Medicine: The Shakes

Malaria, which killed Alexander the Great in his prime and often saved Rome by cutting down besieging armies, is still the greatest enemy of man’s health and welfare. The U.S. is one of the few areas of the world that has reduced malaria’s ravages to manageable size. Elsewhere, it claims 300 million victims, 3,000,000 of whom die each year. By sapping the vitality of its victims, malaria breeds poverty. It bars economic progress in so many parts of the world that it has been called a “gigantic ally of barbarism.”

The Sleeper. Most Americans think of malaria as a tropical disease, says Leon J. Warshaw in Malaria: the Biography of a Killer, published this week (Rinehart; $3.75). Actually, says Dr. Warshaw, the disease has struck from the Arctic to Patagonia. Once known as “the shakes,” it was rife a century ago throughout most of the U.S. Dr. Warshaw, a New York diagnostician, estimates the number of U.S. sufferers today as high as 4,000,000. But no one knows just how many there are, because malaria is a skilled mimic, imitating the symptoms of other diseases.

Granting that malaria is no longer a serious problem in most of the U.S., Dr. Warshaw warns: “It is impossible to predict when a change in climatic conditions, even though temporary, may cause an explosive outbreak.” However, the widespread epidemics expected after U.S. servicemen returned from malarial outposts in Africa and Asia have not developed.

Guardedly optimistic, the U.S. Public Health Service considers malaria licked as a public health menace, but it is still “a sleeping giant.” Says PHS’s Dr. Robert M. Coatney: “We shouldn’t do away with our police force. As soon as we relax, it will come back.”

The Police. For 250 years quinine was the only police agent used to control malaria. Swamp drainage and screening of buildings have been added to the force since 1898, when it was shown that malaria parasites (tiny protozoa of the genus Plasmodium) spend part of their life cycle in female Anopheles mosquitoes. The mosquito picks up the parasites from infected humans, nurtures them and injects them into fresh victims. The parasites run through the bloodstream of their victim, causing periodic fevers at the peak of their reproductive cycle; many lodge in the spleen, causing local pain.

DDT has now become the most powerful of the antimalarial police. New drugs are being perfected to replace quinine and wartime atabrine. The ideal drug, says Dr. Warshaw, must cure (not merely suppress) all forms of malaria. It must be easy to make and take, and so cheap that hundreds of millions of men, women & children all over the world can get it.