The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World

Nowhere in Europe was the scourge more deadly, and the need for a cure more acute, than around the Basilica of St Peter’s in the centre of Rome, where every summer for centuries it killed hundreds of people, making no distinction between peasant, priest or pope.

2 The Tree Required – Rome

‘When unable to defend herself by the sword,Rome could defend herself by means of the fever.’

GODFREY OF VITERBO, poet, 1167

Giacinto Gigli lived for sixty-five years in an alleyway by the Via delle Botteghe Oscure. His small townhouse was one of several built close together. They clung, like a gaggle of shy children, to the end of one of the crooked passageways that cluttered the centre of Rome, seeming almost to lean into one another when the wind whipped around them during the early days of winter. Gigli was not born there, but from the time when he was twelve years old until just before Christmas 1671, when he died at the age of seventy-seven, he returned every night from his work in the papal palace at the Vatican and climbed the stairs to the study, his favourite room, at the top of the house, where his desk was placed between two tall windows.

One of them looked westwards, over the bend in the Tiber where tradesmen, prelates and visitors would cross the bridge that led towards the Santo Spirito hospital and beyond it to St Peter’s and the palace of the Vatican. From that window Gigli could just see the golden dome of St Peter’s, though often it seemed almost to fade away in the summer haze, when the city became too hot to bear and the Pope’s court moved to the palaces and villas in the coolness of the hills that surround the city. The other window, on the far side of the room, looked north-east towards the Quirinale, the highest of Rome’s seven hills, where the Pope’s own summer palace had been built so that he could escape the unhealthy summer air, and where a gentle breeze blew all day through the shady trees.

The Gigli family was part of Rome’s petite bourgeoisie, though by his death Giacinto’s father had been able to leave his son the property near the Via delle Botteghe Oscure, two other smaller houses in the centre of the city, and a vineyard on the road to Frascati, a considerable inheritance for a modest man. When he was twelve Gigli entered the Collegio Romano, the Jesuit school where he studied grammar, humanities and rhetoric. For a while he studied law in the studio of Angelo Luciano, a well-known Roman advocate, and graduated as a specialist in papal law. By that time his father was dying, and as Giacinto prepared to take his place as the head of the Gigli family, the young man’s thoughts turned to marriage. He had known Virginia Lucci all his life. She was his neighbour’s daughter, and the time had come to ask for her hand.

As he grew older, Gigli began to acquire the status of a man of respect. He was made a rione, representing his parish of Pigna in the committees and on ceremonial occasions that would occasionally bring together the city and the Holy City. Dressed in velvet and bedecked with feathers, he would walk in line before the horsemen that accompanied the papal processions. Later he was made a caporione, before eventually serving twice as the priore, the head of all the caporioni, responsible to the Pope for helping collect taxes and keeping order within the Holy City. These duties gave Gigli an intimate insight into Rome, and particularly the clerical administration that ran it. He became something of an expert on Vatican politics – who was in favour and more importantly who was not, how different cardinals behaved and how they were discussed. ‘All this and more is the lifeblood of the Holy City,’ he would write.

We don’t know what Gigli looked like, for no contemporary likeness of him survives. But we know a great deal else about him: how he lived, how he filled his day, what he did when he fell ill, whom he saw and what he ate. Gigli was meticulous about recording the details of his life in his diary, which survives in the Vatican library, writing something every day, even if only a brief phrase or two. He wrote in Latin, in an elegant slanting hand, taking care to reach the very edge of the page before starting on the next line.

Gigli had acquired the habit of chronicling his daily life before his marriage. In 1614, when he was only nineteen, he even began an autobiography, entitled Vita. He kept this up assiduously for about five years, making minute notes of everything that went on in his household, recording the names of the servants who came and went, what they were paid and what they earned in tips or small gifts, like the woollen socks that were given to the nurse who came to care for his only son. While this might seem unnecessarily fussy to some, these were not bad habits for a diarist to acquire. In addition, he also wrote poetry, long verses about his native city and eulogies of the Popes in rhyming octets.

