Speaker 1: The smart Alex scientists were not satisfied to declare our
Speaker 1: cow's stumbling symbols of certain death. They declared that hookworms
Speaker 1: were literally gnawing us into the grave. We had never
Speaker 1: heard of Charles Wardour Styles, who had headed a commission
Speaker 1: to eradicate the hookworm, or the writer Walter Hines Page,
Speaker 1: who promoted his efforts, or the Saint Gothard Tunnel in Italy,
Speaker 1: where the dread parasites had caused the death of so
Speaker 1: many of the workers. The crusade against our unseen enemy
Speaker 1: was sprung on us suddenly. In August nineteen twelve, the
Speaker 1: Winston County Journal ran a blood curdling illustration of a
Speaker 1: greatly enlarged female hookworm that resembled a diamond rattlesnake more
Speaker 1: than a worm. We were told the worm had laid
Speaker 1: three thousand eggs a day, but without an explanation of
Speaker 1: who counted them. Alongside the illustration of the voracious monster
Speaker 1: was that of an emaciated boy teetering on the brink
Speaker 1: of the grave. The journal listed times and places when
Speaker 1: a representative of the Rockefeller Sanitary Commission and the Mississippi
Speaker 1: Department of Health would be on hand to gather fecal
Speaker 1: specimens for hookworm tests. I became so frightened at the
Speaker 1: prospect that I was constipated for a week. In the end,
Speaker 1: my test proved negative and I could look forward to
Speaker 1: a healthy existence, provided the scientist did not discover some
Speaker 1: other deadly menace.
Speaker 2: Oh that was really great.
Speaker 1: Isn't that joyous?
Speaker 2: Yeah?
Speaker 1: I love it.
Speaker 2: So terrified I was consummated for a week. I feel
Speaker 2: like I can relate to that.
Speaker 3: I know.
Speaker 1: So that was. That was from a book called My
Speaker 1: Century in History Memoirs by Thomas D. Clark. Hello everyone,
Speaker 1: I'm Aaron.
Speaker 2: Welsh and I'm Erin Almond Updyke and.
Speaker 1: This is this podcast will kill you today.
Speaker 2: We're talking about.
Speaker 1: Worm, which is so exciting.
Speaker 2: It's thrilling. This is our first macro parasite.
Speaker 1: It is. I was thinking like, did we do did
Speaker 1: we know? No, this is it.
Speaker 2: I did the same thing. I was like, well, we
Speaker 2: didn't know. We haven't done any worms.
Speaker 1: And I love worms.
Speaker 2: I know you do. I know they're one of your
Speaker 2: little loves.
Speaker 1: They are one of my little loves, one of my
Speaker 1: many little loves. Okay, So to celebrate the hookworm, the
Speaker 1: glorious hookworm. What are we drinking today?
Speaker 2: Our quarantine today is do poison.
Speaker 1: Oh dw. And it's called that because.
Speaker 2: That was one of its common names. Is that correct?
Speaker 1: It's because you would walk through corning dew, Yeah, and
Speaker 1: then the little larval hookworms would burrow their way into
Speaker 1: you so lovely. So what's in do poison?
Speaker 2: So we've of course got whiskey, preferably bourbon, but you
Speaker 2: could use rye chocolate liqueur, hazelnuts syrup or hazelnut liqueur
Speaker 2: up to you gonuts. Top it with whipped cream, and
Speaker 2: of course dirt in the form of chocolate cookies, and
Speaker 2: the all important vodka soaked gummy worm.
Speaker 1: Yes, booze soaked.
Speaker 2: But don't forget that. We'll post the full recipe for
Speaker 2: our quarantini as well as our non alcoholic Placey Brita,
Speaker 2: on all of our social media channels as well as
Speaker 2: our website.
Speaker 1: That's right cool. Well, now that we've got that really delicious,
Speaker 1: licking drink in our hands, can you tell me about hookworms?
Speaker 1: Tell me all about the biology.
Speaker 2: Absolutely, we'll take a quick break before we get started.
Speaker 1: Just before we dive into the episode, we want to
Speaker 1: let you know that we have a very special treat
Speaker 1: waiting for you at the end. It's a song specifically
Speaker 1: dedicated to parasites, and you're going to love it. So
Speaker 1: if you usually tune out right as we start listing
Speaker 1: our sources, do yourself a favor and keep listening until
Speaker 1: the very end.
Speaker 2: Let's get into the biology. So hookworm. The way that
Speaker 2: you get infected with a hookworm is when, like you said,
Speaker 2: the baby larvae drill their way into your skin.
Speaker 1: It's so cool, it's so cool.
Speaker 2: And this most commonly happens when you're walking barefoot across
Speaker 2: soil or grass or leaf litter that's just teeming with
Speaker 2: tiny baby larval worms. Although it is possible to get
Speaker 2: infected in other parts of your body. So if you're
Speaker 2: digging in the soil, you can get infected in your hands,
Speaker 2: taking a nap in the grass. Why not anywhere in
Speaker 2: your body? Why not? And there are two main species
Speaker 2: of hookworm that infect humans, Nicator americanis and ant Cyclostoma duadinale.
Speaker 2: In the case of ant cyclostoma, you can also get
Speaker 2: infected by ingesting the worms, eating.
Speaker 1: Them, ingesting the larval Yes, the.
Speaker 2: Larval worms, right, yeah, weird, right, But that's all I'm
Speaker 2: gonna say about that, because like, no one talks about it.
Speaker 2: It's just a thing that exists. Okay, So let's go
Speaker 2: over the life cycle of how these worms get to
Speaker 2: the point where they're going to infect you, because it's
Speaker 2: so cool, it's nice.
Speaker 1: So much, but it's one of my favorites.
Speaker 2: Okay. So it all starts, of course, as it almost
Speaker 2: always does, with an egg, just a little unassuming egg chillin'
Speaker 2: in some soil. About twenty four hours after it pops
Speaker 2: into the soil, it'll hatch into a tiny, little L
Speaker 2: one larval worm, which will just scoot along its way
Speaker 2: for like a week until it grows big enough to
Speaker 2: molt again. Now we call it L two. It's not
Speaker 2: gonna hurt anyone. It's just a worm in the soil
Speaker 2: doing wormy things. But then once that gets big and
Speaker 2: strong enough, it'll molt one more time into an L
Speaker 2: three larva. This is strong enough to slither? Do you
Speaker 2: say slither for a worm? Sure to slither its way
Speaker 2: up to the top of some grass or some leaf litter,
Speaker 2: and wait for your foot.
Speaker 1: How big is this L three?
Speaker 2: Very very small? I know how big the adults are,
Speaker 2: and this is smaller than the adult.
Speaker 1: Oh, like, could you see it?
Speaker 2: Yes, you can see it.
Speaker 1: Is it like bigger or smaller than a nymphle tick?
Speaker 2: Bigger?
Speaker 1: Okay? Yeah?
Speaker 2: So the adults are between five and thirteen millimeters. Okay,
Speaker 2: So I don't know exactly how much smaller the L
Speaker 2: three larva are. I didn't see that in my research,
Speaker 2: but I presume they're smaller but definitely still visible as
Speaker 2: far as I can tell.
Speaker 1: How are they growing? Where are they getting the energy
Speaker 1: to grow?
Speaker 2: So they eat microbes in the soil. Oh yeah, so
Speaker 2: when they hatch out of an egg, they'll eat little microbes,
Speaker 2: but they're not hurting anybody. They're just like chill and
Speaker 2: eating microbes, like living in the soil like normal worms.
Speaker 2: But then once they get to this L three stage,
Speaker 2: they're like, now I'm ready for the big kid meal,
Speaker 2: and that is human flesh and blood. So this L
Speaker 2: three larva waiting on top of the grass for you. You
Speaker 2: come along, I don't know, Just out for a walk
Speaker 2: in the woods without your shoes on, because of course
Speaker 2: why not. The grass feels great between your toes, and
Speaker 2: this little larva burrows its way into your foot, goes
Speaker 2: straight for your blood stream, travels through your blood stream
Speaker 2: back to your heart where all your blood goes out
Speaker 2: of your heart and into your lungs. Yep. Once it's
Speaker 2: once it's in the capillaries of your lungs, it'll bust
Speaker 2: its way out into your alveoli, which are the air
Speaker 2: sacks where gas exchange actually happens. So it literally bursts
Speaker 2: out of your blood vessels into the air sacks of
Speaker 2: your lungs, and then it swims its way up your bronchials,
Speaker 2: through your bronchi all the way to your trachea, to
Speaker 2: the top of your trachea, which is called the epiglottis.
