Malaria

“ MALARIA WORK AND THE HOSPITAL SYSTEM In the early years of our construction malaria was very common and gave a great deal of trouble. As I have explained before, malaria is caused by a small animal parasite which lives in the blood of man and feeds upon the red globules. The excretions of this parasite poison man and cause the fever and other symptoms which we know as malarial fever. This parasite is transferred from the sick man to the well man by the bite of the mosquito. ”

“ It is seen that, in general, consumption, heart disease, pneumonia and typhoid fever caused more deaths than malaria and these were the only diseases that did. But these diseases are much more fatal than malaria. That is, where one person sick with either of these four diseases recovers, dozens are sick with malarial chills and fevers and recover. In other words, malaria causes much more sickness than any one or all of those four diseases rolled in one. ”

“ Malaria is one of the world's most deadly diseases. Even though it is highly preventable and treatable, it causes approximately 881,000 deaths every year [1] , with nine out of ten deaths occurring in sub-Saharan Africa, and 85% of malaria-related deaths in children under five years of age. This is the equivalent of a child dying of malaria in Africa every 30 seconds [ [2] . The most serious forms of the disease are caused by the parasite Plasmodium falciparum ”

“ But the profession is still profoundly impressed with the belief that malaria is an actual or material poisonous substance. To Homer it was the arrows of Apollo in anger, to the mediæval folk-lore it was the mischief of elves and sprites; and, if scientific medicine does not now permit us to personify the malaria, it teaches us at least to materialize it. Although the fevers which malaria produces are quite unlike the fevers that are contagious or communicable, the present scientific guides of the profession are resolved to find a material virus or poison as the cause of them. ”

“ It is at that stage in the development of the parasite in the human body when it multiplies by dividing that the chills and fever in malaria appear. What causes the malarial attack at this point is unknown, unless it be that the parasites give rise to a poison at the time of their division. Between the attacks of chills and fever in malaria there is usually an interval of freedom of a few hours, which corresponds to the period intervening in the life of the parasite in the human body, between the birth of the young parasites and their growth and final division, in turn, into new individuals. ”

“ Malaria. Inkatazi tonizimba, a disease sent by dissatisfied ancestors.
Treatment. Sacrifices, singing, and dancing are practised round the sick to satisfy the ancestors.
Vomitives and purgatives are used and by some the Lasiosiphon Meisneri, one of the [58] “Snakebite” drugs is used, the dose being 1⁄2 oz. of the dried root taken as an infusion.
Malaria is not a prevalent disease amongst the Kaffirs owing principally to the fact that their kraals are always built on high ground. ”

“ Cerebral malaria is the most common clinical presentation and cause of death in adults with severe malaria. The onset may be dramatic with a generalized convulsion, or gradual with initial drowsiness and confusion, followed by coma lasting from several hours to several days. The strict definition of cerebral malaria requires the presence of P. falciparum parasitemia and the patient to be unrousable with a Glasgow Coma Scale score of 9 or less, and other causes (e.g. hypoglycemia, bacterial meningitis and viral encephalitis) ruled out [23] . ”

“ Gentlemen, in dealing with malaria we ought always to hold popular experience in high esteem, for we owe much to it. We owe to it the fact that we have been liberated from the paludal idea, and furthermore, that we have learned that it is often better, instead of trying to prevent the importation, for the most part imaginary, of malaria from distant marshes, to suppress its production in the soil under our feet or in that immediately surrounding us. ”

“ The hill people themselves seem to suffer little from malaria. If they ever do contract the disease they take no medicine, but fast and offer sacrifices to the local deity, beginning with fowls and going upwards through pigs to goats and at last to buffaloes, until either the fever leaves them or they realize that it is their fate to have to bear it. ”

“ Yet no one up to the period I allude to—no physician, at least—had ascribed to neglected drains, ill-conditioned sewers, imperfectly trapped cesspools, overflowing dead-wells, &c., the origin of a malaria much more destructive than the celebrated malaria of fenny or marshy countries, the malaria, if such it really be, equal to the production of that plague, never absent, at times most destructive—the dreadful typhus3 of Western Europe.
At last one man, a shrewd, intelligent, and influential observer, a man of genius, gave to the whole question a new phasis. ”

“ The high burden of malaria in this region has been described decades ago. In 1888, Dr. J. Spitzly, chief of the military health service in Suriname, reported a case of fièvre paludienne fulminante, a very dangerous type of malaria, when visiting the hospital of St. Laurent du Maroni, the first settlement to be encountered when crossing the border river to French Guiana. He could not explain the major difference in malaria incidence that seemed to exist between the two border regions, other than that the river had its function in preventing transmission [8] . ”

“ Exchange blood transfusion has been suggested for the treatment of patients with severe malaria and high parasitemia. For early diagnosis, it is paramount to consider malaria in every febrile patient with a history of travel in an area endemic for malaria.
Introduction
Malaria remains a devastating global health problem. Worldwide, an estimated 300–500 million people contract malaria each year, resulting in 1.5–2.7 million deaths annually [1] , [2] . ”

