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Firm-Led Malaria Prevention in the United States, 1910-1920

Published online by Cambridge University Press:  06 January 2021

Byron Carson*
Affiliation:
Department of Economics, George Mason University, MS 3G4, Fairfax, VA 22030, USA

Abstract

In the absence of capable government services, a railroad company in Texas and multiple cotton mills in North Carolina successfully prevented malaria in the early twentieth century. This Article looks through the lens of economics to understand how and why people had the incentive to privately coordinate malaria prevention during this time, but not after. These firms, motivated by increases in productivity and profit, implemented extensive anti-malaria programs and used their hierarchical organizational structures to monitor performance. The factors underlying the decline of private prevention include a fall in the overall rate of malaria, the increasing presence of the federal government, and technological innovations that lowered exposure to mosquitoes. Understanding how, why, and when firms can prevent diseases has important implications for current disease policy, especially where governments, international organizations, and technologies are not enough.

Type
Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2016

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References

1 See generally Packard, Randall M., “Roll Back Malaria, Roll in Development”? Reassessing the Economic Burden of Malaria, 35 Population & Dev. Rev. 53, 5455 (2009)Google Scholar (providing background information about the costs saved in early public health programs).

2 See infra note 92 and accompanying text.

3 Tullock, Gordon, Problems in the Theory of Public Choice: Social Cost and Government Action, 59 Am. Econ. Rev. 189, 197 (1969)Google Scholar.

4 Standard theories do not suggest it is impossible for uncoordinated individuals to prevent malaria – only that prevention will be less than if the group were coordinated. See generally id. at 197 (finding that “[t]he distinction between any economy of scale which can be obtained only if the customers are located next door to each other and an economy of scale which can be obtained without this type of contiguity is fundamental,” but does not suggest that benefits are nonexistent in the event that customers are not located next door to each other).

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11 Observing firm-led prevention can also be limited due to the difficulty of obtaining accurate historical records on firms. This difficulty creates a bias that attributes the decline in malaria to public services since it is difficult to correlate malaria prevalence with firms that may have provided malaria prevention, but which, alas, cannot be observed.

12 See Richard Cornes & Todd Sandler, the Theory of Externalities, Public Goods, and Club Goods 95-112 (1996), Brubaker, Earl R., Free Ride, Free Revelation, or Golden Rule?, 18 J.L. Econ. 147 (1975)Google Scholar, and Demsetz, Harold, Toward a Theory of Property Rights, 57 Am. Econ. Rev. 347 (1970)Google Scholar for theoretical expositions on public goods and, in particular, their private or voluntary provision. For arguments on specific cases, see Terry L. Anderson & Peter J. Hill, the NOT SO Wild, Wild West: Property Rights on the Frontier (2004), Bogart, Dan, Did Turnpike Trusts Increase Transportation Investment in Eighteenth-Century England?, 65 J. Econ. Hist. 439 (2005)Google Scholar, Cheung, Steven N. S., The Fable of the Bees: An Economic Investigation, 16 J.L. Econ. 11 (1973)Google Scholar; Coase, R.H., The Lighthouse in Economics, 17 J.L. Econ. 357 (1974)Google Scholar, and Klein, Daniel B., The Voluntary Provision of Public Goods? The Turnpike Companies of Early America, 28 Econ. Inquiry 788 (1990)Google Scholar. See David T. Beito, Peter Gordon & Alexander Tabarrok, The Voluntary City: Choice, Community, and Civil Society (2009) and Fred E. Foldvary, Public Goods and Private Communities: The Market Provision of Social Services (1994) for historical evidence on private communities and the private provision of public goods in cities. See Harrison, Glenn W. & Hirshleifer, Jack, An Experimental Evaluation of Weakest Link/Best Shot Models of Public Goods, 97 J. Pol. Econ. 201 (1989)Google Scholar and Smith, Vernon L., Experiments with a Decentralized Mechanism for Public Good Decisions, 70 Am. Econ. Rev. 584 (1980)Google Scholar for details regarding how uncoordinated groups can provide public goods in experimental settings.

