Hookworm disease

“ Much easier is the control of organic physical diseases, as, for example, hookworm infection. A survey of the prevalence of hookworm disease throughout the world, made by the Rockefeller Sanitary Commission, shows that this infection belts the world in a zone 66° wide with the equator near its middle, and that practically every country in this zone is heavily infected. ”

“ He called this variety of worm Necator americanus (American murderer) , although he might more properly have named it Necator africanus. The Negro’s habitation of our soil could be proved by the infection he has left behind, even though the race should disappear. Scientific investigators like Darling have studied hookworm—content to trace great racial migrations.
Investigation and treatment of the hookworm disease is no job for a florist. Much of the work has to do with microscopic examination of human excreta. ”

“ It is extensively distributed in South America, especially Brazil, as well as in Central America, Mexico and the Southern States of the U. S. The inhabitants of many of the islands of the Pacific are heavily infested. Hookworm disease is common in southern Europe.
Etiology and Epidemiology
Etiology.—The hookworm infections of man come almost entirely from two parasites, Ancylostoma duodenale, the Old World species, and Necator americanus, which is generally called the New World species from its having first been reported from the U. S. by Stiles. ”

“ Where a sewerage system exists there is very little danger of the spread of hookworm disease and the same is true where there is proper disposal of the faeces by burning, boiling or treatment in a septic tank. In rural districts, however, where the stool is often deposited in the shade and retirement of a clump of trees, the soil becomes infested with myriads of larvae, so that one standing with bare feet on such a spot easily becomes infected. ”

“ One of the most interesting methods of extension of infection, showing on what small circumstances infection may depend, is seen in the case of the hookworm disease, which causes such devastation in the Southern States. The organism which produces the disease, the Uncinaria, belongs to the more highly developed parasites, and is a small round worm one-third of an inch long. ”

“ The loss of blood and the effects of the poison soon cause the person in whose body these worms are living to become weak, pale, and thin. He is not able to do much work, if any, and the result is that people suffering from this disease are often called lazy. They are not lazy; they are sick, and many of them die.
How hookworm disease can be prevented
All this sickness and all these deaths might be prevented simply by the proper disposal of human excreta. No human excreta should ever be put anywhere except into [122] a properly constructed sewer or properly constructed privy. ”

“ An important point claimed in these investigations is that hookworm disease is especially prevalent among children, and that it not only interferes with their school attendance, but that children who are afflicted with the malady and who have gone from sandy districts to a city have the reputation among their teachers of being more or less backward and even stupid in their studies. All this agrees with well established symptoms of the disease, for it is thoroughly established, not only by Dr. ”

“ It is a subtle disease with a chronic course, and it attacks the health and efficiency of its victims insidiously. It is beginning to do in the United States what it has already done in Egypt, China and India. It will be impossible to control the spread of hookworm in the United States as long as any considerable number of new cases are admitted in immigrants. The law rates it now as a dangerous contagious disease, subject to exclusion. ”

“ Among the diseases caused by parasitic animals are malaria, yellow fever, the sleeping sickness, and the hookworm disease. Animals also carry disease, especially the flies and mosquitoes; rats and other animals are also well known as spreaders of disease.
From a money standpoint, animals called insects do much harm. It is estimated that in this country alone they are annually responsible for $800,000,000 worth of damage by eating crops, forest trees, stored food, and other material wealth. ”

“ But flies and mosquitoes do not stop with fences, nor do they recognize city or county boundaries. Hence, individual effort without community cooperation is likely to be useless.
POLLUTED SOIL AND HOOKWORM DISEASE The terrible hookworm disease so prevalent in our southern states is caused by a minute worm that infests soil polluted with sewage. It penetrates the soles of the feet of those who go barefoot and the palms of the hands of those who work in the soils, finds its way through the blood to the intestines, and thence to the soil again. ”

“ Similarly patients have been admitted to the Wilmington, N. C, Marine Hospital for the study of hookworm infection. Two laboratory officers were detailed with the mine rescue car of the Bureau of Mines to investigate hookworm disease among miners in southern states and lung diseases among Colorado miners, and also to report on the general sanitation and hygiene of mines.
Service Quarters, Marivales Quarantine, Philippine Islands. The San Francisco plague laboratory has continued its work of examining rodents for the germs of bubonic plague. ”

“ The negroes in the South have, by a lifelong proximity and struggle with the disease, acquired a practical freedom from typhoid fever, although it remains with the negro sufficiently to form a focus for the spread of the disease among others not equally immune. Creoles in yellow-fever districts have a natural immunity from the hookworm disease, although probably the class are responsible for its generous transmission to the poor whites with whom they associate. Racial immunity from certain diseases may be shown by statistical studies. ”

“ The hookworm disease is very prevalent, but its ravages are not so apparent as in certain other tropical countries. Venereal diseases are exceedingly common. Evidences of the presence of leprosy and elephantiasis are occasionally seen. ”

“ That Egyptian chlorosis, afterward identified with Old World “hookworm disease,” is caused by the Ankylostoma duodenale was shown by Greisinger in 1851. In the same year the Schistosomum hematobium was shown to be the cause of the “Bilharzia disease” by Bilharz. Küchenmeister discovered the tapeworm, Tænia solium, in 1852, Cohn, an infectious disease of flies due to a parasitic fungus (Empusa muscæ) in 1855, and Zenker showed the connection between trichinosis of pork (“measly pork”) and human trichinosis (1860) as indicated above. ”

“ In the Old World, hookworm disease was probably known to the Egyptians nearly three thousand five hundred years ago, but its cause was not understood until about the middle of the nineteenth century, when it was shown to be due to an intestinal parasite, Agchylostoma duodenale. ”

