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

Rating:
Summary: Splendid Overview Of The Search For Malaria's Cure
Review: Fiammetta Rocco's "The Miraculous Fever-Tree" is yet another contemporary example of the popular science treatise exemplified by Dava Sobel's "Longitude" and Simon Winchester's "Krakatoa" and "The Map That Changed The World". Ms. Rocco, the literary editor of the Economist, takes us on a globe-spanning, centuries-long odyssey in search of Malaria's cure, quinine, distilled from the bark of the South American cinchona tree. It is a moving, elegant look at the age of discovery and exploration, vividly recounting how the discovery and use of cinchona bark, and then later, its chemical derivative, quinine, allowed Western imperial states such as Spain and Great Britain to colonize vast tracts of South America, Africa and Asia. She also offers a fascinating glimpse into malaria's deadly impact on Allied and Axis military forces during World War Two. And she elegantly weaves in her own personal struggle with malaria, which she contracted during her late adolescence/early adulthood in Kenya. Rocco's crisp prose is as eloquent as those from Sobel and Winchester. Without question, this is among the finest books on popular science and medicine published in the past year.

Rating:
Summary: How can you write about the past without knowing the present
Review: If you would write a book about economics would you visit your local bank manager to get all the background information? Would you think that it is sufficient to read your way through some archives? Probably not.
But this is what Rocco does to malaria. Rocco visits her childhood doctor in Kenya and spends a lot of time in archives to write about quinine. This may well be the safest and perhaps also the most comfortable approach to find the material for a book. And it could work for any subject, pianos in Berlin or cheese in Italy. Unfortunately what emerges is not a contemporary picture of the treatment of malaria or the history of malaria treatment but a rather skewed view on a historic niche. How can you try to understand the past if you don't know the present? If you care about some historical particularities, which pope had what malaria problem, written in beautiful English this is your book.

Rating:
Summary: The Story of the Tree of Life
Review: Many schoolboys in the developed world may know that malaria is the second largest killer of mankind in human history. (As a brief aside, the largest killer is ....... man!) I came to this book knowing very little else about the tropical disease. Yes, I knew that it was transmitted by mosquito bites, but my knowledge ended shortly after that point. Therefore I will readily admit to learning a great deal from this book ? about disease transmission and treatment in general and malaria in particular, and of the wonderful, quinine-bearing ?Peruvian bark? of the cinchona tree. The subject areas covered are enormous: combining more than 350 years of medicine, discovery, colonial conquests, papal intrigues, botany, and biological research. It whets the appetite, and shows that there is much to look into further.

The huge scope is both an advantage, and a disadvantage; an advantage because it gives the reader a context, but it highlights areas worthy of greater coverage with some parts a little sparse. There is little of the effectiveness of quinine (from the ?miraculous fever tree?), when compared to modern anti-malaria drugs ? the problems of, say Larium, have been well documented elsewhere. However, the author uses her own family background to off-set the story, and the approach is particularly effective. Parts are from her own story (growing up in Africa), whilst other small portions cover that of relatives (her great grandfather worked on building of the Panama Canal, and survived the ravages of both yellow fever, and malaria).

The dedication of early doctors, and plant specialists shines through, although in some sections the numerous individuals entering the story seem part of a list of people, places and dates. The telling of the mosquito life cycle, and the discovery of the effect of the insect is very good, with detail from the works of both Ronald Ross and Patrick Manson in the 1890?s. I did not realise that malaria was hitherto both so geographically extensive, and so important in war. This included both the Napoleonic wars, and the American Civil War. The life expectancy of British soldiers in West Africa in the early 19th century was less that 6 months, and was a calculated waste of life.

An interesting note is the prevalence of malaria in Europe, with the fatal effects of the papal enclave of 1623; a number of the electing cardinals did not return from their Pope-choosing visit to Rome. Malaria was also very evident in the Essex marshes in the late 17th century; immune local men would go to the hills in search of another woman when a wife died in the lower (malaria infested) regions. Some men had 14 or 15 wives, but never more than one at a time. Perhaps that is where the ?Essex girl? jokes started.

My overall feeling is that the book does not quite achieve its aim, chiefly because it is so hugely ambitious. It is however a very good read, and may even entice you to read further on the subject (with ample source material listed by the author). I am left at the end realising that there are still about 3,000,000 deaths each year from malaria, and most of these are preventable, whether that is using the product of the cinchona tree, or by some other means. The story may encourage people to strive for the eradication of the disease. Read it, and judge for yourself.

Peter Morgan (Bath, UK. [e-mail])

Rating:
Summary: The Unwon Battle of Cinchona Against Malaria
Review: The most devastating disease to humans has undoubtedly been malaria. Fiammetta Rocco is qualified to write about the disease. She has had it herself, and her father had it many times. Her grandparents kept a farm in Africa, and while it can be expected that there were plenty of diseases to bother or kill, malaria was the most prevalent. The story of the battle against malaria has been told many times, but since it combines science, the conquest of nations, and religion, it will always prove inexhaustible. In _The Miraculous Fever-Tree: Malaria and the Quest for a Cure that Changed the World_ (HarperCollins), Rocco has focused on the discovery, utilization, and culture of quinine, the drug that for centuries has brought some hope against the disease. That it has had to work for centuries, of course, means that the battle is far from won.

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.

Rating:
Summary: The Unwon Battle of Cinchona Against Malaria
Review: The most devastating disease to humans has undoubtedly been malaria. Fiammetta Rocco is qualified to write about the disease. She has had it herself, and her father had it many times. Her grandparents kept a farm in Africa, and while it can be expected that there were plenty of diseases to bother or kill, malaria was the most prevalent. The story of the battle against malaria has been told many times, but since it combines science, the conquest of nations, and religion, it will always prove inexhaustible. In _The Miraculous Fever-Tree: Malaria and the Quest for a Cure that Changed the World_ (HarperCollins), Rocco has focused on the discovery, utilization, and culture of quinine, the drug that for centuries has brought some hope against the disease. That it has had to work for centuries, of course, means that the battle is far from won.

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.

Rating:
Summary: How can you write about the past without knowing the present
Review: This engaging account sketches the investigation and quest for a cure for the "mal 'aria" of Rome. "Mal 'aria" was once thought to emanate from the "bad air" of swamps and marshes. Rocco, herself a victim of this dread illness, narrates its impact from ancient times into the modern world. When the death of a pope brought 55 cardinals to Rome to replace Gregory XV, 10 of them had contracted malaria within two weeks. Those who survived returning to Sees in European nations spread further a malady already prevalent in many nations as distant as the British Isles and Scandinavia. Even as the papal successor, who was also prostrated with chills and fever, struggled to survive the infection, some of his minions were advocating a likely cure against great skepticism.

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]

Rating:
Summary: Bark, bugs and battles
Review: This engaging account sketches the investigation and quest for a cure for the "mal 'aria" of Rome. "Mal 'aria" was once thought to emanate from the "bad air" of swamps and marshes. Rocco, herself a victim of this dread illness, narrates its impact from ancient times into the modern world. When the death of a pope brought 55 cardinals to Rome to replace Gregory XV, 10 of them had contracted malaria within two weeks. Those who survived returning to Sees in European nations spread further a malady already prevalent in many nations as distant as the British Isles and Scandinavia. Even as the papal successor, who was also prostrated with chills and fever, struggled to survive the infection, some of his minions were advocating a likely cure against great skepticism.

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]