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  • Quinine: Malaria and the Quest for a Cure that Changed the World
  • Robert Bwire
Fiammetta Rocco. Quinine: Malaria and the Quest for a Cure that Changed the World. HarperCollins Pub. Ltd., 2004. 348 pp. $13.95.

Malaria is one of the world's most devastating diseases, with an estimated 300 million to 500 million cases of malaria and 3 million people dying from the disease annually. Access to effective malaria treatment is an important tool in combating the high morbidity and mortality associated with the disease. In this eloquently flowing book, Rocco skillfully describes the discovery in Peru of the cinchona tree bark, from which quinine is extracted, and its eventual entry into seventeenth-century mainstream medicine as a cure for malaria. Before the discovery of the cinchona bark, malaria treatment in medieval times was based on ineffectual concoctions that were rooted in superstition and an unwavering sense of religious faith. This is perhaps best illustrated by a complicated treatment that involved writing specific words on a piece of paper, then tying the paper to a young virgin using a long string and reciting prayers in honor of the Holy Trinity.

Rocco convincingly and seamlessly weaves the interconnection between the Peruvian Indian knowledge of medicine, the astute observations of Jesuit missionaries, and the devastating effect of malaria in the Roman disoccupato, a sparsely inhabited wasteland, into a logical matrix that conspired to shape the opinion that cinchona bark was an effective cure for malaria, thus ushering in a new era of chemotherapy. Like any new revolutionary concept, cinchona-based treatment for malaria had its proponents and adversaries. The Catholic establishment was enthusiastic about cinchona, while those of the Protestant persuasion were cautious and even contemptuous of a treatment promoted by Jesuits. The merits of cinchona bark also divided the medical community, and the war of words between medical conservatism and the progressive wing of physicians is eloquently depicted in Chiflet versus Conygius. The resourcefulness, sheer determination, and even stubbornness of explorers, botanists, cascarilleros, and adventurers as they combed the South American interior in search of the cinchona tree, and the flourishing trade and bitter rivalry between nations to control the trade, are chronicled with consummate ease. This increasing commercialization led to the wanton destruction of the cinchona tree, threatening to wipe it out from its natural habitat in Peru, Ecuador, and Bolivia. Obtaining cinchona seeds and establishing cinchona cultivation in European colonies outside South America was never going to be an easy task, as the Spanish were opposed to loosening their hold on the lucrative trade. A combination of treachery, smuggling, and outright theft did manage to break the [End Page 229] Spanish monopoly. Cinchona plantations were established in India, Costa Rica, Philippines, Java, and the Congo. However, Rocco cautions that not all is well with the state of cinchona plantations in the twenty-first century. In places like the Congo, where the last remaining plantation of Charles Ledger's quinine-rich cinchona tree species are still found, the tree's very existence is threatened by man and the phytophtora fungus. Hopefully this warning will be heeded, and ways sought to prevent the depletion of this source of affordable quinine, a medicine that remains important in the treatment of severe forms of malaria.

It is in the detailed description of events, the portrayal of the well-known and obscure characters, and the access to rare documents where this book excels as a unique, meticulous undertaking. No location, event, or personage is trivial, and lengthy tidbits are abundant. On the college of cardinals that assembled to elect Pope Gregory's successor in 1623, Rocco narrates how that eminent body not only had to contend with the spiritually demanding task at hand, but had to grapple with the physical and emotional stresses of malaria. She dwells at length on the rituals and rites surrounding the election of a new pope, which would have been outright tedious in a book on cinchona had it not been for her beguiling prose. As much as quinine remains an important drug in the limited armamentarium of malaria treatment, significant microbial resistance to it is developing in Southeast Asia and parts of South America, contrary...

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