Rockefeller Sanitary Commission Research Articles

How the Struggle for Public Health in the Jim Crow South Reflected and Reinforced Systemic Racial Health Inequality

Abstract The twenty-first century COVID-19 epidemic revealed a U.S. public health system that countenanced health inequities and a U.S. public that resisted disease containment policies. This crisis, however, was only the most recent chapter in a longer struggle in the United States to institutionalize public health. We focus on two early twentieth-century public health campaigns in the American South, the unhealthiest U.S. region at the time. Black southerners—denied basic health, political, economic, and social rights under a rising Jim Crow regime—self-organized health services networks, including through the Tuskegee Woman’s Club, the Negro Organization Society of Virginia, and the Moveable School (1890s–1915). Around the same time, a philanthropic project, the Rockefeller Sanitary Commission (RSC, 1909–1914), seeded state-level public health agencies in eleven southern states, thereby installing public health in a top-down manner. We use archival data sources to explore key similarities and differences in the public health concerns and coalition-building approaches of each campaign and southern resistance to their efforts. We find Black-led campaigns often blurred the color line to form coalitions that provided services to the underserved while tackling environmental health risks at the community level. In contrast, RSC affiliates in southern states, as directed by RSC administrators, provided health services as short-term public dispensaries. Services reached Black and White communities willing to participate but in a manner that did not overtly challenge Jim Crow-era practices. Southern resistance to public health expansion persisted under each approach. The legacies of these struggles remain; the political-economic and ideological forces that limited public health expansion while marginalizing Black community health efforts reverberate in public health inequities today.

Helminth Infections in Children.

Helminth Infections in Children.

Rural health in the Progressive Era: revisiting the hookworm intervention in the American South.

Objective: In this study, we investigated Progressive Era public health interventions and connected two subsequent efforts to improve outcomes in the American South: the Rockefeller Sanitary Commission's hookworm eradication efforts in the early 1910s and investments in local health infrastructure between the 1910s and the 1930s. We tested whether hookworm eradication had the largest effects in areas that invested in public health and whether county health organizations-cooperative public-private institutional arrangements-impacted the Rockefeller Sanitary Commission program's success. Materials and Methods: The methods used to measure the effects involved estimation of difference-in-difference and triple-difference models across the geographic samples of the Rockefeller Sanitary Commission's surveyed area, the American South, and the United States. Material on hookworm infection rates and activities by the Rockefeller Sanitary Commission is obtained from the Rockefeller Foundation Annual Reports. Material on the activities, spending, and duration of the different county health organizations is obtained from the Public Health Service Bulletin 222 titled, "A history of county health organizations in the United States: 1908-1933". Results: By comparing similar cooperative and independent county health organizations in the American South with the rest of the United States, we find that cooperative efforts are generally important and strengthen the Rockefeller Sanitary Commission's impact on human capital outcomes in the American South. Simultaneously, independent county health organizations produced negative or non-significant effects. Conclusion: The Rockefeller Sanitary Commission is important in guiding local health efforts. Our results are robust in both the short and long runs. This study sheds light on the effectiveness of public-private partnerships in rural public health during the Progressive Era.

The public communication of science: Angular stone of the rockefeller Sanitary Commission for the Eradication of Hookworm Disease

Abstract This work is part of a larger research project in which we try to identify and examine the communication, outreach, and scientific education strategies that Rockefeller philanthropic initiatives carried out in the southern US during their first stages. The principal objective of this paper is to identify the importance and some of the main innovations of the Public Communication of Science (PCS) made by the Rockefeller Sanitary Commission for the Eradication of Hookworm (RSC) during its five years of life. We present a brief history of the RSC where we highlight the influence that its first Administrative Secretary, Wickliffe Rose, had on its constitution and development as well as the basic elements of its public health communication programs; and the role that education played in the eradication of hookworm. Subsequently, we identify and describe the main public communication of science activities behind the program, with special emphasis on the innovations used to demonstrate, to an incredulous audience, the existence of a parasite invisible to the eyes, as well as the best strategies to eradicate it. Before synthesizing the ideas presented and developing the final reflections, we dedicate a few words to the debate that exists regarding the originality of Rose’s proposal.

