ETIOLOGY 155 



In cases of parturition the patient must not be allowed 

 to leave the bed at any stage of the labour, nor must she 

 be allowed to strain forcibly. If labour is not excep- 

 tionally rapid and easy, operative measures are probably 

 indicated. Haemorrhage is usually slight, but the little 

 loss is still serious. The uterus tends to be atonic and 

 must be supported by the hand as long as there is any 

 tendency to dilatation and for considerably longer than in 

 a healthy person. Active treatment with anthelmintics 

 must be postponed till the patient has recovered from 

 the effects of parturition, and every effort made by careful 

 feeding and nursing to improve the condition. In early 

 pregnancy there is no objection to active treatment, but 

 when near full time there is less chance of a successful 

 result. 



Late in pregnancy a modified treatment, with less starva- 

 tion and purgation, may be tried. It is less dangerous, 

 but not so effective. Eucalyptus mixture is much to be 

 preferred to thymol in these cases. 



The improvement in the general condition after the 

 complete removal of the worms is rapid and begins in 

 about a week or so after that event. Usually two or three 

 attempts to expel the worms have to be made, with an 

 interval of a week in between. 



Etiology. The frequency with which severe anaemia 

 occurs in many tropical countries has long attracted 

 attention. It was usually considered to be climatic or 

 due to malaria. Anaemia no doubt may be due to such 

 causes, but the common extreme anaemia is not. The 

 worms had been seen by many, and the associated anaemia 

 noted, but it was not till the epidemic of anaemia in the 

 St. Gothard Tunnel works was shown to be due to the 

 ankylostome that general attention in the Tropics was 

 directed to this form of anaemia. From this period on- 

 wards there was much discussion as to the actual causal 

 relationship of the anaemia. It was soon found that the 

 worms were often found in persons showing no anaemic 

 condition, and that they might be numerous in such cases, 



