72 
Cervical pulsations . — In the rural vernacular, ‘‘jerking at the neck” 
or “jumping at the neck” refers to an anemic symptom which is 
exceedingly prominent in most medium cases and in all extreme cases 
of uncinariasis. It is simply the violent pulsations of the cervical 
vessels, visible sometimes at a distance of 2 to 4 meters. 
Heart . — Nearly all medium and severe cases complain of having 
“heart disease” or a “fluttering of the heart,” and many of the 
patients are taking medicine for this symptom. (See also p. 35.) We 
have here, of course, the usual cardiac symptoms of an extreme anemia. 
“Palpitation over the heart, in the epigastrium, and in the temporal arteries is sure 
to be present in bad cases, while the anemic murmurs of heart and neck are solely 
dependent upon the degree of anemia, and can be banished by a prolonged course of 
iron. Hypertrophy of heart was noted and verified after death in some of the 
advanced cases.” (Sandwith, 1894, p. 12.) 
Pulse . — Pulse varies from 80 to 132 per minute. In medium and 
severe cases I noticed about 120 per minute probably more frequently 
than either a higher or a lower pulse. This was found in young and 
middle-aged (probably more commonly in children), in males and 
females, and j^et without a temperature which was distinguishable by 
the hand as especially high. 
TEMPERATUKE. 
Not being able to follow any cases for any length of time, hence not 
being able to make continued observations on the temperature, I con- 
sidered that observations in other lines were more important under the 
circumstances. Hence I did not take temperatures carefully. Accord- 
ing to observations by various clinicians, there may be subnormal or 
normal temperature, or the thermometer may register 100° to 102° F. 
“The skin is always cold, and the temperature before thymol generally subnormal 
in uncomplicated cases. After excluding any fever produced by concurrent diseases 
and any defervescence caused by thymol, I find that one-third of my patients had a 
normal temperature during their stay in the hospital, but that two-thirds had a dis- 
tinctly subnormal range, varying from an average of 36.3° C. a. m. to 36.9° C. p. m. 
“Many of these patients when convalescent had an increase of half a degree, 
night and morning. 
“Surgeon-Major Giles suspected that many of his patients in Assam had suffered 
from fever-at the onset of their malady, and he was confirmed in this impression by 
observing pyrexia in the monkeys he fed on anchylostoma embryos. After elimi- 
nating all those who had fever in the hospital, or a history of intermittent fever or 
any enlargement of the spleen, I found that 68 per cent of the remaining stated that 
their trouble had begun with a few days’ fever.” (Sandwith, 1894, p. 12.) 
RESPIRATORY SYSTEM. 
NOSTRILS. 
See page 66. ' 
RESPIRATION. 
Many patients complain of a difficulty in breathing, especially after 
exertion. This symptom is- quite natural, in view of the low condi- 
