p. 16 | The Hookworm Disease by W. A. R.

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Feb 24, 1910

The Hookworm Disease

By W. A. R.

The wide-spread agitation over this subject at the present time reveals to a thoughtful person something of the importance of this dreadful disease which is causing so much poverty, sickness, and distress in a certain part of our fair land. There has just been held in Atlanta, Ga., a conference of leading medical men and other scientists, numbering several hundreds, from all parts of the Southern States for the consideration of this subject and the eradication of this pest. It was the privilege of the writer to represent our denominational medical work in this conference, and I shall endeavor to give here a short synopsis of the conclusions arrived at there.

When we realize, as has been demonstrated scientifically, that in the sandy and sandy loam regions in the Southern States, from Virginia to Mexico, whether in the coast region, along river courses, or in upland regions, from twenty-five to eighty per cent of the population are infested with hookworm, and when we consider the dreadful results following in the wake of this disease, and realize the ease with which the disease might be eradicated, we appreciate to some degree the importance of quick, vigorous, and determined effort to do away with this scourge.

Aside from the introduction of slavery and its attendant evils into the United States, no greater curse has come to the Southland than the hookworm. Hundreds of people annually surrender their lives to this intestinal parasite. Thousands are incapacitated for any kind of labor. Millions are having their life-blood sapped and their usefulness impaired. These are demonstrated facts of science.

Introduction of the Disease

The fallacy of the old saying, “Even exchange is no robbery,” is seen in the evils growing out of an indiscriminate mixing of two races so different as the Caucasian and Ethiopian races. To our colored brother we as a white race have given the dread disease tuberculosis. This disease is destroying the colored race among us three times as rapidly as it does the white race; that is, tuberculosis is three times as fatal to the black man as to the white man. We shall not be able to discuss the reasons for this here. On the other hand, the Negro has brought to us the hookworm, which is many times more fatal to the white man than to the black. The adage should be revised to read, “Even exchange is multiplied robbery.”

The Worm

Male and female worms exist in the proportion of about one of the former to four of the latter. The female is about a third of an inch in length, and about the size of a thread. The habitat of the parasite is the intestinal canal, preferably of the human being. It attaches itself to the mucous lining of the intestine just beyond the stomach, sucks and bores its way into the wall of the intestine, sapping the blood and injecting a poisonous secretion into the circulation. This probably causes the greatest amount of damage to the individual, or host, harboring the worm. Attached thus to its host, it begins its threefold work of sapping the life current, injecting its deadly poison, and laying eggs. Of these latter the female lays at the rate of several a minute, and seems to be able to keep up the rate indefinitely. It may continue this work for many years, and thus probably lays millions of eggs in all. There may be from one to many thousands of these worms in the intestine of a single individual. Microscopical examination will reveal their presence when as few as a dozen, or possibly fewer, of the worms are present. So few as a dozen worms may not cause any noticeable symptoms, but large numbers cause very serious disorders. The eggs are ejected from the female, and later from the host in the excreta. These eggs probably hatch only outside of the human body. Deposited in the damp, warm sandy soil, they find favorable conditions for hatching. The little worms, or larvae, are liberated in the soil, and there await their opportunity to gain access to the body of a new host. This opportunity comes when the skin, as the feet, hands, or other parts of the body, comes in contact with the moist earth. Drying kills the larvae and destroys the eggs.

Having gotten access to the skin, these tiny worms, which in this stage are invisible to the naked eye, begin to burrow into the skin around the hairs, and into the sweat- and oil-glands. After a few hours they have worked their way through the skin into the lymphatics, a part of the circulation. From there they proceed through the lymph channels to the heart, and are pumped with the blood to the lungs. Here they encounter difficulty in passing through the fine capillary tubes of blood-vessels in the lungs, and lodge in the small blood-vessels. Being quite active, they again begin to burrow, and soon reach the air-passages in the lungs. They work their way along these tubules until they reach the trachea (windpipe), when they come up into the throat and are swallowed, pass through the stomach into the intestines, and there attach themselves and begin their life-work. It will be asked if this is the only way the worm may gain access to the intestines. It may be possible that a very few may enter with the food, but it is very unlikely that infection takes place in this way.

Symptoms and Results of the Disease

These are varied:—

1. The most constant and certain symptoms are “ground itch,” “dew itch,” or “barnyard itch,” as it is called. This most often appears on the feet, but may be seen on any part of the body exposed to the soil. Any person having this symptom will most certainly have hookworms in the intestines within a few weeks after such manifestations. Any person who has had ground itch at any time in his life most likely still has hookworms unless he has been freed from them by treatment.

