A story of bark and bite
Aidan Hartley
THE MIRACULOUS FEVER TREE: MALARIA, MEDICINE AND THE CURE THAT CHANGED THE WORLD by Fiammetta Rocco HarperCollins, £16.99, pp. 352, ISBN 0002572028 This engrossing, beautifully crafted history is a parable for our times, I believe, underscoring the fool ishness of men, with some rare exceptions, and the munificence of Nature. Malaria has been around since the dinosaurs. It existed in Britain up to the 1960s, in the vicinity of steam laundries apparently, until the onset of dry-cleaning. No other plague has altered the history of peoples to such a degree. Today Westerners consider it rarely, but it is a shameful truth that three million humans die of the disease annually, most of them poor African children. And as Fiammetta Rocco says, this tragedy is thanks to a mosquito carrier that is 'little larger than a single eyelash'.
Four centuries ago, the revelation that quinine cures malaria did for medicine what gunpowder did for warfare. Amazingly the story of how it happened, though shrouded in legend, has never fully been told until now, which qualifies Rocco's book as a scoop. From one of Kenya's most extraordinary European families, she also brings a personal touch to the story. She has had a `go' of malaria, as have most of her family for generations. Her early memories, when at Lake Naivasha her Neapolitan grandfather cooked wonderful meals to reward the children for swallowing their bitter Nivaquine syrup, are among the finest passages of the book. She describes well how for those of us who live in the tropics the disease is a persistent, ghostly presence.
In the summers of 1620s Rome, popes and cardinals were dropping like flies thanks to the agues caused, they believed, by breathing the malaria of stinking marshes. Since antiquity Europeans had believed that the cure for fevers, or just about anything else, involved bleeding the patient and administering emetics. I can never understand why doctors at the time didn't realise that their methods were efficient only in killing people, but I suppose some would argue they're still at it today.
Quinine, extracted from the bitter bark of the cinchona tree, is indigenous to the Andes. The perplexing aspect of the malaria story has always been that until the discovery of the Americas, when the infection spread, malaria was an old-world disease. How was quinine discovered to be a cure? Even recently I reviewed a book that could not provide the answer. Rocco not only tracked down long-neglected papers in Lima to find the truth, she also slept in the archives over curfew during Peru's political upheavals. Rocco tells how a Jesuit apothecary. Agustino Salumbrino, observed how Andean Indians used cinchona bark to stop shivering in the cold. He thought it might work for the shivering caused by fever, and so sent some to Rome. It was a pharmacological breakthrough that altered the course of medical history. For a while, the Protestants. Oliver Cromwell included, recoiled at the 'Jesuit powder', as if it were some sort of popish date-rape drug. That didn't stop a mountebank named Robert Talbor from peddling it in a potion that made him fabulously rich and caught the attention of Charles II and Louis XIV.
After the 17th century, when quinine was a 'totem to religious power', it became a subject of study. The botanical exploration of cinchona runs alongside other stories such as the discovery of rubber, ornithology and the geography that shaped our modern world. Linnaeus himself classified the cinchona genus. Plant-lovers will enjoy reading the sagas of mainly English adventurers who endured great hardships to collect seeds and cuttings of the beauti ful tree in the Andes for transport to India and Java. Notably moving is the tale of the Indian bark-collector, Manuel Incra Mamani, whom we can thank for tracking down the best cinchona before he was murdered.
By the 19th century quinine had become 'a symbol of the growing power of commerce and exploration'. Nowhere was the matter of malaria and its cure more important than in military affairs. I was fascinated by the account of the ill-fated English expedition against the French at Walcheren in 1809. When he heard of the attack, Napoleon responded, 'We must oppose the English with nothing but fever, which will soon devour them all. In a month the English will be forced to take to their ships.' He was not far wrong. Malaria killed and afflicted thousands.
Malaria also killed so many British in West Africa's toneyards' that there was a ditty that went 'Beware and take care of the Bight of Benin. There's one comes out for forty goes in.' Indeed, historians have described the mosquito as Africa's greatest guerrilla fighter: had whites survived in larger numbers, they might well have copied their American and Antipodean brothers and exterminated the majority of indigenes. Nevertheless, they gained a foothold. In the 1850s, a doctor named William Baikie saved the men of his expedition up the river Niger by forcing quinine down their throats. That success, Rocco asserts, led to the British annexation of Lagos, and later Nigeria. She says, 'It is not hard, looking back, to see the straight line that leads from Baikie's breakthrough with quinine to the Berlin conference of 1884 that lcd to the partition of the continent.'
Incredibly, the discovery that mosquitoes cause malaria was made only in 1902. A doctor in India named Ronald Ross made the breakthrough and in recognition he was awarded the first Nobel Prize for medicine. From that point onwards, fighting the fever was a matter of public health campaigns. Malaria, like smallpox, could have been eradicated by now, had Third World nations been as efficient as Mussolini, who not only made the trains run on time but also drained the Pontine Marshes.
Instead we put our overweening confidence in the 'magic bullet' malaria drugs first developed during the second world war, when the Axis powers captured most of the world's quinine supplies. This has now returned to haunt us. Malaria develops resistance against all synthetic drugs, and despite the current trials no vaccine has ever been developed against a microorganism like the disease's plasmodium parasite. The most effective medicine is still quinine. Like TB, malaria is a 'reemerging' disease. In the 21st century, as the environment we've despoiled now bites back, thank God that one plantation of cinchona still stands on the shores of civilwar-torn Congo's Lake Kivu.
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