Hookworm Eradication: A Case Study In Moral Hedging

"Racists are good sometimes," I say and immediately get cancelled by Twitter

I think it’s often important to engage in common-sense good actions—actions that it’s difficult to imagine anyone actively opposing. No one is like “I think more people should die of malaria.” No one is like “wow, pandemic preparedness is terrible, I wish we were less prepared for pandemics actually.” You might support these for unpopular and complicated philosophical reasons, reasons that might very well be horribly mistaken. But choosing common-sense good actions increases the likelihood that you used the wrong formula and got the correct answer.

As situations get more morally uncertain, the importance of choosing common-sense good actions increases. The more that compassionate people approaching the situation in good faith disagree, the most important it is to seek solutions that are good under a wide variety of different worldviews. This heuristic has an extraordinary ability to protect you from grave ethical mistakes. In this post, I discuss a case study I find particularly vivid and memorable.

Throughout much of American history, white people were very invested in maintaining a firm category boundary between black people and white people. The boundary was troubled, however, by a particular kind of poor Southern white, a group that is almost impossible to refer to without using a slur: “rednecks” or “poor white trash.” The excellent book Not Quite White: White Trash and the Boundaries of Whiteness traces the history of white racists’ responses to this group.

A primary thing that white racists found upsetting about white trash¹ was that they were white people but they acted like black people. They were “lazy” and “idle” (that is, they didn’t work as much as rich people felt they should work). They committed crimes. They didn’t follow middle-class sexual norms. They were dirty and had diseases. Of course, white racists didn’t want to admit that perhaps black people and white people were more similar than different. They certainly didn’t want to attribute crime, dirt, and disease to poverty, or “laziness” to a lack of opportunity to meaningfully improve one’s lot. If that were true, maybe black people weren’t inherently inferior!

The most interesting manifestation of this anxiety was the campaign to eliminate hookworm in the American South from 1909 to 1915. Physicians and educators argued that white trash didn’t have bad genes like the eugenicists supposed. Instead, they argued, hookworm was the “germ of laziness” (pg. 105).

Articles encouraging people to support hookworm eradication usually emphasized that white trash were, well, white. A widely read article from McClure’s was careful to point out:

the ‘poor whites,’ shiftless, ignorant, poverty pinched, and wretched, are of pure Anglo-Saxon stock—as purely Anglo-Saxon as any left in the country.

Walter Hines Page, a popular author of the period, wrote (pg. 121):

The southern white people are of almost pure English stock. It has been hard to explain their backwardness, for they are descended from capable ancestors and inhabit a rich land. Now, for the first time, the main cause of their backwardness is explained and it is a removable cause…

As for the effect of the disease on the intellectual and moral qualities of a people, consider this picture of a dark Virginian neighborhood.The people had for generations been set apart by marked peculiarities from the people surrounding them. They made a dark spot on the map. A nickname of reproach was given to them. They were even regarded by some of the neighboring communities as a distinct race. They lived in abject poverty; they were of very low mental power; they had lost the normal moral perception of the surrounding communities; they lived in promiscuous immorality that is almost incredible. It was a country slum of the worst type…

This whole population has for generations borne the burden of a heavy infection. The community has been islanded and isolated, with cumulative results—physical, intellectual, economic, and moral; from generation to generation there has been a lowering of vitality, physical, and mental. One result has been the deadening of the moral sense and the loss of selfrespect. But the clearing of the moral atmosphere has already set in. The results are not only gratifying; they are stirring. I predict that within five years the whole face of this country will be changed and one will see here a new people and a new earth.

A physician wrote in the journal American Medicine that hookworm was‘‘a matter of national concern’’ because it was known and “removable cause of part of our own racial deterioration” (pg. 132).

Even in articles which didn’t outright compare white trash to black people, black people are conspicuous by their absence. If hookworm caused “lazy sickness”—a folk disease that allegedly afflicted both black people and white trash which made people unambitious, idle, and poor—then naively you’d expect eradicating hookworm to help both black people and white people. But the benefits to black people were never discussed. The white racist knows why black people are like that. The only thing that needs explaining is the behavior of white people.

There’s an interesting lesson from this historical event. The white racist viewpoints here are appalling, even evil. But hookworm eradication is great. Hookworm eradication, in fact, benefited black people—the exact people that white racists despised. Even if your moral beliefs are terrible, you can wind up having a very positive effect on the world.

The reason is that hookworm eradication is robustly good. No one is like “hookworm? Hookworm is great! I want to be infected with hookworm!” Other white racist behavior of the period—like lynching people or sterilizing people without their consent—is not robustly good.² Since racism is in fact wrong, one of these ends up looking a lot better than the others.

Not Quite White: White Trash And The Boundaries Of Whiteness, by Matt Wray. Published 206. 144 pages. $15.

1. In this post, I follow my source’s usage.

2. Even if you are a racist, it should be pretty obvious that, much of the time, when you torture people to death, that is a bad thing to do.