On the afternoon of January 4, 1913 in Atlanta, Georgia, an eighteen year old boy named Benton Walford appeared in court to stand trial for the ambiguous crime of “vagrancy.” For several months, Walford had jumped from job to job, and had taken to living on the streets before being brought to court. He didn’t defend himself as an officer listed the charges. He didn’t react when the judge sentenced him to thirty days in the stockade. He didn’t cry out when he was led out of court alongside “booze-fighters and gamblers.” In fact, observers noted, all the young man appeared able to do was stare forward and “gape listlessly.”
Walford’s lethargy wasn’t his fault. He wasn’t unmotivated, lazy, or willfully skirting his duties as a young man in pre-war Georgia. He was deeply ill. His body was ravaged by hookworms, a parasite that causes chronic anemia, gauntness, and fatigue in severe infections. This was lost on no one at the courthouse. Newspaper accounts of the trial casually note his infection. The judge himself specifically sentenced Walford to the stockades to “forcibly draw out...the lethargy in which the grip of hookworm had held him.”
Three blocks away from the courthouse in a makeshift clinic, six doctors spent their days diagnosing and treating hookworm infections for free. They checked for sores in between the toes of adults who complained about telltale “dew itch” and observed small fecal samples under microscopes to look for hookworm eggs. When the diagnosis was confirmed, patients were administered a very precise combination of thymol and Epsom salt to expel the worms. Patients would gradually recover; albeit those with severe childhood infections would often exhibit chronic conditions similar to malnourished children: stunted growth, a slower learning curve, and delayed puberty.
And yet, Walford wasn’t sent to these doctors. Walford wasn’t tested for infection and given the precise combination of thymol and Epsom salt that would have gradually restored his energy and drive. Walford wasn’t given the opportunity to be cured. Something else was at play in that courthouse, in which casual observers, newspaper reporters, court officers, and the judge himself all decided a month in the stockade was a more appropriate way to handle Walford’s illness than a 10 minute walk down the road to free medical care. You could even say a conspiracy was afoot.
Hookworm is a parasite that thrives in humid, warm environments and sandy soils. It enters the host usually through the soft skin between the toes, causing what is known as “ground itch” or “dew itch” - a telltale symptom of hookworm infection. The worm undergoes a complex life cycle that allows it to anchor in the intestines and feed on the host’s blood. In even moderate infections, hookworms deprive an individual of a considerable amount of blood, causing nutritional deficiency and severe anemia. Consequently, victims suffer from dramatic weight loss, stunted growth, mental underdevelopment, fatigue, and a host of other physical and mental ailments.
Hookworm was first diagnosed in humans in 1838 in Italy. By the late 19th century, most European doctors had come to recognize the symptoms of hookworm infection and had learned to treat it. Still, American doctors largely considered hookworm an old world disease. In 1902, an American-born, German-educated zoologist named Dr. Charles Stiles diagnosed human infections in the American South. What he discovered was not a unique case; hookworm infection was rampant in the South. After nearly a decade of attempting (and failing) to educate the public himself, Stiles was put in touch with the manager of John D. Rockefeller’s philanthropies. In 1909, Rockefeller pledged $1,000,000 (nearly $30M in 2020) to establish the Rockefeller Sanitary Commission (RSC) and eradicate hookworm in the South.
Stiles, Rockefeller, the RSC, and the hundreds of doctors dispersed throughout the South in the years following did not succeed. Instead, they found themselves mired in denial, violence, and rage as Southerners rose up against claims that hookworm existed, let alone caused illness. A conspiracy had gripped the South when Rockefeller and his doctors arrived. As most conspiracies go, the issues that everyone talked about - hookworm and John D. Rockefeller - covered up the underlying causes that spoke to deeper insecurities and fears.
America is no stranger to conspiracies. Most recently, it is the QAnon conspiracy that has gripped the country. In 2020, the focus of QAnon shifted to the coronavirus. Once again, we found ourselves in the middle of a medical conspiracy in which fact is thrown up against denial, violence, and rage in patterns that are notably similar to those that emerged in 1909 in the American South. Almost precisely one hundred years later, and the tactics used to deny, ridicule, and rally in the face of a medical crisis remain the same. This raises a larger question: are conspiracies even particularly unique? The distinct flavors may change year to year, culture to culture, generation to generation. But if you peel back the layers, are we really just dealing with the same ingredients? Combined in different ways throughout history to tap into the same predictable, primitive fears? Does this mean we can predict future conspiracies and start now at protecting against them? Or does it mean this effort is useless, that there is nothing we can do...that there is something immutable within us that is always susceptible to these fears?
