe cases, 
if a portion of the feces is placed ui)on white hlottino- paper, and 
allowed to remain there for twenty minutes to several hours, it leavc‘s 
on the paper a reddish brown stain similar to a blood stain. This 
test will be found useful by physicians who are not prepared foi- 
microscopic tests. 
Microscopic exarninat ion . — If feces less than twenty-four hours old 
are examined microscopically, the eggs will be found in various stag(‘s 
of segmentation. If feces over twenty-four houi’s old are examin(‘d 
the free embryos also are usually found. If free embryos are found in 
perfectl}^ fresh feces, the diagnosis of infection with the worm (Sfron- 
gyloides stercoral i-^^') of Cochin-China diarrhea must be made, and this 
parasite we ma}' tind in the same patient in whom uncinariasis is 
present. 
CIRCULATORY SYSTEM. 
The symptoms of the circulatory system are the most mai’ked and 
most common; thc}^ seem to develop after the svmptoms of the diges- 
tive system, but before those of the nervous system. 
ANEMIA. 
In all medium and severe cases, the anemia is what tirst attracts 
attention. This varies in intensity not onh’ in pioportion to the degree 
of infection, l)ut also to a considerable extent in ])roportion to the 
length of the period of infection. For instance, 100 worms may be 
expected to produces a greater anemia within a given time, say one 
year, than will 50 parasites. But 50 worms may be expected to pro- 
duce more anemia in two years than in one. 
In some niedium cases, the blood vessels of the conjunctiva* may be 
more or less visible, and the visible mucous membranes of the nose, 
mouth, and vulva, may be more or less of a normal or subnormal 
color. In the extreme cases, these structures may be as white as 
marl)le or paper. In the same way the color of the skin will vary 
(see Skin, p. 59; Nails, p. (U) from an almost natural hue to a whitish, 
lemon yellow, or tan color. 
^'This worm is })rol)ubly much more common in tliis country than snpposiMl. The 
cases known to me to (hit(*are: Ikiltimore, Md. — 1 caj^e, 1 <h*ath; reporte<l hy Strong, 
IhOl. Richmond, Va.—l case, 0 deatli; reported l)y Thayer, .\nne Arundel 
County, Md. — 1 case, 0 death; report(*d l>y Thayer, W;u'^hin;;ton, I>. C. — 4 
cases, 0 death; iin})uhlished, Zool, Lah., Ih S. Public Health and Marine-Hospital 
Service. Ohio— 1 case, 0 death; uniniblished. Hr. A. P. ()hhnacln*r (mentioiUMl 
here l)y kind permission of the observer). San trancisco. Cal. — .{ »'a.'^*s, * deaths; 
unpulilished. Dr. 1*. K. Jirown (mentioiu'd hen* by kind jiermis'^ion ot the observer). 
Cuba — ? ca.ses, ? deaths; unpublished, Dr. John (iuiteras (mentioned ln*n* by kind 
permission of the observer). Porto Rico — ? cases; ? deaths;’unpublishe«l, Dr. 1 . K. 
Brown. 
