Symptomatology
In a secondary anaemia, with early and marked cardiac palpitation together with epigastric tenderness and a tendency to mental retardation and physical deterioration, one should always examine the stools for hookworm eggs.
The course of the disease is decidedly insidious and indefinite and the clinical diagnosis notoriously uncertain, as shown by many reports where physicians of experience, after examining a number of persons in a mill or school and only diagnosing 2 or 3% as infected, have been astonished, upon examination of the faeces of the group, to obtain positive evidence of infection in 70 to 80% of the number examined.
For convenience, it is well to divide hookworm cases into 3 groups; 1. Where the person infected fails to show any special evidence of abnormality, the diagnosis resting almost entirely on the finding of ova in the faeces.
Such cases may show very slight reduction in haemoglobin and only admit of a certain lack of energy. The best indication that hookworm infection is doing the host injury is that after treatment they gain in weight and energy and show improvement in mental concentration.
2. Mild cases with moderate degrees of anaemia, the Hb. percentage ranging from 55 to 75. In these cases there is rather marked epigastric tenderness with frequent attacks of acid eructations. Cardiac palpitation and a tendency to shortness of breath may be quite noticeable. Headache and vertigo may be present.
3. Severe cases. In such cases we may find extreme anaemia with Hb. percentages around 35 or even as low as 15. I have always felt that one was only approximating when recording percentages of 10 or lower.
These cases are very weak and show marked cardiac palpitation and dyspnoea upon the slightest exertion. There is often dilatation of the stomach and a protuberant abdomen. The red cells may fall below 1,000,000. There is also oedema, especially about the feet and ankles. Tinnitus aurium is rather frequent.
Such cases often show depravity of appetite, the best-known craving being that for earth. Other patients crave chalk, wood, cotton, etc.