45 
SYMI>T03IAT0L0(a OF I N( INAHI ASIS.« 
In connection with the symptoms, let us recjill that uncinariasis is 
caused l)y hookworms about half an inch lon<^^ which live* in th(‘ small 
intestine for several meters below the stomach. 
These worms fasten to the mucosa and suck blood. They lay 
numerous eggs, which can be found by a microscopic examination of 
the stools. The number of eggs in the feces and, in a general way 
also, the severit}^ of the symptoms will vary with tlu' numluu* of para- 
sites present and with the duration of the infection. 
The injury to the patients results from th(‘ following factors: (1) 
Sucking of blood by the parasites, which is a constant drain on the 
system; loss of blood into the intestine through the minub* wounds 
made by the parasite, a factor which also tends to dei)let(‘ tlu* syst(*m; 
(3) the wounds form })oints of attack for bacteria, hence increase the 
chances of bacterial infection as well as of toxic infection from t)artly 
digested and decomposed food; (4) the wall of the duodenum and 
jejunum becomes thickened and degenerated, and its function is thus 
decidedly interfered with; (5) the parasites in all probability produce 
a poisonous substance which acts ut)on the patient. 
Theoretically there is only one sign which is i)i*esent in every case, 
nameh% the presence of one or more parasites in the inb'stine. If 
«Thin discussion of symptoms 'will be influenced to no slight degree by the fact 
that during my trip my associates have been almost entirely practicing physicians, 
particularly in rural districts, rather than laboratory specialists; and, since it is more 
particularly the country j>ractitioner whom I desire to reach by this paper, I shall 
not hesitate to use vernacular names even if these do not invariably have a cla.s«ical 
origin. 
My trip was undertaken in'order to })rove the fre(iuency an<l geographic distribu- 
tion of the parasite, not to study the syni})toms it causes. It was therefore a zoologi- 
cal, not a clinical, trip, and on this account a zooh)gist, not a clinician, undertook the 
investigation. Not posing in any sense of the term as a clinician, 1 feel that any 
observations which I have made upon symptoms, sensu stricto, should be looketl 
upon as over and above the amount of work which should be justly expecte«l of me. 
Certain symptoms I could not help noticing. The circumstances of my trip, the 
rapid travel, short stops, and the fact that the work was done among strangers, and 
usually in the field instead of in a hos])ital, absolutely excluded certain observations, 
even had I considered that I was the pro[>er pei-son to make them. 
If, therefore, the Header mis.ses in this disciussion observations on any j»arti«*ular 
symptom in which he is especially interested, 1 beg that he will i\*cak that it is self- 
understood that the finer points in symptomatoh>gy must Ik* studied by ex|H*rt 
clinicians. 
■ I regret that it is not fea.sible for meat the jire.sent time to review the entin* medi- 
cal literature on uncinariasis. Such an undertaking would involve an unjustilialne 
delay in sending much-needeil information to jihysicians in the infei’ted district. 
In connection with my own observations, however, I shall mak»‘ fretpient rofi*r- 
ences to the noted paiier entitled “Ob.servations on 400 ca.^es of anchylostomiasis.” 
published in 1894 by F. M. Sand with, M. D.. physician to the Ka."r-el-aini Hospital. 
Cairo, Egypt, thus supplementing my description with the views expressetl by u 
trained clinician. 
