Читать книгу The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World - Fiammetta Rocco - Страница 8

‘When unable to defend herself by the sword,Rome could defend herself by means of the fever.’

GODFREY OF VITERBO, poet, 1167

Giacinto Gigli lived for sixty-five years in an alleyway by the Via delle Botteghe Oscure. His small townhouse was one of several built close together. They clung, like a gaggle of shy children, to the end of one of the crooked passageways that cluttered the centre of Rome, seeming almost to lean into one another when the wind whipped around them during the early days of winter. Gigli was not born there, but from the time when he was twelve years old until just before Christmas 1671, when he died at the age of seventy-seven, he returned every night from his work in the papal palace at the Vatican and climbed the stairs to the study, his favourite room, at the top of the house, where his desk was placed between two tall windows.

One of them looked westwards, over the bend in the Tiber where tradesmen, prelates and visitors would cross the bridge that led towards the Santo Spirito hospital and beyond it to St Peter’s and the palace of the Vatican. From that window Gigli could just see the golden dome of St Peter’s, though often it seemed almost to fade away in the summer haze, when the city became too hot to bear and the Pope’s court moved to the palaces and villas in the coolness of the hills that surround the city. The other window, on the far side of the room, looked north-east towards the Quirinale, the highest of Rome’s seven hills, where the Pope’s own summer palace had been built so that he could escape the unhealthy summer air, and where a gentle breeze blew all day through the shady trees.

The Gigli family was part of Rome’s petite bourgeoisie, though by his death Giacinto’s father had been able to leave his son the property near the Via delle Botteghe Oscure, two other smaller houses in the centre of the city, and a vineyard on the road to Frascati, a considerable inheritance for a modest man. When he was twelve Gigli entered the Collegio Romano, the Jesuit school where he studied grammar, humanities and rhetoric. For a while he studied law in the studio of Angelo Luciano, a well-known Roman advocate, and graduated as a specialist in papal law. By that time his father was dying, and as Giacinto prepared to take his place as the head of the Gigli family, the young man’s thoughts turned to marriage. He had known Virginia Lucci all his life. She was his neighbour’s daughter, and the time had come to ask for her hand.

As he grew older, Gigli began to acquire the status of a man of respect. He was made a rione, representing his parish of Pigna in the committees and on ceremonial occasions that would occasionally bring together the city and the Holy City. Dressed in velvet and bedecked with feathers, he would walk in line before the horsemen that accompanied the papal processions. Later he was made a caporione, before eventually serving twice as the priore, the head of all the caporioni, responsible to the Pope for helping collect taxes and keeping order within the Holy City. These duties gave Gigli an intimate insight into Rome, and particularly the clerical administration that ran it. He became something of an expert on Vatican politics – who was in favour and more importantly who was not, how different cardinals behaved and how they were discussed. ‘All this and more is the lifeblood of the Holy City,’ he would write.

We don’t know what Gigli looked like, for no contemporary likeness of him survives. But we know a great deal else about him: how he lived, how he filled his day, what he did when he fell ill, whom he saw and what he ate. Gigli was meticulous about recording the details of his life in his diary, which survives in the Vatican library, writing something every day, even if only a brief phrase or two. He wrote in Latin, in an elegant slanting hand, taking care to reach the very edge of the page before starting on the next line.

Gigli had acquired the habit of chronicling his daily life before his marriage. In 1614, when he was only nineteen, he even began an autobiography, entitled Vita. He kept this up assiduously for about five years, making minute notes of everything that went on in his household, recording the names of the servants who came and went, what they were paid and what they earned in tips or small gifts, like the woollen socks that were given to the nurse who came to care for his only son. While this might seem unnecessarily fussy to some, these were not bad habits for a diarist to acquire. In addition, he also wrote poetry, long verses about his native city and eulogies of the Popes in rhyming octets.

The papal court was the centre of Gigli’s life. From the first entry in the diary, on 29 May 1608, to the last, when he was almost too blind to write any more, yet fretted about missing the baptism of the Pope’s new baby niece, he specialised in the comings and goings of the Vatican. The Pope’s court was newly returned to Rome after the alternative papacy, set up the previous century in Avignon with the support of the King of France, had threatened to rob Rome of much of its wealth and influence. Restored once more to its traditional home, the leadership of the Roman Catholic Church was doing all it could to spread the counter-Reformation in Europe and impose its spirit, burning heretics and attempting to suppress Protestantism whenever it could.

In the first decades of the seventeenth century, though, when Gigli was making his daily observations of the Holy City, papal Rome still hadn’t really found its feet. The memory of the schism lived on, making the city fathers nervous, hidebound, inward-looking; too fearful of the Turkish forces that threatened Venice, or the Spaniards who lay siege to Naples, ever to be easy. Naturally conservative, papal Rome then was more fearful of change than it had ever been. In 1633 Galileo Galilei, after publishing his arguments for a Copernican cosmology, with the earth and the planets revolving around the sun, rather than with the earth at the centre of the universe as had long been the prevailing view, would be tried for heresy and his works banned.

Like his masters in the Church, Gigli was a conservative man. Over the years we get a good idea of what he approved of and what he didn’t. Gigli was something of a prig, and there was much that went on in Rome that made his lip curl in distaste. Despite that, he had a fine eye for daily life in the city – the storms, the fires, the earthquakes, the fate of the jailed heretics who were often hung, drawn and quartered, their various portions exposed to the populace as an example to those who might be tempted to question the Pope’s authority. He wrote about the availability of bread, about miracles, comets and eclipses of the sun. Although he was a rational, educated man, there was a medieval part of Gigli that could not help but believe that God sent signs to his people below, good signs if he was pleased with them and punishments when he was enraged.

