73 
tion of the blood and the emaciation of the muscles. Respiration is 
rather variable and does not appear to be a symptom of very ^reat 
value; it ma}^ be slow, or it may be increased to about 3t» or more per 
minute. According to Sandwith (1894, p. 12) dyspnea and noises in 
the ears were present, as might be expected with marked anemia. 
MUSCULAR SYSTEM. 
EMACIATION. 
A progressive emaciation is more or less common, especially in 
severe cases. The arms and legs seem to be reduced to skin and 
bones; the chest is so emaciated that the ribs are very prominent and 
the beating of the heart is very evident. What little muscle is left 
is soft and tiabby. 
Emaciation is, however, not present in all cases, and even in some 
medium infections the muscles may be well formed and more or less 
hard. I recall one case in particular: A bov about 14 who showed a 
heavy infection microscopically, a clear clinical history of uncinariasis 
of several years standing, decided anemia, distinct cervical pulsations, 
abdomen rather distended (‘'pot-bellied"), yet his arms and legs were 
well formed and his muscles surprisingly solid for a patient in his con- 
dition. 
Sandwith (1894, p. 13) found the average weight of 100 grown men 
upon admission to the hospital to be 117.5 pounds; the average height 
of these men was 5 feet 5.5 inches, which by Dawson's tables should 
scale at least 135 points. Of the patients who stayed in the hospital 
more than two weeks 7t> per cent gained weight, 22 per cent lost, and 
8 per cent remained stationary. The average loss of weight was 3.2 
pounds, and was, of cour.se cau.sed by the nece.ssary starvation, thymol, 
and purging. The average gain was 5.4 pounds, .some patients gain- 
ing as much as 15, 17, 18, or 2<» pounds. 
GRE.\T PIIY.SICAL WEAKNES.S. 
One of the most pronounced .symptoms <*omplained of is a general 
weakim.-^s. The patient states that he is obliged to rest after e.xm*- 
tion. In light eases a feeling of la.ssitude is experienced without 
being able to a.ssig^n it to any particular cause; as a n'siilt. it is gener- 
all}’ a.s.signed by other people to laziness. In medium casi‘s the patient 
may be able to work one to three or four hours before lH*coming 
exhausted; in verv .severe cases he will scarcelv lu* able to walk across 
the room, or he may be confined U) the b<*d for weeks at a time. 
A physical examination usually shows an emaciation proportionate to 
the weakness. 
