Averting a malaria disaster
CORRESPONDENCE
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Averting a malaria
disaster
Sir-I was recently in Ghana, where
the message of N J White and
colleagues (June 5, p 1965)’ would
probably receive a mixed reception. I
did a ward round in a rural hospital in
my tribe, in which patients, their
relatives, and even some carers are
turning to traditional antifever herbal
preparations such as the ubiquitous
Neem tree ( A z a d i r a c h i a indica).
As I have pointed out, “when I was
a child, I was often soaked and bathed
in water that had been used to boil the
leaves of the Neem tree to prevent me
having convulsions whenever I was
febrile”.’ Indeed, one is often told to
place leaves from the Neem tree in
water overnight, drink two cups every
morning, and you will prevent
malaria. People are now growing other
antifever shrubs in their back gardens.
There is flight from imported drugs
not only because they no longer work,
but also because “cost is usually the
major factor that determines the use
of antimalarial drugs”.‘ Those in
Ghana and Kenya3 who can afford to
buy artemisinin which is imported
from the far east, are so pleased with it
that the suggestion that it should be
combined with other drugs (thus
increasing the cost) to prevent drug
resistance would be considered
unhelpful. In Accra, the mosquito
population was kept low by regular
supervised spraying. However, this
spraying was stopped because the
Ministry of Health advised that
spraying produces DDT-resistant
mosquitoes. Subsequently, the insects
flourished, and deaths from malaria
increased. Meanwhile, Abidjan (C6te
d’Ivoire) rejected the advice and the
results were spectacular and still are.
On my return to Accra, two bodies
of opinion prevailed among the
teaching hospital doctors and ministry
of health specialists. Roughly half of
them agreed with the research
prescription suggested by White and
colleagues’ to avert a malaria disaster.
The others acknowledged that White
and colleagues should be applauded
for proceeding in accordance with
Wolffers and colleagues4 who
suggested that joint research emphasis
should be “on the needs and priorities
of the South”, but disagreed that the
priority required lay merely in
therapeutics. These latter would
advise going back to the colonial days
when drains were filled; coconut shells
with standing water were removed;
the dreaded town council man visited
homes to see whether water-pots had
mosquito-larvae, and sent you to
258
court if he found just one larva; when
spraying was incessant; and when
students, soldiers, and policemen were
punished for getting malaria because it
was discovered that holes in their
mosquito-net had not been mended.
But then came independence, and
the Ghanaian African became
independent of the town council man.
I suspect that WHO head Gro Harlem
Brundtland would sooner provide
funds to buttress a public-health
approach than a drug-importing
approach. Success of public health
requires firm government, and not
necessarily western-style democracy
( v i d e China and the snails of
schistosomiasis). But would averting
a malaria disaster not upset the
population control lobby?
furunculosis. Gratia may well have
been the first to observe bacteriolytic
effects of various types of penicillium.
By coincidence, 3 years later,
Fleming made the same observation
with P notatum. This observation was
later developed by Florey and Chain
and led to an important advance in
medicine.
When Fleming received his Doctor
Honoris Causa from the University of
Liege in 1945, it was Gratia who had
written and presented the opening
speech for the diploma. During the
next year, Fleming was interviewed for
the Belgian radio and his text was also
published. Here is what Fleming says
in this text: “I cannot refrain from
mentioning one other Belgian
bacteriologist my good friend Andri.
Gratia, and I mention him for the
special reason that, but for
circumstance, he might well have been
the discoverer of Penicillin. In 1926 he
noticed that a mould apparently
destroy
and
dissolve
certain
bacteria . . . The mould which he had
might have been Penicillium n o t a t u m
and the active substance might have
been penicillin but as the culture was
not preserved we shall never
Gratia’s mentor, Bordet, would
probably have told him: “My boy, the
problem with you is that you do not
baptize your children!”
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Felix I D Konotey-Ahulu
Crornwell Hospital, London SW5 OTU, U K
(e-rnail: konoey-ahulu@crornwelI-hospital.co.uk)
1 White NJ, Nosten F, hoareesuwan S , et
al. Averting a malaria disaster. Lancet 1999;
353: 1965-67.
2 Konotey-Ahulu FID. Fever in Africa and
WHO recommendation, Lancet 1997; 350:
1549.
3 Kokwaro GO. Use of artemisinin
(Qinghaosu) derivatives in the treatment of
malaria. AfrJ Health Sci 1998; 5: 8-1 1.
4 Wolffers I, Adjei S, van der Drift. Health
research in the tropics. Lancet 1998;
351: 1652-54.
Nobel chronicle:
Fleming and Gratia
Sir-Tonse Raju’s March 13 Nobel
Chronicle (p 936)’ examines the work
of Alexander Fleming, Ernst Boris
Chain, and Howard Walter Florey.
