Book Review 314: Malaria

MALARIA: Poverty, Race, and Public Health in the United States, by Margaret Humphreys. 196 pages, illustrated. Johns Hopkins In “Yellow Fever and the South,” Margaret Humphreys showed how generations of local efforts failed to stop the scourge, but the disease fell immediately to a centralized attack; in fact, the disease in effect created a national public health service. That was in 1905. In “Malaria,” we find that a similar approach did not work. In fact, although malaria disappeared, the disease won. It was not eliminated; rather it eliminated its necessary hosts (us) by chasing us away. The American South was marginal territory for malaria anyway. More than half a century after malaria disappeared from the South, it remains unconquered in Africa, south Asia and some other places. Humphreys, a physician, historian and Southerner, writes with skill, sympathy and candor. She is not afraid to call on her family’s experiences in the Tennessee Valley to illumine her subject. And she packs a lot of information in a few pages. One factoid not in the book, but helpful in understanding the problem, is that when young Abe Lincoln was lawyering in Illinois, malaria was the leading cause of death there. It retreated for a variety of reasons. Humphreys argues that malaria is not a disease of poverty but of location. Not a disease of a particular class or ethnic background, but universal, although some groups have some resistance: Afro-Americans are almost immune to the vivax type, which was the most widely spread in the United States. Yet by the 20th century blacks were the principal sufferers, and from the most awful type, falciparum. Really a group of related diseases, malaria is far more complicated than yellow fever, a disease of towns. Malaria was mostly eliminated from towns in the South when the yellow fever mosquito was eradicated. It stayed in the rural places, where eradication of mosquitoes was impractical. Various methods were tried. The disease plasmodium was assaulted with quinine. That did not work. The anopheles mosquito was assaulted with oil, Paris green and, when it became available, DDT. That did not work although it appeared to. Humphreys contends that while public health measures failed, it was action by the central government that ended malaria. The New Deal’s Agricultural Adjustment Act, intended to erase the uneconomic small farms of the sharecroppers, did it, although with great suffering because of (largely) the corrupt practices of landowners. In any event, the ‘croppers left the land, driven by starvation and despair, lured by work in the towns. Without hosts, the plasmodium died. The process was almost finished by the time DDT arrived. It had been going on since 1860, the peak of plow farming in the South. Today, the people are gone, their fields replaced by pine forests, mechanized cotton fields and pastures. While the complex story of malaria in the 20th century is the meat of the book, the heart is in a chapter of oral histories taken by the New Deal’s Federal Writers Project. There the voiceless (and often illiterate) got to set out their experiences with “fever.” Humphreys, who teaches at Duke, was also led to a trove of forgotten documents on the public health campaign in North Carolina, stored in a rat-infested barn and rescued by her for our heritage. Humphreys is a decade younger than I am. I can remember some of the scenes at the tail end of the malaria era in Tennessee, and I can confirm that things were as she describes them.