by Burch, Druin
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In south-east England the marshes were as deadly as those of the Roman flatlands. Anopheles atroparvus was the mosquito that spread English malaria, and parish records showed that it harvested a great many souls. For hundreds of years the death rates in marshland parishes were greater than births – only a constant influx of migrants kept the communities from slipping whole into their sodden graves. The country was ripe for the arrival of an effective treatment against malaria. The Jesuit bark, however, was too much of a Catholic invention to be trusted by such a Protestant country.
One man with no qualms about Catholicism, orthodoxy or innovation was Kenelm Digby. When Kenelm was a toddler his Catholic father Everard tried to blow up the Houses of Parliament. Along with Guy Fawkes and the other plotters he went to the scaffold.2 Kenelm lived a life of romance, piracy, politics and science. When his wife died in 1633 he was heartbroken, commissioning a eulogy by Ben Jonson and a portrait by Van Dyck before retreating for comfort to his academic researches. He played a part in discovering oxygen, authored a famous cookbook (The Closet of the Eminently Learned Sir Kenelme Digbie Knight Opened, published posthumously in 1669), helped found the Royal Society and developed the modern form of the wine bottle (strengthening the glass so that the wine inside could slowly mature). He also popularised his ‘Powder of Sympathy’. Crossing the line between natural philosophy and magic – a line whose location was as unclear to Digby as to his contemporary Newton – this was a preparation of copper sulphate believed to harness astrological powers. It was to treat wounds, but not to be applied to them. Instead the powder was meant to go on the weapon that had caused them. ‘Sympathy’ would cause the wound to heal in response. In a real way it was a genuine life-saver – in a world where poultices and dressings were toxic and infested with germs, slapping a treatment on a weapon rather than a wound was, a great protection to the suffering.
Having fled England during the early 1640s, and stayed away during the Civil War, Kenelm Digby returned in 1655. He brought with him news of ‘the bark of a tree that infallibly cureth all intermittent fevers. It cometh from Peru, and is that bark of a tree called by the Spaniards kina-kina.’ (Confusion over exactly what tree the bark really came from persisted, problematically. Contemporary reports muddle up the Peruvian balsam tree with the cinchona that produced quinine. To add to the chaos there were also many different types of cinchona, some of which contained so little of the key drug as to be useless.)
Three years later, in 1658, the treatment using cinchona – what Digby called kina-kina – was being advertised in the English press, a London weekly newspaper carrying a notice that ‘the excellent powder, known by the name of “Jesuits’ Powder”, may be obtained . . . at the lodgings of Mr James Thompson, merchant from Antwerp, or at Mr John Crook’s, bookseller, with directions for its use’.
Despite the swell of popular interest, and even the approval of the president of the Royal College of Physicians, no one was really certain what to make of the powder. That year an alderman of the City of London was given it. He died. In a country where Catholics were blamed for everything, the Jesuitical powder was suspected of being murderous. When Oliver Cromwell fell ill with malaria that September, it was said that he refused to touch a powder so tainted with papacy, submitting instead to the treatments of his physicians, whose bleedings and drugs helped hurry him into the grave.3
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Robert Talbor grew up in the marshy fens of Cambridgeshire. He attended the university there for a few years but left in 1668 without getting a degree. He chose to settle in Essex. The coastal swamps of the county appealed to him, he said, for exactly the reasons other people might want to avoid them. ‘I planted myself near the seaside,’ explained Tabor, ‘where the agues are the epidemical diseases.’
Four years later he was confident enough in his researches to publish them. Going into print was a fine way then, as it is today, for a doctor to attract a reputation and a paying clientele. Talbor warned people away from Jesuits’ powder, ‘for I have seen most dangerous effects follow the taking of the Medicine’. He did admit that in the right hands this ‘Powder [was] not altogether to be condemned’ but said he had something better to offer, something less tainted by associations with Rome.
