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Chapter 2 The Mist Rises: Malaria in the Nineteenth Century 30 As the nineteenth century opened, malignant mists were thought to cause malarial fevers; one hundred years later a complex chain of parasite and mosquito explained the disease. Over the course of the century, malaria afflicted the American frontier, helping produce the roughness and hardship that defined frontier life in contrast to more eastern civilization. During at least some decades of the nineteenth century, malaria affected all regions significantly and severely damaged the health of troops in the Civil War.Toward the end of the century, however, the disease retreated, so that by 1900 it was largely a disease of the southern states.What had been a disease of all parts of the United States became in the twentieth century one more indicator of the poverty, backwardness, and unhealthiness of the South. Malaria on the Frontier While malaria declined in the northeastern states, it grew briskly along the westward-moving line of the frontier. When the lands across the Appalachians became available for settlement, Euro-Americans flowed through gaps and down rivers that took them into Ohio, Indiana, Illinois, Kentucky , Tennessee, and states farther south. As families traveled for days by flatboat and set up flimsy camps near the water, their transportation connection to goods and markets, malaria blossomed.During the antebellum period the wave of malaria subsided in these initial encampments as sturdier houses were built farther off the water, while at the same time it moved on to even newer camps farther west and north. Malaria, most of it vivax, became a common feature of raw frontier life, defining in part what it meant to be in the woods, beyond civilization, beyond the safe life of “back home.”¹ Malaria had traditionally been viewed, at least in the more temperate climates of Europe, as a country disease. David Ramsay, a South Carolina physician writing in the late eighteenth century, typically noted that intermittent fevers first appeared after an area had been cleared to make way for settlements and farms. So there was an initial stage without disease, followed by chronic ill health from marsh fevers. But as cities such as Charleston grew, the land became progressively better drained and the location healthier.“It has long been observed in the low countries,”Ramsay wrote, “that they who reside in towns, are more healthy than they who live dispersed in the country.”² Given its association with swamps, malaria declined where people built clusters of houses.It was general knowledge that low, wet lands made bad sites for dwellings or towns; such areas were prone to both flooding and disease. So towns tended to be built on the higher elevations in a region, where the topography encouraged drainage. This tendency was countered by the need for populations to cluster near modes of transportation, and before the advent of railroads in the 1840s, that meant near bodies of water. Some cities, such as Charleston, were favored by sandy soil that drained easily and by surrounding salt marshes that were inhospitable to disease-carrying anophelines. Other cities, just by dint of construction, paving, and drainage, broke the malaria chain by denying anophelines the requisite swampy expanse within a mile of human populations. Hence even in the relatively rural American South and early frontier, as towns became established, malaria withdrew to the countryside . This was evident to medical observers in the South, who sometimes contrasted the preferences of malaria and yellow fever for different stages of settlement. Mobile physician Josiah Clark Nott commented in 1847, for example: “When the forest is first leveled and a town commenced, intermittents and remittents spring up.” So malaria was tied to breaking new ground on the frontier. Yellow fever, however, came later: “As the population increases, the town spreads, and draining and paving are introduced,” he continued, “yellow fever, the mighty monarch of the South, who scorns the rude field and forest, plants his sceptre in the centre, and drives all other fevers to the outskirts.”³ This would become a recurring theme throughout malaria’s course in the United States. It was associated with rough,frontierconditions,notwiththeincreasingcivilizationoftownsand cities. Perhaps the best description of this phenomenon comes to us from the pen of Charles Dickens, who traveled the Ohio and Mississippi Rivers in the spring of 1842 and painted a memorable scene of the raw, primitive frontier lifestyle made bleak and helpless by disease. Dickens’s account was inspired by his visit to Cairo...

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