On a more down-to-earth level, Gigli wrote about people’s anger at the rising taxes, their irritation at the inflexibility of the authorities and their fear of the Tiber’s floods, which he always described as the river getting ‘out of its bed’. In 1630 he wrote of the arrival in Rome of an elephant, ‘which no one had seen for a hundred years’, since the King of Portugal sent one as a gift to Pope Leo X in 1514. This particular beast, by contrast, had been brought to the city by a private citizen, and anyone who wanted to see it had to pay him one giulio for the pleasure.

In turn observant, witty and fastidious to the point of pernicketiness, Gigli became Rome’s most wonderful portraitist. At the start of the seventeenth century, the city had a population of about 115,000. It was a tenth of the size of its imperial predecessor, smaller by far than Paris or London—smaller even than Naples – but it was growing after the ravages of the previous century, when it had been sacked and later flooded, before being visited by the plague and then cast into ruin during the papal schism. With the return of the papacy, diplomats, bankers, doctors, artisans, traders, horsemen and financiers jostled in the capital for any part of the papal chancery’s swelling business.

Most of these people lived and worked, as Gigli himself did, in the occupato, the dense gathering of taverns and tenement houses separated by narrow cobbled streets that nestled in the crook of the arm of the Tiber where it curved in an ‘S’ shape, first west and then south-east. Inevitably they were almost all connected, one way or another, with the Church establishment. The three most important routes into the city converged on the Ponte Sant’ Angelo, just south of the Vatican, bringing travellers who were always hungry for news and for business directly into the heart of the city. Over it rose the bell towers of nearly 350 churches. The tallest among them were the great basilicas that kept watch over the tombs of the apostles. Then there were the churches that guarded the sacred reliquaries of the saints, and occasionally, some believed, even fragments of the True Cross. Lower still were the chapels of the patrician families and the oratories of the guilds. From every sacred spire and belfry the city trumpeted its patronage of the holy. In brick and stone, every street, every façade, every arch and roof and alleyway proclaimed its thousand years as a Christian symbol.

All that lay within the occupato.

Beyond the occupato, though, lay the disoccupato. And that was another story altogether.

To the east of the city, starting at the Capitol, to the south and to the north ranged a barely inhabited wasteland ‘set with ruins, where green snakes, black toads and winged dragons hid, whose breath poisoned the air as did the stench of rotting bodies’, as an eyewitness to the epidemic that killed half of the newly crowned Holy Roman Emperor Frederick Barbarossa’s army had described it in July 1155.

Encircling the town proper and extending out to the Aurelian walls, the disoccupato had barely changed in five hundred years. The loose patchwork of fields and vineyards was set with small houses, sheds and straw huts, tiny churches, gardens, groves and ancient ruins such as the Baths of Constantine and the Temple of Serapis. Much of it was only ever used for a few weeks each year. Dry in midwinter or at the height of a rainless summer, the disoccupato needed just the first downpour of spring to transform it into a swampy marsh, its muddy roads and ditches becoming pools of stagnant water that turned first green and then brown in the summer heat.

Rome at that time may have been an exciting city in which to live, but it was hardly a healthy place, though it was not until 1631 that it suffered the beginnings of the plague epidemic that would eventually kill nearly half its citizens. In an entry written at the end of December 1624, Gigli was full of apologies. ‘I, Giacinto, have not been able to make daily descriptions of life as I would have liked, for I have been sick for a long time, with grave and lingering maladies, as a result of which there are many things I have not seen and others I have not noted. But, with God’s pleasure, I am now well and healthy, and I hope in the Holy Year of 1625 that I will be able to make diligent note of things as they occur unlike those I have missed this year.’

Medicine had barely advanced over the centuries, and it is easy to forget how small a proportion of Europe’s adult population would have been healthy at any one time. Stomach disorders of one kind or another were chronic, both among the rich, whose diet was poorly balanced, and among the poor, who found it hard to find sufficient food for themselves and their children. When they did, it was often rotten. Recurring outbursts of bacterial stomach infections resulted in dysentery, which often killed the old and the very young. Tuberculosis was rife, and for women childbirth was always very dangerous. Both sexes suffered from rotting teeth, while suppurating ulcers, eczema, scabs, running sores and other skin diseases were very common and sometimes lasted for years.

Gigli was constantly preoccupied with matters of health, his own and that of his family. And the malady he wrote about most often was the Roman or marsh fever, which we now know as malaria. ‘It returns every year in the summertime,’ he says, ‘and no one can feel himself to be safe from it.’

Rome then was the most malarious city on earth. Hundreds of people died of the disease every summer, while hundreds more were left so weak they were unable to walk, and became prey instead to the slightest infection. The rise and fall of the Tiber, which often broke its banks and flooded the plain of the Campagna, left pools of stagnant water through the countryside which provided the ideal breeding ground for the Anopheles mosquito that spread the disease. The views of those observers, such as the first-century BC Roman writer Marcus Terrentius Varro, who thought the miasma might be alive, full of what he called animaletti, ‘minute animals [that are] invisible to the eye, breed there [in swamps] and, borne by the air, reach inside of the body by way of the mouth and nose, and cause disease’, were regarded as extremely bizarre. Most Romans in Varro’s time knew only enough to recognise the intermittent fever and shivering that visited them every year.

