Mark Harrison

The discovery in the 17th century of the febrifuge qualities of cinchona bark — then known as Peruvian or Jesuits' bark — was an important event in the history of medicine (Brown, 1698; Honigsbaum, 2001; Jarcho, 1993; see Chapter 2). The bark of the tree Cinchona officinalis L. was, as is well known, the source of quinine — the first truly effective antimalarial drug. It also paved the way for other so-called specific remedies that challenged the Galenic orthodoxy that fevers, like other diseases, should be treated by restoring the body to a healthy equilibrium. The bark came, gradually, to displace the most common methods of fever therapy like blood letting, which dominated European medicine until the middle of the 18 th century. However, it also prompted a search for other specific medicines and for different varieties of febrifuge, varieties that occurred outside the domains of the Spanish-American empire. The motive for this search was partly economic, in that the trading companies of the various European powers wanted to end Spain's profitable monopoly of the cinchona trade. But there was an important medical rationale too: the importance in the Western medical tradition of the principle of locality — the notion that diseases of particular places were best treated by medicines available nearby.

In this short survey, I will examine some of the discoveries made by the British in their East Indian colonies. These discoveries are interesting historically because they represent a forgotten chapter in the history of febrifuges. While much has been written about cinchona and quinine, practically nothing is known about the other febrifuges native to the East Indies and that were widely used by locals and European colonists. In their quest for alternatives to cinchona, medical practitioners depended heavily upon local knowledge, which was generally considered as reliable, if not more so, as scientific trials conducted at home. Although some of the East Indian febrifuges were discussed in learned journals, most appear to have been used and evaluated entirely within the locality in which they originated. The East India Company explicitly encouraged its medical practitioners to rely on local drugs because this reduced the costs of importation (Arnold, 1998). But it was also believed that indigenous plants were more likely to cure fevers of the same locality than imported drugs. This was a vestige of the old belief in divine providence: that where a disease occurred, its remedy was to be found nearby. It also reflected the then common view that all diseases were peculiar to time and place — the product of peculiar environmental and atmospheric conditions. This view of fever remained strong until the late 19th century, especially among medical practitioners working in the tropics (Arnold, 1996; Harrison, 1999).

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The use of local plants was also recommended because of continuing doubts over the efficacy and safety of cinchona. Although its therapeutic properties were widely recognised by the mid-18 th century, there remained some uncertainty over the effectiveness of the drug and how it should be administered. It was also widely known that patients treated with bark could experience unpleasant side effects, including nausea and constipation (Maehle, 1999). In view of these reservations, some British practitioners warned against slavish dependency upon the bark, condemning it as "that idol nostrum of the Faculty" and as a "systematic deceiver of the world." William Stevenson of Newark (1781), for example, believed that the bark of his native oak was far more effective than a remedy imported from South America.

Although there was a good deal of interest in species of cinchona indigenous to British colonies — like those in the West Indian islands (Lindsay, 1794; Ryan, 1782) — the bark failed to dominate medical practice in India, where the East India Company had established trading posts that would later become the centers of colonial power. In India and other outposts of the East India Company, there were no native species of cinchona and various local febrifuges were commonly used alongside or instead of the bark. One specific remedy for fever used by the company's servants during the 17th century was the so-called Malabar Rattle-broom, which was reported in the Royal Society's Philosophical Transactions in 1698. The informant was a Mr. Samuel Brown, an East India Company surgeon at Fort St. George, Madras, who had sent details of the therapeutic powers of this and other plants to a fellow of the society. The seeds of this finger-leaved plant (possibly the Malabar cardamom, Elettaria cardamomum) were made into a decoction that, when introduced into a bath, was said to cure fevers, especially tedious Tertian agues. This and the other medicinal plants mentioned by Brown were all collected within 12 miles of the fort. Some had already been mentioned in the Hortus Malabaricus: a compendium of plants from Southwest India, compiled by the Dutchman Van Rheede; others had apparently been recommended for use by local brahmans, who also gave details of the ways in which they should be used (Brown, 1698). This reliance on local knowledge was a well-established feature of European medicine in the East Indies at that time, and despite growing differences between Western and indigenous medical traditions, interest in local medicines remained strong throughout the 18 th century (Harrison, 2001).

