Health Divided: Public Health and Individual Medicine in the Making of the Modern American State by Daniel Sledge

Author:Daniel Sledge [Sledge, Daniel]
Language: eng
Format: epub
Tags: Medical, Health Policy, Public Policy, United States, Social Policy, Political Science, State & Local, South (AL; AR; FL; GA; KY; LA; MS; NC; SC; TN; VA; WV), History
ISBN: 9780700624300
Google: IDIaMQAACAAJ
Goodreads: 33099346
Publisher: University Press of Kansas
Published: 2017-01-15T09:50:21+00:00

Lingering Hookworm

By the 1930s, hookworm was far less of a problem than two decades before. Indeed, there was a growing sense among the public that the disease no longer represented a significant threat. Rather than being fully eliminated, it seemed, the parasite would continue to persist but with a significantly reduced prevalence and impact. In 1927, the Rockefeller International Health Board announced that hookworm had “almost disappeared from the United States.”

The announcement dismayed hookworm pioneer Charles Wardell Stiles. When publicized, he complained, it “had the effect of still further decreasing the school interest in hookworm disease and, very unfortunately, in inducing many mothers to refuse to accept the diagnosis by physicians and consequently to decline to permit the children to be treated.” Nonetheless, Stiles believed, few Southern physicians took the announcement seriously.32 Writing in 1930, he presented data collected from state health departments and intended to demonstrate that the IHB was wrong. The information on hookworm was compiled through a variety of techniques and was, as he pointed out “not strictly comparable” either across states or with information from the Rockefeller hookworm surveys of the 1910s. At best, it was a hodgepodge of surveys sent to him by state health officers eager to assist in highlighting the ongoing presence of the disease. While 46,036 people were examined in the numbers presented for Alabama, resulting in a 36.9 percent infection rate, West Virginia’s supposed rate of 55.7 percent was based on only 209 examinations. It is impossible to draw meaningful conclusions based on the data Stiles compiled, but it is clear that the disease remained an ongoing problem. “What the figures for 1929 mean to the ‘old timer,’” Stiles wrote, “the one point they are intended to illustrate, is that hookworm infection is still widespread geographically in the Southern States.”33 Despite their best efforts, the RSC, the IHB, the PHS, and state and local health departments had not fully conquered hookworm by the 1930s. A study of hookworm infection in schoolchildren living in five East Texas counties during 1933 and 1934, for instance, found that 33.9 percent of students were infected.34

Beginning in late 1933, the Civil Works Administration embarked on a large-scale privy-building campaign. The effort was continued first by FERA and then by the Works Progress Administration. Over the course of the 1930s, the works programs constructed and distributed hundreds of thousands of sanitary privies.35 Quantifying the impact of this program, however, is difficult. As a cause of death, hookworm disease was minor. Reliable information on cases or infection rates is not available. The best available evidence suggests that the prevalence of hookworm disease was greatly diminished by the end of the 1930s, but also that the disease persisted on a small scale. As late as 1969, South Carolina senator Ernest “Fritz” Hollings would receive condemnation and the epithet “Hookworm Hollings” when he brought attention the presence of hookworm in the South Carolina low country during a “hunger tour” of the state.36

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