In the following years, Rockefeller money helped stamp out boll weevils and improve the yield of southern crops and livestock, swelling the tax base to support public schools. By 1912, more than 100,000 farms had altered the way they cultivated cotton and other crops as a direct result of demonstration work done jointly by the GEB and the U.S. Department of Agriculture.
Emboldened by such feats, the Rockefeller philanthropies steadily expanded their southern programs, among which the most successful was the campaign to eradicate hookworm. As had happened with Dr. Knapp, this odyssey started out with the dispiriting quest of a frustrated dreamer on the federal payroll, Dr. Charles Wardell Stiles.
When the United States acquired Puerto Rico after the Spanish-American War, an army surgeon named Dr. Ashford made a startling discovery: Many poor islanders thought to suffer from malaria were actually infected with hookworm. The son of a Methodist minister, Stiles had crisscrossed the South for years for the U.S. Public Health Service. Based on Ashford’s work, he was seized by the wild surmise that the poor whites of the South—infamous in popular myth for their indolent, sluggish lives—might be suffering from hookworm. In September 1902, outfitted with just a microscope, Dr. Stiles journeyed through the South examining human feces, and, sure enough, he found hookworm eggs everywhere. It was an exhilarating discovery, since hookworm could be cured with fifty cents’ worth of salts and thymol.
When Dr. Stiles reported these results at a Washington, D.C., medical convention that December, he stated that southerners long considered lazy were simply enervated by hookworm. His remarks were greeted with both profound outrage and mocking amusement. The next day, the New York Sun published the lecture under the whimsical headline, “Germ of Laziness Found?” Stiles was aghast: He was being turned into a figure of fun, his great finding trivialized by interminable hookworm jokes. As a zoologist—and therefore presumed ignorant of the human body—he fared no better among physicians: Dr. William Osler went so far as to deny hookworm’s existence in America. Few doctors were prepared to accept that the chronic anemia or continuous malaria commonly attributed to poor whites was, in fact, caused by hookworm, contracted by barefoot people through their soles.
For several years, Dr. Stiles persevered in his crusade to locate private money to apply his theory, and he found an unexpected champion in 1908 when President Roosevelt appointed him to a commission on country life. While touring the South that November, he told another member of the commission, Walter Hines Page, a North Carolina native, that a shuffling, misshapen man on a train platform was suffering from hookworm, not laziness or congenital idiocy. “Fifty cents worth of drugs would make that man a useful citizen in a few weeks,” he said flatly.21 He explained to Page that thymol pried the hookworms loose from the intestine walls—some victims harbored up to five thousand in their systems—and then epsom salts flushed them from the body. As a board member of the Rockefeller Institute, Page was the perfect ambassador to bring Stiles to Rockefeller’s attention.
At the end of their tour, Stiles and Page stopped at Cornell University for a reception, where Stiles met a round, jovial man who had already been briefed by Page: Wallace Buttrick. The two men went back to Buttrick’s hotel room and “talked hookworm almost all night.”22 After years of useless speeches, Stiles was now dazed by the dreamlike speed of events. Back in Washington, he got a telegram summoning him to a New York meeting with Gates and Simon Flexner of the RIMR. After delivering a monologue and showing slides for forty minutes, Gates interrupted him to bring Starr Murphy into the meeting. “This is the biggest proposition ever put up to the Rockefeller office,” Gates told Murphy. “Listen to what Dr. Stiles has to say. Now, Doctor, start from the beginning again and tell Mr. Murphy what you have told me.”23 These sessions lasted for two days, and by the end Gates and his fellows were sold on a mass-mobilization program to eradicate hookworm from the South. It was an ideal opportunity for large-scale philanthropy: Here was a condition that could be easily diagnosed and cheaply cured, with an estimated two million victims in the South. The results would be rapid and visible, giving the program more populist appeal than the rarefied work of the medical-research institute. It would, in short, simultaneously serve the overlapping objectives of science, philanthropy, and Rockefeller public relations.
