96 
a great extent against ground itch. It can hardly be expected, how- 
ever, that the poorer children in country districts will adopt this 
precaution to any extent. 
C03IM0N INTEKPRETATIOX OF HOOKWORM DISEASE. 
Upon several former occasions I have referred to ‘‘cases of anemia 
of obscure origin” as possibly due to uncinariasis. In a recent paper 
(Stiles, 1902b, pp. 207-208) I referred to “dirt-eating” as being possibly 
connected with uncinariasis ; it was also intimated (1902b, p. 215), upon 
authority of Dr. Kirby-Smith, that in Mississippi uncinariasis is con- 
fused with malaria; Harris (1902c) also points out that much of the 
anemia attributed to malaria and dirt-eating is probably due to hook- 
worm disease. 
At present I am able to make more specific statements than for- 
merly. The condition which should be attributed to light infections 
of uncinariasis is usually interpreted as due to malaria or diarrhea; 
medium cases are usually interpreted as an anemia due to malaria 
combined with “improper diet” or ‘ * insufficient nourishment;” severe 
cases are usually attributed to “malarial cachexia,” “dirt-eating,” 
“resin-chewing,” “heart disease,” “dropsy,” “general debility,” 
' “pernicious anemia,” and “lack of proper nourishment.” Such at 
least are the most common diagnoses which have been made by the 
attending ph^Mcians in the cases which I have interpreted as light, 
medium, or severe infections with Uncinaria araericana. 
ECONOMIC IMPORTANCE OF HOOKWORM DISEASE. 
Malaria is admit tedH one of the most important diseases when 
viewed from an economic standpoint. In general, uncinariasis is, in 
the South, fully as important as malaria, and in some respects it is of 
even greater importance. 
Take a given farming area in the sand district with an infection of 
uncinariasis, and assume that 100 farm hands are emplo}"ed. It is not 
an exaggeration to say that these 100 people are not doing the work 
of 80 or 90 average hands. Thus there is a distinct loss of 10 to 20 . 
per cent in the wages and a corresponding loss in the crop returns. 
In some places I should estimate the loss at even a higher percentage, 
say an average of 25 per cent, while in several families which I have 
examined I should say that uncinariasis is reducing the laboring 
capacity, hence the productiveness, of the family to as low as 30 to 10 
per cent, thus entailing a loss of 60 to 70 per cent. 
Nor are the losses in wages and m the laboring capacity, and the 
decrease of productiveness of the family, hence of the farm, ami finally 
of the county and State, the only economic considerations involved. 
Cases are not unknown where families have sold, moved, or destroved 
their homes, or were about to do so, because of the existence of this 
disease and because of the -belief that it might be due to the locality 
in which they lived. 