The papal court was the centre of Gigli’s life. From the first entry in the diary, on 29 May 1608, to the last, when he was almost too blind to write any more, yet fretted about missing the baptism of the Pope’s new baby niece, he specialised in the comings and goings of the Vatican. The Pope’s court was newly returned to Rome after the alternative papacy, set up the previous century in Avignon with the support of the King of France, had threatened to rob Rome of much of its wealth and influence. Restored once more to its traditional home, the leadership of the Roman Catholic Church was doing all it could to spread the counter-Reformation in Europe and impose its spirit, burning heretics and attempting to suppress Protestantism whenever it could.

In the first decades of the seventeenth century, though, when Gigli was making his daily observations of the Holy City, papal Rome still hadn’t really found its feet. The memory of the schism lived on, making the city fathers nervous, hidebound, inward-looking; too fearful of the Turkish forces that threatened Venice, or the Spaniards who lay siege to Naples, ever to be easy. Naturally conservative, papal Rome then was more fearful of change than it had ever been. In 1633 Galileo Galilei, after publishing his arguments for a Copernican cosmology, with the earth and the planets revolving around the sun, rather than with the earth at the centre of the universe as had long been the prevailing view, would be tried for heresy and his works banned.

Like his masters in the Church, Gigli was a conservative man. Over the years we get a good idea of what he approved of and what he didn’t. Gigli was something of a prig, and there was much that went on in Rome that made his lip curl in distaste. Despite that, he had a fine eye for daily life in the city – the storms, the fires, the earthquakes, the fate of the jailed heretics who were often hung, drawn and quartered, their various portions exposed to the populace as an example to those who might be tempted to question the Pope’s authority. He wrote about the availability of bread, about miracles, comets and eclipses of the sun. Although he was a rational, educated man, there was a medieval part of Gigli that could not help but believe that God sent signs to his people below, good signs if he was pleased with them and punishments when he was enraged.

On a more down-to-earth level, Gigli wrote about people’s anger at the rising taxes, their irritation at the inflexibility of the authorities and their fear of the Tiber’s floods, which he always described as the river getting ‘out of its bed’. In 1630 he wrote of the arrival in Rome of an elephant, ‘which no one had seen for a hundred years’, since the King of Portugal sent one as a gift to Pope Leo X in 1514. This particular beast, by contrast, had been brought to the city by a private citizen, and anyone who wanted to see it had to pay him one giulio for the pleasure.

In turn observant, witty and fastidious to the point of pernicketiness, Gigli became Rome’s most wonderful portraitist. At the start of the seventeenth century, the city had a population of about 115,000. It was a tenth of the size of its imperial predecessor, smaller by far than Paris or London—smaller even than Naples – but it was growing after the ravages of the previous century, when it had been sacked and later flooded, before being visited by the plague and then cast into ruin during the papal schism. With the return of the papacy, diplomats, bankers, doctors, artisans, traders, horsemen and financiers jostled in the capital for any part of the papal chancery’s swelling business.

Most of these people lived and worked, as Gigli himself did, in the occupato, the dense gathering of taverns and tenement houses separated by narrow cobbled streets that nestled in the crook of the arm of the Tiber where it curved in an ‘S’ shape, first west and then south-east. Inevitably they were almost all connected, one way or another, with the Church establishment. The three most important routes into the city converged on the Ponte Sant’ Angelo, just south of the Vatican, bringing travellers who were always hungry for news and for business directly into the heart of the city. Over it rose the bell towers of nearly 350 churches. The tallest among them were the great basilicas that kept watch over the tombs of the apostles. Then there were the churches that guarded the sacred reliquaries of the saints, and occasionally, some believed, even fragments of the True Cross. Lower still were the chapels of the patrician families and the oratories of the guilds. From every sacred spire and belfry the city trumpeted its patronage of the holy. In brick and stone, every street, every façade, every arch and roof and alleyway proclaimed its thousand years as a Christian symbol.

All that lay within the occupato.

Beyond the occupato, though, lay the disoccupato. And that was another story altogether.

