The Miraculous Fever-Tree

by Fiammetta Rocco

  Fourteen miles from my grandparents’ farm, on the other side of Lake Naivasha, is the small district hospital. Thirty beds are divided between three wards, but in the rainy season, when malaria can reach epidemic proportions, patients have to queue up to be admitted. Even in the dry months a steady stream of people, most of them women with small children, line up at what passes for an outpatients department round the side of the hospital. Most of them will have travelled in a hot bus or walked many miles to get there, and they sit, uncomplaining and undemanding, beneath the sprawling pepper trees while they wait, sometimes for hours, to be seen by a doctor.

  ‘No wonder they’re called patients,’ laughs a nurse holding a blood sample. She appears cheerier than she ought to be, considering the long hours of work that still lie before her. She and three doctors will see about 180 patients in a morning, spending enough time with each to give a quick diagnosis, offer a prescription or decide if further examination is needed. There is none of the smart whiteness of Dr Saio’s office at the main hospital in Nairobi, though the work that is done here is very similar.

  The hospital in Naivasha is run by local community doctors. The consultation rooms are spotless and the walls are papered with educational posters about AIDS, safe sex and the importance of using clean water for mixing infant formula. Everyone pays fifty US cents to see the doctor, the same again for a blood test, and between ten cents and a dollar for medicine. A limited range of drugs is supplied cheaply by the Anglican Church which, despite its charity, is Protestant enough to have concluded early on that people value something more if they have to pay for it, no matter how small the sum.

  Outside the door is a hand-painted sign with a message from the first Book of Peter, a reminder that so much in Africa is still a matter of faith. ‘Cast all your cares unto Him, for He cares for you,’ it says. Cheap and simple to run, the clinic is more effective than one might think, given its simple furnishings and tiny annual budget. For many Africans, this is the very best medical knowledge they will encounter.

  A woman in a red patterned skirt and a white headscarf enters the consulting room. Asked what her name is, she mumbles ‘Grace’ in a barely audible voice. She complains of a swollen stomach. A nurse palpates her abdomen, and concludes that she is about twenty weeks pregnant. Although this would be her third child, Grace seems not to have noticed that her menstrual periods had stopped, or had any idea that she might be expecting. Perhaps another child was too much of a burden for a poor family, and she did not want to admit the truth. The nurse signs her up for admission to the hospital five months hence, and arranges, meanwhile, for fortnightly antenatal visits.

  The next patient, Joseph, complains of chest pains. He has chronic oedema. His lower legs look like tree trunks and he suffers from high blood pressure. He pulls his thick jacket around him as the doctor prescribes a new medication for his angina, and shuffles out.

  A heavyset young woman in red flipflops and a blue headscarf comes in next. She speaks softly to the doctor in Kikuyu. She is called Sandra. Both her children are running a temperature and she has a bad chesty cough. She wants them all to be tested for malaria. The doctor examines them. ‘Say “ah”,’ he commands, peering down the throat of each child.

  The thick white ulcers of oral Candida indicate that they are probably both HIV positive. Without proper medication, it will only be a matter of time before they have AIDS. On the wall is a poster of a strip cartoon showing how AIDS is transmitted. It says nothing about foetal transfer of the virus. Beside it another chart outlines how to prescribe Amodiaquin, the standard treatment for malaria now that chloroquine, a synthetic anti-malarial compound developed during the Second World War, is so ineffective that many African countries, including Kenya, have discarded it. For a baby of less than seven kilos, you give a quarter of the daily dose. For a child weighing more than fifty kilos, the daily dose is three tablets.

  The nurse asks each child to put out a hand. Gently she swabs a finger, pricks it and smears the gentle swell of blood onto a glass slide. Moments later a lab technician dips the slides into staining fluid, dabs the end with a piece of kitchen towel to clear the excess moisture, and puts the slide to dry on the warm back of a paraffin picnic fridge beside his desk. In a few moments the slides are ready and he slips them under the microscope, the only piece of machinery in the clinic that runs on electricity.

