fever ‘n’ ague / malaria

fever ‘n’ ague. An intermittent fever, attended by alternate cold and hot fits. — Webster, 1882

malaria. Bad air; air tainted by deleterious emanation from animal or vegetable matter; especially, noxious exhalations of marshy districts, capable of causing fever or other disease; miasma. — Webster, 1882

Except for the malaria which I got in Albania, and a fearful cold that I got coming out of the sulphur baths on a cold day in Tiflis, I’m well and flourishing. However, my hair is quite gray, surely as gray as mother’s. I don’t know how you women of the last generations kept color in your hair for so long. Mine simply gave one look at Europe and turned white at the sight. – Rose Wilder Lane to Caroline Ingalls, January 1923.

     
I recently learned that my mother had malaria (“fever ‘n’ ague”) as a child. She’s been my mother for over half a century and I never knew that. She remembers the chills and the fever and feeling awful, and she remembers taking bitter quinine as treatment for it.

Malaria is transmitted by the female Anopheles mosquito. Only female mosquitoes can transmit the disease, and they must have been infected through a blood meal taken from an infected person. Malaria is caused by a parasite; four kinds of malaria parasites can infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae.

Once transmitted to a person, the parasites travel to the liver, where they grow and multiply. During this incubation period, the infected person has no symptoms. After as few as eight days or as long as several months, the parasites leave the liver cells and enter red blood cells. Once in the cells, they continue to grow and multiply. After they mature, the infected red blood cells rupture, freeing the parasites to attack and enter other red blood cells. Toxins released when the red cells burst are what cause the typical fever, chills, and flu-like malaria symptoms.

For most people, symptoms begin ten days to four weeks after infection, although a person may feel ill as early as seven days or as late as an entire year later. Two kinds of malaria, P. vivax and P. ovale, can relapse. In P. vivax and P. ovale infections, some parasites can remain dormant in the liver for several months up to about four years after a person is bitten by an infected mosquito. When these parasites come out of hibernation and begin invading red blood cells, the person will become sick.

     
It took years for the public to be educated about the cause and prevention of malaria. At the time the Ingalls family was living in Indian Territory, it was generally believed that fever ‘n’ ague was caused by “bad air” found in marshy areas, the decay of plant matter, or a disease caused by meteorological changes. [James Henry Salsbury, M.D., Malaria (New York: William A. Kellog, 1885).]

Although Mrs. Scott and the rest of the squatters in Indian Territory thought fever’n’ague was caused by eating watermelons or exposure to the night air, some of the other guesses as to its origin are equally interesting today. An article published in 1872 reports that malaria was caused “by a chemical decomposition of impurities emanating from our own bodies, which circulating in the atmosphere and brought into contact with the blood, produce an abnormal change in the blood by disorganizing the venous and arterial systems.” Another theory was that “spores of microscopic plants, living in the atmosphere, being of a greater specific gravity than that of the atmosphere, fall to the cellars and lower portions of buildings and breed in the moist filth there. Exposure to these organisms causes the disease.” In these and other proposed causes, one can see that they almost have it. You can almost hear the slapping of mosquitoes while impurities are coming in contact with the blood or people are slogging around in all that moist filth.

The Ingallses (and my mother) took quinine to treat malaria; see Little House on the Prairie, Chapter 15, “Fever ‘n Ague”. Quinine destroys the Plasmodium parasite when taken internally. Quinine is a drug made from the dried bark of the Cinchona tree, specifically Cinchona officinalis and several other species in the genus Cinchona.

The potent ingredient in the bark is the alkaloid quinine. It wasn’t until 1820 that quinine was isolated from the bark of the Cinchona tree, although it had been used to treat malaria for hundreds of years prior to that time. Aside from the treatment of malaria, quinine has also been used to treat leg cramps, as a flavoring, and it provides the bitter taste in tonic water. In fact, gin and tonic was originally (and successfully) consumed in the past to prevent attacks of malaria.

Quinine is rarely prescribed for the treatment of malaria today, as it has been replaced by synthetic drugs. But when studying Little House on the Prairie in the classroom, make sure you have a bottle of tonic water so that children can taste the bitterness of quinine. Save the gin for after school.

     

fever ‘n’ ague (LHP 7, 15), see also quinine
malaria (LHP 15)