Speaker 2: That's the flap that normally makes it so you don't
Speaker 2: swallow your food into your lungs. Maybe gives you a
Speaker 2: little tickle right there and maybe you just a little
Speaker 2: and then it's gonna pop up and over that epiglottis
Speaker 2: and down back into your esophagus. It's gonna travel all
Speaker 2: the way down your esophagus, through your stomach and into
Speaker 2: your small intestine.
Speaker 1: And it's like, hmm, I'm home.
Speaker 2: I'm finally home. It'll molt into an adult worm at
Speaker 2: this stage and then it attaches do you want to
Speaker 2: know how it does this.
Speaker 1: Yeah, it has.
Speaker 2: These two hook things, that's why they're called hookworms, and
Speaker 2: they basically gouge their way into your mucosa or in
Speaker 2: some cases, all the way through to your submucosa, which
Speaker 2: is like through an entire layer of flesh inside of
Speaker 2: your intestine, and they attach in there and they mate,
Speaker 2: So you have to do you do have to have
Speaker 2: at least two worms for them to be successful. They
Speaker 2: mate and then they start laying eggs, and then you
Speaker 2: poop out those eggs. They find their way back to
Speaker 2: the soil and the beautiful cycle of hookworm life begins. Anew,
Speaker 2: isn't that gorgeous?
Speaker 1: It's just I still still even after reading about this
Speaker 1: cycle and being amazed. I'm amazed every single time that
Speaker 1: it will go up through your heart into your lungs.
Speaker 1: You cough it up, you swall, I can't. It's incredible.
Speaker 2: It's so complicated, it's inspiring. Yeah, you should all seek
Speaker 2: to have a what is journey?
Speaker 1: You succeed in a journey such as that.
Speaker 2: So that whole process from initial penetration of your foot
Speaker 2: until egg laying adult takes between five and nine weeks,
Speaker 2: so it's a pretty long process. Okay, so let's talk
Speaker 2: about what's happening in your body. Do you even know
Speaker 2: you're infected? You already mentioned one of the first symptoms
Speaker 2: that you might get, which is groundedge, and so that's
Speaker 2: something that can happen at that initial site of penetration
Speaker 2: where you just have kind of an allergic reaction. You
Speaker 2: get itching, you get redness right from where the site
Speaker 2: where the worm's burrowed in. That's your first hint that
Speaker 2: something might be a miss.
Speaker 1: Okay, anytime that any of you have an itchy foot.
Speaker 2: But it's probably it's probably not a hook.
Speaker 1: But that's what you're all thinking, isn't it.
Speaker 2: It could also be totally asymptomatic, and in a lot
Speaker 2: of cases, hookworm infection is almost entirely asymptomatic, and we'll
Speaker 2: talk about when it is versus when it isn't. So,
Speaker 2: once you get past the grounditch, the worm is just
Speaker 2: swimming through your circulatory system and it makes its way
Speaker 2: to your lungs and since it's bursting out of your
Speaker 2: capillaries and busting its way into your LVLI, you can
Speaker 2: imagine that might cause some damage in your lungs. Yeah,
Speaker 2: so you might get some cough, you might get numinitis,
Speaker 2: which just means inflammation in your lungs, and that's just
Speaker 2: a result of mostly a result directly of the worm's
Speaker 2: causing damage, but it also can be from the immune
Speaker 2: response that you mount in response to the damage that
Speaker 2: the worms cause. And then as they make their way
Speaker 2: into your gut, you might have some minor diarrhea, some
Speaker 2: intestinal upset. But if you just have a few worms,
Speaker 2: you might not ever know it because just a few worms,
Speaker 2: these are small, They're not doing a ton of damage.
Speaker 1: NBD. The last one happens to die and you poop
Speaker 1: it out and you see it in your poop.
Speaker 2: Well, I mean, is that that's going to do you
Speaker 2: some psychological damage? Maybe? You mean?
Speaker 1: Sure? It's sort of like if you see one cockroach,
Speaker 1: you know that there are thousands more in your walls.
Speaker 2: Yeah.
Speaker 1: Is it the same with hookworms and intestinal walls?
Speaker 2: Uh? No, I think if you had thousands of hookworms
Speaker 2: in your walls, you'd know it.
Speaker 1: They'd be tens what's the scale at which which we
Speaker 1: start to see infestation?
Speaker 2: Because let's talk about it. So the problem here is
Speaker 2: that because the worms in your gut can produce if
Speaker 2: we're talking about nicatamorus nine to ten thousand eggs a day.
Speaker 2: If we're talking about an Cyclostoma duodenale, we're up to
Speaker 2: thirty thousand eggs per day.
Speaker 1: So it's incredible.
Speaker 2: It's incredible. And these worms are not reproducing in your body,
Speaker 2: so you're not going to get multiple worms from just
Speaker 2: two worms. They're not going to reproduce adult worms in
Speaker 2: your body. However, if you're being constantly exposed to soil
Speaker 2: that's contaminated with human feces and humans are pooping out
Speaker 2: nine to thirty thousand eggs per day, you can end
Speaker 2: up with an extremely high parasite burden. And the reason
Speaker 2: that that's problematic is because when the adult worms use
Speaker 2: their little hooks and they cut their way into your mucosa,
Speaker 2: they use negative pressure, they contract their esophagus to suck
Speaker 2: out your blood, and they use both their physical sucking
Speaker 2: and biting as well as hydrolytic enzymes to burst open
Speaker 2: your capillaries and arterials, suck out a plug of your
Speaker 2: tissue into their open mouth, anti coagulate the crap out
Speaker 2: of you so that you don't stop bleeding, and then
Speaker 2: they're drinking your blood.
Speaker 1: Oh, boy so, and there are species differences between the
Speaker 1: amount of blood that they take as well.
Speaker 2: Yeah, so the smaller worms which are in the cater
Speaker 2: americanas take between like, they take much less blood than
Speaker 2: ant Cyclostoma do adon alle. Even a douadon alley would
Speaker 2: only take a maximum of about zero point three milliliters
Speaker 2: of blood per day, which isn't a lot, right, that's
Speaker 2: point three mills. That's basically nothing. However, I did some math,
Speaker 2: because you know, whenever we start talking numbers, I'm going
Speaker 2: to do some math. The human body has five liters
Speaker 2: of blood. Okay, on average, your red blood cells reproduce
Speaker 2: in one hundred and twenty days, So we can assume
Speaker 2: that your blood volume replaces itself every one hundred and
Speaker 2: twenty days. So if you back calculate, you're making on average,
Speaker 2: about forty five milliliters of blood every day. That's how
Speaker 2: much new blood your body is producing every day. So
Speaker 2: if you have just one worm and you're losing zero
Speaker 2: point three mills of blood per day, no big deal.
Speaker 2: But once you get to let's say one hundred worms,
Speaker 2: that's thirty mils of blood loss per day. Wow, that's
Speaker 2: almost that's more than half of the blood that you're
Speaker 2: able to make every day.
Speaker 1: That's only one hundred worms. And that's only one hundred worms, right, extreme.
Speaker 2: Yeah, it's not. And so your body, if you are
Speaker 2: losing blood, your body will start to upregulate red blood
Speaker 2: cell production. That's that's what your body does. If something happens,
Speaker 2: it will respond. That's why if you give blood and
Speaker 2: you lose a pint, you don't die immediately. Your body's like,
Speaker 2: no problem, We'll use our iron stores and will make
Speaker 2: new red blood cells faster than we normally would. But
Speaker 2: if you're constantly losing thirty or more mills of blood
Speaker 2: per day, eventually those iron stores run out and you
Speaker 2: can't make new blood. You just can't. You don't have
Speaker 2: the materials in your body to actually do it. So
Speaker 2: the biggest thing that we see in people who have
Speaker 2: high worm burdens is iron deficiency anemia. So that's the
Speaker 2: kind of hallmark sign and so much of the sort
Speaker 2: of downstream effects that we see are all due to
Speaker 2: this iron deficiency anemia that just results from blood law itself.
Speaker 1: Wow. Yeah, And you.
