The Miraculous Fever-Tree Read online

  Sitting one lonely evening outside a grass hut assigned to him by a friendly local chief who also sent along a plate of little cakes made of pounded corn, the normally cheery Richard wrote of his younger brother: ‘Towards evening he became worse, and I expected every moment to be his last. The unhappy fate of my late master, Captain Clapperton, came forcibly to my mind. I had followed him into this country where he perished; I had attended him in his parting moments; I had performed the last mournful office for him which our nature requires, and the thought that I should have to go through the same sad ceremonies for my brother overwhelmed me with grief.’

  Despite his brother’s fears, John did not die that night. But the Landers’ experience, and that of the travellers who had preceded them up the Niger, made Baikie all the more resolute about guarding the health of the passengers and crew of the Pleiad. As the only medical officer on board, the responsibility would fall to him. He was determined that the expedition would adhere to a strict medical and dietary regime. All its members would have to take daily doses of quinine, which Baikie had seen used in the West Indies and in the eastern Mediterranean, and which had had such success in treating tertian ague and intermittent fevers in the marshy lands of England and continental Europe.

  By the time the Forerunner caught up with the Pleiad near Fernando Po after a month at sea, though, Baikie had more immediate problems on his hands. The leader of the expedition, John Beecroft, the British Consul of the Bight of Benin and Biafra, had fallen ill and soon died. Baikie, as the highest-ranking government officer left on board, had no alternative but to take charge himself. He was not yet thirty, and had never set foot in Africa.

  Among the many books and journals he had read on the month-long journey out to West Africa was the medical journal of an expedition nearly twenty years before which had been led by another Scottish naval surgeon, James Ormiston MacWilliam. MacWilliam’s record of the endless recurrent fevers with which the passengers and crew fell ill, and the harrowing accounts of their treatment, cannot fail to have impressed Baikie. Like so many doctors before him, MacWilliam favoured castor oil, enemas, mercury, bloodletting and blistering, especially on the back of the neck. Such treatments were difficult enough to administer even in a European sickroom, and one wonders how many patients succumbed to infection after a bloodletting, however well intentioned, in the thick humidity of the West African coast.

  What is most interesting in MacWilliam’s account is the importance that he places on prescribing quinine. Of his sixty-two crewmen, at least fifty-five fell ill with what he calls African remittent fever. He dosed them all with quinine. Although by the end of the expedition sixteen had died, that was half the ratio that the British Army had come to expect among soldiers posted to the West African coast. ‘No medicine was found so efficacious,’ MacWilliam wrote in his medical memoir of the Niger expedition, ‘as quinine.’

  As the Pleiad began its journey up the Niger delta, Baikie was so taken up with the novelty of Africa – the lush vegetation that tumbled into the grey river, the roars of animals he could not see on the forested riverbank, the piles of ivory and hippo teeth to be bought by day, and the sight of the Southern Cross in the sky by night – that he paid little attention to his growing dislike of the ship’s sailing-master. By all accounts, Thomas Taylor could not have been more different from the serious-minded Baikie. He drank on watch, bullied the Pleiad’s African crew and forced them to work on the Sabbath, which caused the God-fearing Baikie to purse his lips in disapproval.

  For as long as they needed to, the two men tolerated each other. But in early October, when the Pleiad had been on the river for nearly three months and had penetrated as far as Dulti, further than any European transport had been before, Taylor’s inattention caused the ship to run aground. ‘The real cause was too apparent,’ Baikie wrote. Two weeks later, despite having been severely reprimanded, Taylor ran the Pleiad aground a second time. But it was the discovery that the crew were beginning to show symptoms of scurvy that led Baikie to relieve Taylor of his command. That the Pleiad’s crew was suffering from a deficiency of vitamin C, which had been almost unheard of in the Royal Navy in the eighty years since Captain Cook proved that the simple introduction of lemon juice into the diet was enough to prevent it, was the direct result of Taylor’s tight-fistedness in victualling the ship with rice and little else. With the help of Daniel May, the second master, Baikie took over the ship himself, and immediately put ashore to buy supplies of meat and fresh fruit.

