The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World

3 The Tree Discovered – Peru

‘Aquí tenían los Jesuitas un local donde expedían al público una corteza febrífuga de la quina o cascarilla.’ (From this place the Jesuits provided the public with a febrifuge made from quinine or bark)

Street plaque on the Jesuit church of San Pedro, Lima

A vicuna, a cinchona tree and the horn of plenty.

The Peruvian national emblem, as seen on every Peruvian coin

In 1663, Sebastiano Bado, a doctor from Genoa, published an account of a story he had heard from an Italian merchant who lived for many years in Lima, the capital of the viceroyalty of Peru.

The Countess of Chinchón, the wife of the Viceroy, fell ill with a tertian fever, which, Bado wrote, ‘in that region is not only frequent but severe and dangerous’. Rumours of the Countess’s impending death spread through the city of Lima and beyond, even reaching the Andean hill town of Loxa, in what is now southern Ecuador. On being told of the Countess’s illness the Prefect of Loxa immediately wrote to her husband recommending a secret remedy he knew of, a concoction made from the bark of a local tree, which he said would cure her of all her ills. The Viceroy sent for the Prefect, who brought with him the remedy. Eagerly the Countess took it, and ‘to the amazement of all’, wrote Bado, ‘she was cured’.

As soon as the people of Lima learned of the Countess’s miraculous recovery they begged her to help them, for they had often suffered from the same fever themselves. The Countess at once agreed. Not only did she tell them what the remedy was, she ordered a large quantity of it to be sent to her so that it could be dispensed to the poor and the sick. In their gratitude the people named the cure ‘the Countess’s Powder’.

For more than three hundred years this sugary story was accepted as the true version of the discovery of quinine, the world’s first pharmaceutical drug, that was carried back to Europe by the grateful Countess. It led to all sorts of literary fancies, most of them mercifully now forgotten. In its day the best-known was Zuma, written in 1817 by the Countess de Genlis, in which an Indian maid in the service of the Viceroy’s household discloses the virtues of the Peruvian bark when her mistress, the Countess of Chinchón, falls ill with malaria. Other variants of this tale include Hualma, the Peruvian, a German novel about the discovery of quinine by a pseudonymous author, W.O. von Horn, and The Saintly Vicereine, a play by a Spanish poet, José María Pemán, the composer of General Franco’s preferred national anthem. Written in 1939, The Saintly Vicereine played for a while to enthusiastic European audiences in search of an evening’s distraction from the impending war, then faded quickly away.

The problem with the story of the Countess’s miraculous discovery, however, is that it is completely untrue.

The Countess of Chinchón died suddenly in Cartagena on 14 January 1641, on her way back from Peru to Madrid, though her husband’s diaries show she was rarely ill before that, and never with anything resembling malaria. Malaria may well have struck the Count, the Viceroy of Peru, on more than one occasion; he even seems to have suffered from it after he returned to Spain. In time he recovered, but the detailed diaries left by his secretary, Antonio Suardo, make no mention of tree barks or miraculous remedies of any description.

That the fable of the Countess’s miraculous cure continued to be retold may have much to do with the fact that cinchona bark, in the early seventeenth century, really was a miracle cure. Here was an incomprehensible disease – malaria, marsh fever or the ague, as it was then called – that had been the scourge of Europe for centuries, while the cure for it was to be found high in the dense forests of a mountain range halfway across the world. The word ‘malaria’ did not then exist, and no one knew what really constituted agues – whether quotidian, tertian or quartan – or how people caught them, let alone how they might be cured of them. Nor, when they came eventually to learn about cinchona bark, did the doctors and apothecarists who prescribed the cure really understand how it worked either.

So how did anyone ever make the connection? How was it possible that a Jesuit priest, with little knowledge of doctoring, came to understand enough about the medicinal properties of the bitter bark to know that it might prove useful in treating malaria, a disease that would not be fully understood for another two centuries?

Some nationalistic South American historians have insisted, with little evidence, that the Spanish conquistadors must have learned about cinchona’s fever-curing qualities from the Incas. While it is certainly true that the local Indians were renowned for their knowledge of plants, poisons and cures, there is scant evidence to support the argument that they knew cinchona bark cured malaria. The conquistadors wrote home about many things in the century after they first arrived in Peru in 1532, but cinchona is not mentioned by any of them. Other historians insist that the Incas kept back the secret of the miraculous fever-tree to show their displeasure at the Spanish occupation. While theoretically possible, this is unlikely, given the extent and complex nature of the contacts between the conquistadors and the local populations they encountered in South America.

