Skin Manifestations.—The dermatitis following the penetration of the larvae is most often about the toes or inner side of the sole of the foot. The skin is very dry and often a pale earthy color. A tallow-yellow tinting of the alae of the nose may be observed. The hair is dry and scanty or absent in pubic and beard regions. Oedema, especially of ankles or feet, is common.
Circulatory and Respiratory Systems.—Palpitation of the heart is early and marked. Functional murmurs are frequent in the advanced stages. Pulsation of the neck veins is also common. The pulse rate averages about 110 and the blood pressure is low. There is frequently some right side dilatation of the heart. A high pulse pressure is common in severe cases. Shortness of breath on slight exertion is the most common respiratory symptom. There are at times cough and bronchitis, probably induced by the irritation of the larvae in the pulmonary alveoli.
Digestive System.—Epigastric tenderness going to the right is very characteristic. The stomach is often dilated and the gastric juice hyperacid. As the anaemia increases the acidity diminishes. It has been suggested that the desire to neutralize this acidity with an alkali is the explanation of the desire for alkali-containing earth on the part of “dirt eaters.”
Patients often are pot-bellied. Constipation is rather a common feature and the stools very rarely show macroscopic blood.
Nervous System.—Hookworm patients are not only physically tired but, as well, mentally tired. The infection in children leads to a backward mental state. Patients have very little energy or initiative and are often considered stupid and lazy. Hypochondriasis is at times noted and some severe cases become melancholic.
The Blood.—The red cell count averages in marked cases 2,500,000 to 3,000,000 red cells per cu. mm. The Hb. percentage is down in such cases to between 30 and 50. The color index is well below 1, except in certain rare cases, when the color index is that of pernicious anaemia, being above 1. These latter cases are very resistant to treatment and often show very few infecting worms notwithstanding the severity of the symptoms.
There is at times a moderate leucocytosis but as a rule the white count is approximately normal.
Eosinophilia is quite characteristic and usually ranges from 15 to 35% of the leucocytes. Eosinophilia tends to disappear as the cases become advanced.
The spleen and liver very rarely give rise to any symptoms and while albuminuria is rather common in advanced cases with oedema about the feet, yet casts are but rarely found.