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The Teaching of Malaria Diagnosis¹

Twenty two of the most recent textbooks on tropical medicine, parasitology, hematology and laboratory methods (1–22) have been examined as to the manner in which they present the subject of the diagnosis of malaria. With three (7, 5, 17) notable exceptions,³ all, either directly or by implication, deal with the diagnosis of malaria on the basis of the findings in stained thin blood smears. In this respect, they are little different from the section of malaria by Marchiafava and Bignami in 1900 (27), whose illustrations need only modern color printing to rival those of the present day.

These books suggest that the recognition of certain particular forms of the parasites in thin blood smears is the only sure method of diagnosis and imply that thick film methods are only for the expert and for surveys.

¹ Presented at the joint session of the American Society of Tropical Medicine and the National Malaria Society, Atlanta, Georgia, Dec. 4, 1947.

³ "Definitive diagnosis depends upon the demonstration of the parasites. For this purpose the thick blood film is far superior to the thin film technic since in the light infections it will be impossible to find plasmodia in the thin film. The thick film will reveal three to four times as many positive findings and will reveal plasmodia in 91–95 per cent of active clinical cases." (7).

"In malarious areas, no matter what the primary complaint or diagnosis, it is imperative that a thick film be examined for malaria in every patient" (5).

"Routine methods for the preparation of thin films for blood studies may be followed but a special thick film technic is now practised by malariologists for routine diagnosis and conduct of surveys. The latter method is advantageous for the discovery of a low concentration of parasistes and for saving time in conducting the examination" (17).

² Department of Tropical Medicine and Public Health, School of Medicine, The Tulane University of Louisiana.