BARE FEET, WORMS, OUTHOUSES, and THYME

These words might not make the best song lyrics, but they sum up AMERICAN MURDERER: The Parasite That Haunted the South, the 3rd book in my Medical Fiasco series

BARE FEET:

During the early 1900s, 80% of the South’s population lived in rural areas.  Many struggled to make a living on their farms. Going barefoot was common because the weather was warm much of the year and because shoes were expensive, especially for growing children.

Two barefoot young children infected with hookworms
[from Byrd, Hookworm Disease, Florida State Board of Health, 1910]

WORMS:

In 1902, a U.S. government scientist named Charles Stiles identified a previously unknown species of hookworm in the South. He called it Necator americanus, or the American Murderer.

Its name refers to this intestinal worm’s effect on the human body. The parasite invades through skin, often bare feet. It travels deep into the gut of the unsuspecting host, where it sucks blood like a vampire. A person carrying hundreds of worms develops hookworm disease.

The steady blood loss causes severe anemia. Victims become emaciated. They have vacant expressions. Their weakened bodies are susceptible to other deadly ailments such as malaria, typhoid fever, and pneumonia. Children fall years behind in physical and mental development.  Because adults are too fatigued to work, families are stuck in a cycle of poverty.

In the South during this period, millions of southerners were infected with hookworms. They were considered lazy, stupid, and sickly. No one, including southern doctors, realized that they had hookworm disease. In fact, the American medical community denied that hookworm disease even existed in the U.S.

A hookworm disease victim from Mississippi
[from Dock & Bass, Hookworm Disease, 1910]

OUTHOUSES:

Hookworms spread from the intestine of one person to the body of another by way of the soil.

Country households weren’t connected to a public sewer system. Many families used crude outhouses or just the bushes. The ground became contaminated with body waste...and hookworms.  People were infected when they walked over this soil in bare feet.

These parasites can’t withstand freezing temperatures, which explains why they were only a health problem in the southern states.

THYME:

Doctors in Europe had discovered a way to kill and remove hookworm parasites from the body. The inexpensive medicine, called thymol, was derived from the herb thyme. 

*************

Charles Stiles learned that American doctors didn’t know how to recognize the symptoms of hookworm disease. Furthermore, they didn’t know that the disease could be easily treated with thymol.

AMERICAN MURDERER tells how Stiles raised the alarm and spearheaded a plan to save southerners from hookworm disease. His efforts led to a successful government–private partnership that remains a model for solving public health problems in the U.S. and around the world. It is a story of discovery, perseverance, inspiration, and hope.

MONDAY, SEPTEMBER 19, 1881 -- A TRAGIC NIGHT

 

On July 2, 1881, President James Garfield, age 49, was shot by an assassin in a Washington, DC, train station.  He was taken to the White House where care would be better than in a crowded hospital. That day, several doctors used their unwashed fingers and unsterilized instruments to probe for the bullet, hoping they could extract it. But it was in too deep. In the days before X-rays, cutting into his body to search for the missing bullet was out of the question.

Although few people expected Garfield to survive the first night, he rallied. During the two weeks after the shooting, his doctors reported that he made steady, slow improvement. His temperature was slightly elevated, but they weren’t worried.  The bullet wound discharged “healthy pus” through a drainage tube, which his doctors interpreted as a sign of healing. Everyone was optimistic. Recuperation might take time, but Garfield was a strong and energetic man.

Today, a physician would recognize that fever and a pus-producing wound pointed to a serious infection.

President Garfield in the White House with his daughter and wife, mid-July 1881
[from Frank Leslie’s Illustrated Newspaper]

On July 22, everything suddenly changed. Garfield was sweating and having intense chills. He ran a high fever. His heart raced. A sac full of pus had formed near the bullet hole. Despite surgery to relieve the pus, Garfield relapsed. The pus built up faster than the doctors could drain it. 

Six weeks after the shooting, Garfield was failing rapidly. He couldn’t keep food down, and his weight had plummeted by 80 pounds. A river of pus oozed from his drainage tubes. He developed abscesses in his armpits and on his chest and back. Fluid started to accumulate in his lungs.

Even though the lead physician, D. W.  Bliss, continued to talk as if recovery was likely, Garfield understood the gravity of his condition. Weary and weak, he begged to leave the White House sickroom. He ached to be outside to see the sky and gaze at the sea.

