Where adhesive plaster comes in contact with the skin it is irritating; some skins will not stand it, and this is particularly true of children, and particularly so in the summer time. The reason I suggest carrying it down so far is one of mechanics; if you carry it down sufficiently low there is no pressure at any one point; there is no strain at all.

"AMERICAN HOOKWORM"-UNCINARIASISDEDUCTIONS DRAWN FROM TREATMENT OF FOUR HUNDRED AND

EIGHT CASES.

BY A. G. FORT, M.D., LUMPKIN.

Uncinariasis is a specific infectious disease caused by the presence of the Necator Americanus in the intestine and characterized by a progressive anemia, various nervous disturbances, weakness and intestinal disorders; common to temperate, tropical and subtropical climates and usually easily cured by the removal of the parasites.

We have but to refer to the transactions of the Medical Association of Georgia for 1903 and 1904 to learn how recent is the discovery of this intestinal parasite in our State. Since the articles of Dr. H. F. Harris in 1903 and Dr. Claude A. Smith in 1904, thousands have been treated in Georgia for this malady. While this is true, yet the relative number of physicians who recognize and treat it is indeed small. Instead of thousands being treated, tens of thousands should have been treated.

Doubtless this condition has existed in Georgia for numbers of years, yet it has been recognized as a disease only for the last six years.

Reports have come from all South Georgia of its presence. In Stewart county, Southwest Georgia, I have, since April, 1904, treated four hundred and eight cases. If this is true of a hilly section of the Southwestern part

of the State it must be true of the flat, moist, warm, sandy sections.

All references in this article to the hookworm apply to the one variety, "Necator Americanus," described by Dr. Stiles, who gave it this name, as follows:

"Uncinaria: Body cylindrical, somewhat attenuated anteriorly. Buccal capsule with a ventral pair of prominent semilunar plates or lips (similar to U. Stenocephala), and a dorsal pair of slightly developed lips, of the same nature; dorsal conical median tooth projects prominently into the buccal cavity (similar to Monodontus); one pair of dorsal and one pair of ventral submedian lancets deep in buccal capsule. Male, 7 to 9 mm. long; caudal bursa with short dorso-median lobe, which often appears as if it were divided into two lobes and with prominent lateral lobes united centrally by an indistinct ventral lobe; common base of dorsal and dorso-lateral rays very short; dorsal ray divided to its base; its two branches being prominently divergent and their tips being bipartite; spicules long and slender. Female, 9 to 11 mm. long; vulna in anterior half of body, but near equator. Eggs, ellipsoid, 64 to 76 micron long by 36 to 40 micron broad, in some cases partially segmented in utero, in other (rare) cases containing a fully-developed embryo when oviposited."

Under favorable conditions of heat and moisture, both being necessary, the ovum hatches out in about twentyfour hours, each ovum producing one worm.

Fortunately, these favorable conditions do not exist in the alimentary canal of a human being, so the number of parasites contained depends entirely on the number that gain entrance from without. In about five days the larvæ reach maturity and are encysted. This is its infective stage. It remains thus dormant until it gains entrance to its human abode, where it is said to reach full size and maturity in about five weeks.

There are two modes of infection-direct ingestion of the larvæ per os and indirect by finding their way through the skin to the veins and lymphatics and thence to the intestine. For a more thorough explanation see "Report of Commission for the Study and Treatment of Anemia," in P. R. 1904.

Moist, sandy, warm and shady places are the best fields for the development of the larvæ. These conditions exist about many gardens and around "horse-lots," and homes. There, on the vegetables ofttimes lies the dormant larva and when ingested he readily finds a welcomed home. The children often play, barefooted, around the "horselots," and ground-itch-mazamorra-a mere symptom of the infection, is very common. Then there are a few scattered here and there who are dirt-eaters and they get a thorough charge of the hookworm.

Out of the 408 treated by me during the past four years, 302 were males-181 whites, 121 blacks. Of the males all had history of repeated attacks of ground-itch—mazamorra. Of the 106 females, 100 were black, and 6 whites. Fifty-four gave history of ground-itch-mazamorra. It might be interesting here to state that two of these were discovered during an attack of typhoid fever.

Usually the symptoms of the disease vary in proportion to the number of offending parasites and to the length of time they have been in the individual, although we sometimes find only a small infection in one markedly affected. They usually present themselves to you for treatment for one of four things-indigestion, bronchitis or consumption, weakness or swelling of their ankles.

You find them sallow, tongue and conjunctiva pale— muscles flabby and soft though they seem to have lost none in weight. All have a "pot belly." There is usually a slight hemic murmur over the heart and coarse rales heard over the lungs. Their faces are pale and haggard

and they come in looking like the "last rose of summer." They tell you they are easily tired, have no energy, they eat a large quantity and every fall they give out completely. Usually they suffer from pains in their epigastrium-constipation and diarrhea alternating. The feces are usually slightly reddish in color although it may have any appearance and contain the ova.

If in children their physical development is below par. "If in young women you find they suffer from amenorrhea or dysmenorrhea.

Three hundred and fifty-six of the 408 treated gave history of repeated attacks of ground-itch—mazamorra.

It is the exception for one to perspire. The temperature has in all uncomplicated cases been subnormal, pulse always rapid and feeble.

The diagnosis of no disease is so easy and sure. You have but to look at one suffering with this infection to make you suspect it and a simple examination of the feces under the microscope will tell the tale. The presence of the egg in the feces is conclusive.

It is well enough to call attention to the fact that this disease may exist in connection with many other diseases, and care should be exercised to not attribute all symptoms to the hookworm without due consideration.

As to treatment-the preparation of the patient is essential to satisfactory results. Any means of completely unloading the small intestine is satisfactory-the object being to reach the worm by means of some anthelmintic.

I usually keep the patient under treatment for twentyfour hours allow them to take a glass of milk for dinner; at about 2 p. m. give them two to four grains calomel, and at 4 p. m. repeat the calomel. Allow them to drink water and a cup of coffee or tea for supper. At 9 p. m. give dose of salts or a seidlitz powder. At 5 a. m. take from