Pestilence, Sacred Trees And A Glass of Tonic Water

I have a soft spot for tonic water. Maybe because it’s the only soda beverage with a taste I never fully understood, impossible to describe: an ambiguous aroma, a strange contrast between that pinch of sugar and a sour vein that makes your palate dry.
Every now and then, during summer evenings, I happen to take a sip on my balcony while I watch the Alban Hills, where the Roman Castles cling to a long-dead volcano. And as I bring the glass to my lips, I can’t help thinking about how strange history of mankind can be.

Kings, wars, crusades, invasions, revolutions and so on. What is the most powerful cause for change? What agent produced the most dramatic long-term modification of human society?
The answer is: epidemics.
According to some historians, no other element has had such a profound impact on our culture, so much so that without the Plague, social and scientific progress as we know it might not have been possible (I wrote about this some time ago). With each stroke of epidemic, the survivors were left less numerous and much richer, so the arts and sciences could develop and flourish; but the plague also changed the history of medicine and its methods.

“Plague” is actually a very generic word, just like “disease”: it was used throughout history to define different kinds of epidemic. Among these, one of the most ancient and probably the worst that ever hit mankind, was malaria.

It is believed that malaria killed more people than all other causes of death put together throughout the entire human history.
In spite of an impressive reduction of the disease burden in the last decade, the World Health Organization estimates that as many as 300 million people are infected by the disease every year. That’s about the size of the entire US population. Of those who fall sick, more than 400,000 die every year, mostly children: malaria claims the life of one child every two minutes.

Malaria takes its name from the Italian words “mala aria”, the bad air one could breathe in the marshes and swamps that surrounded the city of Rome. It was believed that the filthy, smelly air was the cause of the ague. (Giovanni Maria Lancisi suggested in 1712 that mosquitoes might have something to do with the epidemic, but only at the end of the Nineteenth century Sir Ronald Ross, an English Nobel-awarded gentleman, proved that malaria is transmitted by the Anopheles mosquito.)

Back in Medieval Rome, every summer brought back the scourge, and people died by the hundreds. The plague hit indistinctively: it killed aristocrats, warriors, peasants, cardinals, even Popes. As Goffredo da Viterbo wrote in 1167, “When unable to defend herself by the sword, Rome could defend herself by means of the fever”.

Malaria was widespread throughout Europe, Asia, and Africa. Yet, no one knew exactly what it was, nor did they know how to treat it. There was no cure, no remedy.

Well, this is the part that really blows my mind. I cannot shake the feeling that someone was playing a bad joke on us humans. Because, actually, there was a remedy. But the mocking Gods had placed it in a land which had never been attained by malaria. Worse: it was in a land that no one had discovered yet.

As Europe continued to be ravaged by the terrible marsh fevers, the solution was lying hidden in the jungles of Peru.

Enter the Jesuits.
Their first mission in Peru was founded in 1609. Jesuits could not perform medicine: the instructions left by the founder of the order, St Ignatius of Loyola, forbade his followers to become doctors, for they should only focus on the souls of men. Despite being expressly forbidden to practice medicine, Jesuit priests often turned their attention to the study of herbs and plants. Father Agustino Salumbrino was a Jesuit, and a pharmacist. He was among the firsts missionaries in Peru, and he lived in the College of San Pablo in Lima, putting his knowledge of pharmacy to good use as he built what would become the best and biggest pharmacy in the whole New World. Jesuits wanted to convert the natives to Catholicism, but understood that it couldn’t be done by means of force: first they needed to understand the indios and their culture. The native healers, of course, knew all sorts of plant remedies, and the priests took good notice of all this knowledge, picking never-before-seen plants and herbs, recording and detailing their effects.
That’s when they noted that the Indians who lived in the Andes sometimes drank infusions of a particular bark to stop from shivering. The Jesuits made the connection: maybe that bark could be effective in the treatment of marsh fevers.

By the early 1630s Father Salumbrino (possibly with the help of another Jesuit, Bernabé Cobo) decided to send a small bundle of this dried bark back to Rome, to see if it could help with malaria.
In Rome, at the time, there was another extraordinary character: Cardinal Juan De Lugo, director of the pharmacy of the Hospital Santo Spirito. He was the one responsible for turning the pharmacy from an artisan studio to something approaching an industrial production line: under his direction, the apothecary resembled nothing that had gone before it, either in scale or vision. Thousands of jars and bottles. shelves filled with recipes for preparations of medicines, prescriptions for their use and descriptions of illnesses and symptoms. De Lugo would cure the poor, distributing free medicine. When the Peruvian bark arrived in Rome, De Lugo understood its potential and decided to publicize the medicine as much as he could: this was the first remedy that actually worked against the fever.

