He found thousands of adult ancylostomes in the small bowel of a 20-year old soldier who was suffering from severe diarrhoea and anaemia (labelled at the time as Egyptian chlorosis). The subject was revisited in Europe when there was an outbreak of "miners anaemia" in Italy. During the construction of the Gotthard Tunnel in Switzerland (1871–81), a large number of miners suffered from severe anaemia of unknown cause. Medical investigations let to the understanding that it was caused by Ancylostoma duodenale (favoured by high temperatures and humidity) and to "major advances in parasitology, by way of research into the aetiology, epidemiology and treatment of ancylostomiasis".Hookworms still account for high proportion of debilitating disease in the tropics and 50–60,000 deaths per year can be attributed to this disease. References


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Epidemiology
PA is estimated to affect 0.1% of the general population and 1.9% of those over 60, accounting for 20–50% of B12 deficiency in adults. A review of literature shows that the prevalence of PA is higher in Northern Europe, especially in Scandinavian countries, and among people of African descent, and that increased awareness of the disease and better diagnostic tools might play a role in apparently higher rates of incidence. History
A case of anemia with a first recognition of associated atrophic gastritis a feature of pernicious anemia, was first described in 1824 by James Combe. This was fully investigated in 1849, by British physician Thomas Addison, from which it acquired the common name of Addisons anemia. In 1871, the first accurate description of the disease in Europe was by Michael Anton Biermer, a German physician who referred to the insidious course of the condition, and because it was untreatable and fatal at the time, he first referred to it as "pernicious" anemia. In 1900 Russell coined the term subacute combined degeneration of spinal cord.In 1907, Richard Clarke Cabot reported on a series of 1200 patients with PA; their average survival was between one and  three years. Pernicious anemia was a fatal disease before about the year 1920, until the importance of the liver in hematopoiesis was recognized, the treatment of pernicious anemia was unsuccessful and arbitrary. It may have motivated George Whipple, who had a keen interest in liver diseases, to investigate the livers role in hematopoiesis.