M Hi everyone, It's me Josh and for this week's s Y s K Selecta, I've chosen a rather peculiar episode that peaks in on a strange and fascinating quirk of nature and geography that changed the course of history. A lot of the sciences and humanities are covered here, and it is a gross episode, but it's also engrossing, so please enjoy this one on hookworms and the South. Welcome to Stuff you should know, a production of I Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W Chuck Bryant, There's Jerry Rowland. She goes, she just ran away after nine years. I knew that would happen eventually. Yep. She had her little bendel sack over her shoulder and she's barefoot, which is dangerous. Jerry, that was a nice little set up. Yeah, you might get uh, what do you call it, the do itch? Yeah? Or well that's the best one, the ground itch do, which is way better than ground get a little discomfort in the webbing between your toes, a little scratchy. Maybe a few days later you're like, this is this athlete's foot? No, that doesn't make you cough. Yeah. Plus, you're no athlete. Don't flatter yourself, that's what they would say. And then you start coughing a little bit, and a few weeks after that, you're just a big dope that can't lift an arm. Do you go stand up and do anything? You have hookworm? Yeah? Uh, well, there you have it. Were you told as a child like you'll get worms? And you're gonna ask me that because I grew up in the South, Well no, I mean I was told that too. I don't remember hearing this stuff. I remember being scared about uh, scoliosis, and I remember being scared about nuclear annihilation and so as I um, and that's about it. Razors and apples at Halloween, yeah, which is as we've covered, not true. Any instance that happened to that happened because of the urban legend not gi uh No, I've never really heard of this. And what made you think of this? By the way, I don't know you like the parasites. I love parasites. They're interesting, especially this particular parasite, because it turns out the hookworm might be the most interesting of all of the parasitic worms here on planet Earth. If you ask me. Well, agreed, because, as you will see, the social context in the Southern United States of what the hookworm meant over centuries never knew about it, and it's pretty astounding. And as someone who has long had to defend the South as not just a backward place with a bunch of dumb yokels, I'm just gonna from now on, I'm just gonna say, hookworm. Look it up. Listen to our episode, and people right now are going, what in the world. So let's well, let's get into it. Let's remove their the fog of curiosity and maybe irritation a little bit and start talking about hookworms. Right, so we said you it starts with your foot. Yeah, these are round worms. Yes, they're a type of round worm, a nematode right, yeah, nematode phyle um um. They're pretty young, about four million years old. And uh, they have been described in this article you set most commonly as a as far as the way they look as a tube within a tube like a pair of socks. And then at one right at and in they have cutting plates also called fangs or teeth. Mouthparts, yeah, mouth parts, and as Tracy Wilson would put it, and um they use those things for sucking blood. So what they want it's your blood because they get nutrients from your blood and that makes them parasites. Yeah, and they as as we sourced a few really great articles on this. But um as one of them points out to that a good parasite or a good hookworm doesn't want to kill you because, as it says in this article, that means the ride is over, right exactly. They want to keep you alive and lazy so they can just keep reproducing and keep sucking on your blood forever and ever and ever. And in a very large part, fookworms have covalved with humans, and they've done so in a way that they get the maximum benefit out of infecting a human um without the pitfall of killing the human and ending the ride for themselves. Right. So um and they've had four hundred million years to do it. And there's two kinds of hookworms. Mainly, there's tons of hookworms. Like from what I understand, just about every animal. Every mammal has its own type of hookworm, but they don't infect cross animal typically. And there's two types of hookworms that infects humans specifically, there's the New World hookworm naricatur Americana is very open minded. And then there's the old word world hookworm uh and solostoma duodenale minded right, and so both of them thrive in warmer tropical ish climates and the an AMERICANUS in particular loves sandy, loamy soil. And it just so happens that in the America in south has just the kind of climate to host an American it's and it's around. Yeah, so here's what happens. We were kind of kidding around about Jerry walking around barefoot. But Jerry's old like me, and she grew up in the South. We were all we all come from sharecroppers and uh had outhouses. So here's what would happen um all the way up until like which is kind of distressing. Yeah, I thought so too. You could walk around barefoot, as uh Southern children were wanted to do. Yeah. Apparently the chances of your of being a kid with shoes, especially in the rural South, was like next to nothing up until that maybe the fifties or sixties. Really yeah, Uh, so they would like we talked about the do uh the do it? She would walk around barefoot. These little guys would get between your toes, uh, root into your body through the feet, make their way to the blood vessels and start the voyage to the lungs. This is it's a fantastic voyage. Well for them it is. Yeah. Um, it's like inner space. Yeah um, up through the lungs, finally through the circulatory system to the lungs where eventually, like you said, you then you cough it up with a dry cough and then you swallow it into your gut and the intestine. And that's when it's like, this is where I wanted to be all along. And the nuts they go up through the foot circulatory system to the lungs, make you cough, then you swallow them and then they finally get to the place where they're supposed to be, the small intestine, and they latch on and they start sucking blood. Yeah. And hookworms are interesting tape worms or hermaphroditic, but hookworms, like a lot of around worms. Uh, they need to do it. Yeah, I was about to say they like to who knows, maybe a little bit both depending on the mood. They have to in order to reproduce. So what you do is they get into that into ston they find a lover. They take a lover. Excuse me, Robert Lamb in here, they take a lover and then they attach theirselves to the intestinal wall and say, I'm here forever. I'm gonna I mean up to I've seen up to thirty thousand eggs a day. Right, the female will will lay thirty thousand fertilized eggs a day. Right, And that's on the highest end. But you know, let's say the low end is ten thousand, and say the low end is a thousand. It's still a lot of eggs. And that's just one female worm. Right, you can have dozens hundreds of these things. They found that um, the a human can host up to about five hundred worms and survive. You're not living a very fulfilling life, as we'll see, but um, you you could have a number of these worms all pumping out eggs and the worm typically lives between one and five years in the comforts of your gut. And they in um, you can also be reinfected. And here's how right, So when the females are spreading out a thousand to thirty thousand eggs, take your pick. On a daily basis, you're pooping those eggs out and if you're pooping in say, like uh like by the bushes or in some sort of like outhouse. Yeah, it's eighteen seventy five in West Virginia. You don't have indoor plumbing, right, and let's say your outhouse isn't all that great, or you're just again pooping in the bushes. You are probably not wearing shoes. Those two things usually go hand in hand. And so you're stepping in your old fecal material that's still had eggs in it before those eggs have since hatched into larva. Larva gone through the first two larval stages, entered the third infective larval stage, and now it's crawling up into your foot again, and you're what's called worm burden is expanded even further from one or two to ten to twenty two up to hundreds. Yeah, and that's if you just accidentally step in old pooh, whether it's like spread around by animals walking around or by the rain. Um, the chances of are exponentially more. If you have a good old fashioned poop slinging fight. Sure, you you know you don't want to get hit in the mouth, but oh my god, UM, the other problem that um well, it was part of the problem was that, uh, that was the second version of that even was that people were using poop as fertilizer. Now it's one thing again you can't really catch I'm sure you can catch some worms. I know trick gnosis is a problem for humans and that's a pork worm um. But you you using say, horse manure is relatively safe compared to using human manure as fertilizer in your field. That's a relatively recent discovery. People were using human manure as fertilizer for very, very very long time, and it was called night soil because at night, the guys would come out and clean your your privy out and walk the muck, your poop, your FeCO material down the street and collect more and collect more, and then they would turn it into fertilizer. Would say, release the night soil right before they dumped it exactly, and it would be fertilizer and it'd be great to make a crops grow, but it also just contaminate your entire field with hookworms. And then little kids would go out and work the field shoeless and they would become infected from that too. So there were all these really great opportunities for people to become infected by hookworms by but there the hookworm habitat followed a certain a certain line from about West Virginia down to I think East Texas. Uh, and beneath that line that was the hookworm belt. And above it they used human manure for fertilizer too, but they didn't have hookworm. It was in the South that the hookworm was a problem, and it was a big problem, it turned out. Yeah, it just occurred to me. We walked right past maybe the best band name of all time in here, what worm burden? Oh yeah, Wormbirds is pretty good. Um. All right, well that's the setup, uh before we hit you with a social context. So let's take a little break here and we'll talk a little bit more about my