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disease to 1000 deaths from all known causes was 109.9. In 1890, a corresponding ratio was 122.3. In comparison with 1890 the figures for 1900 show a large decrease in the death rate, amounting in the aggregate to 67.7 per 100,000 of the population of those 15 to 44 years old, 86.6 per 100,000 of the population for those 45 to 64 years old, and 108.9 per 1000 of the population for those 65 years old and over.

The bright side of a few of the achievements of medical science has been painted. The dark side of the picture must now be shown, namely: the enormous infantile mortality, and the low percentage of births of native born parents.

During the census year of 1900 there occurred, for all ages, 1,039,094 deaths, of which number 199,325 were under one year of age, 59,879 one year of age, 28,136 two years of age, 17,638 three years of age, 12,554 four years of age. It will be seen from this that an infant's chances of living upon attaining its first year is three time greater than before the first year is reached, and over seven times greater upon attaining its second year, and so on with increasing chances of living.

In studying the causation of deaths of infants under one year of ag, cholera infantum was found to have caused 18,389 deaths, and 55,756 deaths were due to the following general diseases, mostly preventable: Measles, scarlet fever, diphtheria, whooping cough, malarial fever, influenza, typhoid fever, cholera infantum, cerebrospinal fever, smallpox, erysipelas, septicemia, venereal diseases.

With the exception of diphtheria, the deaths from most of these diseases was over 100 per cent greater in infants under one year of age, and five times greater than they were at two years of age. Even in accidents and injuries, such as drowning and burning, the deaths from them were three times greater under one year than at one year

of age.

The slaughter of the innocents, at the tender age of life less than one year, should give food for thought, and it seems to me that as philanthropists, if not as physicians, we could use every means in our power to protect the helpless ones. This can only

be done by proper education of the public to the necessity of increased care during the first year of infant life. We learn from the study of the causation of deaths in infants under one year of age, that the lessened resisting powers of infants at that age is by no means wholly responsible for thousands of deaths that should be prevented. To illustrate what education can do to prevent deaths, I may be pardoned for citing the following: During the months of May and June of 1899, there occurred, in the city of San Antonio, from acute intestinal diseases, 124 deaths, attributed chiefly to cholera infantum. In April, 1900, I had printed in English, German and Spanish languages, directions for the preservation of milk, and for the care of infants during the summer months. These circulars were placed at almost every household in the city. The deaths from acute intestinal diseases in infants under two years of age, in the months of Many and June, 1900, numbered 24, a decrease of 100 for the corresponding months of the pervious year.

I would urge that since the law in our State requires that births and deaths shall be reported, this Association take into consideration the advisability of adopting some method whereby mothers can be given clear and concise instructions upon the care of infants. Indeed, I believe this to be of such great importance that it should be recommended by the American Medical Association, and adopted in every registration State. If this were done, it is not improbable that Congress could be induced to pass an act permitting literature from boards of health and medical societies, bearing upon this subject, to be sent through the mail free, which, of course, would effect an enormous saving.

It is estimated that the excess of births over deaths during the past decade was 12,315,361. The birth rate in the United States is greater than in any other country, except Hungary. But, notwithstanding this fact, the annual rate of increase by excess of births in the class born of native white parents was 19.5 per 1000, while in those born of foreign parents it is 36.5 per 1000. The rate of the colored was less than those of native white parents, 17.8 per 1000.

In the northeast division, consisting of the States of Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont, the rate of annual increase of children of native white parents was but 3.8 per 1000, while in those of foreign white parents it was more than ten times greater, 39.6. Excluding New York from this group, it appears that the annual death rate of native whites of native parentage exceeded the birth rate by 1.5 per 1000, while amongst those of foreign white parentage the birth rate exceeded the death rate by 44.5. The peculiar results noted seem to be confined to the New England States. In the remainder of the country, the excess of births was 21.1 of those of native white parents, 35.7 of those of foreign parents, and 17.9 of the colored. The nearest approach to equality in the rate of excess of births of native and foreign white parents was in the Southern States, where the proportion of foreign parents was least, native white parents 24.1, foreign parents 27.3.

