War and Disease: Biomedical Research on Malaria in the Twentieth Century (review)

In War and Disease, a history focused on the development of antimalarial drugs in the United States before and during World War II, Leo Slater has created a remarkable and admirable book that should find a wide audience among historians of science and medicine, as well as students of military-civilian interconnections in the twentieth century. Slater notes that while the Manhattan Project usually is identified as the prototypical big-science project of the twentieth century, a compelling case can be made that the search for effective antimalarials between 1939 and 1945 similarly influenced the postwar American science environment. Specifically, the wartime antimalarial research infrastructure significantly shaped the subsequent formation of the Centers for Disease Control and Prevention and the National Institutes of Health, and generally foreshadowed the deep interlink-age of the pharmaceutical industry, universities, and government agencies that characterized the latter half of the twentieth century.

The search for effective antimalaria drugs was early identified as crucial to the American war effort because malaria epidemics were expected to occur not only in several major theaters of war—the Pacific, East and Southeast Asia, and the Mediterranean—but also on the home front. The southern United States, the Caribbean bases obtained from Britain, and the Panama Canal were all malarious or potentially malarious areas. Even the briefest reflection by American leaders on the history of disease during military campaigns suggested that malaria would be a serious problem during what was expected to be both the greatest deployment of military forces, and possibly the greatest movement of civilians, including refugees, that the world had ever known. Not only would the previously uninfected be threatened by moving into malarious areas, but some of those millions of people already infected with malaria would bring the disease into new habitats (some previously cleansed of the disease) that were suitable for it. This nightmare scenario was compounded early in 1942 by the Japanese conquest of Java, where cinchona plantations created over the previous century had become the world's primary source of quinine, by far the most important antimalarial drug available at that time.

Slater properly begins his story in the laboratory of Paul Ehrlich, who, among his many astonishing accomplishments, had discovered in methylene blue the first synthetic chemical with antimalarial properties. Following that clue, the German firm Bayer eventually developed the first industrially produced and commercially marketed antimalaria drug, plasmochin. The history over the first four decades of the twentieth century also winds through British and American pharmaceutical and university research, and through the laboratories and fieldwork of the Rockefeller Foundation and its associated philanthropies. For this period Slater focuses on the development of various research models, with their virtues and defects, that allowed researchers to target the elusive malaria microbe.

The core of the book is an investigation of the rapid development of new research methodologies and a complex research infrastructure, beginning in 1939, that was flexible, collaborative, and responsive to change. Slater adopts the term "kaleidoscopic" (used originally by William Mansfield Clark) to describe the piecemeal integration of elements from industry, higher education, the military, and the government to create a coordinated attack on the problem. He emphasizes the importance of interpersonal relationships in making things work and gives some attention to the clash of independent research styles favored in university environments with the increasingly bureaucratic and routinized work patterns associated with government control. Readers could get weary of following the constant branching and reforming of government agencies that Slater recounts, but ultimately this does not mar his relating of the saga.

War and Disease is recommended highly and should be on any reading list regarding the rise of big science in the twentieth century.