The Miraculous Fever-Tree

by Fiammetta Rocco

  But the overwhelming pattern of complaint was of bouts of fever interrupted by shivering, of hard, swollen spleens – a side-effect which was famously known as ‘ague-cake’ – and frequent relapses. ‘First a sort of listlessness pervades the mind,’ one soldier wrote in his diary. ‘The feet get cold, the cold then gradually ascends to the back, and in fact through the whole body; a universal icy shivering, and a chattering of the teeth, next ensue, followed by an ardent thirst.’ These symptoms, together with the fact that the Peruvian bark was observed to be helpful in simple cases, points to endemic malaria, which would particularly have affected a fresh influx of people with no natural immunity to the disease. However, only falciparum malaria is likely to have caused death on the scale observed at Walcheren, and falciparum, although proven by DNA testing in Italy to have existed in Europe since Roman times, was by no means common further north.

  Whatever the root cause, the abominable housing of the ill, the filth, the lack of medical attention and the overcrowding of the sick on the few ships that were available to transport them home contributed to the logistical and medical disaster that, one observer wrote, ‘deluged the British empire with tears’.

  The army commanders in the field were slow to react, in part because there were far too few doctors and assistants to go round, and eventually many of these also fell ill. Making an accurate assessment of what was needed took some organising, but as the number of sick men grew by the day so did the panic.

  In late August, the British Surgeon-General proposed enlisting the services of London hospital surgeons and their principal pupils, called ‘dressers’, at suitable pay and allowances, to come to the army’s aid; the authorities turned him down. By early September he was requesting additional medical assistance ‘without delay’. During the following week he was demanding immediate steps to provide transports and hospital ships. Lord Castlereagh, the War Minister, declared that ‘every possible exertion’ had been made, but complained that it was ‘difficult, if not impossible’ to provide an ‘adequate and immediate supply for a calamity so sudden and so extensive’.

  As they waited for transport back to the ‘cleaner air of England’, the sick were quartered in houses, churches and warehouses, many of them burnt-out and roofless from the fighting. Bedding was in short supply: fifteen men, twelve of them sick, were discovered in a room twelve feet square, with only two blankets between them. Those being sent back to England lay on the beaches for hours on end in their filth and misery, waiting for carts to carry them down to the transports. ‘The poor fellows made every effort to get on board,’ Rifleman Harris recounted; ‘those who were a trifle better than others crawled to the boats; many supported each other; and many were carried helpless as infants. On shipboard the aspect of affairs did not mend; the men beginning to die so fast that they committed ten or twelve to the deep in one day.’

  In mid-September, as the troops at Walcheren were being laid low in their thousands by the fever, and Rifleman Harris and his friend Brooks set about dispensing medicines from their ‘watch-box’ on the quayside, a diligent and admirable army doctor arrived to make an inspection of the facilities.

  The appointment of Sir James McGrigor was to prove a turning point in the Walcheren disaster. A Scottish regimental surgeon with a high, domed forehead and a long nose, McGrigor was a man of forthright views. He liked to make up his own mind, and was unafraid of initiating change. He, more than anyone, was aware of how crucially the army medical administration needed to be overhauled. His handling of the Walcheren disaster would catch the eye of the newly elevated Viscount Wellington, who was aware of how much his Peninsular campaign was handicapped by poor medical services. In time McGrigor became Wellington’s Surgeon-General, and ultimately, as a result of his vision, energy and influence, the reformer of the Medical Department and creator of the Army Medical Corps.

  When McGrigor, as Chief of Medical Staff, arrived in Zeeland to carry out his inspection in the second half of September, he was shocked at what he found. There were sick men everywhere, some of them lying on the ground without even the comfort of a blanket. ‘On examining the stores, both of apothecaries and purveyors,’ he wrote, ‘I found them drained of many articles of the most essential description. There had been a great increase in the consumption of bark, and I found little in store.’ McGrigor wrote repeatedly to the Surgeon-General in London, entreating him to hurry and send fresh supplies of the Peruvian cure. ‘But before it could reach us,’ he later recorded, ‘we were nearly destitute of that powerful remedy.’

  Knowing that stocks were within two days of being exhausted and that it would take at least a week for more to arrive, McGrigor put out the word among the local population that he had gold, and was prepared to buy any bark that was available. Before long he was informed that an American ship – an ‘adventurer’, as he would later describe it to Parliament—had come in with supplies of champagne and claret for the sutlers who provisioned the army. It also had on board several chests of bark. McGrigor gave orders that the entire shipment, 1460 pounds of it, be bought at once. It would just tide him over until the large quantities he had ordered were safely despatched by mail coaches to Deal and then by packet to Walcheren.

  McGrigor realised that the troops needed urgent medical attention, and was determined to hospitalise as many of them as possible. And as soon as was practicable, he began a wholesale medical evacuation. By the end of September, more than 140 ships had been commandeered to transport sick soldiers; but arranging for the men to be moved was no easy business. By then, nearly nine thousand of them needed help. As the transports arrived from England, the sick were hauled up on deck, where doses of bark were dished out in horn tumblers. After the Channel crossing they were lifted onto the English beaches ‘like sacks of flour’. Some died as they landed; others had to wait hours, or even days, before a hospital bed was found for them.

