{"id":456,"date":"2019-05-21T14:19:04","date_gmt":"2019-05-21T18:19:04","guid":{"rendered":"http:\/\/sites.miamioh.edu\/hst-journeys\/?p=456"},"modified":"2024-12-09T13:05:27","modified_gmt":"2024-12-09T18:05:27","slug":"medicine-and-disease-in-history-hookworm","status":"publish","type":"post","link":"https:\/\/sites.miamioh.edu\/hst-journeys\/2019\/05\/medicine-and-disease-in-history-hookworm\/","title":{"rendered":"Medicine and Disease in History: Hookworm"},"content":{"rendered":"\n
\"\"

Hookworm treatment at the Chapel Hill School, Alabama 1923 <\/figcaption><\/figure>\n\n\n\n

By Matt Narbutis<\/strong><\/p>\n\n\n\n

Note: Essay 5 in a series, all from Dr. Amanda McVety\u2019s Spring 2019 class on Medicine and Disease in Modern Society <\/p>\n\n\n\n

Imagine yourself as being a child.\nYou are trying to live a normal life, but a mysterious organism inside of you\nregularly manifests both physical and mental problems.  In addition to you, almost half of your\nfriends and family suffer similarly, yet for the most part, no one is even\ntalking about it, let alone trying anything to get rid of it.  You may end up free from this condition, but\nmost likely it will be present with you until your death.  You\u2019re not living in some sort of apocalyptic\ndisease-ridden world, you are one of the millions of Americans that suffered\nfrom Hookworm at the turn of the 19th century. \nThough having Hookworms was rarely fatal, or even significantly\nimpactful on one\u2019s life, the experience of having the parasitic disease in the\n1930\u2019s resulted in physical discomfort and social stigmatization, which were\ntreated by archaic medicines and often vague preventative measures. <\/p>\n\n\n\n

In\nthe 1930\u2019s Ancylostomiasis\nor, as it is still commonly known today, Hookworm, was a disease scientists and\nhealth practitioners fought and researched with regularity.  The disease was known to be an parasitic\ninfection of the body caused by millimeters-long worms.  Throughout the first two decades of the\ntwentieth century, some adamant scientists believed Hookworm infections were\neither caused by the consumption of contaminated meat or passed\nhereditarily.  However, by the 1930\u2019s it\nwas nearly universally accepted that the infection entered the body almost\nexclusively through skin penetration, with rare cases stemming from ingesting\nHookworm contaminated food[1]<\/sup><\/a>.        <\/p>\n\n\n\n

In\nthe 1930\u2019s, the known history of the disease was relatively comprehensive.  The disease was first documented in 1838 when\nan Italian physician performed an autopsy on a peasant woman.  By the mid 1800\u2019s, the disease had been\ndocumented across the world and known cases existed on nearly every\ncontinent.   Hookworm\u2019s origins in the\nUnited States were thought to be in 1902, though the condition had most likely\nbeen in the country for centuries before.  Around the turn of the century, many Americans\nconsidered the disease to be nothing more than a myth.  This line of thinking however, was halted in\nthe 1910\u2019s when various health organizations and the federal government\nrecognized Hookworms to be a prevalent parasitic infection within the\ncountry.  By the 1920s, the disease was\nthought to have disappeared for the most part from the U.S. as a result of\naggressive treatment and public education.[2]<\/sup><\/a>          <\/p>\n\n\n\n

In\nthe United States one group suffered more from the disease than any other:\nrural Southerners.  Hookworm infections\nwere so rampant in the American South that estimates concluded roughly \u201c30\npercent of the rural southern population\u201d[3]<\/sup><\/a> was\nafflicted by the disease.  Among rural\nSoutherners, those who had frequent interaction with soils and sand, such as\nfarmers and children, were most likely to have the condition.        <\/p>\n\n\n\n

The\nphysical experience of having Hookworms was a tedious one.  Those suffering from the infection\nexperienced anemia, sluggishness, \u201cDelayed pilosity, aches, dizziness,\nepigastric tenderness, lassitude, insomnia, constipation, irregular menses,\n<\/p>\n\n\n

[and]<\/p>\n\n\n\n

frigidity.\u201d[4]<\/sup><\/a>  Despite these symptoms, infections were\nrarely lethal with the few actual Hookworm caused deaths primarily a result of\nanemia in children.  This gave rise to\nthe notion among many that Hookworms didn\u2019t necessitate treatment, as it was\nperceived to be an inconvenient condition rather than a possibly\nlife-threatening one.   \n\n<\/p>\n\n\n\n

The\nsocial experiences of having Hookworms were similar to the physical ones: they\nranged from uncomfortable to debilitating. \nThose with Hookworms were stigmatized and often seen as impoverished,\nlow-class, and uneducated due to the disease\u2019s prevalence in the rural southern\nstates.  The children who suffered from\nthis disease were thought to be \u201cdull, apathetic, unable to concentrate\u201d and in\nextreme cases \u201cmentally retarded\u201d due to their infections[5]<\/sup><\/a>.  Those who were afflicted by Hookworms and\nresided in the South generally had easier social experiences than sufferers in\nthe Northern States, who were even more heavily stigmatized.  This notion makes sense give the diseases\nrelatively rare rate of occurrence in the North compared to the South.      <\/p>\n\n\n\n