  The circular-shaped parasite, with its dot-like red eye at one edge that is so characteristic of malaria, is clearly visible. Sandra and her two children all have malaria, though they are lucky they do not harbour the deadly falciparum parasite. A pharmacist counts out a tiny handful of white pills and slips them into a small square envelope. They are quinine sulphate, which is made from the bark of the cinchona tree grown in the last cinchona forest, in the eastern Congo.

  My grandparents may have been unusually adventurous in the way they happily traded in a comfortable life in Paris for an unknown future in Africa, but their caution in insisting that we all regularly dosed ourselves with quinine was proved right. To many Western travellers today, malaria is something that exists over the horizon. It does not carry the slow promise of death that is embedded in AIDS; in this part of Africa, AIDS has seeped into so many villages that small children and old grandparents are often the only people still to inhabit the silent thatched huts. Nor does malaria conjure up an explosive, primitive fear, like being attacked by a lion or bitten by a poisonous snake. Most travellers know that malaria exists, but they buy an ordinary over-the-counter dose of prophylactics and go on holiday regardless, often ignorant of whether the prophylactics work or not. In Britain there are more articles in medical journals devoted to the depressive side effects of mefloquine, or Larium as it is usually known, one of the strongest anti-malarial prophylactic drugs on the market, than on the disease itself.

  Malaria stalks Africa, where it is a real cause of fear and grief. The United Nations World Health Organisation estimates that as many as five hundred million people are infected by the disease every year. That is eight times the population of France or Great Britain, or twice as many people as live in the United States.

  Of those who fall sick, as many as three million die every year. The very large majority of these are small children for whom clean water, decent food, antibiotics and quinine-based drugs to fight the onset of the disease, let alone a decent prophylactic, are no more than a dream, perhaps heard of, but unattainable. Malaria is so common, and so deadly, that the WHO estimates one person dies of it every fifteen seconds. In the last decade it has killed at least ten times as many children as have died in all the wars that have been fought over the same period. Yet the mosquito that carries it is little larger than an eyelash.

  Out of just under five hundred different varieties of Anopheles mosquito that are recognised today, only about twenty are thought to be seriously responsible for spreading the disease to humans. The malaria parasite packs the salivary gland of the female mosquito, of no danger to anyone including its host until it bites a human being. Only when it injects some of its saliva containing the malaria parasite into the bloodstream does the mosquito transfer this dread disease. In the course of the bite it also withdraws blood. Its victim may already be infected with the parasite. If the mosquito moves on to other people and bites them, the endless cycle of infection and reinfection will simply repeat itself. The Anopheles mosquito needs blood to lay its eggs, but the damage it inflicts on humans is completely incidental to the insect. ‘A man thinks he’s quite something,’ the American writer and cartoonist Don Marquis had his cockroach hero Archy say in archy and mehitabel. ‘But to a mosquito a man is only a meal.’

  The mosquito breeds in pools of stagnant water – overflows from rivers that have flash-flooded and then subsided, roadside ditches, forgotten furrows in uncultivated fields, water butts in towns and rain-filled puddles in the middle of country roads. In the Naples of my grandfather’s youth, the mosquito found a comfortable home in the well-watered window boxes of
the city tenement buildings. When my great-grandfather was in Panama, it was customary for the nurses in the little French clinic on the hill above the engineering works to stand the hospital beds in huge flat bowls of water to stop the black spiders from climbing up the bed legs and biting the patients. No one could have devised a better breeding ground for mosquitoes had they tried. Among the canal workers of the mid-nineteenth century it was customary to warn newcomers that if you didn’t have malaria when you went into hospital, you would undoubtedly catch it while you were there.

  Today malaria is chiefly a danger to people in the tropics, particularly the poor, who live in bad housing with inadequate drainage and no mosquito nets, insecticide sprays or fancy prophylactics. But once upon a time it was common all over Europe. Even so, no one knew exactly what it was. Nor did they know how to treat it. When a cure finally was discovered, it revolutionised theories of medicine and the way physicians thought about treating illness.

