Polly J. Price, Federalization of the Mosquito: Structural Innovation in the New Deal Administrative State

• Jurisdiction: United States,Federal
• Publication year: 2010
• Citation: Vol. 60 No. 2

FEDERALIZATION OF THE MOSQUITO: STRUCTURAL INNOVATION IN THE NEW DEAL ADMINISTRATIVE STATE

Polly J. Price^*

INTRODUCTION .............................................................................................. 326

I. MALARIA IN THE SOUTHERN UNITED STATES: PHILANTHROPY, PRIVATE ENTERPRISE, AND LOCAL CONTROL EFFORTS ..................... 329

A. State Health Departments and Private Philanthropy ................. 332

B. Private Enterprise, State Regulation, and Courts ...................... 335

II. FEDERAL HEALTH INTERVENTION IN THE NEW DEAL ERA ................ 342

A. Creation of the Federal Security Agency ................................... 349

B. The Public Health Service Act of 1944 ....................................... 355

III. THE OFFICE OF MALARIA CONTROL IN WAR AREAS: NEGOTIATING

STATE AUTHORITY ............................................................................. 358

A. An Expansion of Federal Jurisdiction ......................................... 360

B. The Use of DDT for Mosquito Control ....................................... 366

CONCLUSION .................................................................................................. 373

The South is at last being brought to the painful point of taking stock of itself and of facing in their particularity and concreteness the facts in its chronic social and economic maladjustments.

-Walter Wilbur (1934)¹

History is filled with unforeseeable situations that call for some flexibility of action.

-Franklin D. Roosevelt (1935)²

INTRODUCTION

Malaria was a significant problem in the southern United States during the early decades of the twentieth century. Part of President Franklin D. Roosevelt's New Deal focused on economic development of the South, with improvement of public health in that region as an integral part. This Article is a case study of increased federal public health efforts during the New Deal and World War II eras, which replaced some traditionally state and local areas of control as well as private philanthropic efforts.

The rise of the New Deal administrative state saw structural experimentation and innovation at a grand level; this Article's study of federal efforts to combat malaria in the southern United States provides a good example. In one decade, federal efforts ranged from Works Progress Administration employment, experiments with scientific expertise within the Tennessee Valley Authority, federal intervention in civilian areas as a war- strength rationale, and malaria control by federal appropriation. The most significant step resulted from reorganization of the New Deal administrative state under the Federal Security Agency (FSA), an independent agency of the

U.S. government established pursuant to the Reorganization Act of 1939.³The

Reorganization Act was heralded as the first major, planned reorganization of the Executive Branch of the U.S. government since 1787.

Long-lasting effects of this New Deal-era experimentation included partnerships between the federal government and the states, and the permanent establishment of what had been a temporary wartime agency into the federal Centers for Disease Control (CDC), located in Atlanta on property donated by

Emory University.⁴The CDC is today the largest federal agency outside of the

Washington, D.C. area,⁵established in a region that at the time was highly resistant to and suspicious of federal agency activity.

Efforts to "federalize" the mosquito encountered significant limitations, and never accomplished (if indeed it had been the aim) primary federal responsibility for the eradication of malaria. Public health law in the United States is still largely a matter of state authority. Because public health was historically and firmly within the responsibilities of states, federal agencies in the New Deal era worked through state and local governments.⁶Roosevelt's hoped-for national health insurance scheme would not be included in the Social Security Act of 1935, and critics abounded for the lack of resources devoted to the U.S. Public Health Service.⁷Both of these failures of New Deal aims have been attributed to the powerful position of Southern Democrats on the Senate Finance and House Ways and Means committees.⁸

But it is nonetheless the case that a greatly enhanced federal role in public health matters emerged from the New Deal era, with the South's malaria problem as the primary impetus. To combat malaria, the federal aim was to put in place an effective administrative system of distribution-resources and expertise-without overtly usurping the traditional "police power" function of state governments, in recognition of political constraints of the time. As in other key initiatives of the New Deal, the rise of the federal administrative state required coordination and cooperation with state agencies, and in turn fostered administrative innovation at the state level.