Battling Soil-Transmitted Intestinal Worm Disease: From the Hookworm Campaigns of the Rockefeller Foundation to Contemporary Mass Drug Administration

In the early twentieth century, the Rockefeller Sanitary Commission and the Rockefeller Foundation’s International Health Board (later, International Health Division) undertook campaigns in a number of world regions to treat hookworm disease and to promote ‘sanitation,’ that is, improved excreta disposal. The campaigners learned that chemical therapy would not clear all hookworm infections, and they were unable to mobilize the support of governments for the reform of open defecation practices. Some campaigns achieved successes in reducing disease, but they were discontinued in the 1920s on the understanding that sanitation programs were foundational for success in eliminating hookworm disease. In the first decade of the twentyfirst century, under the rubric of “Neglected Tropical Diseases,” global health organizations re-engaged the struggle against all three soil-transmitted helminth (STHs) infections – hookworm, roundworm, and whipworm. The new campaigners rolled out mass drug administration (MDA) programs to reduce the incidence of disease without programs to improve excreta disposal. This approach effectively ignored the lessons of the early twentieth century campaigns. Intestinal worm transmission continued, and the efficacy of the MDA programs was threatened by the emergence of helminthic drug resistance.

Hookworm Eradication as a Natural Experiment for Schooling and Voting in the American South

Educational attainment is robustly associated with greater political participation, yet the causal nature of this finding remains contested. To assess this relationship, I leverage a natural experiment in the Rockefeller Sanitary Commission’s (RSC) anti-hookworm campaign, which exogenously expanded primary and secondary education in the early-twentieth century American South. I evaluate two RSC hookworm interventions: exposure to the campaign and proportion treated. I use genetic matching to control for observable factors that influenced the haphazard dispensing of treatment, and implement new matching methods for continuous campaign interventions. I also use a variety of methods to assess the robustness of the results to a number of alternative accounts. Throughout, I find a consistent positive effect of education on participation, suggesting additional evidence for a causal interpretation of the ‘education effect’.

Commentary: Replication of influential trial helps international policy.

Commentary: Replication of influential trial helps international policy.

Hookworm Eradication as an Instrument for Schooling in the American South

I exploit an historical natural experiment to assess whether more schooling causes greater vote participation. Specifically, I leverage the Rockefeller Sanitary Commission’s (RSC) campaign to eradicate hookworm infection in the early-20th century American South as a plausibly-exogenous instrument for primary and secondary education. I evaluate three county-level interventions from the public health campaign: exposure to the campaign, proportion treated, and pre-campaign hookworm incidence. I use genetic matching to condition on factors that may have driven the haphazard way the RSC collected hookworm incidence rates and targeted counties for treatment, and develop new matching methods for continuous instruments. I then use permutation inference to assess the strength of the campaign exposure instruments, and I employ a simultaneous sensitivity analysis to evaluate robustness to any remaining bias or exclusion restriction violations. Throughout, I find a robust and positive effect of education on participation, not accounted for by other potentially non-excluded paths.

Extending public health: the Rockefeller Sanitary Commission and hookworm in the American South.

The Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (1909-1914) fielded a philanthropic public health project that had three goals: to estimate hookworm prevalence in the American South, provide treatment, and eradicate the disease. Activities covered 11 Southern states, and Rockefeller teams found that about 40% of the population surveyed was infected. However, the commission met strong resistance and lacked the time and resources to achieve universal county coverage and meet project goals. We explore how these constraints triggered project changes that systematically reshaped project operations and the characteristics of the counties surveyed and treated. We show that county selectivity reduced the project's initial potential to affect hookworm prevalence estimates, treatment, and eradication in the American South.

A Standardised Protocol for Evaluation of Anthelminthic Efficacy

A Standardised Protocol for Evaluation of Anthelminthic Efficacy

Mapping Historic Hookworm Disease Prevalence in the Southern Us, Comparing Percent Prevalence with Percent Soil Drainage Type Using GIS

Mapping of Historic US Hookworm prevalence data from the Rockefeller Sanitary Commission (early 1900s) using current GIS (Geographic Information System) software (county shape files) illustrates the extremely high prevalence of hookworm disease (Uncariasis) in the Southeastern US at the time. Some counties in 7 states recorded 50% to 100% of the population with positive screens for hookworm in a monumental surveillance and treatment campaign. Narrative descriptions mentioned higher prevalence in “sand districts” vs. “clay districts”. In order to validate this description for historic data, further GIS databases (STATSGO) were used to classify and quantify the % acreage in Eastern North Carolina falling into moderately- to well-drained soil types. These were then mapped and compared with the historic prevalence data. Most severely infested counties had at least 50% moderately to well-drained soil. Further analysis on soil data for other states with “coastal plains” could provide more background information on Environmental conditions for hookworm prevalence and distribution in US history. “Since history has no properly scientific value, its only purpose is educative. And if historians neglect to educate the public, if they fail to interest it intelligently in the past, then all their historical learning is valueless except in so far as it educates themselves”. Trevelyan, (1922).

