Hookworm - History

History

The symptoms now attributed to hookworm appear in papyrus papers of ancient Egypt (c. 1500 BC), described as a derangement characterized by anemia. Avicenna, a Persian physician of the 11th century, discovered the worm in several of his patients and related it to their disease. In later times, the condition was noticeably prevalent in the mining industry in England, France, Germany, Belgium, North Queensland and elsewhere.

Italian physician Angelo Dubini was the modern-day discoverer of the worm in 1838 after an autopsy of a peasant woman. Dubini published details in 1843 and identified the species as A. duodenale. Working in the Egyptian medical system in 1852 German physician Theodor Bilharz, drawing upon the work of colleague Wilhelm Griesinger, found these worms during autopsies and went a step further in linking them to local endemic occurrences of chlorosis, which would probably be called iron deficiency anemia today.

A breakthrough came 25 years later following a diarrhea and anemia epidemic that took place among Italian workmen employed on the Gotthard Rail Tunnel. In an 1880 paper, physicians Camillo Bozzolo, Edoardo Perroncito, and Luigi Pagliani correctly hypothesized that hookworm was linked to the fact that workers had to defecate inside the 15 km tunnel, and that many wore worn-out shoes. In 1897, it was established that the skin was the principal avenue of infection and the biological life cycle of the hookworm was clarified. In 1899, American zoologist Charles Wardell Stiles brought this evidence to bear on health issues in the southeast United States, identifying "progressive pernicious anemia" seen in the southern United States was caused by A. duodenale and he also identified the other important hookworm species: U. Necator. Testing in the 1900s revealed very heavy infestations in school-age children. In Puerto Rico, Dr. Bailey K. Ashford, an U.S. Army physician, organized and conducted a parasite treatment campaign, which cured approximately 300,000 persons (one-third of the Puerto Rico population) and reduced the death rate from this anemia by 90 percent during the years 1903–1904.

On October 26, 1909 the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease was organized as a result of a gift of US$1 million from John D. Rockefeller, Sr. The five-year program was a remarkable success and a great contribution to United States public health, instilling public education, medication, field work and modern government health departments in eleven southern states. The hookworm exhibit was a prominent part of the 1910 Mississippi state fair. The program nearly eradicated hookworm and would flourish afterwards with new funding as the Rockefeller Foundation International Health Division.

The RF's hookworm campaign in Mexico showed how science and politics play a role in developing health policies. It brought together government officials, health officials, public health workers, Rockefeller officials and the community. This campaign was launched to eradicate hookworms in Mexico. Although the campaign did not focus on long-term treatments, it did set the terms of the relationship between Mexico and the Rockefeller Foundation. The scientific knowledge behind this campaign helped shaped public health policies, improved public health and built a strong relationship between USA and Mexico.

In the 1920s, hookworm eradication reached the Caribbean and Latin America, where great mortality was reported among Black people in the West Indies towards the end of the 18th century, as well as through descriptions sent from Brazil and various other tropical and sub-tropical regions.

Early treatment relied on the use of Epsom salt to reduce protective mucous, followed by thymol to kill the worms. Later tetrachloroethylene was the leading method. It was not until later in the mid-20th century when new organic drug compounds were developed.