“ We can prevent hookworm disease by preventing the ground from being polluted. Polluted ground means that which is made unclean with waste matter from our bodies. The eggs are found in this matter which pollutes the ground. [107]
"Now, Will, always wear your shoes, and see that the soles are good and thick. Then, even though the ground is unclean, hookworms can't get to your feet. I am sure, now that you know about hookworms, you will not go barefooted through the lanes again."
QUESTIONS
1. ”

“ If raw pork containing these worms is eaten by man, the cyst is dissolved off by the action of the digestive fluids, and the living trichina becomes free in the intestine of man. Here it reproduces and the young bore their way through the intestine walls and enter the muscles, causing inflammation there. This causes a painful and often fatal disease known as trichinosis.
The Hookworm.—The discovery by Dr. C. W. Stiles of the Bureau of Animal Industry, that the laziness and shiftlessness of the "poor whites" of the South is partly due to a parasite called the hookworm, reads like a fairy tale. ”

“ Under the directly harmful results are the weakened physical condition of the mother, the increased susceptibility to diseases which are especially common in the coffee districts, particularly anemia, and such diseases as are the results of exposure. The larva of the hookworm lives and finds a fertile field for action in the damp and shady regions devoted to the production of coffee, and as the majority of the women laborers are not accustomed to wear shoes, they easily permit contact and contagion from this disease. ”

“ A family suffering from hookworm.
The cure of the disease is very easy; thymol is given, which weakens the hold of the worm, this being followed by Epsom salts. For years a large area in the South undoubtedly has been retarded in its development by this parasite; hundreds of millions of dollars and thousands of lives have been needlessly sacrificed. ”

“ The hookworm robs them of the good rich blood, and makes children, and even grown persons, dull and lazy. The disease keeps children from growing.
"It is easy to cure the disease, but it is better to prevent it. ”

“ A good example of the thorough and painstaking study of epidemic disease which characterizes the service work, is the exhaustive research made by Stiles of the distribution and results of hookworm infection in the south and especially in the rural sandy districts of Georgia and Florida. ”

“ In 1912 of the 718 cases certified at New York, 64 were landed. If no inspection were made for trachoma, the victims of the disease would flock to the United States in hordes. We have a weighty and difficult problem in handling the trachoma already existent in this country. Every consideration demands its absolute exclusion in immigrants.
One other disease of national importance for the public health, and which has an intimate relation to immigration, is hookworm infection. The economic and social significance of this disease is well known. ”

“ This is a skin affection which is also called larva migrans on account of its being due to the burrowing of more or less undetermined fly [423] larvae in the subcutaneous tissues. In their advance, which is at the rate of from one to several inches daily, they leave a raised pinkish line. The burrow is approximately 1⁄6 inch in diameter. The disease is most common in Southern Russia but is also found in Africa, Asia and South America. Looss considers that hookworm larvae, when penetrating the skin, may produce similar lesions. ”

“ There is more hookworm in Porto Rico, those who should know tell us, than in any other country on the globe, with the possible exception of India and Ceylon. The disease was brought by African slaves—along with most of the troubles of the West Indies—and while it does little harm to negroes, it is often fatal to the whites. The population in the rural areas makes no sanitary provisions, and soil pollution is wide-spread; they invariably go barefooted, with the result to be expected. Ninety per cent. of the laboring class was infected with hookworm when we took over the island. ”

“ In fact this was about the same proportion that I found among the assorted natives brought to the hospital in Rabaul. Hookworm, on the other hand, was only 8.4 per cent as against 74.2 for the whole Territory. Why? Because the group was made up of narrow atolls, where the beaches were the latrines and the tide carried the infecting material away. Malaria and elephantiasis are both mosquito diseases (if you can call elephantiasis a disease—it is merely a symptom of filarial infection) . On one of the islands here I saw a woman’s breasts so enlarged that when she sat they touched the ground. ”

“ The vitality of the people is being sapped by the insanitary conditions under which they live. It was discovered some years ago that hookworm is the cause of the illness that has been preying upon these workers for generations. The dangerous worms thrive in the midst of filth. A clean-up of the village and the42 building of better homes almost certainly eliminates the disease and its cause.
The people of the mill village find most of their recreation in the near-by city. Nearly all of the principal Southern cities have a number of these villages contributory to it. ”

“ They are carried to the heart and lungs by the veins. They go from the lungs into the wind-pipe, and then crawl from the wind-pipe into the gullet. It is then an easy matter for them to get into the food tube in the body.
"The mouth of the hookworm has a sharp hook which it fastens into the wall of the food tube. It hangs there and sucks all the blood it wants. A hookworm will suck a drop of blood a day. In feeding themselves they are slowly bleeding the person, drop by drop. This is the reason the boys or girls who have hookworms look so pale, and feel so tired all the time. ”

“ Here they undergo further development, and in a short time become mature hook-worms, which in their turn lay eggs, and the life cycle begins over again. It is thus seen that a child having hook-worm disease becomes a menace, on account of the privy, to its brothers and sisters, and of course quite commonly receives back into its own body, worms that had previously escaped as eggs. ”

“ It then undergoes a 2nd ecdysis or moulting, but instead of casting off this old covering, it retains it as a protecting sheath. The full grown larva is about 550 by 24 microns. At this time it ceases to take food but can move actively in its sheath so that it can crawl up blades of grass or vertical sides of mines. They can live in this state for months, when moisture and shade are present, but are rapidly killed by drying. Before becoming encysted hookworm larvae are readily destroyed by the action of the sun or chemicals or even by dilution of the faeces, especially with urine. ”