History of Malaria - Early Research and Treatment

Early Research and Treatment

The introduction of molecular methods confirmed the high prevalence of P.falciparum malaria in ancient Egypt. The historian Herodotus (484–425 BCE) wrote that the builders of the Egyptian pyramids were given large amount of garlic, likely to protect them against malaria. Sneferu, the founder of the Fourth dynasty of Egypt, who reigned from around 2613 – 2589 BCE, used bed-nets as protection against mosquitoes, Cleopatra VII, the last Pharaoh of Ancient Egypt, also slept under a mosquito net. Malaria became widely recognized in ancient Greece by the 4th century BCE, and is implicated in the decline of many city-state populations. Hippocrates (460–370 BCE), the "father of medicine", related the presence of intermittent fevers with climatic and environmental conditions and classified the fever according to periodicity: tritaios pyretos / febris tertiana, and tetrataios pyretos / febris quartana (every fourth day).

For thousands of years, traditional herbal remedies have been used to treat malaria. Around 168 BCE the herbal remedy Qing-hao (青蒿) (Artemisia annua) came into use in China to treat female hemorrhoids (Recipes for 52 kinds of diseases unearthed from the Mawangdui tombs).

Qinghao was first recommended for acute intermittent fever episodes by Ge Hong as an effective medication in the 4th century Chinese manuscript Zhou hou bei ji fang, usually translated as "Emergency Prescriptions kept in one's Sleeve". His recommendation was to soak fresh plants of the artemisia herb in cold water, wring it out and ingest the expressed bitter juice in its raw state.

Medical accounts and ancient autopsy reports state that tertian malarial fevers caused the death of four members of the Medici family of Florence: Eleonora of Toledo (1522–1562), Cardinal Giovanni (1543–1562), Don Garzia (1547–1562) and Grand Duke Francesco I (1531–1587). These claims have been reexamined with more modern methodologies. These methods have confirmed the presence of P.falciparum in the remains confirming the original diagnosis.

Treatment of malaria was discussed in several European herbal texts during the Renaissance including Otto Brunfels (1532), Leonhart Fuchs (1543), Adam Lonicer (1560), Hieronymus Bock (1577), Pietro Andrea Mattioli (1590), and Theodor Zwinger (1696).

European settlers and their West African slaves likely brought malaria to the Americas in the 16th century. Spanish missionaries found that fever was treated by Amerindians near Loxa (Peru) with powder from Peruvian bark (Cinchona succirubra). There are no references to malaria in the "medical books" of the Mayans or Aztecs. Quinine (Kinine), a toxic plant alkaloid, is an effective muscle relaxant, as the modern use for nocturnal leg cramps suggests, long used by the Quechua Indians of Peru to reduce the shaking effects caused by severe chills in the Andes. The Jesuit Brother Agostino Salumbrino (1561–1642), an apothecary by training and who lived in Lima, observed the Quechua using the quinine-containing bark of the cinchona tree for that purpose. While its effect in treating malaria (and hence malaria-induced shivering) was entirely unrelated to its effect in controlling shivering from cold, it was nevertheless the correct medicine for malaria. The use of the “fever tree” bark was introduced into European medicine by Jesuit missionaries (Jesuit's bark). Jesuit Barnabé de Cobo (1582–1657), who explored Mexico and Peru, is credited with taking cinchona bark to Europe. He brought the bark from Lima to Spain, and afterwards to Rome and other parts of Italy, in 1632. Francesco Torti published in 1712 that only “intermittent fever” was amenable to the fever tree bark (“Therapeutice Specialis ad Febres Periodicas Perniciosas”, 1712 Modena). This work finally established the specific nature of cinchona bark and brought about its general use in medicine. In 1717, the graphite pigmentation of a postmortem spleen and brain was published by Giovanni Maria Lancisi. He related the prevalence of malaria in swampy areas to the presence of flies and recommended swamp drainage to prevent it.