The Care and Management of Induced Malaria

Abstract

For the treatment of general paralysis of the insane by induced malaria, the Board of Control, in consultation with the Ministry of Health, decided, at the end of 1924, to make an official arrange ment by which a pure strain of the benign tertian malaria parasite would be cultivated in mosquitoes, and would be made available for inoculation by mosquito-bites instead of by the direct inocula tion of blood from other patients. In consultation with the Mental Hospitals Department of the London County Council, the Horton Mental Hospital was selected for the work of pre paring and maintaining the strain of malaria in mosquitpes, and Col. J. R. Lord, C.B.E., Medical Superintendent of the Hospital, undertook the necessary arrangements in collaboration with Col. S. P. James, of the Medical Staff of the Ministry of Health. An isolated villa in the hospital grounds was selected as a treatment-block and laboratory; the Horton Mental Hospital authorities caused it to be mosquito-proofed and furnished, and the Ministry of Health supplied the scientific equipment of the laboratory. The Ministry also arranged that the routine laboratory work should be done by one of their laboratory assistants, Mr. P. G. Shute, under Col. James's supervision. I undertook the selection of cases suitable for treatment and their clinical care and management. The arrange ments were completed in April, 1925, and since that month 33 batches of infected mosquitoes have been prepared and utilized for the inoculation of more than 300 patients in 69 hospitals in England, Wales and Scotland.

Serious and Fatal Illness Associated with Falciparum and Vivax Malaria among Patients Admitted to Hospital at West Sumba in Eastern Indonesia

“…The therapeutic efficacy of induced malaria for tertiary syphilis, an otherwise fatal disease before antibiotics, was only about 35% and hinged upon the severity and number of malaria paroxysms 25. Practitioners were therefore relatively aggressive with malaria therapy, and those patients may be considered to have experienced relatively severe disease 26. The 5–10% case fatality rates among patients classified as seriously ill with a diagnosis of vivax malaria among patients in endemic zones today approximates the 5–15% rates observed among many thousands of patients challenged with P. vivax for therapy of tertiary syphilis 27–34…”

Evidence and Implications of Mortality Associated with Acute Plasmodium vivax Malaria

“…The severity and frequency of these correlated with the probability of treatment success, with severe malaria thus being the intent and instrument of therapy. The many intense daily paroxysms with rigors (about a dozen was a typical course of treatment [ 43]) (Fig. 2) proved extremely physically punishing, and data from that era reveal an exceedingly dangerous therapeutic enterprise.…”

“…In Denmark, for example, 13% of patients died among 100 treated in a 1930 series, whereas a decade later 7% of a series of 579 patients died in treatment (M. Lomholdt [cited in reference 48]). Although optimized, the treatment still required multiple bouts of inadequately treated acute malaria, and reports typically described 5 to 15% treatment fatality rates in American and European treatment facilities applying P. vivax (Table 3) (41,43,(45)(46)(47)(49)(50)(51)(52)(53)(54)(55); J. P. Verhave, submitted for publication). Most deaths occurred after the sixth paroxysm (45).…”

A Retrospective Examination of Sporozoite- and Trophozoite-Induced Infections with Plasmodium Falciparum: Development of Parasitologic and Clinical Immunity during Primary Infection

“…The clinical, chemotherapeutic, and immunologic aspects for infections with P. vivax, P. Ja lciparum, P. malariae, and P. ovale in some 2,500 patients observed at the Horton Hospital were reported. [6][7][8][9] Maiariatherapy in the United States. Malaria therapy was first used in the United States at St. Elizabeth's Hospital in Washington, DC in December 1922.…”