ANKYLOSTOMIASIS 317 



with absolute alcohol, wasli dut glycerine, and stain with hsematin 

 and eosin. 



SYMPTOMATOLOGY. 



Clinical Course. 



Papules or vesicles may form v/here the larv« enter, perhaps due 

 to the pus cocci introduced. This is known as " ground itch " or 

 "bunches." A leucocytosis and an eosinophilia can be seen under 

 the microscope before other symptoms are manifest. The first 

 symptoms generally observed are, however, pallor, weakness, breath- 

 lessness, oedema, general or local, emaciation perhaps concealed by 

 the oedema. Flatulence, dyspepsia, nausea, vomiting, epigastric pain, 

 constipation or diarrhcjca ; later in tlie final stages there may be a 

 general anasarca. 



One finds the ova in the stools with, sometimes, blood and mucus, 

 also Charcot-Leyden crystals. 



In some cases there is a perverted appetite, perhaps due to mental 

 disturbance (geophag\'). 



Impotence is common, 68 per cent, of Sandwith's cases. 



Puberty is delayed in both sexes. It arrests growth and develop- 

 ment generally. 



Lemann noticed that infantilism was present in voung hookworm 

 patients of the Southern United States. He finds that the disease 

 produces : — 



(i) A general retardation of skeletal changes. 



(2) A general retardation of growth, symmetrical and harmonious. 



(3) A failure of development of the genitals as well as the absence 

 of secondary sexual characteristics. 



(4) A general slowness and dullness. 



THE BLOOD EXAMINATION. 



The volume of blood is increased, causing dilatation of the heart 

 and hjemic bruits at the apex. Coagulation is diminished, the blood 

 readily spreading over the skin when punctured. The blood condition 

 predisposes to palpitation, and a quick, thready, dicrotic and inter- 

 mittent pulse. 



The red cells are markedly diminished ; one patient had but 930,000 

 and recovered. The haemoglobin may be as low as 15 per cent. 



There are many changes in the red cells, but they are more uniform 

 than in pernicious anaemia. One finds poikilocytes, megalocytes, 

 normoblasts and megaloblasts. Polychromasia is not infrequent. 

 The eosinophilia is from 10 per cent, to 50 per cent., sometimes well- 

 marked in children, but may be absent in adults (Low). 



The leucocytes, total count, vary from 20,000 to 50,000 per cm. 