Comparing the conspiracies surrounding hookworm and COVID across time, we find striking similarities in the narrative tactics used. In particular, we see three. First, the tendency of conspiracies to deny, downplay, and denounce the medical crisis at hand. Second, an obsession with a cabal of conspirators with secondary, ulterior motives. Third, stoking fears and doubt of treatment.
Like the QAnon and COVID conspiracies today, the primary driver of fear, doubt, and misinformation during the RSC’s presence in the American South was the media. Often, larger regional newspaper publications were pitted against small, hyper localized newspapers. The first reaction of regional newspapers to the claims that hookworm was a chronic problem in the American South was outright denial. Much of this denial was rooted in pride; specifically, the belief that the RSC’s medical crusade was a thinly veiled propaganda attempt to tarnish the South’s reputation.
Stiles’ observations about the conditions of impoverished, sickly North Carolinians was roundly denied by Governor Glenn, who determined Dr. Stiles was mistaken, for “there are no healthier, stronger or better developed men and women than can be found in the rural districts of North Carolina.” A.V. Dockery of North Carolina’s The Caucasian went further, stating plainly that Dr. Stiles had “invented” hookworm out of thin air. Such an invention, journalists reminded their readers, was just another addition in a long tradition of Northern slander. It began with Reconstruction, a period described as “fifteen years...under the domination of a...hostile people.” After barely a moment of freedom, the South suffered under an onslaught of Northern-borne conspiracy. First came accusations against child labor in the South, followed by criticisms of the region’s education, then the insistence upon the dangers of a disease known as pellagra, and finally the invention of hookworm. “It seems,” one paper lamented, “that when one story about the South wears out, some new one is started.” Exasperated and enraged, Southern media demanded that Rockefeller and the RSC “Do the South Justice'' and end the ruse.
Medical evidence, however, is difficult to refute. As RSC doctors spread across the South diagnosing and treating hookworm, it became more and more difficult for the media to uphold the conspiracy that hookworm didn’t exist at all. Soon after the RSC was announced, the discourse among Southern conspiracy theorists and their media channels shifted subtly. Outright denial was complemented and eventually replaced by an attempt to downplay the seriousness of hookworm. Sure, hookworm existed, the narrative went, but its impact was exaggerated by the North.
The overarching conspiracy of Northern propaganda to discredit the South rooted itself deeper in the Southern psyche. By using satire and ridicule as their primary tactics, Southern media simultaneously extolled Southerners’ pride in their regional identity while downplaying the impact of hookworm.
“Where was that hookworm, or ‘lazy disease,’” the Macon Telegraph asked in 1909, “when it took five Yankee soldiers to whip one Southerner?” Newspapers pointed to the hard work ethic of rural Southerners, explaining their tiredness and fatigue as a result of their honest labor, not hookworm. A newspaper from Greenwood, South Carolina published a fictional dialogue between a husband and wife in 1910, in which the wife explained that she had “cooked breakfast, washed the dishes, prepared the children...strained the new milk, churned and worked the butter, swept and dusted, done the ironing, [and] cooked dinner.” She felt so tired at the end of the day she exclaimed, “I am too tired to do my darning!...It must be hookworm!” The Greenwood article praised the rural woman for all she had achieved in just one day. Her fatigue, the newspaper insisted, resulted from her southern work ethic, not a parasite.
“Hookworm indeed!” proclaimed Dockery of The Caucasian, “they are...harmless.” Hookworm existed, but it did not explain the North’s insistence of Southern lethargy or economic stagnation. At most, a newspaper joked, it explained why one college football team “has been...steadily...scored upon, but not scoring.”
Through sarcastic quips and satire, southern newspapers achieved two goals. They voiced their opposition to the RSC by downplaying the hookworm’s seriousness and re-established regional pride that had been questioned by the Commission’s medical declarations.
Satire to defend the South, however, did not suffice for Southerners. The North had launched a conspiracy against their livelihoods, their pride, and their health. Southern media was swift to turn the narrative around on the RSC, denouncing the Northern doctors and Rockefeller himself for spending money on the South when the North itself was in dire straits.
