66 
authors have mentioned the glassy appearance of the eyes of dirt- 
eaters. 
Since my return, several of my clinical friends with whom I have 
discussed this symptom have expressed some skepticism in regard 
to the matter. Although thoroughly convinced of its existence, for 
1 saw it too frequently to be deceived, 1 have written to several 
Southern clinicians requesting them to give me the benefit of their 
independent observations on this point. Up to the time of reading 
‘‘galley proof” of this report the following replies have been received: 
[Extract from a letter from Dr. Hilsman, January 2, 1903.] 
“Replying to your letter, 24th ultimo, I have to say that I have examined the 
patients that we satv in the country, and on making them gaze intently at me as you 
directed, I observed the vacant stare that you described, but did not observe the 
dilation of the pupils. The stare is very much like that of an epileptic as he begins 
to recover from a fit. 
“These cases have improved under treatment suggested by you. The little girl 
passed a large number of the worms.” 
[Extract from a letter from Dr. M. A. Clark, January 30, 1903.] 
“I have delayed, hoping to find the eye symptom you mention, but I have not yet 
found it. My cases are improving slowly.” 
Dr. James Edward Stubbert, of New York, who spent some years 
in Central America and has seen many cases of hookworm disease, has 
stated to me that he has frequently observed the peculiar stare in the 
eyes of dirt-eaters. 
In this connection it is also not uninteresting to note that some 
“worm doctors” claim to la}^ special stress upon the eye in making 
their diagnoses; also that dilation of the pupil, due to irritation by 
intestinal worms as well as to anemic conditions, is recognized by 
certain prominent writers on the eye; further, that dilation of the 
pupil is also a symptom upon which many children’s nurses depend 
in suspecting the presence of worms. 
Sandwith (1891, p. 12) states that the eyes of his patients showed a 
pearly white conjunctiva, singularly in contrast with the yellow color 
of the face. Dr. Scott examined several men for him with the 
ophthalmoscope, and found in half of them a normal fundus, and in the 
other half a very pallid fundus. The refraction tests showed astig- 
matism in many cases. 
Nostrils . — The visible mucous membrane of the nostrils becomes 
pale in proportion to the anemia. 
Lips and gums . — The lips also become pale in proportion to the 
anemia, the inner surface of the lips and the outer surface of the gums 
frequently presenting almost a chalky white appearance. 
Teeth . — Irregularity of the teeth was so common among patients 
affected with uncinariasis that the question arose in my mind whether 
this was not to some extent an expression of the general underdevel-' 
