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122 CHAPTER 5

abound. The inability of victims of this condition
further exacerbate poor economic conditions and
prevent further social development and improvement
of the living conditions in the parts of the world where
the diseases caused by hookworm infection are not
controlled.

History of Hookworm Infections

As is the case for many other parasites, a number of symp-
toms are described in Egyptian literature from a century
ago or more are similar to and could now be attributed
to hookworm infestations. Some ancient physicians de-
scribed conditions as a “derangement” accompanied by
anemia. Over several hundred years, symptoms related
to hookworm infection have been described in medical
documents. In the case of Avicenna, a Persian physi-
cian from the eleventh century, the worm was discovered
in several of his patients and the medical conditions of
these patients were correctly attributed to an infection by
a hookworm.
Several hundred years later, in 1880, after Source: Centers for Disease Control and Prevention (CDC)
Avicenna’s observations, a number of physicians cor-
rectly linked a hookworm infection to the conditions
of diseased mine workers in the European countries
of France; England; Germany; Belgium; and North
Queensland, Australia. These workers, performing their
tasks deep underground, were by nature forced to def-
FIGURE 5-3 Child with hookworm shows visible
ecate inside the lengthy mining tunnels. Many of these
signs of edema, and was diagnosed with anemia
miners were quite poor and wore worn-out shoes that
exposed their feet to the contaminated ground and
pooled water in areas where others had defecated. Prior to the definitive discoveries of hookworm infec-
Almost 20 years later, an epidemic of anemia tions and the signs and symptoms attributed to them
and diarrhea among Italian workers constructing the in the latter decades of the 1880s, the Italian physician
Gotthard Rail Tunnel in Switzerland provided a break- Angelo Dubini was credited with finding the worm dur-
through when it was confirmed that the skin was the ing a postmortem exam of a peasant woman. The details
major route of infection by hookworms. This knowl- of this discovery were published in 1843, and the name
edge, based on observations of those infected and the A. duodenale was no doubt due to the anatomic area of
conditions under which they worked, led to the docu- the body where the worm was found (duodenum). Upon
mentation that described the biological life cycle of the finding numerous samples of these parasites when work-
hookworm. Victims of hookworm infection suffered an ing in Egyptian medical facilities, a German physician
initial skin rash that included signs of iron-deficiency named Theordor Bilharz in 1852 added to the body of
anemia; nausea; abdominal pain; abdominal bloating; knowledge of hookworm infection. Based on samples of
and pica, an abnormal craving for dirt to be ingested these worms obtained during postmortem examinations
(Figure 5-3). (autopsies), he theorized that at least some of the occur-
As is the case in much of medical research, a num- rences of anemia found in the local region could be attrib-
ber of workers have contributed to the body of knowledge uted to hookworm infections. The term used for anemia
for many areas of health, including that of parasitology. was chlorosis, which probably related to iron deficiency