Fiammetta Rocco - The Miraculous Fever-Tree - Malaria, Medicine and the Cure that Changed the World

Travellers from abroad would bring small quantities of new cures to Rome. One Jesuit, travelling back from China, brought rhubarb, which would become widely used for stomach disorders. Another, from South America, came with bezoar stone, calcium phosphate that is formed in the stomach of the llama, which would become highly prized for treating all manner of ailments, from dysentery to infertility.

Yet another priest, also a Jesuit, carried back a small bundle of dried bark, the bitter-tasting outer skin of the cinchona tree, that was used by some Andean Indians of northern Peru as a cure for shivering. The priest, who knew about the marsh fever that was so prevalent in Europe, thought the powdered Peruvian bark might be worth trying against the marsh fever that struck the people of Rome during the summer, causing them repeated attacks of the sweats followed by shivering.

Thus it was that, in a prescription for curing fever noted down in the early 1630s, a Jesuit priest, Father Domenico Anda, the chief apothecarist at the Ospedale Santo Spirito, made the first passing mention of quinine – or to give it its botanical name, cinchona, which was then known as Corticus peruvianus , the ‘Peruvian bark’.

Fac pulverem et irrora oleo Matth. Et cum diascord. Fraest.pul.et ita per triduum.

If you go today to the Santo Spirito hospital and look around the rooms where Father Domenico had his apothecary, you see immediately how important the cinchona bark was to the development of medicine and to the reputation that the Roman apothecary would gain throughout Europe. Around the walls is a series of ceramic tablets. They show Pope Urban’s Spanish priest, Cardinal de Lugo, visiting a feverish patient. At the bottom of one of the tablets is written the words: ‘ Purpureus Pater his solatur in aedibus aegros deluges Limae cortice febrifugio ’ (In this abode, Cardinal de Lugo offered comfort to the sick with the febrifuge bark from Lima). With one hand the Cardinal crosses the patient gently on the forehead; with the other he offers him the Jesuit cure that will help drive away the Roman fever, stay the chills and ease his aching bones.

Father Domenico’s prescription was referred to in a pamphlet written by Pietro De Angelis, the director of the Santo Spirito in the 1950s, who gave himself the task of educating the public about the varied work of the hospital. The original, however, no longer exists. It had been held for many years in the library of the hospital’s most famous director, the seventeenth-century physician Giovanni Battista Lancisi. The library was closed to the public in the early years of the twentieth century because the building was considered unsafe. Repairing it fell foul of Italian bureaucracy and inefficiency, and it would remain closed for more than sixty years. When finally it was reopened in the mid-1990s, Father Domenico’s prescription and three other of the rarest documents in Lancisi’s collection had simply vanished. But a record of the text survives in Pietro De Angelis’s pamphlet.

The medical world in Europe, which had barely progressed since medieval times, would take a spectacular leap forward from the 1630s with the adoption and distribution of cinchona bark in Rome. Not only was quinine the first real treatment for the Roman marsh fever, but the way it worked ran counter to the prevailing orthodoxy about fever as a disease and what was at the root of it. As a result, quinine can be described as the modern world’s first real pharmaceutical drug. In time, it would change medicine forever.

That Europeans learned about it at all can be attributed to the work of a lay monk by the name of Agustino Salumbrino. A determined and energetic man with a quick, restless mind who stood not five feet high in his sandals, Brother Salumbrino had worked as an infirmarian on the wards of the Santo Spirito hospital. Unmarried, and with nothing to tie him to Rome, he set sail in 1604 for Peru, where he was determined to serve the Society of Jesus and heal the sick, and where eventually he founded the most famous pharmacy in Latin America.

The medicine he sent back to Rome came too late to treat Giacinto Gigli’s young granddaughter. But for nearly a century, all the quinine that was dispensed in Europe would come from Brother Salumbrino’s apothecary in Lima.

‘Aquí tenían los Jesuitas un local donde expedían al público una corteza febrífuga de la quina o cascarilla.’ (From this place the Jesuits provided the public with a febrifuge made from quinine or bark)

Street plaque on the Jesuit church of San Pedro, Lima

A vicuna, a cinchona tree and the horn of plenty.

The Peruvian national emblem, as seen on every Peruvian coin

In 1663, Sebastiano Bado, a doctor from Genoa, published an account of a story he had heard from an Italian merchant who lived for many years in Lima, the capital of the viceroyalty of Peru.

The Countess of Chinchón, the wife of the Viceroy, fell ill with a tertian fever, which, Bado wrote, ‘in that region is not only frequent but severe and dangerous’. Rumours of the Countess’s impending death spread through the city of Lima and beyond, even reaching the Andean hill town of Loxa, in what is now southern Ecuador. On being told of the Countess’s illness the Prefect of Loxa immediately wrote to her husband recommending a secret remedy he knew of, a concoction made from the bark of a local tree, which he said would cure her of all her ills. The Viceroy sent for the Prefect, who brought with him the remedy. Eagerly the Countess took it, and ‘to the amazement of all’, wrote Bado, ‘she was cured’.

As soon as the people of Lima learned of the Countess’s miraculous recovery they begged her to help them, for they had often suffered from the same fever themselves. The Countess at once agreed. Not only did she tell them what the remedy was, she ordered a large quantity of it to be sent to her so that it could be dispensed to the poor and the sick. In their gratitude the people named the cure ‘the Countess’s Powder’.

For more than three hundred years this sugary story was accepted as the true version of the discovery of quinine, the world’s first pharmaceutical drug, that was carried back to Europe by the grateful Countess. It led to all sorts of literary fancies, most of them mercifully now forgotten. In its day the best-known was Zuma , written in 1817 by the Countess de Genlis, in which an Indian maid in the service of the Viceroy’s household discloses the virtues of the Peruvian bark when her mistress, the Countess of Chinchón, falls ill with malaria. Other variants of this tale include Hualma, the Peruvian , a German novel about the discovery of quinine by a pseudonymous author, W.O. von Horn, and The Saintly Vicereine , a play by a Spanish poet, José María Pemán, the composer of General Franco’s preferred national anthem. Written in 1939, The Saintly Vicereine played for a while to enthusiastic European audiences in search of an evening’s distraction from the impending war, then faded quickly away.

The problem with the story of the Countess’s miraculous discovery, however, is that it is completely untrue.

The Countess of Chinchón died suddenly in Cartagena on 14 January 1641, on her way back from Peru to Madrid, though her husband’s diaries show she was rarely ill before that, and never with anything resembling malaria. Malaria may well have struck the Count, the Viceroy of Peru, on more than one occasion; he even seems to have suffered from it after he returned to Spain. In time he recovered, but the detailed diaries left by his secretary, Antonio Suardo, make no mention of tree barks or miraculous remedies of any description.