To the east of the city, starting at the Capitol, to the south and to the north ranged a barely inhabited wasteland ‘set with ruins, where green snakes, black toads and winged dragons hid, whose breath poisoned the air as did the stench of rotting bodies’, as an eyewitness to the epidemic that killed half of the newly crowned Holy Roman Emperor Frederick Barbarossa’s army had described it in July 1155.

Encircling the town proper and extending out to the Aurelian walls, the disoccupato had barely changed in five hundred years. The loose patchwork of fields and vineyards was set with small houses, sheds and straw huts, tiny churches, gardens, groves and ancient ruins such as the Baths of Constantine and the Temple of Serapis. Much of it was only ever used for a few weeks each year. Dry in midwinter or at the height of a rainless summer, the disoccupato needed just the first downpour of spring to transform it into a swampy marsh, its muddy roads and ditches becoming pools of stagnant water that turned first green and then brown in the summer heat.

Rome at that time may have been an exciting city in which to live, but it was hardly a healthy place, though it was not until 1631 that it suffered the beginnings of the plague epidemic that would eventually kill nearly half its citizens. In an entry written at the end of December 1624, Gigli was full of apologies. ‘I, Giacinto, have not been able to make daily descriptions of life as I would have liked, for I have been sick for a long time, with grave and lingering maladies, as a result of which there are many things I have not seen and others I have not noted. But, with God’s pleasure, I am now well and healthy, and I hope in the Holy Year of 1625 that I will be able to make diligent note of things as they occur unlike those I have missed this year.’

Medicine had barely advanced over the centuries, and it is easy to forget how small a proportion of Europe’s adult population would have been healthy at any one time. Stomach disorders of one kind or another were chronic, both among the rich, whose diet was poorly balanced, and among the poor, who found it hard to find sufficient food for themselves and their children. When they did, it was often rotten. Recurring outbursts of bacterial stomach infections resulted in dysentery, which often killed the old and the very young. Tuberculosis was rife, and for women childbirth was always very dangerous. Both sexes suffered from rotting teeth, while suppurating ulcers, eczema, scabs, running sores and other skin diseases were very common and sometimes lasted for years.

Gigli was constantly preoccupied with matters of health, his own and that of his family. And the malady he wrote about most often was the Roman or marsh fever, which we now know as malaria. ‘It returns every year in the summertime,’ he says, ‘and no one can feel himself to be safe from it.’

Rome then was the most malarious city on earth. Hundreds of people died of the disease every summer, while hundreds more were left so weak they were unable to walk, and became prey instead to the slightest infection. The rise and fall of the Tiber, which often broke its banks and flooded the plain of the Campagna, left pools of stagnant water through the countryside which provided the ideal breeding ground for the Anopheles mosquito that spread the disease. The views of those observers, such as the first-century BC Roman writer Marcus Terrentius Varro, who thought the miasma might be alive, full of what he called animaletti, ‘minute animals [that are] invisible to the eye, breed there [in swamps] and, borne by the air, reach inside of the body by way of the mouth and nose, and cause disease’, were regarded as extremely bizarre. Most Romans in Varro’s time knew only enough to recognise the intermittent fever and shivering that visited them every year.

Giacinto Gigli had a particular reason to know about the fever. His only grandchild, Maria Cecilia Hortenzia Gigli, died of it at the age of fifteen. One day she complained of an aching head and stiff limbs. Rivulets of sweat ran down her forehead, dampening the sheets. Yet just a few hours later her mother was piling on the covers in an effort to keep the child warm. At seven o’clock in the evening, just three days after falling ill, she passed away.

Gigli was deeply affected by his granddaughter’s death, and he must have fretted greatly at her decline, against which he would have had no cure other than the herbs and amulets left over from medieval times. His diary entry that day is unusually terse, and comes suddenly after a description of a great fire that destroyed the Santa Caterina de’Funari monastery. Numb with grief, he writes only that: ‘She was fifteen years, five months and three days, and her beauty, her virtue and her goodness will be eternally remembered.’

