The Fever Trail

Title: The Fever Trail – In Search of the Cure for Malaria

Author: Mark Honigsbaum

Publisher: Pan Books, 2002 (First published 2001)

ISBN: 9780330481854

Pages: 333

Malaria is a scourge of mankind. Till a few centuries back, it afflicted all parts of the globe with equal severity, but is now confined mainly to the Third World. Millions of children die every year in sub-Saharan Africa due to this illness and the drain on the economy caused by the incapacitation of healthy individuals is considerable. It has killed 60 times more people than AIDS. The book presents a detailed historical narrative of the search for finding a cure for malaria. It tells the story of finding a natural cure in the bark of the cinchona tree in its natural habitat of South America and the epic struggle by a few spirited explorers to get its seeds out to the whole world for starting cultivations elsewhere. The book ends with a brief description of the state of the art in finding a vaccine for it. Mark Honigsbaum is a medical historian and journalist with a long standing interest in the history and science of infectious diseases. He is a regular contributor to British newspapers and has authored four books.

The cinchona plant is a miracle, in the sense that its bark contains the cure for malaria. The case of a single plant being the only effective remedy for a killer disease is rare. It is equally miraculous that man found out about the tree and its gift, as historians suggest that malaria was not endemic to South America. The disease came with the conquistadores from the Old World. The question of who discovered the febrifugal property of the plant may never be answered, but urban legend associates its widespread use with Dona Francisca Henriquez de Ribera, the fourth Countess of Chinchon in Spain, who was the vicereine of Peru. Legend has it that she became ill with malaria and the viceroy despaired of her life. When all else failed, a local Jesuit priest suggested the dried bark of a tree called ayac cara (bitter bark) or quinquina (bark of barks). The lady was cured after administering the bark and the story spread like wildfire. When Carl Linnaeus, the father of taxonomy was faced with the task of naming the species, he settled on cinchona, somehow omitting the first ‘h’ of the lady’s estate. The plant’s original habitat was South America. The finest cinchonas were very particular about the region in which they thrived. The best trees were found on the slopes of Cajanuma Mountain in the Loja province of Ecuador. Honigsbaum don’t keep the reader in suspense of how malaria came to the New World. He ascribes this with the slave trade, in which tens of thousands of Blacks were transported forcibly from the malaria-infected river banks of Africa. Some of the Africans have a natural genetic defence against the disease in the form of sickle-shaped cells in their blood stream, but they act as carriers of the sickness. It is notable that Africans were vulnerable to malaria for indeed a very long time that evolution has favoured a group of individuals with the trait of sickle cells, which of course produces other debilitating effects. The mosquitos which flourished in the half-cleared swamps of South America vectored the parasite Plasmodium falciparum among the natives as well as European settlers.

The book tells the story of transplantation of cinchona trees from South America to India and Java. By the 19^th century, quinine production had started on an industrial scale. Having the monopoly of the bark, the governments of Peru, Bolivia and Ecuador jealously guarded the trees, forbidding export of live plants and seeds. As the bark grew dearer in price, smuggling rose proportionately. Besides, excessive harvest of bark and indiscriminate felling of trees threatened the existence of the species itself. The British and Dutch governments watched the emerging scenario with growing alarm. The South American republics often fought amongst themselves and were breeding grounds for bloody revolutions and coups. Even though it amounted to looting of the biological asset of a sovereign state, it was in the interest of humanity to transplant the trees to save it from extinction and to produce quinine in large quantities for selling to the public at affordable prices. Several teams tried their luck on the slopes of Andes and its foot hills. Richard Spruce, Clements Markham and Charles Ledger were successful in getting the plants and seeds out of South America. However, while haggling over the price, some of it reached the hands of the Dutch. Soon, large gardens of cinchonas sprouted in Dutch Java and at Nilgiri and Darjeeling in India. The Javan plantations carefully grafted the trees to obtain fine specimens with huge quinine content, while the Indian trees got hybridized due to lack of scientific cultivation. Consequently, the cost of Javan quinine was lesser. The Dutch could sell it with greater profit too. By the 1880s, quinine price had reached rock bottom due to increased production in Asia. The South American bark industry collapsed as a result.

Even though the author gives an exhaustive description of the quest for cinchona trees – even by narrating the day to day incidents during the exploration – he glosses over the heroic search for the vector of the disease and Ronald Ross’ discovery that the mosquito was the medium of propagation of the disease. Common wisdom was that malaria was spread through foul air – miasma – found in the presence of swamps and marshes. This was overturned only in the 19^th century when researchers identified the mosquito to be the real culprit. Honigsbaum quotes Susruta, who was an ancient proponent of medical profession that five varieties of diseases are caused by mosquitos. But it is to be noted that Susruta does not identify malaria as such and definitely, this observation was far advanced than the medical line of thought in the middle ages.

The final few chapters of the book are devoted to the quest for finding a synthetic prophylaxis against the disease. Chloroquine is one of the most widely used remedy, but researchers are worried that the malaria parasite is growing resistance to the medicine. This is a terrifying prospect for global society considering the ease with which the malady spreads and it’s long lasting debilitating effects. The falciparum parasite was evolved a very long time ago, conferring on it many genetic traits for survival. A close ancestor of the parasite even has the ability to produce chlorophyll, showing its origin in the remotest antiquity when life itself made its first waddling steps. The book ends with a survey of the quest for finding a vaccine to malaria so that it can be prevented from affecting an individual, rather than as a cure. Researchers are working on the project worldwide, but big pharma’s budget is still not being allocated to it in sufficient measure. Among the researchers in the forefront of the study, the author gives pride of place to Manuel Elkin Patarroyo, a highly influential Colombian researcher. Even though his methodology appears to be a little dubious, his vaccine named SPf66 is still the most efficacious one, though it has much more miles to go before universal adoption. Honigsbaum ends the narrative describing the many initiatives which were projected to be on the verge of bearing fruit. This book was published in 2001, but even now, a vaccine for malaria is still elusive.

The book is very nicely structured with clear text accompanied by good photographic plates and maps. An informative section of foot-notes is given along with an exhaustive bibliography and a thoroughly comprehensive index. The narrative is very lucid and appeals to all classes of readers. The book includes flowery praise for the philanthropic contributions of the Wellcome Trust. However, when we realize that the author is currently working as a Wellcome Research Fellow at Queen Mary University in London, we begin to have doubts on the veracity of the assertion.

The book is highly recommended.

Rating: 3 Star