PREVENTION 265 



tation workers on our sugar and cotton plantations and on the 

 coffee plantations of Central and South America, and the coolies 

 working on the estates of China, India and other tropical coun- 

 tries, practically never wear shoes. The necessity for shoes is 

 unknown, the discomfort of using them when the habit of going 

 without them has been long established makes their use difficult 

 to encourage, and there are very few who could afford such 

 luxuries even if their value were appreciated. As shown above, 

 the hookworm larvae in soil or water commonly gain access to their 

 hosts through bare feet. The readiness with which infection may 

 occur by contact with contaminated ground or water is shown by 

 the case of a prominent American in Porto Rico who became 

 infected by removing his boots and wading in a small pool. 

 Kneeling bare-kneed or resting the bare hands on the moist 

 ground beside a stream or pool to drink; drinking water which 

 has been directly or indirectly polluted; dirt-eating, which is a 

 common perversion of the appetite in intestinally diseased people; 

 eating with soiled or dirty hands; the chewing of dirty finger- 

 nails; in all these and a hundred other ways the agricultural 

 laborer may become infected. 



Miners, working underground where they are continually in 

 contact with earth, are exposed equally as much as agricultural 

 laborers, and more so in relatively cold countries such as those of 

 central Europe, since the warmth resulting from subterranean 

 location allows the parasites to thrive where on the surface they 

 would perish. Dirty hands, unsanitary habits and polluted 

 water are the cause of the high percentage of hookworm infection 

 in mines where no special preventive measures are practiced. 



Sanitation. — Prevention of hookworm disease, were it not 

 for the inevitable ignorance and stupidity of many of the people 

 to be dealt with, would be a relatively easy matter. The com- 

 parative ease with which infections can be discovered, the read- 

 iness with which the parasites, once discovered, can be expelled, 

 and the ease with which heavy infection, even in badly infested 

 countries, can be prevented by cleanliness, sanitation and care 

 of exposed parts of the body are factors which should make the 

 hookworm relatively easy prey for the hygienic reformer. But 

 the hookworm has a valiant ally in the stunted brain and will of 

 its victim and in the unsanitary habits, established by countless 

 generations, which characterize the natives of almost every hook- 