The most important hospital in Rome at the time was the Santo Spirito, which had been built between the Tiber and the walls of the Vatican and which Gigli could see from his study windows. The Santo Spirito trained many of Europe’s finest doctors, but for most of the city’s population the cost of visiting a professional doctor was beyond their means. They preferred, in any case, to consult the herbalists and sellers of secret potions whom they had known all their lives. Many medieval cures had involved patients and physicians trying to expel their diseases by transferring them to other objects. Peasants in a number of European countries would bring a sheep into the bedroom of a fever patient, in the hope of displacing the ailment from human to beast. One cure that was still popular in the seventeenth century involved a sweet apple and an incantation to the three kings who followed the star to Bethlehem. ‘Cut the apple into three parts,’ advised the prescription. ‘In the first part, write the words Ave Gaspari. In the second write Ave Balthasar and in the third write Ave Melchior. Then eat each segment early on three consecutive mornings, accompanied by three “Our Fathers” and three “Hail Marys” as an offering to the Holy Trinity.’

Another prescription, from a well-known sixteenth-century Roman healer named Tralliano, was supposed to be especially good against the most common fevers, called tertian and quartan because they resurged with worrying regularity, either every three days or every four. Tertian and quartan fevers were almost certainly malaria, and Tralliano’s cure was the same for both: ‘Take a ripe peach and remove the pip. Put the pip into an orange and tie it around the neck of the patient. He will be healed expertum et verum.’

Another was more complicated. ‘Write the following words on a piece of paper,’ it advised.

Abracolam …

Abracolai …

Abracola …

Abracol …

Abraco …

Abraco …

Abraco …

Abra …

Abr …

Ab …

A …

At the end, add the phrase, ‘Consumatum est.’ Then have the paper tied to the neck of the patient by a young virgin using a long piece of string and reciting at the same time three ‘Our Fathers’ and three ‘Hail Marys’ in honour of the Holy Trinity.

Gigli and his fellow Romans thought they knew only too well whence spread the fever that killed his granddaughter and was as permanent a feature of the city as the smell of incense or the gentle scent of summer apricots. From the swamps and stagnating ponds of the disoccupato, it was believed, rose dark mists laden with fever. In Rome, went a saying, if you did not catch the fever from the aria, you caught it from the mal’aria. Bad air.

The word malaria, or mal’aria as it was always written until recently, was unknown in English until the writer Horace Walpole introduced it. In July 1740, while on a visit to the Holy City, he wrote to his friend H.S. Conway, ‘There is a horrid thing called the mal’aria that comes to Rome every summer and kills one.’ For more than a century afterwards, though, mal’aria was not taken to mean a disease so much as a noxious gas which rose from swamps or rotting carcases and vegetation, and which caused a group of ailments variously known as intermittent fever, bilious fever, congestive fever, swamp fever or ague.

Whichever of these was really malaria, the Romans had known for centuries about the miasma. From the disoccupato it invaded the city and forced the citizens to take to the hills every year during the worst of the summer heat, leaving the city abandoned; abandoned, that is, by those who could afford to leave. The rest stayed behind, entrusting their health to the Almighty and to the concoctions of the healers whose numbers always grew larger in summer.

Malaria had probably existed in Rome since late antiquity. Chronicles of the imperial Roman army talk of soldiers suffering from constantly recurring fever, chills, sweating and weakness, and many historians believe that one of the main causes of the collapse of the Roman Empire may well have been the prevalence of malaria around the shores of the Mediterranean Sea. In 2001, British and American scientists found malarial DNA in the bones of an infant skeleton that had been unearthed in a fifth-century villa at Lugano, near Rome.

No one is quite certain why, but malaria seems to have receded during the early Middle Ages, only to reappear with even greater severity in the years when Giacinto Gigli lived in Rome at the beginning of the seventeenth century, continuing into the eighteenth century, when it was an annual occurrence in Kent and the fenlands of England, eventually reaching as far afield as Scandinavia, Poland and Russia.

Within the Vatican, many of whose buildings were erected on Rome’s lowland, by the banks of the Tiber, malaria was especially prevalent, striking with little heed for the age, rank or title of its victims. In July 1492 Bartolomeo da Bracciano, one of the senior courtiers at the palace of the Vatican, wrote to his friend Virgilio Orsini: ‘The Pope, last night, had a great fever of the quartan variety, alternating between hot and cold. The Pope is confined to his bed, and it is said that perhaps he will never rise from it.’ Indeed, he didn’t. Four days later, on 25 July 1492, Pope Innocent VIII was dead.

