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

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A rich and wonderful history of quinine – the cure for malaria.In the summer of 1623, ten cardinals and hundreds of their attendants, engaged in electing a new Pope, died from the 'mal'aria' or 'bad air' of the Roman marshes. Their choice, Pope Urban VIII, determined that a cure should be found for the fever that was the scourge of the Mediterranean, northern Europe and America, and in 1631 a young Jesuit apothecarist in Peru sent to the Old World a cure that had been found in the New – where the disease was unknown.The cure was quinine, an alkaloid made of the bitter red bark of the cinchona tree, which grows in the Andes. Both disease and cure have an extraordinary history. Malaria badly weakened the Roman Empire. It killed thousands of British troops fighting Napoleon during the Walcheren raid on Holland in 1809 and many soldiers on both sides of the American Civil War. It turned back many of the travellers who explored west Africa and brought the building of the Panama Canal to a standstill. When, after a thousand years, a cure was finally found, Europe's Protestants, among them Oliver Cromwell, who suffered badly from malaria, feared it was nothing more than a Popish poison. More than any previous medicine, though, quinine forced physicians to change their ideas about treating illness. Before long, it would change the face of Western medicine.Using fresh research from the Vatican and the Indian Archives in Seville, as well as hitherto undiscovered documents in Peru, Fiammetta Rocco describes the ravages of the disease, the quest of the three Englishmen who smuggled cinchona seeds out of South America, the way quinine opened the door to Western imperial adventure in Asia, Africa and beyond, and why, even today, quinine grown in the eastern Congo still saves so many people suffering from malaria.Note that it has not been possible to include the same picture content that appeared in the original print version.

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The two volumes of El Libro de Viáticos y Almacén show just how elaborately Brother Salumbrino and his fellow Jesuit priests would prepare for a trip out of the city. Every traveller would be issued with a mule for riding on, and another for carrying their supplies. Many of the mules’ names survive in the records: La Cabezuda, La Caminante, La Mulata, El Galán. The supplies would include hay for the mules, for the desert of northern Peru in particular was short of fodder, and often of water too. The traveller would also be equipped with a bowl, a spoon for the table and a knife for cutting meat, a bedroll and a sheet, a roll of sealing wax, spices in the form of saffron, pepper and cinnamon, wine, a sombrero, a soutane and a cape to keep out the cold in the mountains. The grandest inventories included travelling altars, supplies of wine and wheat hosts for offering communion, and even silver candlesticks. But, grand or simple, each traveller’s list concludes with patacones , fried plantain chips, for an Indian guide, and more patacones for el gasto del camino , the road toll.

Despite the rips in the pages of these ancient books, they still summon, nearly three centuries on, a pervasive and enormously fierce sense of just how energetic and enterprising the Jesuits were. On 26 April 1628, the earliest entry in the book that mentions Brother Salumbrino, the pharmacist sent the Jesuit college at Arequipa, at least three weeks’ ride south of Lima, not far from Lake Titicaca, four cases of drugs, including eight libras of caña fistula. The following month he sent the college another eight libras of caña fistula and a copy of the Meditations of St Ignatius Loyola. In August of that same year he despatched supplies of tobacco and cocoa and another three boxes of caña fistula , and the following April the mule load to Arequipa would include four bottles with different drugs ‘sent by Brother Agustín’.

San Pablo was making a name for itself as a trading post, and it was not confined to medicines. It imported textiles from England, Spain, France and the Low Countries, Italy and the Philippines, and large quantities of black taffeta from China. It provided Jesuit schools in the region with ink and paper imported from Italy—in 1629 San Pablo despatched three thousand pens in a single huge shipment that went to the Jesuit College in Santiago, Chile. Farm tools such as ploughs, sickles and hoes were in great demand. San Pablo shipped those off too, along with saddles and harnesses, tallow candles and pottery, shoes and clothing for children as well as adults, needles and nails. In 1628 the college sent twelve baras of tailors’ needles from France to Arequipa, while three years later another two thousand needles, described as finas de Sevilla , were needed. Between 1628 and 1629 San Pablo also sent twelve thousand nails to Potosí, ten thousand to Arequipa, and more than twenty thousand to Chile.

