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

Each time he came to see his patient, Salumbrino, like the Mill Hill fathers whom I had visited in north London, felt the call of the mysterious world across the seas. As he listened to Torres Bollo, the lay brother began to recognise what his life’s work would be. He would go to Peru and live in the college of San Pablo in Lima, putting his knowledge of pharmacy to good use as he built up the botíca into the best pharmacy in the New World, which for nearly forty years, until his death in 1642, is exactly what he did.

Today, the soaring Baroque church of San Pedro, next to the Biblioteca Nacional in the centre of Lima, is all that is left of the great Jesuit College of San Pablo, which rapidly fell into disrepair after the Jesuits were expelled from the Viceroyalty of Peru and the rest of the Spanish Empire in 1767.

The church is dark, though well cared for. The remnants of its first crucifix are housed in a glass cabinet in a corner. The dark wood gleams in the shadows. In another corner, a vast reliquary rises. When you look at it more closely, you see that it is made of hundreds of boxes of dusty human bones, said to come from the many local priests who have been canonised and then forgotten.

The priest who says mass there today, under the fifty-two crystal chandeliers strung along the ceiling, urges his congregation, as Catholic priests do everywhere, to ‘go in peace, and to love and serve the Lord’. Despite the medieval, talismanic quality of the church’s interior, its enormous congregations reflect the power that the Catholic Church still commands in Peru, and the extent to which it has permeated every level of political and intellectual life. Alejandro Toledo, who won the presidential election in 2001, considered including two Jesuits in his cabinet. One was a well-known figure, Father Juan Julio Witch, an economist and academic who became a household name in 1997 after the Japanese embassy in Lima was taken over by terrorists during a reception to celebrate the Emperor’s birthday. Given the opportunity to leave the embassy compound, Father Juan elected instead to stay behind with the other hostages. For four months he said mass there every day, urging his small and frightened congregation to keep their spirits up and pray for salvation, while outside television cameras and frustrated army marksmen waited for the terrorists to give way. Today his name is known throughout Peru.

It has long been accepted that the Jesuits were responsible for introducing cinchona into Europe. As I read more about the role of the Society of Jesus in Peru’s long history, I kept wondering if, after all the wars and insurrections, burning and looting, any written material still survived from their earliest time there. Eventually, I learned that the bulk of a large private collection of Peruvian Jesuitica, built up by an obsessive hoarder, Father Rubén Vargas Ugarte, who came from a wealthy family and was himself a Jesuit priest, a historian of the Church and a Peruvian nationalist, had been placed in the state archives in Lima. No one could tell me over the telephone what the collection contained. And so I travelled to Peru, not knowing what I might find, or indeed whether I would find anything at all.

For a long time after I got there, I was little the wiser.

The state archive occupies a dark corner at the back of the building that is better known as the Peruvian national bank. It has its own entrance, but there is no sign on the door; nor, once you are inside, are there any directions to tell you where to go. At least Father Rubén’s material was there, though what it contained no one could tell me. It hadn’t been opened, and although some of its papers had been looked over by scholars past, the collection had come with no inventory and there was no catalogue. But I was welcome, the librarian said, to look through it if I wanted. A long pile of boxes was stacked down the hallway, though quite how far it extended and how many boxes it contained I couldn’t really tell.

The librarian gave me a key to the archive, and said I could work there for as long as I wanted each day. Outside, Peruvians were preparing to go to the polls. The atmosphere was tense, and there was a sporadic curfew. Occasionally I would emerge from the archive at the end of the day and find that I could not return to my hotel. I went back inside and slept on the floor, shielded from the draught by Father Rubén’s mountains of paper.

I began methodically going through each box. I picked out details of property transactions, plantings and harvests on the Society’s haciendas, chronicles of boundary disputes, baptismal records, the sale and purchase of slaves, shopping lists, inventories. I had come across Agustino Salumbrino’s name in the Jesuit archive in Rome, but I still knew very little about him. Would I ever find out more?

