The Fever Trail: In Search of the Cure for Malaria (review)

For centuries, malaria has been both a scourge to mankind and, in good proportion, the source of numerous popular histories. Contributions from recent decades include Robert S. Desowitz, The Malarial Capers (1991); Gordon A. Harrison, Mosquitoes, Malaria and Man (1978); Leon Joseph Warshaw, Malaria: Biography of a Killer (1949); and Marie Louise Duran-Reynals, The Fever Bark Tree (1946)—to name a few. True to this honored genre is Mark Honigsbaum's new book, The Fever Trail.

Honigsbaum traces several threads of malaria's complex history, giving brief glimpses into the nineteenth-century world of colonial exploration and exploitation and also into the world of twentieth-century vaccine research. The first two-thirds of the book deal with the earlier period and the history of the febrifuge bark of the cinchona tree. A crucial turning point was the isolation of quinine from cinchona bark in 1820, which allowed the control of dosage and made the trees and their bark still more valuable. Thus, Honigsbaum offers first a series of ripping yarns of exploration and personal hardships, and, in the end, research—the research adventure being the compelling and sometimes troubling tale of vaccine research in Colombia today, a story that seems only tenuously connected to the rough-and-rugged saga that precedes it.

Overall, the book is character-driven. The four protagonists—three nineteenth-century Britons and a living Colombian scientist—leave one thinking "one of these things is not like the others": Richard Spruce (1817-93), a hypochondriac Yorkshire botanist; Charles Ledger (1818-1905), a cockney schemer; Clements Markham (1830-1916), an explorer, civil servant, and later president of the Royal Geographical Society; and, finally, Manuel Elkin Patarroyo (b. 1947), trained in medicine, virology, and immunology. Honigsbaum includes a host of minor characters: standards of the malaria story, such as Ronald Ross and Alphonse Laveran, and the stand-bys of quinine's history, including Alexander Humboldt, H. A. Weddell, Joseph de Jussieu, and Justus Hasskarl. Larger than life, Honigsbaum's big four are rendered in careful, but largely uncritical, detail. Spruce, Ledger, and Markham all hunted for the cinchona trees in the Andes, and none was particularly well rewarded for his efforts there: Spruce and Ledger died bitter and poor, and Markham's success in life did not hinge on his cinchona connections. In the battle against malaria, Ledger scored a victory without great personal satisfaction: the seeds he smuggled out of South America became the basis of the dominant and economically viable Dutch East Indies plantations in Java. The legacy of Patarroyo remains to be seen: he is still at work on his SPf66 vaccines, wild owl monkeys, and human subjects.

Honigsbaum is a journalist, not a physician or historian, and his approach to the historical and scientific record is not analytical. Oddly, the book also lacks a continuous narrative thread and is episodic, skipping about in time and location, while the lack of textual footnotes often makes it difficult to connect particular facts with specific sources. Honigsbaum gives little attention to Patarroyo's prospects or to other vaccine workers. Likewise, he glosses over nonquinine malaria chemotherapy and the history of vector control, giving DDT scarce mention. Of course, one cannot include everything, especially in treating a story as long and complicated as that of malaria and quinine. While Honigsbaum raises Richard Spruce from relative obscurity, gives a stirring account of the South American frontier, and offers those outside Colombia a view of Manuel Elkin Patarroyo, he gives us little that is new. Nevertheless, he keeps in print much that is interesting and, given the toll of malaria throughout the world, timely.