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Further observations on the Diagnosis of Ankylostoma Infection with Special reference to the Examination of the Blood
Published online by Cambridge University Press: 15 May 2009
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The experience of the last few years in the Westphalian coal-field has shewn that the presence of Ankylostoma in a mine may become a matter of considerable industrial importance. Since it has been shewn that several of the metalliferous mines in Cornwall are throughly infected, the question of how far it may be present in, or spread to, other British mines has arisen in a practical form. When any large number of individuals have to undergo a medical examination for any such purpose it is of importance that such examination should be convenient at once for the examiner and for the examinee, that it should occupy as short a time as possible, and should, at the same time, be reliable. The diagnosis of the presence of Ankylostoma is commonly made by searching for the characteristic eggs in the faeces; and indeed a final diagnosis must rest in nearly every case on the results of this procedure. Which is therefore not easily replaced by any other method when separate individuals are in question. But as applied to a large body of active working men this process has many disadvantages, and at the request of the Home Secretary an inquiry has been made into the practicability of other methods of examination1.
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page 438 note 1 A short account of the results obtained has already appeared as a Parliamentary Paper [Cd. 2066], 1904.
page 439 note 1 What proportion of the total number employed underground constitutes a “sufficient number” is difficult to say. In most cases, however, where the worm has gained a footing in a mine, a large proportion—often nearly the whole—of the men are infected. The proportion, no doubt, varies with the suitability of the conditions (temperature, moisture, etc.) for the abundant growth and spread of the larvae; it will be lower in cool and dry than in hot and wet mines. If these conditions are not unfavourable, an examination of 10 per cent. of the men, taken at random, will probably give a very good idea of the frequency of infection. Scattered cases, however, might easily be missed in this way.
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page 441 note 1 This extension of the cases, and especially the periodical examinations of the blood in men under treatment, has been rendered possible only by a copious supply of films and estimations of haemoglobin for which I am indebted to Mr. R. A. Thomas.
page 442 note 1 The counts in these tables are all based on the classification of 500 leucocytes; in a few cases 1000 were enumerated.
page 443 note 1 At Dolcoath the total number of underground hands (“complement”) is 717, of whom 148 have been examined=20 per cent.
page 444 note 1 Mast cells present, but not seen in the 500 cells enumerated.
page 445 note 1 Eosinophiles present, though not seen in the 500 cells enumerated.
page 445 note 2 Mast cells present.
page 448 note 1 Considerable leucocytosis present from cystitis due to an enlarged prostate.
page 448 note 1 All these neighbouring mines (Botallack, etc.) have shut down some years since.
page 448 note 2 Complement 478: examined 8½ per cent.
page 449 note 1 Repeated searches failed to find any Ascaris eggs in this first sample; in the second they were very abundant.
page 450 note 1 Atlantic sea-water contains 3·4 p.c. NaCl.
page 451 note 1 Mast cells present.
page 452 note 1 Worked at Dolocoath 7 years since, when he was pale and dyspnoeic: soon recovered in this mine.
page 452 note 2 Mast cells present.
page 452 note 3 Eosinophiles found.
page 455 note 1 Even in medullary leukaemia the blood may at intervals be quite normal. The author has seen such a case.
page 455 note 2 We are I believe indebted to Dr Otto Grünbaum for this happy expression of a truth which is often forgotten.
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page 459 note 1 American Medicine, VI. 1903, p. 391: some doubt is here thrown upon the accuracy of our observations relative to the existence of high eosinophile leucocytosis due to Ankylostoma because the authors have not been fortunate enough to meet with such cases. Ashford has however himself recorded a good example (7,200 eosinophiles in 18,000 total leucocytes), though he prefers to consider that it was due to a pneumonia of a somewhat hypothetical nature.
page 459 note 2 The very low figures for the haemoglobin (7—12 p.c.) given here must be regarded with suspicion in the absence of any evidence as to the accuracy of the standardisation of the instrument used. I have recently found that in this part of the scale the MiescherFleischl apparatus gives results about 25 to 30 p.c. too low.
page 460 note 1 Our own figures do not shew this clearly, but the number of cases of severe anaemia seen in Cornwall has been comparatively very small.
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page 474 note 1 The series which are marked A were examined with cover-glasses, B with the cigarette-paper method, C with slide-smears, and the rest by a mixture of all three methods.
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page 479 note 1 Pork is the chief meat eaten by the Cornish miners.
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