Giacinto Gigli had a particular reason to know about the fever. His only grandchild, Maria Cecilia Hortenzia Gigli, died of it at the age of fifteen. One day she complained of an aching head and stiff limbs. Rivulets of sweat ran down her forehead, dampening the sheets. Yet just a few hours later her mother was piling on the covers in an effort to keep the child warm. At seven o’clock in the evening, just three days after falling ill, she passed away.

Gigli was deeply affected by his granddaughter’s death, and he must have fretted greatly at her decline, against which he would have had no cure other than the herbs and amulets left over from medieval times. His diary entry that day is unusually terse, and comes suddenly after a description of a great fire that destroyed the Santa Caterina de’Funari monastery. Numb with grief, he writes only that: ‘She was fifteen years, five months and three days, and her beauty, her virtue and her goodness will be eternally remembered.’

The most important hospital in Rome at the time was the Santo Spirito, which had been built between the Tiber and the walls of the Vatican and which Gigli could see from his study windows. The Santo Spirito trained many of Europe’s finest doctors, but for most of the city’s population the cost of visiting a professional doctor was beyond their means. They preferred, in any case, to consult the herbalists and sellers of secret potions whom they had known all their lives. Many medieval cures had involved patients and physicians trying to expel their diseases by transferring them to other objects. Peasants in a number of European countries would bring a sheep into the bedroom of a fever patient, in the hope of displacing the ailment from human to 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,’ advised the prescription. ‘In the first part, write the words Ave Gaspari. In the second write Ave Balthasar and in the third write Ave Melchior. Then eat each segment early on three consecutive mornings, accompanied by three “Our Fathers” and three “Hail Marys” as an offering to the Holy Trinity.’

Another prescription, from a well-known sixteenth-century Roman healer named Tralliano, was supposed to be especially good against the most common fevers, called tertian and quartan because they resurged with worrying regularity, either every three days or every four. Tertian and quartan fevers were almost certainly malaria, and Tralliano’s cure was the same for both: ‘Take a ripe peach and remove the pip. Put the pip into an orange and tie it around the neck of the patient. He will be healed expertum et verum.’

Another was more complicated. ‘Write the following words on a piece of paper,’ it advised.

Abracolam …

Abracolai …

Abracola …

Abracol …

Abraco …

Abraco …

Abraco …

Abra …

Abr …

Ab …

A …

At the end, add the phrase, ‘Consumatum est.’ Then have the paper tied to the neck of the patient by a young virgin using a long piece of string and reciting at the same time three ‘Our Fathers’ and three ‘Hail Marys’ in honour of the Holy Trinity.

Gigli and his fellow Romans thought they knew only too well whence spread the fever that killed his granddaughter and was as permanent a feature of the city as the smell of incense or the gentle scent of summer apricots. From the swamps and stagnating ponds of the disoccupato, it was believed, rose dark mists laden with fever. In Rome, went a saying, if you did not catch the fever from the aria, you caught it from the mal’aria. Bad air.

The word malaria, or mal’aria as it was always written until recently, was unknown in English until the writer Horace Walpole introduced it. In July 1740, while on a visit to the Holy City, he wrote to his friend H.S. Conway, ‘There is a horrid thing called the mal’aria that comes to Rome every summer and kills one.’ For more than a century afterwards, though, mal’aria was not taken to mean a disease so much as a noxious gas which rose from swamps or rotting carcases and vegetation, and which caused a group of ailments variously known as intermittent fever, bilious fever, congestive fever, swamp fever or ague.

Whichever of these was really malaria, the Romans had known for centuries about the miasma. From the disoccupato it invaded the city and forced the citizens to take to the hills every year during the worst of the summer heat, leaving the city abandoned; abandoned, that is, by those who could afford to leave. The rest stayed behind, entrusting their health to the Almighty and to the concoctions of the healers whose numbers always grew larger in summer.

Malaria had probably existed in Rome since late antiquity. Chronicles of the imperial Roman army talk of soldiers suffering from constantly recurring fever, chills, sweating and weakness, and many historians believe that one of the main causes of the collapse of the Roman Empire may well have been the prevalence of malaria around the shores of the Mediterranean Sea. In 2001, British and American scientists found malarial DNA in the bones of an infant skeleton that had been unearthed in a fifth-century villa at Lugano, near Rome.

No one is quite certain why, but malaria seems to have receded during the early Middle Ages, only to reappear with even greater severity in the years when Giacinto Gigli lived in Rome at the beginning of the seventeenth century, continuing into the eighteenth century, when it was an annual occurrence in Kent and the fenlands of England, eventually reaching as far afield as Scandinavia, Poland and Russia.

Within the Vatican, many of whose buildings were erected on Rome’s lowland, by the banks of the Tiber, malaria was especially prevalent, striking with little heed for the age, rank or title of its victims. In July 1492 Bartolomeo da Bracciano, one of the senior courtiers at the palace of the Vatican, wrote to his friend Virgilio Orsini: ‘The Pope, last night, had a great fever of the quartan variety, alternating between hot and cold. The Pope is confined to his bed, and it is said that perhaps he will never rise from it.’ Indeed, he didn’t. Four days later, on 25 July 1492, Pope Innocent VIII was dead.