The reality is that many Peruvians may not have known that the bark existed at all, at least not as a cure for malaria. The cinchona tree grew in small isolated clumps in the foothills of the high Andes. And although malaria has existed in Peru since the days of Christopher Columbus, it is found in areas of low altitude, as it is in Africa, and not at the heights where the cinchona tree grows most happily.

According to contemporary written accounts, the Indians who lived in the Andes sometimes drank infusions of cinchona bark to stop them shivering. But the observation that it might also cure marsh fever, or tertian ague, came only a century after the first conquistadors arrived in the New World, and it was made not by the local Indians, but by the European visitors.

Two Spanish writers living in Peru were the first to make any detailed description of the effects of cinchona bark on patients suffering from the ague. In 1638 an Augustinian friar and herbalist, Antonio de la Calancha, wrote: ‘A tree grows in the country of Loxa which they call of fevers, whose bark, of cinnamon colour, made into powder given to the weight of two reals of silver in a drink, cures the ague and tertians; it has produced in Lima miraculous results.’

Calancha had been born in Chiquisaca (now Sucre), in the highlands of Bolivia, in 1584. He grew up among the Andean Indians, and was intimately aware of their customs and folk medicine. He entered the Augustinian Order in 1598, and was appointed the Rector of St Idelfonso College in Lima nearly twenty-five years later. Calancha spent much of his adult life writing his nine-hundred-page Corónica moralizada de la orden de N.S.P.S. Agustín en el Peru, and his account of the properties of the cinchona bark was probably written around 1630, the year that the Viceroy, the Count of Chinchón, first fell ill with the ague, as noted in the diary of his secretary, Antonio Suardo.

Another priest, Bernabé Cobó, a Jesuit who arrived in Lima from Spain in 1599, wrote an account of cinchona as a short chapter entitled ‘A Tree for the Ague’ in his magnificent multi-volume Historia del Nuevo Mundo, which was written in 1639 but not widely disseminated for another two centuries. In it he says: ‘In the district of the city of Loxa, diocese of Quito, grow certain kind of large trees, which have bark like cinnamon, a bit coarse and very bitter; which, ground to powder, is given to those who have the ague and with only this remedy it is gone. These powders must be taken to the weight of two reals of silver in wine or any other liquor just before the chill starts. These powders are by now so well known and esteemed, not only in all the Indies, but in Europe, that with insistence they are sent for from Rome.’

The writings of Calancha and Cobó were well known to virtually everyone who has written about cinchona or quinine over the past hundred years. Four other Spanish writers, all of them far more obscure, bear out Calancha and Cobó’s observations that cinchona came to the attention of the Jesuits in Peru in or around 1630.

Gaspar Caldera de la Heredia was born in Seville of Portuguese extraction in 1591 or thereabouts. He studied medicine at the University of Salamanca, practising first in Carmona before settling in Seville, then already the centre of Spanish imports from the Indies. Caldera’s interest in remedies from the New World is easily understood; his father had lived in Mexico, and three of his children went to Lima in 1641, precisely at the time when the use of cinchona in Spain and other parts of Europe was gaining momentum. His writings on cinchona are preceded by a series of letters that he exchanged in 1661 with Girolamo Bardo, the pharmacist at the Jesuit College in Rome and a close collaborator of the doctors from the Santo Spirito hospital who cured Pope Urban VIII of the malaria he caught during the papal conclave that elected him.

Caldera’s Tribunalis Illustrationes et Observationes Practicae, in which he writes about cinchona, was published in 1663, the same year that the Genovese doctor, Sebastiano Bado, published his celebrated book on cinchona, Anastasis Corticis Peruviae Sen Chinae Chinae Defensio. Caldera’s writing shows him to be a learned man, a cautious scientist, a sound clinical practitioner and a faithful witness. Cinchona, he wrote, came from a tree like a large pear tree called quarango by the Indians, who used it as timber. Jesuits at missions in the foothills of the Andes noticed that the Indians drank its powdered bark in hot water when shivering after being exposed to dampness and cold. Quinine has many side effects, some of them quite unpleasant, such as tinnitus, but one of its more beneficial properties is that it can act as a muscle relaxant, which is why it calms the nervous impulse that causes shivering, and why today it is sometimes prescribed for people with pacemakers, or more commonly for those who suffer from leg cramps.