Peru handing Science a cinchona branch (XVII C. etching).

The bark of the cinchona tree contains 4 different alkaloids that act against the malaria parasite, the most important of which is quinine. Quinine’s secret is that it calms the fever and shivering but also kills the parasite that causes malaria, so it can be used both as a cure and a preventive treatment.

But not everyone was happy with the arrival of this new, miraculous bark powder.

First of all, it had been discovered by Jesuits. Therefore, all Protestants immediately refused to take the medicine. They just could not accept that the cure for the most ancient and deadly of diseases came from their religious rivals. So, in Holland, Germany and England pretty much everybody rejected the cure.
Secondly, the bark was awfully bitter. “We knew it, those Jesuits are trying to poison us!

But maybe the most violent refusal came from the world of medicine itself.
This might not come as a surprise, once you know how doctors treated malaria before quinine. Many medieval cures involved transferring the disease onto animals or objects: a sheep was brought into the bedroom of a fever patient, and holy chants were recited to displace the ailment from the human to the 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. In the first part, write the words Ave Gaspari. In the second write Ave Balthasar, in the third Ave Melchior. Then eat each segment early on three consecutive mornings, and recite three Our Fathers and three Hail Marys”.

Even after the Middle Ages, the medical orthodoxy still blindly believed in Galen‘s teachings. Traditionalists who wanted to preserve the ancient doctrine of Galenic medicine at any cost felt the cinchona bark would overturn their view of the human body – and it was actually going to. According to Galen, fever was a bile-caused disorder: it was not a symptom but a disease in itself. A patient with a high fever was said to be suffering from “fermentation” of the blood. When fermented, blood behaved a little like boiling milk, producing a thick residue that to be got rid of before the patient could recover. For this reason the preferred treatments for fever were bleeding, purging, or both.
But Peruvian bark seemed to be curing the fever without producing any residue. How could it be possible?

The years passed, and the success of the cure came from those who tried it: no one knew why, but it worked. In time, cinchona bark would change the way doctors approached diseases: it would provide one of decisive blows against Galen’s doctrine, and open the door to modern medicine.

A big breakthrough for the acceptance of Jesuits Bark came from a guy named Robert Tabor. Talbor was not a doctor: he had no proper training, he was just a quack. But he managed to become quite famous and fashionable, and when summoned to cure Charles II of England of malaria, he used a secret remedy which he had been experimenting with. It worked, and of course it turned out to be the Jesuits powder, mixed with wine. Charles appointed Talbor as his personal physician much to the fury of the English medical establishment and sent him over to France where he proceeded to cure the King’s son too. Without really realizing it, Talbor had discovered the right way to administrate cinchona bark: the most potent mixtures were made by dissolving the powder into wine — not water — as the cinchona alkaloids were highly soluble in alcohol.

By the end of the 18th century, nearly three hundred ships were arriving in Spanish ports from the Americas every year — almost one each day. One out of three came from Peru, none of which ever failed to carry cinchona bark.

Caventou & Pelletier.

And in 1820, quinine was officially born: two scientists, Pelletier and Caventou, succeeded in isolating the chemical quinine and worked out how to extract the alkaloid from the wood. They named their drug from the original Inca word for the cinchona tree bark, quina or quina-quina, which means “bark of barks” or “holy bark”.

Many other battles were fought for quinine, lives were risked and lost. In the 1840s and 1850s British soldiers and colonials in India were using more than 700 tons of bark every year, but the Spanish had the monopoly on quinine. English and Dutch explorers began to smuggle seeds, and it was the Dutch who finally succeded in establishing plantations in Java, soon controlling the world’s supplies.

During WWII the Japanese occupied Java, and once more men wnt to war over tree bark extract; but fortunately this time a synthetic version of quinine was developed, and for the first time pharmaceutical companies were able to produce the drugs without the need for big plantations.

Troops based in the Colonies all consumed anti-fever, quinine-based pharmaceuticals, like for instance Warburg’s Tincture. This led to the creation, through the addition of soda, of several  QuinineTonic Waters; in 1870 Schweppe’s “Indian Tonic Water” was commercialized, based on the famous carbonated mineral water invented around 1790 by Swiss watchmaker Jacob Schweppe. Indian Tonic Water was specifically aimed at British colonials who started each day with a strong dose of bitter quinine sulphate. It contained citric acid, to dissolve the quinine, and a touch of sugar.

