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.In 1925, the campaign discontinued the use of the dispensarymethod, which required the population to come to the doctor at a hookwormclinic, because treated individuals could not be supervised during the hoursafter they took the medicine and many failed to return to the clinic for subse-quent treatments.The replacement intensive method required the hookwormbrigades to travel from house to house to administer treatment.By this timeWarren had changed the antihelminthic dose to.75 cc.of chenopodium incombination with 1.50 cc.of carbon tetrachloride.The drugs were swallowedunder the eye of a trained inspector in the home of the individuals beingtreated, but the inspector did not wait to make sure that the magnesium sul-phate purgative was taken.Assistants returned during the course of the day tomonitor the condition of those treated.Preliminary fecal examinations wereadministered only to individuals who refused treatment.Positive results gave,according to Warren,  an added weight to [the inspector s] already heavy argu-ment, and the individual usually takes the medicine. 104The combined use of mass treatment and the intensive method meant that thehookworm campaign reached almost the entire population of each communityhooked on hookworm 87visited.Even though inspectors now administered the antihelminthics directly,the zeal behind the mass method caused the dangers of treatment to multiply.Nevertheless, the IHB home office continued its laissez-faire approach toWarren s treatment methods, expressing little concern about the not infrequentinstances of poisoning.Over the five-year campaign, there were at least fourdeaths and dozens of recorded intoxications.Most of the fatalities were in youngchildren, who died within hours of antihelminthic administration.Though poi-sonings were communicated to the home office through mandatory reports,these episodes were not always shared with the DSP: IHB men did their best tomuzzle publicity, lest the hookworm campaign be jeopardized.While candid, the IHB incident reports offered extremely defensive inter-pretations of events that might put the competence of officers into doubt.Inthe first months of the campaign, Warren reported that  We have had a veryunusual experience that involves the question of the advisability of allowingnon-technical men of limited secondary education to administer highly toxicdrugs. 105 After receiving oil of chenopodium and carbon tetrachloride, ninety-three people became ill, thirty severely so.Warren identified the probablecause not as the antihelminthics, but rather as pulque, a homemade alcoholicdrink made from the fermented maguey plant and consumed in large quanti-ties, he maintained, by the majority of the population.Warren shifted betweenblaming his Mexican assistants and blaming Mexican drinking habits for thedisaster, leaving the treatment methods themselves beyond reproach.Becauseof the difficulty in changing the popular pulque-drinking custom, Warren s safe-guard was to end the use of carbon tetrachloride, which caused adverse effectswhen mixed with alcohol.Russell recommended that, instead of discontinuingthe use of carbon tetrachloride, patients be advised to eat starchy food beforetreatment in order to protect the liver.106 Warren does not seem to have heededthis suggestion.Warren also failed to reveal that he had hired nonmedical assistants to savemoney.Russell had requested that Warren maintain annual spending at$45,000 so as to  keep the work within the capacity of the Mexican governmentto take over. 107 Warren worried that spending caps would be  at the expenseof thoroughness, 108 but budget rules were one parameter he would not violate.He had promised that he could sustain the campaign at a cost of less than $1per treatment (almost $11 in 2004 dollars) as long as there were no interrup-tions due to unrest.109 The fact that Russell did  not feel competent at this dis-tance to advise [Warren] regarding the method of treatment and wrote that you will be able to arrange this yourself 110 only seems to have reinforcedWarren s haughty attitude.In early 1926 at the height of the campaign several poisonings turnedfatal.Hookworm treatment  should not have killed, a nine-year-old girl fromTlalixcoyan, Veracruz, according to Warren, but she suffered from malnutritionand a previous bout of malaria.Instead of admitting that the hookworm teamg'88 hooked on hookwormg'ought to have recognized her condition and adjusted the dose, Warren deniedresponsibility.111 (Another RF officer in Mexico later found that a castor oilpurge made the chenopodium less toxic, especially for children).112 He accusedthe ayudantes (assistants) of failing to follow instructions and noted that theMexican hookworm campaign director, Solórzano Morfín, was the doctor incharge.Normally, Warren asserted, the hookworm staff was both well paid andwell trained, attracting high-quality men.However, he claimed, the unavoidablehiring of lower-salaried, less-educated ayudantes had led to the deaths of thischild and others.The ayudantes, Warren insisted, could  not be trusted.Whena $100.00 peso indian [sic] tells me he has done something I do not believe himuntil I have seen the results. 113Around the same time, Warren reported that a seven-year-old boy from SanAndrés Tuxtla had died, but he claimed that the death was due to intestinalobstruction, not from the antihelminthics the boy had been given.In his owndefense, Warren claimed that the child could not have died from the treatmentbecause his entire family was infected with hookworm and all the others had sur-vived the treatment.Warren then contradicted himself, suggesting that had hebeen in charge of the case instead of hookworm team member BernardoPeña, a Harvard-trained doctor he would have administered a smaller dose ofcarbon tetrachloride and chenopodium.114This time, however, Solórzano Morfín stepped in.He had a different inter-pretation, complaining that the  medically ignorant Warren had attempted toincrease the number of treatments administered with little supervision.In seek-ing to quickly expand the work of the hookworm brigades, Warren hadapproved the hasty hiring of ayudantes who were assigned a minimum quota ofweekly treatments and left to work with little supervision by brigade doctors.115Warren was also met with criticism from local doctors who decried the dire con-sequences of hookworm treatment.Warren claimed these stories were  origi-nated by charlatans and the few we have encountered who were not in sympathywith the work. 116 He continued,  it is well known that some of our men resignand advertise themselves as specialists ; Mexico s  lax medical practice laws per-mitted  almost anyone to practice, and, for example, an  ignorant mozo[errand boy] is treating people for ten pesos a shot. 117Whether the deaths were directly Warren s fault or not, his cavalier style andunwillingness to take responsibility were met with surprising indifference fromthe IHB home office and silence from the DSP, which was not always informedof campaign casualties.That the local population appeared convinced of theimportance of undergoing hookworm treatment in spite of mishaps and fatali-ties fueled Warren s audacity.After two years running the campaign, he boastedthat  the confidence of the people is such that we can kill a member of the fam-ily with chenopodium and the other members will demand that they continueto receive their treatment.And to throw this bouquet does not cause me theslightest embarrassment [ Pobierz caÅ‚ość w formacie PDF ]