Eleven years later Pope Alexander VI died, again most probably of malaria, after dining in the palatial garden of his friend Cardinal Adriano Castellesi da Corneto in August 1503. Adrian VI died of malaria in the summer of 1523, and in August 1590 Sixtus V too died of malaria at the age of sixty-nine, after a brief and very active pontificate. He had caught it a year earlier while sleeping in a hastily erected cabin during a tour of work being undertaken in the marshes around Castello Caetani, not far from Rome. Even the Borgias, who tried valiantly over the years to murder one another, could not kill each other or their enemies so regularly or so reliably as would malaria.

In the summer of 1623, shortly before Gigli, to his immense pride, was made a caporione for the first time, the Pope, Gregory XV, fell gravely ill. In his diary, the twenty-eight-year-old Gigli reported: ‘His Holiness is not well. We must pray to the Lord.’ It was said that the Pope had caught the fever the previous year, and now it had returned with a vengeance. From his study overlooking the city Gigli could see the palace of the Quirinale, nicknamed Monte Cavallo, where the Pope lay on his sickbed. An earlier Pope, also called Gregory, had chosen this superb site, less than a century before, to build his summer residence in an effort to escape the malaria that always plagued Rome during the hot summer months. In the courtyard in front of the palace, another Pope had had statues of four prancing horses installed. Nearly twenty feet high, they were Roman copies of Greek symbols of Castor and Pollux, the patrons of horsemanship who were known as the ‘horse tamers’, and it was they that gave the hill its nickname.

At the centre of the palace itself, dark heavy drapes shut out the light and the world beyond. For some days the Pope had been lying unmoving in his bed, covered only by a light blanket of fine wool. His head ached, his spleen was swollen and his body tormented in turn by fever and sweating, then by shivering and chills. A small troupe of Penitentiaries, the Jesuits who heard confessions in St Peter’s basilica, prayed at his feet. Occasionally one would rise from his knees and another would step forward to take his place. With their gentle voices and indistinguishable cassocks of rough grey wool, they represented an unceasing rosary of care for the souls of the dying.

As a caporione, Gigli was often called upon to make the short journey from his home near the Via delle Botteghe Oscure to Monte Cavallo. During that long summer of 1623 he made the journey more as a way of obtaining news of the Pope’s health than because there was a great deal of work to be done. For while no one knew whether the pontiff would live or die, the papal courtiers lived in an atmosphere of suspended animation, talking only in whispers. ‘We are all weary,’ Gigli wrote at the end of the first week of Pope Gregory’s illness.

Among those who attended the Pope’s sickroom was his nephew Ludovico Ludovisi. Though not yet thirty, Ludovisi had been made a cardinal by his uncle, which had enabled him to amass a considerable fortune in cash and works of art in just two years. Was his life as a man of influence about to come to an end? Should the Pope die, Ludovisi was too young to be elected pontiff himself. His only future lay in seeking to influence the choice of his uncle’s successor. If a candidate with his backing should attain the throne of St Peter, Ludovisi’s eminence would continue. But he had made many enemies, and would have little time to build the alliances that were essential if he were to sway the complicated negotiations that would follow Gregory’s death.

As soon as the Pope died, the seal on the fisherman’s ring that was the emblem of his pontificate would be broken. The new Pope would be given a new seal with his own name. Predictions of Pope Gregory’s death had been made so often that he had often lamented, in the days when he felt better, that his fellow cardinals had scarcely elected him when they began planning the conclave that would select his successor. Now, it seemed, the end really had come. Gone were the badges of his office, the high, pointed, cone-shaped hat, the silken gloves. Gone too were the papal vestments with their strange names handed down through the ages – the flabellum, the falda and the fanon. On his deathbed Christ’s vicar on earth wore a simple cotton shift with a wrap about his shoulders. Beneath it his pale body was only a man’s, and a rotting one at that.

As Ludovisi and the other senior cardinals looked on, together with the Penitentiaries, Giacinto Gigli and the rest of the city waited outside for news. Pope Gregory’s confessor began the sacrament of extreme unction. With holy oil he anointed the pontiff’s eyes, his nose, his mouth, his ears. The palms of the Pope’s hands had been anointed when he became a priest, so the confessor made only the sign of the cross in oil upon the backs of his hands. ‘By this holy unction,’ he prayed, ‘and by His most tender mercy, may the Lord forgive thee whatsoever sin thou hast committed by touch.’ As death drew closer, the priest began the commendation of the soul, calling: ‘Subvenite’.

In a few moments the secretary of state of the curia would knock at the door with a silver mallet, and call out for the Pope by name. Obtaining no response, he would enter the chamber and approach the bed. With another, smaller, mallet he would touch the Pope upon the forehead. Three times he would call the Pope’s name and tap his cold forehead with his silver mallet. Only then would he pronounce him truly dead.

‘Subvenite,’ prayed the papal confessor once more.

‘Come to his help all ye saints of God. Meet him all ye angels of God. Go forth, O Christian soul.’

It was shortly before ten o’clock at night on 8 July 1623. Pope Gregory’s confessor raised his hand and with the tips of his fingers touched his head, his heart, his left side and his right. In his diary that night, Gigli wrote: ‘In Nomine Patris, et Filii, et Spiritus Sancti.’

