ANKYLOSTOMIASIS 149 



The impairment of the digestion is probably not the 

 direct effect of the worms, but partly due to the fatty 

 degeneration and partly to a chronic catarrhal condition 

 associated with an abundant formation of mucus, which 

 is very common in these cases. The fatty degeneration 

 of the liver and kidneys gives rise to no symptoms that 

 can be referred directly to these organs ; only in the last 

 stages is there albuminuria. Usually the temperature is 

 subnormal, but in the early stages of infection there 

 appears to be pyrexia, and in some cases there is an 

 irregular pyrexia of a mild type that does not yield 

 to quinine, is not associated with any evidence of malaria, 

 and usually subsides with rest and purgation. 



Nervous symptoms are not marked. There is a certain 

 amount of lethargy over and above the natural aversion 

 to exertion in a person with advanced anaemia. There 

 is no paralysis, and the superficial and deep reflexes are 

 normal. Headache and vertigo are not in excess of what 

 might be anticipated from the anaemic condition. 



Diagnosis. The presence of ankylostomes can be dia- 

 gnosed by finding the characteristic ova in the faeces. 

 The examination is easy and any person of ordinary 

 intelligence can readily be taught to examine the faeces 

 and recognize the eggs. A small portion of the faeces is 

 compressed into a thin layer so as to be translucent and 

 is examined by the microscope. The eggs can be found 

 with an inch objective, but it is better to examine with 

 a half or a quarter inch, to distinguish these eggs from 

 others. The eggs are oval, measuring 0-056 to 0*06 by 

 0*034 t 0*038 mm. in Ankylostomum duodenale, and 0*064 

 to "072 by 0*036 mm. in Necator americanm. If measure- 

 ments of the eggs are required care must be taken not to 

 compress the eggs. They have a very thin, transparent, 

 colourless shell, and when freshly passed the contents 

 have commenced to segment into two or four masses. 

 If kept a few hours in a warm place segmentation will 

 be more advanced. If the faeces are too hard to be readily 

 compressed a little water may be added. If the motions 