It is to be trusted that the South will continue to furnish the greatest number of sons to our country, as the number of deaths in the Northeastern States, with the exception of New York, exceeds the annual birth rate of the native whites born of native parentage, hence the South will have to supply the North with native whites of native parentage.

These are matters upon which the public should be enlightened, and it behooves us to make known these facts and to urge a war of education, not alone upon the matters touched upon, but on all important measures in regulation of the public health. There should be medical teachings to the young collegians; they should be enlightened upon the dangers that beset them upon the very threshold of their lives; they should be warned of the dangers that may entail: "the sins of the fathers visited upon their children unto the third and fourth generation."

When we shall have employed our talents for the betterment of the public health, we can then look with pride and feel that the true aim and object of our lives has been accomplished, and that we have truly reflected credit upon our profession, and have practiced the greatest type of medicine-preventive medicine.

THE SIGNIFICANCE OF THE RECENTLY RECOGNIZED HOOKWORM DISEASE FOR THE TEXAS

PRACTITIONER.

CH. WARDELL STILES,* PH. D.,

Chief Division of Zoology, Hygienic Laboratory, United States Public Health and Marine Hospital Service.

Before discussing the subject of hookworm disease, it is a pleasant duty for me, first, to present to the President and members of your Association the compliments of Surgeon-General Walter Wyman, with his best wishes for a profitable annual meeting; second, to express to you my keen appreciation of the honor you have conferred upon me by electing me an honorary member of your Association; and, third, to thank you for the compliment you have shown to my investigations by requesting the Surgeon-General to send me over 1700 miles to address you this evening.

Hookworm disease, or uncinariasis, is by no means a new malady. In Ebers Papyrus, an old Egyptian manuscript written about 3500 years ago, we find a clinical picture described, which is practically identical with the condition which we now name hookworm disease. This disease is found in a number of different animals. In man it may be caused by either of two parasites: the Old World hookworm (Agchylostoma duodenale) causes it in the Old World, and the New World hookworm (Uncinaria americana) causes it in the New World. Cases caused by the Old World parasite occasionally occur in America, due to the importation of the parasite from Europe and the Philippines, and probably some cases in Spain will be found to be due to the New World parasite, since the Spanish soldiers who

*Detailed by Surgeon-General Wyman to represent the Public Health and Marine Hospital Service at the San Antonio meeting of the State Medical Association of Texas.

have returned from Cuba to Spain probably carried some of the worms with them.

In order to understand the disease it is necessary to understand the structure and life history of the parasites which cause it. These parasites are small, round worms, or nematodes, about half an inch long and about the diameter of a hat pin. They inhabit the small intestine, where, fastened to the mucosa, they suck the blood of the patient and at the same time undoubtedly produce a poisonous substance, which is absorbed by the afflicted person.

Their general anatomical characters may be seen from the diagnoses of the respective genera and species, and are clearly shown by the illustrations which I will throw upon the screen.*

ZOOLOGICAL POSITION OF THE PARASITES.

The parasites which cause uncinariasis are worms belonging to the nematode family Strongylidæ.

Family Strongylidæ.

FAMILY DIAGNOSIS.-Nematoda: With body elongate, cylindrical, rarely filiform. Mouth is probably always provided with six papillæ, of which the four submedian are generally salient in form of nodules or conical points. In some cases the mouth is in the axis of the body; in others it is turned dorsally or ventrally, and occasionally provided with a chitinous armature. Esophagus more or less swollen in posterior portion, but without forming in adults a distinct esophageal bulb. Male provided with a caudal bursa, open or closed, entire or divided, and with one or two spicules. Female with one or two ovaries; vulva anterior or posterior of equa

*A more complete discussion of hookworm disease will be found in Bulletin 10, Hygienic Laboratory, United States Public Health and Marine Hospital Service. Application for copies should be made to the SurgeonGeneral, United States Public Health and Marine Hospital Service, Washington, D. C.

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