On the night Pope Gregory died, only thirty-four members of the Sacred College of Cardinals that would elect his successor were in Rome. The other twenty or so were scattered all over the continent, some as far away as Madrid or the Baltic Sea. For a new Pope to be elected, the cardinals had no choice but to go to Rome. But the decision to travel there was not to be taken lightly. Crossing the continent, whether by sea or coach, or even on foot, was difficult and often dangerous. And Rome in the heat of summer, with the incidence of malaria rising virtually every day, was no place to be. Yet if a cardinal did not go, his vote would not be counted. He would not be able to influence the election, and as a result a Pope from a rival faction might take the throne. Knowing that Pope Gregory himself had died of the marsh fever, the cardinals who made their way towards the Holy City in the summer of 1623 did so with great trepidation. Drawing close, most of them would have elected to spend their last night well beyond the disoccupato, where the country air was still clear and there was little danger of breathing in the noxious gases that were believed to cause the fever. On the final day of the journey, each man made sure to rise early. The coach windows were clamped shut, and the cardinals were careful to wrap scarves about their faces, while high above the coachman would whip his horses through the approaches to the city.

That year there was trouble even before the conclave began. The interval between the death of the Pope and the election of his successor – the sede vacante, the vacant throne – had long been a time of release, a civic exhalation after a period of fierce papal control. By tradition, the jails were emptied. When he was caporione, it was Gigli’s job to carry the key to the jails and oversee the prisoners’ liberation. During the sede vacante the populace could say whatever it wanted, and the people did, many of them writing what they thought of the authorities on little pieces of paper which they then stuck on a statue of the limbless Pasquino, which is why he later came to be known as the ‘talking statue’.

The papal interregnum was never so tumultuous as it was following Pope Gregory’s death in 1623, when Rome erupted in an orgy of violence. It was such, Gigli recorded, as no one could remember ever having witnessed.

Not a day passed without many brawls, murders and waylayings. Men and women were often found killed in various places, many being without heads, while not a few were picked up in their plight, who had been thrown into the Tiber. Many were the houses broken into at night and sadly rifled. Doors were thrown down, women violated – some were murdered and others ravished; so also many young girls were dishonoured and carried off.

As for the sbirri [the papal guards], who tried to make arrests, some were killed outright, and others grievously maimed and wounded. The chief of the Trastevere region was stabbed as he went at night on the rounds of his beat, and other chiefs of the regions were many times in danger of their lives. Many of these outrages and acts of insolence were done by the soldiers who were in Rome as guards of the various lords and princes; as happened especially with those whom the Cardinal of Savoy had brought for his guard, at whose hands were killed several sbirri who had taken into custody a comrade of theirs. In short, from day to day, did the evil grow so much, that had the making of a new Pope been deferred as long as it once seemed likely, through the dissensions of the cardinals, there was ground to apprehend many other strange and most grievous inconveniences.

Eleven days after Pope Gregory’s death, when the novena of funeral services was finally ended, fifty-five cardinals entered into the conclave to elect his successor. Three of them – Campori, a veteran of earlier conclaves, Galamina and Serra – arrived on the very evening the conclave doors were closed. Not one of them wanted to stay in the city longer than was absolutely necessary, and as it turned out they were right. None of the French cardinals had managed to reach Rome at all, though that did not stop the envoys of the French King, Louis XIII, from seeking to influence the outcome of the election both from within and, when the papal palace doors were sealed, from without.

From the moment the doors of the Vatican were bricked up until a new Pope was elected, the cardinals lived in the papal palace, voting twice a day, morning and evening, in an effort to reach a nearly unanimous agreement on a candidate. The rest of the time, in between the obligatory attendances at mass, the cardinals lobbied and intrigued against each other, the older generation trying to hold their own against the younger men, the Spanish fighting to gain the upper hand against those supported by France or by Germany. ‘We know nothing of their sacred procedures,’ wrote Gigli primly. ‘Nor should we.’

Of course, this wasn’t strictly true. Gigli could not help but be overcome with curiosity about what was actually happening behind those sealed-up doors. By the main stove in the Sistine Chapel, he tells us, a stack of grass mixed with crushed charcoal lay ready. If, when the ballots were counted at the end of the day, no agreement had been reached, a small fire was lit. The scrutineers bound up the slips of voting paper, wet them and then burned them in the stove. The charcoal and the damp paper turned the smoke from the burning grass a dark grey, a sign to the people of Rome who stood watching that the throne of St Peter was not yet filled. Only when a new Pope was finally elected was the fire lit with grass alone, save for the last bundle of voting slips, this time dry. The smoke that curled up the chimney would be almost completely white.

With no prospect of an early agreement, the cardinals retired at night to a series of small square cubicles, cells almost, that stretched down the corridors of the Belvedere at the centre of the palace. Each room contained a narrow cot of dark wood. Hanging above it on the wall was a crucifix. There was a jug of cold water for washing, and a prie-Dieu. The fare was hardly luxurious. Tradition had it that if no Pope were chosen within three days, the cardinals would be restricted for five days to one dish only at supper. If after that the chair of St Peter was still vacant, they would be fed for the remainder of their stay in the conclave on nothing but dry bread, wine and water.

The tensions in Rome in the last days of July 1623 reflected those all over Europe. With the counter-Reformation, the Catholic Church was once again flexing its muscles after having been temporarily cowed by the rise of Protestantism across the continent. While it had yet to reach the extremes of the Inquisition, the Catholic power of the counter-Reformation was already a force to be reckoned with. Rome would not be so easily swept aside by the new order. In Germany, the Bohemian revolution would soon spread. France and Spain, always natural enemies, were circling each other once again. Each wanted to extend its influence over the small princeling states of northern Italy and beyond, and saw the election of a new Pope as a heaven-sent opportunity to gain the upper hand.

