Tag Archives: cure

Pestilence, Sacred Trees And A Glass of Tonic Water

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.

Peru handing Science a cinchona branch (XVII C. etching).

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.

Caventou & Pelletier.

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).

The Abominable Vice

Among the bibliographic curiosities I have been collecting for years, there is also a little book entitled L’amico discreto. It’s the 1862 Italian translation of The silent friend (1847) by R. e L. Perry; aside from 100 beautiful anatomical plates, the book also shows a priceless subtitle: Observations on Onanism and Its Baneful Results, Including Mental and Sexual Incapacity and Impotence.

Just by skimming through the table of contents, it’s clear how masturbation was indicated as the main cause for a wide array of conditions: from indigestion to “hypoconriac melancholy”, from deafness to “bending of the penis”, from emaciated complexion to the inability to walk, in a climax of ever more terrible symptoms preparing the way for the ultimate, inevitable outcome — death.
One page after the other, the reader learns why onanism is to be blamed for such illnesses, specifically because it provokes an

excitement of the nervous system [which] by stimulating the organs to transient vigour, brings, ere middle life succeeds the summer of manhood, all the sensible infirmities and foibles of age; producing in its impetuous current, such an assemblage of morbid irritation, that even on trivial occasions its excitement is of a high and inflammable character, and its endurance beyond the power of reason to sustain.

But this is just the beginning: the worst damage is on the mind and soul, because this state of constant nervous stimulation

places the individual in a state of anxiety and misery for the remainder of his existence, — a kind of contingency, which it is difficult for language adequately to describe; he vegetates, but lives not: […] leading the excited deviating mind into a fertile field of seductive error — into a gradual and fatal degradation of manhood — into a pernicious, disgraceful, and ultimately almost involuntary application of those inherent rights which nature wisely instituted for the preservation of her species […] in defiance of culture, moral feeling, moral obligation, and religious impressions: thus the man, who, at the advent of youth and genius was endowed with gaiety and sociality, becomes, ere twenty-five summers have shed their lustre on him, a misanthrope, and a nadir-point of discontent! What moral region does that man live in? […] Is it nothing to light the gloomy torch that guides, by slow and melancholy steps to the sepulchre of manhood, in the gay and fascinating spring-time of youth and ardent desire; when the brilliant fire of passion, genius, and sentiment, ought to electrify the whole frame?

This being a physiology and anatomy essay, today its embellishments, its evocative language (closer to second-rate poetry than to science) seem oddly out of place — and we can smile upon reading its absurd theories; yet The Silent Friend is just one of many Nineteeth Century texts demonizing masturbation, all pretty popular since 1712, when an anonymous priest published a volume called Onania, followed in 1760 by L’Onanisme by Swiss doctor Samuel-Auguste Tissot, which had rapidly become a best-seller of its time.
Now, if physicians reacted in such a harsh way against male masturbation, you can guess their stance on female auto-eroticism.

Here, the repulsion for an act which was already considered aberrant, was joined by all those ancestral fears regarding female sexuality. From the ancient vagina dentata (here is an old post about it) to Plato’s description of the uterus (hystera) as an aggressive animale roaming through the woman’s abdomen, going through theological precepts in Biblical-Christian tradition, medicine inherited a somber, essentially misogynistic vision: female sexuality, a true repressed collective unconscious, was perceived as dangerous and ungovernable.
Another text in my library is the female analogue of Tissot’s Onania: written by J.D.T. de Bienville, La Ninfomania ovvero il Furore Uterino (“Nymphomania, or The Uterine Fury”) was originally published in France in 1771.
I’m pasting here a couple of passages, which show a very similar style in respect to the previous quotes:

We see some perverted young girls, who have conducted a voluptuous life over a long period of time, suddenly fall prey to this disease; and this happens when forced retirement is keeping them from those occasions which facilitated their guilty and fatal inclination. […] All of them, after they are conquered by such malady, occupy themselves with the same force and energy with those objects which light in their passion the infernal flame of lewd pleasure […], they indulge in reading lewd Novels, that begin by bending their heart to soft feelings, and end up inspiring the most depraved and gross incontinence. […] Those women who, after taking a few steps in this horrible labyrinth, miss the strength to come back, are drawn almost imperceptibly to excesses, which after corrupting and damaging their good name, deprive them of their own life.

