198 GARRISON. 



infection with whipworms reported from the tropics are due to the 

 failure of workers in tropical countries to record whipworm infections. 



A number of authors 8 have found whipworm to be more common in 

 females than in males and in children (under 15 years of age) than in 

 adults and therefore it is probable that the actual frequency of the 

 parasite in the Philippine population as a whole is higher than is shown 

 by our figures, which are exclusively based upon the examination of 

 adults and almost exclusively of males. 



So far as could be determined from the records of the previous 

 residences of the prisoners examined, the percentage of infections with 

 whipworms appears to be about equal throughout the different provinces 

 of the Islands. 



INFECTIONS WITH HOOKWORMS. 



(52 per cent.) 



Hookworms, after Trichuris, were the parasites most frequently en- 

 countered (52 per cent). Much higher rates of infection with hook- 

 worms have been reported from other countries, but some of these, notably 

 those detailed in the report of the Porto Eican Anaemia Commission, 

 are not suitable for purposes of comparison, for the reason that the 

 examinations were primarily directed to the study of hookworms, while 

 in our own work hookworm infections were recorded no more faithfully 

 than were those with other parasites. 



Calvert, Fearnside and Dobson in India reported 83 per cent, 05.83 per cent, 

 and 75.58 per cent, respectively, and with the exception of their comparatively 

 low rates of infection with whipworms, these authors appear to have recorded 

 all intestinal verminous infections impartially — their rates of total infections 

 being 143, 104.9 and 107. 2S per cent, respectively. 



The recognized pathogenicity of hookworms, their relatively great 

 importance from the view point of clinical medicine and public hygiene, 

 and the seriousness of the problems presented by uncinariasis in other 

 countries, urge us to depart here from a purely statistical pres'entation 

 of the case and briefly to consider the clinical aspect of hookworm 

 disease in the Philippines, so far as we have been able to determine it 

 by observation and inquiry during the past year, in relation with the 

 apparent frequency of hookworm infections. 



While our figures show 52 per cent of the 4,106 prisoners which were 

 examined to be infected with hookworms, clinical manifestations of 

 uncinariasis were rare; in fact, eases of severe anoemia, in the absence of 

 tuberculosis, malaria, or other anaemia-producing diseases, were practi- 

 cally absent. While hundreds of patients come from the provinces to the 

 hospitals of Manila annually, general inquiry among the physicians elicits 



*Bull. Hyg. Lab.. U. 8. Pub. Health & Mar.-Hosp. Serv., Wash. (1900), 28, 

 70-71. 