A reporter from the South Carolina The Watchman and Southron traveled to Washington, DC in 1909 and reported, “people who have recently delighted in the fact that the hookworm disease was prevalent in the South, got a good hard jolt here today when it was reported that at least one hundred cases exist under the very shadow of the capitol dome.” Just days after the South Carolina article, The Evening Chronicle in North Carolina declared that New York City suffered from “ten times as many” cases of hookworm as the South. In particular, the newspaper insisted, hookworm affected most “the wealthy classes in the best Manhattan residence districts.” It was no coincidence that Southern media focused on Washington, D.C. and New York City. The former was the organizational seat of the RSC, the latter the hometown of Rockefeller himself.
Deny, downplay, and denounce. From 1909 to 1914, these strategies were used simultaneously by newspapers across the South to degrade the RSC’s legitimacy, cast doubt on the severity of hookworm, and bandage the wounded pride of the South.
The two most conspicuous figureheads of the RSC were Dr. Stiles and Rockefeller. Both of these figures attracted attention, criticism, and accusation from Southern conspiracists. Wrapping one’s head around a multi-generational infrastructure failure in the South to identify and address a chronic regional health condition was more difficult than focusing on the nefarious intentions of two outsiders hellbent on destroying the South.
Dr. Stiles, as the face of the campaign and a frequent presence in the dispensaries that traveled the South, was subject to ridicule and anger from Southerners. Stiles was charged with intentionally planting hookworm in the South or, worse, making it up entirely. He was endangered by those conspiracies. In his own documented recollections, Dr. Stiles recalled a lecture he gave in a small town about preventing and treating hookworm. After the presentation, the town sheriff insisted that a bodyguard accompany Stiles on his way out of town. The townspeople had been so distrustful of Stiles and the RSC that the sheriff feared for the doctor’s safety and suggested Stiles not only leave quickly, but never return to the town at all.
If Stiles was at least a known, visible figure in the South, Rockefeller was the shadowy mastermind behind the hookworm conspiracy as a whole. From the earliest days of the RSC’s presence in the South, Southern media couldn’t quite get on board with Rockefeller’s philanthropy. The worthiness of the cause aside, The Times and Democrat of South Carolina noted in 1909, “Mr. Rockefeller’s business methods have been responsible for various bad business and social conditions that have darkened the lives of many thousands of people.” South Carolina’s The Greenville News insisted to its readers that Rockefeller cared nothing for the South. His donation wasn’t a reflection of his care for the plight of Southerners, but rather a reflection of his domineering and “insatiate desire to crush something.”
People couldn’t shake the idea that Rockefeller had ulterior motives for his “donation” to the hookworm cause. They found a voice in Warren A. Candler, a Methodist Bishop from Georgia who emerged as the South’s savior in the face of Rockefeller’s invasion. If the South did not exercise caution, he warned, “Mr. Rockefeller would take charge of both our heads and our stomachs and our bowels of worms.” Rockefeller was no more than a “self appointed philanthropist” bent on creating lies about the South to “create further prejudice against the States and the people of the South”. Bishop Candler wanted Rockefeller out, and insisted the South could “certainly...take care of and...cure our hookworm, without Mr. Rockefeller’s million dollar[s].”
One of the most popular methods adopted by the RSC to address hookworm treatment was the dispensary. Dispensaries were mobile labs in which physicians and microscopists would travel to remote rural areas to conduct their campaign of education, diagnosis, and treatment. The treatment for hookworm was, at the end of the day, fairly straightforward. Under the guidance of a physician, patients would be administered a precise dosage of Epsom salt and thymol capsules in the morning before any food was eaten. Most infections were resolved with one treatment; only the most severe would require a few treatments to expel all the worms. The thymol and Epsom salt treatment, however, came with an important caveat. If administered improperly, mixed with alcohol, or taken with certain foods, the treatment could lead to death.
The risk was small. But against the backdrop of the RSC’s presence in the South, the horror stories of thymol ignited deep set fears among Southerners. Dispensaries reached far into the most rural, undeveloped regions of the South. They were a visible, tangible manifestation of Northern ‘invasion’ during a time when the Civil War was still a fresh wound in the Southern psyche. The backlash was severe, even violent. Southern media spread conspiracies that the RSC, at best, wanted to hurt Southerners and, at worst, was on a campaign to kill them under the guise of philanthropy.
