62 
ing. inflammation, and tendency tovrard the formation of sloughs, free 
skin incisions and the use of hot antiseptic footbaths are indicated. 
Dalgetty (1901. p. 77) advises the application of a strong solution of 
lime and sulphur: strong* phenyl solution is also beneficial, and a coat- 
ing of coal-tar acts for a time as a preventative against infection; but 
when once the vesicles have formed pustules are sure to follow, and 
then the only remedy is to open them, evacuate the pus, and thoroughly 
cleanse them. 
An anonymous writer (? Dr. Elliot, of Assam) in the Journal of 
Tropical Medicine (1900). gives the following directions: 
“ The indications are to get the case as soon as possible; to carefully cleanse the foot 
by soaking it in warm antiseptic solution; then open the vesicles with sharp pointed 
scissors, snip the loose skin away, and finally wash the parts with carbolic acid solu- 
tion (1 in 40), and treat the resulting ulcer with carbolic acid, phenyle oil, extract 
of paroh leaf, zinc ointment, etc., according to circumstances. The soaking, wash- 
ing, and dressing operations are repeated once or twice daily, and healing takes place 
in eight or nine days in favorable cases.” 
It will be noticed that Bentley doe.s not definitely state that he adopts 
Looss's view of intestinal infection through the skin; nor does he defi- 
nitelv state that the hookworm larvte act as anvthing more than carriers 
of bacteria. The conclusion would therefore seem to be that the ground ~ 
itch with which he was dealing is a bacterial infection due very prob- 
ably to fecal bacteria.® If this interpretation is correct, its dependency 
upon uncinariasis does not seem to be proved, although its occurence 
with the disease would seem to be established. 
Additional facts (besides Bentley's experiment.s) which support 
the view that the ground itch . with which he was dealing, is more or 
less connected with hookworm infection are the following: 
Ground itch occurs in the warm rainy season, especially in June, 
July, August, and September, and does not occur in cold weather, 
even when it rains: thus the seasonal distribution in general agrees 
with the infection period of uncinariasis. Grass-covered soil and 
smooth beaten roads do not cause it, neither does working in loose dry 
soil; and these conditions are unfavorable to the development of 
uncinaria.sis. The number of cases increases after a heavy rain and 
rapidly decreases during a hot spell, a fact which agrees with the 
biologv of hookworms. ** The soil itself is sandv, with clav here and 
there; a belt of pure sand. TO to 60 feet thick, lies at a depth of 6 to 
18 feet from the surface;*’ and uncinariasis is preeminently a sand 
disease. 
Still the question is not quite so simple as would at first appear, and 
in connection with the subject the following points come up for con- 
sideration: 
<^Looss has, however, proved that certain cutaneous symptoms follow the entrance 
of hookworm larvae into the skin. 
