56 
examination of the feces until the worms beoin to lav eofg-s. It is. 
however, not excluded that some of the young worms might be passed 
in the stools and be identified, though such a chance is probably 
more theoretical than practical. In an experimental case of infection 
through the skin. Looss showed that eggs did not appear in the feces 
until 71 days after infection. According to Sand with (1891, p. 1:2). 
Surgeon-Major Giles suspected that many of his patients in Assam had 
sufi'ered from fever at the onset of their malady, and he was confirmed 
in this impression by observing pyrexia in the monkeys fed on hook- 
worm embryos. 
Looss (1897. pp. 911-915) noticed nausea as the first svmptom in 
dogs to which he fed the larv» of Agchyhstoma duodenale. 
Bentley (1902 a) practically advances the view that ** ground itch" is 
the primary symptom, and since Looss's view of infection through 
the skin is correct, at least for some cases, some cutaneous symptom 
must in such instances be the first symptom of imcinariasis. (See 
p. 60.) 
STAGES OF rXCTXAEIASIS. 
Since my observations of each patient were confined to one or two 
days, they would not justify me in dividing the disease into stages. 
Lutz (translated by Macdonald) recognized the following stages: 
I. STAGE OF PVRELY LOCAL SYMPTOMS. 
(a) Acute form; (6) chronic form . — The s^Tiiptoms are similar in both forms. The 
disease is ret limited to pains and disordered digestion; no pallor, no rise of pulse. 
II. STAGE OF SIMPLE AXEAOA OE OLIGOCYTHEMIA (CHLOKOTIC STAGE). 
(а) Acute form. — 1. Slight degree: Conjunctival vessels still visible; nails and lips 
pale red; pulse increased in frequency; no blowing murmurs over cardiac area. 
2. Higher degree: Conjimctivae devoid of vessels; nails whitish; lips x>ale; pulse 
frequently veiA* much increased; no blowing murmurs. 
(&) Chronic form . — Anemia has not reached the highest degree. In many cases 
distinct cardiac hypertrophy and dilatation; in other cases disordered valve closure; 
seldom both combined. Moderate Increase of frequency of pulse. 
m. DEOPSICAL STAGE. 
(«) Acute form . — A high degree of anemia; pulse small, much increased in fre- 
quency; no blowing murmurs; edema of a hydremic character. 
(б) Chronic form. — S^miptoms of cardiac defects, with disturlied compensation, or 
of fatt}' degeneration; distinct symptoms of cyanosis; dropsy of engorgement; 
anemia of varying intensity; disordered nutrition. 
DERATIOX OF WCIXAEIASIS. 
In speaking of the duration of uncinariasis, we should clearly dis- 
tinguish between the duration of ca.ses which remain in the infected 
areas, and the duration of cases which after once becoming infected 
move to uninfe.sted districts where conditions are such that reinfection 
is excluded. 