Then one day I found two old books dating back to 1624. They were inventories. Page after page in the volumes of El Libro de Viáticos y Almacén are filled with inky lines that once were black but now are faded to a rusty brown. The quills the writers used were so sharp they have ripped through the paper. That these documents survived at all was a miracle. No one has ever tried to conserve them, and some of the paper crumbled in my hand. Yet it was still possible to read what the Jesuit administrator of San Pablo had written there nearly four hundred years earlier. In addition to listing everything that came into and went out of the college, from the cases of books that were sent from Europe to supplies of medicines, clothing and tableware that were despatched to other Jesuit missions, he also provided a complete inventory of Brother Salumbrino’s pharmacy.

By the time Agustino Salumbrino arrived in Lima in 1605, the mission at San Pablo was firmly established, with several classrooms, a small library, a chapel, private rooms and even an infirmary, which, although basic, was clean and well run. Salumbrino quickly realised, however, that the infirmary was not sufficient to take proper care of all the sick in Lima. What he needed was a proper pharmacy, and a steady supply of medicines. These were hard to obtain in colonial Peru, but Salumbrino was a tireless worker, and he had made up his mind not merely to build a pharmacy, a botíca, as it was called, at San Pablo, but to do it in the grand manner, not only to serve the college’s local needs, but to supply all the Jesuit colleges throughout the viceroyalty.

Agustino Salumbrino’s ambition to set up a pharmacy to help treat the poor of Lima had its roots not just in the rich medical lore that he encountered as soon as he arrived in Lima, but also in the Jesuits’ earliest philosophy. The instructions left by the founder of the order, St Ignatius Loyola, forbade his followers to become doctors. The task that lay before them, he emphasised, should focus upon men’s souls. This did not mean that Jesuits were ignorant of the importance of maintaining good health; indeed, every Jesuit mission was enjoined to appoint one of their number as a ‘prefect of health’ to ensure that the priests’ diet was adequate and that they were well cared for. The most capable lay brothers would be chosen to run the college’s infirmary and have immediate care of the sick. Most important, the Society’s founder insisted, each college would ensure that it had an adequate supply of medicines, either by setting up a pharmacy of its own, or by finding a reliable source of supply. Despite being expressly forbidden to practise medicine, Jesuit priests often turned their attention to the study of herbs and plants, and a number of them, especially in the foreign missions, became apothecaries.

San Pablo’s infirmary was in a clean and quiet courtyard in the south-eastern corner of the college. By the time it was properly established it had about fifteen private rooms, all facing the fountain in the centre of the courtyard. Brother Salumbrino built his pharmacy close by the infirmary. Knowing that he needed to be as self-sufficient as possible, he began by planting a small herbarium in a corner of the garden at San Pablo. He chose plants that were well known for their medicinal properties: camphor, rue, nicotiana, saffron and caña fistula, a Peruvian wild cane that was often used for stomach disorders in place of rhubarb. These Brother Salumbrino and his two assistants made up into medicinal compounds, which were dried, powdered and mixed in the laboratory according to strict pharmaceutical rules. To help him, Salumbrino ordered two of the most important pharmacopoeias then available in Europe: Luis de Olviedo’s Methodo de la Colección y Reposición de las Medicinas Simples y de su Corrección y Preparación (printed in Madrid in 1581), which he had used in Rome; eventually, he also ordered Juan del Castillo’s Pharmacopoea Universa Medicamenta in Officinis Pharmaceuticis Usitata Complectens et Explicans (printed in Cadiz in 1622).

Pharmacopoeias were works that described chemicals, drugs and medicinal preparations. They were issued regularly with the approval of different medical authorities, and were considered standard manuals in every pharmacy in Europe. Besides these two classics, Brother Salumbrino could also consult and follow the prescriptions of Girolamo Mercuriale, physician to the Medicis and Professor at the universities of Padua, Bologna and Pisa, who exercised a profound influence on medical circles all over Europe.

Over the next century and a half the botíca at San Pablo would order at least ten other pharmacopoeias that specialised in local drugs and chemicals, including its vade mecum, Felix Palacios’ Palestra Farmaceutica, which was printed in Madrid in 1713, the year after Francesco Torti had his ‘Tree of Fevers’ published. The botíca put in regular orders for extra copies of Palacios’ work to be sent out to the other Jesuit colleges in the viceroyalty. The book was so highly regarded, and was so frequently referred to, that the pharmacists at San Pablo would eventually write inside the cover of their own copy: para el uso diario de esta botíca (‘for the daily use of this pharmacy’).

