91 
ease, which from its description I helievo to he uncinarijisis, proha})ly 
due to Ui^cuwrin (iinertcamu causes an immense mortality amoin*- the 
children. 
Taken till in all, the data obtained did not convi?ice me that uncina- 
riasis, pev 6'^, is so fatal a disease in man as is tfeiuu’allv supposed. 
On the other hand, I obtained the impression that while very seyei-e 
cases are not infrecpiently fatal, the general etfects of the malady 
upon the S 3 ’stem are of greater and more far-reaching importance tlnm 
the lethalit}" of the infection itself. In other words, if uncinariasis 
were eliminated, the lethality of other diseases, such as pneumonia, 
typhoid feyer, malaria, and also of child birth, would be decn‘ased. 
and in the sand and mixed sand and clay areas this decrease would not 
be an insigniticant factor. . 
One physician stated to me that he was contident that he had lost 
seyeral hundred patients from uncinariasis within the ])ast forty 
years. 
Sandwith (1891:, pp. 16-17) states that of the patients nominally 
under his care, 89.5 per cent were cured or greatly improyed, i^.o per 
cent were unrelieyed, and s per cent died. 
“Most of the fatal cases had loud anemic murmurs, marked subnormal temj^era- 
ture, slight general edema, albuminuria, and great mental weakness. 
“The actual cause of death was exhaustion, from utter al)sence of rallying jwwer. 
It is difficult to believe that the pathological effects are imluced only by hemorrhage 
from the daily suction of scores or even hundreds of worms. In addition to the 
loss of blood, we have general thickening and degeneration of the duo<lenum and 
jejunum, and conse<iuent interference with normal digestion; then nonas-dmilation, 
and eventually a process of slow starvation. It is al.'^o worthy of consideration that 
there may be in jjrolonged cases some self-poisoning from the great numl>er of biti*s 
in the walls of the intestines containing ill-digested and perhaps decomi>osing hnul.” 
rOST-MORTEM ARPEAR.WCKS. 
1 did not iiaye occasion to make jiny autopsies during the trip; 
hence I am unal)le to present any original observations in this line. 
For careful accounts of single cases of autopsies, the r(‘a(h‘r is i*ef(‘rred 
in American literature to Strong (1901), Yates (1901), Claytor (PdOffii), 
and Capps (1903a). 
Sandwith's (189-1, pp. 17-:^0) summary of ;i6 autopsies is not acces- 
sible to many American physicians: hence it is (juot(‘d Inu’e* in full. 
“Some of the earlier autopsies were made by my.'H'lf, the later »>m-s by Or. Kaul- 
mann. The muscles were in <jue case described of normal color, but m all others 
they were very pale. There was usually a great absence of subcutaneous fat. The 
lungs were very pale and e<lematous in all casi*s, and all the organs were extivmely 
Idoodless. 
“In one case there was noted edema of glottis. The lu*art was fouml to l>e hy|H*r- 
trophied ten times [in 10 cases], an<l was very small twice, generally pale Imiwn 
in color, and on three occiisions there were marked changes in the mitral valve. 
The most common abnormality in the liver was a brownish-yeliow fatty ap|K*aninc»*. 
