It is one of the oldest diseases recorded in history. The Ebers papyrus, dating back to 1500 B.C., speaks of “worms in the abdomen” and makes the hieroglyphic guess that the trouble was caused by “much handling of sand.” It is more likely that the infection came from the sacred scarab, a creature so unclean that it is commonly called the “dung beetle.” Moses said to his wanderers in the wilderness, “And thou shalt have a paddle upon thy weapon; and it shall be, when thou wilt ease thyself abroad, thou shalt dig therewith, and shalt turn back and cover that which cometh from thee.” Without that wise precaution against the infesting parasite, the Children of Israel might never have seen their Promised Land.
The Greeks probably had a name for it; ages later an Italian doctor called it Ankylostoma, which is fairly good Greek for “hookmouth.” Caesar’s legions carried it from Africa into Italy. In 1838 Dr. Dubini of Milan found 105 infected post mortems, and a year later it was discovered that Italian laborers had conveyed hookworm into the Alps. Australia got her dose of it when she imported Orientals and Islanders to work her plantations.
Hookworm and his wife came to America with Africa’s compliments to slavery. No worm travels far on its own belly; it is the human belly, to mix a metaphor, that gives wings to the pest. During the Spanish American War Colonel Bailey K. Ashford of our Medical Corps studied “coffee picker’s anemia” in Puerto Rico; he segregated the hookworm in these cases and wired the news to Dr. Charles W. Stiles of the United States Health Service. Stiles became our pioneer investigator in the South, something of a martyr to science. He called this variety of worm Necator americanus (American murderer), although he might more properly have named it Necator africanus. The Negro’s habitation of our soil could be proved by the infection he has left behind, even though the race should disappear. Scientific investigators like Darling have studied hookworm—content to trace great racial migrations.
Investigation and treatment of the hookworm disease is no job for a florist. Much of the work has to do with microscopic examination of human excreta. But the physician is a realist, and every function of the body has, for him, the equal rights of a true democracy.
Here is the life cycle of this dreadful little bloodsucker: Its eggs cannot hatch in the intestine, where the hungry mother clings and lays them by thousands. They must pass out with the bowel movement and lie exposed to moist, warm, shady air; under these conditions, they hatch in from twenty-four to thirty-six hours, and begin their progress as tiny larvae in search of human flesh. They infest the soil for several feet around the filth in which they have incubated. Enterprising ones crawl up weeds and will even bore their way into ankles under thin stockings.
Once inside the skin the embryo finds the blood stream and makes its long pilgrimage—through the heart, through the lungs, up the throat; then down into its destined home, the upper intestine, where it fastens its teeth and grows by what it feeds on, human blood. On one drop of blood a day it grows almost to the size of a pin and develops jaws as steely strong as wire-cutters. Multiply these blood-drops by a hundred, by a thousand, and watch the pale anemia that lays the sufferer open to the first epidemic that comes along.
In infected districts the health physician’s job was routine diagnosis and routine treatment. When we had to treat and survey whole villages and tribes within a limited time we gathered as many as we could into an audience and lectured them in whatever language they happened to speak. After the lecture we would hand them out small tin containers, each marked with a person’s name. We told them carefully how to put a small portion of each individual’s next bowel movement into the tin with his name. We urged that all tins be returned next morning. These specimens we usually examined by the “Willis salt flotation” method. This routine was invented by a brilliant young Dr. Willis, an Australian whom I broke in during the campaign in 1919. In the Willis test a specimen of excreta the size of a small filbert is mixed in a tin container with saturated salt solution. The solution comes level with the top of the container, and a glass slide is laid over it. The eggs concentrate by floating to the surface and are lifted with the salt solution when the glass is raised. Under the microscope the floating eggs can be seen. When the Willis test proved positive the patients were set aside for treatment—if we had the time and the drugs to finish the job. Those were the days of “the awful oil of chenopodium,” as it was often called. It was regarded as a specific; it was relatively ineffective, and dangerous to use with large groups. I shall go into that later.
Much of the work planned for Papua was the making of “surveys,” which means a medical census of vast areas as remote from our usual earthly experience as so many lunar landscapes. Perhaps I am running a little ahead of my story and putting too much stress on ankylostomiasis, the hookworm disease. Our later work carried us into investigations of every tropical malady, from ringworm to leprosy.
At last Papua and novel adventures lay ahead of me, if we ever got there. The Morinda was poking her distracted snub nose into blue water, doing her darnedest. It was Sunday morning and our skipper was an old-fashioned practical joker. Captain Teddy Hillman, brief of bone and round of belly, solemnly invited me to his cabin to hear his phonograph play “Shall We Gather at the River?” Sadly he asked me how I liked it, and when I said, “Fine, you old so-and-so,” it was somehow the perfect reply, for he spatted my knee and crowed, “Then we’ll make you a member of the Gin Club!” Gin Club initiates ordered drinks by pushing buttons that had needles concealed in them. The drinks came in the sort of glasses you order at trick-stores; lift one and it squirts gin over your shirt-front. All very adolescent, but anything went on slow-going junks like the Morinda.
The job ahead was much on my mind. We had been given seven months to cover a Territory which, to a large part, had defied explorers, where the census had been little more than guesswork, where estimates placed a thousand natives for every two Europeans. The inspectors I brought with me were four of the six men I had planned to put in charge of separate surveys or use for laboratory work. They were Australian boys, except Chris Kendrick, a tropics-seasoned Englishman and one of the ablest helpers I have ever sent into the field; with a sort of planned recklessness he used his head so well that he might have gone through hell and brought back the Devil’s hookworms. With few exceptions all my inspectors had that sporting spirit—“Tomorrow, by the living God, we’ll try the game again.” The youngest of the ones who came with me on the Morinda was Bill Tully, only eighteen; the oldest was thirty. A terrific shortage in tropical physicians had made helpers like these an absolute necessity. They had been trained to diagnose and treat a limited number of native diseases and to lead our dark safaris wherever the work called them, from gloomy swamp to savage mountaintop. A man’s job, and they were men.