The work of Fleming and Andre
Gratia on the bacteriolyse is also
important. The two men knew each
other well and took part in high-level
scientific meetings on this subject.
Andre Gratia (1893-1950) was a
pupil of Jules Bordet (Nobel prize
winner in 1919). He worked
successively for the Free University of
Brussels with Bordet, then for the
University of Liege in 1932.
In 1924, Gratia and Sara Dath
published their observations on the
bacteriolyse via a mould, an
actinomycete, the “streptothrix”
(streptomycete) .* They realised that
the lytic agent was secreted by the
mould, even without ~ x y g e n .For
~
many people, Gratia is the father of
the antibiotics.
The next year, they observed
another lytic agent for an anthrax
culture that was lysed by a mould, a
variety of Penicillium g l a u c ~ m Gratia
.~
also discovered the mould of a type of
penicillium that he used to treat
*C d e Scoville, C De Brouwer, M Dujardin
Laboratiore de Sante au Travail, Public Health
School, Free University of Brussels, 8-1070
Brussels, Belgium
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1 Raju TNK. The Nobel Chronicles. Lancet
1999; 353: 936.
2 Gratia A, Dath S. Proprietk
bactkriolytiques de certaines moisissures.
C R Soc Biol 1924; 91: 1442.
3 Gratia A, Dath S . De I’action
bacteriolytique des streptothrix. C R Soc
Eiol 1925; 92: 1125.
4 Gratia A, Dath S. Moisissures et microbes
bactkriophages. C R SOCEiol 1925; 92: 461
5 Fleming A. Seance inaugurale de Radiouniversitaire a I’INR a Bruxelles le 19-1046. Revue Med L i i e 1947; 2: 73.
DEPARTMENT OF ERROR
zyx
The exceptional brain of Albert Einstein-In this
article by Sandra Witelson and colleagues
(June 19, p 2149), the legend to figure 1 should
read “Photographs taken in 1955. . .”
Relation between laboratory test results and
histological hepatitis activity in individuals
positive for hepatitis B surface antigen and
antibodies to hepatatis 6 e antigen-In this
article by Frank ter Borg and colleaques Uune
27, 1998, p 1914), the first equation and the
following sentence on p 1917 should have been:
P,,,=l
1 +e-I
And P,,, is the probability of having chronic
active hepatitis.
-
-
T H E LANCET Vol354 July 17, 1999
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Averting a malaria
disaster
Sir-I was recently in Ghana, where
the message of N J White and
colleagues (June 5, p 1965)’ would
probably receive a mixed reception. I
did a ward round in a rural hospital in
my tribe, in which patients, their
relatives, and even some carers are
turning to traditional antifever herbal
preparations such as the ubiquitous
Neem tree ( A z a d i r a c h i a indica).
As I have pointed out, “when I was
a child, I was often soaked and bathed
in water that had been used to boil the
leaves of the Neem tree to prevent me
having convulsions whenever I was
febrile”.’ Indeed, one is often told to
place leaves from the Neem tree in
water overnight, drink two cups every
morning, and you will prevent
malaria. People are now growing other
antifever shrubs in their back gardens.
There is flight from imported drugs
not only because they no longer work,
but also because “cost is usually the
major factor that determines the use
of antimalarial drugs”.‘ Those in
Ghana and Kenya3 who can afford to
buy artemisinin which is imported
from the far east, are so pleased with it
that the suggestion that it should be
combined with other drugs (thus
increasing the cost) to prevent drug
resistance would be considered
unhelpful. In Accra, the mosquito
population was kept low by regular
supervised spraying. However, this
spraying was stopped because the
Ministry of Health advised that
spraying produces DDT-resistant
mosquitoes. Subsequently, the insects
flourished, and deaths from malaria
increased. Meanwhile, Abidjan (C6te
d’Ivoire) rejected the advice and the
results were spectacular and still are.
On my return to Accra, two bodies
of opinion prevailed among the
teaching hospital doctors and ministry
of health specialists. Roughly half of
them agreed with the research
prescription suggested by White and
colleagues’ to avert a malaria disaster.
The others acknowledged that White
and colleagues should be applauded
for proceeding in accordance with
Wolffers and colleagues4 who
suggested that joint research emphasis
should be “on the needs and priorities
of the South”, but disagreed that the
priority required lay merely in
therapeutics. These latter would
advise going back to the colonial days
when drains were filled; coconut shells
with standing water were removed;
the dreaded town council man visited
homes to see whether water-pots had
mosquito-larvae, and sent you to
258
court if he found just one larva; when
spraying was incessant; and when
students, soldiers, and policemen were
punished for getting malaria because it
was discovered that holes in their
mosquito-net had not been mended.
But then came independence, and
the Ghanaian African became
independent of the town council man.