The early history of Talbor’s efforts was partially uncovered when Rudolph Siegel, a twentieth-century medical historian researching Galen and his teachings, bought a copy of Leclerc’s 1702 Histoire de la médecine. There, scribbled on the fly-leaves, was a first-hand account of ‘how Quinquina became finally established all over Europe’. Siegel and a colleague were unable to determine the name of the man who wrote it, but established that he was a French nobleman. From 1672 to 1678 France and the Dutch were at war, and for two years from 1672 England joined in on the side of the French. The unidentified French nobleman was recuperating at that time in England. ‘Being very ill with an intermittent fever which I contracted in Flanders and which afflicted almost our entire army during that year, the woman attending our quarters brought to me a very poor man who had cured several of my servants.’ The man was Robert Talbor and, despite his appearance of dishevelled poverty, his self-confidence was enough for the French officer to swallow the cure that he offered, ‘a powder steeped in a large glass of white wine’. It worked:
I was able to embark on my week’s service at the Court of King Charles II, who however had to go by water to Sheerness, the most fever-ridden place in the whole of England. I told this to my little doctor, who gave me permission not only to go there, but also to amuse myself swimming, and even in debauchery if I felt inclined. Thus, when I went on board ship I could not avoid telling the whole story to the most inquisitive King in the whole world, who is also the greatest patron of empirics.
The description of Charles II’s interest in and support for science was accurate. On 28 November 1660, only a few months after his Restoration, the Society of London for the Improvement of Natural Knowledge was founded. Known as the Royal Society, it was supported by the monarch who gave it its charter in 1662. Fighting against the pervasive influence of dogma – of inherited wisdom – the Society sought to pursue new ways of finding out about the world. Knowledge was no longer to be something that belonged to people by virtue of their eminence and reputation; instead it was for all those who knew the methods for finding it. This was Francis Bacon’s ‘experimental’ philosophy. The Society’s motto, Nullius in Verba, may be roughly translated as ‘Nothing in Words’. No matter how respected or senior a teacher, what he said was not to be taken as dogma. Members of the Royal Society wanted conclusions that followed unavoidably from clearly described and repeatable experiments, not the words of experts. Like Talbor, the Royal Society was interested in quinine and performed experiments with it. Despite Bacon’s efforts however, the Society’s broader idea – that truth was something that needed to be uncovered by rigorous experiment – remained radical.
The ingredients of Talbor’s medicine were his secret. He wrote that it consisted of ‘a preparation of four vegetables’, two being foreign and two domestic. Hearing about its powers, Charles II demanded to meet Talbor, and, according to the French nobleman, personally organised experiments. He asked his own physicians to analyse Tabor’s cure, to see what it contained that had so powerful an effect. When they proved unable to do this, the king ‘gave [Talbor] a pension of 300 pieces and a Knighthood and made him one of his personal physicians’. The deal was that Talbor would reveal his ingredients to the king, and in return the king would keep the secret safe for the length of Talbor’s life. The secret turned out, of course, to be Jesuit bark, fashionably repackaged. (The other ‘vegetables’ were rose leaves, lemon juice and, mixing everything together, grapes in the form of wine.)
Charles II used Talbor’s success to poke fun at his physicians. Following the death of the London alderman from the Jesuit bark, they ‘had expressly forbidden . . . Quinquina as a useless and dangerous drug’. Then, in 1679 while at Windsor Palace, Charles II fell il
l with malaria. Convinced that Jesuit bark was the only thing that could save his life, he demanded to be given it. His royal wish was granted, and he rapidly recovered. ‘After which, the King . . . pressed Dr. Lower maliciously, asking him how the very thing which was so bad for [him] had become so wonderfully good for him.’
Embarrassed, Dr Lower replied ‘that this was a remedy from which only kings were worthy of profiting’. It was as close as the royal physician could get to admitting an error.
