Читать книгу The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World - Fiammetta Rocco - Страница 9

‘Aquí tenían los Jesuitas un local donde expedían al público una corteza febrífuga de la quina o cascarilla.’ (From this place the Jesuits provided the public with a febrifuge made from quinine or bark)

Street plaque on the Jesuit church of San Pedro, Lima

A vicuna, a cinchona tree and the horn of plenty.

The Peruvian national emblem, as seen on every Peruvian coin

In 1663, Sebastiano Bado, a doctor from Genoa, published an account of a story he had heard from an Italian merchant who lived for many years in Lima, the capital of the viceroyalty of Peru.

The Countess of Chinchón, the wife of the Viceroy, fell ill with a tertian fever, which, Bado wrote, ‘in that region is not only frequent but severe and dangerous’. Rumours of the Countess’s impending death spread through the city of Lima and beyond, even reaching the Andean hill town of Loxa, in what is now southern Ecuador. On being told of the Countess’s illness the Prefect of Loxa immediately wrote to her husband recommending a secret remedy he knew of, a concoction made from the bark of a local tree, which he said would cure her of all her ills. The Viceroy sent for the Prefect, who brought with him the remedy. Eagerly the Countess took it, and ‘to the amazement of all’, wrote Bado, ‘she was cured’.

As soon as the people of Lima learned of the Countess’s miraculous recovery they begged her to help them, for they had often suffered from the same fever themselves. The Countess at once agreed. Not only did she tell them what the remedy was, she ordered a large quantity of it to be sent to her so that it could be dispensed to the poor and the sick. In their gratitude the people named the cure ‘the Countess’s Powder’.

For more than three hundred years this sugary story was accepted as the true version of the discovery of quinine, the world’s first pharmaceutical drug, that was carried back to Europe by the grateful Countess. It led to all sorts of literary fancies, most of them mercifully now forgotten. In its day the best-known was Zuma, written in 1817 by the Countess de Genlis, in which an Indian maid in the service of the Viceroy’s household discloses the virtues of the Peruvian bark when her mistress, the Countess of Chinchón, falls ill with malaria. Other variants of this tale include Hualma, the Peruvian, a German novel about the discovery of quinine by a pseudonymous author, W.O. von Horn, and The Saintly Vicereine, a play by a Spanish poet, José María Pemán, the composer of General Franco’s preferred national anthem. Written in 1939, The Saintly Vicereine played for a while to enthusiastic European audiences in search of an evening’s distraction from the impending war, then faded quickly away.

The problem with the story of the Countess’s miraculous discovery, however, is that it is completely untrue.

The Countess of Chinchón died suddenly in Cartagena on 14 January 1641, on her way back from Peru to Madrid, though her husband’s diaries show she was rarely ill before that, and never with anything resembling malaria. Malaria may well have struck the Count, the Viceroy of Peru, on more than one occasion; he even seems to have suffered from it after he returned to Spain. In time he recovered, but the detailed diaries left by his secretary, Antonio Suardo, make no mention of tree barks or miraculous remedies of any description.

That the fable of the Countess’s miraculous cure continued to be retold may have much to do with the fact that cinchona bark, in the early seventeenth century, really was a miracle cure. Here was an incomprehensible disease – malaria, marsh fever or the ague, as it was then called – that had been the scourge of Europe for centuries, while the cure for it was to be found high in the dense forests of a mountain range halfway across the world. The word ‘malaria’ did not then exist, and no one knew what really constituted agues – whether quotidian, tertian or quartan – or how people caught them, let alone how they might be cured of them. Nor, when they came eventually to learn about cinchona bark, did the doctors and apothecarists who prescribed the cure really understand how it worked either.

So how did anyone ever make the connection? How was it possible that a Jesuit priest, with little knowledge of doctoring, came to understand enough about the medicinal properties of the bitter bark to know that it might prove useful in treating malaria, a disease that would not be fully understood for another two centuries?

Some nationalistic South American historians have insisted, with little evidence, that the Spanish conquistadors must have learned about cinchona’s fever-curing qualities from the Incas. While it is certainly true that the local Indians were renowned for their knowledge of plants, poisons and cures, there is scant evidence to support the argument that they knew cinchona bark cured malaria. The conquistadors wrote home about many things in the century after they first arrived in Peru in 1532, but cinchona is not mentioned by any of them. Other historians insist that the Incas kept back the secret of the miraculous fever-tree to show their displeasure at the Spanish occupation. While theoretically possible, this is unlikely, given the extent and complex nature of the contacts between the conquistadors and the local populations they encountered in South America.

The reality is that many Peruvians may not have known that the bark existed at all, at least not as a cure for malaria. The cinchona tree grew in small isolated clumps in the foothills of the high Andes. And although malaria has existed in Peru since the days of Christopher Columbus, it is found in areas of low altitude, as it is in Africa, and not at the heights where the cinchona tree grows most happily.

