I have a soft spot for tonic water. Maybe because it’s the only soda beverage with a taste I never fully understood, impossible to describe: an ambiguous aroma, a strange contrast between that pinch of sugar and a sour vein that makes your palate dry.
Every now and then, during summer evenings, I happen to take a sip on my balcony while I watch the Alban Hills, where the Roman Castles cling to a long-dead volcano. And as I bring the glass to my lips, I can’t help thinking about how strange history of mankind can be.
Kings, wars, crusades, invasions, revolutions and so on. What is the most powerful cause for change? What agent produced the most dramatic long-term modification of human society?
The answer is: epidemics.
According to some historians, no other element has had such a profound impact on our culture, so much so that without the Plague, social and scientific progress as we know it might not have been possible (I wrote about this some time ago). With each stroke of epidemic, the survivors were left less numerous and much richer, so the arts and sciences could develop and flourish; but the plague also changed the history of medicine and its methods.
“Plague” is actually a very generic word, just like “disease”: it was used throughout history to define different kinds of epidemic. Among these, one of the most ancient and probably the worst that ever hit mankind, was malaria.
It is believed that malaria killed more people than all other causes of death put together throughout the entire human history.
In spite of an impressive reduction of the disease burden in the last decade, the World Health Organization estimates that as many as 300 million people are infected by the disease every year. That’s about the size of the entire US population. Of those who fall sick, more than 400,000 die every year, mostly children: malaria claims the life of one child every two minutes.
Malaria takes its name from the Italian words “mala aria”, the bad air one could breathe in the marshes and swamps that surrounded the city of Rome. It was believed that the filthy, smelly air was the cause of the ague. (Giovanni Maria Lancisi suggested in 1712 that mosquitoes might have something to do with the epidemic, but only at the end of the Nineteenth century Sir Ronald Ross, an English Nobel-awarded gentleman, proved that malaria is transmitted by the Anopheles mosquito.)
Back in Medieval Rome, every summer brought back the scourge, and people died by the hundreds. The plague hit indistinctively: it killed aristocrats, warriors, peasants, cardinals, even Popes. As Goffredo da Viterbo wrote in 1167, “When unable to defend herself by the sword, Rome could defend herself by means of the fever”.
Malaria was widespread throughout Europe, Asia, and Africa. Yet, no one knew exactly what it was, nor did they know how to treat it. There was no cure, no remedy.
Well, this is the part that really blows my mind. I cannot shake the feeling that someone was playing a bad joke on us humans. Because, actually, there was a remedy. But the mocking Gods had placed it in a land which had never been attained by malaria. Worse: it was in a land that no one had discovered yet.
As Europe continued to be ravaged by the terrible marsh fevers, the solution was lying hidden in the jungles of Peru.
Enter the Jesuits.
Their first mission in Peru was founded in 1609. Jesuits could not perform medicine: the instructions left by the founder of the order, St Ignatius of Loyola, forbade his followers to become doctors, for they should only focus on the souls of men. Despite being expressly forbidden to practice medicine, Jesuit priests often turned their attention to the study of herbs and plants. Father Agustino Salumbrino was a Jesuit, and a pharmacist. He was among the firsts missionaries in Peru, and he lived in the College of San Pablo in Lima, putting his knowledge of pharmacy to good use as he built what would become the best and biggest pharmacy in the whole New World. Jesuits wanted to convert the natives to Catholicism, but understood that it couldn’t be done by means of force: first they needed to understand the indios and their culture. The native healers, of course, knew all sorts of plant remedies, and the priests took good notice of all this knowledge, picking never-before-seen plants and herbs, recording and detailing their effects.
That’s when they noted that the Indians who lived in the Andes sometimes drank infusions of a particular bark to stop from shivering. The Jesuits made the connection: maybe that bark could be effective in the treatment of marsh fevers.
By the early 1630s Father Salumbrino (possibly with the help of another Jesuit, Bernabé Cobo) decided to send a small bundle of this dried bark back to Rome, to see if it could help with malaria.
