Humanity's Burden: A Global History of Malaria (review)

The conceptual worldview of ecology is at the center of James Webb's approach to malaria, as is fitting for a book in the Cambridge series on "Studies in Environment and History." Webb grounds this fine survey of malaria's history in a solid understanding of the parasite's biology. He deftly describes the web of influences that determine disease success, including climate (temperature, moisture), environment (land cleared or forested, standing versus moving water, characteristics of human structures), innate human characteristics such as genetic immunities, demography and population movement, and so on. And he ably projects this complexity across the globe and across time.

Webb's chronicle depends heavily on the vast body of historical literature concerning malaria that has emerged since the 1960s. His account begins with the Stone Age and ends with the Gates Foundation. Webb characterizes his approach as "historical epidemiology," which he defines as "the field of study that integrates both spatial and temporal dimensions of the changing patterns of disease" (p. 10). Webb is less interested in the cultural interpretation of disease (no Michel Foucault or social constructionism here), and more in exploring when, where, and why malaria flourished.

About half way through the book, humans begin to fight back. The intricacies of the discovery and understanding of the cinchona alkaloids, including quinine, is ably summarized. Quinine was both used as a generic anti-fever drug, and questioned as an appropriate therapy because it appeared to "stimulate" when physicians felt an "inflamed" patient needed to be "depleted." Cinchona bark actually came from several different species of trees and varied in potency from species to species and region to region. The resulting disparities added to the confusion surrounding the use of quinine, a story told with accuracy and detail here.

Webb goes on to chart the discovery of the malaria parasites and their vectors in the late nineteenth century, and describes the many controversies in the twentieth around the proper approach to malaria control. He reviews the two major modes of attack—use of medication against the parasite or strategies for mosquito control—and adeptly brings together the multiple, global studies that evaluated their efficacy. Webb recognizes the importance of both world wars in foregrounding research on malaria and its control, and neatly encapsulates the efforts of regional and global public health agencies in the last half of the twentieth century. Throughout his tone remains neutral; although he clearly describes the reasons for the failure of, for example, the WHO eradication campaign of the 1960s, his language instructs while avoiding recrimination.

Lest someone think this review is too positive (and quid pro quo for his statement on p. 154 that my assessment of malaria's decline in the USA was "argued convincingly"), let me take issue with a couple of points. Webb takes as an established fact Samuel Cohn's hypothesis that medieval plague was caused not by Yersinia pestis but a "filoviral infection . . . related to Ebola fever," (p. 11) a point upon which many historians (backed by DNA evidence from plague burial grounds) would disagree. Another oddity is the claim on p. 87 that in Argentina "there were no anopheline vectors capable of transmitting malaria," even though on p. 117, citing Eric Carter's work, he acknowledges that by the late nineteenth century the northwestern part of the country "developed the reputation as the most backward and malarial within Argentina."

But these are small points. This is an excellent book, one perfect for classes on global health history and the history of medicine. It is a model for the ecological history of a disease, and especially impressive in that this work comes from a historian without prior entry into the historiography of medical history. While Webb presents the many approaches to malaria control, and particularly the many pitfalls inherent in partial measures that destroy acquired immunities while not eradicating the disease, he does not advocate a method for...