Some Pages from the History of the Prevention of Malaria."
Total Page：16
File Type：pdf, Size：1020Kb
Glasgow Medical Journal New (7th) Series February, 1935 Vol. V No. II ORIGINAL ARTICLES SOME PAGES FROM THE HISTOEY OF THE PREVENTION OF MALARIA.* By Sir MALCOLM WATSON, M.D., C.M., D.P.H., Hon. LL.D.Glasg., Hon. F.R.F.P.S.Glasg., Diplomatist (Honoris Causa) of King Edward VII College of Medicine, Singapore. Introduction. Gentlemen?When your President and Council honoured me by an invitation to deliver the Finlayson Memorial Lecture, they suggested that an historical account of malaria and malaria control would he appropriate to the occasion. That invitation I accepted with pleasure for a number of reasons. It gave me an opportunity of paying a tribute to one to whom I have often listened and to one whose name and person were familiar to a whole generation of Glasgow medical students as a teacher. Yet he himself never ceased to be a student of medicine; the shelves of your library are enriched by his work as an historian. For many years Finlayson's Clinical Manual was one of my cherished posses- sions, an ever-present aid in time of need when I was isolated in the tropics, and that old well-thumbed volume would have an honoured place on my book shelves to-day but for a desire of white ants to digest its contents. * Being the Finlavson Memorial Lecture delivered before the "Royal Faculty of Physicians and Surgeons, Glasgow, on 29th November, 1931. yoL. cxxui. no. n. 49 Sir Malcolm Watson And yet another reason was that it gave me another oppor- tunity of meeting old friends, and of acknowledging my debt to the great city in which I was born, and to the great Medical School in which I was trained. If I have succeeded in any degree, that success has to be attributed to my good fortune " " in sitting under men like .Bower, Buchanan, MacLeod, Gairdner, Macewen, Coats, Middleton and Hawthorne, and two who are present to-day?Barclay Ness, a past President, and Munro Kerr, your President?to name but a few of the teachers of the Glasgow Medical School. A third reason was that those who saw the early stages of the prevention of malaria and have direct personal know- ledge of it are becoming fewer in number. Manson, Ross, Gorgas and Simpson have crossed the bourn. Those who remain are very senior, if not in the sere and yellow leaf. What we saw and thought is, perhaps, worth recording, because it was a period of great activity in tropical medicine; indeed one of the great eras in medicine, wThen one discovery thundered on the heels of another. In the sixteenth century a spirit of high adventure filled the veins of Portuguese, Spaniard, English and Dutch alike, and led to geographical discoveries such as the world had never seen before. Late in the nineteenth century a similar spirit infused the medical men of many races, and the discoveries of Koch of Germany, Pasteur of France, Lister, Manson and Ross of Britain, and Reed of America opened a new era in medical thought; so that men could go forth with a new light and new confidence both to cure disease and to prevent it. It seemed to me that, having spent so much of my life in tropical lands, and especially in the study of malaria and its prevention, this would be a suitable opportunity to attempt to trace briefly the history of the prevention of malaria since Ross made his epoch-making discovery on '20th August, 1897, and completed our knowledge of the life cycle of the malaria parasite in the mosquito on 9th July of the following year. Ross expected that his discovery would lead to measures for the prevention of malaria by mosquito reduction being taken at once throughout the world. But although the scientific world was deeply interested, and although his discovery fired men to research in tropical medicine in which the important part played by insects in the spread of disease came to be 50 History of Malaria Prevention fully realized, little practical use of Boss' discovery was made, to his unconcealed and bitter disappointment. In 1910 Ross published his Prevention of Malaria. It contains con- tributions from many lands on the work that had been done in the previous ten years. As an historical record it is of great interest; but it is likewise tragic evidence of the failure of the world as a whole to use the discovery. After Lister made his great discovery there was a time-lag of nearly a generation before antiseptic and aseptic surgery was properly understood, and came into general use. History has repeated herself by a similar lag in the prevention of malaria. To-day I propose first to survey the history of prevention in various