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Prevention of Communicable Disease: Service

HOOKWORM DISEASE This disease has existed from time immemorial, but especial attention has been directed to it in the United States in recent years. Investigations by Dr. Chas. Wardell Stiles of the United States Public Health and Marine Hospital Service and those made under the supervision of the Rockefeller Institution, have proved that this disease is widely prevalent, especially in the southern states, and is of enormous economic importance.

It is caused by soil pollution. The eggs and larvæ of the hookworm are passed in large numbers in the discharges of infected persons. Thence they may be communicated to others by contaminated food or water or directly from the soil through the skin. This mode of infection is perhaps the most common in rural districts where all children and many adult members of the population go barefoot in summer and are thus more or less constantly in contact with infected soil. In the rural sections of the southern states all the factors necessary for the propagation of this disease are found. The conditions most favorable to its development are warmth, moisture, an open porous soil and infected people who pollute the soil. North of the Ohio and Potomac Rivers the climate is too cold and in the arid west too dry to favor the disease.

The adult hookworm is about onethird or two-thirds of an inch in This shows the head of a hookworm as the parasite is feeding, attached to the wall of the bowels. (P. H. & M. H. Service.) length and about the thickness of a small hairpin, or a No. 30 thread.

Its head bends back on its neck like A PREVENTION OF COMMUNICABLE DISEASE 171 a hook, hence the name. The mouth is equipped with lances which pierce the flesh and make openings through which the blood can escape. These carry a poisonous secretion from a gland in the worm's head which keeps the blood from clotting. In severe cases, the worms occur in enormous numbers and take large quantities of blood from the system.

Much more is lost from constant oozing of the wounds. The secretion injected by the worm is poisonous and causes a chronic inflammation which impairs digestion. The wound also affords entrance for diseaseproducing bacteria to the system. There is also a general lowering of the body tone which exposes the victim to all sorts of diseased conditions. The symptoms in general are those of malnutrition and may be mild, medium or severe. In general the patient becomes very much weakened, the body looks bloodless and development is stunted. The proverbial laziness of the Georgia "cracker" and other so-called "poor whites" in southern states is now believed to be the result of hookworm infection.

Treatment and Prevention.-Happily this disease may be readily and quickly cured and is entirely preventable. The following method of treatment is advised by Dr. Stiles, the leading authority on the subject.

He says: "The fundamental principle underlying the treatment of hookworm disease is the same as that which underlies the treatment of all other zooparasitic diseases, namely, first treat the parasite, not the patient. After the parasite is treated, attention may be directed to treating the patient. "Although hookworm disease may occur in persons in any walk of life, it is particularly among the poorer classes that it is found, and the average hookworm patient (children excepted, to a certain extent) can not afford to lose several days' wages to undergo treatment. It is therefore frequently expedient to conduct the treatment Saturday evenings and Sunday mornings. It will often be found difficult to arouse the interest of a community in regard to the presence of hookworm disease and the need of treatment. This can frequently be done, however, if it is borne in mind that the resulting anemia is, in common with other anemias, a frequent cause of amenorrhea. Warning.-"Notwithstanding that primarily we are to treat the parasite, not the patient, it should be remembered that if too great a quantity of thymol is absorbed by the patient, alarming symptoms and even death may occur. Accordingly, the patient and the patient's family should be carefully warned not to permit the patient under any circumstances to have on the Sunday during which the treatment is given any food or drink containing alcohol, fats, or oil. Patent medicines should be mentioned in particular, because of the alcohol many of them contain, and even milk and butter should be forbidden. I know of one case of serious thymol poisoning which followed promptly after the patient took a copious drink of milk the day thymol was taken.