Hookworm in the South

HOOKWORM IN THE SOUTH

The Southern Disease

Hookworm is an aggressive intestinal parasite that causes physical and mental under-development and other symptoms such as dry hair, ulcered shins and feet, protruding shoulder blades and stomachs, and a general lack of energy. The hookworm contaminates soil through unsanitary privies or out-houses; primarily, victims become infected by walking through larvae-rich soil in bare feet. The disease was common in the rural American South after the Civil War. This "germ of laziness" or "ground itch" created a southern stereotype: poor, barefoot, lazy, deformed, and mentally deficient.

First Known American Cases

The parasite was first identified in Europe in the mid 1800s. A few American physicians suspected its presence in the United States as well, but the first confirmed case was not reported until Philadelphia physician Abe Blickhalm published an account in 1893. Other cases from Richmond and New Orleans soon appeared, and in 1901 Dr. Allen J. Smith diagnosed a sailor in Galveston, Texas. Smith believed this hookworm was a different species from the European parasite.

Recognition

One man, Dr. Charles Wardell Stiles, was primarily responsible for identifying the American hookworm and alerting the nation to its devastating effects. Born in North Carolina, Stiles became a zoologist with the Department of Agriculture's Bureau of Animal Industry. Even before Blickhalm's report in 1893, Stiles noticed that the symptoms of the hookworm disease he saw in animals were similar to those of many poor whites in the rural South. Stiles and Smith traded information via correspondence, and Stiles made a trip through the Gulf-Atlantic states to confirm his theory. In May 1902 Stiles, then the chief of the Division of Zoology of the U.S. Public Health Service, reported to the Pan-American Sanitary Congress that he had found the "germ of laziness" and that hookworm disease was common in the American South.

Reactions

Stiles's announcement produced swift reactions. Some physicians and public officials praised the zoologist for pinpointing the cause of a serious health problem. Many southerners, however, were indignant and disgusted by the idea that their fellow citizens were infested with worms. Newspapers in the North and South turned the situation into an excuse for mocking editorials and cartoons.

Eradication

Stiles was convinced that an education campaign could solve the hookworm problem, but it took several years of effort on his part before he could convince any authorities to implement such a program. In 1908 Stiles was appointed by President Theodore Roosevelt to the Country Life Commission, a group formed to suggest ways to improve farm life. Through this appointment Stiles met Walter Hines Page, a crusading southern journalist. Page had connections at the General Education Board, a philanthropy funded by industrialist John D. Rockefeller. In October 1909 Rockefeller donated $1 million to fund the Rockefeller Sanitary Commission. This commission cooperated by invitation with state boards of health in creating education and eradication programs that helped hundreds of thousands of hookworm disease sufferers in the southern states. The commission operated until the end of 1914, by which time hookworm control was well advanced in those states. More than twenty years after Stiles's first suspicions about the "germ of laziness," his untiring efforts finally produced results.

Sources:

Mary Boccaccio, "Ground Itch and Dew Poison: The Rockefeller Sanitary Commission 1909-14," Journal of the History of Medicine and Allied Science, 27 (January 1972): 30-53;

James H. Cassedy, "The "Germ of Laziness" in the South, 1900-1915: Charles Wardell Stiles and the Progressive Paradox," Bulletin of the History of Medicine, 45 (1971): 159-169;

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