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Malaria

Bryan Applications, M

The fevers described as malaria, ague, marsh fever, jungle fever and by other names, are caused by the invasion of the blood by species of a minute animal parasite belonging, to the class of protozoa. These fevers ravage the populations of tropical and subtropical countries and also exist in some countries within the temperate zone. On their conquest or control depend the restoration and maintenance of vigor to many large communities, the spread of civilization, the success of schemes of colonization and the full exploitation of the natural resources of the tropics. Much credit for this is due to the recognition of the relationship of the mosquito to malaria, a discovery made in India, after infinite difficulties, by the British army bacteriologist, Ronald Ross. The parasites are picked up from the blood of an infected individual by a mosquito of the genus anopheles, and after process of development in the body of the insect are injected into the body of another individual.

Young malarial parasites thus introduced into the blood make their way into red cells and grow at the expense of the cells. After a time the parasite subdivides into a number of young parasites, the mass assuming what is called a rosette form, and then the red cell ruptures, setting free the young parasites, each of which makes it way into a fresh red cell to begin the process over again. The discharge of the parasites into the blood stream coincides with the onset of fever. Some of the parasites do not follow this course, but develop into sexual forms, male and female. If these are taken up by a mosquito they join together in the insects stomach, producing an active cell with two pointed ends, which makes its way into the stomach wall of the insect, where it grows for a time and then subdivides into a number of young parasites. By the rupture of the containing capsule these are liberated, and they then make their way into the salivary glands of the insect, ready to be discharged wherever the insect bites.

This development in the mosquito occupies about ten to twelve days, so that after taking up infected blood a mosquito may take several meals of blood without infecting its host. Three species of the malarial parasite are found in human beings, namely, Plasmodium vivax, Plasmodium malariae and Plasmodium falciparum.

The cycle of development in the blood of the first takes 48 hours and of the second 72 hours, so that bouts of fever occur every third and every fourth day respectively; these fevers are therefore described as benign tertian, and quartan, fever. The development of Plasmodium falciparum is more irregular, and the fever produced is called malignant tertian or sub-tertian fever. The temperature may not reach normal in the intervals of the bouts, the fever assuming a remittent form. A daily rise of temperature may occur from two separate infections with the tertian parasite. In sub-tertian fever the sexual forms of the parasite are not developed in the blood, as in the other two, but in the tissues and especially the spleen and bone-marrow, this fact accounting for some of the difficulty encountered in treating this fever.

Three stages of an attack:

In a typical attack of ague there are three more or less clearly defined stages, namely, the cold, the hot and the sweating stage. At the outset the patient feels chilly and may shiver violently with his teeth chattering. This may last from ten to thirty minutes, and then he feels hot and inclined to throw off bedding that he was grateful for in the first stage. There is headache commonly and perhaps sickness and vomiting. This stage, in which the temperature reaches its maximum, perhaps to 104° or 105° R, may last for four or five hours, after which free perspiration breaks out and the temperature falls rapidly, with a great access of comfort to the patient.

The spleen is enlarged in malaria and there may be tenderness over it. During the apyrexial stage the patient may be well enough to go about his ordinary duties, but after a succession of attacks there is more or less weakness.

In the remittent type symptoms may be severe. The patient may be delirious or stuporous, and coma may supervene. Sometimes there is deep jaundice and there may be blood in the stools and urine. Albuminuria is not uncommon. Sometimes the condition may suggest dysentery or cholera, and cases have been mistaken for appendicitis. In other instances symptoms have pointed to respiratory disease, bronchitis, pleurisy or pneumonia.

In chronic malaria the spleen is enlarged, probably considerably, and hard, a condition sometimes referred to as ague-cake. There is a progressive anemia and the skin may have a clayey tint. The appetite is poor and there is wasting and weakness. Sleeplessness is sometimes a troublesome symptom, or palpitation and shortness of breath, or neuralgia. There may be lesions in the eyes or ears and impairment of sight or hearing. Mental depression may reach the degree of melancholia, though sometimes maniacal attacks occur. There are 250,000 cases of malaria every year in the southern United States,

Quinine as a preventive:

Preventive treatment, in so far as it is concerned with protection from mosquitoes by nets and otherwise, is of some value. As sometime elapses between infection and the onset of symptoms, eleven days, on the average; for benign tertian, fourteen for quartan and six for malignant tertian, additional protection is afforded by taking quinine regularly, 5 to 10 grains daily or 20 grains twice a week, 10 grains in the morning and 10 at night. A pregnant woman should take smaller doses, but more frequently.

The diagnosis of the existence and variety of malaria is most exactly made by a microscopic examination of the blood, but as this means may not be available, and possibly even on examination no parasites might be found in a specimen of blood, it should be presumed that fever occurring in a malarious country is of this nature and quinine should be given in order to test this presumption.

Quinine sulphate is the salt generally used, and preferably it should be dissolved, though a good brand of tablet may be satisfactory. The dosage should be 30 grains daily while there is fever and for three days afterwards, and then 10 grains daily before breakfast for three months.

If the patient is vomiting and does not retain his medicine, 20 grains of quinine hydrochloride dissolved in a little water should be given in a starch enema. When there is a difficulty of this kind, or when symptoms are very urgent, a doctor would give quinine by an intramuscular injection or, in some cases, by an intravenous injection.

It is important that the bowels should act well, and it is desirable to give calomel, 1 to 3 grains, at the outset, and a saline each morning. Calomel with sodium bi-carbonate, is popular in the South.

As regards dietetic and general treatment, it should be that laid down for the state of fever (q.v.). During the cold stage, hot-water bottles, hot drinks, and additional blankets will be required, and when the sweating stage has ceased the patient should be sponged with warm water, have dry pajamas and fresh bedding. It will generally be desirable, during convalescence to give a mixture or tablet containing iron and arsenic as a tonic. See: Fever..

Application and treatment:

This should be treated as an infectious disease, and the use of standard treatment regimen via water pans is suggested. Expect immediate partial relief, and complete recovery should be attainable within 30 days.