Historical epidemiology and global health history.

The subdiscipline of historical epidemiology holds the promise of creating a more robust and more nuanced foundation for global public health decision-making by deepening the empirical record from which we draw lessons about past interventions. This essay draws upon historical epidemiological research on three global public health campaigns to illustrate this promise: the Rockefeller Foundation's efforts to control hookworm disease (1909-c.1930), the World Health Organization's pilot projects for malaria eradication in tropical Africa (1950s-1960s), and the international efforts to shut down the transmission of Ebola virus disease during outbreaks in tropical Africa (1974-2019).

A Rockefeller Foundation health primer for US-occupied Nicaragua, 1914-1928.

The article presents views from above and below of the Rockefeller Foundation's International Health Commission's (IHC's) hookworm control program in Nicaragua from 1914 to 1928. It looks at the meaning, impact, and unique configuration of the Nicaraguan mission, while taking into account the larger global institutional project of this important international health actor. Although the IHC program in Nicaragua complemented some of the social policy goals of the US intervention in Nicaragua, which was a de facto protectorate during this period, the institution cannot be considered a direct expression or agent of US foreign policy. Ultimately the shape and limits of the IHC mission to Nicaragua were determined by the institutional project of the international public health agency itself, and by local considerations ranging from the characteristics of the staff to the response of rural communities to the anti-hookworm campaigns.

["The demon that turned into worms": the translation of public health in the British Caribbean, 1914-1920]. / "O demônio que se transformou em vermes": a tradução da saúde pública no Caribe Britânico, 1914-1920.

The earliest programs of the Rockefeller Foundation's International Health Commission - IHC were pilot projects for the treatment of hookworm disease in the British colonies of British Guiana and Trinidad. These pioneering ventures into international health have often been portrayed as governed by rigid biomedical principles. In contrast to this view, the article emphasizes the degree to which the exigencies of a public health project that sought to make biomedicine intelligible within the medical systems of subject populations combined with the knowledge of local IHC staff members of Indo-Caribbean descent to generate some fascinating experiments in ethno-medical translation. One term in particular "The Demon that Turned into Worms" is focused on to show how these efforts at medical translation may have legitimized and promoted medical pluralism.

["Doliarina and iron powder": an important medicine at Peckolt Pharmacy]. / "Pós de doliarina e ferro": um dos remédios importantes da Farmácia Peckolt.

The pharmacist Theodoro Peckolt was one of the most important figures in the history of the chemistry of natural Brazilian products. Like other nineteenth-century pharmacists in Brazil, he developed formulations and sold them at his pharmacy in Rio de Janeiro, and these enjoyed great prestige in the eyes both of the public and the medical community. The article discusses the relation between the illness originally called "opilação" (ancylostomiasis, or hookworm) and nineteenth-century treatment. It focuses especially on Peckolt Pharmacy's "Doliarina and iron powder," a formulation extracted from the Ficus gomelleira rubber plant. One of the article's goals is to use modern methods to analyze Ficus gomelleira and identify the chemical composition of the drug.

Historical epidemiology and global health history / Epidemiologia histórica e história global da saúde

Abstract The subdiscipline of historical epidemiology holds the promise of creating a more robust and more nuanced foundation for global public health decision-making by deepening the empirical record from which we draw lessons about past interventions. This essay draws upon historical epidemiological research on three global public health campaigns to illustrate this promise: the Rockefeller Foundation's efforts to control hookworm disease (1909-c.1930), the World Health Organization's pilot projects for malaria eradication in tropical Africa (1950s-1960s), and the international efforts to shut down the transmission of Ebola virus disease during outbreaks in tropical Africa (1974-2019).

Resumo A subdisciplina epidemiologia histórica se propõe a criar um alicerce robusto e refinado para o processo de tomada de decisões em saúde pública global, aprofundando registros empíricos que nos ensinam sobre intervenções passadas. Este artigo se baseia na pesquisa epidemiológica histórica de três campanhas globais de saúde pública para ilustrar essa proposta: os esforços da Fundação Rockefeller para controle da ancilostomose (1909-c.1930), os projetos-piloto da Organização Mundial da Saúde para erradicação da malária na África tropical (décadas de 1950-1960), e os esforços internacionais de interrupção da transmissão do vírus Ebola durante surtos na África tropical (1974-2019).

Public health policy paradoxes: science and politics in the Rockefeller Foundation's hookworm campaign in Mexico in the 1920s.

