90 WILLETS. 



haciendas, but nevertheless, general impressions as to the physical condi- 

 tion of the inhabitants were received. As a class, the people are anaemic 

 and they have very little ambition. Many of the children present marked 

 evidence of ascariasis. It was attempted repeatedly to select cases of 

 infection Avith the hookworm before the microscopic examinations were 

 made, but only unsatisfactory results were obtained. 



It was not difficult to secure a history of symptoms which are frequently 

 present in intestinal helminthiasis, such as nausea, vomiting, pain in 

 various parts of the abdomen, constipation, diarrhoea, headache, dizziness, 

 and restlessness, but it can not be stated that these symptoms were caused 

 by the parasitic infections. Many factors are acting upon these people 

 to lower their vitality and give rise to the symptoms mentioned. Climate, 

 early marriage, rapid child bearing, poor food, excessive smoking, habitual 

 use of alcoholics, and tuberculosis, all have their influence as well as the 

 parasites. To determine the proportion of the symptoms due to hel- 

 minthiasis would be a difficult problem, the solution of which would 

 require most careful study extended over a considerable period of time. 



The important question of the significance of hookwoitn infections 

 among the Filipinos remains unanswered. A few years ago infections 

 with this parasite were considered to be of importance, but during the 

 past two years, there has been a growing tendency to attach less and less 

 significance to them until now some believe them to be so mild that their 

 influence is practically nil, or that the Filipinos enjoy a degree of immu- 

 nity to the effects of the parasite. Such a change in opinion, is neither 

 a strange occurrence, nor one peculiar to the Philippine Islands. Beliefs 

 regarding the significance of ho'okworm infections in the United States 

 have varied. Too much importance was attributed to mild infections 

 a few years ago, whereas, in my opinion there is an inclination to attach 

 too little to them at present. It is the consensus of opinion among 

 those who have worked with intestinal parasitism in the Islands that 

 marked cases of the disease are rare among Filipinos. On the other 

 hand, it has not been proved that the infections are so mild as to be of no 

 importance from an economic point of view, or that of health. That intes- 

 tinal parasitism has an effect upon mortality and morbid conditions in the 

 Philippines is evidenced by the results obtained at Bilibid prison upon the 

 institution of a routine examination and a routine treatment against the 

 parasites. The Director of Health reports that a few years ago, when the 

 Bureau of Health began its work at the prison, the annual death rate 

 was 238 per 1,000. In response to the institution of sundry hygienic 

 measures, the mortality fell to 75 per 1,000, and it seemed impossible to 

 decrease the death rate beyond this figure. At this time the routine 

 examination of the fajces for evidences of intestinal parasitism and the 

 routine treatment of infected cases was begun, with the result that the 