In Rome, at the time, there was another extraordinary character: Cardinal Juan De Lugo, director of the pharmacy of the Hospital Santo Spirito. He was the one responsible for turning the pharmacy from an artisan studio to something approaching an industrial production line: under his direction, the apothecary resembled nothing that had gone before it, either in scale or vision. Thousands of jars and bottles. shelves filled with recipes for preparations of medicines, prescriptions for their use and descriptions of illnesses and symptoms. De Lugo would cure the poor, distributing free medicine. When the Peruvian bark arrived in Rome, De Lugo understood its potential and decided to publicize the medicine as much as he could: this was the first remedy that actually worked against the fever.
The bark of the cinchona tree contains 4 different alkaloids that act against the malaria parasite, the most important of which is quinine. Quinine’s secret is that it calms the fever and shivering but also kills the parasite that causes malaria, so it can be used both as a cure and a preventive treatment.
But not everyone was happy with the arrival of this new, miraculous bark powder.
First of all, it had been discovered by Jesuits. Therefore, all Protestants immediately refused to take the medicine. They just could not accept that the cure for the most ancient and deadly of diseases came from their religious rivals. So, in Holland, Germany and England pretty much everybody rejected the cure.
Secondly, the bark was awfully bitter. “We knew it, those Jesuits are trying to poison us!”
But maybe the most violent refusal came from the world of medicine itself.
This might not come as a surprise, once you know how doctors treated malaria before quinine. Many medieval cures involved transferring the disease onto animals or objects: a sheep was brought into the bedroom of a fever patient, and holy chants were recited to displace the ailment from the human to the beast. One cure that was still popular in the seventeenth century involved a sweet apple and an incantation to the three kings who followed the star to Bethlehem: “Cut the apple into three parts. In the first part, write the words Ave Gaspari. In the second write Ave Balthasar, in the third Ave Melchior. Then eat each segment early on three consecutive mornings, and recite three Our Fathers and three Hail Marys”.
Even after the Middle Ages, the medical orthodoxy still blindly believed in Galen‘s teachings. Traditionalists who wanted to preserve the ancient doctrine of Galenic medicine at any cost felt the cinchona bark would overturn their view of the human body – and it was actually going to. According to Galen, fever was a bile-caused disorder: it was not a symptom but a disease in itself. A patient with a high fever was said to be suffering from “fermentation” of the blood. When fermented, blood behaved a little like boiling milk, producing a thick residue that to be got rid of before the patient could recover. For this reason the preferred treatments for fever were bleeding, purging, or both.
But Peruvian bark seemed to be curing the fever without producing any residue. How could it be possible?
The years passed, and the success of the cure came from those who tried it: no one knew why, but it worked. In time, cinchona bark would change the way doctors approached diseases: it would provide one of decisive blows against Galen’s doctrine, and open the door to modern medicine.
A big breakthrough for the acceptance of Jesuits Bark came from a guy named Robert Tabor. Talbor was not a doctor: he had no proper training, he was just a quack. But he managed to become quite famous and fashionable, and when summoned to cure Charles II of England of malaria, he used a secret remedy which he had been experimenting with. It worked, and of course it turned out to be the Jesuits powder, mixed with wine. Charles appointed Talbor as his personal physician much to the fury of the English medical establishment and sent him over to France where he proceeded to cure the King’s son too. Without really realizing it, Talbor had discovered the right way to administrate cinchona bark: the most potent mixtures were made by dissolving the powder into wine — not water — as the cinchona alkaloids were highly soluble in alcohol.
By the end of the 18th century, nearly three hundred ships were arriving in Spanish ports from the Americas every year — almost one each day. One out of three came from Peru, none of which ever failed to carry cinchona bark.
And in 1820, quinine was officially born: two scientists, Pelletier and Caventou, succeeded in isolating the chemical quinine and worked out how to extract the alkaloid from the wood. They named their drug from the original Inca word for the cinchona tree bark, quina or quina-quina, which means “bark of barks” or “holy bark”.
