148 TROPICAL MEDICINE AND HYGIENE 



element in the pathology of the disease, and the extent 

 to which the change has taken place affects the prognosis. 



Fatty degeneration may occur early in the course of 

 the disease, before the anaemia is extreme. The heart is 

 one of the organs earliest affected, and dilatation is very 

 common. This may be accelerated by strain or over- 

 fatigue, and the patient may die suddenly. This occa- 

 sionally happens to a person straining at stool or taking 

 any violent exertion. Frequently over- fatigue results in 

 a cardiac dilatation, from which the patient does not 

 recover, but dies in a few hours or days. 



With the patient absolutely at rest the pulse, though 

 very soft and compressible, may not be fast, but with the 

 slightest exertion it becomes very rapid. Murmurs, at 

 first haemic, but later definitely due to regurgitation, are 

 developed with slight exertion. Venous pulsation can 

 usually be observed in the neck, as well as a venous hum. 



Epigastric pain is a common but not invariable 

 symptom, and may occur early in the disease. 



The appetite is usually good, but may be capricious, 

 and in some places earth-eating geophagy is common 

 in such patients. Occasionally coal and other abnormal 

 substances may be eaten. In the last stages there may 

 be aversion for food. 



When there is constipation the eggs of the worm will 

 be found uniformly distributed throughout the faeces. 

 When there is watery diarrhoea much undigested food is 

 passed, and the eggs will fall to the bottom. These 

 conditions are probably due to the fatty degeneration of 

 cells in the mucosa, and in such cases the prognosis is 

 less favourable. In the liver and kidneys extreme degrees 

 of fatty degeneration are common. 



Dysentery as a complication is common. Occasionally 

 there is melaena from the passage of blood into the small 

 intestine, and rarely the haemorrhage into the intestines 

 is profuse, and death occurs rapidly. In such cases a little 

 altered blood may be passed per rectum, or there may be 

 a large quantity. In some cases no blood is passed, but 

 the small intestines may be distended with blood. 