Speaker 2: Can start to see this especially depending on who you're
Speaker 2: talking about. So women, if you are a woman of
Speaker 2: reproductive age who has a uterus, you're probably losing blood
Speaker 2: every month, which means that you're already more susceptible to
Speaker 2: iron deficiency anemia. If you are a child, you don't
Speaker 2: have a full five liters of blood, which means you're
Speaker 2: already more susceptible to iron deficiency anemia because you don't
Speaker 2: have as much blood and you don't have as much
Speaker 2: iron stores. You're just a smaller human. It's actually adults
Speaker 2: who have the highest burden of hookworm, which is totally
Speaker 2: the opposite of most other soil transmitted helmets, where you
Speaker 2: see the highest burden in children. And it's thought that
Speaker 2: this is because hookworms are really good at evating our
Speaker 2: immune system, so while other worms you get a high
Speaker 2: burden and then you can eventually clear them with your
Speaker 2: immune system. Not so. So it's just a linear trend
Speaker 2: where you're exposed over your whole life, and the older
Speaker 2: you get, the more worms you have.
Speaker 1: Oh I see, isn't that crazy?
Speaker 2: Yeah huh so, yeah, that's how you end up with
Speaker 2: iron deficiency anemia. That's the biggest issue with hookworm infection,
Speaker 2: and children especially are at really high risk because when
Speaker 2: children suffer from high burdens of hookworm, and they end
Speaker 2: up with iron deficiency anemia. They can also have growth
Speaker 2: retardation and cognitive impairments which are life long, and so overall,
Speaker 2: you can start to see the effects of iron deficiency
Speaker 2: anemia with as few as forty to one hundred and
Speaker 2: sixty worms. That's the range that I found, and it's
Speaker 2: not uncommon to find people with much much higher worm
Speaker 2: burdens than forty two one hundred and sixty worms.
Speaker 3: Yeah, so.
Speaker 2: That's that's hookworm in a nutshell. The good news about
Speaker 2: it is that it is quite treatable. It usually only
Speaker 2: takes a few doses over a few days of anti
Speaker 2: holme ethics albendazol or another benzimittazol if you're interested in
Speaker 2: what you treat it with, and you can pretty much
Speaker 2: get rid of all of them. However, the biggest problem
Speaker 2: is that if you don't address the sanitation issues that
Speaker 2: often are the cause of hookworm infection, then reinfection is
Speaker 2: almost inevitable.
Speaker 1: Right, So, I have a question that's a little bit
Speaker 1: out there. Okay, you mentioned that hookworms are really good
Speaker 1: at evading your immune system. Do they suppress your immune system?
Speaker 1: That's not my out there question.
Speaker 2: So I don't know if they suppress your immune system directly.
Speaker 2: They do, and there's a lot of interesting evidence that
Speaker 2: they modulate your immune system, so they do have big
Speaker 2: effects on changing the way that your immune system responds
Speaker 2: to them. The interconnectedness between the human immune system and
Speaker 2: parasitic worms is so amazing. It's so cool.
Speaker 1: It is because there are ancient enemies and friends at
Speaker 1: the same time. It's incredible, it's so so interesting. But
Speaker 1: so my out there question is, I remember during my
Speaker 1: masters I ran into many different studies on people self
Speaker 1: treating with hookworms, to treat MS, to treat crones, to
Speaker 1: treat ibs and other sort of autoimmune disorders. What's going
Speaker 1: on there?
Speaker 2: So I was I had all of this in the
Speaker 2: current events section, but we can talk about it.
Speaker 1: Now, Okay. I wasn't sure if I was jumping the gun.
Speaker 2: Yeah, so yeah, So this all stems from this idea
Speaker 2: of what's called the hygiene hypothesis, which I think we've
Speaker 2: talked about before on this I don't remember.
Speaker 1: Let's do a refresher anyway, Okay, So a quick refresher.
Speaker 2: The hygiene hypothesis, which is also sometimes called the old
Speaker 2: friends hypothesis, is this idea that the reason that we
Speaker 2: see such high rates of allergies and autoimmune diseases in
Speaker 2: a lot of wealthy nations is because cause we have
Speaker 2: eliminated all of the diseases that we normally are exposed to,
Speaker 2: especially parasitic worms, which our immune system essentially evolved under
Speaker 2: constant attack in in conjunction with like constantly being exposed
Speaker 2: to things like parasitic worms. And so it's the idea
Speaker 2: that our immune system evolved to respond at a baseline
Speaker 2: level assuming that we were always going to be infected
Speaker 2: with something. When you take all of that away, your
Speaker 2: immune system's like, well, what the heck am I going
Speaker 2: to do? Guess I'll start attacking myself. That's the very
Speaker 2: simplified hygiene hypothesis. So people have suggested purposefully infecting people
Speaker 2: with helmets such as hookworms can help to control autoimmune diseases,
Speaker 2: especially gastrointestinal autoimmune diseases like alterative colitis crones celiac disease,
Speaker 2: and also to help control allergies and other autoimmune diseases
Speaker 2: like you said, like MS. So the basic idea is
Speaker 2: that if you give patients a few worms. Not a
Speaker 2: high burden, because we know that's terrible, but just a
Speaker 2: few they'll attach to the gut like they would normally,
Speaker 2: and it induces a certain amount of inflammation, but it
Speaker 2: also modulates your immune system in ways we don't fully understand,
Speaker 2: and this will then reduce the symptoms of these other
Speaker 2: hyper inflammatory autoimmune type diseases.
Speaker 1: And it seems anecdotally to sometimes work, but what are
Speaker 1: the stats on that.
Speaker 2: So there's a really interesting review article. It came out,
Speaker 2: I believe in twenty fifteen. I'll definitely post it on
Speaker 2: our website. It's very mixed results, leaning towards it doesn't
Speaker 2: seem to be working. Okay, So in animal studies it
Speaker 2: definitely works, but in clinical trials it hasn't been successful.
Speaker 2: And so one of the ideas is that maybe you
Speaker 2: need to have been expos to worms before the onset
Speaker 2: of this hyper inflammatory state, which I thought that's super
Speaker 2: interesting that like maybe once you already have crones you
Speaker 2: cannot heal it with a worm, but maybe if you
Speaker 2: had had worms you would be less likely to get
Speaker 2: crones or something like that. So at this point, there
Speaker 2: isn't really a lot of clinical evidence that it works
Speaker 2: at all, but it is still a cool concept and
Speaker 2: there is definitely still research that's being done on it,
Speaker 2: so ah cool. Yeah. So that's pretty much the biology
Speaker 2: and a little bit of the current research just for fun. So, Aaron,
Speaker 2: how do you get to this point? Where did these
Speaker 2: guys come from? Okay, I'll tell you right after we
Speaker 2: sell you more things.
Speaker 1: Though there have been exceptions, like with leprosy and tuberculosis,
Speaker 1: we've mostly been dealing with pathogens that leave no physical
Speaker 1: trace of infection on bones or in fossil form, so
Speaker 1: our search of the history of a pathogen can't really
Speaker 1: extend much beyond the earliest writings. Of course, we can
Speaker 1: make guesses based on the evolutionary history and current geographic distribution,
Speaker 1: but we mostly can't rely on physical specimens to confirm
Speaker 1: those guesses. But here, in dealing with our first lovely
Speaker 1: wormy parasite, suddenly we can start saying words like archaeoparasitologist
Speaker 1: and paleo parasitologist, and my favorite, copro lite, which means
Speaker 1: fossilized poop.
Speaker 2: Oh my gosh, I never thought about how cool that
Speaker 2: is that we'd have so much more evidence because the
Speaker 2: worm eggs are there.
Speaker 1: The worm eggs are there, you can do paleo epidemiology. Oh,
Speaker 1: I got chills. How cool?
Speaker 2: That is amazing?
Speaker 1: Yes, yeah, so these worms they sometimes sometimes rarely, but
Speaker 1: they do sometimes have what it takes to survive the
Speaker 1: extensive fossilization or mummification process. Researchers paleo parasitologists have found
Speaker 1: evidence of fossilized hookworms dating back as far as seventy
Speaker 1: two hundred years before present, so about five thousand BC,
Speaker 1: and there have been other more recent archaeological findings of
Speaker 1: hookworm eggs and fossilized poop or in at least one case,
Speaker 1: adult hookworms in the intestine of a mummy. Whoa, which
Speaker 1: is the species Anceelostoma duadin.
Speaker 2: Alley, which, of course I pronounced wrong. That's cool.
Speaker 1: I don't know how you pronounce it.
Speaker 2: You know what, It's fine.
