A Drive for Community Health Work : The Rockefeller Sanitary Commission and Local Public Health Experts in the American South, 1909-1916

HIRATAI YumiHookworm disease, one of the diseases of laziness along with malaria and pellagra, afflicted people in the American South until the first half of the twentieth century.Some local physicians paid attention to the prevention of this endemic disease after scientists, such as Bailey Ashford and Charles Wendell Stiles, discovered the pathogen ancylostoma in the soil in the early 1900s.However, the overall indifference and unwillingness to recognize the problem by physicians and lay people made the efforts for prevention sporadic. 1The control of diseases required updated information, motivation, funds, and administrative support.Massive efforts to control hookworm disease began in 1909, when the Rockefeller Sanitary Commission (hereafter the RSC ) started its investigation in Southern states to improve people s health and to give the southern districts an incentive for establishing local public health institutions.During this five-year program, the RSC conducted infection surveys and delivered education, followed by dispensary work and, eventually, intensive community health work that also covered maladies other than hookworm disease.After the RSC dissolved in 1915, the Rockefeller Foundation (RF) continued to support community health work through the International Health Commission (IHC) until federal funds were poured into the South in the New Deal era.Controlling hookworm disease was the beginning of the institutionalization of public health apparatuses 158 158 covering the health of the local people. 2Historians have studied the conditions in which the RSC s programs and activities were conducted, and if the programs really did improve the public health administrations in the Southern states.William Link placed the philanthropic groups activities in the context of the Southern progressive movements at the turn of the twentieth century.He observed that outside reformers, who cooperated with the state officers, helped to modernize health and educational institutions in the community, though they faced strong resistance from the local traditionalists and were, therefore, compelled to revise or withdraw their initial plans. 3In the field of public health, people would generally be reluctant to accept new measures, such as changing lifestyles, much less vaccination.The chief motive of the local public health experts should have been health improvement of the local residents, however, what they thought of outside reformers-cooperators, directors, or otherwise-is not clear in Link s argument.It seems the local experts were rather passive toward the residents health improvement.Focusing on the development of public health systems in the Southern states, Cheryl Elman, Robert A. McGuire, and Barbara Wittman argued that the RSC tailored its strategy to fit the circumstances, eventually supporting progressive districts with enthusiastic local elites.They also demonstrated that not all interventions were effective, and that population size, economic stability, and local leaders attitudes influenced the results. 4This argument resonates with other historians discussions that the development of public health was closely tied with the level of political and economic modernization of the city or state. 5For example, Judith Sealander points out that public health campaigns were effective if the balance of education and enforcement worked well. 6Where public administration systems could support public health measures, philanthropic reformers were able to adjust their methods for intervention, and continue or increase its subsidy.The less developed districts did not fully utilize the help and