As always at the start of a conclave there were many interests, many candidates. There was Cardinal Sauli, who at the age of eighty-five had been a major contender in at least two earlier conclaves, and would have been so again had it not been for the fact that he was known to be completely under the influence of his valet and his wife. There was Cardinal Ginnasio, an inveterate gambler who had won 200,000 crowns in one night while he was Papal Nuncio in Madrid. There was Cardinal Campori, who had arrived at the last minute in the hope that he might this time wear the tiara that had been denied him at the previous conclave. And there was Cardinal Ascoli, a monk who regarded uncleanliness as a sign of godliness, and was generally shunned by his more urbane colleagues. There was also the dead Pope’s young nephew, Ludovico Ludovisi, greedy for power and influence. Known as ‘il Nipote’, it was he who introduced the word nepotism to Italian and the other Romance languages.

No clear victor emerged from the first scrutiny on the morning of 20 July. The votes of the fifty-five cardinals were distributed among several of their number, but it was already obvious that the final battle would be between two factions.

Ludovisi, despite his youth, was the leader of one group. He was hampered, however, by the fact that his uncle’s short pontificate meant he had been able to create only a small number of new cardinals. The recently appointed Cardinal Richelieu, who within months would become Chief Minister to the French King Louis XIII, mentions that Ludovisi begged the Pope on his deathbed to strengthen his party with fresh nominations. This the Pope refused to do, adding somewhat unexpectedly, ‘that he would already have to account to God for having made so many unworthy ones’.

The second group, which was made up largely of the cardinals who had been named by Pope Gregory’s predecessor, the Borghese Pope Paul V, was more powerful. Ten months earlier, in September 1622, its leader, Scipione Borghese, Pope Paul’s nephew, had given his fellow Cardinal Ludovisi a copper pendant painted by Guido Reni of the ‘Virgin Sewing’, but this did little to hide the fact that the two men hated one another. During Pope Gregory’s pontificate, Borghese had managed to keep his faction more or less intact, even though some of the cardinals supported him with more enthusiasm than others. Yet, big as it was, this group was not strong enough to carry the day without making strategic alliances with some of the other cardinals who were supported by an array of different interests.

The French, for one, were keen to play their part in the proceedings, and Richelieu regarded the election of a francophile Pope as essential to tilting matters France’s way in northern Italy, where politics were less than stable. Moreover, Richelieu knew that within the College of Cardinals was one who would be devoted to his interests.

Maffeo Barberini came from a Florentine family that had made a fortune in trade. Orphaned as a young boy, he was sent to his uncle, who was a member of the curia. When the lad showed promise, his uncle steered him into an ecclesiastical career, and before long he was appointed Papal Nuncio in France, where he made the acquaintance of Richelieu and the French King. This last was something of a stroke of luck. When the Nuncio in Spain, Cardinal Mellini, had been elevated to the purple, France immediately requested that as a matter of etiquette the same honour should be conferred on Barberini. Cornered, Pope Paul V, Scipione Borghese’s uncle, felt he had no alternative but to comply, which he did, though with little grace. So although technically Barberini was a cardinal of Borghese’s generation, he was not bound to him by any feelings of gratitude or loyalty. Richelieu, who was aware of these undercurrents, made secret arrangements with Ludovisi and the Grand Duke of Tuscany to support Barberini once their own candidates failed, as they were bound to do.

After the first day the scrutinies continued, with the voting swinging between Ludovisi’s first candidate, Cardinal Bandini, and Borghese’s Cardinal Mellini, a Florentine whom everyone knew would never be elected – not least because he had eighty-three nephews to provide for, which might risk carrying papal nepotism a little too far. Several days went by. The enmity between the two camps was almost physical, and Borghese and Ludovisi refused even to speak to one another. Matters were not helped by the heat, which was growing daily more oppressive. The cardinals were appalled at the idea of a protracted conclave under such unhygienic conditions.

Then, the calamity they had all feared happened. One by one, the cardinals began to fall ill with the fever. Still worse for some, more than two dozen of their attendants also became indisposed, and were incapable of attending to their duties. The cardinals’ underclothes remained unwashed. Their cubicles and the passages of the Belvedere where they were housed quickly fell into a condition of nauseating neglect, ‘the atmosphere being laden,’ one of them wrote in his diary, ‘with putrid miasmas and sickening smells of decaying victuals that the potent perfumes of the young cardinals could not manage to disguise.’ As Gigli added, ‘It was lacking in all dignity.’

By 3 August, after the college had been in conclave for fifteen days, at least ten of the fifty-five cardinals were ill with malaria. The next day, Borghese too succumbed. The physicians suggested potions, blistering, bleeding. Nothing worked. Borghese began thinking of leaving the conclave. All of a sudden, the francophile Cardinal Maffeo Barberini began canvassing support within his own party, supported by some of the other senior cardinals, including Ludovisi. On 5 August Cardinal Borghese had another and more severe attack of the fever. In a panic, he wrote to the Dean of the conclave asking for permission to quit the proceedings. Apprised of the fact, Ludovisi and his supporters began lobbying the Dean to refuse Borghese’s request. His absence, they argued, would create a deadlock, and the entire assembly would be forced to risk their health, even their lives, for the convenience of one man.

The Cardinal Prince of Savoia was entrusted with the task of telling Borghese that the Dean refused to grant him his request. Borghese fell into a rage, and when it was suggested to him that the election of Barberini might be the quickest and simplest solution to the problem, he realised that he had been outmanoeuvred by his enemies. Judging that anything was better than running the risk of remaining in the fetid atmosphere of the Holy City, he grudgingly gave his consent.

