89 
the last three years I have looked u])on it as a waste of time to admin- 
ister any other anthelminthic than thymol for this ])arasitc" \A</chylo- 
stoma dnodenale]. Certainh^ pen-sons in the conditions d(‘scrih(‘d should 
not be allowed to go untreated, and despite the view advance‘d by soim‘ 
authors, smaller doses of thymol, repeated one day per week and 
extending oyer several weeks, may be expected to yield some n'sults. 
Mid e fern . — Several European authors advise the use of large dostvs 
of extract of male fern in treating hookworm disease. Kichhorst's 
(1901, p. 314) recent ‘’‘Practice” places the dose at In grams (2.5 tluid 
drams) to 20 grams (5 fluid drams). It has been j)ointi‘d out by Lepino 
(1891a, 1891b) and others that such large doses of this drug arc* likely 
to be followed by serious toxic symptoms and even by death. Lepine 
summarizes the conditions as (1) sym})toms of gastrointestinal irrita- 
tion characterized by the redness and the hemorrhages; (2) nervous 
symptoms (convulsions and paralysis); (3) alhuminuria, and (4) glyco- 
suria, and he warns not to give over 8 grams of the extract as a maxi- 
mum dose. Hare gives the dosage of the exti-act as 4 to s grams 
(about 1 to 2 fluid drams). Male fern should be* follow(*d in three to 
four hours by a calomel purge, aided b}- a saline, but not hy castor or 
other oils, as the latter increase the danger of absor})tion, hc'nce of 
poisoning. 
Calomel . — While thymol is at present considered the most reliahh* 
remedy in hookworm disease, indications are not lacking (see p. 7»>) 
that considerable good may be accomplished in the American form of 
the disease by the use of calomel. This drug will not, however, he* 
followed by such prompt and satisfactory results as will thymol. 
' GENERAL TREATMENT. 
The administration of thymol has for its object the expulsion of tin* 
parasite, hence the removal of the cause of the disease*. 'Phis should 
be supplemented by efforts to build up the de{)h*t(*d systc*m by means 
of good nourishing food, iron, etc. It is well to give tin* iron daily, 
except on the days that thymol is taken. Sandwith (lS94, ]). 25) 
claims that the blood was most benefited by a daily su{)ply of 1.5 grams 
(23 grains) of the sulphate of iron in watc*r in thrc'c* (*(jual doses. 
I’liOCNOSiS. 
Among physicians I found the view rather prc*val(*nt that the ])rog- 
nosis was poor for children who })r<*sent(*d sever<* cases «>t tin* disi*ase. 
This view is probably due to tin* fact that tin* eaiist* ot tin* troubh* 
was not understood, ln*nce tr(*atment was not directed to r(*movir>g 
the cause. 
The proposition now before us is, lirst. to n-move the int<*stinal par- 
asites, and second, to build u[) tin* patients. 
