Health on the Farm: A Manual of Rural Sanitation and Hygiene

by H. F. Harris

Character of the Disease.—The animal parasite called hook-worm closely resembles, externally, the pin-worm which so often occurs in children. The female, which is larger than the male, measures somewhat more than half an inch in length, and has the thickness of a knitting-needle; the male is between a quarter and three-eighths of an inch in length as a rule. The parasite possesses around its mouth a row of minute plates somewhat resembling hooklets, by means of which it grasps hold of the mucous membrane of the intestine and bruises it sufficiently to cause the blood to flow; with this blood the parasite nourishes itself. At the same time the worm injects into the tissues a poison which has much to do with the symptoms that occur in the disease that it produces.

These worms are usually present in great numbers, there being as a rule from 500 to 2,000 of them, and as they unquestionably live at least eight or ten years, the unfortunate victim suffers for a long period of time as a result of their presence. While living in the intestines the females lay enormous numbers of eggs which pass out with the feces, and under suitable conditions of temperature and moisture there develops within each of them, within from two to three days, a minute snake-like embryo which bursts through the shell of the egg and passes into the neighboring earth. Here the embryos live for considerable periods of time, and, ultimately, may infect other individuals, or those from whom the eggs were passed. There are at least two ways by which these embryos gain entrance into the human body. Some do so by getting into drinking-water and being swallowed; but, extraordinarily, they most frequently penetrate through the skin. When this happens the parasite, in passing through the skin, produces the disease known as “ground-itch.” The vast majority of the victims of this affection are children with whose skin the embryo comes in contact while they go barefooted during the summer months.

Course of the Disease.—Having entered through the skin, the embryos of the hook-worm, moving by a circuitous route finally reach the intestines, and, grasping hold of the mucous membrane with their saw-like teeth, they begin to suck blood and grow until they reach the size of the adult worm in about a month or six weeks. Depending upon the number which have gained entrance, and the susceptibility of the individual, there now begins to develop symptoms of profound anæmia; the skin of the child becomes very pale, and assumes a sort of yellowish hue, and in cases where there is a severe infection, the victim begins to suffer with shortness of breath and dropsy. When this occurs the patient sometimes dies, but more commonly death results from contracting some other disease, which, under ordinary conditions, would produce no serious results. One of the most unfortunate effects of this malady is that when children become infected they cease to grow, and frequently retain the appearance of early youth even after they have reached full maturity in years. These unfortunates are generally incorrectly regarded as dirt-eaters. The symptoms frequently last over a period of many years, as in the intestines of these victims the worms that originally infect them live certainly eight or ten years, and during this period it is beyond question true that additions to the original number are frequently received.

Diagnosis and Treatment.—There is no disease that can be diagnosticated with more ease and certainty; the eggs are present in the feces in great numbers, and by means of a microscope they can always be detected. In all cases where the disease is suspected, a half-teaspoonful of the feces of the person supposed to be infected should be placed in a bottle and sent to a competent microscopist for examination. This is done free of charge at the laboratories of most State Boards of Health in those parts of the country where the malady exists. Whenever an individual shows the symptoms above detailed, an intelligent physician should at once be called. We have medicines that act as specifics, and the disease can always be cured in a very short period of time.

Preventive Measures.—Of course the best method of preventing this disease is to administer to those already infected the proper medicines, and cause the expulsion from the intestines of the worms that lay the eggs.

The indiscriminate scattering of the feces around the stables, so very common in many districts, should be absolutely forbidden. Around the house where individuals have lived who have the disease every care should be taken to prevent contact with the earth in the neighborhood of places where the ground might have become infected. It would be advisable for children and others to wear shoes for at least a year after the last individual having the disease was cured; and as a precautionary measure it should be insisted upon that properly constructed privies or water-closets should be at every house, and that they should be used by everyone in whom there is a possibility that the disease exists.

DIPHTHERIA AND ITS TREATMENT.

Loeffler's discovery in 1884 of the germ of diphtheria, and its relation to the disease of the same name, established the specific infectious nature of this malady, and demonstrated beyond a doubt that membranous croup is not ordinarily an independent affection, but is almost always simply diphtheria of the wind-pipe. The discovery of antitoxin, some time later, reduced the mortality of diphtheria from an average of 30% to 10% in ten years; its use has also shortened the course of the disease, and decreased greatly the frequency of the paralytic conditions that not uncommonly follow this malady.

Character and Course of Diphtheria.—Diphtheria is an affection caused by a bacterial microbe which produces a poison that acts locally upon the tissues invaded, and also, as a result of its introduction into the general circulation, brings about more or less profound effects on the entire system.

The period of incubation is from two to ten days. The onset is generally characterized by a rise of temperature from 100°F. to 104°F., chilliness, headache, and pain in the back and limbs. Albuminuria is common. The glands of the neck often become swollen. In mild attacks a slight sore throat is all that is complained of. In the majority of cases the disease attacks the throat and tonsils, and is characterized locally by the appearance of a membrane, which is usually gray or yellowish-white, elastic, and adheres tightly to the surface upon which it lies. At times, however, the membrane is soft and pliable, and is easily separated from the tissue; such cases are frequently diagnosticated as follicular tonsillitis. A bad cold is occasionally the only symptom of the disease. The diagnosis should always be confirmed by bacteriologic examination. In some instances the wind-pipe is primarily attacked, but when the disease affects this part of the throat it is generally a consequence of the extension of the membrane downward from the region of the tonsils. In the former case the diagnosis is somewhat difficult, as cultures taken from the throat may not show the presence of diphtheria bacilli, though material that is coughed up may contain myriads of the germs; in this phase of the disease interference with respiration is the symptom most to be feared. The mucous membrane of the nose, eyes, ears and generative organs, may be affected. Wounds are also liable to become infected with this organism. In rare instances the membrane may extend down into the bronchial tubes and lungs, and has been found on post-mortem examination covering the inside of the stomach.