old kinfolk right after this. Alright, so before we broke, we talked about what the hookworm is and all the different, uh myriad ways which it could spread, from accidentally walking in poop to poop slanging fights, night soil nights released the night soil rolling in it to ultimate rotically increase your worm burden. Um. So you found this great article called how a worm gave the South a bad name by a woman named Rachel Newer. Um, it's on Nova. Yeah, it was really good, and she is from the South and kind of wrote it from that point of view. Um, and I get the feeling like, like me, she kind of his long head to defend the American South as Hey, we're not a bunch of dumb, lazy yokels. Because that was you know, for a long time, um, and still continuing today to a certain degree. Yeah, that notion kind of exists that if you're from the South, you're kind of slow, you may be a little dim witted, you may be lazy. And this was you know, for white folks, Black folks, Native Americans, just something about the South made you lazy and dumb, especially among the lower socioeconomic classes. And this wasn't just like off the cuff um stereotyping. It was rooted in fact, in reality, there was something different about people of a of the lower socioeconomic classes in the South. Specifically, if you put them side by side among the same socioeconomic classes of the North, the ones in the North would be like, let's shovel some cold baby, and the ones in the South would be like, I'm just gonna lay here down next to my wheelbarrow because I can't I can't get up. And so Southerners were came to be seen as lazy, shiftless, couldn't be trusted to do an honest day's work, and they just thought it was part of the Southern character. Yeah. And this wasn't just um a perception, like they literally lagged behind the North in terms of productivity, um economic development. Uh. And we'll you know, we'll talk about some of these statistics as we go. Well, Plus the Civil War didn't help anything either. Well, Now, that was obviously a big setback, right, so it would have buried in the South, and it would have been for any region right at level of devastation and um um death. But coupled with their already predisposition to this, that what what came to be called the lazy germ Uh it was, it just set it back even further. Yeah. And at one point in the American South up to fort amazingly of the population, like you said, from southeastern Texas to West Virginia and all the way down, um was infected with hookworm. Yes, that's a lot of people. I mean, it's obviously not a majority, almost a majority that would have it would have been a dumb Southerner. I mean, that's a lot of folks. It is a lot of folks, And that was the culprit mind this lazy shiftlessness among the poverty stricken Southern poor and the rural. The poverty stricken, rural Southern poor was apparently the majority of the South from the end of the Civil War up until the I believe the mid nineteen or mid twentieth century. Um, you were if you were a Southerner, it was likely that you were poor and did not live in the city until about the forties. And there's a pretty clear demarcation line if you did if you were wealthy in the South, or you were lived in the city in the South in the nineteenth and early twentieth century, you wore shoes, you had bed pans um, and you could probably avoid this. But if you didn't like those are they It says in this article that it was almost impossible to avoid if you were poor and lived in the South, because you also didn't have very good sanitation. No, you were just was just perfectly set up for you to keep getting reinfected. Um. You know, every couple of years you shed a dead hookworm. But in that time, you probably would have taken on several more. All right, so what does this mean if you get hookworm, like we said, it's it's likely not going to directly kill you. Uh, you might die from a common cold. Um, you might die from malaria or typhoid fever, or you know, something else may ultimately take you out because your body is so weakened. But what it does in large part is it causes an iron deficiency. Yeah, if you're a pregnant woman or a kid, iron deficiency is really bad. Um, if you're a child, you need that iron for your brain development. So you know, not only would you get like physical symptoms like stomach bloat. Uh what what was the the I thing? Like this? The dull, fishy stair fishy i'd stare. Yeah, just sort of like they're basically described these kids just sort of vacant, right, just staring off into space. Um. So you know some of those are physical symptoms, but others were literally like a lower i Q. Right. And so they believe that an Americans came over as a result of the Atlantic slave trade, that it was imported from Africa. So for centuries, generations of kids, Um, we're being born in the South who had there, Um, they were physically and developmentally stunted by hookworm infections. Yeah. Sometimes girls wouldn't begin menstruation. Boys a lot of times would not even hit their growth spurts. And not only where they had lower i q s and learning, uh, you know, development disabilities, but they were smaller and weaker. Yeah, and then you combine this loss of blood. So so apparently about a hundred worms in a in a normal adult will drink about a teaspoon a day, which doesn't sound like that much. But if you couple it that level of iron deficiency with uh, pre existing malnourishment due to poverty or the lack of availability of like good food, Uh, then it really becomes a huge problem. And it goes from like this is a problem to this is this is a catastrophic problem that can keep an entire region of a country down productive productively. Yeah. And it uh like a lot of disease we've talked about, whether it's like famine or lack of clean water. It's it's cyclical in nature, so it would occur where there was poverty, and then it would keep people from working to work their way out of poverty. And it just kind of compounded on each other. Right, and then think about slavery as well. Right, So, not only have you been brought over to the US as a slave, you're being forced to work against your will in these horrific conditions. You're also being forced to work and live in the same conditions that promotes hookworm. So you're feeling lazy and shiftless. Ts for you you're a slave. Add that to your toil and misery, right, you know, I could just it just keeps getting worse. All right, So I think we've made it clear, big problem in the South, but again, no one had any idea why. Yeah, it was just you know, the lazy South, and it's you know, people have said that it literally set the South back like decades and decades from the rest of the country. No one knows what's going on. Until nineteen o two, this dude came along and they should be kind of a weird movie to market, but this would be a good movie. I think the story of Charles Styles and hookworm, it's a big roller coaster, right all right, So, uh, nineteen o two, this guy named Charles Styles comes along. He's a zoologist from from New York, city, educated in Europe, no less, so he played real well in the South yeah, which, as you'll see, it was a bit of part of the problem. Uh. And the Department of Agriculture said, hey, we need you to help these farmers down there keep their animals healthy. So go down there and check things out. And he was like he started to notice. He's like, something's going on. These people are physically stunted. They're a little off. Yeah, they're mentally stunted. And I don't think they're just dumb and lazy. So he started apparently he sounds like one of these guys that was just had to get to the bottom of it something, you know, Like he wouldn't just say, you know, oh well everyone's right about how it is down here. So he really stuck to his instinct and realized that it was hookworm. Yeah. He literally was the guy who discovered that that was the problem exactly. I think he um he did that by analyzing stool samples. So he basically just hung around men's rooms. He said like, you're going to use that, and they'd say, no, have at it. He just I was educating by the way, exactly, and the people would just walk away all right, is that I went down. I don't know how it went down. I looked, Actually, this guy is not the most celebrated person to ever save an entire region from an infection. Um so, there's not I didn't find a lot of background information on him in particular. Um So, I have no idea how it happened. I saw somewhere that said that he became accidentally infected, and that's how he understood. Didn't see it backed up anywhere else. I have no idea how this man came to say moment right, because again, you gotta you have to be trading in fecal material here. So like this guy had his hands on human poop at some point, right, or thought to look there? I'm not sure. Maybe he was in a good old fashioned poop slang. Inte. It makes the most sense that he was. He's like something's on to god, Oh it's a worm. Uh. The point is, though he was not well received, local doctors didn't want to hear it. They would listen. They dismissed him as you know, this this carpetbag in Yankee from Europe, who you know, educated in Europe, who's down here telling us, you know, he's he's an animal expert, and he's telling us about our poop making us lazy. Yeah, crazy Europe your animal expert. Yeah. They really didn't listen to him much. So he was like, fine, I'll just go to John de rock Feller and tell him I'm going to tell on you. That's basically what happened. Yeah, Rockefeller was this is at the time when income inequality was about at the levels it was now, and the wealthy industrialists of the age were really really worried that they were going to have the social order overthrown by angry people, so they invented philanthropy. Right. Yeah, this is back when they worried about that kind of thing, right, And Rockefeller said, well, we can't just we can't do anything to actually support the problems that capitalism creates, because then we'll just be drawing attention to the fact that there are major problems with capitalist system. What else can I support? And he heard about Styles, and Styles took a meeting with Rockefeller and some of his his higher up friends, and apparently at that meeting they closed the deal, like we're funding this thing with the million bucks right out of the gate, which is about twenty six million