59 
(luring this time visited any tropical or subtropical sand area. If such 
a fact does develop, uncinariasis is among the pi-obabilitiivs and a 
microscopic examination of the feces should lu' mach*. 
(JEXEKAL EXTEKNAI. AIM’EAHANCE. 
GENERAL LACK OF DEVELOPMENT — STI NTED (iKOWTH. 
In severe cases of long standing the ]>atient is iind(‘veloped both 
physically and mentally. A boy oi* girl [2 to 14 years old may Im‘ as 
small as the average child of b or 8; a young man or woman of is to 
22 3 ^'ars old may present the general development of a child 12 to lb 
3 ^ears of age, but the face may appear either like that of a child or 
like that of a veiw old person, especially like that of an elderly dwarf. 
Similar conditions have been described as a s 3 unptom of dirt-(Miting. 
SKIN. 
The skin has an anemic, waxy white to a yellow or tan, shriveled, 
parchment-like or tallow appearance. In general it is that color 
known in the South as a ‘"Florida complexion.'’ In some cast's of 
malaria, if one trusts too much to the apiiearance of the skin, In* is 
likeh' to be misled into an erroneous diagnosis of uncinariasis, but tlu^ 
general clinical history is usually sufficient to distinguish Ix'tween 
the two diseases, while the microscopic examination gives a iiositive 
diagnosis. (See also, Temperature, p. 72.) 
Woundn heal d(ndi /. — Among the first severe cases of uncinai’iasis 
found, I noticed that several of the ])atients wore bandages. Suspi'ct- 
ing the possibility of ground itch and I’ecalling Looss's and Ik'iit lew's 
theories (see below), 1 immediately impiired into the history of the 
sores. According to the testimony of the patients the ulcers pn'si'ut 
had started as small wounds produced mechanically: the' wounds had 
failed to heal promptly, had grown woi’se, and were now about a 
year old. This same story was ri'lated to nn* by (|uite a numlu'r of 
patients, and many other jiersons sullering fi'om uncinariasis assni’i'd 
UK* that in their cases cuts and bruis(‘s lu'ah'd \’(*rv slowly. t(‘stimonv 
which was repeat(‘dly corroborated by local physicians. 
Cutaneous lesions atused Inj uneina luasts . — 4'ln' stat(*nients just ma(h* 
lead to a consideration of certain Vi(‘ws recently advanced by Looss 
and Bentley. 
//DD.S'.v'.S' iheonj of cutaneous in fedom. Looss (llHd) has shown that 
if a dro}) of wat(*r contaiidng embryos ot Aac/iifh»stninu dmtdt ntdt \s 
placed upon the skin an itching s(*nsiition is produc(‘d: the worms 
enter the hair follicles, and from theia* they s(‘cm to bore into tlie 
surrounding’ tissues. Looss further advanct'd th»‘ I’ather stai’lhng 
oi)inion that the larva' then reaclu'd tin' int('stine. and In' reconnied 
observations which gave a certain amount <jt t)lausii)ilit v to this vn'w. 