Disease and Development: Evidence from Hookworm Eradication in the American South

This study evaluates the economic consequences of the successful eradication of hookworm disease from the American South. The hookworm-eradication campaign (c. 1910) began soon after (i) the discovery that a variety of health problems among Southerners could be attributed to the disease and (ii) the donation by John D. Rockefeller of a substantial sum to the effort. The Rockefeller Sanitary Commission (RSC) surveyed infection rates in the affected areas (eleven southern states) and found that an average of forty percent of school-aged children were infected with hookworm. The RSC then sponsored treatment and education campaigns across the region. Follow-up studies indicate that this campaign substantially reduced hookworm disease almost immediately. The sudden introduction of this treatment combines with the cross-area differences in pre-treatment infection rates to form the basis of the identification strategy. Areas with higher levels of hookworm infection prior to the RSC experienced greater increases in school enrollment, attendance, and literacy after the intervention. This result is robust to controlling for a variety of alternative factors, including differential trends across areas, changing crop prices, shifts in certain educational and health policies, and the effect of malaria eradication. No significant contemporaneous results are found for adults, who should have benefited less from the intervention owing to their substantially lower (prior) infection rates. A long-term follow-up of affected cohorts indicates a substantial gain in income that coincided with exposure to hookworm eradication. I also find evidence that eradication increased the return to schooling.

Privies, Progressivism, and Public Schools: Health Reform and Education in the Rural South, 1909-1920

NONE OF THE SOUTHERN SOCIAL REFORMS OF THE PROGRESSIVE ERA were individually more important or together more coherent than the modernization of public health and public education. The two reform movements began in similar ways: with the creation of the Southern Education Board in 1901 and, eight years later, with the establishment of the Rockefeller Sanitary Commission. I These organizations, coalitions of middle-class activists, reforming professionals, university presidents, and northern philanthropists, espoused methods practiced by progressives elsewhere: exposure and publicity, manipulation of public opinion, and bureaucratic and interventionist social policy. Historians agree that studies of health and education are central to understanding southern social reform, but they disagree about the role of Rockefeller philanthropy. 2 Some historians stress the humani

The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South

InThe Germ of Laziness, historian John Ettling tells the fascinating story of the Rockefeller Sanitary Commission, an agency founded in 1909 to combat hookworm disease in the South. Ettling tells his story with great skill and sensitivity, weaving biography and analysis into a portrait of medical science and philanthropy at the beginning of this century. Hookworm disease was epidemic in the South at that time, but few American physicians knew of its existence before Charles Wardell Stiles began his one-man crusade against it. Stiles was a highly skilled zoologist who knew Virchow socially, and who had studied under Leuckart and Pasteur at the time when the hookworm was identified and its life cycle described. After his return to the United States he became aware of how widespread the disease was in the South, especially in the sandy coastal regions; he then began to travel about with specimens and a

Ground itch and dew poison; the Rockefeller Sanitary Commission 1909-14.

Ground itch and dew poison; the Rockefeller Sanitary Commission 1909-14.

The elimination of urban yellow fever in the Americas through the eradication of Aedes aegypti.

