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"It's actually very hard to say when malaria was first endemic or brought into this country," says Dr Mary Dobson. "We have to be very careful when using records to say 'this was malaria'."
The designation 'malaria' – literally, 'bad air' – was first used in the early 19th century. Before that, terms such as 'ague', 'marsh fever' or 'intermittent fever' were used to describe malaria-like illnesses. From the 15th century onwards, malaria was endemic along the coasts and estuaries of south-east England, the Fenlands, and estuarine and marshland coastal areas of northern England. The growth in international trade in the 16th century contributed to the spread of disease, as international traders introduced new sources of infection.
"We don't know what proportion of deaths can be directly attributable to malaria," acknowledges Dr Dobson, whose studies of mortality were published in 'Contours of Death and Disease in Early Modern England' (Cambridge University Press, 1997). Dr Dobson reconstructed mortality figures from local parish registers, which provide a record of burials but not always a cause of death.
Nevertheless, it seems that malaria was a threat to health, and several ingenious remedies were developed to combat the fevers: Fenland locals became addicted to opium from locally grown poppies, while hostelries served opium-laced beer. But it was a remarkable quinine-based remedy that had the biggest impact on malaria mortality statistics.
Alkaloid quinine was first extracted around 1820 from the bark of cinchona trees introduced into Europe from Peru by Spanish Jesuits in the 17th century. Robert Talbor, an English apothecary's apprentice, pioneered the use of cinchona in malaria treatment. His secret remedy cured many sufferers in the Fens and Essex marshes before it was administered to King Charles II and notable European royalty. Talbor received an honorary knighthood and was appointed Royal Physician.
But it was not until after Talbor's death in 1681 that the King of France – with Talbor's consent – disclosed the secret remedy. By the later part of the 19th century, quinine had become the mainstay of malaria treatment in England. "People are commenting on going to get the white powder from the druggist," says Dr Dobson. "It becomes a regular part of life."
By the late 1800s, the causes of malaria were becoming clear, with the discovery of malaria parasites and the role of mosquito vectors. Ronald Ross, credited with discovering the key role of mosquitoes in the transmission of malaria, attempted to eradicate malaria from England around the First World War era; he enlisted 'mosquito brigades' to eliminate mosquito larvae from stagnant pools and marshes.
A second key figure, S P James, took a different approach. According to Dr Dobson, he believed that "malaria will only disappear with improvements in housing and the separation of mosquitoes from humans." James became better known for his use of malaria as a form of therapy for syphilis – the high temperatures induced by the infection destroyed the syphilis bacterium. His survey work conducted on malaria in north Kent – after the First World War – revealed that as many as 500 civilians were affected by a mini malaria epidemic, triggered by the import of parasites by soldiers stationed in Thessalonika.
Since the 1950s, locally transmitted malaria has essentially died out. However, the number of imported cases of the disease has risen from 200 in the 1970s to over 2000 today, largely because of the growth of global travel. So can we expect another malaria epidemic in England? Probably not, suggests Dr Dobson. "We've moved so far forward in terms of our environment and housing conditions that it would not take long to break the malaria transmission cycle."
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14/6/06 [WTD023991] The history of malaria in England.doc