Hookworm

The parasite responsible for giving American southerners a bad reputation.

For centuries American southerners were maligned as lazy, slow, shiftless, dumb. Southerners had “the germ of laziness.” There was just something different about southerners that made them less-than their northern counterparts. As it turned out there was something different about them but it had nothing to do with genetics or social conditioning. That something was hookworm.

Hookworm

Hookworm, and specifically the New World hookworm Necator americanus, is a parasitic worm that arrived in America by way of the slave trade in the 17th century. In the larval stage hookworms live in wet warm shady soil where they wait to encounter a human. A person walking barefoot outdoors may make contact with a hookworm at which point it can penetrate the skin and crawl into the foot. From there it travels through the circulatory system to the lungs where it triggers a dry cough. The human host then unknowingly coughs up the worm only to swallow it down to the small intestine, which is where the worm wanted to be the entire time. The worm then lives around 1-2 years (or longer) attached to the wall of the intestine, sucking blood, and where a female worm can lay up to 30,000 eggs per day. Eventually these fertilized eggs are pooped out in a poorly built outhouse or in some bushes, contaminating the soil to start the process again. It’s disgusting.

Because hookworms thrive in warm humid environments they do particularly well in the southern climate of the United States. The area from southeastern Texas to West Virginia became nicknamed the “hookworm belt”. For poor southerners who couldn’t afford shoes and didn’t have indoor plumbing it was almost impossible to avoid hookworm. By 1910 it’s believed that around 40% of the people living in the south were infected with millions of worms.

Putting their gross lifecycle aside, the problem with hookworms is that they steal your blood. Alone one worm won’t do much damage, but getting infested by multiple worms on a continual basis over years/decades has a severely damaging cumulative effect. By consuming your blood hookworms can cause an iron deficiency. People with hookworms become tired, lose weight, and have little strength to do anything. Pregnant women are at risk for anemia and a greater chance of dying in child birth. Infected children can suffer irreversible developmental problems including stunted growth and intellectual disabilities. All of this matches the unfair characterization of southerners as slow rednecks.

A nurse brings hookworm medicine to a rural Alabama family, 1939.
A doctor and a nurse examine for hookworm in an Alabama school, 1939.

The cumulative effect

In 1902 zoologist Charles W. Stiles discovered that hookworms were endemic to the southern US. In 1909 John D. Rockefeller got involved by funding the creation of the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease. They campaigned across the south to educate, test, and help treat hookworm. Students in small country schoolhouses would submit stool samples to their teachers to be tested – some schools even required students be screened for hookworm. People would go to health clinics on the weekends to learn more. An estimated 7.5 million southerners had hookworms. While the Rockefeller Commission helped treat the problem what greatly reduced hookworm was the urbanization of the south enabling more people to afford shoes and sanitary indoor plumbing.

The barefoot Texas boy on the right has hookworm, 1939.

Beyond the health consequences the socioeconomic impact of hookworm is also destructive. The US regions with hookworm had lower rates of literacy and school attendance than areas without it. A 1926 study of Alabama children showed that the more worms a child had the lower their IQ. Even today children with chronic hookworm face up to 40% lower future wage earnings when they grow up. General productivity is measurably lower as a result of hookworm. The southern regions that were worst infected with hookworms saw the greatest income expansion after treatment, but unfortunately centuries of infection had a cumulative effect. Eight of the ten poorest US states are still southern states.

Hookworm in the US is typically thought of as a problem of the past but it is still very much a problem of the present. Given the severe income inequality in the US, hookworm is thriving in regions living below the poverty line. Hookworm lives in, and reinforces, poverty and while 85% of the world lives on less than $30 a day 10% of the world is currently living in extreme poverty. Around the world an estimated 477 million people are currently living with hookworms inside them.

Egyptian Mummies: From Medicine to Paint

For hundreds of years Europeans used ground up Egyptian mummies as medicine and paint pigment.

The Arabic word mūmiyā (which later became “mummia”) was the name for the black sticky asphalt material that came out of the ground used as a sealant, an adhesive, and as medicine around the ancient world. Pliny the Elder and others wrote about the medicinal uses for mummia which became a bit of a cure-all for a range of ailments.

Unfortunately mummia the petroleum product looked like another black substance that was a byproduct of the Egyptian embalming process. As such the word “mummia” came to mean both the petroleum product AND the byproduct of Egyptian mummification, which was then even further confused as meaning an entire mummified body. This is how we got the word “mummy”. Unfortunately this series of mistakes also led to hundreds of years of cannibalism.