Speaker 1: It's fine. Someone will let us know maybe. But I'm
Speaker 1: guessing that it's probably not that surprising to you that
Speaker 1: we have this ancient evidence of hookworms. You probably would
Speaker 1: expect this relationship between hookworms and humans to be quite ancient.
Speaker 1: But here's the kicker. Oh, most of these findings come
Speaker 1: from the New World aka North and South America.
Speaker 2: Huh, why is that the kicker, because that's weird.
Speaker 1: Well, it's probably not that it's the majority that is
Speaker 1: found there. That could just be sampling bias. It's that
Speaker 1: they're found there at all.
Speaker 2: That means that people they came over with them, They
Speaker 2: came over and infected exactly.
Speaker 1: But how did that happen? So let's talk for a
Speaker 1: minute about the peopling of the Americas. There are still many,
Speaker 1: many open questions about when in North and South America
Speaker 1: were settled and how people got there. There are a
Speaker 1: couple of things, though, that are generally accepted. One is
Speaker 1: that the people probably came from Asia, and they probably
Speaker 1: arrived over ten thousand years ago, probably even longer like
Speaker 1: fourteen thousand, and you probably learned like I did that
Speaker 1: The most commonly accepted route is overland migration via Boringia,
Speaker 1: which is that piece of land that connected eastern Siberia
Speaker 1: and western Alaska where there's now water, the Bearing Strait.
Speaker 1: Once over the land bridge, they dispersed throughout the two
Speaker 1: continents fairly rapidly. I don't know exactly how rapidly, Not
Speaker 1: like over the course of months, but over the course
Speaker 1: of three weeks.
Speaker 2: Yeah, shoveled all the way down to the tip.
Speaker 1: Okay, but where do hookworms fit into this? Like I said,
Speaker 1: fossilized hookworm egs and mummified hookworm bodies have been found
Speaker 1: in archaeological sites in North and South America pre Columbian,
Speaker 1: indicating that during these early migrations, they brought the parasites
Speaker 1: with them. Right, But this poses a pretty substantial problem
Speaker 1: for hookworms, which require time outside the host in a
Speaker 1: suitable environment in order to develop into larvae and infect
Speaker 1: something new.
Speaker 2: And there they're kind of finicky too.
Speaker 1: Yeah. They're generally restricted to the tropical and temperate zones
Speaker 1: of the earth between I think thirty six degrees north
Speaker 1: and thirty degrees south. Nice latitude.
Speaker 2: That's some deep knowledge there.
Speaker 1: It's the hookworm belt. So they can't establish these more
Speaker 1: northern areas because the climate is too harsh. So how
Speaker 1: then could hookworms have been brought over the Baringia land Bridge.
Speaker 2: Because they're in your body forever, dude.
Speaker 1: Okay, yes, they can live for five to ten years,
Speaker 1: but it's not like this migration took place over five
Speaker 1: to ten years.
Speaker 2: That's true.
Speaker 1: It probably took one hundred of years for people to
Speaker 1: migrate up, over and down, and this would have also
Speaker 1: required that the people who migrated would have had hookroom
Speaker 1: infection in the first place, which if they were living
Speaker 1: far enough north, would not be likely. Basically, this discovery
Speaker 1: of pre Columbian hook rooms and the New World, if
Speaker 1: that is what they are, strongly points towards an alternative
Speaker 1: migration route, such as along the Pacific coast, which is
Speaker 1: not a new hypothesis, stop it. Yeah so, I do
Speaker 1: need to point out that these findings and their implications
Speaker 1: were debated are debated amongst some researchers. In fact, I
Speaker 1: haven't seen so much sniping and shade and just straight
Speaker 1: up insults in scientific articles for a long time. Oh
Speaker 1: it was. I was like, oh, Mike, when's the next
Speaker 1: response coming? Response to fuller response.
Speaker 2: To even more than than the dilution effect debate, A.
Speaker 1: Wait it fell It felt more personal. So but yeah, so.
Speaker 1: The one of the primary opponents of these conclusions doubts
Speaker 1: that the fossils belong to hookworms in the first place,
Speaker 1: since evidence is scarce. There are only a few eggs,
Speaker 1: sometimes one egg in one location, and it's hard to
Speaker 1: tell tiny ova apart when they're in fossilized poop.
Speaker 2: That's true, it's almost impossible.
Speaker 1: And some of these archaeological sites are in locations that
Speaker 1: are inhospitable for hookworm development. So for instance, in a
Speaker 1: very arid region of Peru where there really aren't hookworms now,
Speaker 1: and because the hookworms couldn't live in the very arid sand.
Speaker 2: Could they be animal hookworms.
Speaker 1: So that would point towards the dog hookworm would be
Speaker 1: the most likely. That's the only that's one of the
Speaker 1: only other ones that can infect humans, but it doesn't
Speaker 1: often complete its life cycle.
Speaker 2: I've got stories on those. If you want to talk
Speaker 2: about doghookworm in humans.
Speaker 1: Sure, but I don't know. I think that the point
Speaker 1: is it would require a pretty substantial burden in order
Speaker 1: to be established in a population. And this person also
Speaker 1: doubts that the dating was done correctly and all these
Speaker 1: other things this person also says are also doubts that
Speaker 1: a heavily infested person could have gone on or survived
Speaker 1: an overwater transpecific migration. So ancient DNA analysis could of
Speaker 1: course address all of these or some of these at
Speaker 1: the very least, but these samples are quite precious, and
Speaker 1: the researchers maybe rightly don't want to destroy them for
Speaker 1: a procedure that might not work. Ancient DNA analysis, from
Speaker 1: what I understand, is really hard as low success rates.
Speaker 1: Sometimes it's probably getting better. But however, there's also the
Speaker 1: fact that studies of more modern hookworm distributions somewhat lends
Speaker 1: support to the pre Columbian presence of hookworms in the
Speaker 1: New World as well. So a study of the intestinal
Speaker 1: parasites of an indigenous group and Paraguay found a much
Speaker 1: higher ratio of Antelostoma dwaden alley to Nicator americanus, which
Speaker 1: is the opposite of what was found in settlers of
Speaker 1: European origin and also is the same species that was
Speaker 1: found in the mummy from Peru Okay. So this to
Speaker 1: me is extremely thrilling. Like I find this to be
Speaker 1: mind blowing that you could look at a piece of
Speaker 1: fossilized poop or at a mummy's intestine and say, oh,
Speaker 1: you know what, Humans settled in North America in a
Speaker 1: completely different way than what we have been thinking the
Speaker 1: whole time, or maybe it was an additional route. But
Speaker 1: I also don't know how this is perceived in the
Speaker 1: anthropology community. So if there are any anthropologists or paleontologists
Speaker 1: out there, please let me know. I tried to find
Speaker 1: some current status on on these and like updated articles,
Speaker 1: and I just maybe didn't have the right search terms.
Speaker 1: But yeah, didn't find anything that.
Speaker 2: Is just so so interesting though.
Speaker 1: Isn't that amazing? I love it? Okay, moving on, Okay,
Speaker 1: it wouldn't be an episode of this podcast will kill
Speaker 1: You if I didn't mention ancient ancient Egypt or Greece.
Speaker 2: Yeah, some ancient civilization.
Speaker 1: Pola, ancient something that, yeah, hookroom appears to get a
Speaker 1: shout out in that Ebers Papyrus, which is a collection
Speaker 1: of medical and herbal knowledge from ancient Egypt around fifteen
Speaker 1: fifty BCE. I've mentioned it before on this podcast a
Speaker 1: few times. I don't remember on what In this papyrus,
Speaker 1: there is something called ah ah ah or AAA disease
Speaker 1: that could be describing hook romanemia but might also be
Speaker 1: shist a semiasis. Yeah, And Hippocrates described a condition that
Speaker 1: included the combination of dirt eating geophagi, intestinal distress, and
Speaker 1: a yellowish complexion that could be hookroom infection.
Speaker 2: Yeah.
Speaker 1: There are also a few other random reports from the
Speaker 1: Mediterranean Basin in ancient and early medieval periods that are
Speaker 1: thought to refer to hookroom infection. In any case, we
Speaker 1: can assume that hookworms were not only present throughout human history,
Speaker 1: but most likely pretty abundant. Despite this, and despite their
Speaker 1: size and visibility, I mean, you can see them. Human
Speaker 1: hookworms weren't described until eighteen thirty eight.
Speaker 2: Wow.
