On the Prevalence of the Anchylostoma Duodenalis in Madras

as anchylostomiasis by the physicians in charge of the wards, one being the case included above; and of these six were discharged cured and one relieved. As regards the nationality of the twenty-six hosts, twenty-three returned themselves as Hindus, one each as Eurasian, Native Christian and Pariah. Two of the Hindus were Nayars from the West Coast, the rest were the ordinary Tamil cooly class drawn chiefly from the neighbourhood of Madras, but partly from the whole Presidency, many coming long distances. The actual figures are five born and bred in Madras; nine who had been some weeks to a few years there; eleven who came from other parts of the Presidency direct to the hospital; and one, a beggar, who had probably been all over the districts. This shews that the parasite exists both in the Presidency Town and widely throughout the Presidency. The ages of these patients varied from 16 to 70, the average being 36. This hospital admits as in-patients only males over 12 years of age, and no statistics are therefore available for women and children. Those cases are returned as anchylostomiasis in which the eggs of the worm are found in the feces in great abundance, and no other cause is evident for the very marked anaemia from which they suffer. Usually they give a history of an ansemia increasing for one or two years with, in some cases, but not in all, a febrile onset of a few days, and usually some discomfort, doubtless duodenal, referred to the epigastrium. Of organic changes produced by this parasite, I have found none certain, but in two cases changes which I was inclined to attribute to them. One was in a case which died from perforation of the small intestiue high up. The perforation had taken place through a cicatricial mass, not much indurated, encircling the bowel; and the duodenum and first few feet of the ilium were found to be the seat of eleven circular cicatrices, some as much as two inches long, and most unusual in appearance. I thought, and still think, these were due to the bites of anchylostomata at some previous time which had ulcerated and cicatrized. If not, I do