According to contemporary written accounts, the Indians who lived in the Andes sometimes drank infusions of cinchona bark to stop them shivering. But the observation that it might also cure marsh fever, or tertian ague, came only a century after the first conquistadors arrived in the New World, and it was made not by the local Indians, but by the European visitors.

Two Spanish writers living in Peru were the first to make any detailed description of the effects of cinchona bark on patients suffering from the ague. In 1638 an Augustinian friar and herbalist, Antonio de la Calancha, wrote: ‘A tree grows in the country of Loxa which they call of fevers, whose bark, of cinnamon colour, made into powder given to the weight of two reals of silver in a drink, cures the ague and tertians; it has produced in Lima miraculous results.’

Calancha had been born in Chiquisaca (now Sucre), in the highlands of Bolivia, in 1584. He grew up among the Andean Indians, and was intimately aware of their customs and folk medicine. He entered the Augustinian Order in 1598, and was appointed the Rector of St Idelfonso College in Lima nearly twenty-five years later. Calancha spent much of his adult life writing his nine-hundred-page Corónica moralizada de la orden de N.S.P.S. Agustín en el Peru, and his account of the properties of the cinchona bark was probably written around 1630, the year that the Viceroy, the Count of Chinchón, first fell ill with the ague, as noted in the diary of his secretary, Antonio Suardo.

Another priest, Bernabé Cobó, a Jesuit who arrived in Lima from Spain in 1599, wrote an account of cinchona as a short chapter entitled ‘A Tree for the Ague’ in his magnificent multi-volume Historia del Nuevo Mundo, which was written in 1639 but not widely disseminated for another two centuries. In it he says: ‘In the district of the city of Loxa, diocese of Quito, grow certain kind of large trees, which have bark like cinnamon, a bit coarse and very bitter; which, ground to powder, is given to those who have the ague and with only this remedy it is gone. These powders must be taken to the weight of two reals of silver in wine or any other liquor just before the chill starts. These powders are by now so well known and esteemed, not only in all the Indies, but in Europe, that with insistence they are sent for from Rome.’

The writings of Calancha and Cobó were well known to virtually everyone who has written about cinchona or quinine over the past hundred years. Four other Spanish writers, all of them far more obscure, bear out Calancha and Cobó’s observations that cinchona came to the attention of the Jesuits in Peru in or around 1630.

Gaspar Caldera de la Heredia was born in Seville of Portuguese extraction in 1591 or thereabouts. He studied medicine at the University of Salamanca, practising first in Carmona before settling in Seville, then already the centre of Spanish imports from the Indies. Caldera’s interest in remedies from the New World is easily understood; his father had lived in Mexico, and three of his children went to Lima in 1641, precisely at the time when the use of cinchona in Spain and other parts of Europe was gaining momentum. His writings on cinchona are preceded by a series of letters that he exchanged in 1661 with Girolamo Bardo, the pharmacist at the Jesuit College in Rome and a close collaborator of the doctors from the Santo Spirito hospital who cured Pope Urban VIII of the malaria he caught during the papal conclave that elected him.

Caldera’s Tribunalis Illustrationes et Observationes Practicae, in which he writes about cinchona, was published in 1663, the same year that the Genovese doctor, Sebastiano Bado, published his celebrated book on cinchona, Anastasis Corticis Peruviae Sen Chinae Chinae Defensio. Caldera’s writing shows him to be a learned man, a cautious scientist, a sound clinical practitioner and a faithful witness. Cinchona, he wrote, came from a tree like a large pear tree called quarango by the Indians, who used it as timber. Jesuits at missions in the foothills of the Andes noticed that the Indians drank its powdered bark in hot water when shivering after being exposed to dampness and cold. Quinine has many side effects, some of them quite unpleasant, such as tinnitus, but one of its more beneficial properties is that it can act as a muscle relaxant, which is why it calms the nervous impulse that causes shivering, and why today it is sometimes prescribed for people with pacemakers, or more commonly for those who suffer from leg cramps.

The Jesuits, Caldera noted, believed that cinchona might be effective in checking the shivering that is associated with ague, and they tested the powdered bark on a few patients suffering from quartan and tertian fever. Shortly afterwards, some Jesuits of the missions in Quito took the bark to Gabriel de España, an energetic pharmacist who had his botíca in Lima near the bridge over the Río Rimac, and who was renowned throughout the young city for his knowledge of local medicinal plants. De España began to pass samples of cinchona to a number of physicians as well as other apothecaries in the city, who used the bark in the treatment of intermittent fevers with great success.

Gaspar Bravo de Sobremonte, who studied medicine at the University of Valladolid, where he held several chairs including Surgery, Method and Medicine, also wrote about cinchona. Bravo was considered one of the best physicians of his day, and many of his works were published in Spain and France. In the second edition of his Disputatio Apologetica pro Dogmatica Medicine Praestantia, which was published in 1639, he describes how the Spaniards – ‘us’, he calls them – used Peruvian bark to treat intermittent fevers after observing Indians in Peru drinking the powdered bark in hot water when they were shivering with cold.