Arrangements were made to transport him by train to Elberon, New Jersey, a seaside town where Garfield had enjoyed vacations. On September 6, a specially outfitted train took him north to a large cottage next to the ocean. Close friends and family held out hope that the sea air and change of scenery would help him recover.

Garfield savored the sounds of the ocean and sight of people swimming. He said he felt as if “he was himself again.”

But the pus kept draining from the president’s gunshot wound.  His lung infection worsened, and he coughed up pus and mucous. He had periods of chills followed by sweating. At times, he hallucinated.

President Garfield and his wife by the sea in Elberon, New Jersey
[from Frank Leslie’s Illustrated Newspaper]

On Monday evening, September 19, Garfield called to his friend who was on duty in the president’s candlelit room. “What a pain I have right here.” He placed his hand over his heart.

With that, James Garfield fell unconscious.  Less than a half hour later, he took his last breath. It was 10:35 p.m. James Garfield was dead, eighty days after the bullet had pierced his back. 

An autopsy was performed, but controversy went on. What actually killed the president? The bullet or medical malpractice? Could his life have been saved?

Long after President Garfield’s death on September 19, 1881, his assassination affected politics, government, and medicine.  I tell the entire tragic story in AMBUSHED!: The Assassination Plot Against President Garfield.

JULY FOURTH WEEKEND, 1881--DANGER!

 

President James Garfield (Library of Congress)

President James Garfield, age 49, planned to begin his summer vacation on Saturday, July 2. He and his two oldest sons were to catch a train from Washington to New York where they would join his daughter and his wife, Lucretia. Lucretia had been recuperating from malaria at a New Jersey beach hotel. From New York, the family arranged to travel by train to Garfield’s class reunion at Williams College in Massachusetts before setting off on a trip through New England. The two youngest Garfield boys would stay with relatives until the family reunited at the Garfield farm in Ohio later in the summer.

On Saturday morning, Garfield roughhoused with his sons at the White House before they all departed for the train station by carriage. The president’s secretary of state had last-minute business with him, and the two men rode together. The Garfield boys followed in a second carriage.

When Garfield climbed out at the Baltimore and Potomac station (now the site of the National Gallery of Art),  he had no idea of the danger awaiting him. No Secret Service agents guarded a president in 1881 or checked an area before he arrived.

No one realized that Charles Guiteau had been stalking President Garfield for weeks. Upset about being denied an appointment in Garfield’s administration, Guiteau was convinced that the president had “wrecked the once grand old Republican party, and for this he dies.” Guiteau bought a pistol and practiced using it. When he read in the newspaper that the president was leaving for his vacation on Saturday’s 9:30 train, he knew it was time to make his move.

As James Garfield  and his secretary of state walked through the station waiting room, Guiteau stepped from the shadows. He shot twice at Garfield’s back before heading for an exit. The president fell to the floor.

Police officers assigned to the station immediately grabbed Guiteau and dragged him outside. Meanwhile, bystanders rushed to help the president. Garfield’s two sons, who had been on their way into the station when their father was shot, hurried to his side.

(Library of Congress)

(St. Paul , MN, Sunday Globe, July 3, 1881)

Soon, as many as ten doctors arrived at the station after hearing about the shooting. Garfield’s condition didn’t look good to them. They agreed that he should be taken back to the White House for treatment and, possibly, to die.

Somehow Garfield managed to stay alive through Saturday and Sunday. Two expert surgeons were sent for, and they arrived from New York and Philadelphia on Monday morning, July 4.

The grim news shocked the nation. Only sixteen years before, President Abraham Lincoln had been assassinated. How could this happen again? Monday’s July Fourth festivities were subdued as Americans waited to learn whether their president had survived the assassin’s bullet.

They would spend the rest of the summer of 1881 anxiously following daily reports about the president’s health. Could Garfield’s doctors save him? Had their mistakes put him in new danger?

In AMBUSHED!: The Assassination Plot Against President Garfield, I tell the story about this fiasco that changed the course of political and medical history.

(Washington Evening Star, July 2, 1881)

 

THE VAMPIRE THAT HAUNTED THE SOUTH

On May 10, 1902, a 35-year-old scientist at the Department of Agriculture announced in a medical journal that he’d found a previously unknown human parasite in the southern states. He warned that the creature was causing illness and death among millions of people. This discovery forever changed public health in the U.S. and around the world.

Dr. Charles Stiles had studied with the world’s parasite experts in Germany. As part of his training, he learned about human hookworm, an intestinal parasite that had first been discovered in Europe in 1838.