Cannibal Medicine

Since the petroleum based mummia was used both externally as a salve as well as ingested internally, the Egyptian mummy version of mummia became used in the same ways. The 11th century physician Constantinus Africanus even described mummia as a “spice” found in the sepulchers of the dead. Soon the human version replaced the petroleum version and people began to crumble & grind human corpses for medicine.

With the Crusades, Europeans learned of mummia and its medicinal possibilities. This significantly increased European demand for Egyptian mummies and by the 15th-16th centuries there was a thriving trade in mummies. Thousands of bodies were being exhumed and shipped to Europe to be turned into medicines. In 1586 English merchant John Sanderson shipped 600 pounds of mummies to London to sell at various apothecaries. This was fueled in part by orientalism, that Egyptian mummies had some sort of exotic ancient knowledge or power.

Europeans would consume portions of Egyptian corpses for help with general pain, ulcers, inflammation, epilepsy, cough, difficult labor, etc. – none of which worked, or if they worked it wasn’t the mummy that was the active ingredient. The practice was so common Shakespeare included mummy as an ingredient in the witches’ potion in Macbeth. Demand was so high that by the 17th century some mummy dealers were producing counterfeit mummies. Newly deceased people, animals, or prisoners who had been purposefully starved & executed, were put through a process to simulate ancient Egyptian mummies.

After a few hundred years of medicinal cannibalism Europeans began to express doubt as to the practice’s efficacy (and ethicality). The 16th century herbalist Leonhard Fuchs felt foreign mummies were acceptable but local ones were wrong. While doubts arose during the Renaissance in the 16th century it took until the 18th century age of Enlightenment for the practice to fall out of fashion. As consuming mummies slowly ended Egyptian mummies took on a new role: paint pigment.

The Egyptian Widow by Lourens Alma Tadema is an 1872 painting of Egyptian life potentially painted using mummy brown paint.
Liberty Leading the People by Eugène Delacroix is another painting that’s theorized to contain mummy brown.

Mummy Brown

Around the end of the 16th century artists began using ground up Egyptian mummies (mixed with other materials) to produce mummy brown, a shade of brown pigment. Apothecaries that were grinding up mummies for medicine began to grind them up for paint as well. As a paint it was good for shadows, flesh tones, and glazing. Artists Benjamin West, Martin Drolling, Lawrence Alma-Tadema, Edward Burne-Jones, Eugène Delacroix, and others all painted with mummy brown.

It wasn’t until the 19th century that mummy brown began to fall out of favor. That said as recently as 1926 C Roberson & Co. still sold mummy brown made with ground up Egyptian corpses. As mummy brown died out so too did hundreds of years of large-scale desecration of deceased Egyptians, using human beings for medicines and paints.

Abracadabra

The magic word with a magical/medical past.

The exact origin of abracadabra is unknown but what is known is, before its modern usage by stage magicians, it was used as a real magical incantation. The earliest documented instance is the 2nd century medical text Liber Medicinalis by Serenus Sammonicus. As physician to the the Roman emperor Caracalla, Sammonicus prescribed wearing an amulet with the word abracadabra written on it to cure malaria.

A 13th century version of the 2nd century medical text Liber Medicinalis by Serenus Sammonicus showing abracadabra written in triangular form.

Abracadabra’s use in healing magic may have to do with its possible etymologies. One possibility is that it comes from the Hebrew “ebrah k’dabri” or “I will create as I speak”. Or it may have come from “Abraxas” the mystical word/god from the Gnostic belief system. One language it’s not from is Aramaic (which the internet likes to say it is). Often quoted as coming from “Abra Kadabra” meaning “May the thing be destroyed”, this false Aramaic etymology became a popular internet “factoid” because J.K. Rowling used it as the basis for her “Avada Kedavra” spell in the Harry Potter series (a spell that does not cure malaria … or anything else).

Abracadabra became a popular protective magical word to cure a variety of ills. One application was to write abracadabra out 11 times but each time removing the new last letter, forming a triangle pointing down. This could be written on parchment and worn around the neck, or carved into a pendant of some kind, but the idea was the same – you used the word to summon protective spirits. As you worked your way down, abracadabra would disappear and hopefully so would your illness.

In a metal pendant or written on parchment, abracadabra in triangular form was said to have protective / healing powers.

From Real Magic to Stage “Magic”

Over the millennia, as our scientific knowledge grew, we learned more about medicine and our belief in magic diminished. In general we no longer rely on magic to cure/protect us from the unknown. Our scientific understanding of the world leaves little room for magic; in a similar way to how we no longer have sea monsters on our maps. Magic went from being a highly-regarded area of study, to fun entertaining tricks illusions with rabbits in hats, decks of cards, sleight of hand, magic wands, etc. Similarly, abracadabra went from being a real magic word to being a performative word for stage magicians.