Speaker 1: Animal hookwrooms had been known to occur for decades, but
Speaker 1: it wasn't until eighteen thirty eight that an Italian physician
Speaker 1: named Angelo Dubini was dissecting a young cadaver and noticed
Speaker 1: some worms attached to the intestinal wall. He checked them
Speaker 1: out under the scope and realized they were different from roundworms,
Speaker 1: and they had these plates in their mouth end. It
Speaker 1: has a mouth and a butt end. Oh of course, okay,
Speaker 1: that seemed to hook onto the intestinal wall, so he
Speaker 1: named it hookworm. So clever ancleiostoma is how it was
Speaker 1: spelled back then. I yeah, who knows. Other cadavers he
Speaker 1: looked at also appeared to be infested with this hookworm,
Speaker 1: but he didn't believe that they were the cause of
Speaker 1: death in any of these cases. In fact, the hookroom
Speaker 1: didn't outwardly appear to have harmed its human host at
Speaker 1: all except for some inflammation at the site of attachment.
Speaker 1: After this announcement of hookworm discovery, people started finding it everywhere,
Speaker 1: and a few decades after this new parasite was described,
Speaker 1: a trio of Italian scientists connected the adult hookworm to
Speaker 1: the eggs it produceds which appeared in the stool of
Speaker 1: infected people. So then if you had a microscope and
Speaker 1: a willing donor, you could check for hookworm infection to.
Speaker 2: Lock in their poop.
Speaker 1: Yeah, but there was still a lot about hookworms left
Speaker 1: discover like transmission route treatment other species, and linking the
Speaker 1: infestation with disease symptoms because hookworms were discovered sort of incidentally,
Speaker 1: like Dubini wasn't exactly on a quest to find hookworms,
Speaker 1: he just sort of found them. The modern description of
Speaker 1: symptoms came after the discovery of the infectious agent, which
Speaker 1: is not what you're used to seeing what we're used
Speaker 1: to seeing. And one of the tricky things about hookworm
Speaker 1: is that the intensity of symptoms can depend on the
Speaker 1: intensity of infestation, so it can make linking the parasite
Speaker 1: to the disease a little bit more difficult. Anemia, for instance,
Speaker 1: was tentatively linked to hookworm infection early after its discovery.
Speaker 1: But there are a lot of things that could cause anemia,
Speaker 1: one being just poor nutrition, and so it would take
Speaker 1: a substantial event to make that link, and that would
Speaker 1: occur in Italy, which again Italy. I didn't know how
Speaker 1: how much of hookworm history is linked to Italy. In
Speaker 1: eighteen eighty, during an outbreak of anemia and a bunch
Speaker 1: of miners who were working on the Saint Goddard Tunnel
Speaker 1: in the Alps stool inspections of hundreds of miners, which
Speaker 1: aren't you glad you don't have that job. I would
Speaker 1: love that job just looking at poop all.
Speaker 2: Day or not. I bet they were full of full
Speaker 2: of things.
Speaker 1: I'm sure that they were, But you wouldn't get sick
Speaker 1: of looking at poop after a bit. I don't know
Speaker 1: in the smell.
Speaker 2: I mean, it's just a few hundred miners. Just a
Speaker 2: few hundred sounds like a small research study, seems manageable.
Speaker 1: Well, you, if you had been one of these researchers,
Speaker 1: you would have found rampant hookworm infestation. So fun in
Speaker 1: one miner who actually died, over fifteen hundred hookworms were found.
Speaker 1: Oh my gracious, Yeah, fifteen hundred, So I don't know
Speaker 1: the math on that. Wow, in terms of blood.
Speaker 2: Loss, and these are antelostoma, Yeah, okay, so we can
Speaker 2: for the more higher rates of blood loss. Yeah, that's
Speaker 2: three hundred and seventy five mills a day or more.
Speaker 1: Dang dude, that's amazing.
Speaker 2: Wow.
Speaker 1: So the physician who who counted those fifteen hundred hookworm
Speaker 1: basically it was like, Okay, guys, I'm pretty sure that
Speaker 1: hopeworm causes an ethiath, so maybe we should do something
Speaker 1: about this.
Speaker 2: I've got a pretty strong feeling on this one.
Speaker 1: It's kind of a hunch, but it's also pretty pretty certain.
Speaker 1: And so the next year, actually a successful treatment was developed,
Speaker 1: which is super fast. One year later, one year after
Speaker 1: this outbreak. Wow, so the treatment thim al could be
Speaker 1: extremely dangerous. But still that's less than fifty years after
Speaker 1: the first human hookroom infection was described.
Speaker 2: Wow.
Speaker 1: Yeah. But still the question of transmission route remained, and
Speaker 1: I honestly don't know whether it was suspected that hookworm
Speaker 1: and other intestinal worms were transmitted through feces in some
Speaker 1: manner at that time, but the exact details of hookworm
Speaker 1: transmission were uncovered by someone named Arthur Loose. One day
Speaker 1: he was working in the lab and accidentally spilled a
Speaker 1: beaker of water containing hookworm larvae on his hands, like
Speaker 1: you do. Yeah, And he noticed that the spot where
Speaker 1: he had spilled the water burned and turned red and
Speaker 1: was very itchy. So he was like, hmm, I'm gonna
Speaker 1: bet that's hookworm larvae and started checking his poop for
Speaker 1: signs of hookworm eggs, which he found a couple of
Speaker 1: months later.
Speaker 2: Yeah, five to nine weeks.
Speaker 1: Five to nine weeks. And he started telling people about this,
Speaker 1: and people did.
Speaker 2: Not buy it.
Speaker 1: I'm sorry you did what.
Speaker 2: Imagining this guy being like, no, seriously, check my poop.
Speaker 1: I've got these eggs.
Speaker 2: I know it came from when I spilled that water
Speaker 2: on my hand.
Speaker 1: Yeah.
Speaker 2: Oh, this poor guy man, I know, right, poor Arthur
Speaker 2: Arty Artie.
Speaker 1: Yeah. I don't know why. People didn't quite buy it,
Speaker 1: but you know, poor guy. But eventually they had to
Speaker 1: because more testing confirmed not only this percutaneous route, but
Speaker 1: all of the nitty gritty of the entire migratory path
Speaker 1: of that parasite. By the late eighteen hundreds and into
Speaker 1: the early nineteen hundreds, there had been substantial progress made
Speaker 1: on getting a sense of the global distribution of hookworm,
Speaker 1: and on understanding various aspects of hookworm ecology, biology, and pathology.
Speaker 1: But much of the research and awareness was limited to
Speaker 1: Europe and parts of North Africa. The America's really lagged behind,
Speaker 1: and the pair site was largely unknown until well after
Speaker 1: the first treatment was developed. It would take Charles Wardell Styles,
Speaker 1: the discoverer of hookworm in North America, to change that.
Speaker 1: Originally from New York, Styles left the US in the
Speaker 1: late eighteen hundreds to study zoology in Europe. While he
Speaker 1: was there, he spent much of his time in Germany
Speaker 1: learning from the leading medical zoologists and parasitologists of the day,
Speaker 1: and he developed a passion for worms.
Speaker 2: Of course he did, who wouldn't I know.
Speaker 1: Right after he got his doctorate at the age of
Speaker 1: twenty three, oh stop, he returned to the US to
Speaker 1: work at the Department of Agriculture to find ways to
Speaker 1: increase production by decreasing disease. As a European educated scientist,
Speaker 1: he was in super high demand, not only at his
Speaker 1: official job, but also as a part time lecturer. He
Speaker 1: was shocked by how few physicians had ever heard of
Speaker 1: hookworm period He spent a chunk of his lectures describing
Speaker 1: the worm, showing slides of its life stages, and then
Speaker 1: suggesting that if the future doctors at these lectures ever
Speaker 1: come across anemic patients in the tropics or in the South,
Speaker 1: to suspect hookworm. One future doctor that was present at
Speaker 1: one of these lectures, Bailey Ashford, would move to Puerto
Speaker 1: Rico shortly after graduation as an Army surgeon. While there,
Speaker 1: he noticed that a huge number of people, especially among
Speaker 1: the more impoverished agricultural workers, seemed to be anemic, and
Speaker 1: that anemia was a commonly accepted cause of death. He
Speaker 1: was like, what's going on here? What is causing this?
Speaker 1: He tried a protein rich diet and that didn't help.
Speaker 1: Malaria didn't seem to be present in the blood. But
Speaker 1: what about the poop?
Speaker 2: What about the poop?