Junior was deputed, as was so often the case, to sell his father on the need for a commission to fight hookworm. Although Stiles had modestly suggested a half-million dollars, Gates fixed on one million dollars as a nice round sum that would capture the South’s attention. Since the region remained touchy about any assumption that it was riddled with listless imbeciles, Junior reassured his father that the board would recruit a southern contingent. On October 20, 1909, Junior implored him to act fast and stake out a leadership role in the hookworm fight. Two days later, Rockefeller replied: “Answering your letter 20th with reference to hook worm, it seems to me that $1,000,000 is a very large amount to promise, but I will consent to this sum, with the understanding that I shall be conferred with step by step and consent to whatever appropriations are made from time to time. This, however, need only be known to such as you choose to have know it.”24 Since Rockefeller had started to take winter golfing vacations at the Hotel Bon Air in Augusta, Georgia, he derived special pleasure from the gift. As he said, “It has been my pleasure of late to spend a portion of each year in the South and I have come to know and to respect greatly that part of the country and to enjoy the society and friendship of many of its warm-hearted people.” 25
As expected, many southern editors reacted to the hookworm campaign as a calculated affront to their honor and dignity. Originally, the effort was to be known as the Rockefeller Sanitary Commission for the Eradication of Hookworm in the South. To avoid stigmatizing the South, it was shortened to the Rockefeller Sanitary Commission or even the U.S. Sanitary Commission. Instead of being based in New York, like other Rockefeller programs, it opened in 1910 in Washington, D.C., diplomatically south of the Mason-Dixon line.
The executive secretary was a Tennessee native, Dr. Wickliffe Rose. Another clergyman’s son, Rose, forty-seven, was a shy, immaculate man who often wore bow ties and stared primly through wire-rimmed spectacles or pince-nez. Steeped in the writings of Kant and Hegel, grounded in the Latin and Greek classics, and fond of writing poetry in French, he had been dean of Peabody College and the University of Nashville before becoming general agent of the Peabody Education Fund, where he came to the GEB’s attention. The courtly Rose, modest and painstakingly thorough, supplied both the tact and determination that made the hookworm campaign a smashing success.
In mapping out his strategy, Rose adopted the GEB model of using Rockefeller money as a catalyst for government cooperation. The first order of business was a detailed survey to identify the centers of hookworm infestation. Once again, the states were urged to hire sanitation directors to educate the public about the menace. State medical boards sent young doctors into rural areas, their salaries paid by Rockefeller money. These campaigns were often carried out under the auspices of state health boards, thus providing political protection. As Gates privately explained this decision, “To put Mr. Rockefeller’s name prominently forward . . . would impair the usefulness of the work.”26 This was doubly necessary since many southern communities saw the Sanitary Commission’s work as a degrading new form of northern carpetbagging. Yet for all the efforts to shroud Rockefeller’s involvement, many southerners knew the program’s real sponsorship and devised preposterous theories to explain it. One was that Rockefeller was entering the shoe business and financed the hookworm campaign to accustom southerners to wearing shoes year-round, instead of only during the winter months.
The campaign relied on extensive publicity and showy gimmicks, and it sent out “health trains” with traveling exhibitions on modern sanitation. Perhaps the single most important factor in its success was the introduction of dispensaries for public-health work. In 1910, only two southern counties had such dispensaries. That
number burgeoned to 208 counties within three years, thanks to Rockefeller money. To coax crowds into these dispensaries, the field workers (in a manner oddly reminiscent of Doc Rockefeller) distributed handbills saying, “See the hookworms and the various intestinal parasites that man is heir to.”27 In the rousing spirit of tent revival meetings, rural people formed long lines and gaped at hookworm eggs through microscopes or examined them squirming in bottles. Because infected people were cured swiftly, it seemed no less miraculous than faith healing to many people, and the throngs often erupted into singing “Onward Christian Soldiers.” In a single day in 1911, 454 people were cured of the disease. One field director in Kentucky wrote, “I have never seen the people at any place so wrought up and so full of interest and enthusiasm.” 28 Except for Florida, every southern state joined in the program.