lands, in order to discover, if possible, the reason for progress in some countries and delay in others, and then more briefly to scan the future. Of course, this lecture makes no pretence to be a complete history of all that has been done in the past thirty-six years. What I have attempted has been to record something of what has come within my own personal knowledge and experience. It is, as its title indicates, only " Some Pages from the History of the Prevention of Malaria." The Fit*st Successful Anti-malarial Work in the British Empire. The work in Malaya, begun in 1901, was described by Boss as the first successful anti-malarial work in the British was so it Empire. In that year the malaria intense that threatened the existence of two small towns, on the coast of the State of Selangor, no farther from the equator than Chester is from London. People of all races walked in fear of it. Business was suspended, and religious ceremonies and processions were organized in an appeal to higher powers for help. One of the towns was a new port for the Federated Malay States. The High Commissioner actually sent a tele- I was instrumental in gram ordering its closure, but having that order withdrawn. Although the work of eradicating malaria seemed well nigh hopeless on account of the high temperature, the heavy rainfall (100 in. a year), the extensive the work was swamps and the luxuriant tropical vegetation, was so successful1 that in a few months life in the towns proceeding smoothly, the port was not closed, and the number 51 Sir Malcolm Watson of deaths among 3,500 people fell from 582 in 1901 to 144 in 190*2, and later to a mere fraction of that number,* as the following figures show :? Deaths in the Towns of Klang and Port Swettenham. Other Year. Fever. Diseases. Total. 1900, ... 259 215 474 1901, ... 368 214 582 1902, ... 59 85 144 1903, ... 46 69 115 1904, ... 48 74 122 1905, ... 45 68 113 I wish to draw particular attention to the decrease in the deaths from other diseases.2 It was entirely unexpected, and indeed its significance would not have been understood but for my work in the hospital, which showed that large numbers of patients were admitted complaining of diseases such as nephritis, abscess, convulsions, diarrhcea and dysentery, but who had malarial parasites in their blood. They were suffer- ing from malaria, from the complications of malaria, or from infections by organisms which had been able to gain an entrance from the lowered vitality of the host as a result of malaria. This was a discovery of the very highest importance in public health in the tropics, and it has thrown a light on malaria in many lands. I would also like to emphasize, for reasons which will appear later, that the discovery was made as the direct result of practical work, or, as I might call it, a large-scale experiment in the control of malaria in these two towns. Nothing but the combination of such an experi- ment with hospital work could have established so clearly this knowledge. There is one other lesson I would like to emphasize. It is that the success of this work was due to the careful pre- paration of plans. Accurate microscopical work was done in * In 1901 the number of cases of malaria treated in the hospital, indoor and a " out-patients, among population of 3,500,, was 1,772. For the year ]933 the number of cases of malaria infected in the Sanitary Board area of and Port Swettenham one Klang (now administrative area) was 117 among a . population of 34,920. The spleen rate of school children in the town area is 2.9 per cent among 1,561 children." 3 52 History of Malaria Prevention the hospital; accurate statistics of the disease in hospital, and among Government officers, were compiled; an entomological survey showing the distribution of anopheles was made; and our engineers prepared the plans carefully. Being myself physician, health officer and entomologist, there was perfect co-operation with the engineer. But not less important was the strong support given to the schemes by the District Officer, Mr. H. B. Ellerton, and the acting Harbour Master, Mr. C. W. Harrison; indeed, it would only be doing justice to these two members of the Malayan Civil Service to say that they were the first to propose these anti-malarial schemes, and that as early as February, 1901. There was nothing half-hearted about this work. We were out to get success, if success were to be got. Money was spent freely in the light of our know- ledge at that time. I say, bluntly, we deserved success. Fortune favoured the bold, but we had greatness thrust upon us, for our success was far beyond our expectations.