ANKYLOSTOMIASIS— UNCINARIASIS 563 



murs ; over the jugular vein distinct nun's murmurs may be recognized. Oc- 

 casionally an organic cardiac affection develops. As a rule, there is a diminu- 

 tion in the number of red blood-corpuscles, the amount of hemoglobin is 

 decidedly- reduced; sometimes there is leukocytosis. The lungs are usually 

 normal, provided accidental complications are not present. The microscopic 

 examination of the feces shows, besides more or less altered blood cells, the 

 presence of countless ova which, as a rule, are uniformly distributed through 

 the entire fecal mass. Almost invariably Charcot-Leyden crystals are found. 

 The parasite itself is generally only detected in the feces after the administra- 

 tion of anthelmintics. 



With increasing severity of the disease the patients show the distinct symp- 

 toms of progressive anemia. Edema develops in the extremities and in the 

 face, and to this are added frequent attacks of fever. Changes in the eye- 

 ground, edema of the papilla, and effusions of blood into the retina have 

 frequently been observed. In some cases bone pains are noted; Leich ten- 

 stern in such a case observed simultaneously a decided enlargement of the 

 spleen. 



The majority of the severe anemic phenomena may probably be explained 

 by the blood-absorbing properties of the parasite. The ankylostoma are, as it 

 were, luxurious blood-absorbers, since they nourish themselves only from the 

 blood-plasma, while the red blood-corpuscles leave the intestinal canal of the 

 parasite in an unchanged condition. The loss of blood by secondary hemor- 

 rhage from the wounds, particularly during the time in which the parasites 

 frequently change their position for the purpose of copulation, is perhaps 

 even greater than the amount of blood absorbed. Lussano, by very interesting 

 investigations, believes he has proven that the ankylostoma give off like other 

 entozoa toxic products of metabolism which have a deleterious effect upon 

 the blood. Ervant, Arstan, Verdun, Zinn and Jacoby and others have ex- 

 pressed the opinion that, besides a blood-sucking activity, there is probably a 

 toxic effect upon the blood which is an important factor in the origin of ane- 

 mia. Bohland has determined an abnormally great decomposition of albumin 

 in ankylostoma patients. 



If the disease is not recognized, if there is no relief, the debilitated patient 

 suffers for weeks and months, and finally succumbs with the symptoms of 

 general marasmus; or intercurrent affections terminate life. Only rarely 

 does a change of climate and of the mode of life bring about a spontaneous 

 recovery. 



The cadavers of patients who die of ankylostomiasis are usually but little 

 emaciated, provided the cases have been uncomplicated, but they are invariably 

 pale and waxy-yellow. The pannieulus adiposus, the fat in the mesentery, 

 in the heart, and in the mediastinum, is often decidedly increased. The mus- 

 cles are pale; general dropsical phenomena, including hydrothorax and 

 hydropericardium, are common. There is marked anemia of all organs. 

 The heart muscle is often dilated, hypertrophied, pale or grayish-brown. The 

 liver and spleen are more or less atrophic, and occasionally show amyloid de- 

 generation. Similar changes are often noted in the kidneys. The small intes- 

 tine is in some cases decidedly narrowed, the colon sometimes shows signs of 



