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.
Almost every post appearing on these pages is the result of several days of specific study, finding sources, visiting the National Library, etc. It often happens that this continuous research makes me stumble upon little wonders which perhaps do not deserve a full in-depth analysis, but I nonetheless feel sorry to lose along the way.
I have therefore decided to occasionally allow myself a mini-post like this one, where I can point out the best bizarre news I’ve come across in recent times, passed on by followers, mentioned on Twitter (where I am more active than on other social media) or retrieved from my archive.
The idea — and I candidly admit it, since we’re all friends here — is also kind of useful since this is a time of great excitement for Bizzarro Bazar.
In addition to completing the draft for the new book in the BB Collection, of which I cannot reveal any details yet, I am working on a demanding but thrilling project, a sort of offline, real-world materialization of Bizzarro Bazar… in all probability, I will be able to give you more precise news about it next month.
There, enough said, here’s some interesting stuff. (Sorry, some of my own old posts linked here and there are in Italian only).
The vicissitudes of Haydn’s head: Wiki page, and 1954 Life Magazine issue with pictures of the skull’s burial ceremony. This story is reminiscent of Descartes’s skull, of which I’ve written here. (Thanks, Daniele!)
In case you missed it, here’s my article (in English) for Illustrati Magazine, about midget pornstar Bridget Powers.
Continuing my exploration of human failure, here is a curious film clip of a “triphibian” vehicle, which was supposed to take over land, water and the skies. Spoiler: it didn’t go very far.
In the Sixties, the western coast of Lake Victoria in Tanzania fell prey to a laughter epidemics.
Found what could be the first autopsy ever recorded on film (warning, strong images). Our friend pathologist says: “This film clip is a real gem, really beautiful, and the famous Dr. Erdheim’s dissecting skills are remarkable: he does everything with a single knife, including cutting the breastbone (very elegant! I use some kind of poultry shears instead); he proceeds to a nice full evisceration, at least of thoracic organs (you can’t see the abdomen) from tongue to diaphragm, which is the best technique to maintain the connection between viscera, and… he doesn’t get splattered at all! He also has the table at the right height: I don’t know why but in our autopsy rooms they keep on using very high tables, and therefore you have to step on a platform at the risk of falling down in you lean back too much. It is also interesting to see all the activity behind and around the pathologist, they were evidently working on more than one table at the same time. I think the pathologist was getting his hands dirty for educational reasons only, otherwise there would have been qualified dissectors or students preparing the bodies for him. It’s quite a sight to see him push his nose almost right into the cadaver’s head, without wearing any PPE…”
La peste è stata la più catastrofica fra le malattie umane. Presente per millenni, con ciclici ritorni, la peste ha spesso plasmato la storia del nostro continente: durante le epidemie più dure, le perdite in termini di vite umane erano talmente gravi da obbligare l’intera società a ristrutturarsi completamente. Secondo molti studiosi, alle varie ondate delle malattia corrispondono altrettanti cambiamenti significativi nelle innovazioni tecnologiche, nei valori, nella concezione dell’uomo e dell’universo. Ed è facile immaginare che quando un simile flagello colpiva l’umanità, gli occhi si rivolgevano ai simboli della fede, per cercare di capire le motivazioni di questa “prova” inflitta da Dio, o semplicemente per trovare conforto.
Ecco allora nascere il vocabolo tedesco pestkreuz, (plague cross in inglese), termine dai molti e diversi significati.
Quando, durante il XVII Secolo, le epidemie di peste bubbonica martoriavano l’Europa, prese piede l’usanza di marcare con la vernice rossa le porte delle case visitate dalla malattia, disegnandovi delle grandi croci accompagnate da invocazioni che invocavano la pietà del Signore. Si segnalava così la presenza del morbo, allertando il vicinato. Fu così che si incominciò a parlare di “croci della peste”, ma la relazione fra il feroce e incurabile morbo e il simbolo salvifico non si fermò a questo.
Ben presto le croci vennero usate anche nel commercio: si trattava di strutture temporanee, in legno o in pietra, che venivano issate per indicare i luoghi di scambio e di mercato posti al di fuori delle mura cittadine e che, almeno in linea teorica, erano al sicuro dal contagio. Se volevate vendere o acquistare della merce avendo qualche speranza di non rimanere infettati, dovevate cercare queste croci, sotto cui si radunavano piccoli mercati estemporanei.
In Inghilterra alcune di queste croci erano equipaggiate con una bacinella d’acqua, dentro la quale venivano sommerse tutte le monete prima e dopo gli acquisti, come misura precauzionale; in altri casi l’acqua era sostituita da aceto, che avrebbe dovuto fungere da “disinfettante”. La più celebre di queste vasche è la Vinegar Stone di Wentworth.
Altri tipi di croci della peste avevano finalità caritatevoli, come ad esempio quella, incompleta, conservata a Leek, Staffordshire: a quanto si dice, ai suoi piedi si poteva lasciare del cibo e delle provviste per gli ammalati, senza entrare in contatto con essi.
Ma forse la declinazione più curiosa di questo rapporto fra l’icona cristiana e la peste sta in alcuni crocifissi, tipici soprattutto dell’area austro-germanica nel XVI e XVII secolo, che ritraggono Gesù afflitto dalle piaghe bubboniche: la morte, compagna di tutti i giorni, influenza anche gli artisti.
Per quanto apertamente astoriche, queste sanguinose rappresentazioni erano un mezzo per far immedesimare il fedele nel supplizio sopportato dal Cristo, ma anche viceversa – era il Redentore che scendeva fra gli uomini, soffriva con loro, portava sul corpo gli stessi segni di dolore della gente comune, si prendeva carico della loro angoscia.
Infine, l’ultima tipologia di croce della peste è anche la più triste, e più diffusa in tutta Europa: quella che commemora i cosiddetti plague pits, “pozzi della peste”. Si tratta delle tombe di massa, in cui venivano tumulate le vittime, talmente numerose da non poter essere seppellite singolarmente.