Review Article

Social Consequence of Disease in the American South, 1900 – World War II

Authors: Mike G. Martin, MD, Margaret E. Humphreys, MD, PHD

Abstract

The early 20th century Southerner lived in a disease environment created by a confluence of poverty, climate and the legacy of slavery. A deadly trio of pellagra, hookworm and malaria enervated the poor Southerner-man, woman and child—creating a dull, weakened people ill equipped to prosper in the modern world. The Northern perceptions of the South as a backward and sickly region were only compounded by the realization that her population was malnourished, infected by worms, and continually plagued by agues and fevers. As historian John Duffy concluded, “As a chronically debilitating disease, it [malaria] shared with the other two the responsibility for the term ‘lazy Southerner.'”


Key Points


* Negative stereotypes of Southerners may have been founded on their unique disease burden.


* Malaria, pellagra and hookworm were each endemic and uniquely crippling to the South before World War II.

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References

1. Humphreys M. Yellow Fever and the South. New Brunswick, NJ, Rutgers University Press, 1992.
 
2. McPherson JM. Ordeal by Fire: The Civil War and Reconstruction. New York, McGraw-Hill, 1992.
 
3. Ettling J. The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South. Cambridge, Harvard University Press, 1981.
 
4. Hotez PJ, Brooker S, Bethony JM, et al. Hookworm infection. N Engl J Med. 2004;351:799–807.
 
5. Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med 1991;325:687–694.
 
6. Bleakley H. Disease and development: evidence from the American South. J Eur Econ Assoc2003;1:376–386.
 
7. Etheridge EW. The Butterfly Caste: A Social History of Pellagra in the South. Westport, CT, Greenwood Publishing Company, 1972.
 
8. Little YA. The dietetic treatment of pellagra, with report of eleven cases. South Med J 1915;8:659–662.
 
9. Etheridge E. Pellagra: an unappreciated reminder of Southern distinctiveness: disease and distinctiveness in the American South. In: Disease and Distinctiveness in the American South. 1988, p100–119.
 
10. Kraut AM. Goldberger's War: The Life and Work of a Public Health Crusader. New York, Hill and Wang, 2003.
 
11. Sydenstricker VP. The history of Pellegra: its recognition as a disorder of nutrition and its conquest.Am J Clin Nutr 1958;6:411–414.
 
12. Andrews JM, Grant JS. Military Mobilization in potentially malarious areas of the United States. Medical Department, United States Army: Preventive Medicine in World War II. Washington, DC, Office of the Surgeon General, 1963.
 
13. Humphreys M. Malaria: Poverty, Race, and Public Health in the United States. Baltimore, The Johns Hopkins University Press, 2001.
 
14. Wilks NE, Turner PP, Somers K, et al. Chronic ill-health from unrecognized malaria. East Afr Med J1965;11:580–583.
 
15. The Commission for the Study and Prevention of Malaria to John D. Rockefeller, Oct 1, 1913, Proposal for Rockefeller Foundation to Fund Malaria campaign, Central File 1897 – 1923, Malaria, 1913, Records of the USPHS, Record group 90, NACP.
 
16. Gallup JL, Sachs JD. The economic burden of malaria. Am J Trop Med Hyg 2001;64:85–96.
 
17. Sachs J, Malaney P. The economic and social burden of malaria. Nature 2002;415:680–685.
 
18. Holding PA, Kitasao-Wekulo PK. Describing the burden of malaria on child development: what should we be measuring and how should we be measuring it? Am J Trop Med Hyg 2004;71:71–79.
 
19. Al Serouri AW, Grantham-McGregor SM, Greenwood B, et al. Impact of asymptomatic malaria parasitemia on cognitive function and school achievement of schoolchildren in the Yemen Republic.Parasitology 2000;121:337–345.