13 Cases of firm-led malaria prevention are numerous. In addition to the cases discussed in this article, there is evidence to suggest that Tennessee Coal, Iron, and Railroad and the Norfolk and Western Railroad provided anti-malarial campaigns in Alabama and Virginia, respectively. Va. State Bd. of Health & State Health Comm’r, Annual Report on the State Board of Health and the State Health Commissioner to the Governor of Virginia for the Fiscal Year Ending September 30, 1918 (1919); National Iron and Steel Publishing Company, Steel and Iron, Volume 49 (1915). Von Ezdorf also discusses the case of Electric Mills in Mississippi. von Ezdorf, R. H., Demonstration of Malaria Control, 31 Pub. Health Reps. 614, 615-16 (1916)Google Scholar. The comments following Hovenberg’s 1918 article also suggest that the Missouri Pacific and Illinois Central railroads provided malaria prevention. Van Hovenberg, H.W., The Bearing of Malaria on Railroad Operation, 11 Southern Med. J. 562, 567-69 (1918)Google Scholar [hereinafter Van Hovenberg, The Bearing of Malaria on Railroad]. So did an association of coal mining companies in Sardinia during the early twentieth century, as well as mining companies in Ghana and South Africa during the later half of the twentieth century. GBCHealth & Roll Back Malaria, The Business Case for Indoor Residual Spraying (IRS): A Private Sector Workshop on Comprehensive Malaria Control Meeting Report (Malembe Ebama & Jasson Urbach eds., 2011); Frank M. Snowden, the Conquest of Malaria: Italy, 1900-1962 (2006). There is also a literature on workplace programs devoted to preventing HIV/AIDS and TB in southern Africa. Yassi, Annalee et al., Workplace Programmes for HIV and Tuberculosis: A Systematic Review to Support Development of International Guidelines for the Health Workforce, 25 AIDS Care 525 (2013)Google Scholar. I focus on two cases in particular merely because I am more familiar with them and historical evidence is more readily available.

14 See generally von Ezdorf, supra note 13 (detailing a report by a surgeon in the United States Public Health Service who describes two instances where local private authorities implemented the recommendations provided by public malarial investigators).

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16 Yoram Barzel, Economic Analysis of Property Rights 114-27 (2d ed. 1997); Demsetz, supra note 12, at 352 (depicting the change in property rights over hunting grounds, from common to more private, as the value of beaver fur increased in the Labrador Peninsula during the 17th and 18th centuries).

17 Allen & Croxson, supra note 5; Jamasji-Pavri, supra note 6.

18 Klein, supra note 12, at 795-97.

19 Buchanan, James M. & Craig Stubblebine, Wm., Externality, 29 Economica 371, 372-77 (1962)Google Scholar.

20 Cornes & Sandler, supra note 12, at 137-42; Cheung, supra note 12, at 30.

21 Cheung also focuses on the particular contractual arrangements between bee farmers and orchard owners, which helped to lower the cost of exclusion. Cheung, supra note 12, at 32.

22 Ebola (Ebola Virus Disease): Prevention, Ctrs for Disease Control & Prevention (July 22, 2015), http://www.cdc.gov/vhf/ebola/prevention/index.html [http://perma.cc/NCH6-4KZX].

23 Measles (Rubeola): Top 4 Things Parents Need to Know about Measles, Ctrs for Disease Control & Prevention (Feb. 20, 2015), http://www.cdc.gov/measles/about/parents-top4.html [http://perma.cc/7RXG-QRAX].

24 See generally Sappington, David E. M., Incentives in Principal-Agent Relationships, 5 J. Econ. Persps. 45, 5256 (1991)Google Scholar (describing the incentive effect of monitors in principal-agent relationships).

25 Barzel, supra note 16.

26 Gary J. Miller, Managerial Dilemmas: The Political Economy of Hierarchy 102-19, 159-177 (1992).

27 Lazear, Edward P. & Rosen, Sherwin, Rank-Order Tournaments as Optimum Labor Contracts, 89 J. Pol. Econ. 841, 841-42 (1981)Google Scholar.

28 See, for example, the other cases mentioned in note 13.

29 See von Ezdorf, supra note 13, at 615.

30 Hoyle, James Cranford Jr., The Roanoke Rapids Health Plan and the Origin of North Carolina Blue Cross, 32 N.C. Med. J. 188, 188 (1971)Google Scholar (“The town actually began in 1895, when two mills – one a cotton mill, the other a knitting mill – were built on the banks of the river ….” ).