By 1767, when the Jesuits were forced to leave Peru and the final inventory of the pharmacy was compiled, the San Pablo medical library contained about a hundred books. The full list, given in another set of books that I found among Father Rubén’s boxes, Cuenta de la Botíca 1757–1767, included the ancient classics by Galen and Hippocrates as well as voluminous Latin commentaries on the two masters by several medieval doctors. The library also had books on several other branches of medicine, including anatomy and osteology, treatises on different kinds of fevers and their remedies, descriptions of contagious diseases and their infections, and the methods of combating them.

Surgery was also a favourite subject at San Pablo, and one could find on the shelves of the college’s library Bartolomé Hidalgo de Agüero’s Thesoro de la Verdadera Cirugía y Via Particular contra la Común (printed in Seville in 1624), and Juan Calvo’s Primera y Segunda Parte de la Cirugía Universal y Particular del Cuerpo Humano, which was published in Madrid in 1626 and reprinted many times in the seventeenth century, and was still in use more than a hundred years later – though one shudders to think of operations being carried out without the benefit of any anaesthetic or antibiotics in the humid atmosphere of seventeenth-century South America.

The Jesuits who came to Peru just after Pizarro’s conquest of the Incas were the first order with a clear mission to educate and then, by doing so, to convert the Indians to Catholicism.

There was a clear division, though, over exactly how this should be done. The ascetic, intellectual Jesuits who ran the order from Rome were of one view, while the energetic activists who left their homes to promote its interests overseas were of quite another. The young Jesuits in Lima were pioneers of the soul. They believed strongly in catechism. Each day, a group of priests would leave San Pablo, walking in procession through the streets of Lima, holding a crucifix and ringing a bell to attract groups of Indians and blacks to whom they would preach. Not everyone liked this. One early Provincial Superior of the Jesuits in Peru, José de Acosta, was dismayed by this helter-skelter missionary activity, and was bitterly critical of having so many men tramp around as ‘holy vagabonds’. His own bias tended towards the old Jesuit ideal of learned men influencing councils and kings.

What he failed to realise was that most of the Jesuits, such as Brother Agustino Salumbrino, who went to Peru early on were not driven to write books or meditate. They were zealous, educated men, full of drive and courage, who wanted to make a difference, whether it was by saving souls or promoting good health.

The early Jesuits soon expanded their missionary activity to Cuzco, the old Inca capital that Pizarro seized in 1534. They bought a fine palace that had been taken over by one of Pizarro’s lieutenants on the main square, only to tear it down and build the towering pink Baroque church that still stands today. From there the Society sent its priests out into the countryside to make contact with the local Indian communities and urge them to renounce the animist gods they had worshipped for centuries in favour of a Christian Almighty.

The Inca world was ruled by spirits and superstition. Every village was surrounded by secret places – trees, rocks, springs and caves – that had a magical significance. The Incas collected unusual objects, and in every house there were canopas, or household deities, displayed in a niche in a corner or stowed in a special place, wrapped in cloths. They observed rituals throughout their daily lives, sprinkling chicha or coca when ploughing, saying prayers and incantations when crossing rivers, making sacrifices on particular occasions and always leaving an object on the pile of stones that is still often to be found at the top of every pass.

The Incas lived in fear of the sorcerers, the old men who foretold the future by studying the shape of ears of corn, the entrails of animals or the movement of the clouds, and were terrified of the magic spells they cast to cause love or grief in their victims. But they also revered them, for many of the sorcerers were medicine men as well as magicians. In some parts of Peru they would undertake trepanning, cutting open the skull to let out evil spirits and to offer the patient some relief from pain or swelling. The rich Quechua language shows that the Incas had a fine knowledge of anatomy and medicine, with words such as hicsa for abdomen, cunca oncoy for angina, susuncay for putting to sleep, siqui tullu for coccyx, husputay for haemorrhage, hanqqu for nerve and rupphapacuy for fever.

