'IRAQ AND THE PERSIAN GULF' [‎274r] (550/862)

PUBLIC HEALTH AND DISEASE 423
Baghdad during the 12-year period 1923-1934 show that the relative
incidence of these fevers was: typhoid fever, 75-4 per cent.; para
typhoid A, 8-8 per cent.; paratyphoid B, 15-8 per cent. It is some
what surprising that paratyphoid B infections are nearly twice as
numerous as paratyphoid A. Paratyphoid B is the common infection
in most European countries. In India paratyphoid A is predominant,
paratyphoid B being extremely rare.
The enteric fevers were responsible for considerable sickness and
mortality among British troops between November 1914 and De
cember 1918, when the average annual rates of admission to hospital
for these diseases were British 17-5 per 1,000 and Indians 1-96.
Before 1918 paratyphoid A was 5 times commoner than paratyphoid
B and 3 times commoner than typhoid. In 1918 there was a notable
decrease in the proportion of paratyphoid, because of improvement in
vaccine. The case-mortality rates for the three fevers during 1916-
1918 were: typhoid fever, 11 *4 per cent.; paratyphoid A, 3 -6 per cent.;
paratyphoid B, 7*5 per cent. These paratyphoid mortality rates are
higher than they are normally in peace conditions. Though Indian
troops showed a marked insusceptibility to enteric, cases among them
tended to be much more severe than among British troops.
A small percentage of convalescents from enteric fevers continue to
harbour and excrete the causative germs for long periods. These
carriers of infection play an important role in the spread of the disease.
Polluted water-supplies, flies and dust are potential vehicles of in
fection. All visitors to Iraq should be protected by inoculation against
typhoid and paratyphoid A and B.
Intestinal Parasitic Worms
The infection rate of Iraqis with intestinal worms is high. The
number of cases of diseases ‘due to Helminths’ treated in medical
institutions in 1939 was 44,852, 1-3 per cent, of total attendances.
The most prevalent is the hookworm {Ankylostoma duodenale),
although the number of cases of ankylostomiasis treated in 1939 was
only 6,147. Man can harbour a certain number of hookworms with
no appreciable discomfort, but he feels better without them and has
a higher productive capacity. Heavy infections cause serious illness
and intense anaemia, but these appear to be infrequent in Iraq,
though, from examinations made, it would seem that more than one-
quarter of the population, drawn from all over the country, is infected.
The larva of A. duodenale gains access to the body through the skin,
generally of the ankle or foot. Infection is generally contracted by