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The Fever Trail: in Search of the Cure for Malaria

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The Fever Trail: in Search of the Cure for Malaria BOOK REVIEW ginning of the nineteenth century, it was times. Spruce and Ledger died in relative The Fever Trail: In known that cinchona trees could be poverty and Mamani died from a beating Search of the Cure for found, in relatively small numbers, over a he received from the Bolivian police when wide area on the western side of the they tried, unsuccessfully, to make him Malaria Andes and that their taxonomy was com- disclose for whom he was collecting cin- plex. Only a few species had bark with a chona seeds. high yield of quinine, but these were not In the latter part of the book, by Mark Honigsbaum easy to identify, as trees of the same Honigsbaum describes briefly the discov- Farrar, Straus & Giroux, $25.00, 328 pp, 2002 species varied morphologically in differ- ery of the malaria parasite and its vector ent ecological conditions and hybrids and the development of the synthetic were common. Furthermore, cinchona anti-malarials such as chloroquine and the REVIEWED BY BRIAN GREENWOOD trees fruit irregularly so that even when extraction by Chinese scientists of highly London School of Hygiene and Tropical Medicine suitable trees were found, it was at times effective anti-malarials from the plant London, UK necessary to watch them for months, or Artemisia annua. It would be interesting to even years, before seeds and seedlings know more about how this was accom- At a time when the genomes of both could be obtained. These then faced a per- plished but this would require access to Plasmodium falciparum and Anopheles gam- ilous journey down steep trails and rivers Chinese sources. The last chapter of the biae have been deciphered, it is remarkable to the coast followed by a long sea pas- book describes the quest for a malaria vac- that the treatment of severe malaria still sage. Not surprisingly, early attempts at cine with an emphasis on the work of the depends upon an extract of the bark of a exportation failed when seedlings were Colombian scientist Manuel Patarroyo, South American tree first identified by lost to natural disasters or to deliberate thus providing a link back to South Europeans as a cure for malaria nearly 400 damage by local collectors who, justifi- America. However, this chapter seems out years ago. The ‘discovery’ of quinine by ably, feared losing their livelihood. The of place in the book. http://www.nature.com/naturemedicine Spanish colonialists in the first half of the problem of shipment was overcome only As the international community begins seventeenth century and its subsequent with the development by Nathaniel Ward once again to grapple with the problem of introduction into Europe has been de- of sealed boxes with glass malaria in poor countries, scribed several times before. In The Fever walls and tops that allowed there are many relevant Trail, Honigsbaum passes over this part of seedlings to survive ad- lessons to be learnt from the story fairly briskly in this very readable verse conditions over peri- the quinine story and book that concentrates on the efforts of ods of several months. Honigsbaum highlights the European colonial powers to establish The first seedlings estab- these well. Quinine was cinchona plantations in their expanding lished successfully in initially very expensive, as empires in South East Asia. This was con- Batavia were collected by may be the case for some sidered of vital importance because of Justus Hasskarl. Unfor- of the new antimalarials over-exploitation of natural stands of cin- tunately, as a result of ei- under development, and chona in South America, civil unrest ther bad luck or bad this led Cardinal Lugo to © Group 2002 Nature Publishing among many of the newly independent science, these trees introduce a tiered pricing South American republics, an increasing (Cinchona pahudiana) were system for Jesuit bark in appreciation of the public health burden poor quinine producers Rome in the mid-seven- and economic costs of malaria in India as and were subsequently re- teenth century through well as the high mortality from malaria placed by C. ledgeri, which produced bark which the rich subsidized the poor. The among expatriates trading in parts of with a much higher quinine content. transfer of cinchona seedlings from South South East Asia and West Africa. The story These trees were grown from seeds col- America to South East Asia by the colonial of the establishment of cinchona trees lected in Bolivia by Manuel Mamani, a powers, often by underhanded means, outside their natural habitat is an exciting Bolivian Indian, for Ledger, an English can be viewed as a typical example of ex- one involving enormous courage and for- trader and explorer who had spent most ploitation of the resources of poor devel- titude from the cinchona tree hunters but of his life in South America. Ledger’s oping countries by the rich. Markham, also greed, deceit, official insensitivity and brother had tried to sell his seeds to the however, did not see it this way. His ob- bungling and some good and bad science. authorities in London but had been re- jective, which seemed to be genuine, was Honigsbaum tells the story of the remark- buffed. Seeds of another species, C. suc- to make an effective anti-malarial avail- able exploits of Charles-Marie de La cirubra, collected by Richard Spruce, a able in every small shop in India at a price Condamine, Richard Spruce, Charles professional plant collector and colleague (one farthing) that the poor could afford, Ledger, Sir Clements Markham and others of Alfred Russell Wallace, were established a very contemporary objective. For a especially well, perhaps in part because he successfully in the Nilgit Hills in India. while, he succeeded only to run into the has visited several of the sites that played These trees were also poor quinine pro- problem of cartels (the Kina Bureaus in important roles in their expeditions. His ducers but their bark contained other ef- Amsterdam) and various other restrictive own experiences are never allowed to in- fective anti-malarial alkaloids. With the practices. trude on the main story but they must exception of Markham, who became a The Fever Trail is very well written, infor- have given him an enhanced appreciation distinguished President of the Royal mative and entertaining and should ap- of what these explorers achieved. Geographical Society, the contributions peal to a wide audience interested in the The task that faced the cinchona tree of the cinchona tree hunters received lit- history of medicine, exploration or inter- hunters was a formidable one. By the be- tle official recognition during their life- national health. 1346 NATURE MEDICINE • VOLUME 8 • NUMBER 12 • DECEMBER 2002.
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