Rural Hygiene

by Henry N. Ogden

An interesting experiment was made some years ago by sending a malarial mosquito by mail from Italy to England, where an enthusiast allowed himself to be bitten by the insect. He had had no trace of malaria before, but a week after the mosquito's bite he came down with the disease. It has also been noted that in such parts of the country as Greenland and Alaska, where mosquitoes are as thick as in the far-famed New Jersey marshes, malaria does not result from the mosquito bites unless a malaria patient from other countries starts the infection.

The disease itself may be mild or severe. It takes about a week after the mosquito bites before the symptoms appear, and sometimes the attack is postponed for weeks or months. Chills are the usual accompaniment of the disease; in children under six, convulsions are more common. The chill lasts from a few minutes to an hour, and directly after the chill comes the fever, which lasts three or four hours. The attacks usually occur every other day and sometimes every two days, generally at the same time of day. When persons have lived for a long time in malarial regions, the intermittency of the chill and fever is less noticeable and the continuous character of the fever often leads the disease to be mistaken for typhoid. The intermittent regularity of the fever, however, although between attacks the temperature never falls to normal, distinguishes this type of malarial fever from true typhoid. The positive determination of the disease is possible by an examination of the patient's blood, in which the malarial parasite can readily be found. Quinine is the remedy and the only remedy, and, fortunately, it does no harm, even before the character of the disease is positively known. The chill seems to be due to the development of a new brood of parasites in the blood of the malarial patient, and in order that the quinine shall have its effect on the blood, it must be swallowed three or four hours before the time of the expected chill, and then it will probably prevent, not the next chill but the one after. If the quinine cannot be taken directly with reference to an expected chill, then it must be taken regularly, sometimes for months before the chills cease.

Yellow fever.

Yellow fever, although not common in this country, is interesting as being almost exactly similar in its mode of infection to malaria. It is transmitted through a parasite, as is malaria, and can only be passed along through the agency of another kind of mosquito, known as stegomyia. In 1899 there was a serious outbreak of this pestilence in the cities of our southern coast, and the terrors of the plague of the Middle Ages were revived for a number of months. Trains going out of the infected regions were stopped by crowds armed with guns and the passengers prevented from proceeding, lest the disease might spread. No goods or freight were allowed to pass out from the infected area, and the prejudice against intercourse with the outside world went so far that guards even forbade the carrying of disinfectants to the victims.

Like malaria, the disease is one requiring a hot climate, generally because it is favorable to mosquito growth. It is most common in the seacoast cities of the South, and is probably transmitted often by mosquitoes brought on board ship. Since Havana has been cleaned up by Americans, the danger formerly existing from intercourse with that city has ceased, although only three years ago the writer stopped in a hotel at Havana, where two persons had died of yellow fever a week before. The smell of disinfectants in the hotel was so great that not a fly or insect of any sort was visible, and no other hotel in the city could have been safer or more comfortable. It has been proved positively that yellow fever cannot be transmitted by direct contact, since, in the interests of science, volunteers have slept in beds from which the dead from yellow fever had just been removed without contracting the disease. That the infection is due only to mosquitoes is proved by the fact that later, when bitten by mosquitoes, they succumbed to the disease. It requires about two weeks for the disease to pass through its regular stages in the body of the mosquito, so that there is no possibility of its transmission for that time after the mosquito has come in contact with a yellow fever patient.

The symptoms of yellow fever are characteristic and very severe. The eyes first become bloodshot and, in the course of two days, yellow, whence the name of the disease. Severe vomiting is also characteristic, the discharge being sometimes discolored like coffee or even tar and known as black vomit. The skin appears yellow, a condition which lasts for some time and is particularly noticeable if by the pressure of the finger on the skin the blood is made to recede. Among persons previously in good health, the death-rate is about that of typhoid fever, but among those in unfavorable surroundings and among those given to the use of alcohol, the rate will be much higher. Practically, it may be expected that this disease, like malaria, will disappear from the face of the earth. When the only requirement is the destruction of the mosquitoes and when mosquitoes can be so easily killed as already explained, it is only a question of time before mosquitoes and the diseases they cause will be stamped out. In Havana, before 1901, the number of the deaths yearly was about 750. In the year after the American intervention, when Colonel Gorgas, by military command, insisted on the thorough cleaning of the houses and the general use of kerosene in all drains and cesspools, there was not one single death.

Hookworm disease.

The third parasitical disease common in some parts of the United States has received much attention during this last year and is known as the hookworm disease. It is a new discovery in medical science, and whereas the physical condition of the victim is usually a clear indication of the disease, a positive diagnosis is always obtained by the use of the microscope. Several years ago it was announced in the United States that the laziness and shiftlessness of the poor whites living in the sand lands and pine barrens of the South was due, not to any inherent cussedness but to the presence of a parasite in the intestine, known in Italy and Germany as the hookworm, the disease being called Uncinariasis.

The development of the disease is interesting. The worm, which is about an inch long and looks not unlike a bit of thread, lays eggs by the thousand in the intestinal tract of a human victim. Afterwards they pass out in the excreta and, favored by heat and moisture, develop in the soil in about three days into minute larvæ. These larvæ have a most extraordinary power of attaching themselves to and penetrating into the human skin and body. They may also enter the human body in a drink of water or on unwashed vegetables. In infected regions the soil becomes fairly alive with these larvæ, and it is hardly possible for a child to walk barefoot outdoors without becoming infected. When the larvæ have penetrated the hand or foot, they begin a long and circuitous journey through the body, moving from the extremities through the veins to the heart and thence to the lungs. From here they are carried through air cells into the bronchial tubes, thence along the mucous membrane up the windpipe and down into the stomach and finally, from the stomach, they pass out into the intestines, the goal of their long journey.

This all takes time, and probably from the time they enter the skin to the time they begin their murderous work on the lining of the intestines requires about two months. In the intestine the larvæ develop into adults; but before this final stage an intermediate existence is reached, at which time they attach themselves to the mucous lining and bore into it, presumably for the purpose of making a nest in which later to lay their eggs. The burrowing parasite causes a great loss of blood, and it is on account of the resulting anæmia that the poor whites show always such incapacity, indifference, and apparent laziness. That this disease is of importance in considering the hygienic condition of the country is apparent when it is pointed out that in the southern part of the United States, chiefly in the rural districts, there are at least two million persons at present infected with the disease, and that should these hookworms be blotted out of existence, two million incapables would be changed into two million active Americans, ready to raise the southern districts to a commercial elevation which their natural resources seem to justify.