92 
In one case there ^Yere several abscesses and the liver weighed 3,700 grams, and in 
one patient there was well-marked jaundice. 
“The spleen was enlarged in one-third of the post-mortems. The kidneys invari- 
ably showed some change, though this was often much more' marked, in one kidney 
than in the other. They were very pale in 24 patients, 3 of whom had several 
small cysts. Of the remaining 2 patients one had granular kidneys and the other 
had cysts, but the kidneys were of normal color. 
“The brain was always exceptionally white, and in one case there was recent 
apoplexy. 
“The small intestines showed, of course, the most important changes. As a rule, 
there were many hemorrhages and bites in the jejunum and ileum, but in one of the 
cases where the bites were carefully counted there were only 6 in the jejunum and 
ileum, and no worms were found. In another case, however, there were 575 bites 
in the small intestine, besides 250 anchylostoma. In yet another there were 100 
bites, the farthest of which was 4.5 meters from the pylorus. In only two cases 
was there much liquid blood in the intestine. 
“I have not observed the constant changes in the mucous membrane of the stomach 
described by Giles. The great variability in the number of anchylostoma found at 
the autopsies is interesting. In 7 cases, all treated by thymol during life, no worms 
could be found. In an eighth case, also treated by thymol, but insufficiently, there 
were 10 worms. The remaining 18 cases had not had the advantage of thymol. Six 
of them, nevertheless, were found to have less than 10 worms, and in two of these 
corpses only 1 worm was found in each jejunum. Three other cases numbered 20, 
40, and 50 worms, but the remaining 9 had numbers varying from 170 to 381, termi- 
nating with the maximum record of 863. On that occasion the autopsy was made 
seven hours after death, and the worms were scattered from a point 1 inch beyond 
the pylorus for the length of 3 meters; 217 of the 863 were attached still to the intes- 
tine and were surrounded by much bloody mucus, while 646 were lying free in the 
intestine; 16 of the latter were still alive, and one couple were in copulation, 
‘ ‘ Next the position of the worms deserves notice. It was quite the exception to find 
any parasites in the duodenum. Can it be that when the duodenum becomes thick- 
ened and riddled, as it were, with the ravages of former generations, the anchy- 
lostomum fastens by preference on to the jejunum? Some such cause as this 
suggestion of gradually shifting the pasture is required to explain the interesting fact 
that it is not the most advanced cases of anemia which will always yield the largest 
quantity of worms. In such cases the parasite must not only have to burrow extra 
deep, but the blood when reached is, of course, deficient in quantity. Or is it that 
the half-starved worms are dislodged by repeated attacks of diarrhea? The furthest 
feeding ground that I have seen was 6.30 meters from the pylorus, where there was 
a worm firmly attached, But, as a rule, the attached worms are all within 2 meters 
of the pylorus, and have their heads and sometimes half their bodies buried in the 
mucous membrane. It is often impossible to dislodge them by a strong stream of 
water, and they must then be pulled out by forceps. 
“I examined about 50 cases to see the proportion of male to female worms, and 
found it 56 to 44 per cent. This is not in accordance with some of the authorities, 
who say that males are always more rare than females, and that males are less 
influenced than females by the action of expellent drugs.” 
«“Dubini has only once seen the worm in the ileum. The nearest feeding ground 
seen by me was 24 centimeters from the pylorus. In that case there were 100 worms 
attached and 281 detached, besides oxyurides.” 
