150 TROPICAL MEDICINE AND HYGIENE 



are liquid they should be allowed to stand, and the 

 deposit taken up with a pipette, as the eggs are heavy and 

 sink to the bottom. 



The anaemia and the presence of ankylostome eggs 

 in the stool, and the blood changes described, including 

 eosinophilia, are sufficient for diagnosis. In advanced 

 cases the anaemia may persist after the expulsion of the 

 worms. In these cases, without the history, a correct 

 diagnosis cannot be made. 



Prognosis. This is very good in cases where the anaemia 

 has developed rapidly and the patient is young, provided 

 the worms are completely expelled. Treatment with anthel- 

 mintics is deceptive, unless the faeces are examined a 

 week or so later for eggs, as it frequently happens that 

 only a small proportion of the worms are expelled after 

 their administration, though the remaining worms may 

 not pass eggs for some days. In aged persons, in those 

 who have been anaemic for prolonged periods, and where 

 the digestive functions are imperfect, as shown by the 

 amount of undigested food passed, the results of treat- 

 ment are less certain. In such persons very successful 

 results may be obtained, but are not so uniform. 



In parturient women the prognosis is very grave. This 

 is not only because even a small loss of blood is badly 

 borne by advanced anaemics, but because the prolonged 

 strain and violent exertion lead to cardiac failure. Such 

 patients frequently die shortly after the child is born. 

 There is no tendency to post-partiun haemorrhage. Pre- 

 mature labour is common. Children are often stillborn, 

 but may be living and in good condition. 



Untreated cases may remain stationary for years, but 

 usually the anaemia steadily increases, and the fatty 

 changes in the viscera result in further impairment of 

 health, and the patients die either from anaemia, from the 

 results of the fatty changes, or from some intercurrent, 

 possibly trivial, disease. 



Morbid Anatomy. The body usually appears to be well 

 nourished, and subcutaneous and peritoneal fat may be 