The book goes on to describe the hallucinatory state in which the nymphomaniacs fall, frantically hurling at men (by nature all chaste and pure, it seems), and barely leaving them “the time to escape their hands“.
Of course, this an Eighteenth Century text. But things did not improve in the following century: during the Nineteenth Century, actually, the ill-concealed desire to repress female sexuality found one of its cruelest incarnations, the so-called “extirpation”.

This euphemism was used to indicate the practice of clitoridectomy, the surgical removal of the clitoris.
Everybody kows that female genital mutilations continue to be a reality in many countries, and they have been the focus of several international campaigns to abandon the practice.
It seems hard to believe that, far from being solely a tribal tradition, it became widespread in Europe and in the United States within the frame of modern Western medicine.
Clitoridectomy, a simple yet brutal operation, was based on the idea that female masturbation led to hysteria, lesbianism and nymphomania. The perfect circular reasoning behind this theory was the following: in mental institutions, insane female patients were often caught masturbating, therefore masturbation had to be the cause of their lunacy.

One of the most fervent promoters of extirpation was Dr. Isaac Baker Brown, English gynaecologist and obstetrical surgeon.
In 1858 he opened a clinic on Notting Hill, ad his therapies became so successful that Baker Brown resigned from Guy’s Hospital to work privately full time. By means of clitoridectomy, he was able to cure (if we are to trust his own words) several kinds of madness, epilepsy, catalepsy and hysteria in his patients: in 1866 he published a nice little book on the subject, which was praised by the Times because Brown “brought insanity within the scope of surgical treatment“. In his book, Brown reported 48 cases of female masturbation, the heinous effects on the patients’ health, and the miraculous result of clitoridectomy in curing the symptoms.

We don’t know for sure how many women ended up under the enthusiastic doctor’s knife.
Brown would have probably carried on with his mutilation work, if he hadn’t made the mistake of setting up a publicity campaign to advertise his clinic. Even then, self-promotion was considered ethically wrong for a physician, so on April 29, 1866, the British Medical Journal published a heavy j’accuse against the doctor. The Lancet followed shortly after, then even the Times proved to have changed position and asked if the surgical treatment of illness was legal at all. Brown ended up being investigated by the Lunacy Commission, which dealt with the patients’ welfare in asylums, and in panic he denied he ever carried out clitoridectomies on his mentally ill patients.

But it was too late.
Even the Royal College of Surgeons turned away from him, and a meeting decided (with 194 approving votes against 38 opposite votes) his removal from the Obstetric Society of London.
R. Youngson and I. Schott, in A Brief History of Bad Medicine (Robinson, 2012), highlight the paradox of this story:

The extraordinary thing was that Baker Brown was disgraced, not because he practised clitoridectomy for ridiculuous indications, but because, out of greed, he had offended against professional ethics. No one ever suggested that there was anything wrong with clitoridectomy, as such. Many years were to pass before this operation was condemned by the medical profession.

And many more, until eventually masturbation could be freed from medical criminalization and moral prejudice: at the beginning of the Twentieth Century doctors still recommended the use of constrictive laces and gears, straight-jackets, up to shock treatments like cauterization or electroconvulsive therapy.

1903 patent to prevent erections and nocturnal pollutions through the use of spikes, electric shocks and an alarm bell.

