1764 



HELMINTH INFECTIONS 



It is not known what effect the journey from the skin to the 

 ahmentary canal has upon the host, but it is certain that in course 

 of time a marked effect upon the blood and the organs of the 

 body is produced, which often appears out of proportion to the 

 number of worms which can be found in the intestine. Loeb and 

 Smith find that the worm produces a substance which hinders the 

 coagulation of the blood. Some observers — e.g., Gabbi — have 

 found that the blood of ancylostome patients is more toxic than 

 the blood of healthy people, and contains more haemolytic sub- 

 stances, but this has been denied by Marini. Padoa and others 

 have observed that the processes of intestinal putrefaction are very 

 marked in ankylostomiasis. In our opinion the anaemia is due to 

 a complex of causes — viz., the haemolytic toxins secreted by the 

 worm, actual loss of blood from the bites of the worms, and microbic 

 secondary infections. 



Morbid Anatomy. — An eruption about the feet, oedema about the 

 ankles, with a peculiar dead-white appearance of the conjunctiva, 

 are often seen on the post-mortem table. On opening the abdomen, 

 it will be noted that the tissues are damp, the peritoneum sodden, 

 the intestines very pale, and some straw-coloured fluid will generally 

 be seen in the peritoneal cavity. All the organs appear damp and 

 pale. The lungs are oedematous, the heart pale and fatty, with 

 sometimes hypertrophy of the left ventricle. The liver is fatty; 

 the spleen presents various appearances, but generally is shrunken ; 

 the pancreas is normal, as are the suprarenals; the stomach shows 

 chronic gastritis; the jejunum and ileum are usually contracted; 

 and the mucosa is often dark red in colour, and marked by small 

 haemorrhagic points, which indicate the position of the bites. The 

 ancylostomes may be found in large numbers, or may require 

 considerable looking for. Sometimes they are firmly attached to 

 the mucosae. The kidneys are usually enlarged, pale, and fatty. 



Symptomatology. — The first stage or invasion of the body by the 

 embryos may be marked by dermatitis of various types, papulo- 

 vesicular or pustulo-ulcerative. The dermatitis is generally 

 situated on the soles of the feet, and called by the natives of the 

 West Indies ' mazamorra ' (ground-itch), and is also known as 

 ' pani-ghao ' and the sore feet of coolies. It is probable, as remarked 

 by Balfour, that the symptoms of the initial dermatitis, urticarial 

 wheals, redness, and itching, are due directly to the larvae, while the 

 pustular stage is caused by secondary pyogenic infection. The 

 second stage is the development of a leucocytosis and an eosinophilia 

 before the definite disease begins. The third stage is when the 

 anaemia begins to be appreciable. 



The patient becomes pale, weak, and dropsical, the pallor being 

 most marked in the conjunctiva of the lower eyelid, which becomes 

 of a peculiar dead-white appearance. The emaciation may be 

 marked, but, on the other hand, it may be concealed by the dropsy. 

 In many cases there is oedema round the ankles, and in others there 

 may be general oedema, with often ascites, oedema of the legs. 



