80 
States as a whole, uncinariasis must be considered as one of the most 
common and widespread maladies; in frequency it belongs in the 
general class with malaria, tuberculosis, and gonorrhea. 
In cities and in rural clay districts it is probably less common than 
any one of these three maladies, for such localities may present local 
foci of infection for the diseases in question, while the local foci of 
infection with uncinariasis are much more limited. 
Among the negroes of the rural sand districts, uncinariasis seems to 
be much less common than either tuberculosis or gonorrhea. Its 
apparent rarity may, however, be deceptive (see p. 51). 
Among the whites of the rural sand districts, uncinariasis is appar- 
ently the most common disease found. Nevertheless, in some sand 
districts, probably with a clay or other impervious subsoil favorable 
to the formation of marshes, malaria rivals uncinariasis for first place. 
From these qualified statements it will be seen that I do not feel 
justified in adopting the view advanced by Harris, namely, that uncin- 
ariasis is ^ ‘ the most common of the severe diseases of the South. ” 
In all probability, further study will show that in Mexico, Central 
America, and parts of South America, hookworm disease is more 
important and more common than in the United States. 
Sand with (1891, pp. 5-6), in discussing the frequency of this disease 
in Egypt, says: 
“It is impossible to know what amount of the population [of Egj^pt] is affected, 
but the statistics of the recruiting commissioners for 1892 are worth quoting. Nearly 
every adult male peasant is liable for conscription, and the conscripts are immedi- ■ 
ately examined in their villages. In upper Egypt 5,988 men were called, and 200, 
or 3.3 per cent, were rejected for anaemia. In lower Egypt 661, or 6.2 per cent were i 
rejected from this cause out of 7,420 men. Every province furnished anaemic rejec- ■ 
tions, but Menoufieh came highest on the list with 13.9 per cent, while I find from I 
hospital statistics that no less than 15 villages in that province are infected. The 
recruiting medical officer, who is an Englishman, only rejects those who are obvi- 
ously too anaemic to serve with the colors, accepting many who are already the j 
hosts of the bloodsucking worm. Thus the medical reports for the Egyptian army ' 
show that in 1890 there were 114 admissions to the hospital for anaemia, in 1891, 107 | 
admissions, and in 1892, 170 admissions. In 1891, 22 soldiers were invalided from the 
service for anaemia, and 65 in 1892, besides 1 death. The number of admissions for 
debility is equal to those for anaemia, and doubtless includes many cases of anchy- 
lostomiasis.” 
Dobson (1893, p. 63), examined 547 of the healthiest looking coolies [j 
from India and found hookworms in no less than 454 of them. 
V 
CLINICAL DIAGNOSIS OF HOOKWORM DISEASE. j 
As stated above, a man who is familiar with this disease should j 
have no difficulty in recognizing severe cases, especially if he is in the , ^ 
area of infection. In light and medium cases, however, it is unsafe to 
make a diagnosis upon symptoms alone, unless such cases are associated I 