They amassed a great store of knowledge about local plants and how to use them to treat different ailments, and were particularly expert on poisons and plants with hallucinogenic qualities – every man would carry upon him a little packet of coca leaves for chewing on. They also used the trumpet-shaped Solanaceae, or datura as it is better known, in magic spells to cast their enemies into a trance, sarsaparilla as a diuretic, tembladera (Equisetum bogotense) against pyorrhoea, a plant they called llaquellaque (Rumex cuneifolius) as a purgative of the blood, ortiga (Urtica magellanica) to cure sciatica, and payco (Chenopodium ambrosoides) against worms.

The two volumes of El Libro de Viáticos y Almacén show just how elaborately Brother Salumbrino and his fellow Jesuit priests would prepare for a trip out of the city. Every traveller would be issued with a mule for riding on, and another for carrying their supplies. Many of the mules’ names survive in the records: La Cabezuda, La Caminante, La Mulata, El Galán. The supplies would include hay for the mules, for the desert of northern Peru in particular was short of fodder, and often of water too. The traveller would also be equipped with a bowl, a spoon for the table and a knife for cutting meat, a bedroll and a sheet, a roll of sealing wax, spices in the form of saffron, pepper and cinnamon, wine, a sombrero, a soutane and a cape to keep out the cold in the mountains. The grandest inventories included travelling altars, supplies of wine and wheat hosts for offering communion, and even silver candlesticks. But, grand or simple, each traveller’s list concludes with patacones, fried plantain chips, for an Indian guide, and more patacones for el gasto del camino, the road toll.

Despite the rips in the pages of these ancient books, they still summon, nearly three centuries on, a pervasive and enormously fierce sense of just how energetic and enterprising the Jesuits were. On 26 April 1628, the earliest entry in the book that mentions Brother Salumbrino, the pharmacist sent the Jesuit college at Arequipa, at least three weeks’ ride south of Lima, not far from Lake Titicaca, four cases of drugs, including eight libras of caña fistula. The following month he sent the college another eight libras of caña fistula and a copy of the Meditations of St Ignatius Loyola. In August of that same year he despatched supplies of tobacco and cocoa and another three boxes of caña fistula, and the following April the mule load to Arequipa would include four bottles with different drugs ‘sent by Brother Agustín’.

San Pablo was making a name for itself as a trading post, and it was not confined to medicines. It imported textiles from England, Spain, France and the Low Countries, Italy and the Philippines, and large quantities of black taffeta from China. It provided Jesuit schools in the region with ink and paper imported from Italy—in 1629 San Pablo despatched three thousand pens in a single huge shipment that went to the Jesuit College in Santiago, Chile. Farm tools such as ploughs, sickles and hoes were in great demand. San Pablo shipped those off too, along with saddles and harnesses, tallow candles and pottery, shoes and clothing for children as well as adults, needles and nails. In 1628 the college sent twelve baras of tailors’ needles from France to Arequipa, while three years later another two thousand needles, described as finas de Sevilla, were needed. Between 1628 and 1629 San Pablo also sent twelve thousand nails to Potosí, ten thousand to Arequipa, and more than twenty thousand to Chile.

As this trade blossomed, Brother Salumbrino’s influence also soon extended beyond the walls of the college. Like the library at San Pablo, which ordered books from Europe and sent them out to colleges all over the viceroyalty, the pharmacy became an early distribution centre of medicines and medical information for other Jesuit institutions in the area. Salumbrino supplied medicines to the Jesuits who left San Pablo on long missions among the Indians in the Andes, and to other Jesuit outposts

The Libro de la Botíca neatly lists everything that San Pablo supplied to the other Jesuit colleges in the viceroyalty: agua fuerte and aguardiente, powdered mother of pearl, pine resins, black and white balsam, bezoar stone, nicotiana in powder, caña fistula, cinnamon, nutmeg, sal volatile – the original smelling salts – mercurio dulce or mercury sulphide for treating syphilis, black pepper, ambergris, senna, tamarind, sugar, camphor, sweet and bitter almonds, almond oil, tobacco from Seville, essence of roses and violets, rhubarb, chocolate and, of course, cinchona bark, that would eventually be despatched, dried in strips or in powder, in huge quantities all over the continent and also across the Atlantic.