31 Id.

32 Id.

33 Edwin Akers, Zebb Denny, & Ed Henderson, A City’s Heritage (1972). Roanoke Rapids Diamond Jubilee. According to Denny, Patterson served as general manager and treasurer of the RMC between 1896 until 1926. Patterson was treasurer of ROMAN since its founding in 1900 until 1919, when he became president and manager. Samuel Patterson was one of the founders of PMC around 1910, and served as its general manager. See also Sidney B. Allen & R. Stanford Travis. Jr.. Halifax County: Economic and Social: A Laboratory Study in the Rural Social Science Department of the University of North Carolina (1920), http://digital.lib.ecu.edu/16892 [http://perma.cc/NUS4-297F].

34 Unless otherwise noted, I define “Roanoke Rapids” as the entire town that encompasses the four blocks of Roanoke Rapids, Rosemary village, and Patterson village.

35 von Ezdorf, supra note 13, at 615-16.

36 Carter, Henry R., Malaria in North Carolina, 28 Pub. Health Reps. 2739, 2739, 2746 (1913)Google Scholar.

37 Id. at 2760.

38 Id. at 2759-60.

39 von Ezdorf, supra note 13, 615-17. The North Carolina Board of Health asked the surgeons to survey malaria rates in 1913. Only those areas with enough interest and income would eventually carry out antimalarial campaigns.

40 Id. at 617.

41 Id. at, 614-17. Thus, it seems von Ezdorf focuses his attention on the malaria problem and anti-malarial work associated with Roanoke Rapids, proper, and Patterson.

42 Id. at 616.

43 Id.

44 Id. at 625.

45 Id.

46 Id. at 618.

47 Eradicating Malaria: Roanoke Rapids Sets Example for South, Reduces Cases A Third in A Year, Roanoke Rapids Herald, Apr. 9, 1915, at 1; Freeing Community From Malaria’s Grip: Detailed Report of Splendid Health Work Done in Community During 1914 Under Supervision of Doctor T. W. M. Long and Mayor J. T. Chase, Roanoke Rapids Herald, Mar. 5, 1915, at 1-2. These companies included the RMC, the PMC, the ROMAN, the Roanoke Rapids Power Company, and the Beaver Board Company.

48 Id.; von Ezdorf, supra note 13.

49 Allen & Travis, supra note 33, at 19.

50 von Ezdorf, supra note 13, at 618.

51 Id. at 620. During the first year of work, between January 1914 and December 1914, approximately 6.9 miles of ditches were dug, 40 acres of land were cleared of underbrush, 59 wagonloads of tin cans and debris were removed, and 3,000 gallons of oil were used. In Patterson Mill, wastewater was diverted from the bleaching plant to serve as a larvicide.

52 Id.

53 Id. This amount would be equivalent to $87,270.61 in 2016 dollars. Consumer Price Index Inflation Calculator for $3683.61 in 1914, CPI Inflation Calculator, http://www.bls.gov/data/inflation_calculator.htm [http://perma.cc/3PCM-4PHM] (searching $3683.61 in 1914; then selecting 2016 and calculate).

54 Eradicating Malaria, supra note 47, at 1.

55 von Ezdorf, supra note 13, at 621, 626.

56 See Hunt Parker, R., Dr. Thomas Williams Mason Long: A Memoir, 4 N.C. Med. J. 192 (1943)Google Scholar.

57 Robert B. Robinson, Roanoke Rapids: The First Hundred Years, 1897-1997 (1997); Parker, supra note 56, at 192-93.

58 Hoyle, supra note 30, at 189.

59 Latest Health Survey of Community: Splendid Tribute to the Success of the Sanitary Measures Adopted. Government Engineers Praise Dr. Long's Work, Roanoke Rapids Herald, Oct. 9, 1914, at 1. In addition to the extensive and coordinated efforts to combat malaria, there is clear evidence to suggest people consumed quinine in Roanoke Rapids. Between June and October of 1913 and 1914, the number of quinine prescriptions declined from 380 to 226, which is indicative of the effect anti-mosquito work had on the prevalence of malaria.

60 U.S. Sanitary Engineer Visits Roanoke Rapids and Pronounces Sanitation Good - Finds Few Anopheles Present, Roanoke Rapids Herald, June 26, 1914, at 1.

61 Id.

62 von Ezdorf, supra note 13, at 621.

63 Id. at 620-21.

64 Id. at 617.

65 Id. at 618-19. This Table represents a brief summary of the comparative statement of the results.

66 Id. at 621.

67 Id. at 622.

68 Anti-Malarial Work Increasingly Successful: Report of Dr. T. W. M. Long for Year 1916 Shows Practical Elimination of Malaria in this Community, Roanoke Rapids Herald, May 18, 1917, at 1.

