Malaria: Poverty, Race, and Public Health in the United States (review)

Malaria is a disease of the American past. But from the early days of colonization until the 1940s this mosquito-borne scourge was a major threat to health and life, impeded economic development, and influenced settlement patterns. The frontier West and the South were especially hard hit. Malaria's demise was instrumental in America's rise to world prominence. Yet in spite of its long and costly presence, malaria in the United States has never before been systematically and critically studied. Margaret Humphreys's Malaria fills this void. Trained in medicine and history, she is uniquely qualified to tell the story of malaria from the perspectives of the physician and the social historian.

Humphreys begins her study with an examination of the biology and evolution of the malaria parasite and its vector, the anopheles mosquito. She proceeds to trace the history of malaria in the United States. From colonization into the nineteenth century the disease was widespread, being the preeminent frontier disease. By the twentieth century it had become a southern disease, and Humphreys stresses the role of poverty, race, and geography in its persistence. She then focuses her attention on public health efforts launched against malaria in the South during the first four decades of the century. Rising prosperity—which was accompanied by better housing, an improved diet, and advances in health care for both black and white southerners—and the movement of the at-risk-population away from malarious areas, Humphreys contends, deserve more credit for malaria's disappearance than either public health measures dating from the nineteenth century or the U.S. Public Health Service's extensive DDT spraying campaigns in the 1940s. (She notes that this conclusion is supported but not proven by the evidence.) A poignant penultimate chapter on popular perceptions of health, disease, and malaria among lay southerners puts a face on the disease and personalizes the misery it produced.

To facilitate an understanding of its complex story, Humphreys considers malaria from three perspectives: those of the physician, the people, and the parasite. The first, the medical response to the disease, was relatively easy to research because of an abundance of materials. The second, the victim's experience of the disease, was a more complicated task because of the clash of disparate voices and, in some cases, the paucity of them. The third, the parasite's biological history, was the most difficult to discern owing to the murky history of the disease until the twentieth century. These three perspectives, Humphreys writes, were "never distinct from each other," confronting the student of the disease with "a maze of interlocking and shifting influences" (p. 5).

Humphreys reminds her readers that malaria remains a major international problem. (Forty percent of the world's population lives in malarious regions.) She had hoped early on that her research might result in more than a history of malaria in the United States—that an account of its conquest here might provide clues for malariologists in their ongoing struggle. But she learned that the story of malaria's conquest in the United States, largely because of fundamentally different socioeconomic and geographic conditions, was of little value in the wider modern world.

This personal disappointment aside, Humphreys has produced an outstanding work. It is an exemplary combination of medicine and history—truly a model for the historical study of a disease. The book is exhaustively researched, compellingly argued, and engagingly written. It will have lasting appeal to a wide audience, and most especially to those interested in social history, medicine, public health, and the South.