The Jesuits, Caldera noted, believed that cinchona might be effective in checking the shivering that is associated with ague, and they tested the powdered bark on a few patients suffering from quartan and tertian fever. Shortly afterwards, some Jesuits of the missions in Quito took the bark to Gabriel de España, an energetic pharmacist who had his botíca in Lima near the bridge over the Río Rimac, and who was renowned throughout the young city for his knowledge of local medicinal plants. De España began to pass samples of cinchona to a number of physicians as well as other apothecaries in the city, who used the bark in the treatment of intermittent fevers with great success.

Gaspar Bravo de Sobremonte, who studied medicine at the University of Valladolid, where he held several chairs including Surgery, Method and Medicine, also wrote about cinchona. Bravo was considered one of the best physicians of his day, and many of his works were published in Spain and France. In the second edition of his Disputatio Apologetica pro Dogmatica Medicine Praestantia, which was published in 1639, he describes how the Spaniards – ‘us’, he calls them – used Peruvian bark to treat intermittent fevers after observing Indians in Peru drinking the powdered bark in hot water when they were shivering with cold.

In the 1670s, two other Spanish doctors also wrote about the curative effects of cinchona. Pedro Miguel de Heredia (no relation of Gaspar Caldera de la Heredia) studied medicine at one of the greatest of the Spanish faculties, Alcalá de Henares. There he held the chair of Prima of medicine, retaining it several times after the compulsory contests that took place every four years. Miguel left Alcalá de Henares in 1643. More than forty years later, the second edition of his four-volume Operum Medicinalium recounted how the Jesuits in Peru had tested cinchona.

Similarly, Miguel Salado Garcés, who held the chair of Method at the University of Seville and was committed to discovering every new drug that came from America, wrote in 1655 in his Estaciones medicas that ‘the missionaries of the Society of Jesus [in the province of Quito] used the powders of Quarango following the second transit of Galen with great ingenuity, after observing that the Indians took them when shivering from cold after swimming in iced water or from the coldness of the snow, and stop trembling within a short time; [the Jesuits] used them to control the shivering in tertian and quartan fevers: and as they noticed that the repetition of the fever stops, they advised them as a great febrifuge (and they still continue to do so) to cure them …’

Caldera, Bravo, Miguel and Salado Garcés all put the Jesuits at the centre of the story of the early discovery of cinchona in Peru. But who was responsible for gaining it such wide renown in Europe?

In the spring of 1605 a small group of Jesuit priests disembarked at Callao, at the mouth of the Rio Rimac downstream from Lima. For nearly three hundred days they had been tossed about, never knowing a moment’s quiet as they rode the swells of the vast Atlantic Ocean on their journey towards the southern tip of South America. The final part of the voyage, hugging the continent’s west coast, was if anything worse than the open sea. Gigantic waves hurled themselves across the vessel, throwing up thick columns of spray that then collapsed upon the deck, drenching everything in a foamy swirl and threatening to drive the ship onto the jagged rocks.

Now that they had reached dry land, their leader Father Diego de Torres Bollo urged them ashore. As he called for yet more donkeys to carry the supplies that the priests had brought with them from the Holy City, one of their number, a small man in sandals and the rough brown tunic of a lay brother, broke away to look around him.

Agustino Salumbrino was then about twenty-five years old, but his beard was thick and he looked older, for he had started work when he was still very young, and had never taken a single day of rest since. While Salumbrino had already studied and travelled more than most men would have done in a lifetime, he knew that Peru was the place where he would spend the rest of his days. More than that, he knew exactly what he would do with his time there.

Francisco Pizarro’s conquest of Peru in the 1530s was well known to Europeans by the beginning of the seventeenth century, for at least two of the conquistadors who had travelled with him to South America had written widely-read accounts of the magnificent Inca civilisation. Pizarro’s conquest was driven entirely by greed for Inca gold and treasure, but he painted it with a religious sheen to give legitimacy to his actions. Accompanying him on his first journey to the New World was a troop of Dominican priests. Four decades later, on 1 April 1568, the first Jesuit priests, eight of them in all, arrived in Lima.

