Extending Public Health: The Rockefeller Sanitary Commission and Hookworm in the American South

Abstract

The Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (1909-1914) fielded a philanthropic public health project that had three goals: to estimate hookworm prevalence in the American South, provide treatment, and eradicate the disease. Activities covered 11 Southern states, and Rockefeller teams found that about 40% of the population surveyed was infected. However, the commission met strong resistance and lacked the time and resources to achieve universal county coverage and meet project goals. We explore how these constraints triggered project changes that systematically reshaped project operations and the characteristics of the counties surveyed and treated. We show that county selectivity reduced the project's initial potential to affect hookworm prevalence estimates, treatment, and eradication in the American South.

Of dogs and hookworms: man’s best friend and his parasites as a model for translational biomedical research

“…Over 80 percent of helminth infections are caused by soil transmitted helminths (STH) [ 5 ]. Elimination of STH in Western society started in the early 20th century as a result of better sanitation and public sewerage programs [ 6 ]. The problem of helminth infections in developing nations was recognised, but it was not until the advent of anthelmintic drugs and the World Health Organisation initiatives of the 1950s that widespread elimination of STH was attempted [ 7 – 10 ].…”

The Hookworm Blues: We Still Got ‘em

“…While these classic tropical diseases are prevalent, no infection is more associated with the American South than hookworm. 7 , 8 Necator americanus , the New World hookworm, a common parasite in Africa during the time of the European settlers, was probably introduced to the South through the slave trade. Hookworm, Strongyloides , and other geohelminths found a hospitable environment, characterized by a warm, moist climate; sandy or loamy soils which provided burrowing hookworm larvae protection from the sun; and poor hygiene and waste disposal practices.…”

“…Although certainly hyperprevalent for generations, hookworm was not recognized as a problem in the American South until 1902, when Charles Stiles recognized the similarity of symptoms between many hookworm patients from Europe and the southern United States. 7 , 8 Subsequent epidemiologic studies supported by John D. Rockefeller discovered hookworm prevalence of about 40% throughout the rural South. It is now generally accepted that the anemia and lassitude associated with a heavy worm burden contributed significantly to decreased productivity in the region.…”

“… 8 , 9 Control efforts initiated by the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease and subsequently taken up by local and state governments spanned 11 states, included treatment of more than 400,000 people, and expanded education to healthcare providers, teachers, and the general public about infection risks, leading to the promotion of prevention measures such as the construction of latrines and the routine wearing of shoes. 8 , 9 Prevalence of infection dropped considerably over the next several decades, but studies in the 1950s and 1960s found that hookworm prevalence of up to 15% still existed in poor populations in south Alabama and eastern Kentucky. 7 Despite this persistence, there is good evidence to suggest that decreased worm burden contributed to the educational improvements and economic growth seen throughout much of the South in the last century.…”

“… 7 Despite this persistence, there is good evidence to suggest that decreased worm burden contributed to the educational improvements and economic growth seen throughout much of the South in the last century. 8 , 9 …”