Death on Delicate Wings
By Awake! correspondent in Nigeria
It is not a war that grabs the headlines; yet it has claimed untold millions of human lives. It is not a war fought with bombs and bullets; yet in terms of misery and lives lost, it rivals or surpasses those that are. In this war, death comes, not in the bellies of heavy enemy bombers, but on the fragile wings of a female mosquito.
IT IS night; the household is asleep. Into the bedroom wafts a mosquito, her wings beating between 200 and 500 times per second. She hungers for human blood. Gently, she lands on the arm of a boy. Since her weight is only 1/10,000 ounce, the boy does not stir. She then unsheathes a saw-toothed stylus in the thorny tip of her mouthparts with which she pierces the boy’s skin over a capillary. Two pumps in her head suck out his blood. At the same time, malaria parasites pass from the mosquito’s salivary glands into the boy’s bloodstream. The operation is over quickly; he feels nothing. The mosquito flies away, bloated with up to three times her body weight in blood. Not many days later, the boy is sick to the point of death. He has malaria.
It is a scene that has been repeated thousands of millions of times. The result has been misery and death on a colossal scale. Without a doubt, malaria is a cruel and relentless enemy of mankind.
Patient Search for the Enemy
One of the cardinal discoveries in the war against malaria was made, not by the great scientists of Europe, but by a British Army surgeon based in India. Scientists and doctors of the 19th century, in harmony with the thinking of the previous two thousand years, assumed that people caught the disease by breathing foul swamp air.* In contrast, Dr. Ronald Ross believed the disease to be passed from person to person by mosquitoes. Even after it was known that malaria involved parasites in the human bloodstream, researchers continued to search for clues in the air and water of swampland. Meanwhile, Ross searched the stomachs of mosquitoes.
Considering the primitive lab equipment he had to work with, looking into the stomachs of mosquitoes was not an easy thing to do. As he worked, clouds of mosquitoes and gnats swarmed around him, determined, according to Ross, to avenge themselves “for the death of their friends.”
At last, on August 16, 1897, Ross discovered, in the stomach walls of the anopheles mosquito, spherical organisms that had grown in size overnight. Malaria parasites!
Filled with jubilation, Ross wrote in his notebook that he had unlocked the secret that would save “a myriad men.” He also wrote a verse from the Bible book of Corinthians: “Oh death where is thy sting? Thy victory oh Grave?”—Compare 1 Corinthians 15:55.
The Ravages of Malaria
Ross’s discovery was a milestone in the war against malaria, one that helped open the way for mankind’s first major offensive against the disease and the insects that carry it.
Throughout most of history, mankind’s losses to malaria have been heavy and sustained. Egyptian hieroglyphics and papyri testify to malaria’s carnage 1,500 years before Christ walked the earth. It ravaged beautiful lowland cities of ancient Greece and cut down Alexander the Great in his prime. It decimated Roman cities and drove the wealthy to the highlands. In the Crusades, the American Civil War, and the two world wars, it killed more men than did many major battles.
In Africa malaria helped earn West Africa the epithet “White Man’s Grave.” In fact, the disease so hindered the European scramble to colonize Africa that one West African university proclaimed the mosquito a national hero! In Central America, malaria helped defeat French efforts to build the Panama Canal. In South America, with the building of the Mamoré-Madeira railway in Brazil, malaria was said to have claimed a human life for every tie laid.
The Fight to Win
Defenses against the mosquito, but not knowingly against malaria, span the millenniums. In the 16th century B.C.E., Egyptians used the oil of the tree Balanites wilsoniana as a mosquito repellent. A thousand years later, Herodotus wrote that Egyptian fishermen wrapped their nets around their beds at night to keep the insects away. Seventeen centuries later, Marco Polo reported that wealthy residents of India slept on beds with protective curtains that could be closed at night.
Elsewhere, men discovered natural remedies that had real value. For over 2,000 years, malaria in China has been successfully treated by a plant called qinghaosu, an herbal remedy that has been rediscovered in recent years. In South America, Peruvian Indians used the bark of the cinchona tree. In the 17th century, cinchona came to Europe, and in 1820 two Parisian pharmacists extracted from it an alkaloid called quinine.
The value of quinine in preventing and treating malaria was slow to be appreciated, but once it was, it became the drug of choice for a hundred years. Then, early in the second world war, Japanese troops captured important cinchona plantations in the Far East. The resulting severe shortage of quinine in the United States prompted intensive research to develop a synthetic antimalarial drug. The result was chloroquine, a drug that was safe, highly effective, and inexpensive to produce.
Chloroquine quickly became a major weapon against malaria. Also introduced in the 1940’s was the insecticide DDT, a powerful killer of mosquitoes. Although DDT stands for the intimidating chemical term dichlorodiphenyltrichloroethane, many English speakers remember the letters by the words “drop dead twice,” an appropriate memory aid, since not only does DDT kill mosquitoes at the time of spraying but later its residual presence on walls that have been sprayed kills insects.*
Following the second world war, scientists armed with DDT and chloroquine organized a global counterattack against malaria and mosquitoes. The battle was to be fought on two fronts—drugs would be used to kill the parasites in the human body, while massive spraying with insecticides would obliterate the mosquitoes.
The goal was total victory. Malaria was to be wiped out of existence. Leading the assault was the newly formed World Health Organization (WHO), which made the eradication program its top priority. Determination was backed by money. Between 1957 and 1967, the nations spent 1.4 billion dollars in the global campaign. Early results were spectacular. The disease was vanquished in Europe, North America, the Soviet Union, Australia, and some countries of South America. Professor L. J. Bruce-Chwatt, a veteran malaria fighter, reflected: “It would be difficult to describe today the tremendous enthusiasm that the concept of eradication evoked throughout the world during those halcyon days.” Malaria was reeling! WHO boasted: “Eradication of malaria has become a reality within our reach.”
