Evening Republican, Volume 23, Number 14, Rensselaer, Jasper County, 15 January 1920 — FAIL TO WIPE OUT HOOKWORM [ARTICLE]

FAIL TO WIPE OUT HOOKWORM

Complete Elimination Has Not * Yet Been Attained. TO TAKE NEW STUDIES Report Of Rockefeller Foundation Says Study and Investigation Is Necessary—Cure of an Individual Found Simple Task, but to Prevent Reinfection From Larirae in Soil la Difficult—Fight on Fifteen Years. Failure to eradicate completely hookworm disease from any one area during 15 years of scientific struggle against that scourge by Its own and other health agencies is acknowledged in the Rockefeller foundation’s annual report. Intensive scientific study of certain control factors, notably the viability of the worms in various kinds of soil and other mediums and the possibility of making certain the existence of other forms of transmission than those already well understood, are suggested as offering hope of attaining more complete results. It is probable that such studies soon will be undertaken. “Nothing could be simpler In theory than the few measures necessary for the control of hookworm infection,” the report says. “The cycle of the worm from the moment the egg is deposited on the ground until it has reached the small intestine of its human host and developed to its adult stage is well understood, as are also the details of Its life story” and environment; and there are at least two drugs which are most potent in free: Ing the human system of the parasites. It should therefore be relatively simple to locate and to cure those who have the disease, to prevent others from contracting it, and thus to bring about, within limited ardas at least, Its complete eradication. Although the problem of complete eradication Is simple when stated on paper, it la not so in practice. The board has been engaged in work against hookworm disease since 1910, similar work was undertaken in Porto Rico in 1904, and the attack on the disease in the mines of Belgium, Holland and Germany began as early as 1902, yet It Is impossible to point to any one mine or area from which the infection has been completely eradicated. In the mines of Germany It was reduced from 16JB per cent in 1903 to .18 per cent in 1912; in those of the Netherlands, from 25 per cent in 1903 to .32 per cent in 1918, and in those of the Liege district of Belgium, from 22.8 per cent In 1902 to 1.2 per cent in 1913. These are the nearest recorded approaches to complete control. Many Obstacles In Way. / obstacles stand in the way of complete eradication, even in Isolated areas having no immigration and with natural conditions that either limit or preclude intercourse with the outside world. It is seldom possible to examine every individual'in an area or to treat until cured all who are found Infected; when latrines of a proper type are installed in sufficient numbers to prevent soil pollution, it is still necessary to accustom the people to the use of them —and this is a task that usually requires a. long period of education and enlightenment; and even when both the foregoing conditions are fulfilled there still remains for a time the danger of reinfection from hookworm larvae already In the soil.” After an extended survey of its experieace with reinfections, which were found to show the highest rates on estates in Ceylon, the foundation reports: . “These high rates of reinfection should not be accepted as Indicating that no considerable progress has been made toward bringing the disease under control. It should be remembered that the problem of hookworm control is primarily one of reducing mass infection. The practical phase of the task Is concerned with the removal of the largest possible number of worms from the largest possible number of, infected persons. Upon this basis the best criterion for judging the effectiveness of a curative campaign in any area is not the percentage of infected persons who are cured or who remain cured, but the proportion, expelled and destroyed, of the total worms harbored by the population. “Even though in certain of The areas mentioned from 50 to 100 per cent of the persona formerly cured of the disease hats since become reinfected tlere can be little doubt that as a result of treatment the average number of worms harbored by each Infected person has been very materially reduced. Conditions extremely favorable for the prevalence and persistence of file Infection exist practically throughout all countries in which the work has been conducted; there is at pres--3t lack of definite knowledge as to w long larvae remain Infective in । the soil ; the latrine accommodations ( provided in many areashave been defectlve or inadequate, the habits of the people grossly Insanitary, and, in addition, war conditions have interfered seriously with due and effective sanitary supervisions and reasonable regimentation. Under these circumstances reinfection wa* bound to occur to greater <r tesa dsgrue, but it unQUcstionaoiy sanitation is Introduced and the curative measures are extended. * _ ... — . w.

forts at control in alnerent parts or । nvor a narind more than 15 years ft is still Impossible to point to any single area from which the disease has been completely erodtfeted suggests that perhaps the work is being carried out with a lack of scientific information on cara — ■—s-m fa tain poims concern mg wuitu ucuuuv that a series of studies may soon be made which will supply definite experimental proof on the phases of “One of the moat important factors in need of farther study Is that relating to the viability of hookworm larvae in soil and other media. In the past It has been commonly supposed that after a period of from six to ten months the soil would become sterile and the disease would gradually die out, but the evidence now at hand seems to indicate that soil once heavily Infected —particularly In tropical countries where the temperature seldom or never drops to the freezing point —must remain infected for a considerable time even after sanitary conditions have been improved. Thus, Kofold has recently reported that in the soil of California the larvae remained alive for 12 months, and It is probable that in more tropical climates they persist for even longer periods.” Part of the report Js devoted to describing infection and sanitary surveys undertaken in various countries and recounting the difficulties of preventing the most serious source of Infection—soil pollution. The providing of adequate latrines Is set forth as the best method of bringing about this result ... “Some data from Arkansas and Texas brought together by means of the laboratory car Metchnikoff, during the treatment of infected soldiers in IS a possibility of the Infection being transmitted by dust' Thia subject is worthy of further study. The role played by insects, particularly files, In transmitting the Infection also remains to be thoroughly investigated, the chapter concludes.