90 
To accomplish the first desideratum may require some patience, hut 
efl'orts will eventualh^ he successful. The second point may also he 
carried out, unless, of course, the patient is too far gone at the time 
of treatment to recover from the effects of the disease. 
In not all cases can it he expected that a dwarfed, emaciated, and 
stupid child can he immediately placed upon the same physical and 
mental basis as his brothers, hut even such cases can be gTeatl}" 
improved. 
LETHALITY OF HOOKWOEM DISEASE. 
I know of no extensive and exact statistics regarding the lethality of 
uncinariasis, and traveling as rapidly as I did, it was impossible to 
establish any definite facts from personal observation, since it was the 
exception that 1 saw any case more than once. Furthermore, owing 
to the fact that many light cases will escape attention, an}^ lethality 
percentages published will probabh" be above the actual figures. 
I doubt whether sufficient data are at hand to justify even approxi- 
mate statements regarding the lethalify of hookworm disease. That 
numerous cases, not properly treated, terminate fatally can not be 
doubted. Still, it is remarkable how low a person may be with hook- 
worm disease and still live. 
Among physicians I met with the most contradictory ideas on this 
subject. Several excellent observers maintained that all severe cases 
which reached an edematous condition were invariably fatal; equally 
keen observers doubted whether this disease was frequentfy the actual 
cause of death; the view was quite general that patients sufiering from 
medium or severe attacks of this malady very seldom lived through 
even medium or light attacks of such diseases as typhoid fever, or 
pneumonia, and that severe attacks of malaria were frequently fatal; 
also that the}" were very uncertain patients in confinement. 
In my own observations, several points seemed quite significant. 
In the first place, the large number of cases of long standing found in 
so many families did not indicate a high lethality. Further, several 
adults were seen who had formerly unquestionably presented severe 
infections, but who are now in a fairly good state of health. In one 
family with 9 children living, most of whom clearly presented light, 
medium, or severe infections, there was a history of death of 9 other 
children, but satisfactory answers as to the cause of these deaths were 
not obtained. That some of the children had died of uncinariasis is 
very probable. On the other hand, families were seen with 8 to 10 
children, all or nearly all in an anemic condition, some with clear 
medium to severe cases of uncinariasis, yet without history of any 
fatal case in the family. I have heard of localities in Central America 
(but have not investigated them personally) where it is said that a dis- 
