342 DISCUSSION. 



Dr. Victor G. Heiser, Director of Health for the Philippine Islands, 

 professor of hygiene,. Philippine Medical School, Manila, P. I. — The 

 paper of Major Chamberlain is an excellent resume, presented in an 

 interesting manner, of the work done in connection with the hookworm 

 and serves as an example of how wrong deductions may be drawn from 

 an insufficient number of observations. For instance, as a result of the 

 4,000 or more stool examinations which were made of the prisoners at 

 Bilibid, over half of the prisoners were found to be infected with 

 hookworms, and by eliminating these parasites the mortality was reduced 

 from 75 to 12 per cent per thousand. There seemed to be no question 

 that the reduction in the mortality was due to the elimination of 

 intestinal parasites, and more especially the hookworm, because the 

 treatment was carried out by brigades, which consisted of 300 prisoners, 

 and more than a year was consumed in this work, and the death rate 

 fell among those prisoners who had been freed of their intestinal 

 parasites. At that time many medical men were inclined to reason 

 that the same percentage of infection must exist among the general 

 population, and that if the intestinal parasites could be eliminated a 

 mortality rate as low as that found in the Temperate Zones might be 

 obtained in the Philippines. However, since it was shown that the 

 percentage of infection among the general population was not over 15 

 and that the majority of those examined showed no symptoms, it was 

 evident that no such improvement in the mortality rate could be expected. 



Dr. Gilbert E. Brooke, port health officer, Singapore, delegate from the 

 Straits Settlements, Singapore. — In Singapore we have not had much 

 experience with this disease. On the quarantine station we do a certain 

 number of post-mortem examinations of coolies who die at the station, 

 but it is very rarely that we find many cases of this infection. During 

 a cholera epidemic on the station, I. found at one time that eucalyptus 

 oil, which we were giving as a cholera prophylactic, resulted in the 

 expulsion of numbers of agchylostomes. This oil might therefore prove 

 a nonirritating and useful vermifuge. 



Dr. J. M. A tkinson, principal medical officer, Hongkong, delegate from 

 the government of Hongkong. — I quite agree with Doctor Castellani in 

 thanking Major Chamberlain for his interesting paper. Was there 

 not any record in the old Spanish days of the presence of Agchylostomum 

 duodanale in the Philippines? 



Cases are seen at the Government Civil Hospital, Hongkong, but 

 this disease is not common there and the parasites are generally found 

 when examining the stools of patients admitted suffering from other 

 diseases. 



If, as I understand Doctor Chamberlain, the white troops from the 

 United States have in all probability introduced Necator americanus 

 into these Islands, could not this be prevented by a special medical 

 examination of those men before leaving the States? 



