60 Aiilqjlostomiasis in Grenada 
usually complained of great weakness, pain in the epigastrium, or pal¬ 
pitation—either separately or in combination. The appearance of the 
patients was that of being well-nourished, the cheeks being fat and the 
body well covered. Puffiness under the eyes, pulsation of the great 
vessels of the neck and oedema around the ankles were, however, very 
frequently observed. Upon examination the conjunctiva was found to be 
oedematous and anaemic in proportion to the severity of the infection ; 
in some cases this was very marked, in others no variation from the 
normal could be noted. The tongue was usually swollen, anaemic and 
indented by the teeth and the mucous membrane of the mouth was 
also anaemic. The bluish-black pigmented patches of which mention 
has been made by many observers were found to be present in 65 ®/o 1 
and this I found to be about the same percentage in which it occurs in 
other cases not affected with the disease. I am of the opinion that no 
connection exists between these pigmented areas on the tongue and 
ankylostomiasis. The epigastrium was generally found to be painful 
on pressure and pulsation of the epigastrium was common in advanced 
cases of the disease. The heart, in approximately 20 % of the 
cases, was found to be enlarged towards the left; sometimes being 
just outside the nipple line, at others being as far out as the mid- 
axillary line. Haemic bruits were usually found to be present in these 
cases; but, in advanced cases of the disease, mitral regurgitation was 
fi’equently noted. The rate of the heart beat is usually found to be 
normal and regular when the patient is at rest; but on the slightest 
exertion, as in getting up from a chair, the rate is at once accelerated. 
Nothing abnormal is usually noted in the lungs; but those cases, which 
through their extreme weakness and disability have been compelled to 
remain in their beds, generally have some oedema at the bases. 
The liver was generally found to be normal, but in some 5 % 
of the cases slight enlargement was present. Occasionally the en¬ 
largement is extreme and in my series two such cases were observed, 
in which the hepatic enlargement extended down to within two inches 
of the umbilicus, and there was considerable ascites. Both these cases 
died. 
The kidneys were not palpable in uncomplicated cases and the 
spleen was only made out in those cases which had previously had 
malaria. Examination of the urine showed the presence of albumen 
in 14 “/o of the cases infected with the parasite. In no case 
was I able to demonstrate the presence of albumose. My experience 
differs entirely from that of those observers who find that albuminuria 