In the 1670s, two other Spanish doctors also wrote about the curative effects of cinchona. Pedro Miguel de Heredia (no relation of Gaspar Caldera de la Heredia) studied medicine at one of the greatest of the Spanish faculties, Alcalá de Henares. There he held the chair of Prima of medicine, retaining it several times after the compulsory contests that took place every four years. Miguel left Alcalá de Henares in 1643. More than forty years later, the second edition of his four-volume Operum Medicinalium recounted how the Jesuits in Peru had tested cinchona.

Similarly, Miguel Salado Garcés, who held the chair of Method at the University of Seville and was committed to discovering every new drug that came from America, wrote in 1655 in his Estaciones medicas that ‘the missionaries of the Society of Jesus [in the province of Quito] used the powders of Quarango following the second transit of Galen with great ingenuity, after observing that the Indians took them when shivering from cold after swimming in iced water or from the coldness of the snow, and stop trembling within a short time; [the Jesuits] used them to control the shivering in tertian and quartan fevers: and as they noticed that the repetition of the fever stops, they advised them as a great febrifuge (and they still continue to do so) to cure them …’

Caldera, Bravo, Miguel and Salado Garcés all put the Jesuits at the centre of the story of the early discovery of cinchona in Peru. But who was responsible for gaining it such wide renown in Europe?

In the spring of 1605 a small group of Jesuit priests disembarked at Callao, at the mouth of the Rio Rimac downstream from Lima. For nearly three hundred days they had been tossed about, never knowing a moment’s quiet as they rode the swells of the vast Atlantic Ocean on their journey towards the southern tip of South America. The final part of the voyage, hugging the continent’s west coast, was if anything worse than the open sea. Gigantic waves hurled themselves across the vessel, throwing up thick columns of spray that then collapsed upon the deck, drenching everything in a foamy swirl and threatening to drive the ship onto the jagged rocks.

Now that they had reached dry land, their leader Father Diego de Torres Bollo urged them ashore. As he called for yet more donkeys to carry the supplies that the priests had brought with them from the Holy City, one of their number, a small man in sandals and the rough brown tunic of a lay brother, broke away to look around him.

Agustino Salumbrino was then about twenty-five years old, but his beard was thick and he looked older, for he had started work when he was still very young, and had never taken a single day of rest since. While Salumbrino had already studied and travelled more than most men would have done in a lifetime, he knew that Peru was the place where he would spend the rest of his days. More than that, he knew exactly what he would do with his time there.

Francisco Pizarro’s conquest of Peru in the 1530s was well known to Europeans by the beginning of the seventeenth century, for at least two of the conquistadors who had travelled with him to South America had written widely-read accounts of the magnificent Inca civilisation. Pizarro’s conquest was driven entirely by greed for Inca gold and treasure, but he painted it with a religious sheen to give legitimacy to his actions. Accompanying him on his first journey to the New World was a troop of Dominican priests. Four decades later, on 1 April 1568, the first Jesuit priests, eight of them in all, arrived in Lima.

The city was then only thirty-three years old, and still known by the name Pizarro had given it, La Ciudad de los Reyes. Despite its strange microclimate, which casts a thick fog over the coast for nearly ten months of the year, the City of Kings deeply impressed the small party of Jesuits. They admired the formal chequer pattern of the streets, so characteristic of sixteenth-century Spanish towns, that extended in a straight line right down to the Rio Rimac, which now runs through the centre of the city. They thought highly of the beautiful public square in front of the viceregal palace, the monasteries of the religious communities and the buildings of the civil and ecclesiastical administrators. Father Diego de Bracamonte, one of the newly arrived Jesuits, paid Lima a handsome compliment when he wrote home describing the city as ‘another Seville’.

Among the first tasks to which the young Jesuits set their minds was finding a suitable location for housing the fledgling mission. Before paying a call on the acting Governor, Lope Garcia de Castro, they explored the city. They soon chose a square, three blocks to the east of what is now the Plaza Mayor, which then housed the Viceroy’s palace, and three blocks from the Franciscans, in a rather densely populated area of the city. After a brief public hearing, the Jesuits were granted the expropriated property, for which they were obliged to pay twelve thousand pesos in compensation to its former owners. The transaction, which was completed in just over two weeks, makes it sound as if the Jesuits had arrived in Lima with plenty of money. If anything, the reverse was true: for thirteen years after they moved in to San Pablo the Jesuits had to assign one of their most capable lay brothers to be the limosnero, the man in charge of begging alms on a daily basis from the well-to-do families of the city.

In the early years, the Jesuit College of San Pablo depended for its existence on these donations from the citizens of Lima, and a series of small and sporadic royal grants. In 1581, though, San Pablo took over a property outside the city, and over nearly two centuries, until the Jesuits’ expulsion from the Spanish Empire in 1767, those holdings steadily increased in size until the Society of Jesus became one of the country’s biggest landholders. Its haciendas produced wheat, which was ground into flour in a mill that was also owned by the college. The Society planted new vines and an olive grove, which provided the Jesuit fathers with as much wine and oil as they needed. They raised cattle and goats, and grew sugar cane. A trapiche, or sugar mill, produced sugar and cane syrup. By 1600 San Pablo owned about ten rural properties, of which some were put under intense cultivation while others were used for grazing.