So here I am, now, looking at the Alban Hills. The place where I live is precisely where the dreaded ancient swamps once began; the deadly “bad air” originated from these very lands.
Of course, malaria was eradicated in the 1950s throughout the Italian peninsula. Yet every time I pour myself a glass of tonic water, and taste its bitter quinine flavor, I can’t help thinking about the strange history of mankind — in which a holy tree from across the ocean might prove more valuable than all the kings, wars and crusades in the world.

Most of the info in this post are taken from Fiammetta Rocco, The Miraculous Fever-Tree. Malaria, medicine and the cure that changed the world (2003 Harper-Collins).

Viaggi spaziali

L’esplorazione spaziale, iniziata in modo pionieristico alla fine degli anni ’60, ha conosciuto un momento “morto” negli ultimi decenni, ma oggi sta tornando ad essere parte integrante dei progetti delle grandi agenzie aerospaziali. Gli Stati Uniti hanno pianificato i primi viaggi su Marte per la metà degli anni 2030; ESA, Russia e Cina sembra abbiano in progetto missioni similari. Ma al di là dello stimolo che questi salti nell’ignoto regalano alla nostra fantasia, ci sono dei lati oscuri con cui fare i conti (che sono poi quelli che ci interessano, qui a Bizzarro Bazar!).

Innanzitutto, teniamo presente che le enormi distanze da superare pongono diversi grattacapi. Prendiamo ad esempio una missione su Marte. Il vero problema, sostengono i professori della NASA, sarebbe il costo del “biglietto” di ritorno. Far decollare una nave spaziale dalla Terra richiede già una quantità di carburante inimmaginabile, e dotare il mezzo di una quantità di combustibile tale da permettere il viaggio di rientro è al momento pura utopia. Questo significa che il volo verso Marte sarebbe di sola andata. I primi pionieri dovrebbero divenire dei veri e propri coloni, disposti non soltanto ad esplorare il nuovo pianeta, ma a fondarvi una comunità. Dovrebbero essere scelte coppie in grado di riprodursi, per dar vita alla prima vera colonia marziana che comprenda bambini nati e cresciuti sul Pianeta Rosso. Quanti di voi non esiterebbero un attimo a lasciarsi tutto alle spalle per iniziare una nuova vita su Marte? Quale uomo accetterebbe di partire sereno, sapendo che non farà mai più ritorno, che non vedrà mai più il mare, i suoi famigliari, gli uccelli nel cielo?

Parecchi, a quanto sembra. Da quando il Journal of Cosmology ha indetto il “sondaggio”, almeno 500 volontari si sono presentati all’appello. Persone per cui l’avventura, la curiosità e la gloria valgono più di ogni altra cosa; persone che non hanno più nessun legame; persone che sognano un’epopea spaziale da quando hanno 10 anni. Forse sarà proprio questo il bacino al quale gli scienziati attingeranno, in un prossimo futuro, per selezionare gli equipaggi di questa epocale “invasione”.

Ma i viaggi spaziali sono anche lunghi, e il lato più cupo della nostra personalità può prendere il sopravvento. Lo spazio può diventare una gabbia fatta di paranoie, illusioni e depressione, fatto da cui gli scrittori di fantascienza ci mettono in guardia da molti anni. Innanzitutto, la solitudine. Una solitudine inimmaginabile. Finora i viaggi sono stati troppo brevi per una qualche manifestazione psicologica in questo senso. Ma la NASA continua a ponderare gli effetti dannosi dell’isolamento per lunghi periodi di tempo, tanto da investire 1,74 milioni di dollari nella Virtual Space Station, una sorta di “psicologo-robot” che dovrebbe aiutare e dare consigli agli astronauti depressi dalla profonda solitudine. Nel 2008, uno studio condotto al NHC HealthCare in Maryland Heights ha indicato che un cane robotico si è rivelato un ottimo rimedio per la solitudine dele persone anziane, quasi quanto un cucciolo reale… anche se l’immagine di un astronauta solo nello spazio, che parla e coccola un cane-robot non è delle più confortanti.

Nello spazio, un posto che a torto riteniamo “vuoto”, si spargono radiazioni di vario tipo. Senza la protezione dell’atmosfera, queste radiazioni possono essere pericolose. E non si tratta qui soltanto delle temibili esplosioni di raggi gamma (evento talmente raro da essere trascurabile), ma anche semplicemente delle più comuni radiazioni cosmiche: alcuni esperimenti hanno dimostrato che l’esposizione a questi raggi può causare alterazioni nell’ippocampo, l’area del cervello responsabile della creazione di nuove cellule cerebrali e ritenuta responsabile dell’apprendimento e degli stati di umore. Proteggere con scudi appropriati gli astronauti potrebbe significare ridurre i danni cerebrali e la depressione di un viaggio al di fuori dell’orbita terrestre.