69 See Moody, Anthony, Rapid Diagnostic Tests for Malaria Parasites, 15 Clinical Microbiology Rev. 66, 67 (2002)Google Scholar (stating that blood film technique was developed in the early 1900s and it is still the accepted laboratory practice for the diagnosis of malaria). See also Ndao, Momar et al., Comparison of Blood Smear, Antigen Detection, and Nested-PCR Methods for Screening Refugees from Regions Where Malaria Is Endemic after a Malaria Outbreak in Quebec, Canada, 42 J. Clinical Microbiology, 2694, 2694 (2004)Google Scholar (stating that the most common test for malaria diagnosis remains the microscopic examination of blood smears).

70 von Ezdorf, supra note 13, at 618.

71 Id. at 619.

72 Id. at 622.

73 Id. at 618-22.

74 An article in the Roanoke Rapids Herald reports on the results of the campaigns between 1915 and 1916. Anti-Malarial Work Increasingly Successful, supra note 68, at 1. Blood smears taken by the USPHS show that in 1915, 3.51% were positive cases, and 1.58% were positive cases in 1916. Id.

75 von Ezdorf, supra note 13, at 621.

76 Id. at 624.

77 Eradicating Malaria, supra note 47, at 1.

78 von Ezdorf, supra note 13, at 624-25.

79 See Hofsommer, Don L., St. Louis Southwestern Railway's Campaign against Malaria in Arkansas and Texas LXII, Ark. Hist.Q. 182, 182 (2003)Google Scholar (for a general history of the railroad, their anti-malaria work, and that the SSW ran through eastern and southern Arkansas on its way from St. Louis to Texas).

80 Van Hovenberg, H.W., How Cotton Belt Cut Malaria Rate 97 Per Cent in Nine Years, 22 Railway Engineering & Maintenance 382, 382 (1926)Google Scholar [hereinafter Van Hovenberg, How Cotton Belt Cut Malaria].

81 Van Hovenberg, H.W., The Bearing of Malaria on Railroad Operation, 11 Southern Med. J. 562, 564-66 (1918)Google Scholar [hereinafter Van Hovenberg, The Bearing of Malaria on Railroad].

82 Ass’n of Schools of Pub. Health, “Malaria in Eastern Texas: Prevalence and Geographic Distribution,” 32 Pub. Health Reps. 1301, 1301-02 (1917).

83 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 382.

84 Ass’n of Schools of Pub. Health, supra note 82, at 1304. As the report suggests, reported cases are not a true representation of actual number of the malaria count because only 14% of those surveyed responded; the report suggests the estimates underrepresent the actual amount of malaria. Id. at 1302. Interestingly, this work was initially carried out by Dr. Ezdorf until his death in 1916. Id. at 1302 n.1.

85 Id. at 1306.

86 Id. at 1304.

87 Id.

88 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 382.

89 Id.

90 Eradicating Sickness Among Employees, 18 Railway Maintenance Engineer 205, 205 (1922). The SSW report of 1921 suggests these numbers represent only one fourth of the total number of malaria cases as many workers may have had malaria but did not require hospitalization. Id. H.W. Van Hovenberg also suggests they may have consulted other physicians. Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 382.

91 J. M. Herbert, Malaria Control: A Demonstration of its Value to Railroads Based on Experience of the St. Louis Southwestern Railway Lines, 1917-1920 (1921); “Cotton Belt Route”, St. Louis Southwestern Railway Lines, A Report to Mr. J. M. Hebert, President 19 (1921) [hereinafter Southwestern Railway Lines]. Between 1913 and 1916, malaria cases accounted for about one fourth to one fifth of medical and surgical hospital cases. Id.

92 See Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, 382-83; Van Hovenberg, The Bearing of Malaria on Railroad, supra note 81, at 563.

93 Van Hovenberg, The Bearing of Malaria on Railroad, supra note 81, at 564.

94 Id. Hovenberg states the trust had two purposes. First, it was to increase labor productivity and decrease hospital cases of malaria. Second it was to help local towns and businesses along the SSW lines. By 1920, the “Malaria Prevention Fund” had contributed $41,541.96 for SSW to combat malaria. Southwestern Railway Lines, supra note 91, at 8.

95 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 383.

