266 HOOKWORMS 



worm-infested country, and for these reasons alone the eradi- 

 cation of the disease has in many cases been a greater stumbling 

 block to medical science than that of even malaria or yellow fever. 

 Mosquitoes are easier to control than are the hopelessly ignorant 

 and stupid victims of hookworm disease! 



The keynote in the prevention and eradication of hookworm 

 disease is the prevention of pollution of the soil, in other words, 

 proper sanitation. Not only the hookworm, but almost all of the 

 true nematode parasites of the human intestine, are the direct 

 outcome of unsanitary conditions. The early stages of develop- 

 ment, so far as is known, are invariably passed in water or moist 

 soil, and for this reason the sanitary disposal of faeces would 

 forever put an end to such of these parasites as are pecuhar to 

 man. The difficulties involved in this simple hygienic principle 

 are infinitely greater than the average civilized and cultured 

 person would suspect. In southern United States, 68 per cent 

 of the rural homes are estimated to be without privies of any kind. 

 In many rural districts where privies do exist, their use is restricted 

 to the women and children or to the family of the manager. 

 In most tropical countries where coolie laborers are employed, 

 practically all of whom carry infection, no attempt is made to 

 provide any kind of place for defecation; not even a simple hole in 

 the ground. The condition in this regard among the " jibaros " 

 or plantation laborers of Porto Rico, for instance, is fairly repre- 

 sented by this case — of 61 hookworm patients at Utuado, 55 

 never had used privies of any kind, and of the six who did oc- 

 casionally use them only two lived in rural districts! The ex- 

 tent to which the unhygienic conditions may go, and the readi- 

 ness with which infection with various intestinal worms may take 

 place, is demonstrated by the occurrence in Brazil of three species 

 of intestinal worms in a baby three months old. 



The time when the value accruing from proper sanitation will 

 be realized to an extent sufficient to make man as careful con- 

 cerning his personal habits as are some of his domestic animals is 

 still in the future; but it is reasonable to hope that it will soon 

 be at hand. It is a significant fact that the domestic cat, which 

 sanitarily covers up its excreta, has, on the average, fewer intesti- 

 nal parasites than the less careful dog. Dr. Stiles has recently 

 tested the effect of sanitation and consequent reduction of in- 

 testinal parasites, both protozoans and worms, by examination of 