Un altro problema dei viaggi astrali è la fornitura e la purificazione dell’aria. Molti studi condotti sugli scalatori di alta quota hanno dimostrato come uno scarso approvvigionamento di ossigeno porti a un calo di attenzione, di capacità cognitiva e di riconoscimento linguistico. In situazioni ancora più estreme, a ridotto apporto di ossigeno, si verificano danni permanenti al cervello. Per questo si stanno dotando le astronavi di potenti rilevatori, in grado di accorgersi in largo anticipo di un cambio nell’aria della capsula. Vengono sviluppati anche dei software in grado di “misurare” la coerenza delle risposte degli astronauti a determinate domande, per prevenire eventuali danni psichici.

Aggiungete a questo quadro lo stress del lavoro di un astronauta, costantemente vigile e attento, che deve tenere sott’occhio i parametri della missione, controllare l’equipaggiamento, sapendo che soltanto un po’ di lamiera lo protegge dall’agghiacciante vuoto siderale. Molte persone, in situazioni molto meno stressanti, si imbottiscono di psicofarmaci. L’uso e l’abuso di tali sostanze (già oggi utilizzate a bordo delle stazioni spaziali) sarà un ennesimo grattacapo da risolvere. E pensate anche solo per un momento a questa situazione: non siete voi a impazzire nello spazio, ma il vostro collega. Se nella vostra giornata quotidiana c’è sempre un orario di fine lavoro, che vi permette di staccare la spina, beh, su una navicella spaziale non esiste. Per quanto professionali gli astronauti si possano dimostrare, dovranno anche essere addestrati a far fronte a qualsiasi imprevisto, persino il crollo psicologico di uno dei membri dell’equipaggio.

Ed arriviamo infine alla questione più spinosa e difficile. Cosa fare quando un astronauta muore nello spazio?

La mitica Mary Roach, giornalista scientifica autrice dell’imperdibile Stecchiti (2005), ha da poco scritto un libro sui viaggi spaziali. Con la sua consueta scrupolosa curiosità, ha indagato anche il problema della morte nello spazio. E ci ha illuminato sulle ultime tendenze della NASA al riguardo.

La morte, già di per sé destabilizzante, diviene ancora più insostenibile in un ambiente estremo come il cosmo. Nessuno sa come un piccolo gruppo isolato nello spazio possa reagire di fronte alla scomparsa di un membro: sentimenti di paura, perdita di controllo, rabbia, colpa o attribuzione di colpa possono instaurarsi. Di fronte a un decesso che colpisce inaspettatamente un membro dell’equipaggio durante una missione, il tempo per preparare il corpo sarà soltanto di 24 ore, per prevenire infezioni. Ad ogni astronauta verrà chiesto di riempire un diario in cui annotare e sfogare le proprie emozioni al riguardo.  Il corpo, dopo una cerimonia funebre che ricordi quelle terrestri (che serva da guida per la difficile situazione e riaffermi i valori che ci accomunano), verrà deposto in un modulo apposito, studiato per eseguire la cosiddetta Promession: si tratta di un “compostaggio” ecologico dei resti umani, per mezzo del quale il corpo viene completamente congelato, poi scosso violentemente fino a ridurre la salma in una fine polverina. La capsula contenente il cadavere polverizzato verrà poi estromessa dall’astronave, là dove nessuno può vederla, trattenuta da un braccio meccanico, e lì resterà fino a quando l’astronave non rientrerà sulla Terra (ritraendosi poco prima dell’impatto con l’atmosfera); una volta atterrata potrà finalmente avere degna sepoltura. Una particolare attenzione verrà mantenuta sui “sopravvissuti”, per evitare crolli psicologici e follia.

Ecco l’articolo di Mary Roach in cui viene spiegata l’intera procedura (in inglese).

Il sogno di “fare l’astronauta” non ha mai perso il suo fascino. Ma oggi, quando questa fantasia sta quasi per diventare realtà, gli scienziati continuano a interrogarsi su quali siano le vere barriere con cui dovremo fare i conti. E pare che i mostri più pericolosi, gli alieni più letali, prenderanno corpo nella nostra stessa mente.