People who improved our knowledge of malaria

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Malaria is an ancient disease, that announces its presence in the human body with a high grade fever. Since ancient times, a catastrophic, high grade fever with chills and intense shivering was believed to be malaria. Hippocrates believed it to occur due to bad air that emanated from swamps, and hence the name.

In 323 BC when Alexander the Great was returning after a successful conquest of India, he had a fever for two weeks and died. History believes he had malaria, while he could have had countless of other diseases that present with fever. Similar is the story of Vasco-da-Gama who died in 1524, or David Livingstone, who passed away in 1873. This century long spell of speculation and ignorance was broken by a few personalities, who have also featured in postage stamps.

Louis Alphonse Laveran

It was only in 1880, when for the first time we could link malaria, with presence of organisms in the blood cells. This discovery was made by Alphonse Laveran, a French military doctor. Born in 1845, he completed his medical education in 1867 and followed footsteps of his father to join military service. In 1878 he was posted in Algeria, where malaria was common. While examining blood films of patients with malaria, he found some structures in the red cells, which he reported as parasites in 1881. This discovery was initially met with skepticism, but Laveran persisted. By 1889 his work was accepted, and French Academy awarded him with Breant Prize for discovery of malarial parasites.

Laveran was a serving military doctor, and not a scientist when he made initial discovery of the malarial parasite. This discovery led to a better understanding of the malaria life cycle in humans. However, the transmission of malaria and another half of its life-cycle was yet to be discovered. Another unlikely scientist, Ronald Ross, would help us know more.

Ronald Ross

Ronald Ross, was born in 1857 to a British Army Officer, who was then posted in Almora, India. His father sent him to England when he was eight. Ross was more inclined towards mathematics, poetry and drawing in his early years. Forced into medical profession by his father, he completed his medical education in 1881, and was posted in Madras under Indian Medical Services. In one of his visits to England in 1894, he met Patrick Manson, who is also known as Father of Tropical Medicine. Manson introduced Ross to malaria, and to evaluate if mosquitoes had something to do with it. Manson emphasized that India is a best place for such a research.

In 1896-97, he was posted in Secundrabad, where his painstaking research led him to complete the life-cycle of malarial parasite. He proved that malarial parasite multiplied inside the mosquito-gut, after they had a human-blood meal. This discovery made on 20th August 1897, was published in Indian Medical Gazette a mere seven days later, and in the British Medical Journal later the same year.

Unfortunately, Ross was transferred to Calcutta and his subsequent study of the Life cycle of malarial parasite was interrupted. Inspite of this, he resumed his work at this new place. He started his work on Plasmodium relictum, a species that causes bird-malaria. In July 1898 he could describe the entire life cycle of a malarial-parasite. He and Manson rightly believed that bird and human malaria have identical life cycles.

Giovanni Grassi, Ronald Ross and Nobel Prize

Meanwhile in Italy, another scientist Giovanni Battista Grassi was working on life cycle of malaria. Between 1896-98 Grassi and his coworkers proved that only female Anopheles mosquitoes could transmit malaria. They described life cycles of human malarial-parasite species – P. vivax, P. falciparum and P. malariae. Grassi went on to prove that malaria can be prevented, by limiting mosquito bites. Initially both Ross as well as Grassi were considered for a joint 1902 Nobel Prize. The arbitration committee that was chaired by Robert Koch, however awarded the Prize only to Ross.

Nobel prize even eluded Laveran. This anomaly was partially corrected in 1907 when The Nobel Prize in Medicine was awarded to Laveran for recognition of his work on the role played by protozoa in causing diseases. Grassi and his coworkers never got awarded for their work.

Personalities that helped us cure and prevent malaria

Fever was treated by various types of herbal medication since the ancient times. For instance, Peruvians in Andes treated it with bark of the Cinchona tree. Ancient Chinese treated it with a sweet sagewort plant named qinghao. Many years later we rediscovered these remedies as modern drugs Quinine and Artemesinin respectively.

Pelletier and Caventou and Quinine

Quinine is considered to be one of the most important medical discoveries of the 17th century. The exact nature of its discovery remains unclear.There are tales of the Spanish Countess of Chinchon being cured of a recurring fever by using liquid containing Cinchona bark. This probably prompted her to return to Spain in 1638 with the seeds and precious bark. During the early 17th century, the bark was ground into a powder and mixed with wine. In 1820, French scientists Pierre Pelletier and Joseph Caventou developed the processes to extract quinine from Cinchona bark. The duo also extracted strychnine and colchicine from other plant sources.

By 19th century, Europeans in the British colonies started planting Cinchona trees to avoid importing large amounts of the drug. Owing to its bitter taste, quinine was mixed with sugar and soda, creating the first tonic water. The tonic water was mixed with gin to make the bitterness of quinine more palatable. Thus, tonic and gin became an integral part of military culture across the British Empire. Further, treatment of malaria with quinine marks the first known use of a chemical compound to treat an infectious disease.

An odd use of Malaria: Pyrotherapy

Once malarial parasites were discovered, and the ailment could be treated with quinine, a lesser known Nobel for use of malaria was awarded in 1927. Austrian psychiatrist Julius Warner Jauregg, used inoculation of malaria to treat neurosyphilis. This Pyrotherapy for syphillis had became popular in the pre-antibiotic era. However, this dangerous practice came to an end, as we discovered better ways to treat syphilis.

Paul Muller and DDT

The German chemist Othmer Zeidler synthesized a compund called DDT in 1874. Initially considered as useless, in 1939 Paul Müller discovered its insecticide usage. By the end of the second world war, DDT was used to control malaria. DDT had became a powerful way of fighting malaria by attacking the vector. In 1947 Paul Müller received Nobel Prize for this discovery. Extensive DDT based mosquito elimination campaigns were launched in 1950s. However its toxic effects on environment soon became apparent. By 1970 DDT was replaced by more quickly degraded, less toxic insecticide agents.

Tu YouYou and Artemesinin

Over the years, malarial parasite (plasmodium) developed resistance to quinine analogues. Search for better drugs to treat malaria, found its mate in traditional Chinese medicine. Today artemesinin compounds are mainstay of malaria therapy across the world. This discovery was also made by an unlikely researcher from mainland China. The discovery of artemisinin is described as “the most important pharmaceutical intervention in the last 50 years of second millennium.”

A Chinese scientist Tu YouYou discovered artemisinin in 1972. She extracted it from qinghao, a popular plant in traditional Chinese medicine. This discovery led Youyou to win the Nobel Prize in Medicine or Physiology in 2015. She is the first mainland Chinese scientist to have received a Nobel Prize in a scientific category, and she did so without a doctorate, a medical degree, or training outside China.

Malaria research won Nobel Prize at least five times, Ronald Ross in 1902, Laveran in 1907, Julius Warner in 1927, Paul Muller in 1939 and Tu YouYou in 2015. Lets lend faces to all these names, as we await a global malaria elimination in years to come.