Hookworm

“ Hookworm infection (uncinariasis, ankylostomiasis) is commonly caused by infection through the skin of the feet, but the possibility of mouth infection cannot be disregarded, and in regions where hookworm disease exists methods of guarding against food contamination should be practiced, as well as other precautions. Billings and Hickey [93] believe that hookworm disease is contracted by unconscious coprophagy (from raw vegetables) much more frequently than is generally supposed. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ There is another pest in the South which does not attack the farm crops, but goes straight for the farmer. If the Country Life Commission had done nothing more, they would have justified their appointment by the attention they called to the ravages of the hookworm, which have, no one knows how long, scourged the poor white communities in the Southern States. The effect of the disease set up by the hookworm, which infests the intestines, is a complete sapping of all energy, mental and physical. ”

“ 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. ”

“ One of the most important symptoms of 'hookworm' disease is an extreme lassitude, both mental and physical; this condition is due to the emaciation and to the thin watery character of the blood, which does not properly nourish either the brain or the muscles. Now, curiously enough, it is especially in the sand areas of the south that the poorer whites, known as the 'poor white trash,' are found, and Dr. Stiles, who has been living among these people for a number of weeks, positively states that it is among these people that hookworm disease is especially common and especially severe. ”

“ The Greeks probably had a name for it; ages later an Italian doctor called it Ankylostoma, which is fairly good Greek for “hookmouth.” Caesar’s legions carried it from Africa into Italy. In 1838 Dr. Dubini of Milan found 105 infected post mortems, and a year later it was discovered that Italian laborers had conveyed hookworm into the Alps. Australia got her dose of it when she imported Orientals and Islanders to work her plantations.
Hookworm and his wife came to America with Africa’s compliments to slavery. No worm travels far on its own belly ”

“ 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. ”

“ The third parasitical disease common in some parts of the United States has received much attention during this last year and is known as the hookworm disease. It is a new discovery in medical science, and whereas the physical condition of the victim is usually a clear indication of the disease, a positive diagnosis is always obtained by the use of the microscope. ”

“ After the worm gets through the skin, it is taken into the blood and carried to the lungs, and from there it finds its way to the throat and is swallowed. It makes no difference whether the hookworm is swallowed or enters the body through the skin; it finally reaches the intestinal canal, where it then makes its home. Sometimes thousands of these worms are found in a single person, and each one of them entered the body through the mouth or through the skin. The worms do not multiply in the body, and the eggs they lay never hatch until after they have left the body. ”

“ The workers of the Rockefeller Foundation have found eighty per cent of the people of the provinces afflicted with hookworm. Highly commendable is the work done by these representatives of the Institute, but so long as the common people know nothing of sanitation, clean and [Pg 134] pure food, present conditions will continue. And physical "hookworm" is accompanied by a similar mental condition. There is a moral hookworm throughout the country, and life slumps down to a hand-to-mouth drag from one day to the next. ”

“ Therefore hookworm ova in freshly passed faeces never show other than commencing segmentation while development of the larvae of Strongyloides takes place in the intestines, so that in freshly passed faeces we find, generally, actively moving larvae or at least eggs containing fully developed embryos. Hookworm ova very rarely show more than 4 segments or exceptionally 8 segments in the freshly passed egg.
In the presence of oxygen these ova rapidly develop into larvae, particularly at a temperature of about 27°C. Beyond 37°C. and below 14°C. development does not seem to take place. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ A learned man who had studied tropical medicine in London announced that the human hookworm could infect the pig and be carried by him. This was a serious claim, likely to upset all calculations; especially since he declared that he had proved his theory on a South Pacific island. I wanted to find out for myself, so I went to a friend whose wife had a pet pig that she had raised on a concrete floor to avoid that curse of Fiji’s swine growers, intestinal parasites. ”

“ It was just as Paley had shown: rainfall flooded their shallow wells and mixed with the foulness of their latrines so that both wells and latrines had the same bacterial flora. In some districts hookworm infection ran as high as 98 per cent. This condition was not limited to primitive natives by any means; the Hindu and Moslem of ancient culture were quite as ignorant of sanitation, and more worm-laden than their dark brown brothers. ”

“ 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. ”

“ Infection can spread rapidly from a single case. Not many hookworm carriers have been discovered among immigrants, probably because the facilities for their detection are so meager. But the heavy immigration from countries where uncinaria is abundant, as well as the recent suggestive work of Dr. H. M. Manning at the Ellis Island Immigrant Hospital, indicate that there is a constant stream of fresh infection pouring in. ”

“ 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. ”

“ The saliva of the hookworm has the curious property of preventing coagulation of blood like leech extract, and when it is remembered that the worms may vary in number from several hundred to a thousand or more, and that each worm moves frequently from place to place on the intestinal wall, it is apparent how excessive and continuous is the drain on the blood and lymph juices. ”

“ 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. ”

“ From specific germs that may be carried in sewage at any time there may result typhoid fever, tuberculosis, cholera, dysentery, diarrhea, and other dangerous ailments, and it is probable that other maladies may be traced to human waste. From certain animal parasites or their eggs that may be carried in sewage there may result intestinal worms, of which the more common are the hookworm, roundworm, whipworm, eelworm, tapeworm, and seat worm. ”

“ 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. ”

“ 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. ”

“ This might have added important clues in the search for Rennell Island’s history, for the hookworm contents of a race may tell a great deal about the origins and migrations of a people. Dr. S. T. Darling, eminent in tropical medicine, had developed theories on this parasite, which he collected all over the globe. He demonstrated that [Pg 305] the original habitat of the Ankylostoma duodenale was north of twenty degrees north latitude, while the Necator americanus stemmed from a region south of that line. This is a point which has not been given due weight by anthropologists. ”

“ 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. ”