The origins of US international health endeavors are intertwined with the Progressive Era's faith in science as arbiter of humankind's secular problems. No agency better exemplifies the period's confidence in science than the Rockefeller Foundation's International Health Board (IHB), which set out to export the new public health theory and practice around the world. An examination of the IHB's hookworm program in Mexico in the 1920s demonstrates that, notwithstanding the Rockefeller Foundation's (RF) self-conscious commitment to scientific neutrality, its programs continuously engaged political criteria, exhibiting the competition, coexistence, and inseparability of the worlds of science, politics, and international health policy. Analysis of the program's quotidian decisions and larger strategies further reveals the protean quality of RF science-politics, which enabled responses to parochial and broadly-conceived needs at multiple levels. In the focus on hookworm, the selection of campaign sites, hookworm diagnosis methods, treatment procedures, definition of cure, and the assignment of responsibility for prevention, scientific and political considerations were inextricably bound. The science-politics paradox was molded by the hookworm program's constituencies in Mexico, including political leaders, health bureaucrats, physicians, business interests, public health workers, peasants, and Rockefeller officers. The multiple, often contradictory, roles of the RF's hookworm campaign are characteristic of the policy paradoxes that emerge when science is summoned to drive policy. In Mexico the campaign served as a policy cauldron through which new knowledge could be demonstrated applicable to social and political problems on many levels. The repeated pledge of scientific neutrality belied the hookworm program's inherent aim of persuading government officials, the medical community, business interests, and the populace of the value of investing in public health as a means to improve social conditions, further a medical model of health and sickness, increase economic productivity, and promote good relations between the US and Mexico.

Eradication, control or neither? Hookworm vs malaria strategies and Rockefeller Public Health in Mexico.

Malaria's epidemiological importance in Mexico greatly exceeded that of hookworm, but the Rockefeller Foundation (RF) paid far more attention to hookworm. Although the RF collaborated with malaria campaigns around the world, malaria was only incidental to the RF's activities in Mexico. The hookworm campaign, on the other hand, involved the RF at every stage, from conceptualization and design to financing, hiring, and day-to-day administration. This paper seeks to understand why the RF's involvement in Mexico differed for the two diseases and what the organizational, political, and health implications were for these divergent approaches. Beginning in the mid 1920s the Mexican government developed a modest anti-larval service, periodically draining and filling ditches and swamps, dusting Paris green, petrolizing stagnant water, and administering quinine. Following the RF's 1927 shift towards scientific investigation, it began to sponsor small-scale malaria research, collecting climatological, entomological, epidemiological, and clinical information. The Mexican government eagerly petitioned the RF to join a national effort, but it was reluctant to become involved. A National Malaria Campaign was established in 1935 under President Lázaro Cárdenas to coordinate education, sanitary engineering, and treatment. The popular Campaign followed RF strategies even without its direct participation. Meanwhile, the RF avidly pursued modest malaria research in Mexico, funding U.S. investigators to conduct experiments on pesticides, mosquito-trapping, and controversially, watering methods for rice. These efforts culminated in the world's first field trial of DDT against louse-borne typhus and later as a residual spray for malaria. In the end the RF used Mexico as a convenient locale for scientific research that had global implications but only an incidental relationship to Mexico's own Malaria Campaign. Likewise, the RF's much more active hookworm program was more a means than an end, leading not to eradication of the disease, but to Mexico's commitment to modern public health organization and methods.

Conforming strategies of public health campaigns to disease specificity and national contexts: Rockefeller Foundation's early campaigns against hookworm and malaria in Brazil.

The early experience of Rockefeller Foundation in Brazil, starting in 1915, reflected the idea of extending learned experience in Southern US to a wide international context. Health education and the creation of permanent local health services were expressed as main guidelines for cooperation with State and federal Brazilian agencies. Translating to the shaping of public health models the terms of scientific hygiene associated with the pastorian revolution, RF pictured different actions as part of a three step rationale of survey, experiment and demonstrations. In this paper we focus on Lewis Hackett's campaign, designed as a demonstration campaign of the "intensive method" of hookworm control, with the final purpose of enlisting local agencies in long-term action (1919-1924) and the malaria campaign in Rio de Janeiro State Lowlands (1922-1928) led initially by Mark Boyd as an "experimental control work" of field observation, campaign, control and maintenance to set guidelines to malaria control in tropical areas. The course and ultimate results of these experiences showed the need to adapt formal models to complex national and State-building context and to disease specificity, leading to pragmatic adaptations in the issue of control and eradication and on the shaping of vertical and horizontal health services. The failure of these two experiences in terms of disease control helped to strengthen the move, predominant in the next two decades, to vertical campaigns with least dependency on local social and political dynamics, as in the exemplar case of Frederick Soper's Anopheles gambiae eradication campaign (1938-1942).

Hookworm disease: Puerto Rico's secret killer.

Drs. Bailey Ashford and Pedro Gutiérrez, with the economic aid of the United States and Puerto Rican governments, were able to implement a program to reduce the incidence of hookworm infestations in Puerto Rico during the turn of the century. The program was conducted in three phases. The first phase consisted of evaluating the prevalence of infestations among the population. The second phase was concerned with treating patients and reducing further infestations. The last phase of the program was the implementation of prevention programs whose goals were to educate the population on the mechanisms of contaminations and to help implement improvements in the waste disposal systems so as to reduce the exposure to contaminated soil. The programs greatly improved the level of health of many Puerto Ricans. The incidence of hookworm infestations was reduced from 90% to 15% among members of the population. The program obtained world-wide recognition and serves as a model for similar programs.

