64 
Anhjlostomiasis in Grenada 
was unusual for a patient to require more than three administrations of 
the drug, and it not rarely happened that one day’s treatment was 
sufficient to completely expel the parasites. No ill-effects followed its 
administration to either parturient women, or to children. The only 
complication ever noticed was that of haemoglohinuria, and this 
occurred in five cases of the patients treated with beta naphthol; 
about 1 “/o of the cases. Of these five cases, three were males and 
two females. On each occasion the drug was stopped at once and 
liquid extract of ergot in half-drachm doses substituted. In four cases 
the haemoglohinuria ceased within forty-eight hours, and in the fifth 
the urine was clear on the third day. In these cases, after a few days’ 
rest, treatment w^as continued with thymol without recurrence of the 
renal symptoms. 
It is advisable in all cases where treatment for the removal of these 
parasites is being carried out, to re-examine the stools for ova after 
worms have ceased to appear in the motions; since Ankylostoma 
duodenale seems to acquire an immunity to a drug after a certain 
period of treatment. In these cases, where ova are found upon re- 
examination, I found it advisable to change the vermifuge altogether; 
as continuance with the one which I had been using previously was 
ineffective. This immunity of the parasite to a drug may happen in 
the case of any of those which I used, hut most frequently happened in 
the case of thymol. 
(2) With regard to the treatment of the heart it was generally 
found advisable, where marked dyspnoea, palpitation, or irregularity of 
the pulse was jrresent, to give the patient a course of digitalis before 
commencing treatment for the removal of the parasites; and to continue 
its use on alternate days until treatment with beta naphthol was 
finished. 
The treatment for the anaemia was carried out subsequent to the 
removal of the parasites, and was generally very prolonged. Con¬ 
valescence in Hospital on a liberal diet and the administration of a 
mixture containing iron, arsenic and strychnine gave the best results. 
Recovery from the anaemia was slow and it is generally some months 
before the normal haemoglobin percentage is regained. 
When the ascites is marked, in those cases with hepatic enlarge¬ 
ment, tapping may be frequently needed. I found that neither the 
pyrexia nor the albuminuria called for special treatment; since removal 
of the worms was followed by cessation of these symptoms in all un¬ 
complicated cases. 
