Hookworm was a prolific parasitic disease among Southern poor, and was spread by poor sanitation practices. It was first recognized in the white tenant farmer population whose “primitive sanitary practices caused continual reinfection.” An estimated 35 percent of those families did not even have privies (Beardsley 1987:51). The textile mill work force came mainly from that population, and perhaps at least one third of those who came to work in the industry were infected. Historian Edward Beardsley (1987:49) noted that,
“Victims not only looked bad; they functioned poorly as well. There was of course a range of disability, depending mostly on the number of worms a person carried hooked onto the intestines. Fifty would make a light case, whose symptoms would be a little blood loss. But infestation could exceed five hundred, in which event the victim's very life was threatened from exhaustion and cardiac arrest. In moderate infestation, which described the great majority of cases, the red blood cell count fell off sharply, and the victim was anemic, undernourished, and listless; eventually there was physical and occasionally mental retardation. Pregnant women were at special risk as they could not retain the higher level of minerals and nutrients they needed. As a result, they had problems in labor, and a higher proportion of their infants were stillborn.”
The effects of this disease were especially cruel for children in the community, and it shaped the outside world’s perception of them. A prematurely aged face on the body of a child was so common that to many an observer, it was synonymous with the “typical cotton mill child” (Stiles 1910, quoted from Beardsley 1987:49). By 1916 improved treatments had alleviated some of the suffering, but hookworm was still a problem. Prevention could only be accomplished through use of sanitary privies or sewer systems, and these improvements were slowly. A Public Health Service (PHS) study in South Carolina in 1916 discovered that most mill villages “provided families the kind of foul privy that was an encouragement to hookworm and other infection,”...and South Carolina “had no law requiring villages to install sewer systems, and there were too few sanitary inspectors to encourage much in the way of voluntary change” (Beardsley 1987:51, 54).