Other accounts hold that it was with Louis XIV that Talbor struck his deal for a pension and secrecy, in return for the ingredients and the right to publish them for the benefits of mankind after Talbor’s death. Certainly it is true that, once Talbor died in 1681, The English Remedy or Talbor’s Wonderful Secret for Curing of Agues and Fevers, was published originally in French and by Louis’s own doctor.4 The account of Talbor’s dealings with Charles II, however, were noted down at first hand by the French nobleman who introduced them.
Whatever the truth of the slightly conflicting details, two things are certain. Jesuits’ bark slowly became established as an effective remedy – although its popularity, despite the fact it was unique as a curative therapy, neither exceeded nor replaced that for bleeding. (Even by the middle of the nineteenth century, bleeding, vomiting and drugs to cause diarrhoea were, along with ‘the unlimited use of coffee and whisky . . . the treatments for malaria favoured particularly by the [American] frontiersmen’.) Secondly, the world had changed in other ways. Curiosity and empiricism were becoming respectable.
Cinchona – Jesuits’ Bark – is not an example of the tremendous wisdom of traditional therapies. It is difficult to know how it was originally used amongst the natives of South America, but it was not for malaria. Until the Europeans arrived and inadvertently brought it with them, that disease did not exist.
What seems to have been discovered early on by the South Americans, before malaria arrived, was that certain barks reduced fevers. To the extent that they used bark to ease symptoms and suffering, they were using it in a way that deserves the name of medicine. Fever, though, is not a disease. Instead it is part of the body’s response to infection, part of the body’s defence against illness. Living creatures, even very simple ones, are exquisitely sensitive to temperature. When we are infected, our bodies raise their core temperatures purposefully. This makes us uncomfortable, distressed, even delirious and confused, but it makes life more difficult for invading infective organisms. We suffer when our core temperature rises, but bacteria breeding within us suffer more.
Reducing an adult’s fever, in other words, can have two sorts of effect. It can make you feel better. And, by stopping your body fighting off an infection, it can make you actually get sicker. Abolishing a fever can be like going into battle with your eyes shut: the experience might cause less distress, but you are not necessarily safer.
Cinchona for malaria acts differently. The South Americans and the Europeans that started using it did so because they thought it reduced fever – which it does. But it also directly kills the plasmodium that causes malaria. The fever fades away partly because the drug directly reduces it, but also subsides because the drug kills the living creature that prompts the fever to begin with.
On 30 July 1809, the British landed in the Low Countries, in what is now Holland. Their force of almost 40,000 troops was the largest of their long campaign against the armies of Napoleon’s France. Their aim was to destroy a major French fleet (which had already moved somewhere else) and to support the Austrians (who had already been defeated).
The British occupied a swamp-filled island called Walcheren. During the four and a half months they spent there, over 4,000 of their men died. Just over a hundred lost their lives in battle; the rest succumbed to feverish illness. Malaria, possibly in combination with typhus, was chiefly responsible. The British withdrew in December. More than a year later 12,000 campaign veterans were still sick.
The military need for Jesuit bark was clear. Yet getting hold of the bark was not easy. The cinchonas grew thousands of metres above sea level in spectacularly inaccessible regions of the Andes, protected by the Amazon to one side and the rainforest to the other. Added to this the trees varied hugely in hue, shape and size, and they hybridised with one another so cheerfully as to be perpetually inconsistent to those who wanted to harvest them.
In the wake of Vesalius’s 1543 De humani corporis fabrica, anatomy had come to be studied seriously and methodically. The long eighteenth century had seen widespread developments in physiology, while chemistry had developed into a discipline that was beginning to correctly identify elements and compounds. In the second decade of the nineteenth century – too late for the soldiers of Walcheren – several people successfully isolated the most active compound within cinchona bark. Quinine, as it came to be called, was found at different concentrations in the different species of trees. Pelletier and Caventou published their 1820 ‘Chemical Researches on the Quinquinas’ in the Parisian scientific journal Annales de Chimie et de Physique. The paper opened up the way to identifying the most useful varieties of cinchona, but otherwise the discovery was strictly an advance in Chimie and not in Physique. Identifying the active ingredient of cinchona did not enable anyone to manufacture it. The molecules of living organisms were not only beyond the reach of chemists, they were thought to be permanently so. These ‘organic’ molecules, as they were called, were believed only to result from the processes of living cells, not from the experiments of chemists. Many believed that this was because they contained some fragment of soul, some portion of a quality that had been placed there by God in His creation of life. Human efforts to do the same with artifice were widely held to be futile.