As this trade blossomed, Brother Salumbrino’s influence also soon extended beyond the walls of the college. Like the library at San Pablo, which ordered books from Europe and sent them out to colleges all over the viceroyalty, the pharmacy became an early distribution centre of medicines and medical information for other Jesuit institutions in the area. Salumbrino supplied medicines to the Jesuits who left San Pablo on long missions among the Indians in the Andes, and to other Jesuit outposts

The Libro de la Botíca neatly lists everything that San Pablo supplied to the other Jesuit colleges in the viceroyalty: agua fuerte and aguardiente , powdered mother of pearl, pine resins, black and white balsam, bezoar stone, nicotiana in powder, caña fistula , cinnamon, nutmeg, sal volatile – the original smelling salts – mercurio dulce or mercury sulphide for treating syphilis, black pepper, ambergris, senna, tamarind, sugar, camphor, sweet and bitter almonds, almond oil, tobacco from Seville, essence of roses and violets, rhubarb, chocolate and, of course, cinchona bark, that would eventually be despatched, dried in strips or in powder, in huge quantities all over the continent and also across the Atlantic.

From the earliest years the Jesuits of San Pablo were of the clear belief that conversion of the Indians would come about not by force, but by education and persuasion. For that reason they were quick to send young priests out into the field. Many of the young Jesuits who were posted to Peru made it a priority to learn Quechua and the other Indian languages, and to accustom themselves to the Indians’ way of life.

The Jesuits in the field, especially those who had been sent north-east of Lima, to Loxa in the Andes, began to persuade the local Indians to seek out the árbol de las calenturas , the ‘tree of barks’, as Bernabé Cobó, another Jesuit and a colleague of Salumbrino’s, would describe cinchona in his Historia del Nuevo Mundo in 1639. They taught them how to cut off the bark in vertical strips so as not to kill the tree, and to plant five new trees for every one they cut down. The Jesuits would place the saplings in the ground in the shape of a cross, in the belief that God would then help them grow better. More than two centuries later, an English plant-hunter and bark-trader would observe: ‘Always when passing [these plantations] my Indians would go down on their knees, hat in hand, cross themselves, [and] say a prayer for the souls of the Buenos padres.

After they stripped off the bark, the cascarilleros or barkhunters would cut it into pieces and leave it to dry in the sun. Taking care not to break the fragile, powdery strips, they would wrap them carefully in pieces of cloth and then in watertight leather packs for transporting down the hills by mule to Lima.

San Pablo began to distribute cinchona bark – or cascarilla as it was known in Spanish – to the other Jesuit colleges in the viceroyalty, and even as far as Panama and Chile. Eventually Brother Salumbrino also began sending supplies of cinchona to Europe.

The first person listed in the Libro de Viáticos y Almacén as leaving San Pablo with a quantity of cinchona bound for Europe is a Father Alonso Messia Venegás, an elderly Jesuit priest who carried a small supply of it in his bags when he travelled to Rome in 1631. Father Alonso knew, as every Jesuit did, how malarious the Holy City was, and had heard accounts of the terrible conclave of 1623 when so many of the visiting cardinals died. Rome was in dire need of a cure for the fevers, and Brother Salumbrino was eager to see if the plant that stopped people from shivering could be put to use curing the chills that were a symptom of the marsh fever. Little did he know that not only did it stop the shivering, it could also be used to treat the disease.

The physicians in Rome found that the bark was indeed an effective treatment for the intermittent fever, and thereafter every Procurator who left San Pablo for the Holy City to represent the Peruvian Jesuits at the congress that elected the Jesuit Vicar-General every three years would take with him new supplies of the febrifuge bark. Shortly after Father Bartolomé Tafur, who served as the Peruvian representative at the congress of 1649, arrived in Rome he renewed his acquaintanceship with Cardinal Juan de Lugo, who was then in charge of the apothecary at the Santo Spirito hospital, and was becoming cinchona’s champion in the Holy City. In 1667 Felipe de Paz took with him a trunk filled with the corteza de la calenturas , and in 1669 Nicolás de Miravál arrived with 635 libras of cinchona for distribution in the curia , having left a similar amount in Spain.

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