Within this dreadful galaxy of old anti-masturbation devices, there’s one looking quite harmless and even healthy: corn flakes, which were invented by famous Dr. Kellogg as an adjuvant diet against the temptations of onanism. And yet, whenever cereals didn’t do the trick, Kellogg advised that young boys’ foreskins should be sewn with wire; as for young girls, he recommended burning the clitoris with phenol, which he considered

an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.
The worse cases among young women are those in which the disease has advanced so far that erotic thoughts are attended by the same voluptuous sensations that accompany the practice. The author has met many cases of this sort in young women, who acknowledged that the sexual orgasm was thus produced, often several times daily. The application of carbolic acid in the manner described is also useful in these cases in allaying the abnormal excitement, which is a frequent provocation of the practice of this form of mental masturbation.

(J. H. Kellogg, Plain Facts for Old And Young, 1888)

It was not until the Kinsey Reports (1948-1953) that masturbation was eventually legitimized as a natural and healthy part of sexuality.
All in all, as Woody Allen put it, it’s just “sex with someone you love“.

On the “fantastic physiology” of the uterus, there is a splendid article (in Italian language) here. Wikipedia has also a page on the history of masturbation. I also recommend Orgasm and the West. A History of Pleasure from the Sixteenth Century to the Present, by R. Muchembled.

The premature babies of Coney Island

Once upon a time on the circus or carnival midway, among the smell of hot dogs and the barkers’ cries, spectators could witness some amazing side attractions, from fire-eaters to bearded ladies, from electric dancers to the most exotic monstrosities (see f.i. some previous posts here and here).
Beyond our fascination for a time of naive wonder, there is another less-known reason for which we should be grateful to old traveling fairs: among the readers who are looking at this page right now, almost one out of ten is alive thanks to the sideshows.

This is the strange story of how amusement parks, and a visionary doctor’s stubbornness, contributed to save millions of human lives.

Until the end of XIX Century, premature babies had little or no chance of survival. Hospitals did not have neonatal units to provide efficient solutions to the problem, so the preemies were given back to their parents to be taken home — practically, to die. In all evidence, God had decided that those babies were not destined to survive.
In 1878 a famous Parisian obstetrician, Dr. Étienne Stéphane Tarnier, visited an exhibition called Jardin d’Acclimatation which featured, among other displays, a new method for hatching poultry in a controlled, hydraulic heated environment, invented by a Paris Zoo keeper; immediately the doctor thought he could test that same system on premature babies and commissioned a similar box, which allowed control of the temperature of the newborn’s environment.
After the first positive experimentations at the Maternity Hospital in Paris, the incubator was soon equipped with a bell that rang whenever the temperature went too high.
The doctor’s assistant, Pierre Budin, further developed the Tarnier incubator, on one hand studying how to isolate and protect the frail newborn babies from infectious disease, and on the other the correct quantities and methods of alimentation.

Despite the encouraging results, the medical community still failed to recognize the usefulness of incubators. This skepticism mainly stemmed from a widespread mentality: as mentioned before, the common attitude towards premature babies was quite fatalist, and the death of weaker infants was considered inevitable since the most ancient times.

Thus Budin decided to send his collaborator, Dr. Martin Couney, to the 1896 World Exhibition in Berlin. Couney, our story’s true hero, was an uncommon character: besides his knowledge as an obstetrician, he had a strong charisma and true showmanship; these virtues would prove fundamental for the success of his mission, as we shall see.
Couney, with the intent of creating a bit of a fuss in order to better spread the news, had the idea of exhibiting live premature babies inside his incubators. He had the nerve to ask Empress Augusta Victoria herself for permission to use some infants from the Charity Hospital in Berlin. He was granted the favor, as the newborn babies were destined to a certain death anyway.
But none of the infants lodged inside the incubators died, and Couney’s exhibition, called Kinderbrutanstalt (“child hatchery”) immediately became the talk of the town.

This success was repeated the following year in London, at Earl’s Court Exhibition (scoring 3600 visitors each day), and in 1898 at the Trans-Mississippi Exhibition in Omaha, Nebraska. In 1900 he came back to Paris for the World Exhibition, and in 1901 he attended the Pan-American Exhibition in Buffalo, NY.

