ANCYLOSTOMUM DUODENALE. 387 



was previously strongly pigmented, becomes dingy pale yellow, 

 yellowish, or greenish white, paler and grayer even in negroes, 

 and at the same time very withered, flabby, dry, peeling, and 

 cool ; the conjunctiva bluish white, the lips and all visible mucous 

 membranes almost as pale as death. Great dulness and apathy 

 in every movement, general weakness and exhaustion, come on 

 with vague pains in the joints, constant palpitations of the heart, 

 with enormous intensity of its beating, returning upon the least 

 movement, and frequently also pain in the region of the heart. 

 The second sound of the heart is sometimes audible even at a 

 distance of several paces ; in auscultation, either both sounds 

 are equally loud, or the first sound is short and weak, not clear, 

 diffused, or combined with systolic, vesicular, whistling murmurs ; 

 the pulse is very frequent and small ; there are murmurs in all 

 the larger arteries, and a loud rushing is audible in the 

 jugular vein, with a purring which is sensible to the touch. 

 In individual, very rare cases, all the signs of an organic disease 

 of the heart or aorta are met with. The patients complain of 

 giddiness, frontal and temporal headaches, and rushing sounds in 

 the ears; the respiration is frequent and short, and the respiratory 

 murmurs weak ; after a few days dyspnoea occurs ; in many the chest 

 is emphysematously enlarged. The urine is abundant, pale, and 

 very rarely contains albumen. Besides these, constant hunger, 

 singular appetites, occasional status gastricus, with slight febrile 

 movements, slimy coating of the tongue, and sensibility of the 

 lower part of the abdomen, are exhibited. The spleen is 

 occasionally a good deal enlarged, the liver frequently diminished 

 in size. In short, a high degree of anaemia and hydraemia is 

 perceived. With indulgence and good fare, this state often lasts 

 for years, in many cases its progress is very acute. But even with 

 great care the individuals remain pallid, sickly, and miserable ; 

 slight acute diseases which make their appearance, are very 

 serious, and at last dysentery carries off the patient. Only 

 occasionally a patient recovers by a change of climate and all other 

 conditions of life. Fatiguing labour and debilitating antiphlogistic 

 treatment hasten the end. Or the patients die from diarrhoea, 

 general dropsy without albumen in the urine, &c., in spite of 

 all the iron and wine. 



In the bodies we find, watery infiltration in various places, 

 flabby pale muscles, great anaemia of all parts, especially the 

 brain, the lungs, the stomach, and the intestnal mucous mem- 



