Dr. Malawista spent nearly his entire career at Yale University, where he was chief of rheumatology for 21 years and where he oversaw the laboratory that helped solve a medical mystery that began nearly four decades ago in the wooded town of Lyme, Conn.
In the fall of 1975, two women contacted health officials about a disturbing sickness that was afflicting numerous people in their families and their neighborhoods. One young man suffered attacks of leg pain so severe that he could not walk, the New York Times reported. Nearby, a young girl’s knees had become so swollen that she resorted to using a wheelchair.
Those cases and others — concentrated in the towns of Lyme, Old Lyme and East Haddam — were initially suspected to be instances of juvenile rheumatoid arthritis. But the unusually clustered outbreaks suggested a different, perhaps infectious cause.
“I just felt it was too much of a coincidence for four children on one street to have arthritis,” one of the concerned mothers, Judith Mensch, told the Times in 1976, “and I started calling parents to see if their kids had it. I kept at it as a hysterical mother.”
In time, researchers at Yale — about 40 miles from Lyme in New Haven, Conn., — became involved. Working with rheumatologist Allen C. Steere and other scientists, Dr. Malawista began painstakingly reviewing cases of the then-
“He was very good at what I would call seeing the big picture,” said Erol Fikrig, a Lyme disease expert and chief of the section of infectious diseases at Yale’s medical school. “Often in science, it’s important to delve into the details. . . . But it’s also important to look with broad strokes at what’s important and what impacts public health.”
The researchers ruled out foodborne or waterborne agents as well as vaccines and other medicine as potential causes, according to accounts of their investigation. And they noticed that all the patients lived in wooded areas. That point, along with the fact that outbreaks seemed to peak during the summer and early fall, suggested that the cause of the disease might be related to a type of insect.
By 1977, Dr. Malawista and his colleagues had identified the condition that he first labeled “Lyme arthritis.” The name was changed to “Lyme disease” after the ailment was shown to encompass a wide range of symptoms beyond joint pain.
Early indications of Lyme disease include a large, red rash; fevers; chills; and muscle aches. Later-stage symptoms include serious conditions of the heart, joints and nervous system.
Dr. Malawista and his colleagues initially suspected that Lyme disease was caused by a virus, a hypothesis disproven in 1982 when Willy Burgdorfer, a zoologist and microbiologist working in Montana, identified the offending bacterium, which was dubbed Borrelia burgdorferi.
Scientists ultimately identified the deer tick as the carrier of Lyme disease. Dr. Malawista and his colleagues had contributed to that research by comparing the incidence of the illness on the east and west sides of the Connecticut River. They found a higher incidence on the east side, where there was also a greater population of deer and deer ticks, according to an account in the Yale Journal of Biology and Medicine.
In the mid-1980s, Dr. Malawista was credited with helping to demonstrate the effectiveness of antibiotics in treating the disease, particularly when it is caught early.
“We are thrilled that a goodly percentage of these individuals are cured apparently by penicillin,” Dr. Malawista said in 1985, “because that tells you that the organism is there at that stage of their disease, that it’s required to drive the disease, and that when you get rid of it, the disease goes away.”
Stephen Evan Malawista was born April 4, 1934, in New York City. He was accepted by Harvard University at age 15, his wife said, and received a bachelor’s degree in experimental psychology in 1954 after studying under professors including the behaviorist B.F. Skinner. He received a medical degree from Columbia University in 1958.
In the early years of his career, Dr. Malawista was a clinical associate of what was then known as the National Institute of Arthritis and Metabolic Diseases, a division of the National Institutes of Health. He joined Yale in 1966 and continued his teaching, research and clinical work until shortly before his death, his wife said.
Survivors include his wife of 44 years, Tobé Miller Malawista of Hamden; a half-brother; and a stepsister.
Dr. Malawista was primarily known for his work on Lyme disease, but he also conducted important research on gout and made “seminal observations about how white blood cells interact,” said Linda K. Bockenstedt, a Lyme expert and Yale colleague.
He contributed to research on a Lyme disease vaccine, but no vaccine is currently on the market. Antibiotics remain the best treatment, said Jonathan A. Edlow, a Lyme disease expert at Harvard Medical School. Edlow also emphasized the importance of preventive measures, such as wearing long-sleeve shirts and long pants while hiking, checking oneself for ticks after being outside and removing them.
“The problem is, when we move into nature,” Dr. Malawista once said, “nature moves into us.”