Hookworm

Long before hookworm was identified as a parasitic disease, its mostly white victims were a common presence in the South. Pale and listless, with vacant stares and winged shoulder blades, these “lazy” southerners, a staple of northern literature, seemed dismal proof of the human and economic collapse of a once proud cotton South. But in the early 1900s Washington zoologist Charles W. Stiles exploded the shiftless-southerners thesis and showed that their traits had a biological basis: infestation by a worm, Necator americanis, which was native to Africa and had migrated west with the slaves. Nurtured in the South’s damp and sandy soil, it caused severe anemia, stunted growth, and often mental retardation in victims. What made Necator most threatening, however, was its soaring infection rate (in parts of South Carolina it ranged up to thirty-five per cent).

The starting point of infection was the lack of sanitary privies in most of the rural and mill village South. Thus, human waste containing Necator eggs was scattered on bare ground. Within two days the eggs hatched out larvae, which migrated up stems of plants to lie in wait for a returning host. It was then a simple matter–facilitated by southerners’ lack of shoes–for larvae to transfer to the host’s feet or ankles. They then pierced the skin and traveled to the small intestine. These larvae matured into adult worms, which “hooked” onto tissue and began a blood-feeding that could continue for years. Meanwhile they produced new eggs, which entered the stool to restart the cycle.

When Stiles first reported those findings, the northern press made much of this new southern disease (one paper announcing the discovery of a germ of laziness). Initially southern leaders angrily rejected the findings and resisted calls for health reform, some claiming that northern do-gooders were only trying to profit in the sale of shoes. One Yankee philanthropist, however, was determined to push reform despite resistance. In 1909 John D. Rockefeller and his advisers created the Rockefeller Sanitary Commission for Elimination of Hookworm Disease, which would send experts to some thirty-nine counties in nine states (including South Carolina) with a mission to convince leaders to take steps against this serious malady.

Then in 1911 the commission, wanting swifter progress, shifted from education to treatment, adopting an approach that had worked in Mississippi: the traveling dispensary. Taking the doctor to the people proved hugely successful, partly because treatment (thymol) was free and sure–if potentially dangerous–but mostly because the dispensary had all the flavor of the camp meeting. Going to the dispensary for thymol was similar to going to the revival for religion. Even picnics on the ground were included.

By 1915 when the commission stopped work, 750,000 southerners had received dispensary chemotherapy and hookworm was on the run, aided by the privy-building work of new county health departments. Between 1910 and 1914 infection rates fell sharply everywhere, including South Carolina, which saw a two-thirds drop. After 1915 hookworm still existed, but by the 1940s, thanks to New Deal health spending and the heightened demand for citizen sanitation that accompanied World War II, it was little more than a medical curiosity.

Beardsley, Edward H. A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South. Knoxville: University of Tennessee Press, 1987.

Ettling, John. The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South. Cambridge: Harvard University Press, 1981.

Farmer, Henry. “The Hookworm Eradication Program in the South, 1909–1925.” Ph.D. diss., University of Georgia, 1970.

United States. Congress. Senate. Report on Condition of Women and Child Wage-Earners in the United States. Vol. 17, Hookworm Disease Among Cotton-Mill Operatives. 61st Cong., 2d sess., 1910. S. Doc. 645.