  Baikie’s assumption of responsibility for the Pleiad and her passengers and crew did much to foster the young doctor’s capacity for decisive leadership. It no doubt also allowed him to be extra vigilant in enforcing the medical regime he had planned. No one on the Pleiad was going to fail to guard against the fever by taking quinine.

  At the end of the expedition Baikie returned home and wrote a book about his travels, which went by the cumbersome title of A Narrative of An Exploring Voyage up the Rivers Kwo’ra and Bi’nue (commonly known as the Niger and the Tsadda), published in 1856. Although it lacks the verve of the later accounts of Henry Morton Stanley, who was as much a show-off as Baikie was a puritan, or the fervent zeal of David Livingstone, the energy and enthusiasm of Baikie’s book carries the reader with him.

  Even more fascinating is the forty-page treatise that he wrote about his success with quinine, which is lodged in the British Library but has never been published. Baikie had reason to be pleased with the care he bestowed on his fellow travellers, and they in turn were more than grateful to him. Of the twelve Europeans and fifty-four Africans aboard the Pleiad, one was murdered and another drowned when he fell into the Niger. Not one died of the fever. ‘While up the Niger in 1854 I had ample opportunity for testing this virtue [of regular doses of quinine], and I most unhesitatingly record my belief in its existence. While in swampy districts it was regularly administered, and its use continued for about a fortnight afterwards, and among twelve Europeans hardly any sickness occurred during our stay of four months in what has hitherto been considered a most unhealthy river.’

  ‘One of the greatest improvements in tropical medical practice of late years,’ wrote Baikie in his neat copperplate after a long preamble on the complicated nature of the various remittent fevers, ‘has been the employment of quinine not as a curative agent but as a prophylactic or preventive.’ Baikie had insisted that the passengers and crew of the Pleiad take a daily dose of six or eight grains of quinine, half in the morning and half in the evening, ‘dissolved in sherry,’ he insisted, ‘as in the Naval service’.

  Baikie had seen quinine used to great effect in the West Indies and in Smyrna in Asia Minor, where malaria was particularly rife. His faith in it was based on observation and experience, for he knew nothing about the root causes of malaria, or how quinine cured it. In his attitude towards medicine he was far less like the Europeans and Americans who, over the centuries, have arrived in Africa with fixed ideas and an arrogant insistence that things were not done well unless they were done their way, and more like the independently-minded settlers who used their inventiveness to devise ways of working—planting, healing, repairing – that best suited the environment in which they found themselves.

  That attitude did not stop Baikie, however, from devising elaborate theories about the causes of malaria and how to be rid of it. Although he wrote often of being attacked by insects, and even, when he was particularly vexed, by ‘legions of bloodthirsty mosquitoes’, he never suspected them to be carriers of the disease. Instead, he subscribed to the common notion that malaria was something that grew naturally out of the vegetation in marshy areas. ‘Walking along pathways through the brushwood,’ wrote one of his fellow travellers on the Pleiad, ‘and far away from what we are apt to consider as the indispensibles of decomposition, we occasionally become conscious of a “steamy vapour”, which flies up with intensity sufficient to bring on an attack of ague (with persons predisposed to it) in the course of a few hours.’ The
free circulation of oxygen, the German chemist Justus von Liebig wrote not long before Baikie left England, was ‘the enemy and opponent of all contagion and miasma’. While Liebig’s pronouncement had made sense in Europe, in the midst of the Niger delta, with as much oxygen as was imaginable, the fever and ‘miasma’ or ‘steamy vapours’ that caused fever were still ever-present.

  Baikie took up another theory set out in MacWilliam’s memoirs, namely that malaria was caused either by ‘submarine volcanic action’, or the ‘reaction of vegetable matter upon the saline contents of the water’. Decaying vegetable matter, Baikie had been told by a distinguished chemist named Professor Daniel, ‘abstracts the oxygen from the sulphate of soda contained in sea water, and a sulphured of sodium is formed. This again, acting upon the water, decomposes it, and sulphuretted hydrogen gas is one of the products of the decomposition.’ Without explaining quite what this gas might be, the inference was nonetheless clear: that sulphuretted hydrogen gas was the basis of malaria.