Pretty soon, the gentle, decorous Wickliffe Rose ran an operation of military scope. During the first year of work, 102,000 people were examined in nine southern states, and 43,000 were identified with hookworm. At the end of five years, Gates reported to Rockefeller that nearly half a million people had been cured. While the disease had not been extirpated completely, it had been reduced drastically. “Hookworm disease has not only been recognized, bounded and limited,” Gates boasted to Rockefeller, “it has been reduced to one of the minor infections of the south, perhaps the most easily and universally recognized and cured of all.” 29 Most important, the states had set up machinery to perpetuate the work and avert backsliding. Lauding the campaign as “well planned and well executed,” Rockefeller especially praised its deft diplomatic touch in dealing with a politically charged situation. The Rockefeller Sanitary Commission was a landmark in epidemiology and preventive medicine, as Charles W. Eliot recognized when he called it “the most effective campaign against a widespread disabling disease which medical science and philanthropy have ever combined to conduct.”30 In 1913, the newly formed Rockefeller Foundation asked Wickliffe Rose to take the hookworm campaign abroad, extending the fight to fifty-two countries on six continents and freeing millions of people from this worldwide scourge.
By 1910, medicine and education had emerged as the top priorities of the Rockefeller philanthropies, and that year the two trends fruitfully dovetailed. The stimulus was a report with the deceptively bland title Medical Education in the United States and Canada. Its author, Abraham Flexner, was the brother of RIMR director Simon. Where Simon was precise and conciliatory, Abe was a combative iconoclast who relished a good intellectual brawl. After graduating from Johns Hopkins, he started a small, innovative private school in Louisville that won a fine reputation among Ivy League colleges. He had the maverick’s talent for casting a fresh, critical eye on practices sanctified by custom, and he provoked a national debate when he proposed that students should graduate college in three years.
When the Carnegie Foundation for the Advancement of Teaching invited him to survey American and Canadian medical schools, Abe pleaded ignorance, but with typical zealousness he visited all 155 schools and came away appalled by the experience. Like his brother, he took the Johns Hopkins Medical School as his model of a competent school. “Without this pattern in the back of my head,” he admitted later, “I could have accomplished little.” 31 By contrast, the majority of schools he visited seemed to be dreary, haphazard affairs, run negligently by local doctors to supplement their income from private practice.
As Flexner doggedly made the rounds, nobody realized that he was the exterminating angel who would snuff out many fly-by-night institutions. The tableaux he described would have been richly satirical had they not been strictly accurate reportage. Since most medical schools relied solely upon tuition fees and could not afford modern equipment, they still languished in the dark ages of medicine. In Washington State, Flexner asked the dean of one school whether they had a physiology lab. “Surely,” said the dean. “I have it upstairs. I will bring it to you.” And he proudly produced a little pulse-taking device. One osteopathic school in Iowa had desks, blackboards, and chairs but could not muster any charts or scientific apparatus. Of the 155 schools, only 23 required more than a high-school education. Since some schools did not even demand that, they were not exactly bursting with brainpower.
In 1910, Flexner published his polemic, known as the Flexner Report—the most pitiless and influential indictment of medical education ever printed. Naming the most notorious diploma mills, the report sparked furious debate, and more than one hundred schools either perished in the ensuing controversy or were absorbed by universities. Among the major casualties were the quaint homeopathic schools so dear to John D. Rockefeller, Sr. Already in decline, the schools were dealt a lethal blow by the Flexner Report.
