Mark Honigsbaum’s Book The Fever Trail is extremely comprehensive look at the first efforts to find a cure for malaria. The story begins in 1638 with the mysterious cure of the Spanish princess Dona Francisa Henriquez de Ribera. While visiting Peru she contracted what appears to have been malaria. A Jesuit priest that was passing through the area heard of her illness treated the disease with an infusion bark from the cinchona tree. She quickly recovered from the disease and returned to Europe to spread the news.
The quinine extracts from the bark effectively lower the temperature of the body enough to prevent the reproduction of the parasite in the body, breaking the cycle of fevers. Unfortunately the species of tree from which this powerful drug was derived was only found in Peru and Bolivia along the Andean fault line. A few British scientists recognized the value of transporting the seeds to Europe where mass production could begin. Among them were Richard Spruce (1817-1893), Charles Ledger (1818-1905), and the Sir Clements Markham (1830-1916). Several attempts were made by each to acquire the seeds. They were often foiled by the South American winters, sickness, and the governments of Peru and Bolivia that carefully protected the rare crop of trees. The bulk of The Fever Trail centers on these travels.
Each of these men hoped to accrue great wealth from the developing a crop of Cinchona trees in the West. After great personal hardship Spruce managed to transport a small quantity of seeds to India where a small plantation was developed. To his disappointment the British government offered him little in compensation. As the plantation matured, it was discovered that the variety of tree that Spruce had bought back was ill suited to the conditions and produced very little quinine.
Ledger’s seeds switched hands a few times before ending up in the possession of the Dutch. With time it was discovered that the variety was far superior to Spruces. By the early 1900s the Dutch plantation in Java was producing nearly 66% of the world’s supply of quinine and reaping significant returns on its investment. After years of petitioning on behalf of Ledger, the upper class Markham succeeded in convincing the Dutch to offer the poverty stricken finder of the tree a small yearly sum of £100. Honigsbaum hopes to give these men their long-due credit for finding the first cure for malaria.
The one downfall of this book is that it was published in 2001. A lot has changed since then in the field of malaria. Honigsbaum indicates toward the end of the book that the Plasmodium Falciparum strain of malaria is beginning to show signs of resistance to quinine. Over the past eight years this level of resistance has increased significantly. Pharmaceutical companies have been forced to seek other treatments to combat the disease. Artemisinin is at the top of the list. While Chinese natural healers have been using the drug for over a thousand years, it has only recently been mass produced to treat malaria. This new drug has been shown to clear the parasite faster than any other drug yet discovered. The plant from which the drug is derived is Artemisia annua, which grows in many parts of the world, including along the banks of the Potomac River in Washington DC.
The use of combination therapies has also become much more common since Honigsbaum finished his book. This is the practice of using multiple drugs in tandem to combat the malaria strain. The benefits of this strategy are that the parasite is killed more rapidly and the development of resistance is slower. Artemisinin is commonly combined with sulfadoxine/pyrimethamine or lumefantrine, depending on condition of the patient. The use of Artemisinin or its derivatives Artemether or Artesunate as a monotherapy is strictly outlawed by the World Health Organization for fear that resistance will render this compound ineffective. Signs of early resistance have already been seen in South Asia. Pharmaceutical companies continue to seek new treatments. While there have been some attempts to develop a vaccine to the disease, none have been successful.
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