of the duodenum, of the jejunum, and, perhaps, of the upper part of the ileum; but if the examination has been delayed for some hours, the parasites will have dropped their hold, and are then to be found lying in the mucus coating the inner surface of the bowel. Many small extravasations of blood —some fresh, others of long standing— are seen in the mucous membrane, a minute wound in the centre of each extravasation representing the point at which the parasite had been attached. Sometimes blood-filled cavities, as large as filberts, are found in the mucosa; each cavity enclosing one or two worms and, probably, communicating by means of a small hole with the interior of the intestine. Old extravasations are indicated by punctiform pigmentations. There may be evidence, in the shape of vesiculations and thickening of the mucosa, of a greater or lesser degree of catarrh. Occasionally, streaks or large clots of blood are found in the lumen of the bowel.
Daniels and others report that microscopical examination of the liver and kidneys shows the presence, within the cells of the parenchyma, of grains of yellow pigment having the reactions of hæmatoidin; indicating an intravascular blood destruction such as occurs in pernicious anæmia and other diseases in which excessive hæmolysis is a feature. On this account, and also because he finds granules of a ferrous nature in the liver cells, Daniels concludes that the anæmia in ankylostomiasis is, in a measure, the result of blood destruction within the vessels by some toxic substance produced by the parasite and absorbed from the bowel. These results have not been confirmed by all other observers; on the contrary, the late Dr. Beaven Rake concluded, from careful estimates of the amount of iron in the livers of five cases of ankylostomiasis, that in this disease the hepatic iron is below the normal average, and that the anæmia is entirely owing to the direct abstraction of blood by the parasites. Further observations are necessary before this question can be decided.
Treatment. Malefern.— Until the introduction of thymol by Bozzolo in 1880, extract of male fern
