262 HOOKWORMS 



young man or woman of 20 may present the general development 

 of a child of 12 or 14, though the face may appear either very 

 childish or prematurely old. Girls who are affected from child- 

 hood lack development of the breasts, but in general there is no 

 marked loss of flesh. The face has a stupid bloated appearance, 

 and the eyes have a hollow stare which is very characteristic. 

 The bloating carried to the abdomen results in " pot-belly." 

 The appetite, at first ravenous, diminishes with the progress of 

 the disease, and frequently becomes perverted so that patients 

 become dirt-eaters, i.e., have a mania for swallowing earth or 

 mud, possibly a reaction involuntarily prompted by the irritation 

 of the intestinal tract by the parasites. Over 25 per cent of the 

 hookworm patients of one physician in our southern states con- 

 fessed to " dirt-eating." The diseased appetite, of course, only 

 adds to the infection. The nervous symptoms, which are rather 

 late in appearance, consist of dizziness, headache and profound 

 stupidity. 



The loss of efficiency from hookworm infection is startling, and 

 the slow development of many countries may be largely attributed 

 to the handicap placed upon the citizens by the hookworm. The 

 effect of the disease can be appreciated from the following ex- 

 amples: the managers of large coffee " haciendas " in Porto 

 Rico state that hookworm reduces the average efficiency of the 

 laborers from 35 to 50 per cent. On a cocoa plantation in 

 Ecuador not over 33 per cent of the work which should have been 

 obtained from 300 laborers was available, due to anemias of 

 hookworm and chronic malaria. On a sugar plantation in 

 British Guiana, after the laborers had been treated for hookworm 

 on a large scale, the working power of the gangs increased 100 

 per cent. Dr. McDonald of Queensland, Australia, reports that 

 hookworm " is sucking the hearts' blood of the whole com- 

 munity." The loss of efficiency of the miners in a single Cali- 

 fornia mine, due to hookworm, has been estimated at 20 per cent. 

 Estimating only 50 per cent of the miners to be infected, the 

 annual economic loss in this one mine would be $20,000 per year. 

 The economic loss due to the infection of 2,000,000 or more people 

 in the southeastern United States or to the infection of from 

 60 to 80 per cent of the 300,000,00^ people of India must be 

 almost incalculable. 



The retarding effect of the disease in education and civilization 



