To Cast Out Disease: A History of the International Health Division of the Rockefeller Foundation (1913-1951) John Farley. New York and Oxford: Oxford University Press, 2004, pp. 336, $49.95. (PB). ISBN: 0195166310

Books about the various Rockefeller philanthropies tend to take one of two tacks: either they see the foundations as totally altruistic organizations that are in operation only to help humanity or they see the foundations as instruments of imperialism or capitalist development. This has been particularly true for stories of Rockefeller funded international health work as that activity, more than any other, can be seen through either lens. What distinguishes the Farley book from others is its attempt to ignore these dichotomous views and concentrate solely on the outcomes of projects and the interpersonal dynamics between central office and field staff. In this endeavour it succeeds quite well. It is well researched, highly readable, and even witty at times. To be sure, the conquest of infectious disease makes for a good story and while it is easy to get lost in the names and the places, the results speak for themselves. The Rockefeller philanthropies devoted considerable attention to hookworm disease, but few authors, including Farley, explain the reasons for this. Hookworm disease produced a profound anaemia in its victims, which made them very unproductive and tired. The disease spread through contact with infected faeces which happened in the dual circumstances of people not wearing shoes and the lack of sanitary privies. The disease itself was not particularly harmful (though there were deaths from other causes that were exacerbated by hookworm), and a simple and cheap chemical cocktail could quickly and efficiently rid a body of its infestation. The elimination of the infestation would produce a noticeable improvement in energy levels and vigour in people, but the real problem was preventing re-infection which could only be done through the wearing of shoes and privies. After taking the cocktail, the change in behaviour in a formerly infected person was so profound and so obvious that everyone who observed it was impressed. Governments and even farm owners might be persuaded to invest in public health, once they saw the results and imagined the impact on economic productivity that could be achieved. The Rockefeller philanthropies had very particular ideas about how to operate. They did not believe in ‘retail philanthropy’, as they called it, and preferred to set up spin-off organizations to distribute grants at the grass roots level. They did not believe in long term operations, but only in demonstrations that could then be taken over by another, more permanent body, once the results were obvious. They did not believe there was a need for different approaches to their programs even when they were in different geographical areas or cultural and political systems. Perhaps most important, they wanted host countries or areas to continue the work exactly as they had started it. To Cast Out Disease is a history of the International Health Division (IHD) of the Rockefeller Foundation. The work in the United States on Hookworm started auspiciously perhaps because there were few language or cultural barriers to overcome and perhaps because local and state governments did not really understand that the work in the hookworm campaign was designed to get them to take over the campaign after a relatively short period of time. The work outside the United States was always more problematic as the intentions and modus operandi of the IHD was not well understood and subject to misinterpretation and bruised nationalistic egos. The work was not abetted by the two World Wars which occurred while it was in operation nor by the various local conflicts which produced serious setbacks. Yet, hookworm gave way to yellow fever, which gave way to malaria and while no disease was cured by the IHD, there is no question the work led to significant developments in sanitation, hygiene, and public health. Moreover, just as the Rockefeller philanthropies founded and endowed the first schools of Public Health in the United States to ensure that there would be a supply of well-trained workers to carry out the projects inspired by the hookworm campaign, they similarly created schools of public health in Toronto, London, Brazil, and later in a number of other European and Asian cities. Farley does an excellent job of detailing the most salient aspects of the history and provides a clear flavour for the problems in different countries as well as for the multitude of personalities involved with the IHD. Perhaps no one else in history, including his parents, has ever called the Reverend Frederick T. Gates (the mastermind behind the Rockefeller philanthropies), Fred, but colloquialisms aside, the history is well researched and well written. In the end, the schools and the approach to disease prevention and amelioration remain as the most visible legacy of forty years of the philanthropic campaign. The story that is told by Farley is compelling and interesting and serves to provide a good foundation for people interested in how our current methods of disease control originated.

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