Malaria in England in the Little Ice Age

Paul Reiter, Centers for Disease Control and Prevention, San Juan, Puerto Rico

Disclosures

Emerging Infectious Diseases. 2000;6(1) 

In This Article

The Cure

The strongest evidence that ague was indeed malaria is the identity of its cure. Until the mid-20th century, the only effective remedy for malaria--at least in western medicine--was an extract of cinchona powder, obtained from the bark of several tree species native to the Andes, in South America. The principal active ingredient in this bark is quinine, a drug that has probably benefited more people than any other in the combat of infectious disease. Quinine is still used today, but few people know that its effective use for malaria therapy was first developed in tests with ague patients living in the salt marshes of Essex, less than 50 km from the center of London. What is more, the field experimentation that led to this English remedy was conducted during the coldest years of the Little Ice Age.

The first prescription of cinchona powder in England is attributed to Robert Brady in 1660. Thomas Sydenham advocated its use in his Methodus curandi febres in 1666. By that time, the "Jesuit's Powder" was already widely known in Europe, but in Protestant England many orthodox physicians were prejudiced against its use--partly because its export from Peru and Bolivia was in the hands of Catholics and its use had not been mentioned in the classical medical texts of Galen and partly because a reliable prescription had not been developed. In the end, popularization of the drug came in a highly unorthodox manner: a relatively untutored man, Robert Talbor, abandoned his apprenticeship to an apothecary to develop a safe dosage and an effective treatment regimen: "I planted myself in Essex near the sea side, in a place where agues are the epidemical diseases, where you will find but few persons but either are, or have been afflicted with a tedious quartan." After several years of study and testing, he developed what we would now call a patent medicine, a secret formulation that was essentially an infusion of cinchona powder in white wine.

In 1672, Talbor popularized his remedy by publishing Pyretologia: a Rational Account of the Cause and Cures of Agues. The success of his treatments became widely known and brought him rapid fame and fortune. Charles II appointed him Physician Royal in 1672. He was knighted in 1678, after he cured the King of an ague[20]. Sir Robert Talbor then traveled to France, where he cured the son of Louis XIV. With the additional title of Chevalier Talbot, he became famous throughout Europe, curing Louis XIV, Louisa Maria, Queen of Spain, and hundreds of other royal and aristocratic persons (Figure 5).

Figure 5. The English Remedy: Talbor's Wonderful Secret for Curing of Agues and Feavers (1682). Robert Talbor sold the secrets of his malaria treatment to King Louis XIV for 2,000 guineas, on condition that they would not be published until after his death. In 1682, Talbor's remedy was published in French; the English translation appeared in the same year. Front page of English translation and introductory page in which Talbor describes how he went to Essex, and used "that good old way, observation and experiment . . . by which observations, and the assistance of my reason (God blessing my endeavours) I have attained a perfect knowledge of the cure of . . . Agues."

Reproduced courtesy of Wellcome Institute for the History of Medicine, London. Talbor's rise to fame has been told in many publications[21,22], yet none of these mention that the entire story took place in a period when temperatures were probably colder than in any other period in the past 10,000 years. Records for central England from 1670 to 1700 suggest that snow lay on the ground for an average of 20 to 30 days (in some years more than 100 days) as opposed to 2 to 10 days in the present century. In the winter 1683-84, the ground was frozen to more than 1 m. Belts of sea ice 5 km wide were present along the coast in the English Channel and are believed to have been 30 to 40 km wide off the coast of the Netherlands. The average summer growing season was approximately 5 weeks shorter than in the 20th century, and in some years the difference may have been more than 2 months[1]. Nevertheless, the fact that the European aristocracy was eager to pour money and honors on an untutored commoner suggests that malaria continued to be a serious problem.

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