Ray City Employer Orders Mandatory Treatment for Malaria
In 1920, practically every employee of the Clements Lumber Company sawmill at Ray City, GA was sick with Malaria. In April 1921, the superintendent of the sawmill ordered that every resident of the company town must take the mandatory treatment for Malaria or leave the town. The timing was significant because the usual, annual epidemic of malaria began in May. The Georgia Board of Health report on malaria advised, “There is little variation from year to year in the beginning of the malarial epidemic. Anti-malarial measures should be adopted in the early spring when the mosquitos begin to hatch. To wait until summer means an increase in the mortality from that disease.”
The ‘sawmill town’ had grown up on the outskirts of Ray City to house the sawmill workers and their families. The Sawmill Census of 1920 shows there were 78 households with 313 residents living in rented homes at the sawmill; more workers lived in the surrounding area and in the town of Ray City. Sixty-five percent of the sawmill laborers were black. The superintendent of the mill was Melvin W. Rivenbark. The local physician supervising the treatment, Dr. H.W. Clements, reported outcomes in a letter the Georgia Board of Health.
Courtesy of National Archives and Records Administration, College Park, MD, photo no. 90-G-22-4
Malaria in Ray City was just a tiny part of the world-wide malaria pandemic that killed millions of people. Few Americans today can recall the devastating effects of malaria, since a massive public health effort eradicated the disease from the United States in the 1940s. Today, the CDC estimates annually there are still 241 million cases of malaria worldwide and 627,000 people die from malaria every year, mostly black children. Throughout history, malaria has been responsible for more human deaths than any other disease.
Malaria is a mosquito-borne disease caused by a parasite in the blood. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. The term malaria originates from Mediaeval Italian: mala aria—”bad air”, a part of miasma theory; the conventional wisdom prior to germ theory was that all diseases were carried by “miasma” vapors, which were believed to emanate from marshy areas. The disease was sometimes called ague or marsh fever due to its association with swamps and marshland. In earlier times malaria caused the abandonment of entire Georgia towns. The state capitol of Georgia was moved from Milledgeville to Atlanta because of malaria. In the Antebellum South, malaria accounted for almost eight percent of all deaths.
Malaria is commonly associated with poverty and has a significant negative effect on economic development. Poor quality housing without screening and situated in or near mosquito-infested areas combined with lack of access to effective treatments or healthcare significantly increased risk of the disease. The effects of malaria on Southern blacks were disproportionate since they were more likely to live in these conditions. In fact, in 1920 blacks were twice as likely to die from malaria as whites. (For similar reasons, contagious diseases in general had a disproportionate effect on blacks. In 1900, black laborers suffered an outbreak of smallpox in Berrien County.)
People with malaria can usually expect a complete recovery, if properly treated. However, severe malaria can progress extremely rapidly and cause death within hours or days. In the most severe cases fatality rates can reach 20%, even with intensive care and treatment. The death rate among children is three times that of adults. Over the longer term, developmental impairments have been documented in children who have had episodes of severe malaria. Studies (Hong, 2008) have shown that survivors were significantly shorter in adulthood, as a result of malnutrition driven by childhood malaria infections. Because of an immune system disrupted by malaria infections, they were more susceptible to other contagious diseases. Adults infected with malaria were more likely to develop chronic health conditions later in life. “For children, malaria could reduce attendance at school and deteriorate their learning ability by impairing cognitive development, performance, and behavior. For adults, it could reduce productivity at work and hinder economic development through its impact on wages and profits”
Malaria eradication in the U.S was largely due to the U.S. Public Health Service’s campaign for mosquito control and malaria treatment. Mosquito control used indoor and outdoor residual poisons, largescale drainage projects, improved housing conditions including window screens, and introduction of mosquito-eating Gambusia minnows into open bodies of water. In the 1920s, a “Standard Treatment” for malaria was developed, involving an eight week course of daily doses of quinine.
Dr. Mannie Alamanza Fort, a physician from Quitman, GA was serving as Director of the Division of Malaria Control for the Georgia State Board of Health reported the following in the 1921 bulletin of the U.S. Public Health Service:
In the spring of last year [1920] we secured an order from the superintendent of a big mill at Ray City, requiring every man, woman, and child in the town to take the standard treatment or move. The following from the local physician tells the result: Correspondence from Dr. Clements, Ray City, GA Dr. M. A. FORT, Atlanta, Ga. Replying to yours of September 26, will say: In 1920 we had at Clements Lumber Co.'s mill some 300 cases of malaria. Beginning in April of 1921, after we had had some 30 cases, we applied the eight weeks treatment universally. The malaria subsided suddenly. I moved from Ray City August 7 of this year, and up to that time there had not been a case of malaria, and if there had been any since I would have heard of it. There is only one thing to do along these lines, and that is the eight weeks treatment. Thanking you for your help in this matter, I remain, Yours respectfully, (Signed) H. W. CLEMENTS
No observations were reported on the contribution of environmental factors in the transmission of malaria at the Clement’s sawmill: proximity to stagnant water, poor quality housing, or lack of window screens. The sawmill was about 1 mile north of Ray City, situated along the boggy margin of Batterby Creek and adjacent to an impoundment pond covering approximately 11 acres. Given the rates of infection it seems unlikely that the rental houses in the “sawmill town” were provided with screens. The 1921 report of the Georgia State Board of Health observed “In the malarial belt the laborer living in a rented house whose landlord will not furnish screens becomes at once a menace to the public health and also a municipal burden.” Surely, they meant “The landlord who will not furnish screens creates a menace to the public health….”
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