ANKYLOSTOMIASIS 147 



energy. The physical and mental deterioration of the 

 poorer classes of whites in the Southern States of U.S.A. 

 is to a great extent due to the frequency with which they 

 are infected with this worm. 



The Blood. Both the number of red corpuscles per 

 cubic millimetre and the amount of haemoglobin are 

 reduced enormously. In some cases, and usually amongst 

 Europeans (Haldane), the reduction in the amount of 

 haemoglobin is in excess of the reduction in corpuscles. 

 In other cases, and more commonly in natives, the 

 haemoglobin is either diminished in the same degree or 

 even to a smaller extent than the number of red cor- 

 puscles. It is unusual to get as much disproportion as in 

 a typical case of pernicious anaemia. In advanced cases 

 the red corpuscles may be less than 1,000,000 per cubic 

 millimetre, and before death may be less than 500,000. 

 The haemoglobin may fall to 15 per cent., or, in fatal 

 cases, the reduction may be still greater. The red cor- 

 puscles are as a rule more uniform in size and colouring 

 than in pernicious anaemia, and poikilocytosis less 

 marked, but exceptions are not rare. Nucleated red 

 corpuscles are rarely to be found in large numbers. In 

 the opinion of the author, amongst natives the blood 

 changes approximate to those in pernicious anaemia 

 rather than to the chlorotic type. Haldane and Boycott, 

 from their observations on Cornish miners, came to a 

 different conclusion. 



The leucocytes are usually not increased, but the 

 relative proportion of eosinophiles is always increased ; 

 usually they form some 10 or 12 per cent, of the total 

 leucocytes instead of the normal 2 to 4 per cent. Not 

 uncommonly much higher proportions are observed, 

 such as 30 to 40 per cent., or even more. 



The blood coagulates with difficulty, and is so thin 

 and watery that it readily spreads over the skin when a 

 puncture is made. The volume of the blood in advanced 

 cases appears to be diminished. 



The fatty degeneration of the viscera forms a serious 



