Rockefeller Sanitary Commission

The Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (RSC) was a campaign that operated from 1909 until 1915 to eradicate hookworm disease (ancyclostomiasis) in the American South. It operated in eleven states: Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas and Virginia.^[1] The campaign was launched with a US$1 million donation by John D. Rockefeller "to bring about a cooperative movement of the medical profession, public health officials, boards of trade, churches, schools, the press, and other agencies for the cure and prevention of hookworm disease."^[2] Although some of the programs lasted until June 1915, the campaign ended formally in 1914 and the property and records of the Commission were transferred to the Rockefeller Foundation and the International Health Board expanded the RSC's work abroad.^[3] Offices were opened in Washington, D.C., in January 1910.

Background

Hookworm disease was one of three major diseases that had plagued the American South since the early 1800s, along with malaria and yellow fever.^[4] In the early 1900s, many people in the South lacked proper sanitary infrastructure, such as sewage and even bathrooms. In addition, poverty and the warm climate led people to walk barefooted, often on feces-contaminated soil, where they might touch hookworm larvae. When the commission was launched in 1909, over 40% of the population in 11 Southern states was infected by hookworm without any knowledge of it.^[5] According to a study, by 1910, 7.5 million Southerners had hookworms.^[6] It is also estimated that the rate of infection in children was at around 30–40%, reaching an almost 100% in the sandy coastal plain.^[6]

Strategy

The commission was under the direction of Wickliffe Rose. It had the following goals: to educate people on the spread of hookworm, to treat the infected, to encourage wearing shoes and to build sanitary outhouses.^[4] The Commission furnished the initial impetus for the public health campaign against hookworm, and furnished states with relevant information about the disease, its treatment, and its prevention.^[3] It paid the salaries of personnel, who were appointed jointly by the states and the Commission, and sponsored public education campaigns and the treatment of infected persons.^[3][7] Through health surveys, travelling dispensaries for treatment and lectures and demonstrations on disease prevention and sanitation, the RSC hoped to create a model that would convince southern states that public health issues were vitally important.^[8] The method combined widespread testing and treatment with door-to-door education in hygiene and an emphasis on public health efforts such as the building of hygienic privies at schools and churches and the requirement that children wear shoes to school.^[9] Treatment involved drinking chenopodium or thymol, both of which were poisonous to the worms, and then taking a dose of Epsom salts to remove the chemicals and the dead worms.^[9]

Legacy

The RSC treated an estimated 400,000 people across the U.S. South.^[10] By the time the commission campaign ended in 1914, hookworm was no longer a severe problem.^[9] According to follow-up studies of infection rates, the campaign succeeded in reducing massively and immediately hookworm disease.^[10] Many sufferers had been treated and cured, public awareness had increased, with resultant changes in behavior that disrupted the hookworm’s life cycle.^[9] The RSC would flourish afterward with new funding as the Rockefeller Foundation International Health Division. Following the success^[9][11] of the RSC, the International Health Division's attention was given to other diseases, including the flu, tuberculosis, typhus, and malaria.^[12]

References