108 
larv line. A louder bruit of a different pitch was audible over the mitral area and 
the base. The pulmonic sound was louder than the aortic closure. 
‘‘The spleen was not palpable, though its area of dullness was enlarged. The liver 
was not felt. The epigastric and umbilical regions were tender to pressure. Knee 
jerks present but not promi^t. 
“Temperature 98.6, pulse 90, respiration 20. Urine 1.015; no albumen, no sugar, 
and no casts. 
“ September 11, blood examination showed hemaglobin 18 per cent; reds, 2,576,000; 
whites, 6,600. Ko stained preparations were made. 
“ September 15, gastric contents were expressed one hour after a test meal of tea 
and toast. No free HCl present; no lactic acid. 
“September 23, blood examination, hemog. 17 per cent; reds, 2,280,000; whites, 
6 , 000 . 
“October 20, blood examination, hemog. 12.5 per cent; reds, 813,000; hematocrit, 
980,000; whites, 4,500; color index, 0.80; volume index, 1.17. The differential count 
showed: small mononuclear, 10 per cent; large mononuclear, 11 per cent; polymorph, 
neutrophile, 66 per cent; pohunorph. eosinophiles, 13 per cent; no rouleaux forma- 
tion; no nucleated red cells; poikilocytosis marked; polychromatoiDhilia marked. 
'‘The presence of pronounced eosinophilia in a case of grave anemia made us 
strongly suspect the existence of an intestinal parasite, so that the stools were exam- 
ined frequently. The earlier specimens of feces were watery from the rectal injections 
employed, and were therefore not easily studied. In a formed movement, however, 
the ova were found in large numbers. These eggs corre-ponded accurately in dimen- 
sions to those of Uncinaria duodenalis, measuring about 56 microns in length and 34 
microns in width. 
“ Subsequently the eggs of Tricocephalus dispar ere found in small number by 
Dr. J. L. Miller. Charcot-Leyden crystals were present in some preparations, absent 
in others. Cover glass smears of feces hardened in alcohol and ether were stained 
with hematoxylin and eosin and eosinophilic granulations demonstrated. These 
granulations, like the Charcot crystals, were never numerous, as is so often the case 
in ankvlostomiasis. 
“ The eggs were successfully cultivated and the larvm brought to mature develop- 
ment. These experiments will be described later. 
“ November 6, examination of the blood gave: hemaglobin 11 per cent; reds, 
748,000; hematocrit, 915,000; whites, 5,600; color index, 88 per cent; volume index, 
122 per cent. Differential count: small mononuclear, 15.8 per cent; large mono- 
nuclear, 6.8 per cent; polymorph, neutrophile, 70.2 per cent; eosinophile, 7.6 per 
cent; eosinophilic myelocytes, 0.2 per cent; mast cells, 0.4 per cent. Poikilocytosis 
and polychromatophilia marked. Coagulation time, five minutes. 
“Previous to this examination the patient had taken thymol in small doses, and 
it is not unlikely that many parasites were swept away and lost in the stools. The 
diminished eosinophilia and the small number of eggs found in the stools thereafter 
lend support to this assumption. 
History in the hospital. — Treatment, on the whole, was unsatisfactory, because of 
the profound weakness of the patient and the irritable condition of the stomach. A 
persistent nausea set in that interfered with stomach feeding and made the adminis- 
tration of thymol ineffective and even hazardous. Nutrient and salt enemata were 
resorted to, but the vomiting persisted until the patient succumbed, on November 13. 
“During his stay in the hospital the most conspicuous symptom was epigastric pain 
of a dull nature at first, subsequently colicky. In the last two weeks,, this pain 
became continuous, and was accompanied by a great tenderness over the epigastric 
and right hypochondriac regions. The liver mass extended at this time about 2 
inches below the costal arch, and the tenderness, on pressure, was as great as that 
seen in hepatic abscess. 
“The bowels, as a rule, were constipated, and required rectal enemata. The tern- 
