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Figure 8. An excellent example of cooperation between landlord and tenant at Gary, W. Va. Not only is this place beautiful, but it is a yard safe for young children to play in. A yard well sodded and free from pigs is one of the best safeguards against many of the parasites discussed in the text.
ing data: In community (- ) 40% of the children were carriers of intestinal worms (chiefly ascaris and trichocephalus). A canvas of these children and their parents (making 299. persons) showed that at one time or another in their lives 105 of them had had typhoid fever. In that community there were said to have been 70 cases of typhoid in 1912. In another community where only about half of the sample bottles were returned, but that in spite of this showed 25% of the children to be carriers of worms, as a result of open outhouses, an epidemic of typhoid fever broke out in 1912, in which between 20 and 30 persons were involved. These facts are suggestive and support the consideration that a company is only going half way in providing deep well water, if at the same time it furnishes open outhouses, or permits careless use of those with deep vaults. If a community and its management could but realize the danger of improper fecal disposal, its constant menace in producing either a slow, cumulative effect of disease on the one hand, or an epidemic effect on the other, they would consider it a thing to be despised and feared.
The data of Tables I, II, III, and IV, therefore, have considerable significance. The 806 worm carriers are constantly sowing the seed for a new crop of their kind. Among those who have had typhoid, also, there are doubtless numerous carriers. If, therefore, the character of the outhouses is such as to favor the spread of worms, as is evidenced by the 800 out of the 2500 persons examined, it is such as to favor typhoid fever and other intestinal diseases also. The explanation often given me for the cases of typhoid, dysentery, and other intestinal troubles was that of “coarse food.” Coarse food? No, it is not coarse food that is the cause; it is what gets into the food. A saying that is almost proverbial among miners is, that children have a hard row to hoe until they pass the ages of five to eight years, because they have so many intestinal troubles.
It may be asked why hookworm is not more commonly found in these mining communities. There are several reasons. (1) The hill sides are as a rule steep and composed of a stony clay; hence if the fecal matter is washed into the open it dries out, this process being deadly both to the larvae and to the eggs. Where the houses are along sand creek bottoms, however, a careful investigation of this phase of the problem would doubtless reveal a larger number of infections in such locality. (2) Hook-worm larvae do not live long in closets with deep vaults, especially those with water in them. Neither do they live long in shallow ones with a stone or clay margin. Concentrated fecal matter is incompatible with their normal life processes, — the toxic substances developing within it kill them. If, therefore, they cannot find a moist, porous medium relatively free from these toxic substances, they die without reaching a host. (3). Long, cold winters are, of course, an important factor in keeping down the infection, but this is only a secondary consideration, since there is ample time for the spread of hook-worm infection, provided tne infected material is dropped in locations favorable to growth
(4) The low temperature of moist mines and the presence of salts no doubt inhibit the growth of larvae and lessen their motility.
It is doubtful if these factors are the only ones that have been responsible for the absence of epidemics in the mines of West Virginia. When additional data can be obtained to clear up certain points, this will be discussed more in detail in another paper. The system of working out coal areas and then allowing them to cave in, is a very important factor in preventing the spread of intestinal parasites that depend upon a larval stage for completing life history through skin infection.
This, however, is no reason why the problem should be ignored. On the other hand it should be worked out in both rural and mining communities, especially tnose bordering upon certain parts of Virginia from which much of our infection seems to be coming; also where new foreign labor is being introduced into the mines.
Summary. 1. The Commission interviewed 3108 individuals and examined 2507 samples of feces, making in all over 5000 microscopic examinations. Of the total number of samples examined, 1876 were men working within the mines, and 631 were children of these miners.
2. Of the total number of persons examined, 806 or 3% were found to be infected with worms. Of these 8U6, 226 were children and 580 men.
3. The intestinal parasites most common are ascaris, trichocephalus, and tape worm, and a smaller percentage of hook-worm, strongyloides, anguillula, oxyuris, and some undetermined types.
4. Hook-worm among the miners of the 17 different mines studied is not common, nor is it at present of economic importance. By this is meant that none of the miners or children were very heavily infected, none showing severe symptoms of anchylostomiasis. It may, however, become of economic importance under certain conditions mentioned in the text.
5. Some of the children were so heavily infected with ascaris as to be worm sick.
6. The large number of ascaris and trichocephalus infections among the men is doubtless due to contamination of the coal dust of the breakways within the mines, whereas that of the children is primarily due to open vaults, unclean seats and floors of the outhouses, and spread of fecal material by pigs, rodents, and various agencies.
7. A comparison of the number of people infected with ascaris and with tricocephalus with the number that have had typhoid fever, shows that there is a close relation between the two. This is associated with the unsanitary condition of the outhouses. Where the closets are unclean and open, there is a high infection with worms; connected with this there is evidence either of an epidemic of typhoid fever and a prevalence of intestinal troubles, or there is a sporadic type of typhoid that is gradually accumulative and eventually involves large 8. In some mining communities there is a system of keeping in touch with sanitary matters; in others there seems to be none. Even some of the doctors in charge consider this "welfare work”, maintaining that they are paid to cure, and not to prevent, disease.
9. Aside from collecting data, the Commission offered many suggestions while inspecting the miners' yards and out-houses, and at all times that it was possible, criticism was offered concerning the danger of defecating in moist breakways and air passages within the mines; illustrated lectures were given by Professor Schultz in which it was explained how the individual contracts the most common parasites; emphasis was laid upon the dangers from fecal, contamination and its importance in connection with typhoid and with other intestinal diseases; instructions were given to treat the rain-barrels with lamp-oil in order to kill mosquito larvae and so lessen the chance of malaria. In fact the Commission carried on an educational campaign which aroused the interest of all classes in health problems.
1. It is suggested that at present what is most needed is a systematic educational campaign in public health matters. One of the most powerful influences for exciting interest is the delivery of illustrated lectures on subjects which have a direct bearing upon the welfare of the community involved. Nothing was more forcibly brought out in our work than the idea that if the public is to coöperate successfully in public health work, it must be made thoroughly conversant with the problems at issue; the practical value of it all must be made clear.
2. The burden of responsibility for proper sanitation must be laid upon the community, which in turn makes each person within its limits responsible to it. Both must be taught that they owe this to themselves and the state. Nothing can prove wiser from an economic standpoint than to instill into each community a pride in the health, cleanliness, and beauty of its surroundings.
3. The state should provide enough full-time health officers to make periodic inspection of small communities unable to employ full-time public health officials; in this way the smaller communities could yet have the value of expert advice on matters of vital interest to them. (The officers, also, to inspect larger communities.) Commercial concerns noted for efficiency have a system of periodic inspection, which insures an alertness and a degree of order not obtainable in any other way. The army employs the same method. The effect of a similar system, properly managed, would work wonders among colored people and the foreign elements of all communities. This has been proved by our own experience and by the experience of the highest types of coal companies within our state that have a system of inspection of equipment, and in a few instances a sanitation committee, which makes periodic inspections of living conditions in the camps.
4. A local committee for each community, composed of the two most influential miners or their wives, chosen by the miners them