The Rise and Demise of Malaria: Some Reflections on Southern Settlement and Landscape

Southeastern Geographer Vol. XX, No. 2, November 1980, pp. 77-99 THE RISE AND DEMISE OF MALARIA: SOME REFLECTIONS ON SOUTHERN SETTLEMENT AND LANDSCAPE Melinda S. Meade For though healthy conditions depending as they do upon soil and climate are not in our power but in Nature's, yet by care we can do much to mitigate the graver evils. Varro (J) Despite two decades of onslaught by human technology, malaria remains one of the most prevalent of serious adult diseases. At the present time as many as five hundred million people may be infected, and with increasing écologie resistance to prophylactic drugs and to insecticides, the disease is ominously resurgent. Americans tend to think of malaria as a disease of tropical, underdeveloped countries, but in the nineteenth century it was the American disease. The United States from Massachusetts and Wisconsin to Florida, from Virginia to California was malarious . Yet, by the turn of the century, before the cause of the disease or its means of transmission was known, the disease had disappeared from most of the country. It persisted, especially in the South, but unsteadily decreased. By World War II only eight states had a mortality rate from malaria of more than one per hundred thousand. Then, through a massive effort, the lingering disease was eradicated. At a time when the worldwide evolution of the malaria disease system is outpacing our technological capacity to develop new chemicals or controls, the experience of the United States constitutes an archive of cultural information invaluable to both the malariologist and the geographer interested in human ecology. The present generation of public health officials has grown up with residual insecticides, accustomed to their use as a single solution, a technological "fix." Such insecticides are failing, and it is widely feared that other methods of intervention have been forgotten. (2) The "ancient lore" ofpre-World War II America worked, within our conditions. This paper reviews the literature on maDr . Meade is Associate Professor of Geography at the University of North Carolina at Chapel Hill, in Chapel Hill, NC 27514. 78Southeastern Geographer laria in the United States and especially the South and tries, with the hindsight provided by our present knowledge of its cultural ecology, to reconstruct some of its history. The parallels its population/habitat/behavior interactions offer with land development and population change in the tropical world today, the importance of socioeconomic improvement , and the passionate conflicts over public interest that it has sparked, make the conditions of its demise immediately relevant. KNOWLEDGE OF THE DISEASE SYSTEM. The major American vector is Anopheles quadrimaculatus Say. (3) The night-biting female A. quadrimaculatus readily enters houses to feed on human blood, resting on the wall afterwards. It is a weak flier, however, and seldom ranges beyond one mile from its breeding ground. It breeds in fresh, quiet, warm waters, with an abundance of vegetation intersecting the water's surface. The vegetation anchors the larva against water movement, feeds it, shelters it from fish, and results in A. quadrimaculatus (henceforth "the mosquito") proliferating in sunny water where the vegetation can flourish. (4) The female mosquito imbibes the gametes of the malaria plasmodia when she takes a blood meal. The plasmodia undergo sexual reproduction in her gut, and subsequently infective forms congregate in her saliva glands where they are transmitted upon the next blood meal. Because blood is needed only for reproduction, and temperature determines frequency of reproduction, an infected mosquito in southern Georgia may infect 10 people in a year, in eastern North Carolina seven, and in New England three or four. The life history of the plasmodia within the human host depends on its species. All the parasites break out of the red blood cells they have consumed in unison, pour into the bloodstream, and find and enter new blood cells. The synchronized cycle results in the characteristic alternation of fever and chills whose periodic duration depends upon species. Falciparum malaria is more virulent and is responsible for most adult deaths. The most prevalent kind of malaria in the United States, as in Europe, was caused by Plasmodium vivax. Vivaxian malaria is a relatively mild though chronic form known for decades as "benign tertian...