Speaker 1: The eternal question. Sure enough, he found hookworm eggs in
Speaker 1: their stool. He made his announcement of discovering the cause
Speaker 1: of widespread anemia and Puerto Rico and sent off some
Speaker 1: adult worm specimens, which he assumed to be Antelostoma duadnale
Speaker 1: to styles as a gesture of professional courtesy, though Ashford
Speaker 1: later claimed to have noticed that these worms looked a
Speaker 1: bit different. It was Styles who would formally describe them
Speaker 1: as a new species of human hookworm, giving it the
Speaker 1: name Nicatur Americanus to indicate that it was a new
Speaker 1: world hookworm. Despite this name, the species was found to
Speaker 1: be widespread in Africa, India, and Australia, and probably made
Speaker 1: its way to the Americas during the import of slaves
Speaker 1: from Africa. Seeing how rampant and detrimental hookworm caused anemia
Speaker 1: was in Puerto Rico, Ashford was able to wrestle up
Speaker 1: some funds to start the Anemia Commission of Puerto Rico
Speaker 1: in nineteen oh three, which at that time was the
Speaker 1: first and largest anti hookworm campaign in the world. Who
Speaker 1: and poor Ashford because it seems like everything he did
Speaker 1: was overshadowed by Styles. Both of them deserve credit for
Speaker 1: raising awareness and promoting treatment of hookworm, but Styles gets
Speaker 1: most of the acclaim slash notoriety. Styles really was the
Speaker 1: one who discovered that hookworm was incredibly widespread in the
Speaker 1: Americans house. He was sent there to hunt for hookworm,
Speaker 1: specifically to see how many people were infected and what
Speaker 1: soil or environmental or living conditions seemed most linked with infection.
Speaker 1: In many of the places he went, more than he expected,
Speaker 1: he saw the characteristic symptoms of hookworm infection geophagi, fatigue,
Speaker 1: and a yellowish or greenish hue.
Speaker 2: Do you want to know why people are eating dirt?
Speaker 1: Is it because they're trying they have pika for like
Speaker 1: iron deficiency?
Speaker 2: Yeah, I just thought listeners might like to know that
Speaker 2: if they didn't know that.
Speaker 1: Oh yeah, yeah, Well, and I know that it's not
Speaker 1: necessarily linked to hookworms, Like you can have PIKA without
Speaker 1: having hookworms.
Speaker 2: It's a really common symptom of iron deficiency anemia.
Speaker 1: Not only was hookworm present in the American South, it
Speaker 1: appeared to be one of the most prevalent diseases there.
Speaker 1: In his nineteen oh two report, which was made public,
Speaker 1: he announced quote, there is not the slightest room for
Speaker 1: doubt that unsnariasis is one of the most important diseases
Speaker 1: of the South, especially on farms and plantations in sandy districts,
Speaker 1: and that much of the troubles popularly attributed to dirt
Speaker 1: eating and even some of the proverbial laziness of the
Speaker 1: poorer classes of white populations are manifestations of unsnariasis.
Speaker 2: Unscenariasis is an interesting word for it.
Speaker 1: Yeah yeah. Styles's conclusion was picked up by a journalist
Speaker 1: who wrote the headline that would give hookworm a catchy
Speaker 1: nickname and breed justified resentment across the South quote germ
Speaker 1: of laziness found question mark. Oh yeah, oohh. Immediately the
Speaker 1: story and the phrase spread, leading to many jokes and
Speaker 1: cartoons and poems and satires all about how laziness was
Speaker 1: all because of this worm. Obviously, this was not well
Speaker 1: received by people in the South who were being targeted
Speaker 1: by these jokes and articles and were being told that
Speaker 1: not only are you lazy, right, but you are also
Speaker 1: filthy and riddled with parasites.
Speaker 2: So terrible.
Speaker 1: And there was also the implication that don't worry, those
Speaker 1: parasites are the cause of your laziness, and we all
Speaker 1: knowing doctors know how to get rid of it for
Speaker 1: you so you can be a productive member of society again,
Speaker 1: because you aren't right now right, the hookworm was being
Speaker 1: blamed for the South remaining separate distinct from the rest
Speaker 1: of the US, rather than racism, poverty, and a lack
Speaker 1: of access to education. Hookworm was this easy fix and
Speaker 1: was viewed as a worthy social cause, whereas the more
Speaker 1: entrenched issues such as racism and education were much more
Speaker 1: controversial and would need an entire shift in the way
Speaker 1: things were done for anything to be to become better.
Speaker 1: These headlines and articles painted this picture of the South
Speaker 1: as a filthy, backwards place full of uneducated, lazy people.
Speaker 1: It was hugely damaging, and the stereotype and myth remained
Speaker 1: long after hookworm had disappeared from these places. For all
Speaker 1: of the negative feeling the term germ of laziness fostered,
Speaker 1: it did do one positive thing. It put hookworm on
Speaker 1: the map. People were talking, writing, thinking about this parasite
Speaker 1: that until then had pretty much not been known. And
Speaker 1: so when Styles teamed up with Surgeon General Wyman to
Speaker 1: begin a campaign against hookworms in the South, people at
Speaker 1: least already knew what hookworms were, so they could shut
Speaker 1: the door in Styles's face that much faster. Apparently he
Speaker 1: wasn't the most easy to get along with guy, and
Speaker 1: I would go as far as to say that he
Speaker 1: was often downright condescending and insulting towards rural Southerners.
Speaker 2: Shocking.
Speaker 1: Also, he was pro child labor cool. So great guy overall,
Speaker 1: great guy. I mean he did do a lot by
Speaker 1: way of treatment and promotion, but he was I think
Speaker 1: he just said I know better than you. Anyway. His
Speaker 1: and Wyman's campaign had a too pronged approach. Improved sanitary conditions,
Speaker 1: especially privies, and spread the word about hookworm and offer treatment.
Speaker 1: They weren't super successful with either, but Styles would not
Speaker 1: let the issue drop. He talked on and on about
Speaker 1: hookworm to anyone that would listen, and eventually someone did
Speaker 1: pay attention. And that someone was Frederick T. Gates, who
Speaker 1: was John D. Rockef you know, Mega rich Man, principal
Speaker 1: philanthropic advisor. In nineteen oh nine, with a one million
Speaker 1: dollar budget, the Rockefeller Sanitation Commission began its goal of
Speaker 1: eradicating hookworm disease in the South.
Speaker 2: One million dollars in nineteen oh nine. Yes, that's so much.
Speaker 2: I don't even know how much money that is.
Speaker 1: Yeah, I don't know what the let's look up what the.
Speaker 2: Inflation version is. Yeah, let's see. Wow.
Speaker 1: Okay, so now it's worth twenty seven million, five hundred
Speaker 1: and ninety four thousand, one hundred and seventy five. So
Speaker 1: twenty seven and a half million dollars billion dollars.
Speaker 2: Goodness, gracious, good gravy. Good gravy is right.
Speaker 1: So they had this goal to eradicate hookworm, and Styles
Speaker 1: was like, Uh, that's not going to be possible. You
Speaker 1: have no idea how rampant hookworm is. That's not possible.
Speaker 1: But they tried anyway, and their approach was similar to
Speaker 1: Styles and Wymans. So one aspect was immediate treatment and
Speaker 1: the other was education primarily focus on how you can
Speaker 1: prevent getting hookworm infection. And this was a massive undertaking
Speaker 1: that required the involvement of hundreds of people on the ground.
Speaker 1: The first step was getting a sense of just how
Speaker 1: enormous their task was going to be by conducting prevalence
Speaker 1: surveys were Rockefeller in Styles and the like, blowing it
Speaker 1: out of proportion, probably not. Surveys from the first couple
Speaker 1: of years showed that over ninety percent of counties surveyed
Speaker 1: had hookworm infections, and overall prevalence hovered around forty three percent,
Speaker 1: with some areas experiencing ninety or one hundred percent prevalence
Speaker 1: of Wow, yeah, it was very, very, very prevalent. While
Speaker 1: the states involved in the sanitation Commission never truly accepted
Speaker 1: Rockefeller's support. Eventually, most did come around to accept that
Speaker 1: hookroom was a big problem and that treatment and infrastructure
Speaker 1: changes should be made. And a big part of the
Speaker 1: shift was because the Commission worked directly with state health departments,
Speaker 1: which at that time were pretty dinky and unorganized, and
Speaker 1: so this really kind of helped spur them into motion,
Speaker 1: to have a direction and a focus and to see
Speaker 1: how things worked at different levels. The Commission also hired
Speaker 1: Southern doctors as inspectors and field workers, which also helped
Speaker 1: inspire a level of trust. Interestingly, women played quite a
Speaker 1: large role in the lab side of things, where they
Speaker 1: were hired over medical students to process samples aka look
Speaker 1: at poop. Women were quoted as doing better work, doing
Speaker 1: it faster, and more satisfactory in every way, which included
Speaker 1: costing half as much as the male med students that
Speaker 1: they replaced. Of course, I was like.