“ The persistent absence from the blood of the malaria parasite and of pigmented leucocytes —if vouched for by an experienced observer— and the negative results attending administration of quinine, together with the absence of definite periodicity in the symptoms, of pronounced anæmia and of marked enlargement of the spleen, should be decisive against malaria. But in the present state of our knowledge it is very hard indeed, until the case is well advanced, to exclude typhoid, paratyphoid, and undulant fever. ”

“ Therefore it is proved that from 0 to 5000 feet above the sea there is no immunity from fever and ague, that over forty miles of lake water between a camp and the other shore are no positive protection; that a thousand miles of river course may serve as a flue to convey malaria in a concentrated form; that if there is a thick screen of primeval forest, or a grove of plantains between the dwelling-place and a large clearing or open country there is only danger of the local malaria around the dwelling, which might be rendered harmless by the slightest attention to the system ”

“ It has been said that one-half the mortality of the human race is due to malaria. This may very well be an exaggeration, but there can be little doubt that, of all the ills that flesh is heir to, malaria is the most deadly, and exercises the most profound influence on the distribution and activities of man. ”

“ In the tropics, however, malaria in its various forms causes an enormous number of deaths and predisposes its victims to so many other dread diseases that it ranks as perhaps the most important human disease. ”

“ The attack of malaria after a tour up-country, the malaria at military stations like Prah-su, the abundance of malaria on railways, are all explicable when the extraordinary condition of universal native infection is appreciated. It is evident that, could Europeans avoid the close proximity of native huts, they would do away with a very obvious and great source of infection.... ”

“ Placed accidentally in a country usually considered as a focus or centre of that malaria or influence, whatever it may be, which man, correctly, perhaps, esteems as the source and cause of remittent and intermittent fevers, I have thought it might prove a labour of some utility to mankind to test the theoretical opinions to which I have alluded, by an appeal to facts submitted to more refined analyses than were known at the period of their promulgation. ”

“ Abstract Malaria represents a medical emergency because it may rapidly progress to complications and death without prompt and appropriate treatment. Severe malaria is almost exclusively caused by Plasmodium falciparum. The incidence of imported malaria is increasing and the case fatality rate remains high despite progress in intensive care and antimalarial treatment. ”

“ Definition.—Blackwater fever is a disease of disputed etiology but recently there has seemed to be rather general agreement that it is connected with repeated attacks of malaria. It is prone to affect the old European residents of parts of the tropics where malignant tertian is rampant.
On the basis of lowered integrity of the red cells, by reason of repeated attacks of malaria, we may have extensive lysis of the red cells following the administration of a dose of quinine or as the result of refrigeration, excessive exposure to the sun or great fatigue. ”

“ Americans are fortunate to live in a land that eliminated malaria decades ago. Today, our country helps fight this disease in Africa, because we believe in the timeless truth: To whom much is given, much is required. On Malaria Awareness Day, we renew our commitment to helping combat malaria in Africa and around the world. ”

“ Even admitting the full influence of a vigorous constitution, and an innate vitality equal to the neutralization of all malaria, a something must still be ascribed to observation leading him to avoid the hurtful and insalubrious agencies at work around him—agencies ever active, ever seeking to destroy. ”

“ For diagnosis in malaria, therefore, skill in the microscopical examination of the blood is of the utmost value, and no pains should be spared by the practitioner in malarious countries to acquire it. In acute untreated malaria the parasite may be detected practically in every case. ”

“ 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. ”

“ All malaria cases in Suriname are currently registered by place of origin and entered in a weekly report that is reviewed by members of the National Malaria Board. The Board initiates prompt active case detection surveys when malaria re-emerges in a village that had been free of malaria or if the number of cases in a specific region increases abruptly. ”

“ People had malaria, and were very ill with it. In some countries many died. Every one thought, however, that the malaria came in some mysterious way from the mists of the low-lying swamps and marshes. ”

“ Most malaria control programmes in the world are based on the examination and treatment of symptomatic cases, also known as passive case detection. Consequently, only people who suffer from symptoms and can take the time and effort to find health care will be diagnosed. Individuals who are not feeling ill may have persistent gametocytaemia and fuel on-going transmission. ”

“ Malaria:—Observers of this disease in such regions as the gold coast of Africa have noted the fact that malarial attacks are generally preceded by impaired digestion. The disease is said to be due to animal parasites. These parasites are supposed to generate in the soil of certain regions, and thence, through the drinking water, or otherwise, find entrance to the human body.
"A healthy stomach is able to destroy germs of all sorts, hence the best protection from malaria is the boiling of all drinking water, and the maintenance of sound digestion and purity of blood by an aseptic dietary." ”

“ There are certain regions in all countries where malaria does not occur, but almost always it will be found that other regions near by are infected and it very often happens that these infected regions are the most profitable parts of the land, the places where water is plentiful and vegetation is luxuriant. Indeed the coincidence of these two things, low-lying lands with an abundance of water, particularly standing water, and malaria has always been noted and gave rise to the earliest theories in regard to the cause of the disease. ”

“ Malaria transmission intensity affects almost all aspects of malaria epidemiology, including community prevalence and age-profile of infection, the incidence and type of disease syndromes, and total malaria mortality [1] , [2] . It also modulates the expected outcome of malaria control. Because transmission intensity varies geographically, maps that describe this variation are necessary to identify populations at different levels of risk, to compare and interpret malaria interventions conducted in different places, and to evaluate objectively options for disease control. ”