Immediately, Ludovisi ordered the bell of the Sistine Chapel to be rung. Borghese was carried there wrapped in blankets, and Barberini’s election took place at once. When the votes were counted, he fell on his knees to pray. Rising, he announced that he accepted the conclave’s choice, and would take the name Urban VIII. The fire in the stove of the Sistine Chapel was lit with grass only. From its chimney rose a plume of white smoke. ‘Habemus papam,’ Gigli wrote in his diary.

The name Urban, many believed, was for Urbi et Orbi – ‘For the city and for the world’ – the motto of the city of Rome over which Barberini, as Pope, would soon preside as both temporal and spiritual leader.

But the Holy City was about to demonstrate that it had powers of its own. ‘As soon as they left the conclave,’ wrote Giacinto Gigli, ‘nearly all the cardinals fell ill and many were on the point of death. Even Pope Urban himself was among the sick.’

By the beginning of August, less than a month after Pope Gregory’s death, the summer epidemic of malaria was spreading all over the city. Hundreds of people lay sick in the Santo Spirito hospital, by the Vatican. On 16 August a papal avviso reported that forty of the cardinals’ attendants had died of the fever. One of the cardinals had already succumbed. On 19 August it was the turn of Cardinal Serra, one of those who had arrived just as the conclave doors were closing. Four days later Cardinal Sauli, who had been a possible candidate for the papacy, also died of the fever. By mid-September four more cardinals were dead, making a total of six, more than a tenth of those who had assembled for the conclave.

Outside the Vatican, the priests who said mass in the small churches on the lower reaches of the Tiber, and the lay members of the city’s many confraternities who worked so diligently among the poor, died in even greater numbers.

The new Pope too could not throw off his illness. Racked with fever, alternately hot and then shivering with cold, he could feel his spleen hard and swollen by the malaria. His coronation was delayed by nearly eight weeks. Even then, he had barely recovered. At the end of his coronation day Urban’s head ached. His neck was stiff, and for many weeks afterwards, one of his courtiers wrote, he could not bear the weight of the coveted papal tiara upon his head. Giulio Mancini, the senior doctor at the Santo Spirito hospital, was summoned to attend him. The new pontiff took to his bed. For nearly two months he did not leave it. Not until early in November, when the temperature had fallen and the summer fever died down, would Pope Urban be strong enough to undertake the ceremony of the possesso, when he would ride across Rome in a procession that saw him symbolically take possession of the Holy City. There were many who had feared that the new Pope would never be well enough to rise from his bed at all. But Urban would confound them all.

The newly-elected Pope was an educated man; yet although the early days of his pontificate were distinguished by a flourishing of the arts and the sciences, he was also deeply conservative, and in time that aspect of his character would prevail. Despite his championing of artists like Bernini and Boromini, his rule over the Roman Catholic Church would be known more for how it shackled its subjects than for how it liberated them through progress. Urban VIII imprisoned Galileo. He waged war across Europe for years at a time, financing his soldiering by imposing such high taxes on the city that he became known as Papa Gabella, the Tax Pope. Yet, having been educated by the Jesuits at the Collegio Romano, he also supported the quest for scientific knowledge and education that they were promoting; indeed, on the very day of his election, 6 August 1623, he issued the bulls of canonisation that made saints of Ignatius Loyola and Francis Xavier, the two men who had founded the Society of Jesus a century earlier. The Jesuits believed in educating first, converting later. Pope Urban became a great patron of Catholic missions abroad, and well before the middle of the seventeenth century there were Jesuit missions as far afield as China and South America.

A year after his coronation, Urban paid an official visit to the Santo Spirito hospital to confer a papal blessing upon Giulio Mancini and the other doctors who had helped save his life when he was sick with malaria.

From its earliest history, the order of the Confraternity of Santo Spirito had a special link with the Vatican. It was the conduit through which the Pope directed nearly all his charitable giving, and Giulio Mancini would remain Urban’s personal physician throughout his reign. One of its surgeons became a specialist at dissecting and embalming. It was he who would be assigned the delicate task of embalming the Pope when he died in 1642.

The Ospedale Santo Spirito in Sassia, to give it its proper name, had the official task of caring for poor pilgrims who flocked to the city in Holy Years. An earlier Pope had built a hospice there for sick paupers after he had a dream in which an angel showed him the bodies of Rome’s unwanted babies dredged up from the Tiber in fishing nets. As many as fifty wetnurses were employed in the hospital at any one time, each being able to suckle two or three babies.

The hospital Pope Urban visited could accommodate the wounded and the fevered in 150 beds, and as many as four hundred during the summer epidemics of malaria. Twice a day each doctor, accompanied by his assistant and the assistant apothecarist, would visit one of the four wards, each of which normally held about forty patients. He inspected and palpated the patients and questioned them about their symptoms. He would scrutinise their blood, which after every bloodletting was kept in a special niche by the bed, and he would prescribe treatments.

Although a special ward was reserved for the nobility, and some of the hospital’s doctors also treated the cardinals and bishops who resided within the Vatican – as well as the Pope – the Santo Spirito was primarily intended to serve the poor. Most of the patients would have been artisans – blacksmiths, tailors, horsemen, bakers and butchers – but there were also many beggars who were cared for by lay nurses. Johannes Faber, a German physician who studied at the hospital, recalled that in 1600, when he began his five-year training, more than twelve thousand people received shelter, food and treatment from the Santo Spirito, as well as medication from the apothecary which had been established on the ground floor.

