Fever & Famine

Second Sino-Japanese War
Dad in the Chinese Army. Photo credit: unknown

I knew Dad had enlisted as a soldier in the Chinese Army during the 2nd Sino-Japanese War. He told me how very lucky he had been to escape seeing any combat. On my last visit to Los Angeles, he told my kids much more about his war experience. That his unit in Kunming was somehow affiliated with the US Army. That Dad had been assigned the role of interpreter, thanks to his knowledge of the English language. And that while he was in the Chinese Army, Dad suffered from fever, the first sign he had contracted malaria.

Mosquitoes

Every day, the rain fell on his army base near Kunming. It filled the makeshift airstrip, making it impossible for any aircraft to land or take off. Rain kept the roads muddy and the tents wet. On average, the wet season in Kunming lasts from April to November with temperatures reaching the tropical during the summertime. With all that water and nowhere to go, Dad’s camp was a natural breeding ground for mosquitoes.

This risk for malaria would have been news to no one.

Malaria was an epidemic disease in China for more than 3000 years. The symptoms were described in ancient writings. For example, Nei Jing (the Canon of Internal Medicine) described them as early as 270 BC. When the People’s Republic of China was founded in 1949, malaria was endemic in two-thirds of Chinese counties …

“Ancient Chinese anti-fever cure becomes panacea for malaria. An interview with Zhou Yiqing” in Bulletin of the World Health Organization, Volume 87, Number 10, October 2009, 733-804

Dad had a mosquito net to protect his cot, which he was careful to drape all the way around. But he didn’t think about tucking the ends under the mattress. He ended up breeding his very own pool of mosquitoes. Soon enough, the fever started.

In an uninfected human, the first signs of malaria present within 10-14 days. Those symptoms include fever, headaches, and vomiting. For Dad, the fever would attack once a week. Gradually, he began to experience more regular and serious attacks.

Famine

Then the war ended and Dad went home to Shanghai. He got a new post, this time as a translator. World War II had caused global disruption in agricultural production. There was a shortage of labor, draft animals, and fertilizers. Crops were abnormally small. Famine might follow.

On 14 February 1946, the General Assembly passed United Nations Resolution 27(I) on the World Shortage of Cereals. The UN Commission on Famine sent researchers into many countries, including China, to determine the nature and depth of the famine.

Dad joined an agricultural team led by a Canadian colonel who, just a few months earlier, had been an artillery officer. Their mission was to measure the amount of arable land. The Canadian colonel liked to ask Dad, how far away do you think that tree is? Dad had no idea but this colonel had learned to eyeball distance with deadly accuracy.

Bark

fever medicine
Cinchona Officialis by Hermann Adolf Köhler (1834 – 1879) [Public domain]. Image source: Wikimedia

Meanwhile, Dad’s fever attacks continued unabated. An English doctor prescribed quinine. Quinine has been used as a malaria treatment since 1633. The natural version is derived from the bark of the cinchona tree. Chloroquinine is a chemical derivative first synthesized in 1934 and widely available ever since. It was, at the time, the drug of choice for non-severe or uncomplicated cases of malaria.

But chloroquinine doesn’t always work. The dosage may be too low, the treatment interrupted, or the quality of the medicine inadequate. It’s also entirely possible that, by then, the parasites running around in Dad’s body had become drug resistant. Plasmodium falciparum and Plasmodium vivax are the two parasite species common in China. These days, both are resistant to treatment by chloroquinine.

As Dad traveled around China in search of arable land, a UN medical team was trying to figure out what people were eating in order to survive. Tree bark was the answer. But this was not enough for the UN investigators. Which tree? How many pieces of bark?

Country Driving: A Chinese Road Trip is a delightful account of Peter Hessler’s time trying to navigate the roads of China. He meets a man living in the village of Sancha, north of Beijing in the shadow of the Great Wall. The man’s family was so poor that they ate elm bark.

The Chinese know all about famine and the foods to which they must resort in order to survive. The first administrative measures date back to the Qin Dynasty (221-207 BC). The Famine Herbal has been in circulation since the early 15th century to guide Chinese to edible roots, plants and tree bark.

Death by Fever

When left untreated, malaria can develop into anemia, hypoglycemia or cerebral malaria. The latter can result in coma, cognitive disability, and death. Dad’s health worsened. He thought he was dying. Back home in Shanghai, he lay in the arms of his sister and waited.

Fight Malarial Fever poster
Do a Good Job of Health Reconstruction in the Countryside. Image source: NIH

Dad says it was an Indian doctor in Shanghai who ultimately saved his life. He prescribed something called Compound 606. Originally used as a magic bullet to treat syphilis, Salvarsan also proved to be effective in some cases of quinine-resistant malaria.

If Dad had stayed longer in China, he might have witnessed the discovery of a new antimalarial drug. The discovery was the fruit of Project 523, a research program launched at the height of the Cultural Revolution.

Project 523 had three goals: the identification of new drug treatments for fighting chloroquine-resistant malaria, the development of long-term preventative measures against chloroquine-resistant malaria, and the development of mosquito repellents.

Jia-Chen Fu, “The secret Maoist Chinese operation that conquered malaria – and won a Nobel” in The Conversation, 6 Oct 2015

Researchers found the solution in ancient medical texts which described qinghao or sweet wormwood (Artemisia annua L.) as a fever remedy. By 1971, Chinese researchers were able to extract artemisinin to create a particularly effective treatment for drug-resistant malaria. The discovery earned Tu Youyou, head of that Project 523 research team, a Nobel Prize in 2015.

In order to witness such a monumental achievement, Dad would have also experienced the Great Leap Forward, the famine it caused, and the Cultural Revolution. But Dad left China in 1948, first for Taiwan and later the United States. His malarial fever days were over.

Like Dad always says, he was a lucky guy.

Facebooktwitterlinkedin