The Miraculous Fever-Tree: Malaria and the Quest for a Cure That Changed the World [Hardcover]

Perhaps the most malarious city in the world was Rome. It was said that the many marshes around the city provided "bad air" (how the disease gets its name), but of course they actually provided breeding grounds for the mosquitoes that spread it. When there was a convocation of cardinals, for the eventual election of Pope Urban VIII in 1623, there was a clash of politics, philosophies, and personalities, but the most worrisome aspect of the meeting was that one cardinal after another sickened and died. At just about that time cinchona bark started coming in. That it was a miracle cure is clear, and part of the wonder was that a constant scourge of Europe had a cure growing in dense forests in the mountains halfway around the world. Jesuit priests in missions in the Andes saw that natives used it to stop the shivers when exposed to dampness and cold, and when it was tried on malaria, not only did it work to ease the shivering, it took away the other symptoms of the disease. It became know as "Jesuit Powder," and Protestants protested against its use; it also seemed to contradict the humoral theory by which medicine was done at the time. Its efficacy meant that it would conquer such prejudices, but Rocco shows how in one world war after another, the medicine was not available to troops who needed it.

Malaria is still a killer, one person succumbing about every fifteen seconds. The pharmaceutical industry is generally uninterested in researching and producing medicines for tropical diseases, and the artificial substitutes for quinine have resulted in resistant strains. But surprisingly, the Jesuit Powder has barely sparked any resistance, and it still works. This detailed and fascinating book ends with the optimistic outlook for the company Pharmakina, based in the Congo, which is simply growing cinchona trees, harvesting the quinine, and selling it at affordable prices. Such an operation won't do for the big drug companies, but sensible profits from a reliable product represent good business. This is a reminder that for all the colorful and dramatic history of malaria and our efforts to treat it, the past is not as important as the future.

Jesuit missionaries in the New World discovered Native Americans using a powdered tree bark to treat fevers and "agues". Sending the powder back to Catholic Europe introduced the first therapy for malaria, probably just as these same interlopers were infesting the Western Hemisphere with the parasite. Cinchona powder, diluted in wine to cover its bitterness, verged on the miraculous. As Rocco describes its effect, she also recounts the resistance to the "Jesuit powder" in Protestant Europe, particularly Britain. Lack of enthusiasm, plus military ineptness, led to a malarial onslaught in 1808, when an English attempt to invade Napoleon's empire ended in disaster.

Empire, war and malaria remained in close company throughout the 19th Century. British incursions into west Africa were stalled by the infection. At one point the medical records indicated more cases of malaria than there were settlers - due to repeat hospital patients. Even against this severity, progress was being made. It's said "there's always one" and Rocco shows how one dedicated man made an immense difference. On a voyage up the Niger, Baikie imposed a strict daily regimen of quinine dosage. One of his crew was murdered and one drowned - but none were lost to malaria.

Returning to the Western Hemisphere, Rocco describes the inept handling of fevers by the in the American Civil War. Vicksburg, she asserts, failed to be taken due to the Union's lack of quinine for its troops investing the city. Even greater disaster awaited the French in their attempt to link the Atlantic and Pacific with a Panama Canal. Instead of treating the workers, the French merely hid the casualty list and hired replacements. Even as late as World War II, battlegrounds in the Pacific highlighted the need for plentiful supplies of quinine. By that time, however, some synthetics had been developed. Malaria, however, is neither easily diagnosed nor treated. Rocco notes that there are several versions of the illness, and many varieties of cinchona. Matching them takes skill.

At the end of the 19th Century, malaria had been identified as a parasite, not the effusion of swampy fumes. Rocco describes the labours of British Army doctor Ronald Ross, who laboured under appalling conditions in India. He traced the course of the parasite, in part by dissecting mosquitoes with a razor blade! This new understanding led to more directed treatment, and, ultimately, a Nobel Prize for Ross. Rocco's diagram of the life cycle of the parasite suggests the complexity of the problem of diagnosis and therapy.

Rocco concludes with a reminder that malaria identified is not malaria eliminated. It kills millions of children every year and prostrates whole communities. South American forests were denuded by exploiters seeking the bark. The synthetics developed proved a temporary solution since the parasite appears to have evolved resistance to them. Today's chief source of natural quinine is a threatened forest in war-torn central Africa. She describes the travails of a firm struggling to maintain supply. The picture would be encouraging if the firm obtained support from industrial nations. That hasn't been forthcoming.

Rocco's opening sentence, "My grandparents had been married for many years when they left Europe for Africa - although not to each other" sets the tone of this book. Her personalised narrative form skips the use of footnotes, but there are Notes on Sources and a Further Reading list. A collection of photos and maps adds reference. [stephen a. haines - Ottawa, Canada]