  Baikie set one of the expedition members to collecting water samples. Eight bottles of water from different parts of the coast were sent back to Professor Daniel for analysis; none of them proved to contain any more sulphuretted hydrogen gas than was present in a comparative sample from Harrogate.

  However quaint Baikie’s theories seem to us now, his faith in quinine proved enduring. That none of the travellers aboard the Pleiad died of fever in the course of the four-month expedition is remarkable. In the context of what came later, this expedition marked a turning point in the exploration and colonisation of Africa.

  Baikie’s success was not limited to his prevention of malaria. He returned to West Africa at the head of a second expedition, and was soon running one of the most successful trading markets in the region. By this time he had taken to wearing a turban, a long cotton shirt called a tobe, and baggy trousers like a zouave. He had an African mistress and had fathered several children, for whom he translated the Book of Genesis into Hausa. But Baikie would grow bitter and disillusioned in Africa. In 1859 he wrote to his patron Sir Roderick Murchison, by then the President of the Royal Geographical Society: ‘I am entirely exhausted. I have not been in anything like a bed for more than two years. I have had fever on more than 120 separate occasions, not reckoning mere recurrences.’ He died of dysentery on his way home to England in 1864, having got no further than Sierra Leone.

  Seven years after Baikie’s first expedition, and as a direct result of its success in treating the fever, the British government annexed the trading centre of Lagos and the lagoon behind it, thus establishing the beginnings of the first British colony on the West African coast. There was such a rapid expansion in the palm oil trade that MacGregor Laird was encouraged to form the African Steamship Company to cope with it. His efforts led the British government to become more interested in the interior of West Africa, and eventually to support and protect a steamship route up the lower part of the Niger.

  Within twenty years, France and Germany too became directly involved in Africa. It is not hard, looking back, to see the straight line that leads from Baikie’s breakthrough with quinine to the Berlin conference of 1884 that led to the partition of the continent and the takeover of so much of it by the major imperial powers. While it was still not known what caused malaria, its cure, quinine, which had been such a totem to religious power in the seventeenth century, was beginning to turn, as the world changed, into a symbol of the growing power of commerce and exploration.

  7

  To Explore and to War – From America to Panama

  Ma called Pa, and he came in.

  ‘Charles, do look at the girls,’ she said. ‘I do believe they are sick.’

  ‘Well, I don’t feel any too well myself,’ said Pa. ‘First I’m hot and then I’m cold, and I ache all over. Is that the way you feel, girls? Do your very bones ache?’

  LAURA INGALLS WILDER, The Little House on the Prairie (1935)

  ‘Death was constantly gathering its harvest all about me.’

  PHILIPPE BUNAU-VARILLA, during the malaria and yellow fever epidemics in Panama City, 1885

  When Laura Ingalls Wilder set out to write about her family; how her Pa and Ma, Mary and Laura and Baby Carrie left their little house in the Big Woods of Wisconsin and headed out west, she knew she’d be writing about more than just ox wagons and the wide open plains. By the time they’d got to Kansas, the family had been through rising creeks and barren valleys, met a wolf pack, a pair of Indians wearing skunk skins, a Tennessee wildcat and a herd of Texas longhorns. But it wasn’t until the blackberries were ripe, at the end of the summer, that they encountered the fever.

  Laura did not feel very well. One day she felt cold even in the hot sunshine, and she could not get warm by the fire … Ma stopped her work and asked, ‘Where do you ache?’

  Laura didn’t exactly know. She said: ‘I just ache. My legs ache.’ …

  Ma and Pa looked a long time at each other and Ma said, ‘The place for you girls is in bed.’

  It was so queer to be put to bed in the daytime, and Laura was so hot that everything seemed wavering …

  Something dwindled slowly, smaller and smaller, till it was tinier than the tiniest thing. Then slowly it swelled till it was larger than anything could be. Two voices jabbered faster and faster, then a slow voice drawled more slowly than Laura could bear. There were no words only voices.

