152 TROPICAL MEDICINE AND HYGIENE 



On microscopical examination fatty degeneration of 

 the intestinal muscosa, of the liver, kidney and cardiac 

 muscle, is found always to be extensive. In the liver, 

 when it is not universal, only the cells in the centre of the 

 lobules may be invaded. In addition to the abundant 

 deposits of hsemosiderin present in all cases, there may 

 be colourless granules giving the reactions of iron in 

 inorganic combination in the acute cases. 



The kidneys may appear of similar dusky chrome 

 colour to the liver. The fatty degeneration affecting the 

 epithelium in the tubules is marked. Deposits of haemo- 

 siderin and iron-bearing granules are most abundant in 

 the epithelial cells of the convoluted tubules. 



If the examination be made a few hours after death 

 all the worms will be still attached to the mucosa, but later 

 they become detached and are then found free, either 

 in the mucus or in the contents of the alimentary canal. 

 Very rarely there are small cysts, each containing a single 

 worm usually taken to be an ankylostome, but possibly 

 some other nematode. No opening into the intestine is 

 found in these cysts, and the worms are usually males. 



In milder cases, or in persons who show no symptoms 

 of the disease, there may be no marked excess of mucus. 

 In these cases both the worms, and also petechiae due to 

 old bites, are found. The rare accident of profuse haemor- 

 rhage into the intestinal canal is probably from damage to 

 a small vessel. 



The brain shares in the general anaemia. The cerebro- 

 spinal fluid is increased in amount. 



Treatment. Good food, rest and tonics are of little or 

 no value unless the worms are expelled, but are important 

 aids to an anthelmintic treatment. In a person in a very 

 weak condition, where there is suspicion of cardiac 

 failure, and in parturient women, immediate anthelmintic 

 treatment is almost certain to be fatal. In such cases 

 attempts must be made to improve the general health 

 before active treatment is commenced. The expulsion of 

 the worms is not an easy matter, and is often successful 