THE CONCEPT of a disease having I individuality and being eradicable came as a logical development fairly soon after Pasteur had eradicated germs in a bottle and had begun the identification of specific bacteria as the causative agents of individual diseases. The prePasteur definition of eradicate, in Webster's Dictionary of 1864, cites the usage ; as, to eradicate disease. This refers to disease in the individual patient and not to a disease as a specific entity. The present generation of health workers is witnessing the validation of this usage, still cited in the Webster International Dictionary, 1961, with reference to the eradication of disease, as a specific separate entity. Examples of the initial enthusiasm for disease eradication include: The Bureau of Animal Industry's eradication of bovine pleuropneumonia in the United States in the last decade of the 19th century. Chapin's much quoted statement, in 1888, regarding the eradicability of tuberculosis; Ronald Ross's work in the early 1900's on the mathematical theory of malaria eradication; William C. Gorgas's declaration in 1909 that yellow fever could be eradicated; and, in the same year, the founding of the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease in the United States. The creation of the Rockefeller Foundation, in 1913, was followed by many overseas campaigns for the eradication of hookworm disease and, in 1915, by the beginning of an effort to eradicate yellow fever from the world. Hookworm disease was peculiarly difficult to eradicate and failed to disappear rapidly from any of the countries where so-called eradication programs were executed. Yellow fever disappeared from the statistics of many countries but its continued existence was dramatically proclaimed to the world when Brazil's capital, Rio de Janeiro, became reinfected in 1928. About this time, severe criticism was leveled at the Rockefeller Foundation for having foisted eradication programs -which could not be executed-on the health authorities of many countries. Eradication programs and even uni-

The Present Status of Hookworm Infection in Florida

Hookworm infection has rightly been considered the foremost parasitic problem in Florida. These parasites, introduced into the State from Africa, encountered the three requisites necessary for their propagation; equitable temperature throughout the year, ample rainfall, and sandy, well drained soil. These factors in an area where a large part of the rural population lived under poor economic conditions provided ideal opportunity for establishing a high incidence and intensity of infection.Historical Background. Hookworm infection was recognized as an important medical problem in Florida as early as 1903 (3). From January of that year until 1909, an active anti-hookworm campaign was carried to the physicians and teachers of the State by the Board of Health. Accurate diagnosis by microscopic examination of fecal material was begun in 1909. The first survey was made in 1910, just prior to the one conducted in the other southeastern states by the Rockefeller Sanitary Commission (15), later known as the International Health Board of the Rockefeller Foundation.

Intestinal Parasitism among Students of Berea College, Kentucky *

INTRODUCTION During the past quarter century, following the reports of Wood (1912) and the Rockefeller Sanitary Commission (1914, 1915), much attention has been given to the problem of human intestinal parasite infections in the southern United States, and including the more temperate regions of the Appalachian Mountains and the foothills extending east, south and west from the mountains proper, (Cort, Otto and Spindler, 1930; Otto, Cort and Keller, 1931; Otto, 1932; Otto and Cort, 1934; and Otto, 1936a). At first these studies were concerned primarily with certain helminth infections, such as hookworm, Ascaris, and Trichuris, among rural population groups. More recently, attention has also been given to the incidence of protozoan intestinal parasite infections for this same general region, and valuable data have been added by various workers (Meleney, 1930; Faust, 1930, 1931; Meleney, Bishop and Leathers, 1932; Byrd, 1936, 1937; Faust and Headlee, 1936; Swartzwelder, 1938).

Preliminary Report on Observations on the Development of Ova of Pig and Human Ascaris under Natural Conditions, and Studies of Factors Influencing Development

State laboratory reports of Alabama since 1924 show a very low infestation with Ascaris among the general population, it being less than 0.2 per cent in the lower coastal plain and approximating 3 per cent in the northern counties. Special surveys (Smillie and Augustine; Caldwell) tend to corroborate these findings. Surveys in Florida (Kerr, 1926) and the findings of the Rockefeller Sanitary Commission (1914) and the state laboratories of Georgia and South Carolina likewise indicate a low Ascaris infestation in those states. On the other hand, ascariasis constitutes a public health problem in Tennessee, North Carolina, Kentucky, and Virginia, being most prevalent in the mountain regions. In both south Alabama and west North Carolina, however, infestation among pigs approaches 50 per cent (Caldwell). In search for an explanation of this distribution, various observations were made in 1926 and 1927. To make these studies possible it was necessary to isolate ova from soils. Briefly, the method devised makes use of (1) antiformin solution to release the ova, (2) sugar solution of high specific gravity to float up the ova, and (3) a small vial to remove them from the surface. Differential counts of the varying stages of development-undeveloped, morula (early, moderate, and late), tadpole, motile, and disintegrated-in 200 to 500 ova give in a sense a quantitatively accurate picture of conditions.

THE NORTH CAROLINA CAMPAIGN AGAINST HOOKWORM DISEASE

THE NORTH CAROLINA CAMPAIGN AGAINST HOOKWORM DISEASE John A. Ferrell, Asst. Secy. CopyRight https://doi.org/10.2105/AJPH.2.4.253 Published Online: August 30, 2011