The haciendas fed and clothed all the 160 or so priests who lived at the college in Lima. By the first half of the seventeenth century they also supported two thousand workers whom the Jesuits employed to run their properties, and three hundred slaves who were engaged in the vineyards of San Xavier, picking and pressing the grapes and producing the well-known Jesuit wines, as well as pisco, the traditional Peruvian liquor that is distilled from white grapes. As the haciendas grew bigger and more efficient, they turned from being simple agricultural properties into agro-industrial plants—a fusion of farms with mills, sugar refineries and distilleries – which delivered to Peruvian markets some of the best wines, flowers, sugar, oil and honey available in the viceroyalty.

Over the years many Jesuits sailed across the Atlantic to join the missions that were being set up in Chile and Argentina, as well as Peru, but there was always room for more. In order to expand throughout the viceroyalty, the Jesuit mission in Lima had to have more resources. And that meant more people.

Thus it was that in 1601 Diego de Torres Bollo, one of the senior Jesuit priests at the mission of San Pablo in Lima, left for Rome to petition the Vicar-General of the Order of the Society of Jesus to send more young Jesuits to South America. To reach the Holy City he had had to sail around the north-west coast of South America to Panama, then travel by mule over the isthmus to Puertobelo before resuming his journey once again by ship. The voyage took many months, and was fraught with danger. Not long after he arrived, Torres Bollo fell ill and was admitted to the Jesuit infirmary in Rome. The man who took care of him was Agustino Salumbrino.

Salumbrino had joined the Jesuits in 1588. After taking his vows in Rome in 1590, he was sent to the Jesuit college in Milan to become an infirmarian. There he made a special study of pharmacy, and when, after a few years, he returned to Rome, he resolved to put his medical knowledge at the service of the many Jesuits who lived in the Holy City. In the course of his convalescence, Torres Bollo, who would later found the Jesuit mission in Paraguay, told Salumbrino all about St Ignatius’ missions in the New World, and the great college of San Pablo which was being built in the young city of Lima. He described the plans the Peruvian Jesuits had for setting up new missions over the whole continent.

Each time he came to see his patient, Salumbrino, like the Mill Hill fathers whom I had visited in north London, felt the call of the mysterious world across the seas. As he listened to Torres Bollo, the lay brother began to recognise what his life’s work would be. He would go to Peru and live in the college of San Pablo in Lima, putting his knowledge of pharmacy to good use as he built up the botíca into the best pharmacy in the New World, which for nearly forty years, until his death in 1642, is exactly what he did.

Today, the soaring Baroque church of San Pedro, next to the Biblioteca Nacional in the centre of Lima, is all that is left of the great Jesuit College of San Pablo, which rapidly fell into disrepair after the Jesuits were expelled from the Viceroyalty of Peru and the rest of the Spanish Empire in 1767.

The church is dark, though well cared for. The remnants of its first crucifix are housed in a glass cabinet in a corner. The dark wood gleams in the shadows. In another corner, a vast reliquary rises. When you look at it more closely, you see that it is made of hundreds of boxes of dusty human bones, said to come from the many local priests who have been canonised and then forgotten.

The priest who says mass there today, under the fifty-two crystal chandeliers strung along the ceiling, urges his congregation, as Catholic priests do everywhere, to ‘go in peace, and to love and serve the Lord’. Despite the medieval, talismanic quality of the church’s interior, its enormous congregations reflect the power that the Catholic Church still commands in Peru, and the extent to which it has permeated every level of political and intellectual life. Alejandro Toledo, who won the presidential election in 2001, considered including two Jesuits in his cabinet. One was a well-known figure, Father Juan Julio Witch, an economist and academic who became a household name in 1997 after the Japanese embassy in Lima was taken over by terrorists during a reception to celebrate the Emperor’s birthday. Given the opportunity to leave the embassy compound, Father Juan elected instead to stay behind with the other hostages. For four months he said mass there every day, urging his small and frightened congregation to keep their spirits up and pray for salvation, while outside television cameras and frustrated army marksmen waited for the terrorists to give way. Today his name is known throughout Peru.

It has long been accepted that the Jesuits were responsible for introducing cinchona into Europe. As I read more about the role of the Society of Jesus in Peru’s long history, I kept wondering if, after all the wars and insurrections, burning and looting, any written material still survived from their earliest time there. Eventually, I learned that the bulk of a large private collection of Peruvian Jesuitica, built up by an obsessive hoarder, Father Rubén Vargas Ugarte, who came from a wealthy family and was himself a Jesuit priest, a historian of the Church and a Peruvian nationalist, had been placed in the state archives in Lima. No one could tell me over the telephone what the collection contained. And so I travelled to Peru, not knowing what I might find, or indeed whether I would find anything at all.

For a long time after I got there, I was little the wiser.

