After some further advice with the local authorities regarding the future management of the disease in its different phases, the Health Officer is ready for other fields of action. For the increased efficiency, tremendous saving of both time and money, every loyal citizen should be grateful.

While it is possibly true that the hookworm campaign inaugurated some years since by the Board will continue without further special or organized effort, with its splendid work, the physical reclamation of our youthful citizens, I do not think, however, that conditions prevailing in many sections warrant this conclusion.

Quite recently, it was my pleasure to canvass a county in which, considering its population, two to four times as much work had been done in the treatment of these sufferers as had been accomplished in any other county in the state. The local medical men were thorough and efficient, they had made a special effort to free their section from this parasite. The inspection of their town school showed that 50 per cent. of the scholars were infested. Through their efforts the percentage had been reduced 15 per cent. The toilets were defective in their construction and as unsanitary as you would expect from continued neglect. In the country schools the infection was present in from 65 to 95 per cent. of the attendance, often including even the teacher. Two schools were without closets, some had only one. In every instance these adjunct buildings were poorly built and, so far as I could learn, none of them had ever been cleaned and disinfected.

At one place 75 per cent. of the children were barefooted, and one that had been recently treated and cured had contracted another attack of ground itch. There was not a community visited in which these good men had not treated and cured children infested with this trouble. You can imagine how gratifying it was to see their rosy cheeks and red lips, in contrast to the pale and wan features of their infected but untreated deskmates.

Yet, despite all the activities of these men, they had scarcely made an impression, so great was the volume of work to be accomplished. It was their testimony that as the crusade gained in popularity it had been comparatively an easy matter to gather in those cases among the intelligent, reading and thoughtful class; but as it extended into the untutored and unlearned it became progressively the more difficult.

*

*

*

*

*

Such conditions as obtain in that county in the main are to be

found in every other county in the state. The proof of the assertion that to allow the work to continue as at present means that the mass of the cases go untreated, is quite evident. While a good beginning has been made, still no one can go out and contemplate the field without being amazed at its vastness.

If this proposition is to be tackled with the seriousness that it demands, it would appear that in point of numbers at least our line-up is a bit weak. As the majority of the country schools have terms of from four to five months, it will necessitate a much larger force if much headway is to be made during this brief season. The country schools open during August or September and end before Christmas. In the past our program has been to commence the inspections during January. As a consequence, we are working at a time when these small institutions are closed and we are unable to reach those most in need of our attention.

The plan of our present method of handling the indigent is a wellthought-out one. It takes for granted that there will be an intelligent co-operation on the part of those applying for treatment and assumes that the conditions required will be understood to be for the interest of those taking advantage of the gratuity. Considerable observation of the measure in its trying out in the field convinces me that it is best adapted to those cases among the intelligent and appreciative public as well as those occurring in dispensary and hospital practice; that because of some of the conditions imposed it rather hinders the progress of the work among the less fortunate. While the strict complance on the part of those taking the treatment in the prompt forwarding of specimens is necessary for the accumulation of data, the compilation of accurate statistics, it is, nevertheless, an unessential in the accomplishment of beneficial results, and is oftentimes an impossible obstacle in the management of those most in need of its benefits.

As a matter of fact, the microscope is of assistance only in cases where the infection is very mild-where there is a question as to the diagnosis. Experience tells me that this series is in the minority; that the mass of the cases demanding our attention present symptoms and evidences of unquestioned diagnostic import. The result is always the same as far as all practical purposes are concerned, and it makes no difference whether the previously instructed individual examines his stools after treatment

for the presence of the worms and keeps this up until their final disappearance, or whether the progress of the treatment is checked by an expert microscopist in a distant laboratory who examines the forwarded specimens at different intervals until the ova have disappeared.

It would seem, without further discussion, that in order to facilitate the accomplishment of more rapid and widespread results, it is essential that there should be a greater and more thorough distribution of unconditioned, unrestricted-in short, free thymol. What we need now is less microscope, less delay on account of data, and a more definite regulation of our efforts to suit the calibre of the patients and the demands of the situation we have to deal with; and last, but by no means least, more thymol. I would suggest a revision of the present methods with this attainment in view,.

Respectfully,

C. T. YOUNG,

Assistant State Health Officer.