Some of the cures recommended for fevers in the East Indies were better known as spices and condiments. Pepper, ginger, and other spices had been used for some time as remedies for stomach complaints and East India Company surgeons were recommended to carry them for this purpose in their medicine chests (Harrison, 2001, p. 48). In the early 17th century, they were also being recommended for the treatment of agues and other fevers. Again, this knowledge was learned from practitioners of Ayurveda and other indigenous medical traditions. A Jesuit priest, whose remarks were reported to the Royal Society in 1713, declared that he had "seen them [practitioners of Ayurvedic medicine] cure Fevers which begin with a shivering Fit, by giving the Patient three large Pills made of Ginger, black Cumin and long Pepper. For Tertian Agues, they give the Person for three Days together three Spoonfuls of the Juice of the Tecorium [sic] or Great Germander, with a little Salt and Ginger" (Papin, 1713). The priest appears to have been referring to Teucrium ciiamaedrys, which is still used in India as a specific remedy for gout, rheumatism, and diseases of the spleen and other organs. Long pepper (Piper longum), ginger (Zingiber officinale), and cumin (Nigella sativa) are also found in modern antimalarial preparations in India, as well as in Africa and Central America (Kurrup et al., 1979; Shankar and Venuvopal, 1999; Sharma, 1999; Singh and Anwar Ali, 1994).

Later in the 18 th century, as the East India Company began to acquire territory and carry out botanical surveys in India, knowledge of indigenous medical plants was gathered more systematically, and this knowledge was centralised in the medical departments of the company's presidencies in Madras, Bombay, and Bengal (Desmond, 1992). Those who worked as company botanists invariably had medical training, and even though they were searching for plants that might be grown and traded by the company, the usefulness of plants in relieving the miseries of humankind remained a guiding inspiration. Many risked death or, certainly, illness in pursuance of their work, though some also found considerable fame. One of these was William Roxburgh, who joined the Madras Medical Service in 1776 and who later became superintendent of the company's botanical gardens at Samalkot (1781-1793) and Calcutta (1793-1813). During his time as a botanist in India, Roxburgh corresponded with many other botanists and medical practitioners. One letter, received by Roxburgh from a British Moravian missionary working in the Danish colony of Tranquebar, mentions that a febrifuge identified by Roxburgh was being used to treat fevers in the local hospital (John, 1792). The febrifuge mentioned was what Roxburgh termed Swietenia febrifuga, a species of the Indian redwood or mahogany tree, known to locals by its Sanskrit name, Seymida. The plant is now more commonly referred to as Soymida febrifuga, following the Sanskrit. During the early 1790s, Roxburgh subjected the bark of this tree to a series of experiments comparing its efficacy with that of the Peruvian bark. He concluded that the Swietenia bark was not only equal to that of cinchona but superior, at least in treating the fevers of India. He prepared the bark as a powder and mixed it with cold water, using a dose of between 20 and 60 grains per day. Some of the doctors with whom Roxburgh was in contact at Tranquebar also tried the remedy, though with more mixed success, and via Danish and German missionary connections, the bark and the seeds of the tree were sent to various botanists and doctors in Europe (Roxburgh, 1792).

Another Indian febrifuge that was commonly known — though apparently little used outside India — was the Spikenard, or Nardus indica, known locally as Terankus in the northwest provinces of India, where the British first came to know of it. The eminent naval physician Gilbert Blane described the plant in an article for the London medical journal Medical Facts and Observations in 1791, so it must have become quite widely known. Blane came across the plant near Lucknow while on a hunting expedition with the Nawab of Oudh. "It is called by the natives Terankus," he wrote, "which means literally, in the Hindu language, 'fever-restrainer.'" He explained that "They infuse about a drachm of it in half a pint of hot water, with a small quantity of black pepper. This infusion serves for one dose, and is repeated three times a day. It is esteemed a powerful medicine in all kinds of fevers, whether continued or intermittent. I have not made trial of it myself, but shall certainly take the first opportunity of doing so" (Blane, 1791). He thought the plant sufficiently important to warrant sending a dried specimen to Sir Joseph Banks, the director of Kew Gardens and the hub of an ambitious attempt to collect and classify useful plants from around the world (Drayton, 2000; Gascoigne, 1998). Blane's confidence in the Nardus was underpinned by his belief that it had an ancient provenance, corresponding to the plant described in Arrian's history of the expedition of Alexander the Great to India; it was apparently used by Hippocrates and Galen. Various species of Nardostachys, as the plant came to be known, were still in use as febrifuges at the end of the 19 th century, although apparently rarely (Dey, 1896). Nor is there much evidence of its use as a febrifuge today.