Under Pope Urban, the apothecary of Santo Spirito would become one of the greatest centres for dispensing medicine in Europe. It was here that quinine, in the form of dried cinchona bark, would be given to the malaria patients in the city for the first time. In 1630 the Pope named a Spanish archbishop, Juan de Lugo, a Jesuit lawyer and university professor, as director of the apothecary. Elevated to the purple in 1642, Cardinal de Lugo would become responsible for turning the pharmacy from an artisanal studio to something approaching an industrial production line.

Like an apothecary that was being built at the same time by another Jesuit across the seas in Lima, Peru, de Lugo’s Roman medicine house resembled nothing that had gone before it, either in scale or in vision. By the time Archbishop de Lugo took charge of the apothecary of the Santo Spirito hospital, its shelves were filled with recipes for preparations of medicines, prescriptions for their use and descriptions of illnesses and symptoms treated by different physicians. Spread on long tables were all the instruments of preparation: pestles, mortars, presses, beakers, alembics, boilers, distillating tubes, glass containers and ceramic jars. Neatly labelled in thousands of jars and bottles were botanical and chemical ingredients. Camillo Fanucci, one of the hospital’s Jesuit apothecaries, wrote in his Treatise on all the Pious Works of the Holy City of Rome: ‘I resolve to tell Monsignor Teseao Aldobrando, commendatore of this hospital, that after looking over the hospital accounts, every year we distribute more than fifty thousand syrups, ten thousand medicines and twenty-five thousand other medicines. And thus, it is obvious to anyone that no expense is spared in this hospital in the care of the sick.’

Travellers from abroad would bring small quantities of new cures to Rome. One Jesuit, travelling back from China, brought rhubarb, which would become widely used for stomach disorders. Another, from South America, came with bezoar stone, calcium phosphate that is formed in the stomach of the llama, which would become highly prized for treating all manner of ailments, from dysentery to infertility.

Yet another priest, also a Jesuit, carried back a small bundle of dried bark, the bitter-tasting outer skin of the cinchona tree, that was used by some Andean Indians of northern Peru as a cure for shivering. The priest, who knew about the marsh fever that was so prevalent in Europe, thought the powdered Peruvian bark might be worth trying against the marsh fever that struck the people of Rome during the summer, causing them repeated attacks of the sweats followed by shivering.

Thus it was that, in a prescription for curing fever noted down in the early 1630s, a Jesuit priest, Father Domenico Anda, the chief apothecarist at the Ospedale Santo Spirito, made the first passing mention of quinine – or to give it its botanical name, cinchona, which was then known as Corticus peruvianus, the ‘Peruvian bark’.

Acc. Flor. Samb. iii
Sal.c.s.	Cortic. Peruvian. i
S.diapol.a	Stib.diapol.
Sir.giov.ii	Sal. Tart.a a g.XV
Spir. Theria.cum p

Fac pulverem et irrora oleo Matth. Et cum diascord. Fraest.pul.et ita per triduum.

If you go today to the Santo Spirito hospital and look around the rooms where Father Domenico had his apothecary, you see immediately how important the cinchona bark was to the development of medicine and to the reputation that the Roman apothecary would gain throughout Europe. Around the walls is a series of ceramic tablets. They show Pope Urban’s Spanish priest, Cardinal de Lugo, visiting a feverish patient. At the bottom of one of the tablets is written the words: ‘Purpureus Pater his solatur in aedibus aegros deluges Limae cortice febrifugio’ (In this abode, Cardinal de Lugo offered comfort to the sick with the febrifuge bark from Lima). With one hand the Cardinal crosses the patient gently on the forehead; with the other he offers him the Jesuit cure that will help drive away the Roman fever, stay the chills and ease his aching bones.

Father Domenico’s prescription was referred to in a pamphlet written by Pietro De Angelis, the director of the Santo Spirito in the 1950s, who gave himself the task of educating the public about the varied work of the hospital. The original, however, no longer exists. It had been held for many years in the library of the hospital’s most famous director, the seventeenth-century physician Giovanni Battista Lancisi. The library was closed to the public in the early years of the twentieth century because the building was considered unsafe. Repairing it fell foul of Italian bureaucracy and inefficiency, and it would remain closed for more than sixty years. When finally it was reopened in the mid-1990s, Father Domenico’s prescription and three other of the rarest documents in Lancisi’s collection had simply vanished. But a record of the text survives in Pietro De Angelis’s pamphlet.

The medical world in Europe, which had barely progressed since medieval times, would take a spectacular leap forward from the 1630s with the adoption and distribution of cinchona bark in Rome. Not only was quinine the first real treatment for the Roman marsh fever, but the way it worked ran counter to the prevailing orthodoxy about fever as a disease and what was at the root of it. As a result, quinine can be described as the modern world’s first real pharmaceutical drug. In time, it would change medicine forever.

That Europeans learned about it at all can be attributed to the work of a lay monk by the name of Agustino Salumbrino. A determined and energetic man with a quick, restless mind who stood not five feet high in his sandals, Brother Salumbrino had worked as an infirmarian on the wards of the Santo Spirito hospital. Unmarried, and with nothing to tie him to Rome, he set sail in 1604 for Peru, where he was determined to serve the Society of Jesus and heal the sick, and where eventually he founded the most famous pharmacy in Latin America.

The medicine he sent back to Rome came too late to treat Giacinto Gigli’s young granddaughter. But for nearly a century, all the quinine that was dispensed in Europe would come from Brother Salumbrino’s apothecary in Lima.