Many other battles were fought for quinine, lives were risked and lost. In the 1840s and 1850s British soldiers and colonials in India were using more than 700 tons of bark every year, but the Spanish had the monopoly on quinine. English and Dutch explorers began to smuggle seeds, and it was the Dutch who finally succeded in establishing plantations in Java, soon controlling the world’s supplies.
During WWII the Japanese occupied Java, and once more men wnt to war over tree bark extract; but fortunately this time a synthetic version of quinine was developed, and for the first time pharmaceutical companies were able to produce the drugs without the need for big plantations.
Troops based in the Colonies all consumed anti-fever, quinine-based pharmaceuticals, like for instance Warburg’s Tincture. This led to the creation, through the addition of soda, of several QuinineTonic Waters; in 1870 Schweppe’s “Indian Tonic Water” was commercialized, based on the famous carbonated mineral water invented around 1790 by Swiss watchmaker Jacob Schweppe. Indian Tonic Water was specifically aimed at British colonials who started each day with a strong dose of bitter quinine sulphate. It contained citric acid, to dissolve the quinine, and a touch of sugar.
So here I am, now, looking at the Alban Hills. The place where I live is precisely where the dreaded ancient swamps once began; the deadly “bad air” originated from these very lands.
Of course, malaria was eradicated in the 1950s throughout the Italian peninsula. Yet every time I pour myself a glass of tonic water, and taste its bitter quinine flavor, I can’t help thinking about the strange history of mankind — in which a holy tree from across the ocean might prove more valuable than all the kings, wars and crusades in the world.
Most of the info in this post are taken from Fiammetta Rocco, The Miraculous Fever-Tree. Malaria, medicine and the cure that changed the world (2003 Harper-Collins).
Fantastico articolo, complimenti!
Grazie Eric. 🙂
Molto bello l’ articolo, ma ti è sfuggito un piccolo refuso: scrivi che Ronald Rosa scoprì le cause della malaria alla fine del diciottesimo secolo, cioè il 1700, ma il medico visse tra la metà del 1800 e l’ inizio del 1900, pertanto tra il XIX e il XX.
Grazie mille, corretto. Ross ha vinto il Nobel nel 1902, quindi era un po’ difficile che fosse vissuto nel ‘700. 😀
Ciao, ottimo articolo, molto ben strutturato e analisi storica precisa. C’é forse un piccolo refuso: dopo “… Lima… ” c’é scritto “virgola” forse é un piccolo errore? Intendeci mettere una virgola per chiudere la frase incidentale?
In ogni caso é un articolo interessantissimo
Uff… corretto anche questo, grazie mille. 🙂
Articolo stupendo: inizia e finisce con un bicchiere di acqua tonica :D. Mi è pure venuta sete. Mi aprirò una bottiglietta di acqua brillante.
Riguardo al discorso malaria, leggevo tempo fa che nelle zone del polesine dove un tempo era diffusissima, sono molto alte le presenze di persone malate di anemia mediterranea. Questo perchè il parassita della malaria non attecchiva in chi soffriva di questa malattia genetica. Per cui si riproduceva per selezione naturale, la persona malata di anemia. Una malattia che preserva da un’altra malattia. Mi ha sempre fatto riflettere questa cosa.
Non conoscevo questo dettaglio, spettacolare!
L’anemia mediterranea e la malaria vanno a braccetto, per così dire, perchè chi è affetto da questa malformazione è protetto da alcuni effetti della malattia e non propriamente immune.
La replicazione del Plasmodio (il microrganismo causa della malaria) fa letteralmente esplodere i globuli rossi, dove la replicazione ha luogo. Queste esplosioni riversano nel torrente circolatorio le sostanze che danno luogo a brividi e febbre.