The state archive occupies a dark corner at the back of the building that is better known as the Peruvian national bank. It has its own entrance, but there is no sign on the door; nor, once you are inside, are there any directions to tell you where to go. At least Father Rubén’s material was there, though what it contained no one could tell me. It hadn’t been opened, and although some of its papers had been looked over by scholars past, the collection had come with no inventory and there was no catalogue. But I was welcome, the librarian said, to look through it if I wanted. A long pile of boxes was stacked down the hallway, though quite how far it extended and how many boxes it contained I couldn’t really tell.

The librarian gave me a key to the archive, and said I could work there for as long as I wanted each day. Outside, Peruvians were preparing to go to the polls. The atmosphere was tense, and there was a sporadic curfew. Occasionally I would emerge from the archive at the end of the day and find that I could not return to my hotel. I went back inside and slept on the floor, shielded from the draught by Father Rubén’s mountains of paper.

I began methodically going through each box. I picked out details of property transactions, plantings and harvests on the Society’s haciendas, chronicles of boundary disputes, baptismal records, the sale and purchase of slaves, shopping lists, inventories. I had come across Agustino Salumbrino’s name in the Jesuit archive in Rome, but I still knew very little about him. Would I ever find out more?

Then one day I found two old books dating back to 1624. They were inventories. Page after page in the volumes of El Libro de Viáticos y Almacén are filled with inky lines that once were black but now are faded to a rusty brown. The quills the writers used were so sharp they have ripped through the paper. That these documents survived at all was a miracle. No one has ever tried to conserve them, and some of the paper crumbled in my hand. Yet it was still possible to read what the Jesuit administrator of San Pablo had written there nearly four hundred years earlier. In addition to listing everything that came into and went out of the college, from the cases of books that were sent from Europe to supplies of medicines, clothing and tableware that were despatched to other Jesuit missions, he also provided a complete inventory of Brother Salumbrino’s pharmacy.

By the time Agustino Salumbrino arrived in Lima in 1605, the mission at San Pablo was firmly established, with several classrooms, a small library, a chapel, private rooms and even an infirmary, which, although basic, was clean and well run. Salumbrino quickly realised, however, that the infirmary was not sufficient to take proper care of all the sick in Lima. What he needed was a proper pharmacy, and a steady supply of medicines. These were hard to obtain in colonial Peru, but Salumbrino was a tireless worker, and he had made up his mind not merely to build a pharmacy, a botíca, as it was called, at San Pablo, but to do it in the grand manner, not only to serve the college’s local needs, but to supply all the Jesuit colleges throughout the viceroyalty.

Agustino Salumbrino’s ambition to set up a pharmacy to help treat the poor of Lima had its roots not just in the rich medical lore that he encountered as soon as he arrived in Lima, but also in the Jesuits’ earliest philosophy. The instructions left by the founder of the order, St Ignatius Loyola, forbade his followers to become doctors. The task that lay before them, he emphasised, should focus upon men’s souls. This did not mean that Jesuits were ignorant of the importance of maintaining good health; indeed, every Jesuit mission was enjoined to appoint one of their number as a ‘prefect of health’ to ensure that the priests’ diet was adequate and that they were well cared for. The most capable lay brothers would be chosen to run the college’s infirmary and have immediate care of the sick. Most important, the Society’s founder insisted, each college would ensure that it had an adequate supply of medicines, either by setting up a pharmacy of its own, or by finding a reliable source of supply. Despite being expressly forbidden to practise medicine, Jesuit priests often turned their attention to the study of herbs and plants, and a number of them, especially in the foreign missions, became apothecaries.

San Pablo’s infirmary was in a clean and quiet courtyard in the south-eastern corner of the college. By the time it was properly established it had about fifteen private rooms, all facing the fountain in the centre of the courtyard. Brother Salumbrino built his pharmacy close by the infirmary. Knowing that he needed to be as self-sufficient as possible, he began by planting a small herbarium in a corner of the garden at San Pablo. He chose plants that were well known for their medicinal properties: camphor, rue, nicotiana, saffron and caña fistula, a Peruvian wild cane that was often used for stomach disorders in place of rhubarb. These Brother Salumbrino and his two assistants made up into medicinal compounds, which were dried, powdered and mixed in the laboratory according to strict pharmaceutical rules. To help him, Salumbrino ordered two of the most important pharmacopoeias then available in Europe: Luis de Olviedo’s Methodo de la Colección y Reposición de las Medicinas Simples y de su Corrección y Preparación (printed in Madrid in 1581), which he had used in Rome; eventually, he also ordered Juan del Castillo’s Pharmacopoea Universa Medicamenta in Officinis Pharmaceuticis Usitata Complectens et Explicans (printed in Cadiz in 1622).

Pharmacopoeias were works that described chemicals, drugs and medicinal preparations. They were issued regularly with the approval of different medical authorities, and were considered standard manuals in every pharmacy in Europe. Besides these two classics, Brother Salumbrino could also consult and follow the prescriptions of Girolamo Mercuriale, physician to the Medicis and Professor at the universities of Padua, Bologna and Pisa, who exercised a profound influence on medical circles all over Europe.

