When He Was Wicked (Bridgertons #6)(103)

Michael was fortunate. Although he did not know it, he suffered from vivax malaria, which can persist in patients’ livers for decades but rarely kills its victims. The exhaustion and fevers caused by vivax malaria, however, are severe.

At the end of the book, both Michael and Francesca worry that a higher frequency of attacks might indicate that he was losing his battle with the disease. In truth, with vivax malaria, this would not have mattered. There is little rhyme or reason to when a vivax patient might suffer an episode of malarial fevers (except in the case of immunosuppression, such as cancer, pregnancy, or AIDS). In fact, some patients experience a complete cessation of fevers and remain healthy for the rest of their lives. I’d like to think that Michael was one of the lucky ones, but even if not, there is no reason to think that he did not live to a ripe old age. Furthermore, since malaria is strictly a blood borne disease, he could not have transmitted it to members of his family.

The cause of malaria would not be understood for decades after When He Was Wicked took place, but the fundamentals of treatment were already known: A cure could be achieved by consuming the bark of the tropical cin-chona tree. This was usually mixed with water, yielding “quinine water.” Quinine was first sold commercially in France in 1820, but its use was fairly widespread for some time prior.



Malaria has been mostly eradicated from the developed world, in large part because of mosquito control efforts. However, it remains a leading cause of death and disability among people who live in the developing world. Between 1 million and 3 million people die of falciparum malaria every year. That averages one death every thirty seconds. Most of the dead are in sub-Saharan Africa, and most are children under five years of age.

A portion of the proceeds of this book will be donated to malarial drug development research.

Sincerely,





Acknowledgments

The author wishes to thank Paul Pottinger, MD, and Philip Yarnell, MD, for their expertise in the fields of, respectively, infectious diseases and neurology.