Hookworm infestation with the nematode Necator americanusis endemic in the highlands of Sri Lanka. Patients present profoundly anaemic with a characteristic facial appearance that often lends itself to a “spot diagnosis.” Indeed, it was common for an intern to tell a colleague in passing, “I see you've got another hookworm coming in.”

Hepatitis A, or infectious hepatitis as it was known a few decades ago (to distinguish it from hepatitis B or serum hepatitis), was also a common infection. At any time, the medicine ward would include three or four patients so afflicted. As inspection of the urine was a better index of jaundice than examination of the eyes, clear glass jars containing a morning specimen of urine could be seen by each patient's bedside. Then, as now, the treatment was largely supportive. As managed care was …