Items summarized here:

• "Important! Hookworm Disease Treated Free," by Durham County (N.C.) Board of Commissioners
• "Free Anti-Typhoid Treatment," by unknown author
• "Fly Catechism," by the North Carolina State Board of Health
• "An Address before the Medical Society of North Carolina," by Charles E. Johnson

The first half of the twentieth century in North Carolina, and in the American South generally, saw a struggle to eradicate illnesses such as hookworm, typhoid, malaria, consumption, and cholera, which were seen as endemic to the South, due in part to sanitation concerns and living conditions in rural sections of the United States. In 1908, President Theodore Roosevelt appointed a commission to improve the conditions of farm life and to reduce the proliferation of disease. In discussing the commission, the Journal of the American Medical Association noted that "[e]very physician with even a limited knowledge of rural life knows the deplorable sanitary conditions which exist in large sections of the country. It is necessary only to refer to the aphorism 'typhoid is a rural disease' and to the wide-spread occurrence of malaria and hookworm disease in the South. In fact, the question of sanitation, important in all sections, is of paramount importance in some sections. The need is so obvious and urgent and some measure of relief, at least, so easy that this would seem to be the most tangible problem the commission could consider" (p. 848). In their article, "Social Consequence of Disease in the American South, 1900-World War II," Mike G. Martin and Margaret E. Humphreys agree with the Journal's conclusions, adding that "A deadly trio of pellagra, hookworm, and malaria enervated the poor Southerner—man, woman and child—creating a dull, weakened people ill equipped to prosper in the modern world" (p. 862).

According to a flier distributed by the Durham County [NC] Board of Commissioners titled Important! Hookworm Disease Treated Free, hookworms can cause "headache, dizziness, shortness of breath, paleness, [becoming] easily tired out in feet and legs, poor appetite for breakfast, indigestion, heartburn, stunted growth, and poor progress in school work on account of poor memory." Hookworm was especially prevalent in the South due to the "lack of proper waste disposal and a paucity of shoes," which brought "the fecal-borne larvae into frequent contact with the southern foot" (Martin and Humphreys, p. 862). More than 40% of Southerners were believed to be infected with hookworm in 1905; the condition caused severe anemia, fatigue and stunted growth (p. 862).

The Durham County flier lists a number of dates and locations for free hookworm treatment where doctors conducted dispensaries and offered lectures on the disease. Warning readers that "[t]here is a lot of Hookworm disease in your neighborhood" and that "The State and county [will] pay the bills for your examination and treatment for this short time only," the flier urges all readers, "sick or well," to visit the free clinics for information and medication. The flier suggests that understanding and treating the disease is a duty as "[p]arents who do not use this opportunity to rid their children of this dreaded disease, are standing squarely across their offspring's future, condemning them ofttimes to an early death or a life of misery, which may result in making them a public charge."

A similar flier, sponsored by the State Board of Health [NC] and the North Carolina Landowners Association and titled Free Anti-Typhoid Treatment, urges residents of Columbus County, "Both White and Colored," to come to one of many free clinics to receive anti-typhoid treatments: "Do Your Duty. Secure Free Protection for Yourself and Family. Urge Others To Do So." Arguing that treatments are "practically sure and harmless protection" against typhoid, the flier lists numerous dates, times and locations where residents can receive treatments during November 1920. The treatments, the flier argues, are necessary since in 1918-1919, North Carolina had "[t]en thousand cases of typhoid fever and one thousand deaths due to the disease," which cost the state "five million dollars."

North Carolina also relied on education to fight disease, as evidenced in Fly Catechism, a flier published by the North Carolina State Board of Health. The posting lists fourteen points concerning the fly, many phrased in question-and-answer format: "Where is the fly born? In manure and filth." The posting clearly links the fly with the spread of many diseases: "What diseases does the Fly carry? He carries typhoid fever, tuberculosis and summer complaint. How? On his wings and hairy feet. What is his correct name? Typhoid Fly." Because the fly "visit[s] the patient sick with consumption, typhoid fever, and cholera infantum," he is "man's worst pest, and more dangerous than wild beasts or rattlesnakes." The flier instructs readers to remove any filth "about the house and yard" and kill the fly whenever he is seen "[b]ecause he may kill us."

Malaria was also a common problem in the South, and in An Address before the Medical Society of North Carolina, Dr. Charles E. Johnson sought to augment the medical community's understanding of the causes of the disease. Invoking the examples of other scientists and thinkers, such as Lord Francis Bacon, Giovanna Maria Lancisi, and Sir Isaac Newton, Johnson states that doctors must "investigate with facility and scrutiny the advantages and disadvantages of all the facts and theories, which are continually coming out of the prolific laboratories of medical Philosophers" (p. 7). His greatest concern in his address is "to discuss the doctrine of the miasmatic origin of disease" generally, and specifically to claim that "marsh miasm, in the sense of an exhalation from putrescent vegetable matter, cannot be the cause of the disease [malaria]" (pp. 8, 9). Arguing against the prevailing view of the time that marsh gas led to malaria, Johnson spends the bulk of his speech offering counter claims. Included among his examples are the laborers of North Carolina who "not only work during the day in these swamps, and drink swamp water . . . but sleep in them at night, in open huts" (p. 21). These men, he claims, "are decidedly the healthiest portion of the laboring classes in those parts of the State" (p. 21). Johnson's evidence leads him to conclude that "whatever this febrific agent may be . . . it cannot be traced . . . by the presence of those conditions of moisture, heat, and vegetation, which are claimed as indispensible for its production" (p. 32). Ultimately, Johnson urges more research in order to understand the causes of malaria. His speech, like the fliers and announcements analyzed here, seeks a remedy for the diseases that plagued North Carolina during the first half of the twentieth century.

Works Consulted: Martin, Mike G. and Humphreys, Margaret E., "Social Consequence of Disease in the American South, 1900-World War II," Southern Medical Association 99.8 (Aug. 2006): 863-864; "The National Farm Commission and Rural Sanitation," Journal of the American Medical Association 300.7, 22, Aug. 1908 (reprinted 20 Aug. 2008), p. 848.

Meredith Malburne