Public health in the South

As I write this article, March 2020, television newsfeeds are reporting a worldwide crisis involving a coronavirus known as COVID-19. It’s a virus impacting the United States and will impact those of us in the South.

The public health experience of the South, at least until the mid-20th century, was in many respects unique in the nation. Although sharing many diseases with the rest of the country, the South at various times suffered maladies largely peculiar to itself, such as Yellow Fever in the 19th century and hookworm and pellagra in the early 20th Century.

Certain infections that have afflicted the nation at large, such as typhoid fever and tuberculosis persisted at serious levels in the South until the 1930s and 1940 years, after being brought under control elsewhere.

The “Sickly South” was an important component of the region’s image in the 19th Century when yellow fever epidemics repeatedly ravaged the Gulf states and lower Mississippi Valley. This “scourge of the South” attracted much negative attention, drained financial and human resources, deterred capital investments and urban population growth and disrupted commerce and transportation.

For much of the 19th century state and local health measures concentrated on epidemic emergencies. With limited knowledge of the nature of diseases and modes of transmission, efforts through commercial quarantine and sporadic urban cleanup campaigns had little effect.

The threat of yellow fever was finally brought under control through the discovery of its transmission by the mosquito and the dramatic campaign against New Orleans’s last epidemic in 1905. This demonstration of the power of “modern science” applied through the combined efforts of federal, state and local health authorities, widely viewed as another turning point in southern health history, ended the long reign of “Yellow Jack” and removed what many called the last great obstacle in southern progress.

However new obstacles were identified, with hookworm and pellagra identified as prevalent ailments in the rural south. These debilitating disorders were persistent and widespread and served to further challenge us in defeating longstanding features of the stereotyped South. The presumed laziness and its backwardness. Despite a trend toward limited insurance on the part of many of our citizens public health improvements are leading to improvements and a pathway to a more modern world.

State and local health authorities, assisted by the U.S. Public Health Service, the Red Cross, the Rockefeller Foundation, and other humanity sources, set forth to spread the gospel of good health. The epidemic of 1878, affecting the South and the Mississippi Valley interior, forced congress to establish a National Board of Health. We now enjoy the services of local health departments who are part of a larger statewide system that includes epidemiologists and other professionals who track health trends and disease. Hopefully the scourge of the coronovirus will soon be included in a listing of the diseases we have conquered.