One federal agency in particular-the Office of Malaria Control in War Areas (MCWA)-institutionalized the federal response to malaria in the South during World War II. This assertion of wartime jurisdiction maintained at least nominally the primacy of state authority. With the war's conclusion, however, the war "emergency" ended, along with some of the MCWA's asserted federal jurisdiction. Although the MCWA became a permanent establishment as the CDC and federal malaria-eradication efforts continued in the South, the federal "takeover," such as it was, would not be maintained. Executive authority expanded during World War II, but in the matter of public health as a federal responsibility, this brief assertion of expanded jurisdiction would be withdrawn.

Public health federalism in the United States is a topic of interest today.⁹

The background for debate about public health federalism stems from the historical understanding that states possessed exclusive police powers with respect to the health and welfare of their citizens.¹⁰The federal government had no such authority within states because the health and welfare of individuals was not an enumerated power in the Federal Constitution.¹¹But despite some claims that the New Deal era profoundly altered the federalism balance in public health law, I suggest that primary state and local authority in the realm of public health remained, with no significant federal presence displacing that state authority. Recognizing that a considerable expansion of federal government health activities did occur, the federal government was still limited to a supporting role with respect to public health administration.

The occurrence of malaria in a population results from a complex interdependence of environmental circumstances and social and economic relationships, dependent upon poverty and inequality as much as geography and climate.¹²The history of efforts to control malaria in the South in the early twentieth century included local, state, and federal governments, along with private philanthropy and private businesses. This division of authority and the complexity of the malaria problem expose the multifaceted nature of public health law in this period.

I. MALARIA IN THE SOUTHERN UNITED STATES: PHILANTHROPY, PRIVATE

ENTERPRISE, AND LOCAL CONTROL EFFORTS

Malaria, along with other mosquito-borne diseases such as yellow fever, affected every region of U.S. territory in the late eighteenth through the mid- nineteenth centuries. By the turn of the twentieth century, however, malaria was largely a problem of the southern United States, and would remain so through the 1940s.

The South's long history of poor health is well documented, as is its distinctive picture as having the worst health in the nation throughout the nineteenth and much of the twentieth centuries.¹³Malaria was endemic and remained the principal cause of disability and death.¹⁴The carrier for the spread of the disease-the anopheles mosquito-was not identified until

1898.¹⁵Its control and eventual eradication in the southern United States awaited the early decades of the twentieth century, when journalists began to make the rest of the nation aware of the South's health plight. This new publicity surrounding the "shocking state of southern health" would eventually lead to assistance from northern philanthropies and the federal government.¹⁶

In the warmer southern climate, the anopheles mosquito could survive to breed year round. Spread of the disease relied upon the mosquito vector-a mosquito became infected with the malaria parasite from a human carrier, and in turn, would spread the disease to other humans. Malaria was thus constantly present in these climates. Moreover, once the malaria parasite infected human hosts, the disease was difficult to eradicate. The only treatment until well into the twentieth century was quinine, an expensive medication, and few physicians at the time recognized the need to continue the medicine long after the disappearance of symptoms of high fever, headache, nausea, and profuse sweating.¹⁷

In 1916, the American Medical Association published a report on public health work in the states.¹⁸The author of the report, Charles V. Chapin, noted the serious burden of malaria in the South. He reported that in one small manufacturing town nearly 50% of the inhabitants had suffered in one summer from "chills and fever."¹⁹But he noted that little systematic work to eradicate malaria had been done by the states, and because of the tremendous burden on the people where it prevailed, it was "surprising that so little has been accomplished by state officials for its control."²⁰

In the early years of the twentieth century, the prevalence of malaria in the South (along with other preventable diseases such as hookworm, pellagra, and typhoid) was recognized as an economic problem, one that caused extensive retardation of economic development because of its social costs and draining effect on labor. The poverty of the region, due in no small part to the presence of hookworm and malaria, drew...