Malaria: Poverty, Race, and Public Health in the United States.

By Margaret Humphreys. (Baltimore and London: Johns Hopkins University Press, 2001. Pp. [xii], 196. $41.50, ISBN 0-8018-6637-5.)

This study by physician and historian Margaret Humphreys treats a small fraction of the career of a disease endured by our primate ancestors some 50 million years ago. However, she always reminds the reader of the larger historical and epidemiological picture. The first chapter, for example, provides a biological history of the protozoan members of the Plasmodium genus that cause malaria when injected into the human body by the anopheles mosquito. It also explains the immune mechanisms developed by humans to resist the infection--and here the slippery concept of race arises, because tropical Africa has been plagued with malaria longer than other places in the world, and consequently, its sons and daughters have developed a greater array of defenses against it.

Humphreys's principal interest is the eradication of malaria from the southern United States after it had disappeared from the rest of the nation. The latter had occurred in stages. By 1800 the disease, omnipresent in the South, was receding in the Northeast but increasing in the Old Northwest as forests were cleared and towns established along mosquito-infested waterways. Yet, by century's end, save for a few pockets, malaria had ceased to be a problem except in the southern states. Railroads meant that towns no longer had to be located on waterways; the presence of cattle diverted mosquitoes seeking blood meals from humans; and the raw conditions of frontier life had been replaced with those of prosperity that lessened exposure to mosquitoes. Quinine, in widespread use by the time of the Civil War, may also have contributed. Quinine neither prevents nor cures malaria, but it does reduce the extent of parasitism and thus probably reduced its spread.

Malaria, however, was not so easily dislodged from the South, despite medicine's turn-of-the-century unraveling of its etiology and epidemiology that shifted blame for malaria from airborne poisons to organisms. The reasons were multiple, but poverty and race played significant roles. Poverty meant little access to insecticides, let alone medicines. It also meant shoddy, crowded housing, generally located close to marshlands, for the mostly African American sharecroppers who acted as reservoirs for falciparum malaria because of their ability to tolerate it. Poverty also meant that the South could not afford the effort to eliminate malaria--an essentially rural disease--from the whole of the region, especially not when it was also under siege from other diseases such as hookworm, tuberculosis, syphilis, and pellagra.

The Rockefeller Foundation and the United States Public Health Service launched antimalarial efforts, and business interests such as railroads, lumber companies, and hydroelectric companies gradually came to understand (or were made to understand) the financial wisdom of sponsoring drainage and larvicidal campaigns. Scholars have given some credit to these efforts for malaria's eventual disappearance from the South by 1950 and much credit to the widespread use of DDT that came out of World War II. Yet Humphreys argues that far more critical was an unintended consequence of the New Deal's Agricultural Adjustment Act, which made large-scale farming more profitable than renting to sharecroppers. The result was depopulation of the countryside, thereby "breaking the chain of malaria transmission" (p. 111).

This is a fresh (and plausible) explanation for the disappearance of another southern "germ of laziness," and it is presented in a study that does a fine job of packaging its findings within a richly documented historical context.

KENNETH F.KIPLE

Bowling Green State University