Period of Great Epidemics


Georgia to Pennsylvania; it marched slowly north and west along the
coast and the river valleys. By the middle of the nineteenth century,
when the disease reached its peak, it had spread even into New England
and northern New York and was especially serious along the Missis-
sippi River and its tributaries. Contemporary writers of that century
placed malaria high on the list of endemic disabling as well as fatal
diseases.
   Although the method of transmission was discovered by Ronald
Ross in 1897-98, and Gorgas started large-scale antimosquito cam-
paigns as early as I9OI, first in Cuba, then in Panama, few active
measures in the continental United States were begun before 1912.
To us malaria is a disease clearly ascertainable by the presence of plasmodia
in the
thick blood smear. To 19th century physicians malaria was and could be but
that
mysterious emanation of swamps and "decaying vegetable matter"
which caused
"malarious" or "estivoautumnal" disease.... Particularly
under frontier conditions,
there was no official and very little unofficial recording of diseases, and
to make things
worse, just at its height, malaria [or fever and ague, the chills, intermittent,
remittent,
bilious fever or whatever it was called] was so common that by many it was
no longer
regarded as a disease at all and therefore, of course, not recorded as such.3'

Chills were part of the inevitable "acclimatization." He ain't
sick, he's
only got the ager, was the common reaction. "Especially the malaria
of
small children, which constitutes the bulk of malaria cases in highly
endemic sections, went unnoticed, at least by medical men. What Hip-
pocrates and Aristotle had known was forgotten. There was even a
widespread belief among doctors that malaria only attacks adults. Lay-
men sometimes seem to have been better observers of infantile malaria."
Daniel Drake, our leading epidemiologist of the interior valley of
North America, leaves no doubt of the extensive prevalence of "au-
tumnal fever," although one is forced to admit confusion among the
intermittent, remittent, and bilious fevers. Timothy Flint, the Massa-
chusetts missionary and herald of the frontier, in his early study on
nineteenth century frontier conditions, makes the following significant
  statement: "The Valley of the Arkansas, with very little exception,
is
  sickly. Remittents and intermittents are so common, that when a per-
  son has no more than a simple fever and ague, he is hardly allowed to
  claim the immunities of sickness .... The autumn that I was there, it
  appeared to me that more than the half the inhabitants, not excepting
  the Creoles, had the ague."
    In our awareness of the confusion among early physicians in the diag-


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