  In England, the hospitals were overwhelmed by the sudden rush of new patients. For Rifleman Harris, who had found himself among a group of the sick ‘sprawling up on the forecastle, in a miserable state, our knapsacks and our greatcoats over us’, the conditions once he was admitted to hospital were almost as bad as in the field. Harris was hospitalised at Hythe on the Kent coast, and from his corner bed he saw the ward, which held eleven men, refilled ten times, the dead being carried out to the local graveyard. ‘When I got out, and went to the churchyard to look upon their graves I saw them lying in two lines there. As they in life had been enranked, so they lay also in similar order in death.’

  The British Army never forgot its terrible encounter with malaria at Walcheren, or the dangers of being caught without adequate supplies of cinchona bark. By mid-December 1809, four months after the troops first began falling ill, more than twelve thousand sick soldiers had been repatriated. Rifleman Harris was one of the thousands whose lives were saved, but he never properly recovered. The doctors attributed a large proportion of deaths to enlargement of the spleen – a classic symptom of chronic malaria – and Harris would later describe how he was ‘dreadfully enlarged in the side, and for many years afterwards carried an extra paunch’.

  When he was discharged from hospital Harris retired, and on a pension of sixpence a day set up as a cobbler in Richmond Street, Soho. Years later, he found himself chatting to an officer on half-pay from the Oxfordshire Light Infantry, who wrote down Harris’s army recollections.

  Meanwhile, many of the soldiers who followed Wellington’s call to Spain, where McGrigor served as Surgeon-General, could be recognised by their Walcheren ‘waistcoats’, a flannel vest with long sleeves made ‘large enough to wrap around the breast’, and the little bottle of Peruvian bark they carried in their holsters instead of a pistol.

  The Statistical Reports on Sickness, Mortality and Invaliding Among the Troops in Western Africa that is housed today in the rare books section of the British Library is bound in navy-coloured leather, and is so little consulted that its pages bristle when opened, giving off a fa
int smell like that of an old powdered wig. Yet when it first appeared in 1840, the book was revolutionary. Here, compiled for the first time, was a detailed and accurate record of the health of every British soldier serving abroad. The move was one of the many innovations introduced by Sir James McGrigor when he began his reform of the Army Medical Department after the catastrophic Walcheren expedition. It would have a profound influence, not just on the way the army dealt with the prevention and treatment of disease among soldiers, but on the expansion of the British Empire.

  Nowhere was this more apparent than in West Africa. Soldiers preparing for a posting to Bight of Benin knew that at virtually any spot on the coast they could be certain that within a year or two they would have buried at least half the regiment.

  In 1832, the first expedition to attempt a complete exploration of the River Niger departed from Britain carrying a pitiable medicine chest that contained little more than calomel, Epsom salts and citric acid. The expedition leaders quickly fell ill with malaria, and many of the members died. Sulphate of quinine, a soluble salt isolated from the natural quinine found in the bark, was included ‘as a strengthener after fever’, but the niggardly supply of just four ounces did nothing for them.

  Nor were other parts of the coast any better. Sierra Leone, which had been established as a home for liberated slaves, was known as ‘a pestiferous charnel house’. In the capital Freetown, the African remittent fever, as malaria was called there, was so serious that two years after the first Niger expedition, the city fathers seriously considered building a wall up to twenty miles long and thirty feet high to stem the invasive miasma that they believed was the cause of the fever.

  The Gold Coast, next door, was said to be ‘the most unfriendly to men of any country on the face of the globe’. At Fernando Po, an island off the west coast of Africa, the standing orders for labour forces were ‘Gang No 1 to be employed digging graves as usual. Gang No 2 making coffins until further notice.’ As for the Bight of Benin, it inspired this sinister sea shanty:

  Beware and take care of the Bight of Benin,

  There’s one comes out for forty goes in.

  In 1840, the first statistics on the health of the troops posted to West Africa revealed that for every thousand soldiers there were 2978 admissions to hospital. That meant that every man could expect to be hospitalised three times a year. Worse still, 483 of those thousand soldiers would die before they could be discharged from hospital.

  Many succumbed in the Gambia, on the most western reaches of the coastal bulge, ‘which proved,’ the report said, ‘the grave of almost every European sent there’. The first detachment of 108 British troops arrived at the Jamestown garrison, at the mouth of the Gambia river, at the end of May 1825, just as the rains started. By 21 September, only twenty-one were still alive, seventy-four having died of malaria. Another ninety-one were kept at sea, aboard a transport named the Surrey. They did not lose a man. But the deaths of their comrades made room for them onshore. Between the end of September and 21 December, sixty-one more had died. The force having now been reduced by deaths to thirty-nine, most of whom were in the final stages of disease, another body of two hundred men was sent in their place. After less than three months, half that number were in their graves, eighty-five of them as a result of malaria. ‘The disease,’ the report concludes, was ‘of the most malignant form, and even in the event of recovery, [it left] the patient with a shattered constitution for life.’

