Preventable Diseases

by Woods Hutchinson

A pall of dread hangs over the whole west coast of Africa. The factories and trading-posts are haunted by the ghosts of former agents and explorers who have died there. Some years ago one German company had the sinister record that of its hundreds of agents sent out to the Gold Coast under a three years' contract, not one had fulfilled the term! All had either died, or been invalided and returned home. It was malaria more than any other five influences combined that thwarted the French in their attempt to dig the Panama Canal and that made the Panama Railroad bear the ghastly stigma of having built its forty miles of track with a human body for every tie.

Malaria ever has been, and is yet, the great barrier against the invasion of the tropics by the white races; nor has its injurious influence been confined to the deaths that it causes, for these gaps in the fighting line might be filled by fresh levies drawn from the wholesome North. Its fearfully depressing and degenerating effects upon even those who recover from its attacks have been still more injurious. It has been held by careful students of tropical disease and conditions that no small part of that singular apathy and indifference which steal over the mind and body of the white colonist in the tropics, numbing even his moral sense, and alternating with furious outbursts of what the French have termed "tropical wrath," characterized by unnatural cruelty and abnormal disregard for the rights of others, is the deadly work of malaria. It is the most powerful cause, not merely of the extinction of the white colonist in the tropics, but of the peculiar degeneracy—physical, mental, and moral—which is apt to steal over even the survivors who succeed in retaining a foothold. Two particularly ingenious investigators have even advanced the theory that the importation of malaria into the islands of Greece and the Italian peninsula by soldiers returning from African and Southern Asiatic conquests had much to do with accelerating, if not actually promoting, the classic decay of both of these superb civilizations.

To come nearer home, there can be little question that the baneful, persistent influence of malaria, together with the hookworm disease, has had much to do both with the degeneracy of the Southern "cracker," or "mean white," and with those wild outbursts of primitive ferocity in all classes which take the form of White Cap raids and lynching mobs.

However this may be, the disease and the colonization habit brought in a crude way their own remedy. The Spanish conquerors of Peru were told by the natives that a certain bark which grew upon the slopes of the Andes was a sovereign remedy for those terrible ague seizures. Indian remedies did not stand as high in popular esteem as they do now; but they were in desperate straits and jumped at the chance. To their delight, it proved a positive specific, and a Spanish lady of rank, the Countess Chincona, was so delighted with her own recovery that she carried back a package of the precious Peruvian bark on her return to Europe, and endeavored to introduce it. So furious was the opposition of the Church, however, to this "pagan" remedy that she was completely defeated in her praiseworthy attempt and was obliged to confine her ministrations to those who belonged to her, the peasantry on her own estate. About half a century later, the new remedy excited so much discussion by the numerous cures that it effected, that it was considered worthy of a special council of the Jesuits, who formally pronounced it suitable for the use of the faithful, thereby attaching to it for many years the name of "Jesuit's bark." Virtue, however, is sometimes rewarded in this world, and the devoted and enlightened countess has, all unknown to herself, attained immortality by attaching her name, Chincona, softened into cinchona, and hardened into quinine, to the greatest therapeutic gift of the gods to mankind. It is not too much to say that the modern colonization of the tropics and subtropics by Northern races, which is one of the greatest and most significant triumphs of our civilization, would have been almost impossible without it. Its advance depended upon two powders, one white and the other black,—quinine and gunpowder.

For nearly three centuries we rested content with the knowledge that in quinine we had a remedy for malaria, which, if administered at the proper time and in adequate doses, would break up and cure ninety per cent of all cases. Just how it did it we were utterly in the dark, and many were the speculations that were indulged in. It was not until 1880, that Laveran, a French army surgeon stationed in Algeria, announced the discovery in the blood of malarial patients of an organism which at first bore his name, the Hematozoon-Laveran, now known as the Plasmodium malariæ. This organism, of all curious places, burrowed into and found a home in the little red corpuscles of the blood. At periods of forty-eight hours it ripened a crop of spores, and would burst out of the corpuscles, scattering throughout the blood and the tissues of the body, and producing the famous paroxysm. This accounted for the most curious and well-marked feature of the disease, namely, its intermittent character, chill and fever one day, and then a day of comparative health, followed by another chill day and so on, as long as the infection continued. One problem, however, was left open, and that was why certain forms of the disease had their chills every fourth day and so were called quartan ague. This was quickly solved by the discovery of another form of the organism, which ripened its spores in three days instead of two. So the whole curious rhythm of the disease was established by the rate of breeding or ripening of the spores of the organism. Later still another form was discovered, which had no such regular period of incubation and gave rise to the so-called irregular, or autumnal, malarial fevers. That form of the fever which had a paroxysm every day, the classic quotidian ague, remained a puzzle for a little longer, but was finally discovered to be due chiefly to the presence of two broods, or infections, of the organism, which ripened on alternate days and hence kept the entire time of the unfortunate patient occupied.