Unfortunately,\nboth the treatments given to sufferers and the preventative measures taken were\nrelatively archaic in the 1930\u2019s.  Carbon\ntetrachloride, a sweet-smelling, volatile liquid closely related to chloroform,\nwhich had previously  been used primarily\nas an industrial cleaner, was the standard of care in treating Hookworm\ninfections.  Though it was effective in\ntreating patients afflicted by the condition, it could be toxic and cause\ndamage to the nervous system, liver, and kidneys in high dosages.  Another common treatment was Chenopodium, a\nflowering plant that was made into a liquid. \nHowever, those who received this treatment often experienced lethargy\nand the dose had to be administered multiple times before it had any positive\neffect thereby drawing out the side effects[6]<\/sup><\/a>,\nthus making Carbon tetrachloride, which only required one dose, the preferred\nchoice.  The preventive measures that\nwere recommended to combat the spread of the disease were fairly vague.  Among them were \u201cProper disposal of human\nexcreta\u201d and the recommendation to \u201cimplement sanitary measures.\u201d[7]<\/sup><\/a>These\nnon-specific recommendations make sense given the fact that Hookworms had the\npotential to live in nearly any soil or sand, thereby making specific\npreventive measures nearly impossible.                     <\/p>\n\n\n\n

Public\ndiscourse regarding the disease went through a turbulent reform over time.  At the turn of the 19th century, a\npractitioner’s suggestion that a patient had Hookworms often resulted in the\npatient being offended.  This is no\nsurprise given the negative connotations and social stigma the disease\ncarried.  However, generous funding from\nthe Rockefeller foundation for education and treatment of the disease resulted\nin a massive expansion of the discourse and the legitimacy in which people\nspoke of it.  Additionally, through the\nhelp of travelling Hookworm educators, who often spoke at schools, the disease\nwas discussed within communities even more.[8]<\/sup><\/a>             <\/p>\n\n\n\n

In\nthe Southern United States, where the disease was the most prevalent, public\nhealth officials did not enforce specific health requirements for disease as\nthey lacked the resources to do so. \nTrying to implement specific guidelines for how cases of the disease\nwould be reported to public health officials and managed by physicians would\nhave been impossible, due to how frequently the condition presented.   However, in the Northern cities, such as New\nYork City, public health officials enforced much stricter regulations, due to\nHookworm\u2019s lack of prevalence there. \nThose with Hookworms were to be removed from hospitals unless they were\nable to be properly isolated and quarantined, and were prohibited from\nmobilization so that they would not spread the disease.  In addition, physicians attending to cases of\nthe disease had to file official reports noting them or else face heavy\npenalties.  These regulations, combined\nwith the prevailing environmental conditions, helped limit the prevalence of\nHookworms in the North.[9]<\/sup><\/a>     <\/p>\n\n\n\n

Both\nthe 1930\u2019s understandings of Hookworms scientifically and historically were\nquite similar to what they are understood to be today.  The developments and insights made in that\nera laid the foundation for the current research on the condition.   Presently, it is common knowledge that\nHookworms in humans are caused by an infection with the nematode parasites\nNecator americanus and Ancylostoma duodenale that are transmitted through\ncontact with contaminated soil.  The\nworms subsequently migrate to the lungs where productive coughing sends them\ninto the gastrointestinal tract where they can cause intestinal blood loss and\nin some cases, anemia.  Historically\nspeaking, it is now know that in the decades leading up to the 1910\u2019s when\neducation and treatment began to take place Hookworms were, and most likely had\nbeen for decades prior, an epidemic in the American South.  It is also accepted as fact that the\ntreatments of the early 20th century did not nearly eradicate Hookworms as\npreviously thought.  Though much has\nchanged since\nthe 1930\u2019s, for the nearly 700 million people who suffer from Hookworm today\nthe feelings of physical discomfort and social stigmatization they experience\nare akin to those experienced by Americans in the 1930\u2019s.[10]<\/sup><\/a><\/p>\n\n\n\n\n\n

Matt Narbutis is a second year student majoring in History, with a co-major in premedical studies.\u00a0 Outside of class he participates in cell signaling and cancer related research. \u00a0\u00a0 <\/p>\n\n\n\n

Bibliography<\/strong><\/p>\n\n\n\n

“The\nLife-History Of The Hookworm.” The\nBritish Medical Journal <\/em>Vol.1, no. 2670 (1912): 499-500.\nhttp:\/\/www.jstor.org\/stable\/25296276.<\/p>\n\n\n\n

“The Prevention and Cure of\nHookworm.” Scientific American<\/em>\n120, no. 14 (1919): 334-53. http:\/\/www.jstor.org\/stable\/26039277<\/a>.<\/p>\n\n\n\n

