S YMPTOMA TOLOGY 



1765 



scrotum, or face. When the ascites is marked, the patient has a 

 protuberant abdomen, and looks at first sight not unhke a person 

 suffering from malarial cachexia or kala-azar. The tongue is said 

 by some observers to have two purplish smears, one on each side 

 of the median line, and to be pigmented, but this in our experi- 

 ence can be seen in normal natives. The appetite may be per- 

 verted and geophagy result, and in addition there are signs of 

 dyspepsia due to the chronic gastritis, and there may be nausea, 

 vomiting, heartburn, and pain over the pit of the stomach. The 

 bowels may be constipated, or there may be diarrhoea. Ova of 

 Ascaris and Trichuris, together with those of Ancylostoma, are often 

 seen in the faeces. Occasionally a little blood and mucus are 

 present, and Charcot-Leyden crystals may also occur. 



Blood. — ^There is marked ansemia, which has been shown by 

 Boycott and Haldane, by using Haldane and Lorrain-Smith's 

 method of estimating the total volume of the blood, to be due to a 

 hydraemia; that is to say, the total volume of the blood is increased 

 without a corresponding increase in the cellular elements and haemo- 

 globin. This is analogous to the blood condition found in chlorosis, 

 and is the reverse of that found in pernicious anaemia, the features 

 of which are very rarely met with in ankylostomiasis. 



The counts given by different observers vary. Thus, Ashford gives as the 

 average of nineteen cases the following figures: Erythrocytes, 1,776,000; 

 haemoglobin, 21 per cent.; colour-index, o-6; leucocytes, 7,000; eosinophiles, 

 iO'3 per cent. Boycott and Haldane in seventeen cases found erythrocytes 

 from 4,072,000 to 1,533,000; haemoglobin from 58 to 17 per cent.; colour- 

 index from 0*71 to 0'56; leucocytes from 44,800 to 3,800; polymorphonuclears, 

 48*7 per cent.; lymphocytes, 14*4 per cent.; mononuclears, S'9 P^^^ cent.; 

 transitionals, 7*4 per cent.; eosinophiles, 23 per cent.; mast cells, 0-6 per 

 cent. Ashford, King, and Gutierrez found erythrocytes from normal to 

 754,000; haemoglobin from 8 to 10 1 per cent.; leucocytes from 5,000 to 

 10,000; polymorphonuclears, 54*5 per cent.; lymphocytes, 16*3 per cent.; 

 mononuclears, 8*6 per cent.; eosinophiles, 17*1 per cent.; other forms, 3*5 per 

 cent. 



The red cells may show pathological changes and poikilocytes ; 

 megalocytes and polychromasia may be seen, as well as normoblasts 

 and megaloblasts. The diminution of the colour-index is said to be 

 the first pathological sign in the blood. In some very rare cases a 

 condition of hyperglobulia has been observed instead of the usual 

 oligocythaemia. 



Boycott has shown that the principal leucocytic changes are to 

 be seen in the blood before a condition of marked anaemia has set in, 

 when it is found that there may be high leucocytosis — 20,600 to 

 56,000 — ^with a very high eosinophile figure of 56'2 to 66'2 per cent., 

 while the haemoglobin was from 98 to 80 per cent. When anaemia 

 sets in, a leucocytosis is much less frequent, being met with in cases 

 in which anaemia develops quickly. On the other hand, a leuco- 

 penia may be seen if the case is very anaemic. The reason for this 

 alteration from a high state of leucocytosis without anaemia to that 

 of leucopenia with severe anaemia might at first sight be thought 