Malaria Fights Back
But victory was not to be. Generations of mosquitoes that survived the chemical onslaught became resistant to insecticides. DDT no longer killed them as easily as it did before. Similarly, malaria parasites in humans became resistant to chloroquine. These and other problems resulted in terrible reverses in some lands where victory had seemed certain. Sri Lanka, for example, where malaria was thought to have been virtually wiped out in 1963, experienced just five years later an epidemic affecting millions.
By 1969 it had become widely accepted that malaria was an enemy that could not be vanquished. Instead of the word “eradication,” the term “control” came into vogue. What is meant by “control”? Dr. Brian Doberstyn, head of the WHO malaria unit, explains: “All we can do now is to try to keep deaths and suffering to a reasonable limit.”
Another WHO official laments: “After the malaria eradication efforts made in the 1950s and the use of DDT against insects, the international community has relented. Poverty, lack of infrastructure, resistance to drugs and insecticides have led to a persistence of the disease. In fact, we have been conquered by the disease.”
Yet another factor is that the drug companies have retreated from their research. One malaria scientist said: “The problem is that it requires a lot of investment, but the return is zilch and encouragement nil.” Yes, although many battles have been won, the war against malaria is far from over. The Bible, however, does point to a time that is near at hand when “no resident will say: ‘I am sick.’” (Isaiah 33:24) Until then, disease and death will still come on delicate wings.
The word “malaria” comes from the Italian mala (bad) aria (air).
DDT was found to be harmful to the environment and has been banned or severely restricted in 45 countries.
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Mosquito Versus Man
It threatens directly almost half of humanity, over a hundred countries, mostly in the tropics. Africa in particular is a stronghold.
Mosquitoes are known to hitch rides on airplanes from tropical areas and have infected people living near international airports.
Casualties inflicted. It strikes 270 million people each year, killing up to 2 million. Particularly brutal to pregnant women and children, on the average it slays two youngsters every minute.
It attacks visitors to the tropics. Each year some 10,000 “imported” malaria cases are reported in Europe and over 1,000 in North America.
Tactics. The female anopheles mosquito infects humans mostly at night. Malaria is also passed by blood transfusion and, rarely, by contaminated needles.
Only in recent years has mankind had the knowledge and means to fight back. Despite the combined efforts of 105 countries that are trying to conquer the scourge, mankind is losing ground.
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Guard Against Mosquito Bites
Sleep with your bed enclosed in a net. Nets impregnated with insecticide are best.
Use an air conditioner at night if available, or sleep in rooms with screened windows and doors. If there are no screens, keep the doors and windows shut.
After sunset, it is advisable to wear long-sleeved clothing and long trousers. Dark colors attract mosquitoes.
Apply insect repellent to parts of the body not protected by clothing. Choose one containing either diethyltoluamide (deet) or dimethyl phthalate.
Use antimosquito sprays, insecticide dispensers, or mosquito coils.
Source: World Health Organization.
H. Armstrong Roberts
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“There Is No ‘Magic Bullet’”
While the prospect of total victory seems remote, the battle against malaria continues. At an international conference on malaria in Brazzaville, Congo, in October 1991, WHO representatives called for a departure from the “ambient fatalism” and recommended a new global mobilization to control malaria. How successful will such efforts be?
“There is no ‘magic bullet’ for malaria,” stated WHO’s director-general Hiroshi Nakajima recently. “We must therefore fight it on many fronts.” Here are three battlefronts that have recently received much publicity:
Vaccines. Scientists have been working for years in search of a vaccine against malaria, and the media occasionally report “breakthroughs” in research. Squelching undue optimism, WHO cautions against the “delusion of the availability of an anti-malaria vaccine in the near future.”
One of the problems in developing a vaccine is that the malaria parasite in man has been remarkably successful in eluding the efforts of the human immune system to destroy it. Even after many years of repeated attacks, people develop only a limited immunity to the disease. Observes Dr. Hans Lobel, an epidemiologist with the U.S. Centers for Disease Control in Atlanta: “You don’t develop immunity after just a few attacks. So [in trying to develop a vaccine] you’re trying to improve on nature.”
Drugs. With the growing resistance of the malaria parasite to existing drugs, WHO is promoting a new medicine called arteether, derived from the Chinese herb extract qinghaosu.* WHO hopes that qinghaosu may be the source of an entirely new class of natural drugs, which may be available to the world community within ten years.
Bed nets. Still effective is this two-thousand-year-old protection against mosquitoes. Malaria mosquitoes usually attack at night, and a net keeps them away. Most effective are nets that have been dipped in an insecticide, such as permethrin. Studies in Africa show that in villages where dipped bed nets were introduced, malaria fatalities dropped by 60 percent.
Qinghaosu is an extract of the wormwood plant, Artemisia annua.
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Traveling to the Tropics?
If you plan to travel to an area where malaria is a threat, you should do the following:
1. Consult your doctor or a vaccination center.
2. Follow exactly the instructions you are given, and if taking an antimalarial drug, continue doing so for four weeks after leaving the malarious area.
3. Protect yourself against mosquito bites.
4. Know the symptoms of malaria: fever, headaches, muscular aching, vomiting, and/or diarrhea. Bear in mind that malaria can become manifest up to a year after your departure from a malarious area even if antimalarial drugs have been used.
5. If you have the symptoms, see a doctor. Malaria can worsen rapidly and can cause death less than 48 hours after the first symptoms have appeared.
Source: World Health Organization.
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H. Armstrong Roberts