Fig. 92.—Fatal case of ancylostomiasis. Red cells 810,000. Hb. 15%. White count 6400. Eosinophiles absent. Upper part of small intestines lined with hookworms. (From U. S. Naval Medical Bulletin.)
It is in children that we have the most serious effects of the disease, there being marked stunting of the growth with a corresponding mental backwardness. Such children show marked retardation and delay in answering the question asked them and often repeat it in a drawling manner. Tested by the Binet-Simon method we may find a sixteen year old child to have the mental development of a ten year old one, but at the same time we would note that from a standpoint of physical development the child only seemed ten years old.
As the child approaches adult age we note a striking lack of sexual development and the lack of pubic hair. In girls there is delay in the onset of the menstrual periods or these may never appear.
In from 80 to 90% of cases there is a history of dermatitis, particularly of toes or feet, which is commonly called “ground itch,” “foot itch,” or “dew itch.” This is most frequent between the toes or on the inner side of the sole of the foot. The irritation is due to the penetration into the cutaneous tissues of the hookworm larvae. The itching is intense and secondary infections often occur as the result of scratching. Vesicles appear about the second day and are often ruptured by the scratching with a resulting pustular or impetiginous conditions. The skin and hair generally are dry.
As a rule the temperature is normal throughout the course of an uncomplicated case of hookworm disease. During the first week or so following a heavy infection there may be pulmonary manifestations when the larvae are migrating by way of the lungs.
In the diagnosis of a case Stiles attaches much importance to a tallow-yellow color of the alae of the nose and the forehead, as well as to the eye characteristics which are like those seen in the eye of a fish or that of an intoxicated person.
He also notes that the pupil tends to dilate instead of to contract when the patient looks at a bright light. It has seemed to me that the condition is rather one of hippus. In severe cases retinal haemorrhages may occur. There may be night blindness. Ascites may be present in advanced cases.
Symptoms in Detail