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were found among the people living upon the hill sides in spite of the deep vaults and good structures over them than was found in the low lands, the reason being that those on the hill side had a more unsanitary way of living than the ones in the hollow. On the hill, conditions existed that were simply intolerable. The people themselves were chiefly to blame; but the company was indirectly responsible in that discipline was not introduced which would protect the innocent and punish the offenders. They had also introduced the economical and-unless rightly planned-objectionable practice of building a house large enough to divide into four compartments, with two doors on one side and two on the opposite side. Thus one deep vault answered for four outhouses. The building was so located that four families were supposed to use it. One can imagine what would happen if a house with 10 to 20 foreigners located near by were attacked with an epidemic of diarrhoea. Who, then, could be held responsible for the cleanliness of the outhouse? Aside from the standpoint of economy, the benefits thought by some to be derived from reducing the number of small vaults may indeed be great, providing the lots are so fenced that the outhouse sits at the intersection of the fences—these running up to the middle of each. Then each door ought to be supplied with a lock, and the family be made responsible for keeping it clean. Even this arrangement can hold very grave sociological problems.
· At any rate, the experiment in this community has failed, for even the new structures were in such a condition on the inside that it was unsafe to use them. The colored people blamed the condition upon the Italians; the Italians said each had to go where it was possible, there not being enough closets. If typhoid fever ever gets a start in such a camp, nothing but a miracle can prevent an epidemic. The large number of worm infections is proof of the extensive contamination of the hands and of the food with feces.
The Peerless Coal Company.
There are three main camps, one in the hollow near the railroad, inhabited mostly by white people, one on the hillside inhabited mostly by colored people, and a third opposite the Tide Water Company. This latter, a new camp, is provided with excellent houses and outhouses; everything is nice and clean, the people are apparently well cared for, and are an excellent class of workers. The older camps were very dirty. The deep, long standing vaults lining one of the alleys, because of not having been cleaned, were indescribably offensive. (4) Pigs were either running loose or else kept in pens near by. I am sure that an occasional visit of a public health officer to advise with the proper authorities would greatly help matters. People become so accustomed to such surroundings that individual.complaints are ignored, and as a result everybody suffers.
Miners of the Peerless. In all, 92 men were interviewed and given bottles, 56 of these were returned and 5 or a little less than 9 per
(4) For some reason these deep vaults were cleaned the last week of our stay cent were found to be infected as follows: ascaris, 1; hookworm, 3; tapeworm, 1. (See table III.)
For some reason, the men got the idea that they did not need to return their bottles; the result is that the highest percentage of hookworm was found here, it being 5.2 per cent.
Children of the Peerless. One hundred and seventeen children were interviewed and given bottles. Eighty-five of these were returned; thirty-seven or 43 per cent of them were infected as follows: ascaris, 14; tricocephalus, 18; tapeworm, 2; hookworm, 1. (See table IV.)
Omstead, (The Houston Coal & Coke Co.) Here only the outside living conditions of the people were studied. Bottles were distributed to 111 children; 86 samples were collected. Of these 34 or nearly 40% were infected as follows: Ascaris, 17; tricocephalus, 11; tapeworm, 5; hookworm, 1. (See Table IV.)
The new management has plans on foot for changing the present system of fecal disposal. Certainly the old management is to blame for a system that was without doubt responsible for the last epidemic of typhoid fever. I requested the people to boil the water; one of a family replied, “What's the use? We boiled our water, and had three cases of typhoid.” Without doubt the large number of typhoid cases was not alone due to the use of water from certain springs, but in a large measure to the very bad condition of the outhouses and the ease with which this infected material could be spread over the entire camp.
General Discussion. In all of the data cited, it must be remembered that the figures represent the very lowest possible infection. There were without doubt in those communities where a large percentage of bottles were not returned, persons that were infected. I have in mind cases where special effort was made to secure samples from suspects, but at first all such efforts were in vain. Finally, after having attended one of our illustrated lectures on the subject, these obstinate persons returned samples and were found to be infected; other suspects would not even attend the lectures. They are a class from whom one could get a response only by force.
As has been emphasized, there can be no doubt of the danger of the open outhouse and of its pollution of small creeks and yards. And this grave consideration must not be lost sight of. In any community that is heavily infected with a parasite that reaches the intestine through the mouth, it must naturally follow that bacterial diseases, the germs of which show an equal resistance to drying, sunlight, etc., will go hand in hand with the parasitic disease. · Indeed, one need but study a community intensively to see that, where the percentage of persons having ascaris or trichocephalus is high, the proportion of those who at one time or another have had typhoid fever, dysentery, or other intestinal infections is also high. Hence the presence of intestinal worms may not only be an index of the extent of their prevalence, but also of an absence of a guarantee against other more deadly diseases associated
Figure 7. A good example of some up-to-date sanitary work being done at Gary, W. Va. Note the concrete vault upon which the outhouse on the hillside is to be placed. These vaults when they contain enough water to cover the excreta are nearly odorless. All hook-worm larvae die, and the contents are rendered harmless by the fermentation that takes place. Such outhouses can be placed near the house without being offensive, where a metal tank on tracks can be hauled up; the liquid fecal matter is then pumped into this tank by means of a hand sewerage pump. It is then hauled away to a suitable place.