Speaker 2: Where is the catch here? Like, what is the real
Speaker 2: reason they're cheaper?
Speaker 1: The money can stretch so far?
Speaker 2: Excellent.
Speaker 1: Kentucky started the trend of hiring women, and apparently Kentucky
Speaker 1: women were so amazing at looking at poop and doing
Speaker 1: their jobs that they were lent out to other states.
Speaker 2: Kentucky women, you need a shirt now, that says Kentucky woman.
Speaker 1: Well, I was just about to say, if we had
Speaker 1: the rights, I would play Neil Diamonds Kentucky woman right now.
Speaker 1: Momentum up for the commission grew, and doctors would travel
Speaker 1: to towns all over the South, carrying with them their microscope,
Speaker 1: glass jars containing hookworm specimens, and plenty of pamphlets. These
Speaker 1: hookworm dispensaries were like old tent revivals. Almost the whole
Speaker 1: town would show up and they some people would bring
Speaker 1: fried chicken, biscuits, boiled eggs, poundcake, peaches, and this is
Speaker 1: those are like I'm quoting that directly from someone who
Speaker 1: was at one of these dispensaries, and they would bring
Speaker 1: a blanket and just spend their whole day watching these
Speaker 1: displays of hookworms. There was also this traveling train car
Speaker 1: that was sort of this interactive exhibit on hookworm where
Speaker 1: you could go and you could do the same sort
Speaker 1: of thing, but it would travel all throughout on the
Speaker 1: railroads of the South.
Speaker 2: That is so cool, Oh cool.
Speaker 1: I don't know if that exists in a museum format today,
Speaker 1: but I would I would love to see that. Yeah.
Speaker 1: Even though the Sanitation Commission had the broad goal of
Speaker 1: eradicating hookworm in the South, what that meant in practice
Speaker 1: was treating white communities for hookworm infection. Many people, including
Speaker 1: politicians and scientists, blamed black people for bringing the parasite
Speaker 1: to the South via slave trade, and most of the
Speaker 1: very few campaigns that did actually focus on black communities
Speaker 1: were motivated more by the fear that they were spreading
Speaker 1: hookworm to white communities. The Risevelt Sanitation Commission lasted five
Speaker 1: years only, nineteen oh nine to nineteen fourteen, over which
Speaker 1: time seven hundred thousand people were treated for hookworm infection,
Speaker 1: which is quite a feat, but barely any long term
Speaker 1: changes were made that would have any lasting impact on
Speaker 1: the prevalence of hookworm in the South. The Commission had
Speaker 1: failed in its stated goal, even though they wouldn't admit that.
Speaker 1: They stopped after that time because I think in part Gates,
Speaker 1: who was the head of the philanthropy division, got bored
Speaker 1: with the issue and recognized that not enough true progress
Speaker 1: was being made. Prevalence was forty three percent at the
Speaker 1: beginning and thirty nine percent at the end, but that
Speaker 1: number would climb up immediately once the Commission left great
Speaker 1: After withdrawing from the South, the Rockefeller Foundation went global
Speaker 1: and they set up programs in China, South and Central America,
Speaker 1: Northern Africa, and many other countries and places. And again,
Speaker 1: even though the dispensaries were popular and many thousands or
Speaker 1: millions of people were treated, there was no permanent change
Speaker 1: in hookworm prevalence because the underlying causes were still there.
Speaker 1: In the southern US, hookworm did eventually mostly disappeared due
Speaker 1: to things like indoor plumbing, cheap and healthy foods, mechanized agriculture,
Speaker 1: but it was still prevalent well into the sixties and seventies,
Speaker 1: and in so many other places of the world it
Speaker 1: hasn't shrunk one bit. And I focused only on the
Speaker 1: US because the story of the Rockefeller Foundation is so
Speaker 1: important in terms of the development of global health initiatives
Speaker 1: and programs. But while that was going on, while people
Speaker 1: were being treated in the American South, many people all
Speaker 1: around the world had still had hookroom infection and it
Speaker 1: was still prevalent. Hookrooms are not germs of laziness, but
Speaker 1: they do perpetuate the cycle of poverty, which is only
Speaker 1: possible to break by changing infrastructure to promote access to
Speaker 1: clean water and improve sanitation. Erin, I know you've probably
Speaker 1: got some jaw dropping numbers for the EPI, So tell
Speaker 1: me where do we stand with hookroom today.
Speaker 2: I can't wait to do that after a quick break.
Speaker 2: You're so right Erin, I have some jaw dropping numbers
Speaker 2: for you.
Speaker 1: Good.
Speaker 2: So it's actually a little bit hard to get numbers
Speaker 2: directly from the World Health Organization on hookworm itself, and
Speaker 2: that's because the World Health Organization addresses hookworm in combination
Speaker 2: with several other diseases which all share this heading of
Speaker 2: soil transmitted helminth infections. So if you look at all
Speaker 2: soil transmitted helmets, we are talking about an estimated one
Speaker 2: point five billion people currently infected.
Speaker 1: That is twenty percent twenty percent.
Speaker 2: Yeah, and again this is all soil transmitted helmets, and
Speaker 2: for most other soil transmitted helminth infections, soil transmitted worms.
Speaker 2: That's what helminth means. It's primarily a disease of children,
Speaker 2: not so with hookworm. Hookworm infections just seem to get
Speaker 2: worse as you get older, and actually adult males tend
Speaker 2: to have the highest of infection, and that's likely due
Speaker 2: to occupational exposures. So especially in certain occupations like you
Speaker 2: said miners, miners are still at really high risk. Also,
Speaker 2: people who work in the tea industry, so picking tea
Speaker 2: or in other agricultural industries are at They tend to
Speaker 2: have the highest burdens of hookworm infection. So the World
Speaker 2: Health Organization has a lot of initiatives to help deal
Speaker 2: with soil transmitted helmets, but they mostly focus on the
Speaker 2: periodic treatment of preschool and school aged children, and they
Speaker 2: say also women of child bearing age and adults in
Speaker 2: certain high risk professions in endemic areas, they recommend periodic
Speaker 2: deworming treatment once a year if the baseline prevalence in
Speaker 2: that community is over twenty percent, and twice a year
Speaker 2: if the baseline prevalence is over fifty percent. The problem,
Speaker 2: which we've already talked about, is that you have to
Speaker 2: combine these deworming treatments with both health and hygiene education,
Speaker 2: but mostly with sanitation infrastructure, right, and the sanitation infrastructure
Speaker 2: is the most difficult part to accomplish, and it's most
Speaker 2: often not accomplished. So while they have done tons of
Speaker 2: deworming every year for a number of years. In twenty sixteen,
Speaker 2: they treated over three hundred and eighty five million school
Speaker 2: aged children with anti helminth thicks. That's sixty eight percent
Speaker 2: of all children who are at risk sixty eight percent.
Speaker 2: So that's pretty good. Is treatment free?
Speaker 1: Yes?
Speaker 2: So treatment is donated by WHO to the health ministries
Speaker 2: in each of these countries, and then they're administered through
Speaker 2: the health ministries.
Speaker 1: Okay.
Speaker 2: Their current goal is to quote eliminate morbidity due to
Speaker 2: soil transmitted helmets in children by twenty twenty, so they're
Speaker 2: one year out. I have a feeling they're not going
Speaker 2: to make it.
Speaker 1: Just to to clarify the distinction between morbidity and mortality
Speaker 1: and what exactly a dally.
Speaker 2: Yeah, So I actually have some better numbers from a
Speaker 2: twenty sixteen review that's about hookworm specifically. So it's estimated
Speaker 2: that if we're just talking about hookworm, probably almost five
Speaker 2: hundred million people are infected, and hookworm infection likely accounts
Speaker 2: for over four million disability adjusted life years, which is
Speaker 2: the measure of disease burden that takes into account the
Speaker 2: number of years lost due to poor health, disability, or
Speaker 2: early death. So we're not only looking at mortality, but
Speaker 2: we're also looking at just the number of years that
Speaker 2: you lose because you're so sick essentially.
