Climate and Health in Hot Countries and the Outlines of Tropical Climatology / A Popular Treatise on Personal Hygiene in the Hotter Parts of the World, and on the Climates That Will Be Met Within Them.

by George Michael James Giles

The disease is, I believe, common enough in other warm climates, but I am not acquainted with its popular designation elsewhere than in India, where it is known by the above name.

On the Prevention of Diseases Caused by Internal Worms.

Internal worms are extremely common in most hot countries, and especially in those climates where moisture and heat are combined. Where they prevail to a serious extent, they often constitute one of the principal causes of mortality amongst natives, but white residents rarely suffer, as the habits of the better-class European to a very great extent protect him from being invaded by these pests.

There are three principal sorts of these parasites: the round-worms, which usually divide their time between some animal and the outer world, and the flat-worms and the flukes, both of which must pass through two or more animal hosts. The life-history of these troublesome guests, especially those belonging to the two latter classes, include some of the most wonderful and interesting pages of natural history, but unfortunately considerations of space prevent our describing these changes except by the barest allusions.

The commonest round-worms that establish themselves in mankind are the common thread-worms and round-worms (Lumbrici), and that much more formidable pest of tropical life, the Ankylostoma, or hook-worm.

Thread-worms and Lumbrici are common enough everywhere, but are far more commonly troublesome in hot climates than at home in Europe. The eggs of both are probably usually carried into the human intestine on food or in drinking water, and in the case of the Lumbricus this is the only way in which the numbers of the parasite can be maintained, as its eggs take a long time to hatch out; but those of the thread-worm, when deposited, are quite ready to burst at once, and though no individual worm as a rule resides within the intestine for any great length of time, the patient infested with them is continually reinfecting himself, so that their numbers have a tendency to increase. Thread-worms are especially common in children, on account of the strong tendency of the little folks to put their fingers in the mouth.

Thread-worms live in the lowest part of the bowel, and so cause much itching and tickling about its orifice. This prompts the child to scratch itself, with the result that some of the innumerable eggs laid by the worms adhere to the fingers, and once there soon find their way, along with the fingers, into its mouth. The intruders are usually easily expelled by an injection of salt and water, but it is difficult to get rid of all of them, and the child is nearly sure to reinfect itself unless it is made to sleep in drawers. Provided reinfection is prevented in this way, however, the remaining worms will soon be got rid of, as this species as a rule does not take up a prolonged residence.

Round-worms can be expelled by the means of a dose of santonin, but as neither these parasites nor tape-worms usually cause immediate serious symptoms, and both this drug and most other vermifuges require a certain amount of care and caution in their administration, it is better to wait any moderate time until the treatment can be supervised by a medical man.

The third common round-worm parasite—the hook-worm namely—though but little known in Europe, is so widely distributed in hot, moist countries, that in such climates the greater proportion of the indigenous races are often affected to a greater or less extent. It is quite a small worm, but fastens on the lining of the bowel in exactly the same way as leeches attack the outer integuments, and exhibits the same insatiable appetite for blood. The extent of the mischief wrought by them depends entirely on the number harboured. When only a few are present, they may be considered practically harmless, and thousands of such cases are to be met with in any country where they are common; but wherever this is so, numbers of subjects will be met with, in whom they are so numerous as to cause serious symptoms and death; so that there are many places where they constitute one of the most serious scourges of the Tropics. The eggs of this parasite, deposited along with the dejecta of persons infested with them, hatch out in the soil, and multiply there enormously, so that owing to the insanitary habits of the populace, the soil round about a native village comes to swarm with this free stage of the parasite. Now as the population is generally a purely agricultural one, and none too nice in its habits, it can be easily understood that persons, eating as they do with unwashed hands, must constantly carry to their mouths some of the earth containing the minute embryos which convey the disease, and hence the process of infection is commonly continuous and progressive. As a matter of fact, out of some hundreds of specimens of drinking water examined by the writer in Assam, where the disease is extremely rife, in no one case was there anything found to show that the malady was commonly conveyed in water, but the contingency is clearly a possible one; and in any case, it is clear that very moderate care as to food, water, and personal cleanliness would suffice to render infection impossible. From what has been said, it is easy to understand that the disease is practically unknown among European residents whose habits have reached the most moderate degree of refinement; but though it may not affect the planter’s health, it reacts most seriously on his pocket, owing to the disastrous amount of sickness and mortality it gives rise to among his native labourers. Now it is perfectly obvious that this disease can be easily prevented by the most ordinary measures of conservancy, and the question whether the evil can be obviated or not, is purely one of whether the master has the will and power to insist on the use of proper latrines. This, however, is by no means so simple a matter as it looks, where one has to deal with labourers belonging to a primitive stage of civilisation. Once seen, the disease is easily recognised by the deadly pallor of the lining membrane of the eyelids, and of the tongue, especially the latter, which looks much like a piece of a wet, pipe-clayed buff belt. By treatment with vermifuges and careful nursing there would be little difficulty in curing people of European habits; but only those who have had to attempt it know how impossible it is to get semi-civilised people to adopt, or even submit to, what to us are the most ordinary sick-room comforts, and as a matter of fact, there is very little hope for a native who is at all seriously affected with these parasites.

The best vermifuge we have is thymol; three doses of 30 grains each, given within six hours, followed up by a dose of castor oil. A certain amount of caution is required in giving this to cases in a very weak state, but after all it is the only chance for them. This medication may have to be repeated once or twice, at intervals of a week, and should be systematically carried out in all cases that have not gone too far. The worst of it is, that unless proper sanitary measures can be carried out, treatment is little better than a waste of drugs, as otherwise the patients will be sure to reinfect themselves within a few weeks, however thoroughly the vermifuge may have done its work.