Cleansing the world of the germ of laziness: hygiene, sanitation, and the Javanese population in Suriname.

In 1915 the Rockefeller Foundation took its hookworm eradication campaign to Suriname, but was soon disappointed because of opposition from its main target group: the Javanese. Moreover, authorities and planters objected to the construction of latrines because of the costs and their belief that the Javanese were "unhygienic". In describing the labor migration from Java to Suriname, I show that this "lack of hygiene" was closely related to the system's organization. I argue that uncleanliness was the consequence of harmful socio-economic and ecological conditions. Secondly I suggest that even though the Foundation did not manage to cleanse Suriname of hookworm, its educational efforts, its emphasis on prevention, and its training of local health workers probably had more impact than Rockefeller officials thought.

The control of hookworm disease in Commonwealth Caribbean countries.

Like other countries around the globe where conditions existed for the parasites causing hookworm disease to thrive, this disease was a serious problem to settlers in countries of the Commonwealth Caribbean, i.e. those countries that were formerly part of the British Empire. Early in the 20th century, the Rockefeller Foundation (RF) assisted the southern United States in controlling this disease. Soon other countries requested assistance and the Rockefeller Foundation responded by creating their International Health Commission to target the problem. Guyana (then British Guiana) was the first country where work was started. Through a system of chemotherapy, sanitation with the provision of latrines and health education the RF assisted the Commonwealth Caribbean countries during the period 1914-1925 in controlling the disease. Most countries continued the programmes started by the Rockefeller Foundation and this paper provides evidence through a series of surveys to show that hookworm disease is no longer a public health problem.

"Pós de doliarina e ferro": um dos remédios importantes da Farmácia Peckolt / "Doliarina and iron powder": an important medicine at Peckolt Pharmacy

Resumo O farmacêutico Theodoro Peckolt é uma das mais importantes figuras da história da química de produtos naturais brasileira. Como outros farmacêuticos do século XIX que atuavam no Brasil, desenvolveu formulações que comercializava em sua farmácia, localizada no Rio de Janeiro, e que tiveram grande prestígio junto à população e à classe médica. O texto apresenta a relação entre a doença identificada inicialmente como opilação e a terapêutica utilizada no século XIX, destacando uma das formulações da Farmácia Peckolt – “Pós de doliarina e ferro”. O produto tem sua origem no látex da espécie Ficus gomelleira(figueira-branca ou gameleira). O artigo tem entre seus objetivos revelar a composição química, feita por métodos modernos de análise do látex deFicus gomelleira.

Abstract The pharmacist Theodoro Peckolt was one of the most important figures in the history of the chemistry of natural Brazilian products. Like other nineteenth-century pharmacists in Brazil, he developed formulations and sold them at his pharmacy in Rio de Janeiro, and these enjoyed great prestige in the eyes both of the public and the medical community. The article discusses the relation between the illness originally called “opilação” (ancylostomiasis, or hookworm) and nineteenth-century treatment. It focuses especially on Peckolt Pharmacy’s “Doliarina and iron powder,” a formulation extracted from the Ficus gomelleira rubber plant. One of the article’s goals is to use modern methods to analyze Ficus gomelleira and identify the chemical composition of the drug.

Hookworm in rural Spain, 1910-1960: shifting paradigms around the Civil War.

BACKGROUND: In Spain, hookworm was first recognised as a miners' disease, becoming the goal of one of the most successful interventions in public health from 1912 to 1931. Hookworm also played a part in the growing interest in rural health problems that peaked during the Republican period (1931-6). The aim of this study was to compare the rationale and content of public health interventions against rural hookworm in Spain before the Civil War (1936-9) with those of interventions after the war. METHODS: Review of published and unpublished documents on hookworm produced by individual physicians and public health officials in the first half of the 20th century. RESULTS: Rural hookworm foci detected in pre-war years were explained in terms of the geographical and human environment and largely attributed to poor working and living conditions, prompting specific health campaigns. New rural foci were detected after the war, but this time the health administration did not intervene. Understanding of the disease changed, its impact on reproduction was highlighted and medical explanations pointed to the negative moral conditions of peasants rather than social issues. CONCLUSION: Civil War brought rupture and continuity to the public health domain. Although the Francoist health administration preserved similar organisation patterns, its practice was governed by different priorities. Moral and even religious positions provided a rationale for what had been previously explained in social and environmental terms. This approach, together with the perception of hookworm as evidence of backwardness, led to official neglect of the condition, which was still prevalent in some rural areas.

How four once common diseases were eliminated from the American South.

Four major diseases stigmatized the American South in the nineteenth and twentieth centuries: yellow fever, malaria, hookworm, and pellagra. Each disease contributed to the inhibition of economic growth in the South, and the latter three severely affected children's development and adult workers' productivity. However, all four had largely disappeared from the region by 1950. This paper analyzes the reasons for this disappearance. It describes the direct effects of public health interventions and the indirect effects of prosperity and other facets of economic development. It also offers insights into the invaluable benefits that could be gained if today's neglected diseases were also eliminated.