Rural Hygiene

by Henry N. Ogden

The treatment of the hookworm disease is simple, and the donation by Mr. Rockefeller of $2,000,000 is intended to be sufficient to furnish the opportunity at least for a complete cure of all the cases. It has been found that a small dose of a preparation of thyme known as thymol stupefies the parasites with which it comes in contact, so that they unloose their claws and are set free in the intestine after its use. A dose of epsom salts shortly after clears them out, and except for the loss of blood, the disease is finished. Sometimes, however, in long-continued cases the worms have penetrated so far into the membrane that the use of thymol cannot withdraw them. In fact, in autopsies, it has been found necessary to take tweezers and to use considerable force in order to pull them out.

The prevention of the disease is really the cure of the disease, an apparently simple matter, as already described. An improvement of sanitary conditions so as to make impossible further pollution of the soil should be also undertaken. Wherever the disease has prevailed in this country or in Europe, it has been because of an utter neglect and disregard of what are now known as ordinary sanitary conveniences, and the report of the Country Life Commission, although many charges were made against the conditions of living in different parts of the country, was far from telling the whole story in the matter of the shortcomings in parts of the southern states. There is, therefore, every reason why the farmer and others living in the country should be urged to make themselves comfortable with all known modern sanitary appliances. This is desirable, first, for the sake of others on whom their sins of unhygienic living might be visited, and then for their own sake, because there such sins would also have an effect to a degree tenfold more severe.

Pellagra.

Another disease peculiar to country life, and which has only within the last few years been recognized, is known as pellagra. Not yet is it even known through what agency the disease is transmitted, but it has been beyond question established that in some way corn is responsible for its spread. Apparently, spoiled corn is necessary, and while presumably the corn itself is not the agent, the parasite or organism that is responsible lives only on corn which has been spoiled. Scientists have long worked on the disease, and it would be a merely speculative pursuit, one of interest to scientists and medical men only, except for the fact that within the last few years it has broken out in this country and is increasing to a most alarming degree. The disease itself is almost hopeless when once established, physicians being yet utterly unable to grapple with it; and while in Italy, Spain, and Egypt it has been known for a century, there is still a death-rate of over 60 per cent, and these deaths occur after most horrible suffering and agony.

As in rabies, the parasite, if it is a parasite, acts through a poison which penetrates to the nervous centers, producing mental disturbances culminating in an active insanity. At the same time, the agent attacks the skin, whence its name "pell'agra," which means "rough skin," so that the body appears as if it were affected with a severe attack of eczema, large patches of skin peeling off and leaving the raw surface. In fact, in one of the Illinois hospitals, only a few years ago, some insane persons, infected with this disease, died, and because the effect of the disease on the skin was not known, the nurse in charge was accused of scalding the patients with boiling water, the appearance of the skin being the only proof. The nurse was discharged, although, without doubt, she was innocent, and the appearance of the skin was due solely to the disease. It has been estimated that there are at present in the United States five thousand victims of pellagra, with the number constantly increasing, although physicians of standing make estimates largely in excess of this.

Apparently preventive measures must consist in eliminating the possibility of the use of spoiled corn. Indications are that the disease appears only when such corn has been used, and in parts of Mexico where corn is always roasted before being used, pellagra is never known. It has been described as a disease of the poor, because the disease has flourished chiefly in districts where poverty is so extreme that corn, and spoiled corn at that, is the only food within reach. Usually, where a mixed diet with meat is possible, pellagra never appears. In other places, as in Italy, where the peasants live on a porridge of corn meal cooked in great potfuls, a week's supply at a time, and during the week exposed to dirt and flies and often spoiled before eating, pellagra is most common. Experiments have shown that in these districts, by excluding corn from the diet and furnishing a substantial fare, the disease has been banished. Unfortunately, the taint of the disease passes from parent to child and even to the third and fourth generation, and the physical deformities commonly seen in pellagrous districts are due to this hereditary taint. Dr. Babcock, Superintendent of the City Hospital at Columbia, South Carolina, after discussing the disease, sums up by saying, "Pellagra is a fact, and the United States is facing one of the great sanitary problems of modern times."

Bubonic plague.

The bubonic plague, or "The plague," as the importance of the disease has caused it to be called, is one of the oldest of known epidemics. In the third century it spread through the Roman Empire, destroying in many portions of the country nearly one-half of the people. Its immediate origin is a bacillus causing symptoms similar to blood poisoning, although in some cases, where the lungs are attacked, the disease has some of the characteristics of pneumonia.

A description of this disease is included here because, while bacterial in its nature, it is transmitted largely, if not entirely, by fleas and by a particular species of flea known as the rat flea. These fleas harbor the plague bacilli in their stomachs and inject them into the bodies of those they bite, in the same way that the anopheles or stegomyia mosquito transmits malaria or yellow fever. Elaborate experiments made in India in 1906 show conclusively that close contact of plague-infected animals with healthy animals does not give rise to any epidemic, so long as the passage of fleas from infected to healthy animals is prevented. When opportunity, however, was given for fleas to pass from one animal to another, the bacillus and the disease was generally carried over. It has also been found that while this species of fleas have their normal residence on the body of rats, they will also desert a rat for man, if the infected rat is dying and no healthy rat is in the vicinity to receive them. It is, then, obvious that to eliminate the disease, the most direct and positive course is to destroy the rats which are the home of the disease.

In India, where the plague appeared in 1896, causing about 300 deaths, it rapidly increased in virulence until in 1907 it caused 1,200,000 deaths. The ports of the Pacific coast became much alarmed, and when cases of the disease were actually found in San Francisco in 1906, the matter was so terrifying that the United States Marine Hospital Service was at once instructed to stamp out the disease if possible. This procedure was directed almost entirely against rats. Deposits of garbage on which rats might feed were removed, rat runs and burrows were destroyed and filled in, and stables, granaries, markets, and cellars where rats might abound were made ratproof by means of concrete. Rats were trapped and poisoned by the thousand, nearly a million being thus disposed of. As a result of such thorough work, the plague was stayed, and in 1909 not a single case of the disease among human beings was found, and although 93,558 rats captured were examined, only four cases of rat plague were found.