64 
to conviction awaiting a more thorough demonstration of the broad 
application of Bentley’s interesting and valuable views. But until 
better proof is advanced than has thus far been brought to lU}^ atten- 
tion, I find it impossible to unreservedly adopt the opinion that Amer- 
ican ground itch is necessarily connected with uncinariasis. 
While not opposing the theory of infection through the skin, but 
admitting, on the contrary, that Looss has proved his point, I 
ma}" state that the conditions which I saw in the southern portions 
of the United States do not indicate that any indirect method of intes- 
tinal infection is necessaiy in order to explain the severe cases of 
unciDariasis observed. The average bo}" or girl suffering from this 
disease is not conspicuous because of personal cleanliness. Bath tubs 
are not found in their homes, and from physical examinations I made 
1 can testify that not onh^ their hands and finger nails, but their entire 
bodies also, are far from a condition unfavorable to parasitism. Suck- 
ing the fingers, picking the teeth, biting the finger nails, or even eat- 
ing a piece of bread with soiled hands will usually suffice to convey 
some dirt between the lips. The sand on which the children play 
must be heavily infested with hookworm larvae, and it certainly can 
not be an exceptional occurrence that the children unconsciously carry 
microscopic worms to their mouth. F urther, the chances for infec- 
tion of surface wells, from which the drinking water is taken, are very 
great in any sandy soil. If, however, cutaneous infection were the 
rule, I should expect to find all barefooted children in the infested 
area suffering not onl}^ from ground itch the entire summer, but also 
from severe infections of hookworm disease. 
Hair . — The hair on the head appears to be about normal, but in cases 
contracted before puberty, the beard and the hair on the body (pubis, 
armpits, arms, legs) are usually undeveloped. I have seen patients 
20 years of age upon whose body hairs were almost absolutefy lacking. 
Breasts . — The breasts of females, who have contracted hookworm 
disease before puberty, remain more or less undeveloped. In a girl 
of 20 years of age, for instance, the breasts may not be developed 
beyond those of a girl of 8 or 9 }^ears old. 
Nails . — The color of the tissue directly under the nails varies with 
the anemia. 
HEAD. 
Face . — The face has an anxious, stupid expression, and in severe 
cases is more or less “bloated” (edematous). 
In fact, a prominent S}unptom of uncinariasis in practically all 
animals in which it occurs is the development, in severe cases, of a [ 
more or less extreme edema. To use the rural vernacular, “the face i' 
bloats,” and “the feet and ankles swell.” The s}^mptom in question . 
is more or less irregular in man as it is in other animals, notabfy in ■ 
sheep, appearing and disappearing at intervals. Upon several occa- ’ 
