Malaria: Historical scourge of Missouri

From the Lutheran Observer, Oct. 14, 1853, "Died at his residence in Bosbarulda Bottom, in Perry co., Mo., on the 20th day of July, Mr. William Hagar Eddleman, aged 36 years..."

My great-great grandfather was one of many Missourians who probably died from malaria. The malady was a problem from the earliest days of European settlement. Old accounts refer to malaria as bilious fever (fever resulting in jaundice), intermittent fever (some cases were malaria), swamp fever, congestive chills or blackwater fever. The Rev. Timothy Flint, observing Missouri in 1819, stated, "Emigrants generally suffer some kind of sickness, which is called 'seasoning,' ...This sickness commonly attacks them the first, second, or third year, and is generally the more severe, the longer it is delayed..."

Malaria is a parasite carried by mosquitoes. When infected mosquitoes feed on a potential host, they inject the organism into the blood, and it travels to the liver to reproduce. Infected liver cells rupture, the parasites invade the bloodstream and infect blood cells. These release more parasites, and the host becomes anemic. Some parasites develop into male and female cells that are taken up by another feeding mosquito, to be spread to another host after reproducing in the insect.

Two types of malaria occurred in the U.S.: Plasmodium vivax and P. falciparum. Vivax malaria is less severe in adults, and it is debatable whether vivax originally occurred in the Americas. However, Plasmodium falciparum came to the Americas as early as the middle 1500s after European contact via infected enslaved Africans and settlers from Portugal and Spain, where malaria was prevalent.

The vector mosquitoes benefited from forest clearing and introduction of rice culture in the southern colonies. By 1750, both vivax and falciparum malaria occurred from the tropics of Latin America to the Mississippi Valley east to New England.

Standard treatment for illnesses until the mid-1800s involved blood-letting, which worsened the effects of malaria. The discovery of a fever-reducing herbal remedy in the bark of the cinchona tree of Peru led to effective treatment of symptoms. Scientists isolated the active ingredient, quinine, in 1820. A Missouri doctor, John Sappington, developed a quinine-based treatment in pill form for the fever. This became the first reliable treatment for malarial symptoms.

Malaria was often worse near wet areas, and people thought "bad air" from these areas was the cause. Researchers discovered the parasite in 1880 and described its life cycle in 1897. They confirmed the role of mosquitoes as the vector by 1908.

Death rates in Bootheel counties remained as high as 11.6 per 10,000 population in 1921. Such actions as using screens at windows and doors, better medical treatment and use of quinine and aggressive mosquito control resulted in elimination of malaria from the U.S. in 1949.

Victims of roughly 2,000 cases of malaria diagnosed in the U.S. annually contract the parasite in other countries. However, the mosquito vectors remain in the U. S. and recent local cases suggest the threat may increase with warmer climate.