It is interesting to note that Indian names were still commonly used to designate plants that had medicinal properties. Within a few decades, this practice began to die out, as the arrogance of the British in India and their confidence in the power of Western science increased. But, in the late 18th and early 19th centuries, partly under the influence of Orientalists (some of whom were surgeons), there was more tolerance and even enthusiasm for the use of Indian names (Harrison, 2001). Francis Hamilton — well known for his botanical and other surveys of India — told the Royal Society of Edinburgh in 1824 that "I prefer using the Sanscrit names, both as being more scientific and as being more likely to remain permanent; for, after a lapse of many ages, they continue to be known to all Hindus of learning" (Hamilton, 1824). Like most other Indian botanists, Hamilton was heavily dependent on local expertise, and his preference for indigenous terminology reflected this.

The same can be said of James Johnson, a naval surgeon working in India at the beginning of the 19th century. Although he spent only a few years in India, Johnson's The Influence of Tropical Climates on European Constitutions (1815) was the chief work on medicine in tropical climates in the first half of the 19th century, and it went through several editions, the last being published posthumously in 1856. In this work, Johnson devoted a great deal of attention to the intermittent and remittent fevers that he regularly encountered in Bengal and wrote much about their causes and treatment. Although he saw himself in the vanguard of medical progress, he was still willing, like many other surgeons in India, to learn from indigenous practitioners. He thus informed his readers that Ayurvedic practitioners in Bengal used the Catcaranja nut (Caesalpinia bonducella) in the final stages of treating fever. The kernel of the nut was pounded into a paste, with three or four corns of pepper, and taken from three to five times a day, in conjunction with a decoction of Cherettah (probably either Swertia chirata or Swertia purpurescens). "The kernel is intensely bitter, and possessed of ... the febrifuge powers of Peruvian bark in a very high degree," he wrote, adding that it also had "a manifest advantage over the latter; for, instead of producing any constipating effects in the bowels, it ... proves mildly laxative." This quality, he noted, made the febrifuge well suited to the climate of Bengal, which, he observed, tended to produce constipation in Europeans. Johnson reported that the remedy had been found so successful that it had been "adopted by many European practitioners" and believed that it would "probably, at no distant period, supersede the bark" (Johnson, 1815). The "fever" or "physic" nut, as it was sometimes known, remained in use throughout the 19 th century (Dey, 1896). It is still commonly used as a febrifuge and antimalarial in India today (Kurrup et al., 1979; Gupta, 1981; Sharma, 1999; Singh and Anwar Ali, 1994).

Had the active ingredients of cinchona not been extracted during the 1830s, it might well have been replaced by indigenous febrifuges, just as Roxburgh and Johnson speculated. As it turned out, quinine came to dominate malaria therapy in India for the next century to the virtual exclusion of local remedies, among practitioners of Western medicine at least. But among practitioners of Indian medical systems, such as Ayurveda and Siddha, and as folk remedies, many of the substances mentioned above remained in common use.

However, practitioners of Western medicine did not entirely lose interest in indigenous drugs. After the posthumous publication of William Roxburgh's Flora Indica in 1820 and 1824, a number of East India Company surgeons such as John Forbes Royle and W.B. O'Shaughnessy attempted to provide scientific accounts of the medical properties of Indian plants. They were soon joined by Indian doctors trained in Western medicine at such institutions as the Calcutta Medical College, which was founded in 1835. Several classic accounts of the pharmacopoeia of India, written by Indians, took their place alongside those of Royle, O'Shaughnessy, and E.J. Waring, who opened up a new era in Indian material medica with the publication of his comprehensive volume Pharmacopoeia of India in 1868. Like Waring, the leading Indian writers were keen to strip Indian material medica of its superstitious associations and to base it on a sound knowledge of chemistry. One such was the Calcutta graduate K.L. Dey, whose classic work Indigenous Drugs of India was published in 1867, going to a second, enlarged edition in 1896. By this time, the profession of medicine in India had become more inclined toward nationalism, though still of a moderate kind. Authors such as Dey fully acknowledged their debts to the British pioneers but took great pride in what they had achieved in the field of medicine. Such was their interest in indigenous materia medica that a whole session of the Indian Medical Congress of 1894 was devoted to it. Dey and colleagues looked ahead to a time when India would have the confidence to draw on its own medical traditions and become largely self-sufficient in the production of its own remedies (Dey, 1896; Harrison, 2001). It is interesting to note that Caesalpinia bonducella and Swertia chirata are key components of the modern antimalarial Ayush-64, which has been used in malaria control programs in the 20th century (see Chapter 5). However, although British colonial doctors took an interest in the local plants used to treat fevers, most did not understand the Ayurvedic system of medicine from which they were taken, and which will be discussed further in Chapter 13.


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