Arthur Shadwell and Harriette Lombard Hennessy

“ For instance, the swampy character of malarial areas is explained by their breeding in stagnant water; the effect of drainage, and the general immunity of high-lying, dry localities, by the lack of breeding facilities; the danger of the night air, by their nocturnal habits; the comparative immunity of the upper storeys of houses, by the fact that they fly low; the confinement of malaria to well-marked areas and the diminution of danger with distance, by their habit of clinging to the breeding-grounds and not flying far. ”

“ Of the mortality due to malarial disease a small part only is referable to the direct attack of intermittent, and chiefly to the fever in its pernicious form. Remittent fever is much more fatal in its direct attack. But probably the greater part of the enormous total of deaths set down to malaria is due to the malarial cachexia. ”

“ The nature of immunity is not known. Some persons are naturally absolutely immune (Celli) , but this is rare; immunity is also sometimes acquired by infection, but as a rule persons once infected are more predisposed than others. Races inhabiting malarious districts acquire a certain degree of resistance, no doubt through natural selection. ”

“ In 1894, however, Sir Patrick Manson, arguing with greater precision by analogy from his own discovery of the cause of filariasis and the part played by mosquitoes, suggested that the malarial parasite had a similar intermediate host outside the human body, and that a suctorial insect, which would probably be found to be a particular mosquito, was required for its development. ”

“ The dwellers in a malarious region like the Terai (at the foot of the Himalayas) are miserable, listless and ugly, with large heads and particularly prominent ears, flat noses, tumid bellies, slender limbs and sallow complexions; the children are impregnated with malaria from their birth, and their growth is attended with aberrations from the normal which practically amount to the disease of rickets. The malarial cachexia that follows definite attacks of ague consists in a state of ill-defined suffering, associated with a sallow skin, enlarged spleen and liver, and sometimes with dropsy. ”

“ It is the general rule, with frequent exceptions, that the quotidian paroxysm comes on in the morning, the tertian about noon, and the quartan in the afternoon. Another rule is that the quartan has the longest cold stage, while its paroxysm is shortest as a whole; the quotidian has the shortest cold stage and a long hot stage, while its paroxysm is longest as a whole. The point common to the various forms of ague is that the paroxysm ceases about midnight or early morning. Quotidian intermittent is on the whole more common than tertian in hot countries ”

“ Anointing the skin with strong-smelling substances is of little use in the open air, but more effective in the house; turpentine appears to be the best. Exposure at night should be avoided. All these prophylactic measures are directed against mosquitoes. There remains the question of protection against the parasite. Chills are recognized as predisposing both to primary infection and to relapses, and malnutrition is also believed to increase susceptibility; both should therefore be avoided. Then a certain amount of immunity may be acquired by the systematic use of quinine. ”

“ The planting of eucalyptus trees is out of favour at present, but it appears to have been successful in Portugal, not from any prophylactic virtues in the plant, but through the great absorption of moisture by its deep roots, which tends to dry the subsoil. Treating the breeding-ponds with petroleum or similar preparations seems to be hardly applicable on a large scale, and in any case can only be a temporary expedient. ”

“ When unhealthy situations cannot be avoided, they may be rendered more healthy by destroying the breeding-grounds of mosquitoes in the neighbourhood. All puddles and collections of water should be filled in or drained; as a temporary expedient they may be treated with petroleum, which prevents the development of the larvae. When a place cannot be kept free from mosquitoes the house may be protected, as in the experiments in Italy, by wire gauze at the doors and windows. ”

“ The genus with which Anopheles is most likely to be confounded is Culex, which is the commonest of all mosquitoes, has a world-wide distribution, and is generally a greedy blood-sucker. A distinctive feature is the position assumed in resting; Culex has a humpbacked attitude, while in Anopheles the proboscis, head and body are in a straight line, and in many species inclined at an angle to the wall, the tail sticking outwards. ”

“ Children are much more susceptible than adults.
Malaria in the Lower Vertebrates.—Birds are subject to malaria, which is caused by blood parasites akin to those in man and having a similar life-history. Two species, affecting different kinds of birds, have been identified. Their alternate hosts are mosquitoes of the Culex genus. Oxen, sheep, dogs, monkeys, bats, and probably horses also suffer from similar parasitic diseases. In the case of oxen the alternate host of the parasite is a special tick (Smith and Kilborne) . ”

“ Some observers maintain that Anopheles does not “sing,” like the common mosquito, and its bite is much less irritating. Only the females suck blood; the act is believed to be necessary for fertilization and reproduction. Anopheles rarely bites by day, and then only in dark places. ”

“ In 1898 Experiment. it was conclusively shown in Italy that if a mosquito of the Anopheles variety bites a person suffering from malaria, and is kept long enough for the parasite to develop in the salivary gland, and is then allowed to bite a healthy person, the latter will in due time develop malaria. The converse proposition, that persons efficiently protected from mosquito bites escape malaria, has been made the subject of several remarkable experiments. ”

“ Three distinct parasites, corresponding with the tertian, quartan and malignant types of fever, have been described by Italian observers, and the classification is generally accepted; intermediate types are ascribed to mixed and multiple infections. ”

“ Mosquitoes caught by the experimenters, and sent to London, produced malaria in persons who submitted themselves to the bites of these insects at the London School of Tropical Medicine. Experiments in protection on a larger scale, and under more ordinary conditions, have been carried out with equal success by Professor Celli and other Italian authorities. ”

“ Mosquitoes in the house may be destroyed by the fumes of burning sulphur or tobacco smoke. According to the experiments of Celli and Casagrandi, these are the most effective culicides; when used in sufficient quantity they kill mosquitoes in one minute. ”

“ The spleen continues to enlarge; the urine is now scanty and high-coloured; the body temperature is high, but the highest temperatures occur during the chill; there is considerable thirst; and there is the usual intellectual unfitness, and it may be confusion, of the feverish state. ”

“ The severe forms of intermittent are most apt to occur in the very young, or in the aged, or in debilitated persons generally. Milder cases of malarial fever are apt to become dangerous from the complications of dysentery, bronchitis or pneumonia. ”