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Eradicating Hookworm

“On the whole the evidence seems to show that the campaign of the Rockefeller Sanitary Commission against the hookworm disease is the most effective campaign against a widespread disabling disease which medical science and philanthropy ever combined to conduct.”   [1]

In 1910, an estimated 40% of the population of the southern United States was infected with hookworm.  The Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (RSC) was created with the intention of eliminating the disease across the region. By implementing a three-pronged approach, including mapping the disease, curing patients, and providing education, the RSC not only dramatically reduced the disease, but created a culture of public health.

Dispensary scene, Dr. Caldwell teaching by lecture and demonstration, Marengo County (Ala.)

Dispensary scene, Dr. Caldwell teaching by lecture and demonstration,
Marengo County, Alabama

Hookworm infection is caused by the transmission of the hookworm parasite common to warmer climates. Hookworm larvae live in soil and typically enter humans through the soles of their feet.  The larvae flow through the bloodstream and into a carrier’s lungs and throat before latching on to the small intestine. Hookworm eggs are expelled through the stool of a carrier, re-contaminating the soil and beginning the process anew. Symptoms vary, but often include stunted growth, anemia and digestive problems. Bloated bellies and a propensity to eat dirt are also hallmarks of the disease.

Charles Wardell Stiles, a parasitologist who had long labored to find the resources to eradicate hookworm, delivered a lecture on hookworm disease to Rockefeller trustees, including John D. Rockefeller, Sr.; John D. Rockefeller, Jr.; Frederick T. Gates and Wallace Buttrick. Following Stiles’ demonstration John D. Rockefeller, Sr. committed $1 million to create the RSC. The trustees took care to appoint Southerners to the Board of the RSC to ease the organization’s acceptance in the region. Wickliffe Rose, a humanities professor from Tennessee, was appointed Executive Secretary of the RSC. While Rose lacked medical expertise, he excelled in the position, proving to be a visionary in public health education.

Cartoon for 'The Story of a Boy' by B. Stephany.

Cartoon for 'The Story of a Boy' by B. Stephany.

In 1910 the RSC began campaigns to eradicate hookworm in nine states, including Virginia, North Carolina, Georgia, South Carolina, Tennessee, Arkansas, Mississippi, Alabama and Louisiana.  The RSC used a three-pronged approach that included:

  1. Conducting a survey to map out the prevalence of the disease in a particular area
  2. Curing patients at mobile dispensaries
  3. Providing education through illustrated lectures and demonstrations that urged prevention through improved sanitary measures, including the construction of privies[2]


Southerners initially distrusted RSC efforts. Many were offended by accusations of infection and refused to accept testing and the treatment of Epsom salts and thymol. Others believed that the disease simply did not exist. Regional newspaper editorials also strongly criticized RSC employees and viewed them as a Northern imposition.[3] 

In spite of these complications, within a year the tide of public opinion had turned in favor of the RSC. Quite simply, the RSC efforts worked. Also, the agency reached out to its critics by engaging the local press with constant updates on their success.[4]

While the hookworm campaign depended on staffing and financial support from the RSC, it was also dependent on each state’s board of health.  The RSC never worked in isolation or without local support. Through this process, the RSC built important health networks among local doctors and health boards.  State and county school officials also became an integral part of the campaign, urging participation in public health demonstrations, testing and treatment, and in some instances, making hookworm screening a condition of school attendance. 

Hookworm treatment at the Chapel Hill School, Alabama 1923

Hookworm treatment at the Chapel Hill School, Alabama 1923

In 1914 Gates lobbied the Rockefeller trustees to close the RSC, claiming that success had been achieved and that other global health issues required more urgent actions. While hookworm disease had not been completely eradicated, Gates believed that significant results had been produced and that local doctors were now ready to take up the challenge. Both Stiles and Rose disputed Gates’ claims of success, but Gates’ influence prevailed. On December 31, 1914, the RSC was disbanded and replaced by the International Health Division (IHD), an organization devoted to modernizing public health worldwide. Modeling its activities after the lessons learned through the U.S. hookworm campaign, the IHD made hookworm eradication a global initiative. 

[1] Frederick Taylor Gates. Chapters in My Life (New York: The Free Press, 1977), 224-225.

[2] John Farley.  To Cast Out Disease: A History of the International Health Division of the Rockefeller Foundation (1913-1951) (New York: Oxford University Press, 2004), 29.

[3] John Ettling. The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge, MA: Harvard University Press, 1981), 130.

[4] Ettling, 148.