longer present. The history and the absence of other sources of anæmia are all we may have to go upon for diagnosis in such circumstances.
Ankylostomiasis is sometimes confounded with beriberi, and vice versa. The presence of paretic and cardiac symptoms not accounted for by the moderate degree of anæmia in beriberi, and their absence in ankylostomiasis, suffice for diagnosis. The anæmia of ankylostomiasis differs from that of malaria, inasmuch as the latter is accompanied by enlargement of the spleen, a sallow and perhaps pigmented complexion, an icteric tint of the scleræ, occasional attacks of well-marked periodic fever controlled by quinine, and, especially, the presence at such times of the malaria parasite in the blood. As an additional diagnostic feature, Rogers has pointed out that whereas in malaria the loss of hæmoglobin is in proportion to the loss of red blood-corpuscles, in ankylostomiasis it is in excess of this. Of course, ankylostomiasis and malarial cachexia may concur, and often do concur, in the same individual.
Some idea of the intensity of the infection may be got from an enumeration of the eggs in a given quantity of fæces; according to Grassi and Parona, the presence of 150 to 180 eggs per c.cg. indicates an infection of about a thousand worms, male and female.
Pathological anatomy and pathology.— As already mentioned, the bodies of the victims of ankylostomiasis are not wasted; on the contrary, there is plenty of fat in the usual situations. The appearance of plumpness is further increased by a greater or lesser amount of general œdema. There may be effusions in one or more of the serous cavities. All the organs are anæmic. The heart is dilated and flabby, its muscular tissue being in a state of pronounced fatty degeneration. The liver, also, is fatty, and so are the kidneys.
If the post-mortem examination be made within an hour or two of death, the ankylostomes, .in numbers ranging from a few dozens up to many hundreds, will be found still attached by their mouths to the mucous surfaces of the lower part