today and they set up the Rockefeller Sanitary Commission for the Eradication of hookworm disease. That's right. But um, despite the fact that they were trying to help Southerners, um, not only with a medical issue, but to advance themselves as a people. Um again, the Southerners A they didn't want a light being shown on this problem because it's gross, uh, and it has a stigma. But they didn't want um again. They didn't want these Yankees coming down there and saying they can fix you, you know. And Rockefeller said t s. He said, I've got an oyster edition named after me, maybe the best oyster dish besides raw. I'm glad you said that. Uh. Should we take a break? Yeah, all right, we're gonna come back and talk a little bit about the road to eradication right after this whom in your body food, don't do you good woman, your body and your food, don't do your Lona around up, come in a night name and we're back and Chuck, we had a not just a jingle that was a real blues song. Yeah, people are like, man, somebody really made an authentic old blues sounding jingle just for this episode. No, that was the legendary Blind Blake with his song Hookworm Blues, which was a real song about the hookworm blues. And I think blind Blake came up with that song in nineteen six, I believe. And the fact that he is singing about hookworms um starting in the nineteen twenties represents, or it just goes to show, like how much progress was made between the time the Rockefeller Sanitary Commission was set up and blind Blake had his number one hit, his number one and in between that time for for promoting this idea that there was such thing as hookworm and that it was a real problem. Because when the Rockefeller Sanitary Commission was set up in nineteen nine, the South was still in face clean the groups of reconstruction. It wasn't the reconstruction era anymore is the Jim Crow South, but it was still really far behind as a result of the war, and there were not a lot of public services available. So one thing the rock Feller Sanitary Commission had going for it was money, and then it was going to be money invested in public health, all right, So this is how they went about it. Uh, it's nine. And like you said, they Rockefeller donated a million bucks, which is how much today? It's pretty good. Um, And they realized, well, I don't assume this was kind of a purposeful move, um that they got a Southerner on board to kind of help lead the charge. Definitely. Um. This person named Wickliff Rose, great name. If there's a hero of this story, it's him. If you asked me, you think so not what's his face? No? Styles? Yeah, alright, I mean he did some great work. It was good. But Whyecliffe Rose was the one who uh Wyecliffe. That's how I pronounced that he was the one who made it happen, because because Styles could have discovered hookworm all day long, but if he didn't have the personality to write cure people, then it doesn't really help. So this would be Matthew McConaughey then in the movie. Yeah so and and Paul Giamatti And this is McConaughey coming in now. Uh So, they get this southerner east from Nashville on board to run the organization. And they had this approach where they would go to a town that they would go to a town in the South with these doctors. But before they did that, they would start this um campaign like an awareness campaign, um in schools to get and as I think we've talked about in other things, you get the kids on board in schools, and they kind of helped get the parents on board, and they started this campaign to tell children about what's going on, and the kids would in turn hopefully go home and tell their parents like, you know, my pa, I ain't dumb, I got the hookworm. Look my poop is wiggling away exactly, and um it was you know, they had a challenge in front of him because, um, you know, you gotta poop in a bag or something and give it to your teacher. Your teacher and entire schools, these one room schoolhouses were infected. And this this one kid they talked to later on said, uh, well he was a kid at the time. Well yeah, he was scared, Like he said, he had constipation for a week. He didn't want to like you didn't want to have hookworm. I don't want my teacher to know me in this way. Yeah, pretty much school sample. Um boy, never mind. But that was but that was the whole setup, right, yeah, I mean like there was there was there was a public information campaign that was part of it. There was community involvement. That was a really big thing that ay Cliff Rose started. He said, we can't do this without the support of the local community. So they built networks with like doctors and local health boards. They got the schools involved, um, and it became a community thing, right. Yeah. So once you have the public on board, they would set up these clinics, um not permanent, these kind of temporary clinics, and they would it was kind of a big deal in the town. It said that they would treat it like an event and people would bring picnics. I don't know that's a wise thing to do at a hookworm clinic, but they would bring picnics. And it says in here that they some people even wanted to get married in the hookworm tent, and I was like, that seems weird and kind of like kitchy. But then I also was like, I bet a lot of these people have never seen the tent before, so they were like one chance to stay. Yeah, yeah, can we get married in the hookworm tent? And so um, there'd be this public information campaign leading up to the day of the hookworm Day you can just call it, and right young a young doctor would ride into town on horseback and he had a microscope and everything he would. Um, there was a couple of parts to it. There was, um, the sanitation lecture, which was, here's how you guys are getting hookworm. Here's how you build what's called the sanitary privy. Yeah, like they couldn't give him indoor plumbing, but they could at least teach them how to have a nice enough out house, right, And there's some very very simple principle. One is like don't don't dig your latrine down until you hit groundwater, don't let it go out into the stream, make sure animals can't get into it, and like spread it around a good door, make sure your feet aren't standing in the same pit that you're pooping in. It's really basic stuff. But like that was a big part of it, right, Um. And then also explaining how the infection process worked. Right, So because they understood very early on, um that yes, you can get rid of hook worms fairly easily, but you can also get reinfected fairly easy. So they had to get that part across as well. Yeah, and like again, you can't buy everyone's shoes, but you can say maybe don't play near the outhouse. You gotta stop the poop slinging fights all together. Yeah, they just have to be gone the thing in the past. That's the number one thing. They're part of the salad days. And then this the sample analysis would begin, and the poor doctor would just look with his microscope at each poop sample and say past fail, pass fail, well, and if the bag was vibrating, they didn't even have to look. Yeah, like that that cheese in Sardinia. I think that with the maggots, the maggot cheese. Didn't we talk about a maggot episode. Surely we did. We're both so um. If you were found to be infected with worms, you would get very simple um pharmaceutical treatment, really simple. Yeah. There's this extraordinarily toxic stuff called thyme all yeah t H Y M O L Yeah. And it would kill your worms. Yeah, and it could also kill you if you took it with the wrong combination of foods or and or alcoholic beverages. You wanted to avoid alcohol and fats and oils on the day you took it. And then you would follow your dose of thyme all with epsom salt, which were to remove the thyme all from your body. Yeah, and uh, they said at some point, you know what, that stuff is super toxic, so why don't we replace that with something called carbon tectric chloride um That must be much better? Now, it was also very lethal, I guess. I just you know, at the time didn't have anything that wasn't also dangerous to take, right, And that did the trick and the fact that the EPSOM salt would get rid of it I think helped quite a bit. Yeah, So the great end of this story would be if the Rockefeller's money was well spent and five to ten years later they eradicated hookworm in the South. But that didn't happen. Um. It was successful in a lot of ways. Awareness kind of be in the chief way, but as we said a few times, reinfection is kind of the biggest problem. Like they might have gotten rid of a lot of hookworm, only you know, to have these kids who couldn't help but have their poop slanging fights, uh, and then get hookworm all over again. Exactly. And so but if you go and read the Rockefeller's um the Rockefeller Foundations um rundown of that program, they basically say it was this one guy who lobbied hard to like just move on. Whatever it was. Somebody from the Rockefeller founder said, we're done with this. We've done our work right. And they had, like you said, in a certain way, they had set up some of the earliest public health networks in the South. They had convinced the South that there was such thing as hookworm and that it was a big problem, and that if they were able to get rid of it, they could um catch up to the rest of the country. And they said, now the local doctors, now the local health clinics can take over from here. But again, yeah, it wasn't until the forties that that hookworm really started to be eradicated, and it had very little to do with the pharmaceutical treatments. It was the fact that indoor plumbing became prevalent or I mean it was literally like better food, better plumbing, more shoes. The end of share cropping, which was a type of um agricultural system that kept people poor and kept people in the fields. So it was it kept the same unsanitary conditions for hookworm infection right there. What did you call it when they would dump the poop night soil? Yeah, no more night soil dumping. Uh. Mechanization started and it was kind of a combination of all these Just the mo dternization of the American South is really what ended it. Um. And you know, the proof is kind of in the pudding in that today in conditions similar to the American South a hundred years ago plus in other parts of the world, it's still a really big problem. It is a really problem, apparently something like I saw up