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Logo of medhistThe Wellcome Trust Centre of the History of Medicine (UCL)Medical History
Med Hist. 2010 July; 54(3): 425–427.
PMCID: PMC2889481

Book Reviews

Humanity’s burden: a global history of malaria
Reviewed by Patrick Zylberman

James L A Webb, Jr.
Humanity’s burden: a global history of malaria, Studies in Environment and History,  Cambridge and New York,  Cambridge University Press,  2009, pp.  xii, 236, £14.99 (paperback   978-9-521-67012-8) 

By the middle of the nineteenth century, the link between swamps (miasmas) and fevers appeared to be well established. The study of malaria was thus based on typical malarial landscapes—the marshes—in North America and Western Europe and on the cycles and intensity of transmission characteristic of Plasmodium vivax (tertian fever). However, this model could not explain the history of infection in other regions of the world where mosquitoes reproduced, not in marshes, but in mountain streams, tidal floodplains or hoof-print size puddles.

The subject of this book resembles first of all a geo-history devoted to retracing the shifting distribution of malaria, a geo-history which borrows from these earlier authors on malaria. Secondly, it resembles an epidemiological history, retracing, over a very long period, the transformations in the nature and meaning of the infection in the course of its intercontinental migrations from Africa to Europe, then to the Americas, until the disappearance of malaria from the temperate zone.

It is an historical epidemiology which quite logically takes an ecological perspective. Here, the units of analysis are the three main zones of malarial infection. The first, dominated by P. falciparum, is geographically limited to Africa. Mortality there is essentially among children under five years old. In the zone where vivax predominated, attacks occurred primarily in the summer. Mortality was rarely above one per cent: “Vivax was the great debilitator, not the great killer.” The zone of mixed infections was located between the first two, from southern China to the Mediterranean basin, by way of the subcontinent. Although mortality and morbidity were lower than in the zone where falciparum predominated, they could none the less reach very high levels when populations had no acquired immunity.

Ecological history and cultural history are closely intertwined. Humanity’s burden identifies three main types of correlation between cultures and landscapes. The first was a pattern of avoidance (East Africa, the Balkans, Central and South America) where populations of the high plains avoided all contact with lowlands during the transmission season. More generally, in agricultural societies, the elites often stayed away from zones of malaria where workers of low social status were concentrated (slaves, serfs, untouchables). The second type was the opposition—disputed by some—between nomads and agriculturalists, the former keeping well away from the latter during the season when the mosquito bit. A third kind opposed agriculturalists and the forest people who remained unscathed by any contamination. By extending slash and burn cultivation (yams in tropical Africa, maize and manioc in the Brazilian forest), agriculturalists spread the infestation. Far from being isolated through disposition, “primitive” people were obliged to withdraw to the deepest forest because of the disease introduced by the agriculturalists. In all these cases, epidemiology and ethnicity were interwoven.

The book is divided into two main sections organized according to an eminently Braudelian plan. The first section covers a very long history of the infection on the three continents. The second, with much shorter undulations, retraces the successes, but more often the failures, of science and of malaria policy as played out in eradication campaigns—in reality the “control” of transmission—from the end of the nineteenth century. A final chapter concentrates on the efforts in Africa with which, for better or worse, the name of the WHO is associated. A long chapter on treatment (quinine, opium) and on the “accelerators” of the diffusion of infection in the nineteenth century (migrations, colonization, transportation, war, drought and famine) separates the two sections.

Humanity’s burden is testimony of a twofold success. The work offers a historico-epidemiological synthesis devoid of unnecessary technical language on a serious pathology of utmost importance in the world today. Epidemiologists, economists, anthropologists and students can draw on it with considerable benefit. It is also a very convincing essay on global history, both from inside (explaining the persistence of the virulence of the infection by studying the connections between different local epidemiologies) and from outside (integrating the advances in the social and natural sciences). The book is enriched by an abundant bibliography.

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