Eleven years later Pope Alexander VI died, again most probably of malaria, after dining in the palatial garden of his friend Cardinal Adriano Castellesi da Corneto in August 1503. Adrian VI died of malaria in the summer of 1523, and in August 1590 Sixtus V too died of malaria at the age of sixty-nine, after a brief and very active pontificate. He had caught it a year earlier while sleeping in a hastily erected cabin during a tour of work being undertaken in the marshes around Castello Caetani, not far from Rome. Even the Borgias, who tried valiantly over the years to murder one another, could not kill each other or their enemies so regularly or so reliably as would malaria.

In the summer of 1623, shortly before Gigli, to his immense pride, was made a caporione for the first time, the Pope, Gregory XV, fell gravely ill. In his diary, the twenty-eight-year-old Gigli reported: ‘His Holiness is not well. We must pray to the Lord.’ It was said that the Pope had caught the fever the previous year, and now it had returned with a vengeance. From his study overlooking the city Gigli could see the palace of the Quirinale, nicknamed Monte Cavallo, where the Pope lay on his sickbed. An earlier Pope, also called Gregory, had chosen this superb site, less than a century before, to build his summer residence in an effort to escape the malaria that always plagued Rome during the hot summer months. In the courtyard in front of the palace, another Pope had had statues of four prancing horses installed. Nearly twenty feet high, they were Roman copies of Greek symbols of Castor and Pollux, the patrons of horsemanship who were known as the ‘horse tamers’, and it was they that gave the hill its nickname.

At the centre of the palace itself, dark heavy drapes shut out the light and the world beyond. For some days the Pope had been lying unmoving in his bed, covered only by a light blanket of fine wool. His head ached, his spleen was swollen and his body tormented in turn by fever and sweating, then by shivering and chills. A small troupe of Penitentiaries, the Jesuits who heard confessions in St Peter’s basilica, prayed at his feet. Occasionally one would rise from his knees and another would step forward to take his place. With their gentle voices and indistinguishable cassocks of rough grey wool, they represented an unceasing rosary of care for the souls of the dying.

As a caporione, Gigli was often called upon to make the short journey from his home near the Via delle Botteghe Oscure to Monte Cavallo. During that long summer of 1623 he made the journey more as a way of obtaining news of the Pope’s health than because there was a great deal of work to be done. For while no one knew whether the pontiff would live or die, the papal courtiers lived in an atmosphere of suspended animation, talking only in whispers. ‘We are all weary,’ Gigli wrote at the end of the first week of Pope Gregory’s illness.

Among those who attended the Pope’s sickroom was his nephew Ludovico Ludovisi. Though not yet thirty, Ludovisi had been made a cardinal by his uncle, which had enabled him to amass a considerable fortune in cash and works of art in just two years. Was his life as a man of influence about to come to an end? Should the Pope die, Ludovisi was too young to be elected pontiff himself. His only future lay in seeking to influence the choice of his uncle’s successor. If a candidate with his backing should attain the throne of St Peter, Ludovisi’s eminence would continue. But he had made many enemies, and would have little time to build the alliances that were essential if he were to sway the complicated negotiations that would follow Gregory’s death.

As soon as the Pope died, the seal on the fisherman’s ring that was the emblem of his pontificate would be broken. The new Pope would be given a new seal with his own name. Predictions of Pope Gregory’s death had been made so often that he had often lamented, in the days when he felt better, that his fellow cardinals had scarcely elected him when they began planning the conclave that would select his successor. Now, it seemed, the end really had come. Gone were the badges of his office, the high, pointed, cone-shaped hat, the silken gloves. Gone too were the papal vestments with their strange names handed down through the ages – the flabellum, the falda and the fanon. On his deathbed Christ’s vicar on earth wore a simple cotton shift with a wrap about his shoulders. Beneath it his pale body was only a man’s, and a rotting one at that.