to um. In this article The War on Hookworms by Andy Borrowitz, he says that up to something like seven hundred and forty million people around the world are thought to have hookworm infections, right, Yeah, about forty fifty million of which are pregnant women, which is you know, obviously one of the uh, one of the worst. Like we said, kids and pregnant women is one of the worst kind of people to get to end the saddest, right and uh, mainly because it increases your chances of dying during childbirth because of anemia. Right. Um. So it is a huge problem around the world. There's there there's this kind of moniker for um hookworm infection along with certain other infections. They're lumped together under the umbrella of neglected tropical diseases. And the reason they're called that is because this is stuff that like you can easily get rid of if you alleviate poverty in the the developing world. But we're not doing that, and it's out of neglect basically. Yeah, it's not. It's not the kind of thing where you can just invent the vaccine and it's gone again because of the reinfection, because these people are still poor and still in those conditions. Um, we're talking at some of the highest rates are Sierra Leone, Democratic Republic of Congo, Nigeria, Ethiopia, India, Venezuela, Indonesia. UM. Also interestingly, UM, China in Brazil, which kind of surprised me. Yeah, well it's the same thing as like the South back in the day, where you have very very um or well off urban areas and very very very poor rural areas. Same thing in parts of China and Brazil today. Yeah, and I think another reason, UM, at least this article you sent kind of makes the argument that it's uh still a problem. In fact, since nine it's declined globally by just five Yes, despite the fact that something like four hundred and fifty million people have been treated for hookworm, But that declines it's only gone down five percent. And all what that's saying is as long as there's the unsanitary conditions, there's going to be hookworm, right, So we have to alleviate the unsanitary conditions, and you do that by alleviating poverty. And there's a group of of foundations like the Bill and Melinda Gates Foundation, World Health Organization, they've gotten together to create this End seven program and that's they're trying to end seven of the neglected tropical diseases by and hookworm is one of them. And there's treatments, there's it's really easy to get rid of hookworm. There's actually a couple of ironic treatments for hookworm. One medication for getting rid of hookworm UM prevents the hookworms from creating a t P, which is like an energy source, so they become lethargic and die, just like they make you lethargic. The other medication, UM attaches the to the hookworms intestines and prevents the hookworm from absorbing nutrients, so they die of malnourishment, just like they make people malnourished. I don't know if it's ironic or if they're like, we're going to get these things back, you know. So, like I was saying a minute ago, part of the big problem uh with eradicating this is that it's not, um, it's not a big news item. Like you know, a lot like Ebola comes along, it grabs all the news and all of a sudden you have a lot of funding. Um, hookworm isn't you know. I don't want to say a sexy disease because that's gross, but it's not. It's kind of just off forgotten, and so they don't have a lot of funding. I'm glad that gates Is are involved because that, you know, that makes it much more high profile. But um, you know, it's still a big, big issue, and uh hopefully you know this will help raise a little bit of awareness. Sure well, if if hookworm is eradecated by twenty we'll have played a rather large role in that. Uh. But now we have a final twist. Yeah, there's this really great quote from the sixties from a Rockefeller um parasitic worm specialist who said that, um, we needed the eventual helmntic defaundation of man saying getting rid of worms from the human race entirely right. And he said that for only in a society made up of parasite free individuals. Well, we know of what the human being is capable. Basically saying like, we have no idea how much we're being held act as a as an entire race, Yeah, by worms, So we need to get rid of them. But there's this growing body of research, chuck that's showing that we actually need to be infected by hookworms. It looks like, well, if it can potentially treat a few types of disease. UM, I don't. I wouldn't say that humans need it, but right now there's some experimental research going on and specific to hookworms, it seems that it might help asthma. Okay, Um, there are other worms that they're using that could help with everything from ulstra to colitis, to Crohn's disease to multiple sclerosis. But when it comes to the little hookworm, they think, um, it might help asthma. Uh. They're not experimenting on humans yet the United States, I don't think. I think only in the United Kingdom right now are they using this in humans. Um. But because it's hookworm, that side effects are basically all the things we've been talking about. Um, you know, every everything bad about the hookworm is going to happen to you. Right. The thinking behind it though, because that makes zero sense, Like why would that help is that for some reason worm parasitic worms prevent the human immune system from going overboard somehow, right, and that the reason why we have autoimmune diseases like multiple sclerosis or um Crohn's disease are because of a lack of parasitic worms in our bodies. Because we've eradicated them. So now these other diseases that are autoimmune diseases have been able to rise. So it kind of is a like you said, a weird little twist. Yeah, we'll see. I mean right now, they're mainly working in mice and rats. Um. But like anytime you're working with mice and rats, it's can't exactly extrapolate that onto humans. So we shall see, it's only one way to find out for you, and I volunteer. Well they you know, I did see some experiments not for this, but um, when they were doing hookworm experiments period, they would infect people with hookworm and you know volunteers. Yeah, and again, I mean like, it's not like a hookworm's gonna kill you. And if you are not going to get reinfected because you wear shoes and use like a toilet with running water. Um, it's sure. Why not you do it for science and money? Yes? Are you got anything else? I do not what we want to recommend the articles how a Worm gave the South Bad Name by Rachel Newer and war on Hookworms from Andy Borrowitz. They're both well worth reading. Uh and Uh, since I said they're well worth reading, it's time for listening to mail. All right, I'm gonna call this uh follow up from a very sweet couple I met at the airport. I think I talked about them after our one I think the Midwestern Tour UM or No, no, no, it was Louisiana New Orleans show. I met this very nice couple who had been to the show. Um. They were I think one of our more veteran and wise UM listeners and show attendee's. They were wonderful. Uh, and they stopped me in the airport. We talked for a little bit, and this is from them. Hey, Chuck, I wanted to follow up after the show in New Orleans. We talked to you at the airport while we were waiting for our flight back to Minneapolis. You were very gracious talking to us when we had clearly interrupted you on your way to do or get something, probably head to poop. We told you our new hobby was going and following you guys around the country. Uh, and making vacations that out of your shows on tour, remember that, m But we haven't made it to a live show since. Um, we haven't done a lot of shows since it. Uh, that's true. Well, we've done a handful. We've both been slacking both parties. Yes, but we're gonna hit the road for some shows later this year, by the way, Uh, stay tuned for that. So you and Josh did, however, inspire us in our new venture. We started a podcast just before we left to drive to Alaska, and May Joyce, who is the lady in the couple, UM, downloaded a bunch of podcasts on how to make a podcast. By the time we got back to Minnesota, we were well on our way to starting Tall Tales and Travel, our podcast about adventures in the outdoors. Uh. Lair and I don't know if it's l A R R E. And I can't remember if it was Lair or Larry Layers probably short for Larry. Maybe it was short for Lawrence, so it's doubly short. I'm gonna call him Lair just l Uh. He has decades worth of stories which have mostly taken place in Alaska. He's been a bush pilot, charter boat captain, a police officer, and general outdoorsman to name a few adventure settings. Yeah, that's a layer. If I've ever heard on Lair. It does most of the talking and Joyce does most of the behind the scenes tasks. It's a division of labor that we've mastered over the last thirty odd years together. We have a website, Tall Tales and travel dot Com where we post photos and videos from Lair's huge archive. Now that we're up and running, we'll be putting more work into sorting and sharing the collection more regularly. By the way, we used square space. Thanks for the tip. Nice anyway, guys, were just writing into thank you for the inspiration to let you know that we haven't given up on seeing you live again. We're going to keep our ears open and here we're stuff you should know will be up next. Plan an adventure to see you there. All the best that is Joyce Olsen and Lair Broward and again check it out at um Tall Tales and Travel dot com or at Tall Tales and Travel dot libson l I B s y N dot com and they were just really sweet and nice and supportive. And the notion that these bowl in their retirement would follow us around the country just kind of knock my socks off. Yeah. So I haven't listened to show yet because it just came in, but I'm going to give it a whirl. Yeah, thanks you guys, and congratulations. It's pretty awesome. Um and uh, I guess if we've inspired you, like Joyce and Lair to do something neat, let us know about it. You can tweet to us at s y s K podcast. You can join us on Facebook dot com slash Stuff you Should Know. You could send us an email. This stuff podcast at how Stuff Works dot com and has always joined us at our home on the web with Stuff you Should Know dot com. Stuff you Should Know is a production of I Heart Radio. For more podcasts my Heart Radio, visit the I Heart Radio app, Apple Podcasts, or wherever you listen to your favorite shows.

