42 
worm. 
The climatic conditions are favourable for the development of this 
rm, and the custom of the people to go about bare-footed or wearing 
light shoes causes the skin of the feet and ankles to be continually 
dirtied. The children during their earlier years run about naked, and 
are always rolling on the ground. 
Some patients can give a history of ground itch OO wring between 
the fingers and toes, but usually no such symptoms have been observed 
Children, especially of the poorer class, suffer from ’ Amazon boils,' 
which occur about the ankles and lower part of the shins. They 
persist for some time and create large scars. It is ]x>ssible that these 
boils are only an intensified form of ground itch which, through 
scratching and carelessness in cleansing, become infected with cocci 
and develop into chronic ulcers. We have examined portions of 
several ulcers, but nothing specific was observed. 
We have been impressed with the severe symptoms present in 
many of our patients, in spite of the fact that they harboured 
comparatively few parasites, and we agree with other observers as to 
the toxic symptoms observable in these cases, which are altogether 
out of proportion to the number of worms found in the intestine. 
Our patients have exhibited the ordinary symptoms noticed by 
all observers. We would call attention to a rather rare form. A 
patient in apparently good health will be seized with a rigor. The 
temperature will rise to 39 5° or 40“ C., to fall after a few hours to 
normal or subnormal, or moderate fever may continue for one to two 
ays. In one adult, two epileptiform seizures occurred, attended by 
n^Z nSe ‘ e T ratUre ' ExaJninati °« of the blood will show a 
eOSln °P hlI ‘ a ' but no evidences of malaria ; there 
nay be slight and transient albuminuria and r u 
an enormous number of ankylostome Th ? “ ' 
seDtic and email a c , 16 «ymol, an intestinal anti- 
eat” re Tot " W ‘ U **** P^ents. 
Children of six to” 1 ““^ of““ ^ f< "“ d at a " ^ 
acquire this habit. Other .LeftL^ld ^ 
such idiosyncrasies as eatino- o d , ^ lldren ma T develop 
drmkmg filthy, even stinking, swam^ate'r ' eather ' “ 
die from an mtercurr™* mfcttk.T ’* UnCertain ’ as nlan y ‘he cases 
Ankylostommms ,s a sattsfactory d.sease to ^ as ^ 
