Hookworm
1909 - Institutional Event
In the early 1900s,
hookworms infected about 40 percent of the South’s population in the United
States. While rarely fatal, hookworm disease left victims weak and
susceptible to other diseases. Some say it contributed to the stereotype of
Southerners as stupid or lazy.
In 1909, the North Carolina State
Board of Health joined with the Rockefeller Foundation to launch a massive
public health campaign against hookworm. The program had three goals:
- To educate Southerners about how hookworm is spread—primarily through unsanitary outhouses or waste disposal in rural areas
- To treat infected people
- To break the cycle of hookworm infection by encouraging people to wear shoes, build sanitary outhouses and keep yards clean
At
temporary free clinics called dispensaries,
many thousands of North Carolinians were tested, treated and informed about the
disease. Dispensaries held daylong programs featuring lectures, demonstrations
and testimonials from people who had been cured. Some events resembled
religious revivals, complete with hymn singing.
The five-year program was a resounding success, nearly
eradicating hookworm disease in North Carolina and 10 other Southern states.
A handbill advertising hookworm dispensaries in Halifax County, ca. 1911.
The Privy Problem
Privy, another name for an outhouse, comes from the word “private.” But starting in 1909 when the hookworm campaign began, privies became a matter of public concern.
Public health workers who surveyed rural homes at that time found that only half had privies. Most were designed in ways that helped spread hookworm and other diseases by allowing waste to run into the soil. Once contaminated, the soil exposed people to hookworm and served as a breeding ground for flies that could spread typhoid. Depending on its location, an unsanitary privy could also contaminate a family’s water supply.
People without privies tended to answer the “call of nature” in a field or behind a bush. Even those who did have outhouses often used chamber pots at night, emptying them into the yard the next day. In both cases, the result was the same—polluted soil and a continuing cycle of hookworm infestation.
To improve health conditions, health workers encouraged North Carolinians to build sanitary privies or upgrade their unsanitary ones.
Unsanitary privies allowed waste to run directly into the soil, where disease could spread.
A State Board of Health Poster from 1911 encouraged more hygienic privies.
Vampire of the South
Look like a creature from a horror movie? Journalists of the early 1900s coined the term “vampire of the South” to describe not only the hookworm’s appearance but also its ability to drain the life out of victims. With three pairs of teeth, the parasite anchors itself to the host’s intestinal wall. There it feeds on blood, slowly robbing the infected person or animal of vital nutrients.
Hookworms thrive in the warm, moist, sandy soil common in the South. They usually enter their victims through the skin. So people who walk barefoot on soil contaminated by waste from infected people or animals can become infected, too. Which is why, in Southern rural homes with unsanitary outhouses, children were especially likely to get the disease. Those who did tended to suffer from retarded growth and intellectual abilities, as well as anemia.
The symptoms now associated with hookworm appear as far back as 1600 B.C. in records of ancient Egypt. Today the parasite is still a leading cause of disease in tropical and subtropical developing countries. But, as a result of the 1909 public health campaign and advances in sanitation, it’s now rare among Americans.
Close-up photograph of an adult hookworm. Courtesy of the College of Veterinary Medicine, North Carolina State University