  Nowhere in Europe was the scourge more deadly, and the need for a cure more acute, than around the Basilica of St Peter’s in the centre of Rome, where every summer for centuries it killed hundreds of people, making no distinction between peasant, priest or pope.

  2

  The Tree Required – Rome

  ‘When unable to defend herself by the sword,

  Rome could defend herself by means of the fever.’

  GODFREY OF VITERBO, poet, 1167

  Giacinto Gigli lived for sixty-five years in an alleyway by the Via delle Botteghe Oscure. His small townhouse was one of several built close together. They clung, like a gaggle of shy children, to the end of one of the crooked passageways that cluttered the centre of Rome, seeming almost to lean into one another when the wind whipped around them during the early days of winter. Gigli was not born there, but from the time when he was twelve years old until just before Christmas 1671, when he died at the age of seventy-seven, he returned every night from his work in the papal palace at the Vatican and climbed the stairs to the study, his favourite room, at the top of the house, where his desk was placed between two tall windows.

  One of them looked westwards, over the bend in the Tiber where tradesmen, prelates and visitors would cross the bridge that led towards the Santo Spirito hospital and beyond it to St Peter’s and the palace of the Vatican. From that window Gigli could just see the golden dome of St Peter’s, though often it seemed almost to fade away in the summer haze, when the city became too hot to bear and the Pope’s court moved to the palaces and villas in the coolness of the hills that surround the city. The other window, on the far side of the room, looked north-east towards the Quirinale, the highest of Rome’s seven hills, where the Pope’s own summer palace had been built so that he could escape the unhealthy summer air, and where a gentle breeze blew all day through the shady trees.

  The Gigli family was part of Rome’s petite bourgeoisie, though by his death Giacinto’s father had been able to leave his son the property near the Via delle Botteghe Oscure, two other smaller houses in the centre of the city, and a vineyard on the road to Frascati, a considerable inheritance for a modest man. When he was twelve Gigli entered the Collegio Romano, the Jesuit school where he studied grammar, humanities and rhetoric. For a while he studied law in the studio of Angelo Luciano, a well-known Roman advocate, and graduated as a specialist in papal law. By that time his father was dying, and as Giacinto prepared to take his place as the head of the Gigli family, the young man’s thoughts turned to marriage. He had known Virginia Lucci all his life. She was his neighbour’s daughter, and the time had come to ask for her hand.

  As he grew older, Gigli began to acquire the status of a man of respect. He was made a rione, representing his parish of Pigna in the committees and on ceremonial occasions that would occasionally bring together the city and the Holy City. Dressed in velvet and bedecked with feathers, he would walk in line before the horsemen that accompanied the papal processions. Later he was made a caporione, before eventually serving twice as the priore, the head of all the caporioni, responsible to the Pope for helping collect taxes and keeping order within the Holy City. These duties gave Gigli an intimate insight into Rome, and particularly the clerical administration that ran it. He became something of an expert on Vatican politics – who was in favour and more importantly who was not, how different cardinals behaved and how they were discussed. ‘All this and more is the lifeblood of the Holy City,’ he would write.

  We don’t know what Gigli looked like, for no contemporary likeness of him survives. But we know a great deal else about him: how he lived, how he filled his day, what he did when he fell ill, whom he saw and what he ate. Gigli was meticulous about recording the details of his life in his diary, which survives in the Vatican library, writing something every day, even if only a brief phrase or two. He wrote in Latin, in an elegant slanting hand, taking care to reach the very edge of the page before starting on the next line.

  Gigli had acquired the habit of chronicling his daily life before his marriage. In 1614, when he was only nineteen, he even began an autobiography, entitled Vita. He kept this up assiduously for about five years, making minute notes of everything that went on in his household, recording the names of the servants who came and went, what they were paid and what they earned in tips or small gifts, like the woollen socks that were given to the nurse who came to care for his only son. While this might seem unnecessarily fussy to some, these were not bad habits for a diarist to acquire. In addition, he also wrote poetry, long verses about his native city and eulogies of the Popes in rhyming octets.