I suspect that WHO head Gro Harlem
Brundtland would sooner provide
funds to buttress a public-health
approach than a drug-importing
approach. Success of public health
requires firm government, and not
necessarily western-style democracy
( v i d e China and the snails of
schistosomiasis). But would averting
a malaria disaster not upset the
population control lobby?
furunculosis. Gratia may well have
been the first to observe bacteriolytic
effects of various types of penicillium.
By coincidence, 3 years later,
Fleming made the same observation
with P notatum. This observation was
later developed by Florey and Chain
and led to an important advance in
medicine.
When Fleming received his Doctor
Honoris Causa from the University of
Liege in 1945, it was Gratia who had
written and presented the opening
speech for the diploma. During the
next year, Fleming was interviewed for
the Belgian radio and his text was also
published. Here is what Fleming says
in this text: “I cannot refrain from
mentioning one other Belgian
bacteriologist my good friend Andri.
Gratia, and I mention him for the
special reason that, but for
circumstance, he might well have been
the discoverer of Penicillin. In 1926 he
noticed that a mould apparently
destroy
and
dissolve
certain
bacteria . . . The mould which he had
might have been Penicillium n o t a t u m
and the active substance might have
been penicillin but as the culture was
not preserved we shall never
Gratia’s mentor, Bordet, would
probably have told him: “My boy, the
problem with you is that you do not
baptize your children!”
zyxwvut
zyxwv
zyxwvutsrq
zyxwvutsr
Felix I D Konotey-Ahulu
Crornwell Hospital, London SW5 OTU, U K
(e-rnail: konoey-ahulu@crornwelI-hospital.co.uk)
1 White NJ, Nosten F, hoareesuwan S , et
al. Averting a malaria disaster. Lancet 1999;
353: 1965-67.
2 Konotey-Ahulu FID. Fever in Africa and
WHO recommendation, Lancet 1997; 350:
1549.
3 Kokwaro GO. Use of artemisinin
(Qinghaosu) derivatives in the treatment of
malaria. AfrJ Health Sci 1998; 5: 8-1 1.
4 Wolffers I, Adjei S, van der Drift. Health
research in the tropics. Lancet 1998;
351: 1652-54.
Nobel chronicle:
Fleming and Gratia
Sir-Tonse Raju’s March 13 Nobel
Chronicle (p 936)’ examines the work
of Alexander Fleming, Ernst Boris
Chain, and Howard Walter Florey.
The work of Fleming and Andre
Gratia on the bacteriolyse is also
important. The two men knew each
other well and took part in high-level
scientific meetings on this subject.
Andre Gratia (1893-1950) was a
pupil of Jules Bordet (Nobel prize
winner in 1919). He worked
successively for the Free University of
Brussels with Bordet, then for the
University of Liege in 1932.
In 1924, Gratia and Sara Dath
published their observations on the
bacteriolyse via a mould, an
actinomycete, the “streptothrix”
(streptomycete) .* They realised that
the lytic agent was secreted by the
mould, even without ~ x y g e n .For
~
many people, Gratia is the father of
the antibiotics.
The next year, they observed
another lytic agent for an anthrax
culture that was lysed by a mould, a
variety of Penicillium g l a u c ~ m Gratia
.~
also discovered the mould of a type of
penicillium that he used to treat
*C d e Scoville, C De Brouwer, M Dujardin
Laboratiore de Sante au Travail, Public Health
School, Free University of Brussels, 8-1070
Brussels, Belgium
zyxw
1 Raju TNK. The Nobel Chronicles. Lancet
1999; 353: 936.
2 Gratia A, Dath S. Proprietk
bactkriolytiques de certaines moisissures.
C R Soc Biol 1924; 91: 1442.
3 Gratia A, Dath S . De I’action
bacteriolytique des streptothrix. C R Soc
Eiol 1925; 92: 1125.
4 Gratia A, Dath S. Moisissures et microbes
bactkriophages. C R SOCEiol 1925; 92: 461
5 Fleming A. Seance inaugurale de Radiouniversitaire a I’INR a Bruxelles le 19-1046. Revue Med L i i e 1947; 2: 73.
DEPARTMENT OF ERROR
zyx
The exceptional brain of Albert Einstein-In this
article by Sandra Witelson and colleagues
(June 19, p 2149), the legend to figure 1 should
read “Photographs taken in 1955. . .”
Relation between laboratory test results and
histological hepatitis activity in individuals
positive for hepatitis B surface antigen and
antibodies to hepatatis 6 e antigen-In this
article by Frank ter Borg and colleaques Uune
27, 1998, p 1914), the first equation and the
following sentence on p 1917 should have been:
P,,,=l
1 +e-I
And P,,, is the probability of having chronic
active hepatitis.
-
-
T H E LANCET Vol354 July 17, 1999