The Fever: How Malaria Has Ruled Humankind for 500,000 Years

The Fever is about the history of malaria. Malaria is an ancient disease. Although it was identified in 1880, author Sonia Shah traces it from Roman times. Today we understand much about this disease, but getting to this point has been arduous. First, malaria is caused not by a virus or bacteria, but by a one-celled parasite, the Plasmodium. Five species of Plasmodium infect humans, of which the Plasmodium falciparum is the most serious.This parasite undergoes development in both mosquito and human through eight life stages. These transformations make it harder to detect. Scientists also struggled to discover how it spread. After the mosquito was suspected as the vector, and the Anopheles genus was discovered as the carrier, it was found that certain species of Anopheles carried different types of malaria, while a majority carried none. Additionally, carrier species were found in different parts of the world. So, while Anopheles subpictus might be a major malaria carrier in parts of India, Anopheles gambiae could be a major carrier in sub-Saharan Africa.Finding an effective medicine was a struggle. Quinine at one time was preferred. But when it was most needed during WW II, the Cinchona tree grew mostly within conquered Japanese territory. Several synthetic substitutes gave false hopes when their effectiveness waned with the parasite’s growing immunity.Even after an effective remedy was found, human nature found a way to squander it through mismanagement and indifference. Today, geography, ecology, and economics conspire to prolong malaria’s existence. Humans find out repeatedly that, while Asian and African natives find ways to coexist with the disease, foreigners with no immunity fall victim.Efforts to eradicate malaria have failed. Malaria seems best checked by controlling its environment. Currently the scourge seems hidden from our view in the US. But it is still around, and most prevalent in the poorest countries where preventive measures are neglected.Shah wrote a surprisingly comprehensive book. Her research is thorough. And it appeared that much of her research was first-hand. Her journalistic style, at times digressing but evocative, provides a respite from hard science; however, this might not be appreciated by all readers.I also wondered if the place Shah gave malaria in shaping history is warranted. For example, although Roman campaigns frequently fell victim to sickness, malaria had many malevolent competitors.

Well-written book that presented science and history side-by-side in a compelling mix. Kept my interest throughout. Learned a lot about the history of malaria and why the parasite is so difficult to combat. The poor book deserves a better cover though. I bought it and didn't read it for months because the cover made it look super boring. Glad I finally cracked it open though.

This book was an incredible insight on malaria. As a student who is starting to focus on parasites and how they make us sick, The Fever was a great book to give me a crash course on the history of Malaria. I actually had a hard time putting this book down.

I never know that Malaria was a big issue as it was 100 years ago. This history has never been told in my history classes. It has certainly changed commerce in the world. Her research is wonderfully given in this book.

The enormous scope of this disease is well explored. Liked the author's writing and clear and fascination story

Great read if you are interested in understanding both the historical, biological, and social implications of malaria. Shah uses a relatable tone of voice and speaks from first-hand experiences.

Extremely well written and documented. Easy to read and informative. Good value and well worthy of my time to read.

A good account of malaria as a deadly disease.

This book has enlightened me how dangerous malaria was at the time which took so many lives.

This is worth a read. Sonia Shah provides a thought provoking overview of the history of this persistent disease and the terrible global toll it has caused,

History and science of malaria, a disease that has been around for 500,000 years and is still a problem today, even though many infectious diseases have been eradicated. Malaria is caused by a protozoan parasite that feeds on red blood cells, it's transmitted by mosquitos. After millennia of co-existence with humans, the parasite and our immune system have evolved many defenses and counter-defenses, for example: it hides in the liver to evade detection, and the sickle cell anemia gene provides defense against malaria.Malaria has shaped history in many occasions: natives from malaria-endemic regions have acquired some degree of built-in immunity and rarely die from it, whereas white colonizers had no immunity and died frequently. This prevented white people from venturing deep into Africa, and a Scottish colony in Panama was doomed because everybody got sick. Conversely, human activity affects malaria as well -- malaria spreads when mosquitos have pools of stagnant water to lay their eggs. These conditions can be inadvertently created through land development, seasonality, climate change, etc.Quinine (extracted from cinchona trees) was the first effective remedy for malaria, but supply was limited because it was difficult to grow. During WW2, synthetic quinacrine was developed, but the pathogens soon gained resistance. In the 70s, artemisinin was extracted from traditional Chinese medicine (one of the few success cases) but the parasite developed resistance to that as well, partially because Novartis made it too expensive and people used reduced doses, which leads to resistance. Currently the recommended treatment is artemisinin combination therapy, basically hitting it with a bunch of antimalarial drugs at the same time.People in malaria-endemic countries often don't consider it a particularly serious disease, since 99% of the time you don't die from it, so public funding and interest is generally unstable. Still, it causes a lot of productivity loss as sick people are unable to work, one of the reasons for poverty. An effective counter is filling in ponds of stagnant water, which is how malaria was eradicated in the west; this is not feasible in tropical countries though. In the 50s, they attempted to use DDT to eradicate mosquitos; this was discontinued after birds were reported dying of DDT bioaccumulation. Still, many experts believe that DDT shouldn't have been banned since the benefits outweigh the costs.What's next for malaria? The community is divided on whether complete eradication is a realistic goal; aiming long term control is more feasible. There will be no one-shot silver bullet solution, because in the past, every time the parasite soon develops resistance. Insecticide-treated mosquito nets are cost-effective, combined with medication and ecological reform, but it will be a long, slow battle.

Interesting subject and interesting pieces of the malaria history. However, the ideas seem to be thrown together in no particular order and there is no flow between paragraphs. I had the impression I was reading something by someone who could not focus their thoughts. It took me twice as long to read than what it usually takes me for a book of the same genre and length.