  The papal court was the centre of Gigli’s life. From the first entry in the diary, on 29 May 1608, to the last, when he was almost too blind to write any more, yet fretted about missing the baptism of the Pope’s new baby niece, he specialised in the comings and goings of the Vatican. The Pope’s court was newly returned to Rome after the alternative papacy, set up the previous century in Avignon with the support of the King of France, had threatened to rob Rome of much of its wealth and influence. Restored once more to its traditional home, the leadership of the Roman Catholic Church was doing all it could to spread the counter-Reformation in Europe and impose its spirit, burning heretics and attempting to suppress Protestantism whenever it could.

  In the first decades of the seventeenth century, though, when Gigli was making his daily observations of the Holy City, papal Rome still hadn’t really found its feet. The memory of the schism lived on, making the city fathers nervous, hidebound, inward-looking; too fearful of the Turkish forces that threatened Venice, or the Spaniards who lay siege to Naples, ever to be easy. Naturally conservative, papal Rome then was more fearful of change than it had ever been. In 1633 Galileo Galilei, after publishing his arguments for a Copernican cosmology, with the earth and the planets revolving around the sun, rather than with the earth at the centre of the universe as had long been the prevailing view, would be tried for heresy and his works banned.

  Like his masters in the Church, Gigli was a conservative man. Over the years we get a good idea of what he approved of and what he didn’t. Gigli was something of a prig, and there was much that went on in Rome that made his lip curl in distaste. Despite that, he had a fine eye for daily life in the city – the storms, the fires, the earthquakes, the fate of the jailed heretics who were often hung, drawn and quartered, their various portions exposed to the populace as an example to those who might be tempted to question the Pope’s authority. He wrote about the availability of bread, about miracles, comets and eclipses of the sun. Although he was a rational, educated man, there was a medieval part of Gigli that could not help but believe that God sent signs to his people below, good signs if he was pleased with them and punishments when he was enraged.

  On a more down-to-earth level, Gigli wrote about people’s anger at the rising taxes, their irritation at the inflexibility of the authorities and their fear of the Tiber’s floods, which he always described as the river getting ‘out of its bed’. In 1630 he wrote of the
arrival in Rome of an elephant, ‘which no one had seen for a hundred years’, since the King of Portugal sent one as a gift to Pope Leo X in 1514. This particular beast, by contrast, had been brought to the city by a private citizen, and anyone who wanted to see it had to pay him one giulio for the pleasure.

  In turn observant, witty and fastidious to the point of pernicketiness, Gigli became Rome’s most wonderful portraitist. At the start of the seventeenth century, the city had a population of about 115,000. It was a tenth of the size of its imperial predecessor, smaller by far than Paris or London—smaller even than Naples – but it was growing after the ravages of the previous century, when it had been sacked and later flooded, before being visited by the plague and then cast into ruin during the papal schism. With the return of the papacy, diplomats, bankers, doctors, artisans, traders, horsemen and financiers jostled in the capital for any part of the papal chancery’s swelling business.

  Most of these people lived and worked, as Gigli himself did, in the occupato, the dense gathering of taverns and tenement houses separated by narrow cobbled streets that nestled in the crook of the arm of the Tiber where it curved in an ‘S’ shape, first west and then south-east. Inevitably they were almost all connected, one way or another, with the Church establishment. The three most important routes into the city converged on the Ponte Sant’ Angelo, just south of the Vatican, bringing travellers who were always hungry for news and for business directly into the heart of the city. Over it rose the bell towers of nearly 350 churches. The tallest among them were the great basilicas that kept watch over the tombs of the apostles. Then there were the churches that guarded the sacred reliquaries of the saints, and occasionally, some believed, even fragments of the True Cross. Lower still were the chapels of the patrician families and the oratories of the guilds. From every sacred spire and belfry the city trumpeted its patronage of the holy. In brick and stone, every street, every façade, every arch and roof and alleyway proclaimed its thousand years as a Christian symbol.