  Mary was hot in the bed beside her. Mary threw off the covers, and Laura cried because she was so cold. Then she was burning up, and Pa’s hand shook the cup of water. Water spilled down her neck. The tin cup rattled against her teeth till she could hardly drink. Then Ma tucked in the covers and Ma’s hand burned against Laura’s cheek …

  She lay and watched Mrs Scott tidy the house and give medicine to Pa and Ma and Mary. Then it was Laura’s turn. She opened her mouth, and Mrs Scott poured a dreadful bitterness out of a small folded paper on to Laura’s tongue. Laura drank water and swallowed and swallowed and drank again. She could swallow the powder but she couldn’t swallow the bitterness …

  Mrs Scott said that all the settlers, up and down the creek, had fever ‘n’ ague. There were not enough well people to take care of the sick, and she had been going from house to house, working night and day.

  ‘It’s a wonder you ever lived through,’ she said. ‘All of you down at once.’ …

  No one knew, in those days, that fever ‘n’ ague was malaria, and that some mosquitoes give it to people when they bite them.

  Towards the end of summer, when the earth was baked hot and the rivers and creeks were drying up, and they’d been so long without rain to sluice them clean, was the time when malaria used to take hold in the United States. Early travellers complained frequently of suffering from intermittent fevers, agues and fluxes, though only occasionally did they report in detail the presence of malaria’s more particular symptoms – the fever interspersed with shivering and the swollen, painful spleen.

  Like the southern coast of England, it seemed that the eastern coastal areas of North America were prone only to occasional bouts of malaria. But by the end of the seventeenth century the seasonal outbreaks of ‘fever ‘n’ ague’ had become full-blown epidemics, spread in part by a growing population that had no natural immunity to the disease.

  European ships, especially those that sailed in the summer months when malaria was at its most prevalent along the Kent coast, in the Fenlands and throughout East Anglia, were probably the earliest carriers of mosquitoes harbouring the Plasmodium vivax and Plasmodium malariae parasites to the New World. Later, slave ships from Guinea, which first reached the rice-growing areas of the South Carolina coast in the 1680s, quite probably brought the more deadly falciparum strain with them.

  As in Peru, it seems unlikely that malaria existed in North America before the arrival of the white man. By 1610, it may have been present to greet the Governor of Virginia Baron de la Warr, who ‘arriv[ed] in Jamestowne [and] … was welcomed by a hot and violent ague�
��. The colonists’ letters, journals and diaries were soon speaking constantly of enduring the ‘seasonings’ and ‘fevers’. Laura’s ‘fever ‘n’ ague’ followed frontiersmen who landed in New England and made their way to Georgia and all the way to California. The best and most fertile acres, those in the flatlands of rivers, creeks and streams, held the greatest appeal to settlers, and it was natural that those were the areas that the early travellers chose to take over first; but they were also the places where the Anopheles mosquito flourished. From Virginia, where the Jamestown settlement nearly failed completely because of disease, the Reverend John Clayton wrote in 1687 that intermittent fever was first among the illnesses that attacked the English settlers. Another colonist reported that his sister, having suffered from two or three fits of fever and ague, was now well over the ‘seasoning’. A Scottish settler in Tidewater, Virginia, wrote in 1723 that he suffered greatly from ‘fever and Ague wch is a very violent distemper here’, adding rather bitterly that the place was ‘only good for doctors and ministers’.

  In 1735, the wealthy Virginia landowner William Byrd wrote to the Governor of North Carolina, who was suffering from malaria, warning him to take repeated dosages of the ‘Bark’, or else his ‘feaver’ would ‘as surely return as speech to a silent woman’. Thomas Salmon, describing Virginia in 1738, wrung his hands in anxiety that ‘Fevers and Agues, the Gripes and Fluxes are the most common Distempers.’ Similarly, Philip V. Fithian recorded in his journal on 12 August 1774: ‘The conversation at Table was on the Disorders which seem to be growing epidemical, Fevers, Agues, Fluxes – A gloomy train.’ And a new settler was even more anxious when he arrived in 1785, to find that the colony was ‘Esteem’d the most sickly Province this Except Georgia & South Carolina. Fevers and Agues, Plurises, Bilious Fevers rage Terribly … it appears to me like a general plague.’ Seven of his roommates, he continued, were ‘raging out of the senses’ with ‘Agues and Fevers’.