63 
1. Accordiiio- to Bentley, ground iteli is eontined ontii’olv to tlio 
lower extremities, iind other juithors state tluit it rarely extends ahovt* 
the ankles. Aecording to the physieians in Georgia and Florida, it is 
found on other parts of the body also. I saw one east', said to In* 
t}^pical, where the disease was eontined to one arm. Fnder tln'st* 
conditions is the panighao, discussed hy Bentley, identical with the 
so-called "‘ground itch” which is so common in the southern portion 
of the Fnited States, or is only a part of the American “ ground itclF'* 
produced by hookworm larvae ^ 
2. If ground itch is the initial stage of cutaneous infection with 
uncinariasis (as Looss’s and Bentley’s views would seem to indicate*), 
why should it be eontined entirely to the lower extremities ^ If 
infection b}’ uncinariasis frequently takes place through the skin, 
would not the hands and arms also, especially of children, and more 
particularly the soles of the feet and the palms of the hands, the 
spaces between the toes and fingers, and under the toe nails and linger 
nails, be the most common initial points of ground itch in cast* this 
latter is an initial symptom of uncinariasis 
3. On the same premises would we not commonly find lesions corre- 
sponding to ground itch on the alxlomen of cattle, sheep, goats, dogs, 
cats, foxes, seals, and other animals sutfering from uncinariasis^ 1 
will not deny that such lesions occur, but I have seen many cases of hook- 
worm disease in certain of these animals and I have no recollection of 
having observed anything which corresponded to ground itch. If it 
were as prominent, in the animals named, as the typical “ground itch" 
of man which 1 saw in Georgia, I doubt whether 1 should have over- 
looked it. Possibly I did not have recent infections before me. 
4. According to the testimony of Georgia and Florida ])hysicians 
“ground itch” is exceedingly common; it occurs at some period in the 
life of practically every person, unless he lives exclusively in the city: 
it occurs in the health}^ as well as in the sickly, and in persons who 
neither at the time of infection nor later show the slightest e\ idence 
of anemia. These statements, which I have rei)eatedly heard from 
Southern physicians, can not l)e said to indicate that B(‘utU*y's views 
are applicable to all cases of “ground itch” as we find this diM*as(* in 
this country. 
5. “Ground itch” is said to be common in clay districts as W(*ll as in 
sand districts. Fnder th(*s(* circumstances, why is uncinariasis so pn*- 
eminently a disease of the sand areas ^ 
6. Bentley states that “gnnmditch” is probably always a>sociatetl 
with the presence of the larvjc of A(fcJnilosfoma dnn<l, niiJt in the >nil 
of the affected areas. Doubts may, however, arise as to whether a 
sufficiently wide geographic range has be(*n (*xamiin'd in conni'ction 
with this point. 
In view of the al)ove considerations, it will be well to remairj open 
