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The Importance of Wearing Shoes: Hookworm Disease in Mississippi lesson plan


Students of any age seem naturally to be captivated by gruesome details of historical events. This lesson on hookworm disease provides them with just such information regarding one of the most serious public health issues in post-Civil War Mississippi. As students make connections between the disease and the state’s history, geography, and standard of living, they will also be challenged to explore the ramifications of being part of a region known as the “sickly South.” (Encyclopedia of Southern Culture, p. 1352)


Mississippi Studies Framework: Competencies 1 and 2


Grades 4 (with modifications) through 12


Mississippi History Now article, “The Importance of Wearing Shoes”


Students will:

determine connections between the prevalence of hookworm disease in Mississippi and the state’s history, physical geography, and its standard of living;

describe the effects of hookworm disease;

recognize and evaluate the effectiveness of techniques used to cope with the disease.


Teacher will begin lesson by reading the following story.

In 1910, a young teenager named Jim lived on a small farm in the rural Piney Woods region of Mississippi, about 20 miles north of the Gulf Coast. His family was poor. Clothing was hand-made and “hand-me-down,” and shoes were never worn except on Sundays for church and in the dead of winter. Food was mostly plentiful, provided from a large vegetable garden, a small fruit orchard, and the chickens and pigs raised on the farm. Jim had a number of responsibilities. His chores included working the garden, tending a small number of livestock, and maintaining the farm’s outbuildings: the barn, tool shed, smoke house, and privy. Jim ate well and rested hard each night. However, he often felt tired during the day and frequently complained of aches in his joints. His parents assured him they were just “growing pains.”

As the fall approached, Jim eagerly awaited the family’s visit to the Harrison County Fair. The trip in the mule wagon was long and hot, and Jim was grateful for a place to stay during the night at his cousin’s house. They would stay there again before making the long journey back home. With fifty cents in his pocket, Jim pushed his “growing pains” aside as he enjoyed the mid-way shows, the rides, and games. Jim’s parents visited the livestock show, the prize-winning vegetable and fruit displays, and the educational exhibits.

The children were tired after their exciting adventure and were allowed to sleep late upon returning home. As Jim was leaving to attend to his chores, his mother stopped him at the back door with his shoes in her hands. “Jim,” she said, “from now on, I want you to wear these shoes when you go outside.” Jim hated the tight leather on his feet and started to protest, but thought better of it. As he left the house to check on the outbuildings, he saw things there that puzzled him as well.

Teacher will stop to ask students what they think Jim might have seen that was different in the farm yard. They should also try to explain the mother’s sudden decision for Jim to wear his shoes.



Teacher will engage students in a strategy called a discrepant event inquiry. Working either in small groups or individually, students will attempt to figure out the story by asking questions which can be answered by the teacher ONLY with a “yes” or “no.” Thus, students are encouraged to focus carefully on the problem in order to structure their questions correctly.

NOTE: The solution to this inquiry is that Jim has symptoms of hookworm disease. His mother learned from an educational exhibit that shoes should be worn and that outbuildings, particularly the privies, should be located a distance from the house and should be constructed so that waste products would not intermingle with the surrounding soil. They should be strong enough so that animals could not break in.


Pause after a number of questions have been answered to allow students to confer. They should discuss what they now know, formulate hypotheses, and prepare new questions. Students will engage in several rounds of questioning until either they have explained the story or they are highly motivated to investigate the “mystery.”


Tell students the “mystery” has to do with a disease which struck many Mississippians in the post-Civil War period. Have students brainstorm the types of information they would like to know about the disease. Write these questions on the board or on an overhead. If these are not suggested by the students, ask them to include the following: a. How was the disease introduced to the state? b. Were there particular characteristics, either of the land or the people, that would encourage the spread of this disease?


Read all questions again to the students so they will understand their focus for reading the Mississippi History Now article.


After students have completed the reading, lead a class discussion to answer the questions raised by the students. (If questions are not answered in the article, ask students to do additional research.)


Students will write a brief essay on what they have learned. They should explain connections between the disease and the state’s history, geography, and standard of living.


Have students draw or sketch an outline of the human body on which they will list the symptoms of hookworm disease. Lead students to speculate on how the disease would affect the performance of a: teen-age student; b. farmer; c. mother of five. Ask students to consider some of the stereotypical images of Mississippians and Southerners in general as lazy and/or backward and to think about the rationale for such thinking. Additionally, ask students to stretch even further to reflect how such thinking might impact the state’s business climate. (Example: Would a business want to locate a plant here when potential workers are viewed as lazy and unmotivated?)


To examine the state’s response to the disease, students will complete a chart with the following headings: HEALTH EDUCATION; PATIENT TREATMENT; COMMUNITY COOPERATION.Under each heading, they will list examples found in the reading.


Allow students to check their responses with a partner and together determine the effectiveness of the campaign.


In small groups, ask students to gather information on the outbreak of West Nile Virus in Mississippi during the summer of 2002. They should particularly search for historical (how did it get here?) and geographical aspects of the disease. Ask them to think about the cost of a public health campaign.



Each student will write an ending to the introductory story explaining the “mystery.” (Teacher may want to provide a writing guide of specific points which must be mentioned.)


A class discussion to compare/contrast the hookworm disease and West Nile virus should prove interesting.



Class participation in discrepant event inquiry and discussions


Formative essay


Completion of “human body” outline


Chart completion


Story ending


Summative assessment (if teacher desires) where students could respond to the inquiry: “Was hookworm infestation a problem in Pennsylvania? Explain your answer.”


An “understanding” discussion where students talk about new insights they have gained as as result of the study.



Students may wish to conduct biographical studies of Dr. Charles W. Stiles and Dr. Waller S. Leathers.


Invite a guest from the state’s Office of Public Health to speak on serious health issues in the state’s history. Ask the guest to discuss the monetary cost of dealing with an outbreak of disease.


A student may research the role of the WPA during the Depression in helping to control the spread of the hookworm disease. What did it do?


Explore the philanthropic donation from the Rockefeller Sanitation Commission.


Research the diseases which led to the region being known as the “sickly South.” This would include, in addition to hookworm, pellagra, malaria, and yellow fever.


A study of the growth of public health services in the state would be informative.


Ask students to find descriptions in Mississippi/Southern literature of characters with hookworm disease.


Wilson and Ferris, Encyclopedia of Southern Culture, The University of North Carolina Press, 1989.

McLemore, Richard, A History of Mississippi, Volume Two, University and College Press of Mississippi,1973.

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