Over the next century and a half the botíca at San Pablo would order at least ten other pharmacopoeias that specialised in local drugs and chemicals, including its vade mecum, Felix Palacios’ Palestra Farmaceutica, which was printed in Madrid in 1713, the year after Francesco Torti had his ‘Tree of Fevers’ published. The botíca put in regular orders for extra copies of Palacios’ work to be sent out to the other Jesuit colleges in the viceroyalty. The book was so highly regarded, and was so frequently referred to, that the pharmacists at San Pablo would eventually write inside the cover of their own copy: para el uso diario de esta botíca (‘for the daily use of this pharmacy’).

By 1767, when the Jesuits were forced to leave Peru and the final inventory of the pharmacy was compiled, the San Pablo medical library contained about a hundred books. The full list, given in another set of books that I found among Father Rubén’s boxes, Cuenta de la Botíca 1757–1767, included the ancient classics by Galen and Hippocrates as well as voluminous Latin commentaries on the two masters by several medieval doctors. The library also had books on several other branches of medicine, including anatomy and osteology, treatises on different kinds of fevers and their remedies, descriptions of contagious diseases and their infections, and the methods of combating them.

Surgery was also a favourite subject at San Pablo, and one could find on the shelves of the college’s library Bartolomé Hidalgo de Agüero’s Thesoro de la Verdadera Cirugía y Via Particular contra la Común (printed in Seville in 1624), and Juan Calvo’s Primera y Segunda Parte de la Cirugía Universal y Particular del Cuerpo Humano, which was published in Madrid in 1626 and reprinted many times in the seventeenth century, and was still in use more than a hundred years later – though one shudders to think of operations being carried out without the benefit of any anaesthetic or antibiotics in the humid atmosphere of seventeenth-century South America.

The Jesuits who came to Peru just after Pizarro’s conquest of the Incas were the first order with a clear mission to educate and then, by doing so, to convert the Indians to Catholicism.

There was a clear division, though, over exactly how this should be done. The ascetic, intellectual Jesuits who ran the order from Rome were of one view, while the energetic activists who left their homes to promote its interests overseas were of quite another. The young Jesuits in Lima were pioneers of the soul. They believed strongly in catechism. Each day, a group of priests would leave San Pablo, walking in procession through the streets of Lima, holding a crucifix and ringing a bell to attract groups of Indians and blacks to whom they would preach. Not everyone liked this. One early Provincial Superior of the Jesuits in Peru, José de Acosta, was dismayed by this helter-skelter missionary activity, and was bitterly critical of having so many men tramp around as ‘holy vagabonds’. His own bias tended towards the old Jesuit ideal of learned men influencing councils and kings.

What he failed to realise was that most of the Jesuits, such as Brother Agustino Salumbrino, who went to Peru early on were not driven to write books or meditate. They were zealous, educated men, full of drive and courage, who wanted to make a difference, whether it was by saving souls or promoting good health.

The early Jesuits soon expanded their missionary activity to Cuzco, the old Inca capital that Pizarro seized in 1534. They bought a fine palace that had been taken over by one of Pizarro’s lieutenants on the main square, only to tear it down and build the towering pink Baroque church that still stands today. From there the Society sent its priests out into the countryside to make contact with the local Indian communities and urge them to renounce the animist gods they had worshipped for centuries in favour of a Christian Almighty.

The Inca world was ruled by spirits and superstition. Every village was surrounded by secret places – trees, rocks, springs and caves – that had a magical significance. The Incas collected unusual objects, and in every house there were canopas, or household deities, displayed in a niche in a corner or stowed in a special place, wrapped in cloths. They observed rituals throughout their daily lives, sprinkling chicha or coca when ploughing, saying prayers and incantations when crossing rivers, making sacrifices on particular occasions and always leaving an object on the pile of stones that is still often to be found at the top of every pass.

The Incas lived in fear of the sorcerers, the old men who foretold the future by studying the shape of ears of corn, the entrails of animals or the movement of the clouds, and were terrified of the magic spells they cast to cause love or grief in their victims. But they also revered them, for many of the sorcerers were medicine men as well as magicians. In some parts of Peru they would undertake trepanning, cutting open the skull to let out evil spirits and to offer the patient some relief from pain or swelling. The rich Quechua language shows that the Incas had a fine knowledge of anatomy and medicine, with words such as hicsa for abdomen, cunca oncoy for angina, susuncay for putting to sleep, siqui tullu for coccyx, husputay for haemorrhage, hanqqu for nerve and rupphapacuy for fever.

They amassed a great store of knowledge about local plants and how to use them to treat different ailments, and were particularly expert on poisons and plants with hallucinogenic qualities – every man would carry upon him a little packet of coca leaves for chewing on. They also used the trumpet-shaped Solanaceae, or datura as it is better known, in magic spells to cast their enemies into a trance, sarsaparilla as a diuretic, tembladera (Equisetum bogotense) against pyorrhoea, a plant they called llaquellaque (Rumex cuneifolius) as a purgative of the blood, ortiga (Urtica magellanica) to cure sciatica, and payco (Chenopodium ambrosoides) against worms.