Gates devoured the report. Disgusted with medical practice, he believed that young doctors ended up either as “confirmed pessimists, disappointed and chagrined, or else mere reckless ‘pill-slingers’ for money.” 32 With a big pile of cash at his disposal, Gates would not let the Flexner Report gather dust. When he invited the author to lunch, Flexner pointed to two maps in his book—one showing the locations of the medical schools he visited, the other showing what the country needed. “How much would it cost to convert the first map into the second?” Gates asked, and Flexner replied, “It might cost a billion dollars.” “All right,” Gates announced, “we’ve got the money. Come down here and we’ll give it to you.”33 When Gates asked Flexner how he would spend the first million to overhaul medical research, he said, “I should give it to Dr. Welch.”34 Thus, Welch’s Johns Hopkins Medical School was consecrated as the prototype to be emulated by recipients of Rockefeller money. Hopkins ran its lab departments on a full-time basis, with many faculty members applying themselves solely to teaching and research, a pattern that Gates wished to see duplicated everywhere. Never before had a rich benefactor spent his money in this area. As Dr. Welch said, “It marked . . . the first large public recognition of medical education and medical research as a rewarding subject of philanthropy.”35
In 1913, Flexner formalized his ties with Rockefeller and joined the GEB staff. Flexner and his cohorts singled out well-regarded institutions—Vanderbilt University in the South, the University of Chicago in the Midwest—to serve as regional models. Medical schools that wanted Rockefeller grants had to upgrade entrance standards, institute four-year programs, and adopt the full-time teaching approach. This movement to universalize the Johns Hopkins model proceeded even though it had one highly disgruntled critic: John D. Rockefeller, Sr., who still waged a lonely battle for an alternate form of medicine. “I am a homeopathist,” he complained to Starr Murphy in 1916. “I desire that homeopaths should have fair, courteous and liberal treatment extended to them from all medical institutions to which we contribute.” To Rockefeller’s credit, he did not pull rank on his advisers and often yielded to their judgments, even when they ran counter to his personal wishes. “I am glad to have the aid of experienced men who are able to sift out the applications and give to the deserving, ” he once said. “I am not a good one to judge such things: I am too soft-hearted.”36
In the spring of 1919, the GEB asked its founder for fifty million dollars to extend scientific medical education across the country, the world war having exposed the poor health of many soldiers and the inadequacy of base hospitals. For months, Rockefeller retreated into one of his baffling silences. Just when his lieutenants despaired of a response, he sent a letter pledging about $20 million for the project—a bonanza soon expanded to $50 million. By the time Flexner left the GEB in 1928, it had distributed more than $78 million to propagate the scientific approach to medical education. The sum total of these developments resulted in nothing less than a revolution in medical education. Doc Rockefeller’s son had banished laggards from the profession and introduced a new era of enlightenment in American medicine. In its thirty-year existence, the GEB dispensed $130 million, equal to more than $1 billion today.
While keeping apart from the management of the RIMR and the GEB, Rock
efeller remained more involved with the University of Chicago. Paradoxically, it was the philanthropic effort that most frustrated him and most frequently violated his charitable principles. Meant as an incentive to lure money from Chicago businessmen, his initial endowment had, perversely, deterred people from giving. Reams of press coverage presented the university as Rockefeller’s hobbyhorse. In 1903, Life magazine ran a cartoon of Ye Rich Rockefeller University, showing a lady holding aloft a lamp marked Standard Oil, her robes checkered with dollar signs. Though Rockefeller studiously avoided the campus and visited only three times (1897, 1901, and 1903), he got little credit for this self-abnegation. The public was quick to pounce on his every move as yet another ruse. As Gates wearily recalled:
The people of Chicago had ceased to give except in driblets. A hostile press often spoke of the University as if it were Standard Oil propaganda, its policies always dictated by the Founder, its professors subject to dismissal if they were other than mouthpieces of him, the splendid architectural creation of the Midway Plaisance was a monument to the glory of John D. Rockefeller, erected and maintained in his personal interest.37