Unable to manufacture quinine themselves, people continued their efforts to get hold of the tree. From 1829, European attempts to remove cinchona seeds from South America for cultivation elsewhere in their empires were supplemented by plans to steal away entire trees. Nathaniel Ward, a British family doctor from London, while attempting to devise better ways of hatching out butterflies, discovered a way of protecting living plants in sealed boxes. These Wardian cases made transportation easier, enabling the importation of exotic flowers and the successful smuggling of precious tea plants out of China. The cinchona proved more difficult. From the late 1850s a host of repeated efforts were under way, with English explorers like Richard Spruce, Clements Markham and Charles Ledger organising expeditions to find, transport and replant seeds and seedlings.
Success came only gradually. International cultivation of cinchona proceeded energetically as the nineteenth century closed, but early results were mixed. Initial plantings abroad were in the Dutch colony of Java and the English ones of India and what was then Ceylon. Only in the twentieth century did these efforts, combined with the over-exploitation of natural sources in South America, lead to the bulk of quinine coming from cultivation.
Medical recognition that quinine was effective for treating malaria was largely a matter of luck. The treatment was so good that haphazard observations were sufficient to notice it. It meant that doctors were more effective than they had been before, but no better able to understand the means by which they could continue to improve. What was missing was method.
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1 A parallel can be made with anatomy. The teachings of Galen, which had muddled up human and non-human anatomical structures, overpowered the early anatomists. When, in the dawning Renaissance, they began to open up human corpses and look with their own eyes, their prejudices misled them. Even men like Leonardo da Vinci saw and drew not what was in front of them, but what Galen had taught them to expect. Their expectations moulded their experience. It is hard to imagine a clearer example of the fallibilities of human insight and observation.
2 John Aubrey reported the death. The executioner, he said, pulled out Everard’s heart and announced it to be that of a traitor. ‘Thou liest!’ replied the dying man.
3 The branding of a drug, even in the sev
enteenth century, was everything. The story of Cromwell refusing the powder was apocryphal. The prejudice against the powder was real.
4 Talbor definitely went to France. In 1677, when her own doctors were attempting to cure Louis’s niece of malaria by making her vomit to the point of collapse, Talbor was there with his alternative remedy.
4 Learning to Experiment
THE SUMERIANS SMEARED their wounds with salves. Acids and herbs were some of the ingredients, others were salt, oil, juniper berries, beer, wine, mud and animal fat. Some of these, like salt and strong acids or alkalis, are quite capable of killing bacteria – but kill human cells as well. Others, like mud and meat, contain the sort of germs you want to keep as far away from damaged flesh as possible. Yet intervention remained easier for people to believe in than leaving well alone. After the civilisation of Sumer faded, the Egyptians were covering up their own wounds with similar mixes of meat, grease, honey, ostrich eggs, figs, milk, antelope fat and willow leaves.
What was lacking was not so much a drug that would kill infections – or even a comprehensive understanding of what infections actually were – but a way of being able to tell what worked from what did not. People believed in their own instincts, in the reliability of their intuitions.
They were wrong. Many wounds got better by themselves, many healed up despite being covered with muck. Others festered and people died. Yet without structure to their observations, it was impossible to reliably distinguish the effects of luck from those of useful treatments. Cinchona, when it arrived, had a tremendous effect on malaria, yet people were still opting for bleeding – which helped kill – three hundred years after cinchona reached Europe. What chance did anyone have of noticing a drug whose effect was not massive, like cinchona’s, but only moderate?