Hookworms latch onto the lining of the small intestine and suck blood like tiny vampires. The steady blood loss weakens a victim, especially if hundreds of hookworms are living inside the person. Adults are transformed into dull-witted, frail individuals who have trouble working. Infected children are unable to concentrate or learn in school. A severe hookworm infection can be fatal.

Everyone in this Kentucky family is infected with a large number of hookworms. They exhibit a symptom of hookworm disease­­
––a bug-eyed stare.

America’s medical community denied that human hookworm existed in the U.S.  In fact, most physicians were unfamiliar with the symptoms of an infection. Yet Charles Stiles believed that hookworm was likely here. The South’s warm climate resembled places around the world where the parasite was common. He suspected that doctors were missing cases or misdiagnosing the sick.

By 1902, Stiles had collected proof that hookworm did infect people in the southern U.S. But he was amazed to discover that this hookworm was a completely different species from the one found elsewhere in the world. Stiles named it Necator americanus, or American Murderer.

Stiles’s work had just begun. Could he convince doctors that the threat was real? Could he find a way to cure the many infected southerners and to prevent the parasite from reinfecting them?

I tell the rest of the story in the third book of my Medical Fiascoes series, AMERICAN MURDERER: THE PARASITE THAT HAUNTED THE SOUTH, coming September 27 from Calkins Creek Books/Astra Books for Young Readers.

 

Two brothers from Mississippi show how a hookworm infection affected physical development.  The taller brother is a year younger and weighs more than twice his heavily infected older brother.

Children suffered the most from a hookworm infection. This 11-year-old from Arkansas weighed only 33 pounds.

PRESIDENTIAL ASSASSINATIONS 100 YEARS APART

RONALD REAGAN & JAMES GARFIELD

On March 30, 1981, President Ronald Reagan was shot outside a Washington hotel.  One hundred years earlier, President James Garfield was shot inside a Washington train station. A century of medical progress made the difference in the two men’s fates.

President Reagan waves to a crowd outside the Washington Hilton Hotel seconds before the shooting, March 30, 1981.  
The moment President Garfield is shot, July 2, 1881.


RONALD REAGAN

On Monday afternoon, March 30, 1981, Ronald Reagan, age 70, exited the Washington Hilton Hotel after giving a speech. He had been president for 69 days. Reagan was surrounded by police officers and Secret Service agents.

A young man in the crowd, John Hinckley Jr., raised his gun and shot six times.  Bullets struck and wounded Secret Service agent Timothy McCarthy, DC police officer Thomas Delahanty, and Reagan’s press secretary James Brady. A bullet ricocheted off the presidential limousine and hit Reagan in the chest.

The Secret Service sped the president to George Washington University Hospital’s emergency room. The bullet had missed his heart by barely an inch, but it punctured a lung. Reagan lost more than half his body’s blood. During nearly three hours of surgery, doctors treated his lung injury, removed the bullet, and controlled his bleeding. Reagan received antibiotics to fight possible infection and transfusions to replace his significant blood loss.

Within two weeks, the president walked out of the hospital and returned to the White House, eventually making a full recovery.  Emergency surgery saved his life.

 

James Garfield wasn’t as fortunate.

 

JAMES GARFIELD

On Saturday morning, July 2, 1881, James Garfield, age 49, arrived at the station to catch a train for the first leg of his family’s summer vacation. He had been president for 120 days. Unlike President Reagan a hundred years later, Garfield had no Secret Service or police protection.

As the president casually walked across a waiting room with his secretary of state, Charles Guiteau stepped from the shadows and shot twice. One bullet grazed Garfield’s arm. The other entered his back. After about an hour, he was taken from the train station to the White House in the back of a horse-drawn ambulance.

Garfield’s wound was much less serious than Reagan’s. Though the bullet had broken ribs, it missed Garfield’s organs and ended up harmlessly in fatty tissue. He lost little blood and didn’t need life-saving surgery. But Garfield’s doctors failed to practice antiseptic care. They introduced bacteria into his body during their repeated probing of his wound. After 80 days of suffering in bed, the president succumbed to a deadly infection.

Reagan on his feet four days after the shooting. He left the hospital a week after that.
Garfield remained bedridden for 80 days until his death from infection.

THE ASSASSINS’ TRIALS:

John Hinckley was found not guilty by reason of insanity and sent to a psychiatric institution.

Charles Guiteau, who had a history of mental illness, was found guilty and hung several months after his conviction.

 

 

[Colored images from the Reagan Library.]