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Sentinel for Health: A History of the Centers for Disease Control

University of California Press

Since ancient times, war has meant malaria, and World War II was no exception. During that struggle, however, marked progress was made against the ancient foe. December 7, 1941, a day President Roosevelt said would "live in infamy," marked the beginning of a new assault on a disease that for centuries had plagued armies the world over. Harry Pratt, an entomologist with the U.S. Public Health Service, knew this instinctively. When he learned of the Japanese attack on Pearl Harbor after a lazy Sunday on the beach, Pratt knew that his south Florida unit would no longer chase the aedes mosquito, vector of dengue and yellow fever. Their new target surely would be the anopheline mosquito, vector of malaria.

The sudden entry into World War II of the United States affected the course of public health, just as it did every national concern. "The MCWA was born that day," Pratt recalled, using an acronym that stood for Malaria Control in War Areas, a government agency created just two months later.1 Pratt spent the war years at MCWA and the rest of his career at its successor institution, the CDC. In a formal sense, the letters stood for different names over the years, but they were always symbolic of a new and systematic attack on the plagues of the world, ancient and modern.

America's most recent experience with war offered proof enough of the devastation of malaria. Extraordinary measures were taken in World War I to protect both troops and the public from the disease. The U.S. Army vigorously pursued mosquitoes at its southern camps in 1917 and 1918, and the Public Health Service took up the pursuit in forty-three areas around these camps and stations. But in spite of their

best efforts and a combined expenditure of more than $5 million, malaria was a problem throughout the war, and more than 10,500 cases were reported. Yet some important lessons were learned: mosquito control was too expensive to be financed locally; the states and the counties played a vital role, but the federal government had to be involved, too.2

The early months of World War II focused attention once more on the importance of tropical diseases in wartime, especially malaria. The anopheles mosquito was a worse threat than the Japanese in the Pacific and threatened troops training in the South, which had always been plagued by malaria. "Autumnal fever" discouraged settlement of the region during the colonial period, and during the Civil War, malaria was the major cause of illness in both northern and southern troops. During World War I, the South was the focus of the nation's attack on malaria.

In 1942, there was every reason to believe that malaria posed a threat to the nation's security. The task of fighting it was at once easier and more difficult than in World War I. Advances in technology facilitated the pursuit, but exacted a price of their own. During World War I, it was enough to eliminate mosquitoes from a military base and the surrounding zone over a radius of about one mile, the distance an anopheles mosquito could fly or that persons ordinarily walked. In World War II, the universality of automobiles expanded that radius to thirty miles, a 900-fold increase.3

Dr. Louis L. Williams, the Public Health Service's chief expert on malaria, was put in charge of the fight against the disease in the South. A year before the United States entered the war, he was assigned to a liaison detail with the Fourth Corps Headquarters in Atlanta to work with the state health departments, the Army, and the Public Health Service on malaria-control projects on or near military bases. It was Williams's task to keep malaria from spreading to the armed forces from its reservoir in the civilian population. He brought a great deal of experience to the job. He had fought malaria since World War l, his most recent assignment being as director of the Malaria Commission on the China-Burma highway. Colleagues remembered him as a "rare individual of great spirit, professional ability and administrative competence." 4

In 1941, the incidence of malaria was the lowest since registration had been established in 1910, but the disease was known to occur in five- to seven-year cycles, and the last upswing had been in the mid

1930s. During that decade, the federal government made a massive effort to bring the disease under control. The Works Progress Administration set workers to digging thousands of miles of ditches to drain malaria-breeding sites. In Georgia, where malaria was a particularly difficult problem, two businessmen who later played an important role in making Atlanta an important center for disease prevention also joined in the fight. Preston Arkwright, president of the Georgia Power Company, was concerned about malaria wherever a stream was dammed and a lake created for the production of electric power. In those areas, Dr. Glenville Giddings, Arkwright's son-in-law and a prominent Atlanta physician, organized teams to survey both the mosquito and the human population.5

Giddings was the medical advisor of the Coca-Cola Company, whose board chairman, Robert Woodruff, became interested in malaria when he found the disease widespread at Ichuaway Plantation, his hunting preserve in Baker County, Georgia. Woodruff consulted the county health officer, sent enough quinine to treat everyone in the county, and hired two nurses to distribute it. He also made a grant to Emory University to establish a station at Ichuaway to study malaria. It had been in operation for two years when the United States entered World War II.6

Dr. Joseph W. Mountin, who directed the PHS's State Services division, had a plan for the emergency. He wanted a national organization to keep the more than 600 military bases and essential war-industrial establishments in the South malaria-free. Teams of physicians, entomologists, and engineers would work together to safeguard "the health of our soldiers, sailors, and workers in defense industries—those who are being trained to do the shooting and those who are providing the guns and materials with which to shoot."7

Dr. Williams was relieved of his military duties on February 9, 1942, and told to stand by in Atlanta, ready to establish headquarters for malaria control. The next day Surgeon General Thomas Parran sent a circular letter to all public and state health officials charged with protecting the health of the military. The letter, number seven of a series, referred to a new organization, "National Defense Malaria Control Activities," although the name shortly became "Malaria Control in Defense Areas." A couple of months later, to better conform with the actual facts of the situation, the name was changed to "Malaria Control in War Areas." Circular letter number eight, dated April 27, 1942, made the new name official.8

As the man in charge of MCWA, Dr. Williams looked for a suitable headquarters site. Shortage of office space in Washington preempted that possibility. He considered Memphis, then sites in Texas and California to be closer to the war in the Pacific. It was Surgeon General Parran who finally decided that the headquarters would be in Atlanta. Mark Hollis, a PHS engineer from Georgia whom Williams took with him as his executive officer,...