The mystery of the remedial effect of quinine was also solved, as it was found that, if administered at the time which centuries of experience has shown us to be the most effective, between or shortly before the paroxysms, it either prevented sporulation or killed the spores. So that at one triumphant stroke the mystery of centuries was cleared up.

But here will challenge some twentieth-century Gradgrind: "This is all very pretty from the point of view of abstract science, but what is the practical value of it? The discovery of the plasmodium and its peculiarities has merely shown us the how and the why of a fact that we had known well and utilized for centuries, namely, that quinine will cure malaria." Just listen to what follows. The story of the plasmodium is one of the most beautiful illustrations of the fact that there is no such thing as useless or unpractical knowledge. The only thing that makes any knowledge unpractical is our more or less temporary ignorance of how to apply it. The first question which instantly raised itself was, "How did the plasmodium get into human blood?" The very sickle-shape of the plasmodium turned itself into an interrogation mark. The first clew that was given was the new and interesting one that this organism was a new departure in the germ line in that it was an animal, instead of a plant, like all the other hitherto known bacilli, bacteria, and other disease-germs.

It may be remarked in passing that its discovery had another incidental practical lesson of enormous value, and that was that it paved the way for the identification of a whole class of animal parasites causing infectious diseases, which already includes the organisms of Texas fever in cattle, dourine in horses, the tsetse fly disease, the dreaded sleeping sickness, and finally such world-renowned plagues as syphilis and perhaps smallpox.

Being an animal, the plasmodium naturally would not grow upon culture-media like the vegetable bacilli and bacteria, and this very fact had delayed its recognition, but raised at once the probability that it must be conveyed into the human body by some other animal. Obviously, the only animals that bite our human species with sufficient frequency and regularity to act as transmitters of such a common disease are those Ishmaelites of the animal world, the insects. As all the evidence pointed toward malaria being contracted in the open air, attested by its popular though unscientific name mal-aria, "bad air," and as of all forms of "bad air" the night air was incomparably the worst, it must be some insect which flew and bit by night; which by Sherlock Holmes's process promptly led the mosquito into the dock as the suspected criminal. It wasn't long before he was, in the immortal language of Mr. Devery, "caught with the goods on"; and in 1895 Dr. Ronald Ross, of the Indian Medical Service, discovered and positively identified the plasmodium undergoing a cycle of its development in the body of the mosquito. He attempted to communicate the disease to birds and animals by allowing infected mosquitoes to bite them, but was unsuccessful. Two Italian investigators, Bignami and Grassi, saw that the problem was one for human experiment and that nothing less would solve it. Volunteers were called for and promptly offered themselves. Their blood was carefully examined to make sure that they were not suffering from any latent form of malaria. They then allowed themselves to be bitten by infected mosquitoes, and within periods varying from six to ten days, eight-tenths of them developed the disease. It may be some consolation to our national pride to know that although the organism was first identified in the mosquito by an Englishman and its transmission to human beings in its bite by Italians, the first definite and carefully worked-out statement of the relation of the mosquito to malaria was made by an American, King of Washington, in 1882; though it is only fair to say that suggestions of the possible connection between mosquitoes and malaria had, so to speak, been in the air and been made from scores of different sources, from the age of Augustus onward.

Another mystery was solved—and what a flood of light it did pour upon our speculations as to the how and wherefore of the catching of malaria! In some respects it curiously corroborated and increased our respect for popular beliefs and impressions. While "bad air" had nothing to do with causing the disease, except in so far as it was inhabited by songsters of the Anopheles genus, yet it was precisely the air of marshy places which was most likely to be "bad" in this sense. So that, while in one sense those local wiseacres, who would point out to you the pearly mists of evening as they rose over low-lying meadows and bottom-lands, and inform you that there before your very eyes was the "mylary just a-risin' out of the ground," were ludicrously mistaken, in another their practical conclusion was absolutely sound; for it is in just such air, at such levels above the surface of the water, that the Anopheles most delights to disport himself. Furthermore, while all raw or misty air is "bad," the night air is infinitely more so than that of the day, because this is the time at which mosquitoes are chiefly abroad. In fact, there can be little doubt that this is part of the foundation for that rabid and unreasonable dread of the night air which we fresh-air crusaders find the bitterest and most tenacious foe we have to fight. We have literally discovered the Powers of Darkness in both visible and audible form, and they have wings and bite, just like the vampire.