The Old Enemy

Not since 1640, when extracts of "Jesuits' bark" (cinchona) from Peru first gave Europeans the benefits of quinine for their "ague," has there been such good news for the world's malaria victims, who number hundreds of millions. Doctors can now handle a feverish flare-up caused by practically any type of malaria, and they can prevent relapses in most types. More progress has been made in the last dozen years than in the last three centuries. Last week the A.M.A. Journal published up-to-date reports on some of the latest drugs, based on the experience of G.I.s returned from Korea.

Malaria is not a single, simple disease, but a complex of diseases caused by several kinds of tiny protozoan parasites. In their complicated life cycle, after being transferred from an infected mosquito to a human host, they spend part of their time in the blood cells and part in the tissues.

Falciparum malaria, untreated, is more likely to be fatal than other forms. But the blood parasites, which emerge from the tissues only once, can be knocked out with the old standby, quinine, or wartime atabrine, or postwar Paludrine, Camoquin and chloroquine. The same drugs have done a good job of suppressing the fever flare-ups of relapsing ("vivax") malaria, which occur when the parasites are in the blood.

One-Shot Cure? The big task has been to find a drug which would not only suppress active malaria, but cure the disease by destroying the parasites during the periods when they hide in the body tissues, so that there can be no more relapses. And it should be something that can be taken once, or for a short time, and then forgotten. The Army medics knew that in the G.I.s returning from Korea for discharge they had a perfect test sample of men who would forget about "malaria discipline" as soon as they got home.

While they were in the lines and exposed to Korea's vivax-carrying mosquitoes, the troops got chloroquine (after the first few, disorganized weeks). It worked fine as long as they took it regularly. Even though they were bitten, the men had few feverish attacks. But they still had malaria. When they started home, the medics went to work on them aboard troop-laden transports. This time their weapon was primaquine, developed in the laboratories of Columbia University. These returned soldiers are being checked for relapses. There have been few, according to reports available now (but still incomplete).

Along with this mass test, the Army doctors got a chance to work on the soldiers who had gone to Korea first and come home earlier, without primaquine treatment. Last summer they began to show up at station hospitals all over the U.S. for malaria treatment. Some got only chloroquine, and nearly one-third soon had a second relapse. But of 246 who got pamaquine as well as chloroquine, only one relapsed, and of 231 who got primaquine with chloroquine, none relapsed.

Danger on the Side. Primaquine has one peculiarity: it is much safer for white patients than others; Negroes and many Asiatics may develop a form of anemia after relatively small doses. Also, it has to be given in several doses, so it is not the ideal drug for such a vast area of relapsing malaria as India.

Now Indian doctors report great success in treating fever relapses with a single dose of inexpensive Camoquin; they have also found that later relapses are few, and spaced farther apart. U.S., British and Belgian researchers are hard at work testing yet another new drug, daraprim. A thousand times as powerful as quinine, it can be taken in tiny, tasteless doses, and newborn Negro babies in Africa show no ill effects. So far, varying results with daraprim reflect the protean nature of malaria itself.

Malaria is one of man's oldest enemies, recognized by medicine men long before Hippocrates. Mosquito control has threatened its supremacy. This year, for the first time, there is solid evidence that it may soon be defeated wherever Western medicine can penetrate.

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