M Hi everyone, It's me Josh and for this week's s Y s K Selecta, I've chosen a rather peculiar episode that peaks in on a strange and fascinating quirk of nature and geography that changed the course of history. A lot of the sciences and humanities are covered here, and it is a gross episode, but it's also engrossing, so please enjoy this one on hookworms and the South. Welcome to Stuff you should know, a production of I Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W Chuck Bryant, There's Jerry Rowland. She goes, she just ran away after nine years. I knew that would happen eventually. Yep. She had her little bendel sack over her shoulder and she's barefoot, which is dangerous. Jerry, that was a nice little set up. Yeah, you might get uh, what do you call it, the do itch? Yeah? Or well that's the best one, the ground itch do, which is way better than ground get a little discomfort in the webbing between your toes, a little scratchy. Maybe a few days later you're like, this is this athlete's foot? No, that doesn't make you cough. Yeah. Plus, you're no athlete. Don't flatter yourself, that's what they would say. And then you start coughing a little bit, and a few weeks after that, you're just a big dope that can't lift an arm. Do you go stand up and do anything? You have hookworm? Yeah? Uh, well, there you have it. Were you told as a child like you'll get worms? And you're gonna ask me that because I grew up in the South, Well no, I mean I was told that too. I don't remember hearing this stuff. I remember being scared about uh, scoliosis, and I remember being scared about nuclear annihilation and so as I um, and that's about it. Razors and apples at Halloween, yeah, which is as we've covered, not true. Any instance that happened to that happened because of the urban legend not gi uh No, I've never really heard of this. And what made you think of this? By the way, I don't know you like the parasites. I love parasites. They're interesting, especially this particular parasite, because it turns out the hookworm might be the most interesting of all of the parasitic worms here on planet Earth. If you ask me. Well, agreed, because, as you will see, the social context in the Southern United States of what the hookworm meant over centuries never knew about it, and it's pretty astounding. And as someone who has long had to defend the South as not just a backward place with a bunch of dumb yokels, I'm just gonna from now on, I'm just gonna say, hookworm. Look it up. Listen to our episode, and people right now are going, what in the world. So let's well, let's get into it. Let's remove their the fog of curiosity and maybe irritation a little bit and start talking about hookworms. Right, so we said you it starts with your foot. Yeah, these are round worms. Yes, they're a type of round worm, a nematode right, yeah, nematode phyle um um. They're pretty young, about four million years old. And uh, they have been described in this article you set most commonly as a as far as the way they look as a tube within a tube like a pair of socks. And then at one right at and in they have cutting plates also called fangs or teeth. Mouthparts, yeah, mouth parts, and as Tracy Wilson would put it, and um they use those things for sucking blood. So what they want it's your blood because they get nutrients from your blood and that makes them parasites. Yeah, and they as as we sourced a few really great articles on this. But um as one of them points out to that a good parasite or a good hookworm doesn't want to kill you because, as it says in this article, that means the ride is over, right exactly. They want to keep you alive and lazy so they can just keep reproducing and keep sucking on your blood forever and ever and ever. And in a very large part, fookworms have covalved with humans, and they've done so in a way that they get the maximum benefit out of infecting a human um without the pitfall of killing the human and ending the ride for themselves. Right. So um and they've had four hundred million years to do it. And there's two kinds of hookworms. Mainly, there's tons of hookworms. Like from what I understand, just about every animal. Every mammal has its own type of hookworm, but they don't infect cross animal typically. And there's two types of hookworms that infects humans specifically, there's the New World hookworm naricatur Americana is very open minded. And then there's the old word world hookworm uh and solostoma duodenale minded right, and so both of them thrive in warmer tropical ish climates and the an AMERICANUS in particular loves sandy, loamy soil. And it just so happens that in the America in south has just the kind of climate to host an American it's and it's around. Yeah, so here's what happens. We were kind of kidding around about Jerry walking around barefoot. But Jerry's old like me, and she grew up in the South. We were all we all come from sharecroppers and uh had outhouses. So here's what would happen um all the way up until like which is kind of distressing. Yeah, I thought so too. You could walk around barefoot, as uh Southern children were wanted to do. Yeah. Apparently the chances of your of being a kid with shoes, especially in the rural South, was like next to nothing up until that maybe the fifties or sixties. Really yeah, Uh, so they would like we talked about the do uh the do it? She would walk around barefoot. These little guys would get between your toes, uh, root into your body through the feet, make their way to the blood vessels and start the voyage to the lungs. This is it's a fantastic voyage. Well for them it is. Yeah. Um, it's like inner space. Yeah um, up through the lungs, finally through the circulatory system to the lungs where eventually, like you said, you then you cough it up with a dry cough and then you swallow it into your gut and the intestine. And that's when it's like, this is where I wanted to be all along. And the nuts they go up through the foot circulatory system to the lungs, make you cough, then you swallow them and then they finally get to the place where they're supposed to be, the small intestine, and they latch on and they start sucking blood. Yeah. And hookworms are interesting tape worms or hermaphroditic, but hookworms, like a lot of around worms. Uh, they need to do it. Yeah, I was about to say they like to who knows, maybe a little bit both depending on the mood. They have to in order to reproduce. So what you do is they get into that into ston they find a lover. They take a lover. Excuse me, Robert Lamb in here, they take a lover and then they attach theirselves to the intestinal wall and say, I'm here forever. I'm gonna I mean up to I've seen up to thirty thousand eggs a day. Right, the female will will lay thirty thousand fertilized eggs a day. Right, And that's on the highest end. But you know, let's say the low end is ten thousand, and say the low end is a thousand. It's still a lot of eggs. And that's just one female worm. Right, you can have dozens hundreds of these things. They found that um, the a human can host up to about five hundred worms and survive. You're not living a very fulfilling life, as we'll see, but um, you you could have a number of these worms all pumping out eggs and the worm typically lives between one and five years in the comforts of your gut. And they in um, you can also be reinfected. And here's how right, So when the females are spreading out a thousand to thirty thousand eggs, take your pick. On a daily basis, you're pooping those eggs out and if you're pooping in say, like uh like by the bushes or in some sort of like outhouse. Yeah, it's eighteen seventy five in West Virginia. You don't have indoor plumbing, right, and let's say your outhouse isn't all that great, or you're just again pooping in the bushes. You are probably not wearing shoes. Those two things usually go hand in hand. And so you're stepping in your old fecal material that's still had eggs in it before those eggs have since hatched into larva. Larva gone through the first two larval stages, entered the third infective larval stage, and now it's crawling up into your foot again, and you're what's called worm burden is expanded even further from one or two to ten to twenty two up to hundreds. Yeah, and that's if you just accidentally step in old pooh, whether it's like spread around by animals walking around or by the rain. Um, the chances of are exponentially more. If you have a good old fashioned poop slinging fight. Sure, you you know you don't want to get hit in the mouth, but oh my god, UM, the other problem that um well, it was part of the problem was that, uh, that was the second version of that even was that people were using poop as fertilizer. Now it's one thing again you can't really catch I'm sure you can catch some worms. I know trick gnosis is a problem for humans and that's a pork worm um. But you you using say, horse manure is relatively safe compared to using human manure as fertilizer in your field. That's a relatively recent discovery. People were using human manure as fertilizer for very, very very long time, and it was called night soil because at night, the guys would come out and clean your your privy out and walk the muck, your poop, your FeCO material down the street and collect more and collect more, and then they would turn it into fertilizer. Would say, release the night soil right before they dumped it exactly, and it would be fertilizer and it'd be great to make a crops grow, but it also just contaminate your entire field with hookworms. And then little kids would go out and work the field shoeless and they would become infected from that too. So there were all these really great opportunities for people to become infected by hookworms by but there the hookworm habitat followed a certain a certain line from about West Virginia down to I think East Texas. Uh, and beneath that line that was the hookworm belt. And above it they used human manure for fertilizer too, but they didn't have hookworm. It was in the South that the hookworm was a problem, and it was a big problem, it turned out. Yeah, it just occurred to me. We walked right past maybe the best band name of all time in here, what worm burden? Oh yeah, Wormbirds is pretty good. Um. All right, well that's the setup, uh before we hit you with a social context. So let's take a little break here and