Hotez, Peter J., Simon Brooker, Jeffrey\nM. Bethony, Maria Elena Bottazzi, Alex Loukas, and Shuhua Xiao. “Hookworm\ninfection.” New England Journal of\nMedicine<\/em> 351, no. 8 (2004): 799-807.<\/p>\n\n\n\n

New York (N.Y.). Department of\nHealth. \u201cProvisions of the\nSanitary Code of the City of New York and Regulations Relative to Reportable\nDiseases and Conditions and Control of Communicable Diseases.\u201d (1940): 13-42.<\/p>\n\n\n\n

Nicholls, Lucius, and G. G. Hampton.\n“Treatment Of Human Hookworm Infection With Carbon Tetrachloride.” The British Medical Journal<\/em> 2, no. 3209\n(1922): 8-11. http:\/\/www.jstor.org\/stable\/20420412<\/a>.<\/p>\n\n\n\n

Power, Helen J(Jun 2001) History of\nHookworm. In: eLS. John Wiley & Sons Ltd, Chichester. http:\/\/www.els.net\n<\/p>\n\n\n

[doi: 10.1038\/npg.els.0003582]<\/p>\n\n\n\n

Smillie, W. G., and Cassie R. Spencer.\n“Mental retardation in school children infested with hookworms.” Journal of Educational Psychology<\/em> 17,\nno. 5 (1926): 314.<\/p>\n\n\n\n

Stiles, C. W. “Decrease of Hookworm\nDisease in the United States.” Public\nHealth Reports (1896-1970)<\/em> 45, no. 31 (1930): 1763-781.<\/p>\n\n\n\n

Ch. Wardell Stiles. “Some Practical\nConsiderations in Regard to Control of Hookworm Disease in the United States\nunder Present Conditions.” The\nJournal of Parasitology<\/em> 18, no. 3 (1932): 169-72. <\/p>\n\n\n\n

“The Rockefeller Foundation.” The British Medical Journal<\/em> 2, no. 3493\n(1927): 1154-155. http:\/\/www.jstor.org\/stable\/25327296.
<\/p>\n\n\n\n

\n\n\n\n

[1]<\/sup><\/a>Ch. Wardell Stiles. “Some Practical Considerations in Regard to\nControl of Hookworm Disease in the United States under Present\nConditions.” The Journal of\nParasitology<\/em> 18, no. 3 (1932): 80. <\/p>\n\n\n\n

[2]<\/sup><\/a> Stiles, C. W. “Decrease of Hookworm Disease in the United\nStates.” Public Health Reports\n(1896-1970)<\/em> 45, no. 31 (1930): 1763-781. doi:10.2307\/4579737; “The\nLife-History Of The Hookworm.” The\nBritish Medical Journal <\/em>Vol.1, no. 2670 (1912): 499-500; Stiles, CH (1932):\n“Some Practical\nConsiderations in Regard to Control of Hookworm Disease in the United States\nunder Present Conditions.”   <\/p>\n\n\n\n

[3]<\/sup><\/a>Stiles, C. W. “Decrease of Hookworm Disease in the United\nStates.” Public Health Reports\n(1896-1970)<\/em> 45, no. 31 (1930): 1763.<\/p>\n\n\n\n

[4]<\/sup><\/a> Stiles, C. W. (1930): “Decrease of\nHookworm Disease in the United States,” 1770.<\/p>\n\n\n\n

[5]<\/sup><\/a>Smillie, W. G., and Cassie R. Spencer. “Mental retardation in\nschool children infested with hookworms.” Journal of Educational Psychology<\/em> 17, no. 5 (1926): 314.<\/p>\n\n\n\n

[6]<\/sup><\/a>Nicholls, Lucius, and G. G. Hampton. “Treatment Of Human Hookworm\nInfection With Carbon Tetrachloride.” The\nBritish Medical Journal<\/em> 2, no. 3209 (1922): 8-9. <\/p>\n\n\n\n

[7]<\/sup><\/a>“The Prevention and Cure of Hookworm.” Scientific American<\/em> 120, no. 14 (1919): 334.<\/p>\n\n\n\n

[8]<\/sup><\/a> “The Rockefeller Foundation.” The British Medical Journal<\/em> 2, no. 3493\n(1927): 1154.<\/p>\n\n\n\n

[9]<\/sup><\/a>New York\n(N.Y.). Department of Health. \u201cProvisions\nof the Sanitary Code of the City of New York and Regulations Relative to\nReportable Diseases and Conditions and Control of Communicable Diseases.\u201d (1940): 28.<\/p>\n\n\n\n

[10]<\/sup><\/a> Hotez, Peter J., Simon Brooker, Jeffrey\nM. Bethony, Maria Elena Bottazzi, Alex Loukas, and Shuhua Xiao. “Hookworm\ninfection.” New England Journal of\nMedicine<\/em> 351, no. 8 (2004): 799-807; Power, Helen J(Jun 2001) History of\nHookworm. In: eLS. John Wiley & Sons Ltd, Chichester. <\/p>\n","protected":false},"excerpt":{"rendered":"

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