The city was then only thirty-three years old, and still known by the name Pizarro had given it, La Ciudad de los Reyes. Despite its strange microclimate, which casts a thick fog over the coast for nearly ten months of the year, the City of Kings deeply impressed the small party of Jesuits. They admired the formal chequer pattern of the streets, so characteristic of sixteenth-century Spanish towns, that extended in a straight line right down to the Rio Rimac, which now runs through the centre of the city. They thought highly of the beautiful public square in front of the viceregal palace, the monasteries of the religious communities and the buildings of the civil and ecclesiastical administrators. Father Diego de Bracamonte, one of the newly arrived Jesuits, paid Lima a handsome compliment when he wrote home describing the city as ‘another Seville’.

Among the first tasks to which the young Jesuits set their minds was finding a suitable location for housing the fledgling mission. Before paying a call on the acting Governor, Lope Garcia de Castro, they explored the city. They soon chose a square, three blocks to the east of what is now the Plaza Mayor, which then housed the Viceroy’s palace, and three blocks from the Franciscans, in a rather densely populated area of the city. After a brief public hearing, the Jesuits were granted the expropriated property, for which they were obliged to pay twelve thousand pesos in compensation to its former owners. The transaction, which was completed in just over two weeks, makes it sound as if the Jesuits had arrived in Lima with plenty of money. If anything, the reverse was true: for thirteen years after they moved in to San Pablo the Jesuits had to assign one of their most capable lay brothers to be the limosnero, the man in charge of begging alms on a daily basis from the well-to-do families of the city.

In the early years, the Jesuit College of San Pablo depended for its existence on these donations from the citizens of Lima, and a series of small and sporadic royal grants. In 1581, though, San Pablo took over a property outside the city, and over nearly two centuries, until the Jesuits’ expulsion from the Spanish Empire in 1767, those holdings steadily increased in size until the Society of Jesus became one of the country’s biggest landholders. Its haciendas produced wheat, which was ground into flour in a mill that was also owned by the college. The Society planted new vines and an olive grove, which provided the Jesuit fathers with as much wine and oil as they needed. They raised cattle and goats, and grew sugar cane. A trapiche, or sugar mill, produced sugar and cane syrup. By 1600 San Pablo owned about ten rural properties, of which some were put under intense cultivation while others were used for grazing.

The haciendas fed and clothed all the 160 or so priests who lived at the college in Lima. By the first half of the seventeenth century they also supported two thousand workers whom the Jesuits employed to run their properties, and three hundred slaves who were engaged in the vineyards of San Xavier, picking and pressing the grapes and producing the well-known Jesuit wines, as well as pisco, the traditional Peruvian liquor that is distilled from white grapes. As the haciendas grew bigger and more efficient, they turned from being simple agricultural properties into agro-industrial plants—a fusion of farms with mills, sugar refineries and distilleries – which delivered to Peruvian markets some of the best wines, flowers, sugar, oil and honey available in the viceroyalty.

Over the years many Jesuits sailed across the Atlantic to join the missions that were being set up in Chile and Argentina, as well as Peru, but there was always room for more. In order to expand throughout the viceroyalty, the Jesuit mission in Lima had to have more resources. And that meant more people.

Thus it was that in 1601 Diego de Torres Bollo, one of the senior Jesuit priests at the mission of San Pablo in Lima, left for Rome to petition the Vicar-General of the Order of the Society of Jesus to send more young Jesuits to South America. To reach the Holy City he had had to sail around the north-west coast of South America to Panama, then travel by mule over the isthmus to Puertobelo before resuming his journey once again by ship. The voyage took many months, and was fraught with danger. Not long after he arrived, Torres Bollo fell ill and was admitted to the Jesuit infirmary in Rome. The man who took care of him was Agustino Salumbrino.

Salumbrino had joined the Jesuits in 1588. After taking his vows in Rome in 1590, he was sent to the Jesuit college in Milan to become an infirmarian. There he made a special study of pharmacy, and when, after a few years, he returned to Rome, he resolved to put his medical knowledge at the service of the many Jesuits who lived in the Holy City. In the course of his convalescence, Torres Bollo, who would later found the Jesuit mission in Paraguay, told Salumbrino all about St Ignatius’ missions in the New World, and the great college of San Pablo which was being built in the young city of Lima. He described the plans the Peruvian Jesuits had for setting up new missions over the whole continent.