we'll talk a little bit more about my old kinfolk right after this. Alright, so before we broke, we talked about what the hookworm is and all the different, uh myriad ways which it could spread, from accidentally walking in poop to poop slanging fights, night soil nights released the night soil rolling in it to ultimate rotically increase your worm burden. Um. So you found this great article called how a worm gave the South a bad name by a woman named Rachel Newer. Um, it's on Nova. Yeah, it was really good, and she is from the South and kind of wrote it from that point of view. Um, and I get the feeling like, like me, she kind of his long head to defend the American South as Hey, we're not a bunch of dumb, lazy yokels. Because that was you know, for a long time, um, and still continuing today to a certain degree. Yeah, that notion kind of exists that if you're from the South, you're kind of slow, you may be a little dim witted, you may be lazy. And this was you know, for white folks, Black folks, Native Americans, just something about the South made you lazy and dumb, especially among the lower socioeconomic classes. And this wasn't just like off the cuff um stereotyping. It was rooted in fact, in reality, there was something different about people of a of the lower socioeconomic classes in the South. Specifically, if you put them side by side among the same socioeconomic classes of the North, the ones in the North would be like, let's shovel some cold baby, and the ones in the South would be like, I'm just gonna lay here down next to my wheelbarrow because I can't I can't get up. And so Southerners were came to be seen as lazy, shiftless, couldn't be trusted to do an honest day's work, and they just thought it was part of the Southern character. Yeah. And this wasn't just um a perception, like they literally lagged behind the North in terms of productivity, um economic development. Uh. And we'll you know, we'll talk about some of these statistics as we go. Well, Plus the Civil War didn't help anything either. Well, Now, that was obviously a big setback, right, so it would have buried in the South, and it would have been for any region right at level of devastation and um um death. But coupled with their already predisposition to this, that what what came to be called the lazy germ Uh it was, it just set it back even further. Yeah. And at one point in the American South up to fort amazingly of the population, like you said, from southeastern Texas to West Virginia and all the way down, um was infected with hookworm. Yes, that's a lot of people. I mean, it's obviously not a majority, almost a majority that would have it would have been a dumb Southerner. I mean, that's a lot of folks. It is a lot of folks, And that was the culprit mind this lazy shiftlessness among the poverty stricken Southern poor and the rural. The poverty stricken, rural Southern poor was apparently the majority of the South from the end of the Civil War up until the I believe the mid nineteen or mid twentieth century. Um, you were if you were a Southerner, it was likely that you were poor and did not live in the city until about the forties. And there's a pretty clear demarcation line if you did if you were wealthy in the South, or you were lived in the city in the South in the nineteenth and early twentieth century, you wore shoes, you had bed pans um, and you could probably avoid this. But if you didn't like those are they It says in this article that it was almost impossible to avoid if you were poor and lived in the South, because you also didn't have very good sanitation. No, you were just was just perfectly set up for you to keep getting reinfected. Um. You know, every couple of years you shed a dead hookworm. But in that time, you probably would have taken on several more. All right, so what does this mean if you get hookworm, like we said, it's it's likely not going to directly kill you. Uh, you might die from a common cold. Um, you might die from malaria or typhoid fever, or you know, something else may ultimately take you out because your body is so weakened. But what it does in large part is it causes an iron deficiency. Yeah, if you're a pregnant woman or a kid, iron deficiency is really bad. Um, if you're a child, you need that iron for your brain development. So you know, not only would you get like physical symptoms like stomach bloat. Uh what what was the the I thing? Like this? The dull, fishy stair fishy i'd stare. Yeah, just sort of like they're basically described these kids just sort of vacant, right, just staring off into space. Um. So you know some of those are physical symptoms, but others were literally like a lower i Q. Right. And so they believe that an Americans came over as a result of the Atlantic slave trade, that it was imported from Africa. So for centuries, generations of kids, Um, we're being born in the South who had there, Um, they were physically and developmentally stunted by hookworm infections. Yeah. Sometimes girls wouldn't begin menstruation. Boys a lot of times would not even hit their growth spurts. And not only where they had lower i q s and learning, uh, you know, development disabilities, but they were smaller and weaker. Yeah, and then you combine this loss of blood. So so apparently about a hundred worms in a in a normal adult will drink about a teaspoon a day, which doesn't sound like that much. But if you couple it that level of iron deficiency with uh, pre existing malnourishment due to poverty or the lack of availability of like good food, Uh, then it really becomes a huge problem. And it goes from like this is a problem to this is this is a catastrophic problem that can keep an entire region of a country down productive productively. Yeah. And it uh like a lot of disease we've talked about, whether it's like famine or lack of clean water. It's it's cyclical in nature, so it would occur where there was poverty, and then it would keep people from working to work their way out of poverty. And it just kind of compounded on each other. Right, and then think about slavery as well. Right, So, not only have you been brought over to the US as a slave, you're being forced to work against your will in these horrific conditions. You're also being forced to work and live in the same conditions that promotes hookworm. So you're feeling lazy and shiftless. Ts for you you're a slave. Add that to your toil and misery, right, you know, I could just it just keeps getting worse. All right, So I think we've made it clear, big problem in the South, but again, no one had any idea why. Yeah, it was just you know, the lazy South, and it's you know, people have said that it literally set the South back like decades and decades from the rest of the country. No one knows what's going on. Until nineteen o two, this dude came along and they should be kind of a weird movie to market, but this would be a good movie. I think the story of Charles Styles and hookworm, it's a big roller coaster, right all right, So, uh, nineteen o two, this guy named Charles Styles comes along. He's a zoologist from from New York, city, educated in Europe, no less, so he played real well in the South yeah, which, as you'll see, it was a bit of part of the problem. Uh. And the Department of Agriculture said, hey, we need you to help these farmers down there keep their animals healthy. So go down there and check things out. And he was like he started to notice. He's like, something's going on. These people are physically stunted. They're a little off. Yeah, they're mentally stunted. And I don't think they're just dumb and lazy. So he started apparently he sounds like one of these guys that was just had to get to the bottom of it something, you know, Like he wouldn't just say, you know, oh well everyone's right about how it is down here. So he really stuck to his instinct and realized that it was hookworm. Yeah. He literally was the guy who discovered that that was the problem exactly. I think he um he did that by analyzing stool samples. So he basically just hung around men's rooms. He said like, you're going to use that, and they'd say, no, have at it. He just I was educating by the way, exactly, and the people would just walk away all right, is that I went down. I don't know how it went down. I looked, Actually, this guy is not the most celebrated person to ever save an entire region from an infection. Um so, there's not I didn't find a lot of background information on him in particular. Um So, I have no idea how it happened. I saw somewhere that said that he became accidentally infected, and that's how he understood. Didn't see it backed up anywhere else. I have no idea how this man came to say moment right, because again, you gotta you have to be trading in fecal material here. So like this guy had his hands on human poop at some point, right, or thought to look there? I'm not sure. Maybe he was in a good old fashioned poop slang. Inte. It makes the most sense that he was. He's like something's on to god, Oh it's a worm. Uh. The point is, though he was not well received, local doctors didn't want to hear it. They would listen. They dismissed him as you know, this this carpetbag in Yankee from Europe, who you know, educated in Europe, who's down here telling us, you know, he's he's an animal expert, and he's telling us about our poop making us lazy. Yeah, crazy Europe your animal expert. Yeah. They really didn't listen to him much. So he was like, fine, I'll just go to John de rock Feller and tell him I'm going to tell on you. That's basically what happened. Yeah, Rockefeller was this is at the time when income inequality was about at the levels it was now, and the wealthy industrialists of the age were really really worried that they were going to have the social order overthrown by angry people, so they invented philanthropy. Right. Yeah, this is back when they worried about that kind of thing, right, And Rockefeller said, well, we can't just we can't do anything to actually support the problems that capitalism creates, because then we'll just be drawing attention to the fact that there are major problems with capitalist system. What else can I support? And he heard about Styles, and Styles took a meeting with Rockefeller and some of his his higher up friends, and apparently at that meeting they closed the deal, like we're funding this thing with the million bucks right out of the