(European hook-worm disease; Miner’s anemia; Ankylostomiasis; Hook-worm
disease)
This disease results from infection by the hook-worm of any of the
various types. In Europe it is found in Italy, Belgium, Germany,
France and Switzerland. In America it seems to be of Africo-Asiatic
origin but was first discovered in the Southern states and abounds
chiefly in Texas, Florida, Georgia, North and South Carolina as well
as in the West Indies. Infection comes from unprotected feces that are
allowed to be spread where the feet or hands may come in contact as
it is without doubt that the contagion occurs through the skin. One
authority states that hook-worm is rarely found except in cases where
ground itch has occurred within a period of eight years. Negroes harbor
the parasite and transmit it but seem immune to its effects while the
poorer whites are afflicted to a large degree. The worms are carried
from some abrasion of the skin, by the blood to the heart and lungs,
thence to the pharynx and swallowed, thence to the duodenum and jejunum
where they attach themselves to the lining walls. Here they not only
feed upon the blood but develop a toxin. The female worm is about twice
the size of the male, 10 to 18 mm. as against 6 to 11 mm. and there is
slight difference between the old and new world varieties. The head is
provided with four hook shaped teeth which form the attachment to the
intestine and it is very secure.
=Diagnosis.=—For years the languid, dull, expressionless, lack-luster
of eye and general unambitious characteristics of the inhabitants of
the great sand belt of the United States attracted attention and was
attributed to laziness but the discovery of the hook-worm explained the
cause. Children are stunted in mind and body and have a muddy, dirty
white complexion.
At the beginning there must be a very considerable colony of the
parasites to cause symptoms but as the disease advances there is a
distention of the abdomen from enlargement of the spleen and liver and
from flatulency. There is palpitation, shortness of breath, cardiac
bruits from the severe anemia while edema of the feet and legs is
rather common. The blood shows a severe secondary anemia with its
coagulation time much increased. Leucocytosis is not common; hemoglobin
is from one-tenth to one-half normal with erythrocytes about half
normal.
=Treatment.=—The removal of the worms with the least possible harm to
the body is indicated. Thymol is a poison which is not absorbed by the
body, when carefully given, and which is very toxic to the parasite.
The dose varies from eight grains for a child under five years of age,
to forty-five for an adult. Thymol is soluble in fats and in alcohol,
so that for a day or so before the thymol is given, and from one to
four days after, no fats or alcohol should be taken. The best way to
avoid poisoning by thymol is to give the patient charcoal, then no
fats or alcohol is permitted until the treatment is completed. When
the stools become black, the thymol is given on an empty stomach. A
purgative is given a few hours later. Enemas should be used very freely
in order to facilitate the removal of the injured or poisoned worms.
Another dose of charcoal is given, and when the stools are black again,
the patient may return to his ordinary diet. The denial of fats to the
person so thoroughly accustomed to bacon three times a day is a factor
met with difficulty in dealing with patients of the ordinary class with
the disease. (Clinical Osteopathy.)
=Prophylaxis.=—After treatment it is imperative to prevent reinfection
and to do that the most rigorous sanitary measures must be instituted.
All feces must be disposed of and habits of cleanliness in defecation
insisted upon while negroes, who harbor the worm without showing
symptoms, must be looked after as well as the actual victims. Care of
the feet is important and shoes should be worn in infected regions
and all abrasions of the skin protected. Drinking water must be
uncontaminated which presents a problem as wells and springs are
usually unprotected. Absolute and persistent cleanliness is the answer
to the question of prevention.