Mining is low on the list of enviable occupations. The
hazards one faces when plying one of humanity’s most ancient professions,
burrowing deep into the earth to harvest its hidden treasures in the form of
precious stones and metals, range from grungy to downright gruesome. The
occupation is widely considered to be one of the world’s most dangerous, and it
was only in the 1950s that the mining industry in the United States finally saw
fatalities due to accidents dip under a thousand a year (1).
Not only do miners experience significantly increased
morbidity due to working conditions that are inherently more challenging and
dangerous than those posed by a corporate 9-to-5, but they also face a greater
incidence of infectious diseases than your average desk jockey. Skin and
respiratory illnesses abound in mines, tropical parasites such as malaria and
dengue can plague those in more tropical locales, and rodents in infested mines
can spread leptospirosis and other diseases (2). While these illnesses are
still common in mines located in developing countries, the United States and
the developed world have largely eradicated these ailments, leaving only the dark
and dampness to do battle with.
With regard to disease, we often associate mining with
tuberculosis and black lung, though there was one unexpected hazard that
constituted a significant burden throughout the history of mining and onwards
into the early 1900s: the bloodsucking hookworm.
Ancylostoma duodenale has a
very particular geographical distribution; it’s picky about the temperature,
humidity and type of soil that its eggs and larva inhabit. But in underground
mines, the high levels of dissolved mineral salts in the loamy soil encourage
parasitic growth. The worms flourish in the dank humidity and suffocating
warmth that dramatically appear the farther one descends from the surface.
Their life cycle is further enhanced if humans do not follow basic rules
of sanitation and go barefoot.
The hookworm has a distinctly icky cycle of transmission:
humans shed the larvae in feces, which, after a short period of growth and
maturation, go on to penetrate the unshod feet of other unsuspecting humans.
The larvae travel through thick soles and skin, through arteries and veins to
the well-vascularized lungs, ascending up the throat, and eventually – finally!
– emerging into the throat before being swallowed and delivered to the bowels.
Their journey ends in the small intestine where they mature into their adult
form and attach to the bowel walls to feed on blood, which can leave their
hosts anemic.
Unfortunately, historical accounts indicate that
defecating willy-nilly in the mines was a widely accepted practice up to the
twentieth century. The hours miners worked were long, and ascending to the
surface to attend to one’s business meant time away from work, time that was
not likely to be granted to workers laboring without the protection of OSHA or
similar agencies. Toilets in the depths were crude and few. A common practice
was for stools to be laid among drain gutters, but an influx of rain from the
surface would easily ruin these not-so-carefully laid plans, resulting in a
literal shitschturm.
Even in mining operations that generously provided their
men with the luxury of not having to defecate directly in their workplace,
contamination was common, as one author describes: “Miners were in many instances
expected to return to the surface to defecate when necessary, the usual result
was that the men for sake of convenience and to avoid discomfort would almost
invariable resort to abandoned or unfrequented parts of the workings”(3). Feces
containing the hookworm larvae would be squished and squelched everywhere:
throughout the mine and on ladder rungs, with infected men inadvertently
spreading a worm and its disease onto his colleagues. For miners going barefoot
or wearing improper footwear, the risk of hookworm infection was further
increased.
Widespread hookworm infections among miners led to some
of the classical stereotypes we associate with this occupation: pale men
hacking and coughing from lung diseases, in some part due to the breathlessness
and anemia caused by the staggering iron deficiency that accompanies infection
by these bloodsucking parasites. In fact, “miners’ anemia” has been the
nickname for Ancylostoma infection for centuries, along with other
monikers such as “ tunnel disease,” “miners’ itch,” and “brickmaker’s anemia.”
For centuries, it was thought that the anemia was intrinsically related to the
occupation of mining, to the constant sun deprivation and coal exposure. It
would only be in the mid to late 1800s, as the hookworm’s method of
transmission was fully elucidated, that anemia would be finally attributed to a
worm thriving in loamy soil, living high off of exceedingly poor sanitation.
The extent of hookworm infection was properly assessed in
the mid to late 1800s. The disease was recorded throughout the United States,
Australia and and much of Europe (4). It was found in the gold and silver mines
of Hungary, Sicily’s sulphur mines, and in the coal mines littering Germany,
the Netherlands, Belgium and France (5). It was estimated that 20 to 90% of
miners in Austria suffered from anemia in the late 1800s. More than half of the
men slaving away in the goldmines in the California Gold Rush in the
mid-nineteenth century were thought to carry hookworm, with some populations
said to be infected at a rate as high as 80%. In 1916, when the California
State Board of Health investigated the prevalence of hookworm among the 1400
miners based at the Grass Valley Gold Mining district in Sierra Nevada, all but
two of the men were found to be harboring worms (1).
Hookworm was the source of a “violent epidemic” outbreak
of diarrhea and anemia among men constructing the Swiss Saint Gotthard Tunnel
in 18803 (5). Hundreds were infected, and several died of overwhelming anemia.
Physicians investigating the outbreak were “inclined to hold the adverse
hygienic conditions responsible for the bad health of the men,” finding that
miners were forced to defecate inside the tunnel during the workday and many,
coincidentally, were wearing “leaky and wet” shoes (5).
One physician writing on the prevalence of the hookworm
menace in Californian miners speculated that hookworm infection had been within
the mining community for centuries, from the slave mines of ancient Egypt to
the iron mines of medieval Europe and the modern operations of the Americans,
endlessly cycling through millions of men sent into the dark mines for tin,
coal, and gold (3). It was only until the early to mid 1900s, as both sanitary
measures and efficient worm-killing drugs were introduced to miners that
hookworm was banished from the mines.
Hookworm was, in short, an industrial, occupational
disease. Though mining is a job fraught with danger and the threat of
death, this lowly worm has been a surprising long-time companion. For centuries
the proper sanitation of mines was but an afterthought compared to the threat
of rock falls, explosions, flooding, and collapse. For this reason, hookworm
was able to capitalize on a key pair of sanitary oversights common to
pre-twentieth century mining: a culture of laissez-faire defecation and poorly
clad feet. Thus, for generations of men working our mines, having a touch of
hookworm infection was as common a plight as a slight cough or stepping in
something decidedly untoward on their way to work.
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