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Appendix A
Q. Do you consider that this fever is due directly to the parasites of malaria?
A. I have no evidence to that effect; rather the contrary.
Q. How many autopsies have you made in tropical countries ?
A. About two thousand; in Fiji and British Guiana.
Q. Have you examined the spleen by the microscope for pigment, black or yellow, in
many ?
A. In about the last sixteen hundred as a routine.
Q. What is the relation found by you in adult Indian coolies between the size of the
spleen and the presence of black pigment ?
A. A greater proportion of the small spleens than of the large spleens are pigmented;
and this difference is more marked with advancing years.
Q. Do you ever find enlarged spleen without melanin?
A. In one series of 207 cashes with spleens over 15 ounces, melanin was observed only in
12.5 per cent., while the very large spleens rarefy contained it. On the other hand, in spleens
of 15 ounces and under, 218 in number, 24.7 per cent. contained melanin.
Q. What of Indian children ?
A. The pigmented spleens are generally enlarged.
Q. Did you ever find enlarged spleens without melanin in Indian children ?
A. Yes; on several occasions out of about 100 autopsies on East Indians over one month
of age and under 20 years.
Q. Have you any evidence to show that melanin never disappears until one or more
years after it has ceased to be deposited ?
A. No; I have none.
Q. Have you any evidence to show that it ever does disappear before that period ?
A. Nothing entirely satisfactory.
Q. Do you think that it ever disappears at all ?
A. Yes. In acute infections it is found both in the liver and spleen. In cases where
there is no evidence of recent infection, it is commonly present in the spleen and absent from
the liver, and vice versa in rarer cases; showing that it may disappear from either organ.
Q. Did you find the liver frequently enlarged in association with enlarged spleen in Indian
coolies in British Guiana?
A. Only in acute malaria and pneumonia. In cases of chronic enlargement of the spleen
there was usually no enlargement of the liver.
Q. Does the negro race have enlarged spleen as much as the Indian race ?
A. No; not nearly so much, But the proportion of spleens which are pigmented is
nearly the same, age for age.
Q. Have you been able to study much ankylostomiasis ?
A. In Fiji for three years, in British Guiana for six; the disease being very common in
both countries.
Q. Do you find enlargement of the liver and spleen in ankylostomiasis ?
A. In the liver, the slight enlargement due to fatty degeneration was met with. The
average weight of the spleen, however, was rather less than the general post-mortem average
for the corresponding age. As in other persons, some of the spleens were decidedly above and
some decidedly below the average weights.
Q. Do you find any fever in ankylostomiasis ?
A. Yes; but many cases are entirely free from it or even have an entirely subnormal
temperature. The fever may be of a low continued type; or of a hectic type; or undulatory;
rarely going above 102°F—though 1 have seen it much higher without malarial parasites or
black pigment in the organs. The exacerbations are rarely preceded by direct rigors.
Q. Can you exclude malarial fever in such cases ?
A. No; because the cases occur in a malarious country. As I have said, the spleen is
not enlarged more in a larger proportion of these cases than of the ordinary population.
Q. Do you find yellow pigment and iron in cases of the anæmia of ankylostomiasis?
A. Yes; yellow pigment in the liver invariably; in the kidneys, commonly; very rarely
in the spleen. The iron reaction occurs only in about 8 per cent. of the cases; mostly in
the liver, but also in the kidneys, and certainly very rarely in the spleen.
Q. Can you exclude previous malaria?
A. No. But such pigmentation was equally common in Fiji, where there were no
opportunities for recent malarial infection; and both in Fiji and in British Guiana it was not
associated, as a rule, either with enlarged spleen or black pigmentation. The yellow pigment
was more abundant in the chronic advanced cases and the iron usually absent.
Q. What other changes do you find in the organs in ankylostomiasis ?
A. Fatty degeneration invariably, most marked in the liver, kidneys and cardiac muscles.
Q. Is there emaciation or the reverse in pure ankylostomiasis ?
A. Generally no emaciation.
Q. Do you think that the appearance of ankylostomiasis, that is, of the symptoms known
to be produced by the worms, is ever determined by an attack of some other disease ?
A. Yes; I have known the symptoms to appear suddenly after very mild attacks of
dysentery, apparently cured; and have reason for thinking that malaria, has a similar effect.