Chi soffre di anemia mediterranea, o falciforme, ha i globuli rossi grandi la metà di quelli normali, e con una forma a mezzaluna (o appunto falce). Queste cellule scoppiano dopo molto più tempo rispetto a quelle normali, o riescono a non scoppiare del tutto.
Come Darwin ci insegna, la selezione naturale ha portato i “malati” di anemia falciforme a sopravvivere ai sani nelle zone dove la malaria era endemica.
Spero di non essere stata troppo prolissa.
Ottima spiegazione, grazie Marina.
Anemia mediterranea e falciforme non sono la stessa cosa…. Sono patologie differenti. Ma è corretto che il ciclo del parassita sia ostacolato dagli eritrociti falcemici.
Una precisazione. Non é necessario essere malati, basta essere portatori di anemia mediterranea per esserne immune. La ragione non é solamente morfologica (la grandezza del globulo) ma anche fisiologica (i globuli rossi vivono di un anemico o portatore durano meno. Questo mi ha permesso di lavorare in Africa per 5 anni escludendo a priori la malaria tra le cause dei miei eventuali malesseri…
Come sempre, articolo splendido. E’ sempre un piacere leggerti….
Rifacendomi al commento di gery, posso dire che anche qui in Sardegna la selezione naturale ha fatto il suo corso: chi è affetto da carenza di g6pd (favismo) e talassemia presenta una maggiore resistenza al parassita della malaria. Prima che le paludi venissero bonificate le epidemie erano molto diffuse, e attualmente noi sardi siam quasi tutti fabici e portatori sani di anemia mediterranea (mi ci metto anch’io). ? Un’altra curiosità: il chinino figura tra i farmaci a rischio, seppur basso, per i fabici. Un bel paradosso!
Fortuna allora che il chinino non dovrebbe servire…
Così pare… In ogni caso, articolo bellissimo, come sempre. 🙂
Grazie Cecilia. ?
Grazie da un grande appassionato di gin-tonic!
Alla salute! 😀
Un bell’articolo come sempre. Anche a me oltre al macabro… piace l’acqua tonica! Mi ritrovo in questo sito!
“Strano, macabro, acqua tonica!” 😀
Complimenti per il post! Da oggi guarderò in modo completamente diverso l’acqua tonica.
Prendo l’occasione per dirti che seguo sempre con piacere i tuoi articoli.
Felice che il blog ti piaccia, LJS. 🙂
Chi è l’autore di quei meravigliosi dipinti di antichità e paludi che si trovano nelle illustrazioni dell’articolo? Se non mi sbaglio sono la seconda la quarta e la diciassettesima illustrazione. Grazie e (come sempre) complimenti.
Sono di Enrique Serra Auqué (1859-1918), pittore spagnolo trapiantato a Roma.
Complimenti per l’articolo, ben fatto e curioso. Quando ho letto che il chinino inizialmente aveva un sapore molto amaro e veniva utilizzato per curare la malaria mi è venuto subito in mente la favola Pinocchio di Collodi, quando Pinocchio non vuole prendere la medicina perché tanto amara e preferendo la morte… Chissà se era malato di malaria e la fata turchina gli voleva far prendere il chinino ?
Potrebbe essere, anche se per la verità ben poche medicine sono deliziose… ?
Sono appassionata di storia, e di ogni approfondimento che vada oltre gli eventi politici (guerre, successioni di re e imperatori, conquiste e così via). Non sai con quanto piacere leggo pezzi come questo, grazie!
Uno degli articoli più belli, e non solo di questo blog. ^_^
Grazie mille Alice! 🙂
Meraviglioso e avvincente articolo, un pò come tutti i fantastici articoli di “Bizzarrobazar” … grazie. Un caro saluto Alberto
Articolo interessantissimo. Il tuo blog è meraviglioso e dovrebbe essere più “pubblicizzato”..io,nel mio piccolo,lo sto consigliando a tutti.
Il chinino serviva anche come rimedio fai da te per abortire..
Grazie mille Adele per il tuo contributo nel diffondere il verbo bizzarro! 😀