96 Van Hovenberg, The Bearing of Malaria on Railroad, supra note 81, at 564.

97 Smiley, H.H., What the Cotton Belt Railway Company is Doing for the Prevention of Malaria, 11 Southern Med. J. 576, 576 (1918)Google Scholar; Southwestern Railway Lines, supra note 91.

98 A chronology between 1917-1920 of the campaigns can be found in SSW from 1921. The report also lists miles of waterways under control, as well as the square miles of control area. Southwestern Railway Lines, supra note 91.

99 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 383-88.

100 Id. at 383.

101 The 1921 report of SSW includes maps of Tyler, Lufkin, Wildhurst, Keltys, Texarkana, and others, regarding water courses that had been placed under control. Southwestern Railway Lines, supra note 91.

102 Southwestern Railway Lines, supra note 91.

103 Additional anti-malarial programs included the screening of most of the train cars by extra-gang labor, common laborers, and section crews early in the spring of 1917. Furthermore, SSW advocated the use of quinine as a prophylactic and attempted to learn about proper dosages through experimentation. SSW even financed multiple educational programs regarding the epidemiology of mosquitos and malaria; public lectures were given, videos were shown, and essay competitions were held in elementary schools. Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 383-85.

104 Id. at 385-86.

105 Id. at 386.

106 Id.

107 Southwestern Railway Lines, supra note 91. The report of SSW (1921) suggests that Gould, the St. Louis Southwestern Railway Corporation, and the United States Railroad Administration helped to finance this department. Furthermore, sanitary inspectors were placed across four divisions of the railroad lines in order to monitor malaria work, all under the Sanitary Engineer. A description of this department’s responsibilities is also given. Id. Hovenberg suggests the department was given the full support of the President and Vice President. See Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 382.

108 Van Hovenberg, The Bearing of Malaria on Railroad, supra note 81, at 564.

109 Id.

110 Id. at 564-66

111 Id.

112 Id. at 565.

113 Id.

114 Id. at 566.

115 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 383; Van Hovenberg, H.W., The Control of Malaria for a Railroad System, Based on the Experience of the St. Louis Southwestern During 1917, 1918, 1919, 13 Southern Med. J. 416, 420-21 (1920)Google Scholar [hereinafter Van Hovenberg, The Control of Malaria for a Railroad System].

116 Van Hovenberg, The Control of Malaria for a Railroad System, supra note 115, at 420-21.

117 Southwestern Railway Lines, supra note 91, at 40.

118 Derivaux, R.C., The Relation of the Railroads in the South to the Problem of Malaria and its Control, 33 Pub. Health Reps. 1267, 1270 (1918)Google Scholar.

119 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 385.

120 Id. at 385, 388.

121 See id.

122 This is a reduction in malaria patients of 58%. Hofsommer, supra note 79, at 190.

123 This is a reduction in malaria patients of about 60%. Id. at 185.

124 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 383.

125 Id. at 383.

126 Id.; Southwestern Railway Lines, supra note 91.

127 Southwestern Railway Lines, supra note 91.

128 Id.

129 Hovenberg, 1918, supra note 13, at 566.

130 Southwestern Railway Lines, supra note 91, at 12 n.5.

131 See id.

132 Id.

133 Id.

134 Id.

135 Id.

136 Id.

137 See generally, Hanging by a Thread: Social Change in Southern Textiles (Jeffrey Leiter et al., eds., 1991) (discussing the various challenges of, and efforts to improve, the textile industry of the southern United States); Roy V. Scott, Railroad Development Programs in the Twentieth Century (1985) (discussing the development of the American railroad industry).

138 See von Ezdorf, supra note 13.

139 The importance of institutions like property rights and contracts here is similar to Werner Troesken’s analysis of private and public water companies in the United States, which helped to lower typhoid morbidity in the nineteenth and early twentieth centuries. See generally Werner Troesken, The Pox of Liberty: How the Constitution Left Americans Rich, Free, and Prone to Infection 103-35 (2015) (discussing how water filtration systems lowered typhoid morbidity).

140 SSW operations spanned over thousands of miles, employed thousands of workers, and involved numerous firms and municipalities throughout eastern Texas; thus there is more of an opportunity to free-ride. See Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 382.

141 Sautet suggests the formation of a division is normal for larger firms of the era, as well as an entrepreneurial solution to the complex problems posed by malaria prevention. See Frederic Sautet, An Entrepreneurial Theory of the Firm 109, 126 (2002) (discussing division leaders being entrepreneurs).

