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A case of resistance to benign tertian malaria infection
469 TRANgACTION~q OF TtlE ROYAL ,~OCIETY OF ']~ROPICAL MEDICINE AND HYGIENE.
Vol. XX[l.
No. 5. March, 1929.
A CASE OF R E S I S T A N C E T O B E N I G N T E R T I A N M A L A R I A INFECTION. BY
PHILIP MANSON-BAHR, D.S.O., M.D., F.R.C.P., Physician to the Hospital for Tropical Diseases, London.
It has long been suspected that in some people the resistance to malaria is inherent, while in others it is developed only by previous long-continued and recurring naturally acquired malaria infection. Since the introduction of malaria inoculation as a therapeutic measure in syphilitic disease of the central nervous system, it has been possible to put this matter to the test, and the immunity produced towards malaria is no longer a matter for speculation. KIRSCHNER and VAN LOON (1924) have recorded their inability to reproduce benign tertian malaria in people who had lived in malaria districts since childhood, while ANTIC (1925) has shown that a primarily successful malaria inoculation may be followed by a period of absolute immunity. STEEL and NICOLE (1927), on the other hand, record thirteen cases of general paralysis who appeared to be naturally immune to malaria infection. In 1926 I encountered a case of absolute immunity to malaria in a man who had probably acquired this immunitv during childhood in India, where he had lived the greater part of his life. He was 46 years of age, and presented early and unmistakable signs of general paralysis. He had unequal Argyll-Robertson pupils, slurring of speech, ataxic gait, muscular weakness, and a history of recent fits. The Wassermann reaction was strongly positive in the blood serum, in the cerebrospinal fluid less so. On 28th June, 1926, through the kindness of Colonel S. P. JA~i~s who provided the infected anopheles, he was bitten by three of these insects, ten days later by a batch of six, and after a lapse of three weeks by five more. In no instance did any rise of temperature take place, nor were the plasmodia subsequently recognized in the blood. On 1st July of that same year, and again on 12th August for the fifth time, a great effort was made to produce therapeutic malaria by subcutaneous injections of whole malaria blood--5 c.cm. of blood
470
A CASE OF RESISTANCE TO BENIGN TERTIAN MALARIA INFECTION.
from a naturally-infected benign tertian malaria case being injected subcutaneously on the first occasion and intravenously on the second. In neither instance, again, did any reaction occur nor was there subsequently any evidence that the malaria parasites had obtained any foothold in the body. In order to produce a systemic reaction, resort had to be made to protein shock treatment induced by typhoid-paratyphoid vaccine to which he reacted, after which some improvement in his general condition was noted. I publish this case as I think it affords ample evidence that in this particular instance absolute immunity to naturally produced and artificially induced malaria existed. M y best thanks are due to Dr. H. M. HANSCHELL and to Colonel S. P. JAMES for their assistance in this work.
REFERENCES.
KIRSCHNER, L., and VAN LOON,F. H. (1924). Geneesk. Tydschr. v. Nederl. Indic. lxiv, (3), 451. ANTIC, D. (1925). Centralb.f. Bakt. I. Abt. Orig. xciv, (2), 134 ; 28th January. STEEL, J. P., and NICOLE,J. E. (1927). Lancet. i, 484 ; 5th March.
Vol. XX[l.
No. 5. March, 1929.
A CASE OF R E S I S T A N C E T O B E N I G N T E R T I A N M A L A R I A INFECTION. BY
PHILIP MANSON-BAHR, D.S.O., M.D., F.R.C.P., Physician to the Hospital for Tropical Diseases, London.
It has long been suspected that in some people the resistance to malaria is inherent, while in others it is developed only by previous long-continued and recurring naturally acquired malaria infection. Since the introduction of malaria inoculation as a therapeutic measure in syphilitic disease of the central nervous system, it has been possible to put this matter to the test, and the immunity produced towards malaria is no longer a matter for speculation. KIRSCHNER and VAN LOON (1924) have recorded their inability to reproduce benign tertian malaria in people who had lived in malaria districts since childhood, while ANTIC (1925) has shown that a primarily successful malaria inoculation may be followed by a period of absolute immunity. STEEL and NICOLE (1927), on the other hand, record thirteen cases of general paralysis who appeared to be naturally immune to malaria infection. In 1926 I encountered a case of absolute immunity to malaria in a man who had probably acquired this immunitv during childhood in India, where he had lived the greater part of his life. He was 46 years of age, and presented early and unmistakable signs of general paralysis. He had unequal Argyll-Robertson pupils, slurring of speech, ataxic gait, muscular weakness, and a history of recent fits. The Wassermann reaction was strongly positive in the blood serum, in the cerebrospinal fluid less so. On 28th June, 1926, through the kindness of Colonel S. P. JA~i~s who provided the infected anopheles, he was bitten by three of these insects, ten days later by a batch of six, and after a lapse of three weeks by five more. In no instance did any rise of temperature take place, nor were the plasmodia subsequently recognized in the blood. On 1st July of that same year, and again on 12th August for the fifth time, a great effort was made to produce therapeutic malaria by subcutaneous injections of whole malaria blood--5 c.cm. of blood
470
A CASE OF RESISTANCE TO BENIGN TERTIAN MALARIA INFECTION.
from a naturally-infected benign tertian malaria case being injected subcutaneously on the first occasion and intravenously on the second. In neither instance, again, did any reaction occur nor was there subsequently any evidence that the malaria parasites had obtained any foothold in the body. In order to produce a systemic reaction, resort had to be made to protein shock treatment induced by typhoid-paratyphoid vaccine to which he reacted, after which some improvement in his general condition was noted. I publish this case as I think it affords ample evidence that in this particular instance absolute immunity to naturally produced and artificially induced malaria existed. M y best thanks are due to Dr. H. M. HANSCHELL and to Colonel S. P. JAMES for their assistance in this work.
REFERENCES.
KIRSCHNER, L., and VAN LOON,F. H. (1924). Geneesk. Tydschr. v. Nederl. Indic. lxiv, (3), 451. ANTIC, D. (1925). Centralb.f. Bakt. I. Abt. Orig. xciv, (2), 134 ; 28th January. STEEL, J. P., and NICOLE,J. E. (1927). Lancet. i, 484 ; 5th March.