Added info: In A Journal of the Plague Year, Daniel Defoe mentions that some citizens of London, so desperate for relief from the plague in 1665, took to writing abracadabra in the triangle design on the doors of their homes. The Victorians took to the triangular abracadabra pendant as Western esotericism became popular. Today you can still find abracadabra pendants, should you want a little extra magical protection from the viruses of today.

The Rod of Asclepius vs the Caduceus

Often confused, the one without wings is the medical symbol.

the Rod of Asclepius

The Greek god Asclepius was the son of Apollo and became the god of healing/medicine. There are a host of legends about his medical powers – from his ability to heal the sick to his learning how to resurrect the dead. The most recognizable element of the Asclepius story though is his serpent-entwined staff.

The Rod of Asclepius is a wooden staff with a single snake coiled around it. Like Asclepius himself, there isn’t one consistent story explaining the snake. In one version a snake taught Asclepius the secrets of medicine, in another he watched one snake use herbs to revive another snake, etc. Over time the Greek association of medicine and snakes became intertwined (not unlike the Rod of Asclepius). Temples to Asclepius served as centers of healing, and given his association with snakes, non-venomous snakes were welcome. Snakes would crawl over patients’ beds and had free-reign of the buildings – Indiana Jones’ worst nightmare.

Over the millennia the Rod of Asclepius became an international symbol of healing & medicine. You can find it in the logo of the World Health Organization, a whole host of national medical associations, and on the side of ambulances everywhere … unless someone has accidentally used the caduceus instead.

The Caduceus

From the son of Apollo to the brother of Apollo, Hermes was the Greek messenger god who moved between worlds. After generously giving Apollo his tortoise shell lyre, Apollo returned the favor by gifting Hermes his wand / staff. This wand is known as the caduceus which has two snakes entwined around the wand with a set of wings at the top.

The image of a double snake wand is not unique to the Greeks. The caduceus has origins in ancient Mesopotamia going back to at least 3,000 BCE. Hermes isn’t even the only Greek messenger god to carry one – the goddess Iris also carries a caduceus. Like the Rod of Asclepius, there isn’t just one Greek explanation for the origin or meaning of the wand. One story says that Hermes saw two snakes fighting and he used his wand to break up the fight (and they became entwined around the wand). From this the caduceus has come to represent peace but it also represents trade as Hermes was the god of (among other things) commerce, cunning, and thieves. One thing it does not represent is medicine.

The Confusion

One reason for the confusion between these two symbols is they (more or less) look similar. Further, there is nothing about the Rod of Asclepius that looks particularly medical so it’s easy to forget which is which.

One of the biggest sources of confusion in the United States is the Army Medical Department (AMEDD). For some branch insignias the AMEDD uses the Rod of Asclepius but for others it uses the Caduceus (despite the caduceus having nothing to do with medicine). The Army mistakenly used the caduceus in 1851 and the mistake spread to other branches. At this point they are well aware they’re using the wrong symbol but won’t change.

Today it’s not uncommon to find the caduceus mistakenly on the labels of products that want to look more authoritatively medical, purely as a marketing tactic. Maybe using the symbol for commerce as a manipulative way to generate sales isn’t entirely a mistake.

Added info: perhaps at some point in the future the confusion will be sorted out, but if Starfleet Medical is any indication, the problem will persist until at least the 22nd century.

Double, Double, Toil and Trouble

The witches’ ingredients for the cauldron in Macbeth are mostly coded names for medicinal plants.

Macbeth’s Act 4 opening scene is probably one of the most well known scenes in Shakespeare. The Three Witches (aka the Weird Sisters) are in a dark cave with a boiling cauldron at the center. The witches gather and begin an incantation of dark magic, adding ingredients as they go. “Double, double, toil and trouble; Fire burn, and cauldron bubble.” Each witch then lists a series of ingredients that, at face-value, sound disgusting and macabre. But the ingredients are not what they seem.

Witches, like early alchemists, kept their knowledge a closely guarded secret. After putting all of that effort into R&D you didn’t want the competition getting a hold of your findings. But witches had other reasons for secrecy. Unlike the fictional witches in Macbeth, most “witches” were in reality female medical workers using herbs & botanicals to create medicines. In Medieval Europe medicine was a male-dominated profession and women caught practicing medicine were sometimes branded as witches. As such they had to keep their activity, and their recipes, secret. By using alternate names for their ingredients, the contents of one’s “spell book” were kept secret. Also, using alternate names worked as a safe-guard to keep their proprietary medical knowledge out of the hands of the general public who might mistakenly try to prepare these treatments themselves.

