47 
eggs are discovered in the stools. We may also place here a number 
of cases in which, in addition to the i:)resence of ecrtrs, tliere is a slitrht 
diarrhea or some other slight symptom, including more or less rai)id 
exhaustion after physical exertion, henc^ an indisposition to work, 
which is usually interpreted as laziness. Cases of this class ai-e found 
in the infected areas and elseAvhere, since infected peoi)le may move 
away from the sand districts. 
(2) 2[edlum cases, including those in which the disease has ])rogressed 
to such an extent that a more or less anemic condition is noticed, but 
other symptoms are not especially marked. If these patients were 
found outside the infected area, the diagnostician (especially if he is 
not familiar with the disease) would probably not see anything j)ar- 
ticularly characteristic in them; many of these cases, howi'yer. show 
a more or less typical history, and if a history of rt'sidence upon 
sandy soil in tropical or subtropical regions can be obtained, uncina- 
riasis should certainly be strongly suspi'cted. If tlu'se cases occur in 
a family which also presents severe cases of uncinariasis, the diagnosis 
of hookworm disease in the medium cases is usually (piite sab*, ('ven 
if a microscopic examination is not undertaken. 
(3) Severe cases^ in which we find that striking set of symptoms 
which even the laity in our Southern States attributes to “dirt- 
eating.'' These patients present a facies which is well recognized by 
Southern physicians. If the })atient is found in a Southern sand area, 
the diagnosis is practical!}' certain. If found outside of the inf(‘ctt*d 
area, with a history of j)reyious residence in a Southern sand district, 
its recognition symptomatically ought not to lx* att(‘n(h‘d with dilli- 
culty. In case of doubt, if a microscope is at hand, tin* test may b(* 
made in less than five minutes; if no microscopt* is at hand, the blot- 
ting paper' test (see ]). .81) will usually suffice. 
Turning now to an analysis of symi)toms, I will give my obst*rvti- 
tions on the severe cases. It is needless to state* that tin* symptoms 
discussed may vary in intensity, and that not ev(*ry symptom men- 
tioned is found in every severe case. We lind on the contrary an 
imperceptible gradation l)etween the severest and the light(‘st cases. 
(JEXEKAI. l*KEDISrOSlN(J FACTOIDS. 
INFECTION (X’CCKS CHIEFLY oN SANDY SOIL. 
In connection with the clinical history, tln> )‘(*si(h*ii(M* on sandy soil 
is undoubtedly one of the most important jioints to lx* obtaiiu'd. If 
an anemic patient gives no history of temporary or p(*rmanent resi- 
dence on a sandy soil, uncinariasis is not absolutc'ly excludc'd, but 
according to my experience* the chances are against it. It on the 
other hand a history of sojourn or residence in a sandy rural district 
is obtained, the probabilities of uncinariasis are decidedly incn*ase<l. 