L'edificio costruito per gli incubatori a Buffalo.

The incubators building in Buffalo.

The incubators at the Buffalo Exhibition.

But in the States Couney met an even stronger resistence to accept this innovation, let alone implementing it in hospitals.
It must be stressed that although he was exhibiting a medical device, inside the various fairs his incubator stand was invariably (and much to his disappointment) confined to the entertainment section rather than the scientific section.
Maybe this was the reason why in 1903 Couney took a courageous decision.

If Americans thought incubators were just some sort of sideshow stunt, well then, he would give them the entertainment they wanted. But they would have to pay for it.

Infant-Incubators-building-at-1901-Pan-American-Exposition

Baby_incubator_exhibit,_A-Y-P,_1909

Couney definitively moved to New York, and opened a new attraction at Coney Island amusement park. For the next 40 years, every summer, the doctor exhibited premature babies in his incubators, for a quarter dollar. Spectators flowed in to contemplate those extremely underweight babies, looking so vulnerable and delicate as they slept in their temperate glass boxes. “Oh my, look how tiny!“, you could hear the crowd uttering, as people rolled along the railing separating them from the aisle where the incubators were lined up.

 

In order to accentuate the minuscule size of his preemies, Couney began resorting to some tricks: if the baby wasn’t small enough, he would add more blankets around his little body, to make him look tinier. Madame Louise Recht, a nurse who had been by Couney’s side since the very first exhibitions in Paris, from time to time would slip her ring over the babies’ hands, to demonstrate how thin their wrists were: but in reality the ring was oversized even for the nurse’s fingers.

Madame Louise Recht con uno dei neonati.

Madame Louise Recht with a newborn baby.

Preemie wearing on his wrist the nurse’s sparkler.

Couney’s enterprise, which soon grew into two separate incubation centers (one in Luna Park and the other in Dreamland), could seem quite cynical today. But it actually was not.
All the babies hosted in his attractions had been turned down by city hospitals, and given back to the parents who had no hope of saving them; the “Doctor Incubator” promised families that he would treat the babies without any expense on their part, as long as he could exhibit the preemies in public. The 25 cents people paid to see the newborn babies completely covered the high incubation and feeding expenses, even granting a modest profit to Couney and his collaborators. This way, parents had a chance to see their baby survive without paying a cent, and Couney could keep on raising awareness about the importance and effectiveness of his method.
Couney did not make any race distinction either, exhibiting colored babies along with white babies — an attitude that was quite rare at the beginning of the century in America. Among the “guests” displayed in his incubators, was at one point Couney’s own premature daughter, Hildegarde, who later became a nurse and worked with her father on the attraction.

Nurses with babies at Flushing World Fair, NY. At the center is Couney’s daughter, Hildegarde.

Besides his two establishments in Coney Island (one of which was destroyed during the 1911 terrible Dreamland fire), Couney continued touring the US with his incubators, from Chicago to St. Louis, to San Francisco.
In forty years, he treated around 8000 babies, and saved at least 6500; but his endless persistence in popularizing the incubator had much lager effects. His efforts, on the long run, contributed to the opening of the first neonatal intensive care units, which are now common in hospitals all around the world.

After a peak in popularity during the first decades of the XX Century, at the end of the 30s the success of Couney’s incubators began to decrease. It had become an old and trite attraction.
When the first premature infant station opened at Cornell’s New York Hospital in 1943, Couney told his nephew: “my work is done“. After 40 years of what he had always considered propaganda for a good cause, he definitively shut down his Coney Island enterprise.

Martin Arthur Couney (1870–1950).

The majority of information in this post comes from the most accurate study on the subject, by Dr. William A. Silverman (Incubator-Baby Side Shows, Pediatrics, 1979).

(Thanks, Claudia!)