Some believe that almost all of the 23 ingredients in the witches’ brew are actually coded plant names, even the problematically named “liver of blaspheming Jew”. How much of this Shakespeare knew is unclear. All the ingredients together would make an unrealistic ridiculous concoction, so they were probably chosen for theatrical shock value. He may have found a list of real “witches” ingredients and used them without knowing they were coded names. Still, if you want improved blood circulation some eye of newt (aka mustard seed) might help.

A list with pictures of the 23 ingredients in the witches' brew in Macbeth
A list of the 23 ingredients in the witches’ brew, and their real world counterparts.
Learn more about these and other alternate ingredients.

Pain Medications: What’s the difference?

Common pain medications are similar but have a few differences, and generic drugs are just as good as brand names.

When looking for pain medication there are more than enough options to induce the paradox of choice. The key is in knowing what active ingredient will treat the problem you have. Most pain medications will treat basic aches and pains but they also have different strengths & weaknesses. The following are an introduction to the four most common active ingredients in most pain medications.

Aspirin is best used for:
• reducing heart-attack risk/severity (by thinning blood)
• mild aches & pains
• headaches


Not great for:
• more severe pain

Aspirin (acetylsalicylic acid)

Aspirin was the first modern pain reliever. An example of multiple discovery, both the ancient Sumerians as well as some pre-Colombian Native American tribes used the bark of the willow tree to relieve fevers & pain. Willow tree bark contains salicin which is metabolized into salicylic acid in the human body, something not understood until the early 19th century. Early synthesized versions of salicin were irritating to the stomach. It took until 1897 for the German corporation Bayer to begin mass producing a synthesized version known as acetylsalicylic acid that was kinder on the stomach. Bayer branded their product Aspirin and it quickly became the number one drug in the world.

Aspirin (when spelled with a lowercase “a”) has become the generic name for the active ingredient acetylsalicylic acid. The Bayer corporation “lost” their patent for the drug as a part of the fallout from WWI. Today it is the one of the most widely used medications in the world with about 120 billion tablets consumed each year. While it is used for pain & fever, it’s especially useful for a variety of heart problems.

Aspirin is best used for:

• reducing hear-attack risk / severity (by thinning blood), mild aches & pains, headaches

Aspirin is not great for:

• more severe pain

Ibuprofen is used for:
• aches & pains
• headaches (and hangovers)
• reduces inflammation and relieves arthritis
• reduces fever
• relieves menstrual cramps

Not great for:
• chronic headaches

Ibuprofen

Ibuprofen was developed by Dr. Stewart Adams in the 1960s as an alternative to aspirin for the English company Boots. Adams said he initially tested the drug on his own hangover. Boots sold the drug under the brand name Brufen but today ibuprofen is the active ingredient in a long list of brand name pain reliever drugs. It’s considered the best common pain reliever, better than aspirin.

Ibuprofen is best used for:

• aches & pains, headaches (and hangovers), reduces inflammation and relieves arthritis, reduces fever, relieve menstrual cramps

Ibuprofen is not great for:

• chronic headaches

Naproxen is best used for:
• very similar to ibuprofen but its effects last longer

Not great for:
• it takes longer to kick-in than ibuprofen

Naproxen

Naproxen is similar to Ibuprofen. While its effects take longer to kick-in they last longer. The effects of ibuprofen last 4-6 hours, naproxen’s effects last 8-12 hours.

Naproxen is best used for:

• very similar to ibuprofen but its effects last longer

Naproxen is not great for:

• quick relief because it takes longer to kick-in than ibuprofen

Acetaminophen is used for:
• bringing down a fever
• aches & pains
• headaches

Not great for:
• inflammation
 and joint pain

Acetaminophen (Paracetamol)

Acetaminophen can help treat pain and reduce fevers on its own, but it is also found in combination with other drugs such as in cold & cough medicines. While aspirin, ibuprofen, and naproxen are all nonsteroidal anti-inflammatory drugs (NSAIDs) and help treat inflammation, acetaminophen is not an NSAID and so it treats pain but not any underlying inflammation.

Acetaminophen is best used for:

• bringing down a fever, aches & pains, headaches

Acetaminophen is not great for:

• inflammation and joint pain

Go Go Generic

When you have decided which active ingredient you want relieving your pain the next question is if you should buy name brand or generic store brand. In short: buy generic.

When you buy a name brand pain reliever you are largely paying for marketing. In the United States a generic drug’s active ingredient is required by law to have the same strength as the brand name equivalent. It also has to work the same way in your body (it has to be bioequivalent). Also, like many white label goods, generic drugs are frequently made by the same company making the name brand equivalent.