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REPORT OF THE SANITARY SURVEY COMMISSION.

-of

The West Virginia State Board of Health.

An Intensive Study of the Prevalence of Intestinal Parasites among the Coal Miners of McDowell County.

Professor W. H. Schultz, Ph. D., Messrs. C. 0. Gorby, H. C. Bray, and Wilbur Shirkey.

December 10, 1914.

ACKNOWLEDGMENT.

In making this report, I wish to acknowledge the coöperation of Mr. Edward O'Toole, general superintendent and Mr. Klier, chemist of the U. S. Coal & Coke Company. Mr. O'Toole gave instructions that he would do anything that would aid in the success of our work. Mr. Klier's laboratories were practically turned over to us. Too much praise can not be given a man who lends such able assistance in public work of this kind as did Mr. Klier in aiding as collector and interpreter throughout our stay at Gary.

We wish to acknowledge the intelligent coöperation of, the superintendents of the Bottom Coal Co., Messrs. Sam and Joe Patterson, both of whom aided us in securing data and put at our disposal their offices as headquarters while at Vivian.

Mr. Samuel Evans, general manager at Pageton, and his brother, also rendered valuable service, and took much interest in the work of the commission, as did Mr. W. W. Wood, the superintendent, at Omstead.

We wish also to acknowledge the courteous, and at times helpful Interest of Doctors A. M. Spangler of Pageton, Shanklin of Gary, Stephens and Harrison of Kimbal.

In the seventeen mines that we studied, the bank bosses of each and every one lent us every assistance possible.

W. H. SCHULTZ. Morgantown, W. Va.

Dec. 10, 1914.

Preliminary investigations and incomplete reports of them may easily mislead, and so do considerable injustice to communities or per'sons. In the realm of pure science there are editors who refuse to publish preliminary reports of experiments, maintaining, and with good reason, that it is only completed investigations that yield reliable data. Thus they are helping cultivate in their readers a patience such as is not general, which is born of confidence in the value of thorough and accurate work. The American public is constantly getting the wrong viewpoint, as a result of hasty conclusions obtained from getting the wrong viewpoint, as a result of hasty conclusions got from the press and pseudo-scientific journals. In public health matters, this is signally true. The newspaper is a strong advocate for public health, but its 'copy' is often based upon some ambitious individual's preliminary investigation, and may indeed attract attention to the activities of the investigator, but at the same time unjustly focus the attention of the public upon the health problems of a particular community.

This is practically what was done in West Virginia, when there was given to the public press by some one the result of a very cursory investigation of hook-worm in McDowell county. As a matter of fact there was considerable talk about a subject concerning which no one had any definite information. The notoriety served this purpose; the Governor, members of the Board of Health, and the director of the State Hygienic Laboratory wanted facts, and to this end made possible a scentific study of the problem of sanitation with reference to the parasite, within a limited area of the state. It is the result of this scientific study that I wish to present in the following report.

Method of Precedure. The method of precedure employed by the Commission differs from that employed by many health commissions. It has been a very common practice among public health workers to enter a community and issue a general invitation to those interested to submit to examination. By this, what may for convenience be called the voluntary, method, it is possible to secure a very high percentage of infection; but it neither represents the actual condition of a community nor of a particular class of workers, except in the cases where each and every individual of a community or class volunteers to be examined. This, of course, is seldom the case.

Our méthod, for convenience, may be called the census method. Upon securing the coöperation of a given mining company, it was requested that some responsible employee be sent into the mine with the collector, and a personal interview be held with each and every miner on the pay roll, or that a given number of men be interviewed, representa given section of the mine, as seemed wisest.

The first object was to determine whether or no there was a general infection among the miners, whether this infection was in any way limitspread within the mines. In order to secure these data, special blank forms were printed and each individual interviewed so as to fill out the following card:

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Nationality ............
How long in United States.
How long employed by ....
With whom last employed ....
Name of Asst. Mine Foreman
Name of Section........ ...... Working Place.....
Infected with .......................................

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Age .................. Nationality ......
Town ............................... House No.
Length of Residence at ..
Last Residence .........
Years in School? ...... Weeks per year? ...... Where
Living Conditions ...

111101S ..............................
Sanitary Conditions ....................... Frivy .......
Infected with .........

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As will be seen, inquiry and record was made regarding:

(1) (2) (3) (4) (5) (6) (7)

Name in full (1)
Nationality, province or state reared in
If foreign, length of sojourn in U. S., in West Virginia
Length of time of present employment.
Place of previous employment
Name of foreman to whom at time directly responsible
Exact working place in mine

A small sample bottle was given to the worker, who was requested to collect a fresh sample of his feces for microscope examination. This bottle was numbered to correspond with the serial number on his data card.

At least two microscopic smears were made as follows: Upon a 38x78 mm. glass slide, two drops of water are placed; with a clean tooth pick 10 milligrams of semi-solid feces is rubbed evenly over an area of about 30x70 mm. of the slide. When it is freed from all large grains of sand, coal dust, or vegetable mass, a No. 2 cover slip 25 mm. wide and 50 mm. long is lightly pressed down upon the smear being as free as possible from air bubbles. This should give a slide with particles just close enough to detect any eggs that may lie between the particles. This is called a standard slide or smear. The entire field of this slide is searched under a lense magnifying about 80 diameters, a Spencer mechanical stage being used for moving the slide across the field to insure an examination of every portion of the smear. Along with hookworm eggs and larvae, those of the following parasites were also taken account of; ascaris, lumbricoides, anguillula, oxyuris, strongyloides, taenia solium, taenia saginatta, trichocephalus and unknowns, two of which latter were found. If the individual was infected record was made out upon the reverse of the slip, and the rest left for the local physician to attend to.

The reason for including information that to the layman might appear unnecessary, will readily be obvious by two illustrations that will show how intestinal parasites may be spread.

Prior to the date 1903 hookworm was unknown in England. About this time a British subject enlisted in the army and was sent to India. A large per cent of the laboring class of India is infected with hookworm, and sanitary conditions in many places there are almost ideal for its growth and transmission to others. The soldier became infected and upon his return to England as a private citizen, he obtained work as a coal miner. Soon after the men of that mine showed signs of anemia and a general weakness. This was for some time attributed to lack of proper ventilation. Boycott and Haldane, however, found that the men were, practically all of them, infected with hookworm. The coal dust of the breakways was examined and found to contain numerous larvae in their infecting stage. Even the entries were infected by the men and mules carrying the contaminated coal dust

(1) In many cases it was found that on account of difficult, long names short ones were substituted. In one mine a boss went to the extremity of recording his

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