HO The Philippine Journal of Science 1923 



to 13 per cent of the total number. The total worm count in 

 case 3 is the lowest of these three cases ; and, while the relative 

 proportion of ancylostomes is lower than in the other two, it 

 will be noted that the haemoglobin percentage is 55 as against 

 the -10 and 25 in cases 4 and 8, respectively. These figures 

 represent a startlingly high ancylostome index for the Malay 

 region, but we shall postpone our discussion of that point pending 

 the preparation of our other paper. In passing, attention is 

 drawn to case 6, with a total worm count of 1,340, but with a 

 haemoglobin percentage of 35. In this case only 18 ancylostomes 

 were recovered. 



The general physical examination of the subjects yielded in- 

 formation that harmonizes well with the foregoing. The family 

 and previous personal history of the patients revealed nothing 

 of special bearing on their condition as harborers of hookworms 

 at the time of observation, with the exception of case 10, a 

 girl 10 years old, to whom we shall allude in greater detail 

 farther on. 



Every case presented the gross appearance of advanced anae- 

 mia. In most instances the conjunctivae were all but colorless. 

 At least five of the subjects showed the dusky facies that has 

 been styled "hookworm pallor." All showed varying degrees of 

 emaciation from slight to pronounced, as in case 9. (Edema of 

 the extremities was marked in five cases and one subject, case 

 7, presented a markedly protruberant abdomen. Hsemic mur- 

 murs, ranging from slight to pronounced, were elicited in nine 

 subjects. In a word, all the patients were frankly sick and 

 obviously unfit to carry out their ordinary duties, let alone hard 

 manual labor. 



One subject, case 4, was suffering from pulmonary tubercu- 

 losis in an advanced stage, and the lungs of four others were 

 not above suspicion. There were no other findings of signifi- 

 cance in any of the subjects. 



In short, a fairly thorough clinical and laboratory study of 

 these people failed to discover any cause for their anaemia other 

 than the hookworms they harbored, and we have no hesitation 

 in stating our belief that they were suffering from hookworm 

 disease in its strict sense. 



Detailed discussion of the individual cases would seem to 

 be unnecessary. We desire, however, to direct especial atten- 

 tion to the protocol of case 10, because it presents, in a striking 

 manner, one untoward phase in the problem of education in the 

 Philippine Islands, and shows how at least one child was thwarted 



