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Essays > Malaria (October 19, 1999 by Pat Heyman)
And as civilization flourished on the island, refuse began to collect. With the refuse came the flies. Water began to stagnate in discarded barrels, in the broken pots and pans. It was cupped in bamboo scaffoldings, in the beginnings of gardens, and in the thin marsh of the valley basin. These small putrid waters began to seethe with life: larvae, which became mosquitoes. They were tiny, fragile and very special—and so delicate that they flew only when the sun was down: the Anopheles…
And the people in Happy Valley began to die. –Tai-Pan, James Clavell (1966)
Malaria, a parasitic disease characterized by a series of ascending fevers (paroxysms), is one of man’s oldest and most powerful disease enemies. It was largely responsible for keeping Africa the Dark Continent, closed to Europeans. Until the twentieth century, the cause of malaria remained a mystery, with most people believing that it was caused by poisonous gases released at night from tainted soil. Now we know malaria to be an insect-borne parasitic disease. Scientists believe that it started in Africa and spread to Europe, Asia, and the Americas. According to G. R. Coatney, "by the eighteenth century malaria was a serious endemic disease from Montreal to southern Chile (Garrett )." Malaria was—and still is—endemic in forty percent of the world.
(World Health Organization [WHO], 1997)
According to Laurie Garrett in The Coming Plague (1994), during the 1950s and 60’s, massive worldwide efforts to eradicate the disease by controlling its vector were carried out using the newfound weapon of chlorinated hydrocarbon insecticides—DDT. But even before DDT, some countries had managed to radically reduce their malaria problems. Among these was the United States; the previous trend, coupled with its own DDT campaign left the forty-eight continental States without a single case of Malaria.
So why should you be concerned with malaria?
- The eradication efforts were not so successful in the rest of the world. The map above shows just how unsuccessful. Worse, the malaria-bearing mosquitoes are becoming increasingly resistant to all of our insecticides (Garrett, 1994). At one time, malaria occurred in more than 50% of the continental United States (Zucker, 1996), and it is possible that it could return.
- With the increase of ecotourism and tourism to exotic places, we will encounter an increasing number of people returning with the disease. (I have several friends in Gainesville alone who contracted it while on vacation.)
- Malaria has always been a scourge of the U.S. military, from the Continental Army through World War II, Korea, and Vietnam. As we see U.S. troops increasingly used as global policemen, we will see a corresponding increase of malaria in returning U.S. soldiers. General Douglas MacArthur once said of the World War II Pacific Theater, "This will be a long war, if for every division I have facing the enemy, I must count on a second division in the hospital with malaria, and a third division convalescing from this debilitating disease." Five hundred thousand GIs contracted malaria during World War II (Garrett, 1994).
- There have been recent reports of malaria cases contracted from locally infected mosquitoes. (Zucker, 1996)
- A variety of sources from the Centers for Disease control in Atlanta to the Physicians for Social Responsibility are beginning to warn of an impending outbreak of insect borne diseases including malaria (Regush, 1999).
The following is a brief introduction to malaria, the disease process of ascending fevers, and the prevention of malaria.
Etiology
Pathogenesis
Morphology
Clinical Manifestations