SUPPLEMENT 683 



The first symptom is disturbance of the digestive system ; more 

 often there is a feeling of pain in the epigastrium, more severe upon 

 pressure, heartburn, nausea, vomiting of mucus or food at different 

 times of .the day (occasionally ancylostome ova have been found in 

 the vomit). Whether the eggs which reach the frontal sinus with the 

 vomit can develop into larvae there is questionable, but the records 

 of v. Ziemssen 1 and Huppertz, 2 to the effect that in some instances 

 ancylostomes have been discharged from the frontal sinus, are of 

 interest. The five cases recorded by the latter had a fatal termination 

 from cedematous swellings of the face with severe inflammation of 

 the meninges. The tongue is furred, and extensive catarrhal stoma- 

 titis and ptyalism are recorded. The appetite is variable, increasing 

 or diminishing, there is loathing of nourishment or a marked longing 

 for acid food and unripe fruit, whilst ordinary meals are rejected. 

 At first there is often constipation, later diarrhoea with abundant 

 mucus, and often blood in the stools; microscopically eggs and 

 Charcot-Leyden crystals were found. 



In the further course of the disease symptoms due to increasing 

 anaemia predominate ; the haemoglobin of the blood diminishes from 

 one-fourth to one-fifth of the normal (Baravalle 3 ), the eosinophile cells 

 increase considerably (Boycott, 4 Lohr 5 ), yet in regard to diagnosis 

 eosinophilia cannot be regarded as of equal value to a microscopical 

 examination of the fasces (Brims, Liefmann, and Meckel 6 ). The dis r 

 turbances of the circulatory system take the form of more or less 

 severe palpitation, pain in the region of the heart, quick pulse, oedema 

 of the eyelids, of the face, of the lower limbs, and even of the whole 

 body. Disturbance of the sexual functions (impotence, irregular 

 menstruation, delayed onset of puberty) are not infrequently observed. 



Infection in human beings takes place by the mouth, if uncleansed 

 vegetables are eaten in Japan especially, where human faeces are used 

 and articles of food are not sufficiently carefully cleaned (Inouye 7 ), 

 or from putting food into the mouth \vith dirty hands. Looss 8 does 

 not think that drinking water is dangerous as a rule, for the larvae 

 sink to the bottom in standing water, and are only brought to the 

 top by shaking. Looss has done most valuable service by discovering 

 that infection can arise also through the skin. During the last few 

 years so many authors have confirmed this at first doubted source 



1 v. Ziemssen, quoted by Haenisch, " Diss. Strasburg," 1901. 

 - Huppertz, quoted by Haenisch, " Diss. Strasburg," 1901. 



3 Baravalle, Progresso medico, 1903. 



4 Boycott, Journ, of Hygiene, 1904. 5 Lohr, Zcitschr. f. Heilk.^ xxvi. 



6 Bruns, Liefmann and Meckel, Mllnch. med. Wochenschr., 1905. 



7 Inouye, Arch. f. Verdauungs Krankh. , 1905, xi. 



8 Looss, " Handb. f. Tropenkrankh.," v. Mense, i, p. 129. 



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