Fight Against Malaria

Use of Plasmoquine and Atabrine in Southern States of America

THE present position of the world fight against malaria (which kills 3,000,000 people annually) is set out in a recent article by Paul de Kruif, in “Country Gentleman”. It is written from the point of view of the United States, where a major problem is the continued existence of virulent malaria in the Southern States; but the following extracts are just as applicable to the fever-ridden terri tories of Melanesia.

MALARIA spreads in just.one way: by one kind of she mosquito. This in sect sucks the blood of an infected person; then she bites and spits the mic robes back into healthy people.

Why can’t our bug hunters, using oil, Pans green and drainage ditches, destroy all mosquito breeding places? Such mea sures made the Panama Canal possible.

But—aside from the enormous cost—if our South were thoroughly drained of all its waters that hatch malaria mosquitoes, the land, with a greatly lowered water table, might no longer support its millions of human beings.

Yet the man-to-mosquito-to-man chain must be broken. If mosquitoes can’t be kept from giving malaria to men, why

can’t we keep men from infecting mos quitoes?

Another weapon is quinine, which has saved millions from malarious death. It cures individual cases wonderfully. Yet quinine has dismally failed jto prevent malaria’s wrecking the blood of our Southern millions. Malaria microbes are tough, and in many a human being the curative doses doctors have to use are so terrific they’re dangerous. Many prefer the disease to the cure! Thus the chain of infection survives, and malaria con tinues in the community.

When it became evident that the man to-mosquito-to-man chain couldn’t be broken by quinine, a team of German microbe hunters began to seek a syn thetic drug which would do the trick. By 1925 they had cooked up a chemical which, in experiments with malaria in canary birds, was real poison for male and female microbes. Here was power that quinine lacked.

But there are two kinds of malaria microbes, sexual and sexless neuters.

These neuters are the real killers. Yet, strangely, it is the male and female microbes that perpetuate the chain of malarious death. It is these that a mos quito sucks into her stomach, where they beget myriads of malaria-microbe chil dren which Mrs. Mosquito injects into the blood of healthy people.

To test this new coal-tar chemical— “plasmoquine”—on humans, German microbe hunter Roehl hurried to Spain where malignant, tropical malaria was raging. June, 1925, he sent an excited telegram back to Germany: “Plasmoquine kills sexual malaria parasites in human beings!”

But plasmoquine was feeble against the murderous sexless microbes. Quinine could cure malaria, but couldn’t power fully prevent it. Plasmoquine could pre vent malaria from going via mosquito from man to man. But couldn’t cure it.

Our searchers struck off on a new chemical trail —something that would kill these sexless microbes. And, in 1930, after five years of toiling, they developed a complicated drug which they called “ata brine”.

Like wildfire, beginning 1932, the little yellow pills of atabrine spread over the tropical world. And no death-fighting remedy—with the possible exception of salvarsan for syphilis and insulin for diabetes —has ever had such a roaring “Yes” of scientific approval. From India, from Africa, from the Dutch East Indies, from Central and South America—from all dangerously malarious tropical re

gions—came scientific cheers for atabrine.

Compared to quinine, these pills were harmless. At worst, they colored some people’s skins yellow for a while. Babies could take them safely. And it was amaz ing how littie atabrine you needed to cure most malarious people. One little pill, by mouth, three times a day, for five days or at longest seven. Atabrine magi cally brought people moribund with mali gnant malaria back from the grave. It began to be reported in many a tropical pest-hole that doctors no longer feared even that most sinister form of malaria, “black-water fever”, in which shivering grows more and more violent, fevers fiercer and fiercer, the blood dissolving and running out of the doomed one in horrid dark red urine.

Georgia’s State Health Commissioner T. F. Abercrombie heard of the miracles atabrine was performing in the tropical hospitals of the United Fruit Company.

In 1933 he sent State Epidemiologist Daniel Seckinger, armed with these new fangled pills, to Calhoun County, Georgia.

Here malaria was so vicious that hardly a white family could live in its rural re gions. Here 80 out of every 100 rural school children, in 1932, showed their blood peppered with malaria parasites.

May, 1933, when the mosquitoes began their sinister humming, Seckinger split these farm people up into two gangs: To half the families, in which he found any case of malaria, he gave the 15 pills of atabrine. And since the county was notorious for its malignant malaria, he fed those same families very tiny amounts of plasmoquine three times a week all summer to keep them from giving mos quitoes that deadly infection.

That autumn there was no doubt of the answer. The persons who did not take atabrine suffered six times the amount of malaria suffered by the families under atabrine. Having thus proved the effectiveness of atabrine, Seckinger gave his magic pills to cure all who were sick.

In the bad malaria of 1934 that fol lowed, it was plain that this 1933 ata brine dosage hadn’t left many microbes for the 1934 mosquitoes. While malaria was epidemic over the rest of Calhoun County-death rate at the terrible high of 109 per 100,000—in all of Seckinger’s 54 square miles there wasn’t much malaria. And not one person died of it.

TT ln T^ February ’ 1934 ’ Glynn County’s Health Commissioner, Dr. M. E. Win chester started another experiment.

Aided by seven F.E.R.A. nurses and P.E.R.A. funds to provide free atabrine he canvassed every last home of Glynn County’s rural families. Forty per cent of them gave a history of undoubted malaria the year before. Winchester set up four health centres, with nurses to examine, teach and treat all who came complaining of “dumb chills and innard fever . The nurses enforced a rule that if any member of a family was malarious —everyone in the family got the 15-pill treatment.

That summer and autumn there was at least 90 per cent, malaria, and no deaths from it in Glynn County. Less than 50 people had to come back for a second treatment, and the school teachers were amazed because no children had to fever nt h ° m6 fr ° m schoQl With chills and . r J? , 1935 ’ Winchester extended his tests rnf?SfS rio o St ly i malar i ous P arts of Mclntosh TSI n £oii gato Tth conclusive results.

The health record of these former pest me^%7l S 936Zd m 7. throUgh ““ SUm ' Meanwhile the systematic 15-pill treat ment in the Glynn County health centres

every spring, of all members of all families with any member malarious, had reduced that ancient, perennial, lifesapping plague to hardly more than a memory. And in the blood-test surveys Winchester made each year from 1934 to 1937, in no year did the positives reach one per cent. This record for that invincibly malarious cor ner of our Southland is unprecedented.

Despite this, there are malariologists high in authority who admit they still have to be shown. Dr. L. L. Williams, jr., of the U.S. Public Health Service, points out that malaria has up-and-down swings in periods of years. He fears that Dr. Winchester’s experiments began on a downswing in 1934, and that when the upswing starts, atabrine may be power less.

To such criticism Winchester replies: “If I’m wrong, I’m anxious to be shown.

The Georgia state laboratory examina

tions of the people’s blood show there’s very little malaria. People aren’t losing work time from malaria. They aren’t dying from it. What I want to find out is what’s wrong with the experiment”, Winchester is building Exhibit A for all Southern rural regions that can’t wipe o ut malaria by wiping out mosquitoes. If men no longer can give malaria to mos quitoes, the man-to-mosquito-to-man chain is broken, and malaria should dis appear in a few years.