35 
a paper published in the Eighteenth Annual Report of the Bui’eau of 
Animal Industry, and issued on September 25, 11^02, that we must have 
in the United States an endemic uncinariasis which had been generally 
overlooked. 
Prior to the appearance of the paper in question, Claude Smith, of 
Atlanta, Ga. (June, 1902), had presented a case of uncinariasis before 
the American ^ledical Association (see below, p. lo3), the parasite 
afterwards proving to belong to the species Uncharia amei'ianta. 
H. F. Harris (JuU 19, 1902), also published a case of uncinariasis 
(see below, p. 103) for Georgia. In reply to a letter from' me, he stated 
(August 9) that he had found other cases also, and that he was “abso- 
lutely sure this disease is very common in this [Porter Springs] 
locality.” 
Upon my transfer from the United States Bureau of Animal 
Industry to the United States Public Health and Marine-Hospital 
Service, I decided upon an early study of uncinariasis in man, to 
determine its frequency and geographic distribution in the Southern 
States. A preliminaiy report (Stiles, lt)02c, October 24) was pub- 
lished, giving my results for Virginia, North Carolina, and part of 
South Carolina. This report reads as follow^s: 
[Reports to the Surgeon-General Public Health and Marine-Hospital Service.] 
HOOKWORM DI.SEASE IN THE SOUTH — FREtiUENCY OF INFECTION RY THE I'AR.VSITE 
(UNCINARIA AMERICANA) IN RURAL DISTRICTS. 
(Preliininarv report liy Dr. Ch. Wardell Stiles, cliief of Division of Zoolojzy, Unite<l 
States Public Health and Marine-Hospital Service, detailed for this investijration. ) 
Kershaw, S. C., Octoher 22, 1902. 
Sir: Through the director of the Hygienic Laboratory, I have the honor to submit 
a brief preliminary report in regard to the freipiency and geographic distribution of 
hookworm disease (uncinariasis) in the Southern States. 
Meeting the disease in the Virgilina copper-mine district of southern Virginia and 
northern North Carolina, I have thus far traced it through the coal-mine district of 
Cumnock, N. C., the brickyards of Camden, S. C., and the granite-.siind ilistrict of 
Lancaster and Kershaw counties, S. C. 
The present indications are that it is more ])revalent in samly rc'gions than in clay 
or stone districts. On the farms and ])lantations of the sand region of the two 
counties just mentioned, it appears to be the most common di.'iease of man, and from 
an economic point of view it appears to be of great importance. The extreme cases 
seem to occur more commonly among children and women than among adult males 
over 25, but the present facts at my dispo.sid do not indicate that the malady is quite 
so fatal as the European form of the disea.se caused by rnciiuiria dnodninllft. All of 
the cases thus far examined are due t<i l^ncuuiria amerinma, demonstrating clearly 
that this is an endemic infection and h»tiilly indeixuident of the cases which have 
been introduced from Euroiie, Asia, and northern Africa. 
In general, it may lie said that the “ i)ale skin,” the “heart «li.'X*a‘*t*,” the 
“diarrhea,” the “bloat,” and the .‘suppression of men.‘^*s which 1 have thus far 
examined all represented various stages of heavy infections with r'nriunrin nwerlrawt, 
and it is impossible to escape the conclusion that so far as the farms ami plantations 
