Hookworm and the Idol of Liberty

by John Ellis

By all accounts, hookworm is nasty. An intestinal parasite, victims suffer from diarrhea, pain, lethargy, and debilitating anemia. For most of human history, hookworm was relegated to the African continent and was non-lethal owing to the levels of immunity built up over generations. That changed after, “Western doctors first realized how dangerous they could be in 1880, when a professor at the University of Turin found a lethal form of hookworm disease among workers digging a long tunnel under the Alps between Italy and Switzerland.”[1] Hookworm thrives in warm, moist conditions and is spread primarily via contact with infected feces. The tunnel was warm, moist, and used as a bathroom by the workers who crowded it.

Hookworm also thrives in the climates of the Deep South and Puerto Rico. Scientists and sociologists now believe that the racist and classist belief that Blacks and poor Southern whites are lazy was the result of the effects of hookworm. If you’ve ever heard the pejorative “dirt eaters,” you’ve likely heard it in context of the misunderstanding of hookworm’s affect on those suffering from it. Thankfully, treating hookworm is not only easy but it’s cheap.

In the early 20th century, financed by John D. Rockefeller, doctors embarked on a deworming program throughout the South that included medicine and education. They ran into a problem, though. Poor white Southerners were skeptical of authority and anything that could be seen as impinging on their freedom. In this case, their liberty to not wear shoes and defecate whenever and wherever they wanted while working. Mark Twain didn’t help the cause because he wrote a satire making fun of hookworm, the habits of poor people, and, of course, God.[2]

Led by Dr. Charles Stiles, the team of doctors and scientists faced resistance from those whom they were trying to help, to the point of violence. After a Tampa newspaper threatened to lynch him for daring to dictate to Southerners what to do regarding shoe-wearing and their toilet habits[3], Dr. Stiles retooled his approach. He began utilizing local Southern doctors to spread the message at huge picnics and festivals funded by the Rockefeller Sanitary Commission. Using dramatized testimonials (often fictional), the message didn’t change but the presentation allowed Southerners to believe that altering their habits, as well as taking the medicine offered, was their idea and not that of a nosy, condescending “expert” bent on placing them under subjugation via slowly chipping away at their liberty. At the same time, in Puerto Rico, Dr. Bailey Ashford was also attempting to battle the scourge of hookworm but with even less success.

Dr. Stiles’ efforts were heavily funded by the wealthiest man in the world. He was able to afford to throw swanky “block parties” complete with delicious, rich foods to be enjoyed while listening to actors giving “testimonials”. In contrast, Dr. Ashford was given a pittance by the colonial treasury. And the hookworm problem was even more extensive in Puerto Rico than it was in the mainland’s Deep South.

The mountains of Puerto Rico were filled with coffee farms worked by impoverished peasants. Like the tunnel under the Alps, the farms were hot, humid, and crowded. The workers didn’t wear shoes and worked among the fecal waste left by themselves and their coworkers. It was the perfect breeding ground for hookworm. Unfortunately, Dr. Ashford and his teams’ efforts were stymied not just by the lack of funds but also by the concept of liberty. Attempts to get the farm owners and supervisors to enforce the wearing of shoes and the use of specified latrine areas was met with complaints that doing so violated the notion of liberty. Thirty years after Dr. Ashford started his efforts to combat hookworm, Puerto Rico still suffered from high rates of the intestinal parasite.[4]

In both cases – the mainland’s Deep South and Puerto Rico – people suffered mightily because of the entrenched over-evaluation of liberty. Protecting the “right” to not wear shoes is an odd hill to die on (sometimes literally). Likewise, defending your “right” to defecate wherever you want is nonsensical in light of the devastating effects of something like hookworm. From a Kingdom ethics standpoint, life is a God-given good and our post-Enlightenment concept of freedom/liberty does not take precedence over that God-given good. “Give me liberty or give me death” is a statement of rebellion against God because it flatly states that whatever you’re clinging to is more valuable than the gift of life God has given you. To drill into that, losing the “right” to not wear shoes does not cause you to disobey God. The early Christians disobeyed the authorities only in those instances when the authorities explicitly demanded that they disobey God – strictures on preaching the gospel, for example.[5]

I’m not going to draw out any contemporary applications, but our inherited epistemic hubris and its accompanying belief that we have the right to be the authoritative arbiter over our life does have parallels with those in the early 20th century who pridefully clung to their right to not wear shoes and defecate wherever they wanted even if it meant continued suffering and even death for themselves and their neighbors. To be clear, contemporary parallels aren’t solely, or even mainly, in the realm of medicine/science. Our prideful clinging to liberty affects life in every area of society. Of all people, followers of King Jesus should prayerfully consider where and how our embrace of the post-Enlightenment concept of freedom/liberty has strayed into the idolatrous. Are we metaphorically and pridefully clinging to our right to defecate wherever we want even if doing so endangers the lives of those made in the image of God?

Soli Deo Gloria


[1] Daniel Immerwahr, How to Hide an Empire: A History of the Greater United States (New York: Picador, 2019), 139.

[2] Mark Twain, Letters From the Earth ed. Bernard Devoto (New York: Perennial Library, 1962), 34-39.

[3] Mark Sullivan, Our Times: The United States, 1900-1925 (New York: Charles Scribner Sons, 1930), 328.

[4] Arnold Dana, Porto Rico’s Case, Outcome of American Sovereignty (New Haven, CT: The Tuttle, Morehouse, and Taylor Company, 1928), 39.

[5] It should be noted that when the early Christians obeyed God rather than man, they didn’t take up the sword  but accepted the punishment meted out to them by the authorities.

One thought on “Hookworm and the Idol of Liberty

  1. Sadly, idolatry of person freedom is one of the nasty leeches clinging onto a very correct rejection of people who steal God’s place and proceed to rule over others on their own terms (an act often referred to as “patriarchy”. There are, of course, other definitions for the term, but I’m not dealing with those). The leech creates a false dichotomy, and the discussion blasts right through the nuanced ground that allows the existence of good authorities and of compassionate unforced submission.
    Those kinds of stuff are always hard to digest intelectually, I wonder how many leeches I’m not seeing that are clinging to me? Thankfully we have a Lord to focus on, and don’t have to carry all the knowledge of the world.

    Thanks for writing!

    Liked by 1 person

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