It is evident that as a complication in typhoid, in kidney disease, in dysentery, in malaria, in fact in any chronic or exhausting disease, the importance of this anæmia-producing parasite cannot be ignored.
The practitioner in the tropics, therefore, must be constantly on the look-out in all cases of anæmia, of dyspepsia, and of debilitated conditions generally, for the ankylostomum. He must bear in mind that this parasite, as will be presently pointed out, if permitted to remain in the intestine for a length of time, may be the cause, not only of remediable anæmia, but of irremediable anæmia-produced degenerations of various organs. On this account, also, its early recognition becomes a matter of the first importance.
Further, ankylostomiasis is an important disease from the standpoint of the employer of native labour. The invaliding and inefficiency which it causes among coolies, not to mention the deaths, are of ten financially a serious matter to the planter and the mine-owner. To them, any wisely directed expense or trouble undertaken for the treating and controlling of this helminthiasis will be abundantly repaid by the increased efficiency of the labourer.
Symptoms.— The essential symptoms of ankylostomiasis are those of a progressive anæmia; an anæmia which is generally associated with dyspeptic trouble, but which, in uncomplicated cases, is not associated with wasting. If the progress of a case be unchecked, serous effusions in different organs and fatty degeneration of the heart ensue, and death may occur from syncope or from intercurrent complication.
One of the earliest symptoms of an extensive ankylostomum invasion is pain or uneasiness in the epigastrium. This is generally increased by pressure, but, for the time, may be relieved by food. The appetite, sometimes defective, is more often ravenous, though its gratification is apt to give rise to dyspeptic trouble of various kinds, to colic, to borborygmus, and perhaps to diarrhœa of imperfectly digested food. Constipation may be present in some instances, irregularity of the bowels in others. The taste may be perverted, some patients exhibiting and persistently
