Tale of a bark with bite

The Miraculous Fever Tree

April 30, 2004

The neglect of malaria by the western medical establishment is a familiar theme nowadays. Malaria's persistence in most of the developing world is a stark reminder of the political nature of medical resource allocation.

While high-tech solutions to western ills such as cancer, heart disease and Alzheimer's enjoy vast funding and scientific rewards, two recent "breakthroughs" in malaria are the discovery that sleeping under nets impregnated with insect repellent is a good thing, and that the old Chinese herbal remedy, artemisia, has a place in modern treatments.

Few diseases have such a complicated medical and social history, and no other disease had a medical remedy three-and-a-half centuries ago, when European doctors first began to use an exotic drug imported from South America. Variously called Peruvian Bark, Jesuit's Bark or, more simply, "the bark", this bitter-tasting medicine could have a dramatic effect on people suffering from a disease with as many names as its remedy: ague, intermittent fever or "the fever". Its modern term, malaria, was not invented until the 19th century, and was not routinely used until the 20th, by which time its literal meaning - bad air - had been rendered obsolete by the discovery of the causative parasite and the role of the anopheles mosquito in its spread.

As Fiammetta Rocco cheerfully admits in her introduction, the history of quinine has been recounted several times recently, making the task of originality that much harder. In her quest to say something new, she has travelled widely. She is particularly good with the South American materials, the role of the Jesuits in finding the precious cinchona tree and processing the bark in the apothecary of their college at San Pablo, and the later Spanish and French expeditions to learn more about this indigenous tree. She breathes life into neglected historical characters such as Agustino Salumbrino, the Jesuit lay brother who oversaw the San Pablo apothecary, and Jose Celestino Mutis, the Spanish botanist who in 1791 established a Botanical Institute in what is now Columbia, one of whose main purposes was to make the cinchona tree better known to European naturalists.

The history of malaria and the cinchona tree are closely intertwined, and Rocco weaves vignettes on the disease into her account. The papal conclave of 1623, during Rome's malaria season, becomes in her hands an exciting tale of high church intrigue, debility and death. John Sappington, working on the US frontier in the early decades of the 19th century, is elevated from the position of nostrum vendor to pioneer of commercial pharmacy. The last large cinchona forest, in Africa, becomes a parable of cheap, effective drugs, produced largely by Africans for Africans.

Rocco exploits archives and printed sources scattered throughout the world, although occasionally her vivid narrative simplifies complex issues. She also delves into her family history and family members' brushes with the disease. Her French great-grandfather survived both yellow fever and malaria, working as an engineer building the Panama Canal; her Italian grandfather and French grandmother, who eloped to Africa in the 1920s, suffered the malarious consequences, as did their son and the author herself. She skilfully weaves these personal narratives into the larger canvas.

This is a moving book, energetically researched and gracefully written.

Ever since Dava Sobel turned longitude into an unexpected subject of general interest, historians have attempted to replicate her feat. This book makes quinine and its tree a subject of unusual interest. The intractable incidence of malaria in the world today suggests that while quinine may not have changed the world, the pursuit of the tree and the drug derived from it have stimulated individuals for centuries. Their motives were not always admirable, but their stories have been captured here with great aplomb.

W. F. Bynum is emeritus professor of the history of medicine, University College London.

The Miraculous Fever Tree: Malaria, Medicine and the Cure that Changed the World

Author - Fiammetta Rocco
Publisher - HarperCollins
Pages - 348
Price - £16.99
ISBN - 0 00 257202 8

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