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Perspectives in Biology and Medicine 46.1 (2003) 153-156

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Malaria: Poverty, Race, and Public Health in the United States. By Margaret Humphreys. Baltimore: Johns Hopkins Univ. Press, 2001. Pp. xi + 196. $41.50.

Few people realize that malaria was endemic in vast areas of North America and that it was introduced by immigrants from Europe and slaves from West Africa. Fewer still appreciate the enormous impact that the disease wrought on the human population and its social structure in the United States, even up to the early 20th century. While people may be aware of malaria as a tropical disease afflicting major parts of Africa, Southeast Asia and South America, few will put it closer to home than an occasional risk to travelers in such distant climes. Oh, how far from reality this is! Through the pages of her book, Margaret Humphreys paints a picture of this dramatic disease in North America, showing its pervasive effect on the social makeup, distribution, and population structure, both Native American and immigrant. Her examination of the advent of malaria in North America, its impact on society, social mores, and development, as well as its final decline and disappearance is a masterful rendering of historical medicine and public health. Her thesis will make readers ponder the malaria-associated developments here and should influence our thoughts as we wrestle with the problem still afflicting so much of humankind.

The book is well written and of interest to anyone concerned with public health and infectious diseases. I would consider it a must-read for any malariologist or student of human disease. The study unfolds in the manner of a well-crafted thriller and is all the more captivating because of its revelation of the sociological impetus wrought by this parasitic disease. The text is authenticated and the references are set in a clearly marked section at the end of the book. It is apparent that a prodigious amount of material has been found and examined in order to develop the themes, and the world of science owes a debt to historians such as Humphreys who dedicate so much time and effort to important issues that often baffle those in the field.

The story unfolds systematically. The introduction carefully and accurately spells out major factors involved in the epidemiology of malaria. While Humphreys explains the salient features very clearly, perhaps a little more stress on the relapsing nature of Plasmodium vivax might have helped clarify reasons why this species was not cured completely by quinine and other anti-malarial drugs. Humphreys describes the relevance of the vector mosquito, showing [End Page 153] how it interrelates with its human source of food and with the parasite in the maintenance of this devastating disease. My only reservation about the entire text lies in the terminology the author uses to describe the parasite genus. Malaria is caused by any one of four species of Plasmodium affecting humans. The word Plasmodium is the name of the genus, and it cannot be used in the plural as "plasmodia" for convenience. In fact, plasmodia are organelles in slime moulds, and hence the use of this word is inappropriate and inaccurate. However, in deference to the author, one must note that she obviously follows other authors in this terminology, including the famous Leonard Bruce-Chwatt. But it is incorrect.

In "The Pestilence that Stalks in Darkness," the author describes the manner in which the parasites must have been introduced into North America and the impact of such a plague on the new settlers as well as the native peoples. This process of deduction and historical interpretation is done carefully and convincingly. The initial introduction was likely that of P. vivax from northern Europe, which appears to have become established in the original colonies and was the cause of several outbreaks of "chills and ague" among the new settlers, as well as perhaps numerous severe outbreaks of illness among non-immune Native American peoples. With the advent of slavery from Africa, the importation of P. falciparum was another source of...


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