1766 



HELMINTH INFECTIONS 



to be explicable by the hydrsemia producing the angemia. Boycott, 

 however, considers that this is not so, for he points out that leuco- 

 cytosis can occur with marked ansemia, and that there is always a 

 tendency on the part of the blood to restore its average volume and 

 composition when altered from the normal, and comparing the 

 normal leucocytic count of the hydrsemia of chlorosis, says that, 

 if there was no other factor, the leucocytic count of ankylostomiasis 

 would not be affected by the hydrsemia. 



He thinks that the true explanation is probably exhaustion of 

 the bone-marrow produced by the ansemia, and that it is partially 

 due to a failure on the part of the individual to react to the stimulus 

 to produce the eosinophile leucocytes. In any case, the leucocytic 

 reaction does not bear any relationship to the ansemia. According 

 to Boycott and Haldane, if the eosinophiles are deducted from the 

 total number of the leucocytes, and the percentage of the remainder 

 then calculated, it will be found to be nearly normal. The eosino- 

 philia has been found to remain after the ova have quite disappeared 

 from the fseces. Any inflammatory complication which leads to a 

 polymorphonuclear increase may hide the true eosinophilia. The 

 leucocytes are normal in structure, a few neutrophile, but no 

 eosinophile myelocytes are to be seen. Wemberg and Mello have 

 shown that the injection into guinea-pigs of extracts of various worms 

 induces a certain degree of eosinophilia. 



Reviewing this description of the blood, we would point out that 

 it looks as though toxins were stimulating the production of the 

 eosinophiles, and at the same time preventing a proper formation 

 of haemoglobin, and finally producing the hydrsemia. We must 

 state, however, that occasionally we have come across severe cases 

 showing no eosinophilia. Low has demonstrated that eosinophilia 

 is generally well marked in children, while it may be absent in 

 adults, and suggests that the eosinophiles, which are tissue cells at 

 first, come into the blood in response to some stimulus set up by 

 the infection, but gradually disappear as this stimulus weakens 

 with the prolongation of the infection. As a result of the diminution 

 of the production of hsemoglobin, the iron in the liver is 

 diminished. 



Patients often complain of palpitation or difficulty in breathing. 

 The lungs will be found normal, but the heart may be displaced 

 downwards and to the left, and be feeble, with a hsemic bruit at the 

 base. The vessels of the neck may be seen to pulsate markedly. 

 The pulse is quick, and may be weak, thready, dicrotic, and in- 

 termittent. The liver is very often enlarged, especially in children. 



Fever. — Fever in ankylostomiasis was described years ago by 

 Manson, Fernando, and others, and more recently attention has been 

 called to it by Gabbi and one of us. In some cases there is no 

 fever, while in others this feature is present. In our experience 

 three types of ankylostomiasis fever may be met with : — 



I. The low intermittent type, which is the commonest, and in 

 which the temperature seldom rises above ioo° F. 