Speaker 1: Which it's very easy to look at things like plague
Speaker 1: and smallpox and tuberculosis and go, okay, those are those
Speaker 1: big mortality numbers. But these, with the number of people
Speaker 1: that are infected did this is hugely impactful and I
Speaker 1: think in a way that seems to be more invisible,
Speaker 1: but it shouldn't be.
Speaker 2: Right, it's really problematic. It's also estimated that it causes
Speaker 2: an economic burden of one hundred and thirty nine billion
Speaker 2: dollars every year.
Speaker 1: Wow, what about a vaccine? I know that there was
Speaker 1: some Peter Hotez vaccine initiative.
Speaker 2: Yeah, yeah, that still exists. From what I can tell,
Speaker 2: it doesn't seem to be moving along all that rapidly.
Speaker 2: In twenty thirteen and again in twenty fifteen when they
Speaker 2: published updates, they were still in phase one trials. So
Speaker 2: that's the most that I found about it. If you're
Speaker 2: interested in the specific areas where hookeworm infection is the
Speaker 2: biggest problem and where soil transmitted helmets in general are
Speaker 2: at their highest burden, there's a really cool interactive map
Speaker 2: that the who has that, I'll post on our website
Speaker 2: where you can look at every country and you can
Speaker 2: at least get an idea of the number of school
Speaker 2: age children that they estimate need to be receiving preventive therapy.
Speaker 2: So it's not a perfect estimate because it doesn't include
Speaker 2: adults at all, but I do think it's interesting.
Speaker 1: That's very cool an interactive map.
Speaker 2: Yeah, it's really cool. It's it's very interesting. But in
Speaker 2: twenty seventeen, a paper came out that got some popular
Speaker 2: press that it's a very very small sample size, but
Speaker 2: they did a survey in Alabama in a county that
Speaker 2: is one of the poorest in the entire state, that
Speaker 2: has over thirty percent of the population live under the
Speaker 2: poverty line, and in many of the homes, they do
Speaker 2: not have access to sanitation, so waste from their houses
Speaker 2: are going either through ditches or pipes just directly away
Speaker 2: from the residents with no actual sanitation system aka primo
Speaker 2: grounds for helminth infections, and in stool samp of fifty
Speaker 2: five people, again very small sample size, fifty five people
Speaker 2: in this county, they found thirty percent of them infected
Speaker 2: with hookworm. Yeah, so this idea that hookworm does not
Speaker 2: exist anymore in the US is not.
Speaker 1: True, not at all.
Speaker 2: So that's something I think that's important to keep in mind.
Speaker 2: We in the US really liked to pretend that things
Speaker 2: are over there and our problems that don't affect anyone
Speaker 2: back here at home. But that's just plain not true.
Speaker 1: Yeah, even in nineteen thirty nine. So the Rockefeller Sanitation
Speaker 1: Commission ended in nineteen fourteen, and in nineteen thirty nine,
Speaker 1: I think they published this report that said human hookworm
Speaker 1: infection all but gone in the southern US. At that time,
Speaker 1: forty percent of people were still infected.
Speaker 2: It's interesting because when this article came out, which again
Speaker 2: i'll post this on the website, the popular press that
Speaker 2: I read that referenced it, they started hookworm was once
Speaker 2: eradicated in the US, thought to be gone, but now
Speaker 2: it's back, And I'm like, it was never gone, it
Speaker 2: was just nobody cared.
Speaker 1: No, it's still in some in certain populations, extremely prevalent.
Speaker 2: Yeah, hookworm, it's still around. It's a huge problem worldwide.
Speaker 2: Do you want to ask me how scared we should be?
Speaker 1: How scared should we be? I think you.
Speaker 2: Should be very concerned. How about that?
Speaker 1: Can you say more about that.
Speaker 2: I think that hookworm is like many neglected tropical diseases.
Speaker 2: It's something that just perpetuates this cycle of poverty, and
Speaker 2: I think that if you are a human, that should
Speaker 2: be really concerning to you.
Speaker 1: Yes, well, in the fact that we have the technology,
Speaker 1: the resources, the personnel to make this a disease of
Speaker 1: the past, and yet it's not happening because there's no
Speaker 1: money in it. And there are tons of people doing
Speaker 1: great work on fighting that, on fighting these, you know,
Speaker 1: hookworm and other neglectrotropical diseases, including who, including Bill and
Speaker 1: Melinda Gates Foundation, including Peter Hotez, who is like his superstar,
Speaker 1: and lots of lots of other people. Is yeah, but yeah,
Speaker 1: there is concern five hundred million people. Five hundred million
Speaker 1: people are infected.
Speaker 2: Yep.
Speaker 1: If you walk away with from this episode with any number,
Speaker 1: let it be that one.
Speaker 2: Yeah, So sources, sources.
Speaker 1: I'll post a bunch of articles on this. Paleoparasitology early
Speaker 1: pre Columbian evidence of hookworm infection. Cool. But a few
Speaker 1: things that I do want to shout out. The first
Speaker 1: and foremost is this book called The Germ of Laziness
Speaker 1: by John Ettling, And there was this great article on
Speaker 1: the PBS website called how a worm gave the South
Speaker 1: a bad Name by Rachel Newer. And in that article
Speaker 1: there was a link to a YouTube channel called gross
Speaker 1: Science from Nova, which I have never heard of, but
Speaker 1: it's full of shortish videos like under five minutes. I
Speaker 1: think that are just about one many, many, many different things.
Speaker 1: But among these there's a whole section on like parasites
Speaker 1: and pathogens and so in one of the episodes, the
Speaker 1: focus was hookworms. It was so well presented and so fun.
Speaker 1: So seriously, if you guys want some multimedia, check that
Speaker 1: channel out Gross Science.
Speaker 2: That sounds awesome. I have a bunch of really cool articles.
Speaker 2: We will post all of them on our website. This
Speaker 2: podcast will Kill You dot com. You can find all
Speaker 2: of our sources from every single episode there.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 2: And thank you for listening to us ramble, and for
Speaker 2: writing us and emailing us and tweeting at us and
Speaker 2: following us on Instagrams, like this is really cool that
Speaker 2: we get to do this.
Speaker 1: It is also you really need to check out the
Speaker 1: song called Hookworm blues by someone named blind Blake came
Speaker 1: out in nineteen twenty nine. It's a blues song about hookworm.
Speaker 1: What could be cooler?
Speaker 2: It's fantastic.
Speaker 1: We'll post it.
Speaker 2: Yeah.
Speaker 1: Until next time, wash your hands, you filthy animals, and
Speaker 1: now listen to this fantastic song by our good friend
Speaker 1: Merrimack Valley Girl. It's called Parasite Love Song, and it's
Speaker 1: basically the most perfect song for this podcast ever. You
Speaker 1: can find more of her music and gigs on Merrimackvalleygirl
Speaker 1: dot com and her instagram Merrimack Valley Girl. So that's
Speaker 1: spelled m E r amec. Valley Girl will include the
Speaker 1: links in the show notes and on our social media pages.
Speaker 1: Here is Parasite Love Song.
Speaker 3: I cannot live without you, not even for a day.
Speaker 3: Please don't try to push me out, Please just let
Speaker 3: me stay. It's a miracle I've found you. Introductions were
Speaker 3: not forced. They'd brought us together. Let nature take her course.
Speaker 3: You tried to avoid me, but my instincts were too good.
Speaker 3: Your defense is now arising, but I knew that they would.
Speaker 3: I never want to hurt you. I don't want to
Speaker 3: make you. Please do you understand me? Do you know
Speaker 3: that I have needs. Have you ever felt so wanted?
Speaker 3: I may be a fluke, our support may not be mutual,
Speaker 3: but please do not rebuke your giver. I'm a taker,
Speaker 3: but relations can evolve. I'll adapt to stay with you.
Speaker 3: Our problems can be solved.
Speaker 2: Oh what do I.
Speaker 3: Love about you? You're such a lovely host, your beautiful
Speaker 3: and rich inside where it counts the most. I promise I.
Speaker 2: Won't cheat on you. Please just let me stay.
Speaker 3: I cannot live without you, not even for a day.
Speaker 3: I want you out. You make me sick.
Speaker 1: I want you out. You make me sick.
Speaker 3: I want you out, your magne sick. Oh, you're lousy
Speaker 3: and your magne sick.