New Book Chronicles History of Battle Against Malaria

September 26, 2002
By Ed Regis
The New York Times

Malaria is and always has been a scandal to medicine.

Until the late 1800s, scientists were not even sure of its cause (the bite of a mosquito harboring the infectious plasmodium), but instead attributed the disease to miasmas, random vapors or poisonous exhalations from the earth—hence the name, malaria, from the Italian for "bad air."

Proposed treatments ranged from the canonical quack bloodlettings and purges to the smoking of cigars in order to "purify" the atmosphere.

And, as has often happened in the history of medicine, once scientists finally discovered a cure, quinine, they had no idea how it worked. Indeed, the complete biochemical explanation of how the quinine molecule interrupts the life cycle of the malaria parasite is not fully understood even today.

What everyone is sure of is that the disease has been a great killer.

Between 1.5 million and 2.7 million people still die from the illness every year, out of 300 million to 500 million annual cases.
According to Mark Honigsbaum, a British journalist and the author of "The Fever Trail: In Search of the Cure for Malaria," "some parasitologists believe that malaria may have killed one out of every two human beings who ever lived."
It is a painful disease, with the victim writhing in bouts of fevers and chills that alternate with periods of apparent remission before finally either dying or recovering.

"Soon you have a raging thirst and headache," Honigsbaum says, "and as you slip into delirium, you may believe you are literally burning up."

Quinine comes from the bark of the cinchona tree, which exacted a severe price, as it was found among the most inhospitable areas of the world: On slopes of the Andes Mountains along the coast of South America.

The bulk of "The Fever Trail" is an account of three British adventurers who risked health, life and sanity searching for the tree, which they hoped they could bring back to Europe for cultivation.

The text is replete with descriptions of one or another explorer "cutting a path through the jungle with his machete," and other staples of prime-time adventure literature.

For a mythic quest narrative, it has everything but an encounter with mermaids.

Finally entering the present, Honigsbaum reports on recent efforts to eradicate or control malaria and attempts to discover better drugs, or a vaccine. He gives exceptionally short shrift to DDT, a potent killer of the Anopheles mosquito, the vector of malaria.

When the World Health Organization began its unsuccessful campaign for worldwide malaria eradication in the 1960s, DDT was its disease fighter of choice. The chemical then came into disrepute because of its damaging effects on several bird species.

But the author relegates to an endnote the fact that in December 2000 the UN approved limited use of the chemical, and that the Malaria Foundation International advises that "spraying houses with DDT is still one of the most effective and affordable methods of malaria control."