gate, which is about twenty six million today and they set up the Rockefeller Sanitary Commission for the Eradication of hookworm disease. That's right. But um, despite the fact that they were trying to help Southerners, um, not only with a medical issue, but to advance themselves as a people. Um again, the Southerners A they didn't want a light being shown on this problem because it's gross, uh, and it has a stigma. But they didn't want um again. They didn't want these Yankees coming down there and saying they can fix you, you know. And Rockefeller said t s. He said, I've got an oyster edition named after me, maybe the best oyster dish besides raw. I'm glad you said that. Uh. Should we take a break? Yeah, all right, we're gonna come back and talk a little bit about the road to eradication right after this whom in your body food, don't do you good woman, your body and your food, don't do your Lona around up, come in a night name and we're back and Chuck, we had a not just a jingle that was a real blues song. Yeah, people are like, man, somebody really made an authentic old blues sounding jingle just for this episode. No, that was the legendary Blind Blake with his song Hookworm Blues, which was a real song about the hookworm blues. And I think blind Blake came up with that song in nineteen six, I believe. And the fact that he is singing about hookworms um starting in the nineteen twenties represents, or it just goes to show, like how much progress was made between the time the Rockefeller Sanitary Commission was set up and blind Blake had his number one hit, his number one and in between that time for for promoting this idea that there was such thing as hookworm and that it was a real problem. Because when the Rockefeller Sanitary Commission was set up in nineteen nine, the South was still in face clean the groups of reconstruction. It wasn't the reconstruction era anymore is the Jim Crow South, but it was still really far behind as a result of the war, and there were not a lot of public services available. So one thing the rock Feller Sanitary Commission had going for it was money, and then it was going to be money invested in public health, all right, So this is how they went about it. Uh, it's nine. And like you said, they Rockefeller donated a million bucks, which is how much today? It's pretty good. Um, And they realized, well, I don't assume this was kind of a purposeful move, um that they got a Southerner on board to kind of help lead the charge. Definitely. Um. This person named Wickliff Rose, great name. If there's a hero of this story, it's him. If you asked me, you think so not what's his face? No? Styles? Yeah, alright, I mean he did some great work. It was good. But Whyecliffe Rose was the one who uh Wyecliffe. That's how I pronounced that he was the one who made it happen, because because Styles could have discovered hookworm all day long, but if he didn't have the personality to write cure people, then it doesn't really help. So this would be Matthew McConaughey then in the movie. Yeah so and and Paul Giamatti And this is McConaughey coming in now. Uh So, they get this southerner east from Nashville on board to run the organization. And they had this approach where they would go to a town that they would go to a town in the South with these doctors. But before they did that, they would start this um campaign like an awareness campaign, um in schools to get and as I think we've talked about in other things, you get the kids on board in schools, and they kind of helped get the parents on board, and they started this campaign to tell children about what's going on, and the kids would in turn hopefully go home and tell their parents like, you know, my pa, I ain't dumb, I got the hookworm. Look my poop is wiggling away exactly, and um it was you know, they had a challenge in front of him because, um, you know, you gotta poop in a bag or something and give it to your teacher. Your teacher and entire schools, these one room schoolhouses were infected. And this this one kid they talked to later on said, uh, well he was a kid at the time. Well yeah, he was scared, Like he said, he had constipation for a week. He didn't want to like you didn't want to have hookworm. I don't want my teacher to know me in this way. Yeah, pretty much school sample. Um boy, never mind. But that was but that was the whole setup, right, yeah, I mean like there was there was there was a public information campaign that was part of it. There was community involvement. That was a really big thing that ay Cliff Rose started. He said, we can't do this without the support of the local community. So they built networks with like doctors and local health boards. They got the schools involved, um, and it became a community thing, right. Yeah. So once you have the public on board, they would set up these clinics, um not permanent, these kind of temporary clinics, and they would it was kind of a big deal in the town. It said that they would treat it like an event and people would bring picnics. I don't know that's a wise thing to do at a hookworm clinic, but they would bring picnics. And it says in here that they some people even wanted to get married in the hookworm tent, and I was like, that seems weird and kind of like kitchy. But then I also was like, I bet a lot of these people have never seen the tent before, so they were like one chance to stay. Yeah, yeah, can we get married in the hookworm tent? And so um, there'd be this public information campaign leading up to the day of the hookworm Day you can just call it, and right young a young doctor would ride into town on horseback and he had a microscope and everything he would. Um, there was a couple of parts to it. There was, um, the sanitation lecture, which was, here's how you guys are getting hookworm. Here's how you build what's called the sanitary privy. Yeah, like they couldn't give him indoor plumbing, but they could at least teach them how to have a nice enough out house, right, And there's some very very simple principle. One is like don't don't dig your latrine down until you hit groundwater, don't let it go out into the stream, make sure animals can't get into it, and like spread it around a good door, make sure your feet aren't standing in the same pit that you're pooping in. It's really basic stuff. But like that was a big part of it, right, Um. And then also explaining how the infection process worked. Right, So because they understood very early on, um that yes, you can get rid of hook worms fairly easily, but you can also get reinfected fairly easy. So they had to get that part across as well. Yeah, and like again, you can't buy everyone's shoes, but you can say maybe don't play near the outhouse. You gotta stop the poop slinging fights all together. Yeah, they just have to be gone the thing in the past. That's the number one thing. They're part of the salad days. And then this the sample analysis would begin, and the poor doctor would just look with his microscope at each poop sample and say past fail, pass fail, well, and if the bag was vibrating, they didn't even have to look. Yeah, like that that cheese in Sardinia. I think that with the maggots, the maggot cheese. Didn't we talk about a maggot episode. Surely we did. We're both so um. If you were found to be infected with worms, you would get very simple um pharmaceutical treatment, really simple. Yeah. There's this extraordinarily toxic stuff called thyme all yeah t H Y M O L Yeah. And it would kill your worms. Yeah, and it could also kill you if you took it with the wrong combination of foods or and or alcoholic beverages. You wanted to avoid alcohol and fats and oils on the day you took it. And then you would follow your dose of thyme all with epsom salt, which were to remove the thyme all from your body. Yeah, and uh, they said at some point, you know what, that stuff is super toxic, so why don't we replace that with something called carbon tectric chloride um That must be much better? Now, it was also very lethal, I guess. I just you know, at the time didn't have anything that wasn't also dangerous to take, right, And that did the trick and the fact that the EPSOM salt would get rid of it I think helped quite a bit. Yeah, So the great end of this story would be if the Rockefeller's money was well spent and five to ten years later they eradicated hookworm in the South. But that didn't happen. Um. It was successful in a lot of ways. Awareness kind of be in the chief way, but as we said a few times, reinfection is kind of the biggest problem. Like they might have gotten rid of a lot of hookworm, only you know, to have these kids who couldn't help but have their poop slanging fights, uh, and then get hookworm all over again. Exactly. And so but if you go and read the Rockefeller's um the Rockefeller Foundations um rundown of that program, they basically say it was this one guy who lobbied hard to like just move on. Whatever it was. Somebody from the Rockefeller founder said, we're done with this. We've done our work right. And they had, like you said, in a certain way, they had set up some of the earliest public health networks in the South. They had convinced the South that there was such thing as hookworm and that it was a big problem, and that if they were able to get rid of it, they could um catch up to the rest of the country. And they said, now the local doctors, now the local health clinics can take over from here. But again, yeah, it wasn't until the forties that that hookworm really started to be eradicated, and it had very little to do with the pharmaceutical treatments. It was the fact that indoor plumbing became prevalent or I mean it was literally like better food, better plumbing, more shoes. The end of share cropping, which was a type of um agricultural system that kept people poor and kept people in the fields. So it was it kept the same unsanitary conditions for hookworm infection right there. What did you call it when they would dump the poop night soil? Yeah, no more night soil dumping. Uh. Mechanization started and it was kind of a combination of all these Just the mo dternization of the American South is really what ended it. Um. And you know, the proof is kind of in the pudding in that today in conditions similar to the American South a hundred years ago plus in other parts of the world, it's still a really big problem. It is a really