Rural Diseases

RURAL DISEASES

Hookworm

Hookworm, or ancylostomiasis, is a condition caused by a parasite found in tropical and subtropical climates, especially where the inhabitants do not wear shoes and where the soil is contaminated by human excrement. In the early twentieth century Dr. Charles Wardell Stiles of the United States Public Health Service found that hookworm was epidemic in the southern United States. The parasite entered the sole of the foot and made its way to the intestine, resulting in pain, diar-rhea, anemia, and listlessness. Victims sometimes experienced a craving to eat a certain type of white clay.

Sanitary Commission

The Rockefeller Foundation established a sanitary commission that educated people about the problem and encouraged practical measures for permanent sanitation. In sixteen southern counties surveyed by Rockefeller workers between 1910 and 1915, the rate of hookworm infection was 59.2 percent. By 1923 the rate had fallen to 23.9 percent. Hookworm remained a problem in the South throughout the 1920s. Adequate control was made possible only by the vast social and economic changes and improvement in sanitation practices of the late 1930s and early 1940s.

Pellagra

Pellagra in its early stages was sometimes confused with sunburn or poison oak. A skin rash symmetrically marked the victim's hands and feet and sketched an ugly red butterfly across the patient's face. The effect of this very apparent symptom of the disease was to set pellagrins apart. Because the cause of the disease was unknown, some hospitals refused to admit sufferers because of the fear of contagion.

Symptoms, Treatment

Other symptoms included diarrhea, delusions of persecution, and depression. The disease was often fatal, not only because of the debilitating effects of the symptoms, but also because patients were prone to commit suicide, especially by drowning. Victims were frequently confined to mental hospitals. In 1914 the United States Public Health Service assigned Dr. Joseph Goldberger, a dedicated and determined investigator, to study the disease, which was most prevalent in the southern states, a region that was still suffering from poverty resulting from the Civil War and its aftermath. Goldberger postulated that a faulty diet was the cause of pellagra. Despite the fact that he never identified the specific deficiency, Goldberger found that brewer's yeast was an effective treatment for pellagra. The mortality rate for pellagra between 1924 and 1928 was 58 percent, and the United States Public Health Service estimated 170,000 cases in 1927. Between 1927 and 1932 the Red Cross distributed three quarters of a million packages of garden seeds and more than 200,000 pounds of brewer's yeast. In 1937 Dr. Conrad A. Elvehjem and his colleagues at the University of Wisconsin identified nicotinic acid as the specific ingredient which cured pellagra.

Tularemia

A man working in a Washington, D.C., meat market went to his physician, Dr. J. Lawn Thompson, in 1921 for treatment of what he told the physician was well known among butchers who handled rabbits as "rabbit fever." Other cases with similar symptoms were known in Utah as "deer-fly fever" and in Idaho as "glandular type of tick fever."

Francis

In a landmark article in the Journal of the American Medical Association in 1925, Edward Francis, a surgeon with the United States Public Health Service, synthesized various reports and presented evidence that all were caused by one organism, Bacterium tularense, which grew in the blood of infected rodents. Infection could occur through a skin lesion when hunters or butchers handled contaminated meat or when a tick or deer fly which had bitten an infected animal bit a human. Although Edward Francis was not the first to describe symptoms, he was the first to synthesize reports and present data to show how the disease was transmitted. He also named it tularemia.

Symptoms, Treatment

Symptoms of the disease included chills, fever, headache, body pains, vomiting, tender and enlarged lymph glands, prostration, and a punched-out circular sore about one-fourth inch in diameter at the site of the infection. Diagnosis was by agglutination of the bacteria in the blood serum of the patient. Treatment in the 1920s was primarily bed rest, and convalescence might take from two months to a year. Death was rare but did occur in more serious cases.

TULAREMIA NAMED

The disease is named tularemia on account of the presence in the blood of the causative organism, Bacterium tularense. This organism was so named by McCoy and Chapin, who discovered it in 1912 as the cause of a fatal epidemic among the ground squirrels in Tulare County, California. Tulare County was so named because that region was once covered with extensive marshy beds of the reed tuie, a large variety of bulrush."

Source:

JAMA, 84 (25 April 1925): 170.

Sources:

John Duffy, The Healers: The Rise of the Medical Establishment (New York: McGraw-Hill, 1976); republished as The Healers: A History of American Medicine (Urbana: University of Illinois Press, 1979), pp. 240-241, 424-423;

Elizabeth Etheridge, The Butterfly Caste: A Social History of Pellagra in the South (Westport, Conn.: Greenwood Press, 1972), pp. 160-163, 192-193;

Edward Francis, 'Tularemia," JAMA, 84 (15 April 1925): 1243-1250;

Alan I. Marcus, "The South's Native Foreigners: Hookworm as a Factor in Southern Distinctiveness," Disease and Distinctiveness in the American South, edited by Todd L. Savitt and James Harvey Young (Knoxville: University of Tennessee Press, 1988), pp. 79-99;

The Rockefeller Foundation Annual Report, 1913-1914, p. 11-12; 1923, p. 1ll;

Jay P. Sanford, "Tularemia Revisited," JAMA, 250 (16 December 1983), 3225-3226.