improved, having gained six pounds and stools reduced. to two or three daily.

The next two cases probably need an apology, for being classed under the title of this paper, after the excellent work done by Drs. H. F. Harris and Claude A. Smith of this Association, but hook-worms are by no means common in this section of Georgia.

Case 6.-March 16, 1905. H. D., referred by Dr. Chas. E. Simon of Baltimore, age nine, schoolboy. Complains of being weak and nervous. Family history: Good. A younger brother, strong and ruddy. Personal history: Has never had any diseases of childhood except whooping cough. Never sick except chills four years since, and cured of these by spending summer in Asheville. Present trouble started three years ago, and been poor and anemic ever since, but never had ground itch until last summer. Had thirty grains of thymol in Baltimore but did not find any worms, also male fern without effect.

Examination: Poorly nourished anemic boy, skin sallow, with puffiness under eyes; tongue broad, flat and pale; heart slightly hypertrophied; lungs, negative; temperature, 99 degrees; pulse 88, and 100 after slight extion; R. B. C., 3000000; no plasmodium malaria; urine 1.020, acid, clear; feces contain ovae uncinariae, but not in great numbers.

Treated with magnesium sulphate and thymol, being careful to see that the thymol was very finely powdered before before putting in capsules. There were five movements and some uncinariae passed.

Case 7-March 29, 1905: R. F., aged ten, schoolboy from South Georgia. Complains of feeling weak and tired. Personal history: Has had only whooping cough, but has never been strong. "Has had ground itch lots," and chills since January.

Examination: Poorly nourished, anemic boy; heart hypertrophied; lungs negative; pulse 98; temperature 98 degrees; liver enlarged and spleen palpable; abdomen large, legs small; R. B. C. 2710000; plasmodium malariæ; urine 1.022, acid, clear, no sugar, no albumin; feces contain ovæ uncinariæ in great numbers. A typical case of uncinariasis.

Treated malaria first and when patient was stronger, thymol treatment, for hook-worms, which brought them in great numbers. Examination of feces a week later showed a few eggs still; so further treatment will be

necessary.

Summary: These cases present the following unusual features: The first, tuberculosis of the intestines without active pulmonary tuberculosis. The second, strongyloides intestinalis, which had never been reported in America until Thayer of the Johns Hopkins reported three cases in 1901, and since only a few cases, about eight, have been reported. We found in this case that strongyloides are very resistant to all anthelmintics, as we never succeeded in securing a partheogenetic mother worm. This was also a more profound type of anemia than any with uncinariasis.

Amebic dysentery, as found in three, four and five, is more common than many of us suppose. While some cases yield promptly to quinine, others require additional remedial agents and hydrogen peroxide, borolyptol, creosote and bismuth subnitrate are very efficient.

Case sixth disproves an idea once prevalent that hookworms were found only among the poorer classes and badly nourished children, as he belongs to a family of wealth and refinement. Case six agrees with the suggestion made by Dr. Claude A. Smith, that the number of uncinariae found in a case depended on the number of attacks of ground-itch, as this boy "had ground-itch a lot" and he had lots of hook-worms.

MUCOUS COLITIS.

BY WILLIAM B. ARMSTRONG, M.D., ATLANTA.

Synonyms: Membranous enteritis; diarrhea tubularis; mucous colic, etc.

Definition: It is a disease presenting great variety of nervous symptoms and characterized by abdominal pain, followed by the passage of considerable quantities of mucus in the form of shreds and bands or casts of a portion of the intestine. Alarming hemorrhages occasionally occur with the passage of mucus.

History: This condition has been known for centuries. One of the first cases was described by Fernelius in Paris in the year 1554, of an ambassador of Charles V. Mason Good described "diarrhea tubularis" in 1825, and DaCosta called attention to the nervous element of this condition in 1871. In recent years it has been carefully studied by a number of investigators, prominently among whom are Hermann Nothnagel and Carl von Noorden.

Etiology: Most cases occur in nervous, neurasthenic, hysterical individuals. Women are more often affected than men, and adults more frequently than children.

Pathological anatomy: The pathological findings throw but little light upon the nature of this condition. Hemmeter subjected certain portions of the colon that were covered with a thick layer of mucus to careful macroscopic and microscopic examinations and failed to find any histologic evidence of inflammation. O. Rothman has found evidence of slight catarrhal inflammation which

he regards as secondary. The membranes when viewed under the microscope are transparent and structureless, and imbedded in them are granules, broken down epithelial cells, crystals and particles of fecal matter. These membranes have been thoroughly investigated chemically and have proven to be composed of mucus.

no cause.

Symptoms: These patients complain of a great variety of nervous symptoms, prominently among which are palpitation of the heart; sense of fullness in the abdomen, often accompanied with flatulence; inability to take a long breath; indefinite pains, and great mental depression. I have had patients tell me they had much rather die than remain in their present mental state, and when asked to state their feelings they simply say they suffer from terrible attacks of the "blues," for which they find As a rule their appetite is poor, and they often suffer from headache. Just before an attack the nervous symptoms increase in severity and often a severe headache develops; the patient complains of pain in the region of the umbilicus, the right or left inguinal region, or over the whole abdomen. Often the pain is so severe that drugs have to be administered for its control. Tenderness may be present over the whole abdomen, or confined to the course of the colon, or the right or left inguinal region. Occasionally McBurney's point is the site of greatest tenderness. At this time nausea and vomiting may occur. The temperature seldom goes much above normal. After these symptoms have become established the patient may at any time pass large quantities of mucus in the form of shreds and bands or casts of the intestine. These casts are often of considerable length, measuring from a few inches to considerably over a foot. In rare cases alarming hemorrhages from the bowel occur just previous to or during the passage of mucus.

All of the mucus may

be passed at one time, or there may be several passages a day for several days. After this the patient is very much prostrated, but the pain and tenderness are greatly relieved. Such attacks may occur at intervals of weeks or months.

Generally the cases are not as plain as the one just described, but the patients will tell you they suffer from indigestion, a sense of fullness in the abdomen, palpitation of the heart, and that they are extremely nervous. They may or may not mention having passed large quantities of mucus, and when questioned on this point may deny it. (This is due to the fact that water-closets are used and that stools are seldom seen.) They generally give a history of chronic constipation, or constipation alternating with diarrhea. Upon examining these patients you generally find them fairly well nourished, with a flabby and slightly coated tongue. Examination of the blood shows a slight degree of anemia. Examination of the stomach contents shows slight increase or decrease in HCL in a few cases it is entirely absent. Examination of feces, after administering a purgative, generally shows a considerable quantity of mucus.

Pathogenesis: The cause of this peculiar condition is still a mooted question. Some believe it to be the sequel of previous inflammation of the lower intestinal tract; others incline to chronic constipation as the cause, while still others think that the cause must be looked for in the nervous system. The nervous element of this condition is certainly most prominent, and in the absence of positive pathological evidence one is almost forced to lean to the latter theory, viz.: that the nervous system is an important causative factor. Nothnagel describes two classes of cases, one in which the mucous membrane of the colon presents a perfectly normal appearance; in these