A gratifying introduction to this chapter about the origin and progress of our hookworm work is afforded by some words of Dr. Charles W. Eliot, in a private letter to me, written near the climax of this work in the South.
“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. Although the mortality is not so great from this disease as from small pox, cholera, diphtheria, and the bubonic plague, get the human misery and disability it causes are probably greater in the long run than any which those somewhat spasmodic or periodic plagues occasion
The first popular knowledge of the hookworm in the United States was afforded by the humorous and sarcastic announcement of the daily papers one morning that a doctor in North Carolina had discovered “the lazy bug” in the intestines of the people of the South. Of course the yarn was received with high indignation in the always sensitive South, and a smile of amused incredulity everywhere else. Southern laziness had always been ridiculed in the North, but had charitably been attributed to the climate, not to a “bug.” Later, I saw a more serious statement to the effect that an expert on intestinal parasites, Stiles by name, employed by the government, had discovered a blood-sucking parasite in the intestines of humans, producing anemia and other physical disqualifications, and that this infection was frequent in many parts of the South. This was followed by indignant denials from Southern physicians and declared to be a libel on the South. But Dr. Stiles was not to be intimidated or put down. He offered conclusive proofs. He showed the worms, disclosed their hooks, and exhibited visually the complete cycle of their life history from the egg. Intelligent and effective magazine articles began to appear, and these I read with deep interest. My imagination began to play around the alleged devastation and suffering caused by this disease. I consulted Dr. Flexner. He had known Dr. Stiles personally many years, for Stiles had lectured regularly at Hopkins. The hookworm was well known, he said, in Europe, and Dr. Stiles was not the first to discover it in the United States. But Dr. Stiles had been the first man in our country to effectively call public attention to it, to visualize its probable distribution, and to disclose its manifold disabling results. Dr. Flexner vouched for Dr. Stiles’ ability and scientific attainments. At my request, Dr. Flexner arranged with Dr. Stiles to give me a private demonstration in my office in New York. This demonstration was entirely conclusive as to the fact of the disease. In answer to my questions, Dr. Stiles thought there were perhaps two million cases in the South, but admitted that this was a mere guess; nor had he yet surveyed the various areas of special infection, or formed a plan of eradication, or an estimate of cost. It was agreed between us that he should study further and report on all the larger aspects of the problem. These studies consumed much valuable time, but at length he was able to report that his estimate of two million cases was not exaggerated. It proved in the sequel to be an understatement. He thought that the eradication in the United States would cost Half a Million Dollars. It did cost nearly Two Millions.
I was now ready to present the matter to the Messrs. Rockefeller, Senior and Junior. They recognized the high importance of the subject and committed themselves to the needed funds for a campaign of extermination of the hookworm in the United States.
But the South was still sensitive and angry. We could do nothing effective without cordial Southern cooperation. A board of administration composed mainly of distinguished and influential Southern men must be organized. I could easily name such a board, but would they accept membership in the face of a hostile South? I made a tentative list of the men we needed, and made my plans for enlisting them. Fortunately there was about to be held at the hospitable mansion of Mr. George Foster Peabody, at Lake George, a conference of several days, on Southern education, to be attended by most of the very men on my list. I arranged with Dr. Stiles to be our guest at Lake George at the time of this conference, and to bring all the equipment for his demonstration. It was easy to persuade Mr. Peabody to set aside an evening for the stereopticon lecture of Dr. Stiles. The evening came and the effect was overwhelming. The Southern guests immediately recognized the mysterious “ground itch” of their barefoot boyhood. But their amazement knew no bounds when Stiles disclosed the previous life history of the cause of the ground itch, from the egg in the soil to the minute worm in the sole of the foot, and then its after history in the blood, until at last it fastened its poisoned fangs in the lining of the intestines where, increasing in number year by year so long as the victim went barefoot, whether child or adult, it had sometimes reached the number of five thousand in a single victim. The life cycle of a single worm had been demonstrated to be as long as twelve years.
The distinguished Southern leaders present, whom I wanted on my Board, were universally known throughout the South, and stood among the most influential. They discussed the disabling effects of this disease, vital, educational, economic, moral, and social. They saw in its eradication a new hope for the South. The world had recently been appalled by the destruction of life in the sinking of the Titanic. But at least ten Titanics full of children and youth were sunk by the fatal ravages of the hookworm every year, to say nothing of the nearly complete disablement of many times the number. Every man I wanted on my Board instantly accepted, heedless of the Southern criticism sure to come. It could not last long and in time would change to gratitude.
We organized with circumspection so as not to affront Southern sensibilities more than necessary. The headquarters should not be in New York, but in the neutral territory of the National Capital. We would drop the word Hookworm and all special reference to the South from the name of our Board, and call it the United States Sanitary Commission. Dr. Stiles had thought Half a Million Dollars would be needed, and this Mr. Rockefeller had promised me before the Lake George meeting. But to startle the South we fixed on a Million, with Mr. Rockefeller’s consent, and got the word into the headlines, and also published the names of the eminent Southern leaders on our Board. The South was not convinced, but it was silenced. Local mut- terings only continued for a time to be heard, and a few loud-mouthed cranks. We chose a Southern man, Dr. Wickliffe Rose, as Executive Secretary, a most fortunate choice, and the beginning of what has proved to be a great career.
North Carolina, then, as always since the Reconstruction days, the most progressive of the Southern states, was chosen by us as the field of our first great demonstration. Here in the sand hill region the disease was very prevalent and destructive. The state leaders were fearless and able men, and we won them all and so set to work with free hands. With great skill and tact Dr. Rose enlisted all the influential forces— men and women alike—in all the infected counties of the state. We ourselves in North Carolina alone successfully treated over six hundred thousand cases. The work was thoroughly systematized, the workers were trained scientifically, health boards were organized in every county, public funds were voted, and popular interest became intense and universal.
