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Epidemiology of Nematodes, Cestodes, and Trematodes 123

anemia, as it was attributed to low level of color of red made a trip through the Gulf-Atlantic states, hoping to
blood cells, and is used today for a deficiency of chloro- confirm his theory that the poor medical conditions of
phyll in plants. many of the rural inhabitants were linked to hookworm
infection.

HOOKWORM INFECTIONS IN Early Public Health Efforts
THE UNITED STATES Targeting Hookworm Infections

In 1899 an American zoologist named Charles Wardell In 1902 Stiles made a strong case for an education cam-
Stiles, who was chief of the Division of Zoology of the
paign that he thought could be quite effective if imple-
U.S. Public Health Service, reported to the Pan- American mented to completely solve the hookworm problem. So
Sanitary Congress that he had found the “germ of
after several years of effort, Stiles was appointed in 1908
laziness” and that hookworm disease was common in the by President Theodore Roosevelt to the Country Life
American South. Outdoor latrines and close proximity
Commission, a group dedicated to improving farm life. At
to contaminated soil by animals where rhabditiform lar- this time in U.S. history, farming was a way of life that oc-
vae as a noninfective stage develop into filariform larvae
cupied the majority of the population, and particularly so
are capable of infecting those coming in contact with the in the South. Through this appointment from the presi-
soil (Figure 5-4). Stiles, as a crusader for the health of
dent, Stiles met Walter Hines Page, a southern crusader
the people of the South, identified the disease commonly and journalist. Page had a working relationship with a
called “progressive pernicious anemia” as being caused
number of members of the General Education Board,
by A. duodenale. a philanthropic effort funded by industrialist John D.
But because A. duodenale is found primarily in
Rockefeller, and this coordination of a worthwhile project
northern Africa and India, the causative organism was was successful.
most likely N. americanus, although African slaves
With this impetus, John D. Rockefeller, Sr.,
could have brought the disease to the New World. bestowed a gift of one million dollars in the fall of 1909
Testing of school-age children in the 1900s revealed
to initiate an organization with a lofty title called the
very heavy infestations in the group. Stiles noticed Rockefeller Sanitary Commission for the Eradication of
that the symptoms of the hookworm disease he saw
Hookworm Disease. The result was a five-year program
in animals were similar to those of many poor Whites that proved to be a tremendous success for the public
in the rural South. Stiles and Smith traded information
health of the United States. Efforts to eradicate hook-
by continually corresponding with each other as Stiles
worms were multipronged, and included public educa-
tion, medication for those afflicted, field work to research
effective projects, and the construction of modern gov-
ernment health departments in eleven southern states.
But in the 1930s, an economically distressed period of
Source: Centers for Disease Control and Prevention (CDC) many children showed signs of hookworm due to a de-
time in the United States when the Great Depression
reared its head, public officials again found that a great

clining lifestyle.

Treatment of Hookworm
Disease

ished in the warmer climates of the southern United
States, the efforts were extended into the Caribbean na-
FIGURE 5-4 Hookworm rhabditiform larva, early, Following efforts to rid the area where hookworms flour-
noninfectious immature stage tions and into Latin America in the 1920s. The move to