142 Van Hovenberg, How Cotton Belt Cut Malaria, supra note 80, at 387.

143 See generally Lazear, Edward P. & Rosen, Sherwin, Rank-Order Tournaments as Optimum Labor Contracts, 89 J. Pol. Econ. 841 (1981)Google Scholar (compensating workers based on relative position, rather than by evaluating workers individually resembles prizes, which may encourage more efficient workers).

144 Faust, Ernest Carroll, The History of Malaria in the United States, 39 Am. Sci. 121, 122-23, 125 (1951)Google Scholar.

145 Faust, supra note 144, at 122.

146 Angus Deaton, The Great Escape: Health, Wealth, and the Origins of Inequality 31 (2013).

147 Faust, supra note 144, at 122.

148 Tetzlaff, Frank, Operation of the United States Public Health Service Malaria Control Program, 63 Pub. Health Reps. 557, 562 (1948)Google Scholar.

149 Id.

150 Id.

151 Id.

152 Barber, M. A., The History of Malaria in the United States, 44 Pub. Health Reps. 2575, 2578-79 (1929)Google Scholar.

153 See generally Tetzlaff, supra note 148 (discussing the residential use of DDT).

154 Id. at 561.

155 Le Prince, J. A., Mosquito Control About Cantonments and Shipyards, 34 Pub. Health Reps. 547, 551 (1919)Google Scholar.

156 Id.

157 Faust, supra note 144, at 126.

158 See Williams, L. L., Civil Works Administration Emergency Relief Administration: Malaria Control Program in the South, 25 Am. J. Pub. Health 11 (1935)Google Scholar (discussing the CWA); See Margaret Humphreys, Malaria: Poverty, Race, and Public Health in the United States 99-112 (2001) (discussing the WPA and the TVA).

159 Humphreys, supra note 158 at 110-12. Humphreys suggests this theory. Barreca et al show it empirically throughout the southern United States. Barreca, Alan, Price Fishback, and Shawn Kantor. 2012. See generally Barreca, Alan I. et al. Agricultural Policy, Migration, and Malaria in the United States in the 1930s, 49 Explorations Econ. Hist. 381 (2012)Google Scholar. See generally Sledge, Daniel and Mohler, George, Eliminating Malaria in the American South: An Analysis of the Decline of Malaria in 1930s Alabama, 103 Am. J. Pub. Health 1381 (2013)Google Scholar.

160 Kitron, Uriel and Spielman, Andrew, Suppression of Transmission of Malaria Through Source Reduction: Antianopheline Measures Applies in Israel, the United States, and Italy, 11 Revs. Infectious Diseases 391, 397 (1989)Google Scholar.

161 Faust, supra note 144, at 126.

162 Williams, supra not 158, at 11.

163 Id.

164 Id. at 11-12.

165 Id. at 12.

166 Id.

167 Bispham, W. N., Malaria in the Southern United States, 32 Southern Med. J. 848, 850 (1939)Google Scholar; see generally Humphreys, supra note 8.

168 Kitchens, supra note 8, at 579 (providing data for the state of Georgia); Sledge & Mohler, supra note 159 (providing data for Alabama).

169 Id. at 574.

170 Sledge & Mohler, supra note 159, at 1389.

171 Kitchens, Carl, A Dam Problem: TVA’s Fight Against Malaria, 1926-1951, 73 J. Econ. Hist. 694, 698 (2013)Google Scholar.

172 Bishop, E. L., Malaria—Control Activities of the Tennessee Valley Authority, 51 Pub. Health Reps. 970, 970 (1936)Google Scholar.

173 Kitchens, supra note 171, at 695.

174 Id. at 708.

175 See generally Medical Dep’t, U.S. Army, Preventive Medicine in World War II Vol. 6 (1963).

176 See id. at 74 (noting that in early 1940, arrangements were made between the Secretary of War and the Federal Security Administrator to use the U.S. Public Health Service to safeguard the troops and maintain sanitary conditions in the South).

177 Parascandola, John, From MCWA to CDC—Origins of the Centers for Disease Control and Prevention, 11 Pub. Health Reps., 549, 549 (1996)Google Scholar.

178 Id. at 550.

179 Faust, supra note 145, at 126.

180 Tetzlaff, supra note 148, at 558.

181 Id.

182 Parascandola, supra note 178, at 550.

183 See von Ezdorf, supra note 13, at 616-18.