The two volumes of El Libro de Viáticos y Almacén show just how elaborately Brother Salumbrino and his fellow Jesuit priests would prepare for a trip out of the city. Every traveller would be issued with a mule for riding on, and another for carrying their supplies. Many of the mules’ names survive in the records: La Cabezuda, La Caminante, La Mulata, El Galán. The supplies would include hay for the mules, for the desert of northern Peru in particular was short of fodder, and often of water too. The traveller would also be equipped with a bowl, a spoon for the table and a knife for cutting meat, a bedroll and a sheet, a roll of sealing wax, spices in the form of saffron, pepper and cinnamon, wine, a sombrero, a soutane and a cape to keep out the cold in the mountains. The grandest inventories included travelling altars, supplies of wine and wheat hosts for offering communion, and even silver candlesticks. But, grand or simple, each traveller’s list concludes with patacones, fried plantain chips, for an Indian guide, and more patacones for el gasto del camino, the road toll.

Despite the rips in the pages of these ancient books, they still summon, nearly three centuries on, a pervasive and enormously fierce sense of just how energetic and enterprising the Jesuits were. On 26 April 1628, the earliest entry in the book that mentions Brother Salumbrino, the pharmacist sent the Jesuit college at Arequipa, at least three weeks’ ride south of Lima, not far from Lake Titicaca, four cases of drugs, including eight libras of caña fistula. The following month he sent the college another eight libras of caña fistula and a copy of the Meditations of St Ignatius Loyola. In August of that same year he despatched supplies of tobacco and cocoa and another three boxes of caña fistula, and the following April the mule load to Arequipa would include four bottles with different drugs ‘sent by Brother Agustín’.

San Pablo was making a name for itself as a trading post, and it was not confined to medicines. It imported textiles from England, Spain, France and the Low Countries, Italy and the Philippines, and large quantities of black taffeta from China. It provided Jesuit schools in the region with ink and paper imported from Italy—in 1629 San Pablo despatched three thousand pens in a single huge shipment that went to the Jesuit College in Santiago, Chile. Farm tools such as ploughs, sickles and hoes were in great demand. San Pablo shipped those off too, along with saddles and harnesses, tallow candles and pottery, shoes and clothing for children as well as adults, needles and nails. In 1628 the college sent twelve baras of tailors’ needles from France to Arequipa, while three years later another two thousand needles, described as finas de Sevilla, were needed. Between 1628 and 1629 San Pablo also sent twelve thousand nails to Potosí, ten thousand to Arequipa, and more than twenty thousand to Chile.

As this trade blossomed, Brother Salumbrino’s influence also soon extended beyond the walls of the college. Like the library at San Pablo, which ordered books from Europe and sent them out to colleges all over the viceroyalty, the pharmacy became an early distribution centre of medicines and medical information for other Jesuit institutions in the area. Salumbrino supplied medicines to the Jesuits who left San Pablo on long missions among the Indians in the Andes, and to other Jesuit outposts

The Libro de la Botíca neatly lists everything that San Pablo supplied to the other Jesuit colleges in the viceroyalty: agua fuerte and aguardiente, powdered mother of pearl, pine resins, black and white balsam, bezoar stone, nicotiana in powder, caña fistula, cinnamon, nutmeg, sal volatile – the original smelling salts – mercurio dulce or mercury sulphide for treating syphilis, black pepper, ambergris, senna, tamarind, sugar, camphor, sweet and bitter almonds, almond oil, tobacco from Seville, essence of roses and violets, rhubarb, chocolate and, of course, cinchona bark, that would eventually be despatched, dried in strips or in powder, in huge quantities all over the continent and also across the Atlantic.

From the earliest years the Jesuits of San Pablo were of the clear belief that conversion of the Indians would come about not by force, but by education and persuasion. For that reason they were quick to send young priests out into the field. Many of the young Jesuits who were posted to Peru made it a priority to learn Quechua and the other Indian languages, and to accustom themselves to the Indians’ way of life.

The Jesuits in the field, especially those who had been sent north-east of Lima, to Loxa in the Andes, began to persuade the local Indians to seek out the árbol de las calenturas, the ‘tree of barks’, as Bernabé Cobó, another Jesuit and a colleague of Salumbrino’s, would describe cinchona in his Historia del Nuevo Mundo in 1639. They taught them how to cut off the bark in vertical strips so as not to kill the tree, and to plant five new trees for every one they cut down. The Jesuits would place the saplings in the ground in the shape of a cross, in the belief that God would then help them grow better. More than two centuries later, an English plant-hunter and bark-trader would observe: ‘Always when passing [these plantations] my Indians would go down on their knees, hat in hand, cross themselves, [and] say a prayer for the souls of the Buenos padres.’