  One morning in early May 1854, William Balfour Baikie turned into the John Laird yard at Birkenhead and caught sight of the ship that would carry him up the Niger, the Pleiad. As a graduate of Edinburgh’s prestigious school of medicine and a surgeon in the Royal Navy, Baikie had read the statistical reports on the health of soldiers, and knew all about the risks involved in an expedition to West Africa.

  Just 105 feet in length, the Pleiad was the first exploring ship to be designed specifically so that she would not have to take on wood from the African coast, a known source of fever, as fuel. She had five staterooms for officers, all elegantly fitted out with mahogany tables, green morocco leather sofas and a bronzed chandelier, and their own bathrooms. An ample library completed the suite of furniture. The dozen sabres that hung on either side of the main door of the Pleiad’s library added to her air of buccaneering confidence.

  The shipwright MacGregor Laird had agreed to the Admiralty’s conditions, that he should build the steamer and pay all the expenses of her maiden voyage to West Africa for a fee totalling £5000, because he had a hunch that despite its reputation as a hell hole, the region had great commercial potential; and Laird was a man who liked to be in at the start.

  Looking about him, Dr Baikie knew he was right to have taken his former supervisor at the Haslar hospital Sir Roderick Murchison’s advice to volunteer for the next Niger expedition. As a poor Orkney boy, the eighth of thirteen children, Baikie had to take his opportunities when they came. He had struck Murchison as a potential explorer because of his medical training and his enthusiasm for field botany. The Pleiad, which would be the expedition’s home, left Dublin after her sea trials on 20 May. Baikie and most of the other expedition members followed four days later in another packet, the Forerunner.

  The Niger did not hold the same romance as the Nile in the eyes of the Victorians. The river would never have a Livingstone to capture the imagination of the British public, although the romantic Mungo Park, with his Byronic locks and mysterious death in 1806, came close. Nor were its explorers lauded, as the later Nile generation was to be, in the Illustrated London News and asked to speak at the Royal Geographical Society. But in the mid-nineteenth century, the Niger was about to overtake the Nile in commercial importance. After centuries of disagreement over whether the river was a minor tributary of the Nile or a part of the Gambia, the Niger had recently been proved to be a giant waterway in its own right, earning its local name as the ‘River of Rivers’.

  Rising in the hot flatlands of northern Guinea, it flows in a gigantic semi-circle, 2600 miles long, before shattering into innumerable rivulets in the delta that spills into the Bight of Benin. On the way, the muddy grey whale of the Niger passes through regions as disparate as the white desert sands of central Mali and the verdant borderlands of Nigeria’s frontier with Niger. Its massive eastern tributary flows through the thick green forests of central Cameroon which would provide Edgar Rice Burroughs with the setting for his tales of the ape man, Tarzan.

  The fact that the Niger was one of the unhealthiest regions on earth did not deter explorers, missionaries and traders from trying to penetrate it as far as they could. Spurred in part by the Lairds and other European traders, the Niger was about to become the backbone of a huge trade in palm oil that would reach as far as the central Sahara, and lead to the division of West Africa between Britain, France and Germany. The naval surgeon Dr Baikie, with his near-obsessive prescriptions of quinine as a prophylactic against malaria, would ease the way.

  The Forerunner passed through the Bay of Biscay and across to Madeira, where the passengers went briefly ashore to buy fresh bunches of cherries. From there they headed south again, around the West African bulge. Shoals of flying fish leapt out of the water, some landing on deck, where they were scooped up by the ship’s cook. Baikie paid them little attention, for he was too busy reading. Sitting in his stateroom, or, when the weather was not too rough, out on deck, he devoured the accounts of earlier travellers to the region, including Mungo Park, like Baikie a Scot and a naval surgeon, who had fallen sick with ‘the fever’ within less than a month of landing in West Africa after ‘imprudently exposing myself to the night dew, in observing an eclipse of the moon’. Park reported that the next day he found himself ‘attacked with a smart fever and delirium’; his recovery was very slow, and he was prone to relapses. In November 1805, Park’s expedition surgeon, John Martyn, wrote in his journal: ‘Thunder, death and lightning: – the devil to pay: lost by disease Mr Scott, two sailors, four carpenters, and thirt
y-one members of the Royal African Corps, which reduces our numbers to seven.’

  The mortality rate of the earliest expeditions to the Niger was frightening. In the course of Park’s second journey in 1805, of forty-four Europeans who accompanied him from Gambia, thirty-nine died. In 1833, MacGregor Laird, who commissioned the Pleiad and was the son of the principal Liverpool shipowner trading with Africa, had returned with only eight of the forty men with whom he had set out.

  Such hardship would have been familiar too, Baikie read, to the cheerful Lander brothers, two young indentured servants from Truro who found themselves leaderless when their master, Hugh Clapperton, died in Sokoto in April 1827, more than three months’ journey from the sea, before having achieved his goal, the discovery of the source of the Niger.

  Like Mungo Park before them, and indeed Clapperton too, the Landers, especially John, the pensive and naturally studious younger of the two brothers, regularly succumbed to the African remittent fever. Dosing themselves with little more than soda powder and calomel, it is not surprising that they so often began the journal they wrote together with the words: ‘I found my brother in a high fever this morning.’