Meanwhile the other infected states of the South began to call for Dr. Rose and his work. In due course, every county of every state was surveyed, organizations were perfected wherever necessary, health boards were organized, and all practicing physicians were trained in the cause and cure of the disease. After seven years of intense labor, Dr. Rose and his organization, then covering the entire South, had so far exterminated the hookworm there as practically to leave the disease to local hands. His further extensive health work in the South, not being mainly concerned with the hookworm, belongs to other pages.
But of the Hookworm Campaign which forms the title of this chapter, the years in the South were not the end, but the beginning. The Hookworm Campaign became world-wide.
The eggs of the hookworm, always deposited on the soil, could not survive heavy or continuous frost. This necessarily limited the disease to the frost-line, about thirty degrees of latitude on each side of the Equator. We knew that it existed within these limits in Europe and, in mines, outside the frost-line. The disease was of great antiquity. It had been described by physicians in Egypt as early as the Pyramids. It was highly probable that within the frost limits the disease belted the globe. After consulting Mr. Rockefeller I wrote Dr. Rose, whose headquarters had remained at Washington, requesting him to make a survey of the prevalence of the disease throughout the world, and for this purpose, to use, so far as he could, the diplomatic agencies both of our own country and of all foreign countries with which we were diplomatically connected. Every agency was enlisted in the service, and he reported at length the complete confirmation of our fears. Ten hundred millions of the seventeen hundred million inhabitants of the globe lived within the area of possible infection, the amount of infection being dependent on the density of population, the nature of the soil, and the habits of the people.
After due consideration we determined to organize a new and world-wide agency to attack this and other curable or preventable disease, and to promote universal health. It seemed best to make this new organization a subordinate agency of the Rockefeller Foundation. Accordingly, I drew up, and at its next meeting presented to the Foundation, a preamble and resolutions which were duly adopted, and the work of the International Health Commission was duly organized under them. These resolutions establishing the International Health Commission were prepared by me by request as the originator of the idea of extending the Southern hookworm work to a world-wide agency for advancing the science of medicine:
“WHEREAS the Rockefeller Sanitary Commission, organized in 1909 for the eradication of Hookworm Disease in the United States, has found more than two million people in the Southern states to be infected with the disease, involving vast suffering, partial arrest of physical, mental, and moral growth, great loss of life, and noticeable decrease in economic efficiency over vast regions; and
“WHEREAS the Commission has treated or caused to be treated more than five hundred thousand persons; has ascertained that the diagnosis of the disease can be made with ease and certainty, and that it can be readily cured and easily prevented; has found that the people, physicians, state boards of health, county and municipal officers are eager to cooperate in all helpful wags, and that, following the treatment and cure of this disease, an intelligent public interest is awakened in hygiene and in modem scientific medicine and in practical measures for permanent public sanitation; and
“WHEREAS the Commission has ascertained by diligent and extensive inquiry that Hookworm Disease prevails in a belt of territory encircling the earth for thirty degrees on each side of the equator, inhabited according to current estimates by more than a thousand million people; that the infection in some nations rises to nearly ninety per cent of the entire population; that the disease has probably been an important factor in retarding the economic, social, intellectual, and moral progress of mankind; that the infection is being spread by emigration; and that where it is most severe little or nothing is being done towards its arrest or prevention; therefore it is
“RESOLVED that this Foundation is prepared to extend to other countries and people the work of eradicating Hookworm Disease as opportunity offers, and so far as practicable to follow up the treatment and cure of this disease with the establishment of agencies for the promotion of public sanitation and the spread of the knowledge of scientific medicine; and to this end, be it
“RESOLVED that this work be entrusted to a special committee to be called The International Health Commission, consisting of the members for the time being of the Executive Committee of this Foundation and such other persons, members of the Foundation or otherwise, as they may associate with themselves; and be it further “RESOLVED that The International Health Commission be authorized to adopt such policies and to employ such agencies as it may deem best adapted for the conduct of the work, and also to adopt rules and regulations for its own government and for the expenditures of such funds as shall be placed at its disposal; and
“RESOLVED that at each annual meeting of the Foundation, The International Health Commission shall report to the Foundation in detail its operations and expenditures, and shall present for approval its budget for the following year.”
A great part of the more heavily infected areas of the world belonged to the British Empire. Clearly our first work would be to enlist the English government. Fortunately, Walter Page was our Ambassador to England. He knew all about the hookworm, was highly influential with Earl Grey and other members of the Cabinet, and quite ready to lend us his influence. I suggested to Dr. Rose to get through Page, if possible, a chance to demonstrate before the English Cabinet. This was done. These enlightened statesmen quickly perceived the service the International Health Commission, with the vast financial resources of the Rockefeller Foundation behind it, was likely to be to the British Empire, and they gave Dr. Rose every possible encouragement. All other countries concerned followed in due time the English example. I cannot burden these pages with the details of the work or how widely it has taken on other diseases, like yellow fever, malaria, or how far it has endowed hospitals, medicine and medical research in many parts of the world. My last reports are that it has operated among some sixty-two peoples or more, and has proved to be the most widespread and perhaps the most important work of the Rockefeller Foundation.
The resolutions establishing the International Health Commission were drawn up in 1913. I wrote to Mr. Rockefeller, Senior, at the time, as follows:
“You have doubtless seen the preamble and resolutions—for public and private use—which I drew up for the extension of the Sanitary Commission to a world-wide work by the Foundation. I think this by far the most needful and important, as well as the most extensive public benefaction ever undertaken by man, and that it will have in the end permanent and highly beneficent results for the whole human race.”
Next Section:
Chapters In My Life 