From the earliest years the Jesuits of San Pablo were of the clear belief that conversion of the Indians would come about not by force, but by education and persuasion. For that reason they were quick to send young priests out into the field. Many of the young Jesuits who were posted to Peru made it a priority to learn Quechua and the other Indian languages, and to accustom themselves to the Indians’ way of life.

The Jesuits in the field, especially those who had been sent north-east of Lima, to Loxa in the Andes, began to persuade the local Indians to seek out the árbol de las calenturas, the ‘tree of barks’, as Bernabé Cobó, another Jesuit and a colleague of Salumbrino’s, would describe cinchona in his Historia del Nuevo Mundo in 1639. They taught them how to cut off the bark in vertical strips so as not to kill the tree, and to plant five new trees for every one they cut down. The Jesuits would place the saplings in the ground in the shape of a cross, in the belief that God would then help them grow better. More than two centuries later, an English plant-hunter and bark-trader would observe: ‘Always when passing [these plantations] my Indians would go down on their knees, hat in hand, cross themselves, [and] say a prayer for the souls of the Buenos padres.’

After they stripped off the bark, the cascarilleros or barkhunters would cut it into pieces and leave it to dry in the sun. Taking care not to break the fragile, powdery strips, they would wrap them carefully in pieces of cloth and then in watertight leather packs for transporting down the hills by mule to Lima.

San Pablo began to distribute cinchona bark – or cascarilla as it was known in Spanish – to the other Jesuit colleges in the viceroyalty, and even as far as Panama and Chile. Eventually Brother Salumbrino also began sending supplies of cinchona to Europe.

The first person listed in the Libro de Viáticos y Almacén as leaving San Pablo with a quantity of cinchona bound for Europe is a Father Alonso Messia Venegás, an elderly Jesuit priest who carried a small supply of it in his bags when he travelled to Rome in 1631. Father Alonso knew, as every Jesuit did, how malarious the Holy City was, and had heard accounts of the terrible conclave of 1623 when so many of the visiting cardinals died. Rome was in dire need of a cure for the fevers, and Brother Salumbrino was eager to see if the plant that stopped people from shivering could be put to use curing the chills that were a symptom of the marsh fever. Little did he know that not only did it stop the shivering, it could also be used to treat the disease.

The physicians in Rome found that the bark was indeed an effective treatment for the intermittent fever, and thereafter every Procurator who left San Pablo for the Holy City to represent the Peruvian Jesuits at the congress that elected the Jesuit Vicar-General every three years would take with him new supplies of the febrifuge bark. Shortly after Father Bartolomé Tafur, who served as the Peruvian representative at the congress of 1649, arrived in Rome he renewed his acquaintanceship with Cardinal Juan de Lugo, who was then in charge of the apothecary at the Santo Spirito hospital, and was becoming cinchona’s champion in the Holy City. In 1667 Felipe de Paz took with him a trunk filled with the corteza de la calenturas, and in 1669 Nicolás de Miravál arrived with 635 libras of cinchona for distribution in the curia, having left a similar amount in Spain.

By the second half of the seventeenth century, according to an early map of Lima in the state archive, the citizens of the capital had begun calling the street in front of the Jesuit infirmaries Calle de la cascarilla, Bark Street. Now part of the long, fume-laden Jirón Azangaro, which runs through downtown Lima from the Palacio de la Justicia as far as the Franciscan convent near the river, Calle de la cascarilla would remain up to the start of the republican period in 1825 as a public testimony to San Pablo’s role in distributing cinchona first in Peru and then around the world, and it appears in many of the maps of that time.

The final decade of the botíca at San Pablo saw Brother Salumbrino’s ambitions come to fruition. The pharmacy itself, where the cinchona bark was weighed out and packed, was beautifully furnished. On its wall hung a large portrait of Salumbrino which his fellow Jesuits had commissioned in 1764 at a cost of 140 pesos, and which bore the legend: ‘Agustino Salumbrino, first founder of this pharmacy of San Pablo’.