One widely circulated letter in Southern media was a plea from Dr. Stiles himself for Southerners to trust the thymol treatment and follow only precise care from a physician. Stiles had learned of three compounds being sold on the market as cures for hookworm. He reached out to the editor of North Carolina’s Progressive Farmer in 1910 to “warn your readers also that the extravagant claims found in these advertised cures...are not to be believed.” The plea was distributed across Southern media, continuing to appear in publications through 1911.
In late 1909, almost a year into the RSC’s campaign, The Raleigh Times published a column begging its readers to acknowledge the scourge of hookworm and seek proper medical treatment. “The hookworm does exist” the paper felt compelled to insist to its readers. The article was published a week after Bishop Candler’s November 1909 sermon, in which he lambasted Rockefeller and cast doubt on the intentions of the RSC doctors. For their part, The Raleigh Times did not endorse Candler’s “denunciation of Mr. Rockefeller’s donation.” In their opinion, the disease was less a medical issue and more of an operational one. Money, politics, and infrastructure were getting in the way of effective diagnosis and treatment. But even The Raleigh Times acknowledged the concern about thymol: “Simply to put thymol and salts on the market, to be bought and self administered, would be to kill more people that are killed by the hookworm.” No matter where and how the Southern media talked about curing hookworm, it was tinged with doubt and fear. Behind the entire campaign was the dark and nagging worry that the RSC perhaps cared so little about the lives of Southerners as to purposefully give them a fatal treatment.
The hookworm conspiracy arose in the South following a multi-decade crisis of identity and security. The South was struggling after losing the Civil War and the economic failure of Reconstruction. The laws implemented in the postbellum South to provide opportunity for former slaves had succumbed to Jim Crow, and by 1909 the South had devolved to resemble itself in the immediate antebellum years with sharecropping replacing slavery in name only. Comparatively, the North was doing well. It was industrializing quickly, booming economically, and could point to its Southern neighbor to insist on its own social and racial enlightenment. It was in this world - one in which Southerners struggled to figure out who to blame for the latest in their societal failures - that they found scapegoats in hookworm, in the RSC, in the North, and in Rockefeller himself.
One hundred years later, and the pattern re-emerges. QAnon has arisen in post-crisis America. The economic and cultural boom of the 90s had dissolved with the dot com burst, 9/11, the Iraq War, the Great Recession, growing political polarization, and exponential global communication that exposed more people to the realities of oppressed populations at home and abroad. COVID emerged in 2020 as the latest crisis, one that threatened core beliefs in American superiority and played excellently into the hands of political division and medical misinformation. In the year since lockdowns began in the United States, we have seen the exact same narratives and patterns dominate COVID conspiracies as those employed during the hookworm health campaigns in the early 1900s. COVID conspirators have denied the existence or the origins of the virus outright. They’ve downplayed its severity through comparisons to the flu and common cold. They’ve ridiculed health workers for protesting and politicians for wearing masks. They’ve found evil scapegoats in the shadowy intentions of Bill Gates, the Clintons, and George Soros. They’ve sown doubt about vaccines and hawked questionable cures in their stead.
The modern political and media landscape no longer survives on regional newspapers and lightning rod sermons, but rather thrives on a ceaseless stream of algorithmically-delivered content. What was a regional division in the early 1900s has become a division within homes, families, companies, and social circles. In these two worlds that barely resemble each other 100 years apart, however, we reacted to a crisis in a remarkably similar way. We used the same tactics and the same patterns to sow doubt, fear, and division in the misguided effort to retain our pride, explain our reality, and lash out at our insecurities. This all begs the question: is there anything that can be done to stop this cycle?
The fate of the hookworm would suggest no.
The RSC campaign ended abruptly in 1915. A couple of decades following the RSC’s departure, hookworm was declared eradicated from the United States. In 2017, The American Journal of Tropical Medicine published a groundbreaking report. In Lowndes County, Alabama, 19 of 55 people were found to have active hookworm infections. Hookworm had left the American psyche decades prior, expelled by years of conspiracy that discredited the reality that the population was chronically ill. The conspiracists had won their battle. Beneath the ground, however, hookworm had never left.
Perhaps, like hookworm, conspiracies are just part of American soil.