2. Anemia. Lack of blood from the two causes—the sucking of the blood by the worm and the poisoning by injecting toxin—manifests itself in the pale, pearly skin, blue lips, and white sclera of the eye. The anemia is especially noticeable in the forehead and the alae of the nose.

3. Loss of strength and vigor. When this disease was called anew to our attention a few years ago, some newspapers announced the discovery of the germ of laziness. It is true that a great deal of the inactivity of people where this disease prevails is due to this cause, but it is no more a thing to be treated lightly than any other severe infection. If half the people about us had from a few hundred to several thousands of bloodsuckers, or ticks, or even mosquitoes, sucking their blood continuously, we would think it time something was being done. Is it any the less urgent because these parasites are hidden in the intestines?

4. Emaciation. Many of those suffering from this disease are thin in flesh, flabby of muscle, small in stature, and older looking than normal. Often men and women of age will look like children of seven or eight years as far as development goes, but will have an old, drawn, anxious look.

5. Dropsy. A noticeable puffiness under the eyes is often seen in this disease. The feet and ankles may be swollen, possibly the hands. The abdomen contains excessive fluid, and becomes enlarged and pendulous, causing a “pot-bellied” appearance.

6. Winged scapula. The shoulder-blades seem lifted from the back. This may be to such an extent that the hand can be pressed in behind the shoulder-blades several finger breadths.

7. The evidence upon which the absolute diagnosis of the disease is based is the finding of the eggs by means of the microscope in the excreta from the bowel. This is the most certain, easy, and generally accepted evidence, and is the one sought in every scientific diagnosis. There should be no hesitancy in submitting to this kind of procedure on the part of any one who suspects he has the disease, or who is in a locality where this disease prevails. To refuse to do this or to hesitate is folly, based on false modesty. Science is exact, and should not in this most important disease be frustrated by foolish sentiment.

Treatment

One of the best lessons I ever learned in grammar was the application of this sentence, which was given for analysis: “Pitt’s perplexing question was, ‘What are you going to do about it?’” That is the question before us now. There is no disease known to medical science that could be eradicated more easily than hookworm disease. One year’s time should, in a civilized nation, completely exterminate this disease which is costing us so dearly. It is not the late war, it is not the slavery question, it is not the race problem, it is not the tariff, not even the liquor traffic or tuberculosis, that is the great menace now to the South, but it is the hookworm. There is nothing under the shining sun that can demonstrate so conclusively and promptly and completely whether we will observe simple sanitary rules and adopt simple measures for doing away with this scourge as will our attitude toward this most important question in the near future.

What, then, is the conclusion of this whole matter? I will summarize it

under three heads; namely, 1. Educate; 2. Educate; 3. EDUCATE.

1. Educate the people concerning the necessity of sanitary conditions about their premises. The spread of the disease would be impossible if sanitary rules were observed. All excreta from the bowels must be thoroughly disinfected, and must not under any circumstance be deposited in or on the ground until this is done. This same precaution would diminish the number of cases of typhoid fever and some other diseases by ninety per cent. This new agitation over the hookworm may add force to our long-standing demand for better hygienic conditions everywhere. In this way the disease may be a blessing in disguise.

Proper sewerage must be provided in cities, and sanitary dry closets in the country are absolute necessities. We must not longer follow the primitive custom of heathenism in polluting the ground, else we shall continue to reap the results of this defiling habit. Water-tight buckets must be provided for our closets, with dry earth, slaked lime, and an occasional administration of chlorid of lime to keep the buckets free from odor. Cesspools for closets are dangerous because of drainage toward adjacent wells, as well as on account of foul odors. Where used, however, they must be kept dry and odorless with dry earth, slaked lime, chlorid of lime, etc.

2. Educate the people to recognize the symptoms and appreciate the dangers of the disease. This can be done by physicians, ministers, teachers, lecturers, and mothers and fathers. Any one who tries to calm your fears about this dreadful disease lacks wisdom. Every person living in a sandy country in the Southern States or in California should know by having a proper examination made whether or not he has the disease.

3. Educate the people to seek treatment for the disease. This should be given only by a competent physician. The treatment is very simple, is certain, costs but little, and does not incapacitate a person at all for his daily duties. It is well, however, for a person under treatment to take one day off for this purpose. The treatment consists in the proper use of Epson salt or other saline, thymol or beta-naphtol, in proper doses. There is therefore no excuse either for further infection or for a person to suffer longer with this easily curable but devastating disease. As a preventive measure it is well for those living in a region where the disease prevails to wear boots or shoes to protect the feet from the moist earth, and also to keep his hands as free from the soil as possible.

Next week I hope to make some propositions to enable our people to join in this warfare against the greatest scourge of the sunny Southland.

W. A. R.