THE FEVER TRAIL
In Search of the Cure for Malaria.
By Mark Honigsbaum.
Illustrated. 307 pp. New York:
Farrar, Straus & Giroux. $25.
MALARIA is and always has been a scandal to medicine. Until the late 1800's, scientists were not even sure of its cause (the bite of a mosquito harboring the infectious plasmodium), but instead attributed the disease to miasmas, random vapors or poisonous exhalations from the earth -- hence the name, malaria, from the Italian for ''bad air.'' Proposed treatments ranged from the canonical quack bloodlettings and purges to the smoking of cigars in order to ''purify'' the atmosphere. And, as has often happened in the history of medicine (Jenner's smallpox vaccine, for example), once scientists finally discovered a cure, quinine, they had no idea how it worked. Indeed, the complete biochemical explanation of how the quinine molecule interrupts the life cycle of the malaria parasite is not fully understood even today.
What everyone is sure of is that the disease has been a great killer. Between 1.5 million and 2.7 million people still die from the illness every year, out of 300 million to 500 million annual cases. According to Mark Honigsbaum, a British journalist and the author of ''The Fever Trail: In Search of the Cure for Malaria,'' ''some parasitologists believe that malaria may have killed one out of every two human beings who ever lived.''
It is a painful disease, with the victim writhing in bouts of fevers and chills that alternate with periods of apparent remission before finally either dying or recovering. ''Soon you have a raging thirst and headache,'' Honigsbaum says, ''and as you slip into delirium, you may believe you are literally burning up.''
Quinine comes from the bark of the cinchona tree, which exacted a severe price, as it was found among the most inhospitable areas of the world: on slopes of the Andes Mountains along the coast of South America. The bulk of ''The Fever Trail'' is an account of three British adventurers who risked health, life and sanity searching for the tree, which they hoped they could bring back to Europe for cultivation: Richard Spruce, a hypochondriac Yorkshire moss collector; Charles Ledger, a cockney trader who hoped to make a fortune; and Clements Markham, a historian, linguist and patron of Robert Scott's expeditions to the Antarctic.
Their journeys are exciting up to a point. The problem is that the book describes so many of these bold exploits that the accounts tend to blur together and merge into one, as our heroes confront a virtually unending succession of slippery riverbanks, rapids, whirlpools and impassable streams; impenetrable swamps, marshes and bogs; dense, matted, steaming forests; clinging vines, tangled roots, fields of mud, sheer cliff faces, narrow gorges, attacks of altitude sickness, dysentery, hunger, fatigue and exposure; frozen mountain passes, sun-baked lunar craters, extinct volcanoes, vertical descents, chilly mists, wind gusts, vast sheets of freezing rain, snowy peaks, slick glaciers, precipitous ridges, giddy heights, rock slides, herds of llamas, alpacas and ''bulls running through the bush,'' mosquitoes, flies, stinging bees, poisonous shrubs, mad dogs, venomous snakes, flesh-eating maggots, pools of slime, ugly green mosses and molds and, of course, people Markham called ''savage Indians.'' The text is replete with descriptions of one or another explorer ''cutting a path through the jungle with his machete,'' and other staples of prime-time adventure lit. For a mythic quest narrative, it has everything but an encounter with mermaids.Continue reading the main story
Finally entering the present, Honigsbaum reports on recent efforts to eradicate or control malaria and attempts to discover better drugs, or a vaccine. He gives exceptionally short shrift to DDT, a potent killer of the Anopheles mosquito, the vector of malaria. When the World Health Organization began its unsuccessful campaign for worldwide malaria eradication in the 1960's, DDT was its disease fighter of choice. The chemical then came into disrepute because of its damaging effects on several bird species. But the author relegates to an endnote the fact that in December 2000 the United Nations approved limited use of the chemical, and that the Malaria Foundation International advises that ''spraying houses with DDT is still one of the most effective and affordable methods of malaria control.''
Honigsbaum also mentions two malaria cases of unknown origin that appeared on Long Island in 1999. The incidence of introduced (as opposed to indigenous) malaria is worse than these cases suggest, however, for in 1999 the C.D.C. reported a total of 1,540 cases in the United States, the greatest concentration of them, 246, appearing in New York City.
BUT for Honigsbaum the adventure story is king, and to my taste his most compelling chapter is ''The Vaccine Hunters,'' largely an account of Manuel Elkin Patarroyo, who says he has invented a working antimalarial vaccine, a preparation he calls SPf66. In his home country, Colombia, Patarroyo is as famous as the latest rock star, celebrated wherever he goes. In the late 1980's, to further his efforts, the Colombian government gave Patarroyo his own private island deep in the jungle -- Isla de los Micos. Here, in mid-Amazon, Patarroyo conducts his research, injecting owl monkeys with his vaccine and then exposing them to the malaria parasite (he has also vaccinated himself and his entire family with SPf66).
Honigsbaum accompanies Patarroyo on one of his visits to the island and watches as he vaccinates 50 monkeys, then collects a batch of survivors from an earlier experiment, puts them in canvas sacks, takes them on a boat deeper into the Amazon and releases them back into the wild. This is truly exciting stuff -- shades of H. G. Wells's ''Island of Dr. Moreau.'' One of the animals, apparently injured during the trip, limps off into the woods. ''Poor monkey,'' the author says. ''Think of the children dying of malaria every 30 seconds in Africa,'' Patarroyo responds. ''That's who you should reserve your sympathy for.''
One can take comfort from the fact that Patarroyo is not the lone researcher trying to develop an effective vaccine; several others are working to make malaria a thing of the past. Until that happy day arrives, the disease will continue to take its toll, and remain an embarrassment to science.Continue reading the main story