50 
on that account present more favorable conditions for the growth to 
the “encysted stage, and probably also a longer preservation of that 
stage. 
In this connection it may be noted that Looss has used charcoal as 
a medium in which to cultivate the larvae of Agchylostoma duodenale. 
INFECTI02C OCCUES CHIEFLY IV THE EUKAL DISTEICTS. 
Since the infecting agent of uncinariasis is spread througli the feces, 
we may expect to find infection taking place (other things being equal) 
in localities where the fecal matter is not properly disposed of. Fur- 
thermore, we would not expect that paved streets or grass lawns 
would favor the development of the disease. TTe need not therefore 
expect local foci of infection to occur in cities and towns which have 
proper sewerage s^^stems and in which the streets and walks are paved 
and the yards sodded; but we may expect to find local foci of infec- 
tion in localities where box privies are used but not properly cared 
for, or where promiscuous defecation occurs in the woods, fields, mines, 
etc. This condition is in fact exactly what is found. AYhile unci- 
nariasis is not entirely absent from those premises on which the feces 
are properly disposed of, in cities like Washington, Eichmond, Charles- 
ton, Macon, Jacksonville, and Ocala, such cases as are found can not 
be shown to have developed there; but probably in most every case 
they can be either probably or positively shown to have been con- 
tracted elsewhere. In a number of cases I have established this point 
with a probability, which for all practical purposes may be looked 
upon as a certain^. We may therefore exclude the greater portion 
of the inhabitants of sanitary districts of cities from consideration in 
connection with uncinariasis and may with confidence la}^ down the 
general rule that any anemia developing in them as result of local 
infection (namely infection at home) is much more likely to be due to 
malaria or other causes than to uncinariasis. 
As we approach the outskirts of cities and towns and enter the rural 
districts, localities in which box pri^fies are used but not always prop- 
erly cared for, we meet with conditions which are more favorable to 
infection with the hookworm disease. Accordingly, in cases of anemia, 
especially in women and children, developing in such localities, unci- 
nariasis must be taken into consideration as one of the possible causes. 
Sandwith (189F) states that his patients came from all parts of Egypt 
except some of the seaport towns. 
As we go into the country and visit the farms we not infrequently 
find a condition, in respect to the disposal of fecal discharge, which 
almost beggars description. Taking the rural districts visited during 
my recent trip as example, it is not an exaggeration to say that with 
the exception of the planters' premises, not over half of the country 
houses or huts of the sand regions have any privy at all; if there is 