After they stripped off the bark, the cascarilleros or barkhunters would cut it into pieces and leave it to dry in the sun. Taking care not to break the fragile, powdery strips, they would wrap them carefully in pieces of cloth and then in watertight leather packs for transporting down the hills by mule to Lima.

San Pablo began to distribute cinchona bark – or cascarilla as it was known in Spanish – to the other Jesuit colleges in the viceroyalty, and even as far as Panama and Chile. Eventually Brother Salumbrino also began sending supplies of cinchona to Europe.

The first person listed in the Libro de Viáticos y Almacén as leaving San Pablo with a quantity of cinchona bound for Europe is a Father Alonso Messia Venegás, an elderly Jesuit priest who carried a small supply of it in his bags when he travelled to Rome in 1631. Father Alonso knew, as every Jesuit did, how malarious the Holy City was, and had heard accounts of the terrible conclave of 1623 when so many of the visiting cardinals died. Rome was in dire need of a cure for the fevers, and Brother Salumbrino was eager to see if the plant that stopped people from shivering could be put to use curing the chills that were a symptom of the marsh fever. Little did he know that not only did it stop the shivering, it could also be used to treat the disease.

The physicians in Rome found that the bark was indeed an effective treatment for the intermittent fever, and thereafter every Procurator who left San Pablo for the Holy City to represent the Peruvian Jesuits at the congress that elected the Jesuit Vicar-General every three years would take with him new supplies of the febrifuge bark. Shortly after Father Bartolomé Tafur, who served as the Peruvian representative at the congress of 1649, arrived in Rome he renewed his acquaintanceship with Cardinal Juan de Lugo, who was then in charge of the apothecary at the Santo Spirito hospital, and was becoming cinchona’s champion in the Holy City. In 1667 Felipe de Paz took with him a trunk filled with the corteza de la calenturas, and in 1669 Nicolás de Miravál arrived with 635 libras of cinchona for distribution in the curia, having left a similar amount in Spain.

By the second half of the seventeenth century, according to an early map of Lima in the state archive, the citizens of the capital had begun calling the street in front of the Jesuit infirmaries Calle de la cascarilla, Bark Street. Now part of the long, fume-laden Jirón Azangaro, which runs through downtown Lima from the Palacio de la Justicia as far as the Franciscan convent near the river, Calle de la cascarilla would remain up to the start of the republican period in 1825 as a public testimony to San Pablo’s role in distributing cinchona first in Peru and then around the world, and it appears in many of the maps of that time.

The final decade of the botíca at San Pablo saw Brother Salumbrino’s ambitions come to fruition. The pharmacy itself, where the cinchona bark was weighed out and packed, was beautifully furnished. On its wall hung a large portrait of Salumbrino which his fellow Jesuits had commissioned in 1764 at a cost of 140 pesos, and which bore the legend: ‘Agustino Salumbrino, first founder of this pharmacy of San Pablo’.

The walls were covered from floor to ceiling with solid oak shelves laden with bottles and flasks. Several tables and chairs were spread around the room, made of wood imported from Chile, and in the centre of the room was a long, wide mahogany counter of a beautiful reddish-brown colour. On top of the counter, in sharp contrast to the dark heavy wood, rested four delicate scales.

The three black employees who worked in the pharmacy spent their day in the laboratory, a forest of glazed earthenware and shiny instruments, some of lead or bronze, some of pure silver. The laboratory was filled with large jugs, scales, all kinds of stills used for distilling liquids, glass and metal funnels of all shapes and sizes, crystal flasks, retorts and matrasses, gridirons and hand mills, pumping engines and ovens, condensers and cauldrons, handsaws and sieves.

Brother Salumbrino’s Jesuit masters might have been uncomfortable in that room, with its heavy fumes and thick, unpleasant odours of medicines and chemicals, but they would have been happy to know that in San Pablo’s pharmacy he and his brother pharmacists had the means to preserve and restore the health of the hundreds of priests working in the field. The final inventory of the pharmacy includes more than five hundred medicines, in addition to the books in the library and the vast quantity of stills, bottles and other material that filled the laboratory’s shelves. Of the medicines in the pharmacy, by far the most valuable was una grande tinafa – a great jar – of cinchona bark, which is valued at one hundred pesos.

Despite the excellence of its pharmacy, the small world of San Pablo was about to be engulfed in political events that were fuelled, as so often happens, by fear and greed. Secret orders had arrived from Madrid: the Society of Jesus was to be expelled from the whole of the Spanish Empire on the orders of King Charles III, who feared its swelling power and longed to own its properties and who finally, after many decades, had chosen to believe the Jesuits’ enemies who had long tried to discredit them in the eyes of Charles and his court.

At four o’clock in the morning of 9 September 1767 the Viceroy, Don Manuel de Amat, had everything ready to carry out the King’s instructions in Peru. Four hundred soldiers were stationed within the viceregal palace. In the dead of night a number of the most important men in Lima also arrived at the back door of the palace, summoned by a handwritten note from Amat that read, ‘I need you for matters of great service to the King, and I warn you to come so secretly that not even those of your household would realise that you had gone out.’