problem, apparently something like I saw up to um. In this article The War on Hookworms by Andy Borrowitz, he says that up to something like seven hundred and forty million people around the world are thought to have hookworm infections, right, Yeah, about forty fifty million of which are pregnant women, which is you know, obviously one of the uh, one of the worst. Like we said, kids and pregnant women is one of the worst kind of people to get to end the saddest, right and uh, mainly because it increases your chances of dying during childbirth because of anemia. Right. Um. So it is a huge problem around the world. There's there there's this kind of moniker for um hookworm infection along with certain other infections. They're lumped together under the umbrella of neglected tropical diseases. And the reason they're called that is because this is stuff that like you can easily get rid of if you alleviate poverty in the the developing world. But we're not doing that, and it's out of neglect basically. Yeah, it's not. It's not the kind of thing where you can just invent the vaccine and it's gone again because of the reinfection, because these people are still poor and still in those conditions. Um, we're talking at some of the highest rates are Sierra Leone, Democratic Republic of Congo, Nigeria, Ethiopia, India, Venezuela, Indonesia. UM. Also interestingly, UM, China in Brazil, which kind of surprised me. Yeah, well it's the same thing as like the South back in the day, where you have very very um or well off urban areas and very very very poor rural areas. Same thing in parts of China and Brazil today. Yeah, and I think another reason, UM, at least this article you sent kind of makes the argument that it's uh still a problem. In fact, since nine it's declined globally by just five Yes, despite the fact that something like four hundred and fifty million people have been treated for hookworm, But that declines it's only gone down five percent. And all what that's saying is as long as there's the unsanitary conditions, there's going to be hookworm, right, So we have to alleviate the unsanitary conditions, and you do that by alleviating poverty. And there's a group of of foundations like the Bill and Melinda Gates Foundation, World Health Organization, they've gotten together to create this End seven program and that's they're trying to end seven of the neglected tropical diseases by and hookworm is one of them. And there's treatments, there's it's really easy to get rid of hookworm. There's actually a couple of ironic treatments for hookworm. One medication for getting rid of hookworm UM prevents the hookworms from creating a t P, which is like an energy source, so they become lethargic and die, just like they make you lethargic. The other medication, UM attaches the to the hookworms intestines and prevents the hookworm from absorbing nutrients, so they die of malnourishment, just like they make people malnourished. I don't know if it's ironic or if they're like, we're going to get these things back, you know. So, like I was saying a minute ago, part of the big problem uh with eradicating this is that it's not, um, it's not a big news item. Like you know, a lot like Ebola comes along, it grabs all the news and all of a sudden you have a lot of funding. Um, hookworm isn't you know. I don't want to say a sexy disease because that's gross, but it's not. It's kind of just off forgotten, and so they don't have a lot of funding. I'm glad that gates Is are involved because that, you know, that makes it much more high profile. But um, you know, it's still a big, big issue, and uh hopefully you know this will help raise a little bit of awareness. Sure well, if if hookworm is eradecated by twenty we'll have played a rather large role in that. Uh. But now we have a final twist. Yeah, there's this really great quote from the sixties from a Rockefeller um parasitic worm specialist who said that, um, we needed the eventual helmntic defaundation of man saying getting rid of worms from the human race entirely right. And he said that for only in a society made up of parasite free individuals. Well, we know of what the human being is capable. Basically saying like, we have no idea how much we're being held act as a as an entire race, Yeah, by worms, So we need to get rid of them. But there's this growing body of research, chuck that's showing that we actually need to be infected by hookworms. It looks like, well, if it can potentially treat a few types of disease. UM, I don't. I wouldn't say that humans need it, but right now there's some experimental research going on and specific to hookworms, it seems that it might help asthma. Okay, Um, there are other worms that they're using that could help with everything from ulstra to colitis, to Crohn's disease to multiple sclerosis. But when it comes to the little hookworm, they think, um, it might help asthma. Uh. They're not experimenting on humans yet the United States, I don't think. I think only in the United Kingdom right now are they using this in humans. Um. But because it's hookworm, that side effects are basically all the things we've been talking about. Um, you know, every everything bad about the hookworm is going to happen to you. Right. The thinking behind it though, because that makes zero sense, Like why would that help is that for some reason worm parasitic worms prevent the human immune system from going overboard somehow, right, and that the reason why we have autoimmune diseases like multiple sclerosis or um Crohn's disease are because of a lack of parasitic worms in our bodies. Because we've eradicated them. So now these other diseases that are autoimmune diseases have been able to rise. So it kind of is a like you said, a weird little twist. Yeah, we'll see. I mean right now, they're mainly working in mice and rats. Um. But like anytime you're working with mice and rats, it's can't exactly extrapolate that onto humans. So we shall see, it's only one way to find out for you, and I volunteer. Well they you know, I did see some experiments not for this, but um, when they were doing hookworm experiments period, they would infect people with hookworm and you know volunteers. Yeah, and again, I mean like, it's not like a hookworm's gonna kill you. And if you are not going to get reinfected because you wear shoes and use like a toilet with running water. Um, it's sure. Why not you do it for science and money? Yes? Are you got anything else? I do not what we want to recommend the articles how a Worm gave the South Bad Name by Rachel Newer and war on Hookworms from Andy Borrowitz. They're both well worth reading. Uh and Uh, since I said they're well worth reading, it's time for listening to mail. All right, I'm gonna call this uh follow up from a very sweet couple I met at the airport. I think I talked about them after our one I think the Midwestern Tour UM or No, no, no, it was Louisiana New Orleans show. I met this very nice couple who had been to the show. Um. They were I think one of our more veteran and wise UM listeners and show attendee's. They were wonderful. Uh, and they stopped me in the airport. We talked for a little bit, and this is from them. Hey, Chuck, I wanted to follow up after the show in New Orleans. We talked to you at the airport while we were waiting for our flight back to Minneapolis. You were very gracious talking to us when we had clearly interrupted you on your way to do or get something, probably head to poop. We told you our new hobby was going and following you guys around the country. Uh, and making vacations that out of your shows on tour, remember that, m But we haven't made it to a live show since. Um, we haven't done a lot of shows since it. Uh, that's true. Well, we've done a handful. We've both been slacking both parties. Yes, but we're gonna hit the road for some shows later this year, by the way, Uh, stay tuned for that. So you and Josh did, however, inspire us in our new venture. We started a podcast just before we left to drive to Alaska, and May Joyce, who is the lady in the couple, UM, downloaded a bunch of podcasts on how to make a podcast. By the time we got back to Minnesota, we were well on our way to starting Tall Tales and Travel, our podcast about adventures in the outdoors. Uh. Lair and I don't know if it's l A R R E. And I can't remember if it was Lair or Larry Layers probably short for Larry. Maybe it was short for Lawrence, so it's doubly short. I'm gonna call him Lair just l Uh. He has decades worth of stories which have mostly taken place in Alaska. He's been a bush pilot, charter boat captain, a police officer, and general outdoorsman to name a few adventure settings. Yeah, that's a layer. If I've ever heard on Lair. It does most of the talking and Joyce does most of the behind the scenes tasks. It's a division of labor that we've mastered over the last thirty odd years together. We have a website, Tall Tales and travel dot Com where we post photos and videos from Lair's huge archive. Now that we're up and running, we'll be putting more work into sorting and sharing the collection more regularly. By the way, we used square space. Thanks for the tip. Nice anyway, guys, were just writing into thank you for the inspiration to let you know that we haven't given up on seeing you live again. We're going to keep our ears open and here we're stuff you should know will be up next. Plan an adventure to see you there. All the best that is Joyce Olsen and Lair Broward and again check it out at um Tall Tales and Travel dot com or at Tall Tales and Travel dot libson l I B s y N dot com and they were just really sweet and nice and supportive. And the notion that these bowl in their retirement would follow us around the country just kind of knock my socks off. Yeah. So I haven't listened to show yet because it just came in, but I'm going to give it a whirl. Yeah, thanks you guys, and congratulations. It's pretty awesome. Um and uh, I guess if we've inspired you, like Joyce and Lair to do something neat, let us know about it. You can tweet to us at s y s K podcast. You can join us on Facebook dot com slash Stuff you Should Know. You could send us an email. This stuff podcast at how Stuff Works dot com and has always joined us at our home on the web with Stuff you Should Know dot com. Stuff you Should Know is a production of I Heart Radio. 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