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Quinine's Target

Every "history of pharmaceuticals" article ever written probably mentions quinine, and well they should. (I certainly reserved an entry for it while writing my own chemical history book). It's a classic example of a natural product drug, one that was not known to the classical Mediterranean world but was only appreciated by Europeans after they came into contact with the New World civilizations. Malaria was most certainly known to them - it was a disease thought to be cause by harmful vapors (mal aria) particularly in warm, humid areas, but there was no effective treatment in the Old World pharmacopeia.

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  The global history of quinine, the world’s first anti-malaria drug

Upuntil the 1940s quinine was the go-to way to treat malaria infections. Its history is one tightly entangled with the history of European empires, and their quests for domination in the malaria-ridden areas of the world. Just like the empires quinine supported the history of this drug, and the plant it derives from, stretches the globe: from the Andean jungles of South-America to the global network of British botanical gardens, from the colonial plantations of Southern-India to the Indonesian island of Java.

  The tree that changed the world map

Deep in the Andean rainforest, the bark from an endangered tree once cured malaria and powered the British Empire. Now, its derivatives are at the centre of a worldwide debate.

 Elixirs Made To Fight Malaria Still Shine On The Modern Bar

Turns out, gin and tonics aren't the only drinks with ties to the feverish disease. If you're sipping an absinthe cocktail or an Italian aperitif this holiday season, chances are you're also imbibing a bit of malaria's history.

 Quinine just the tonic for malaria

My mother nearly died from malaria – and it returned periodically to haunt her over the years in the form of fever and chills. Had she enjoyed a regular intake of gin and tonic, might she have avoided being so ill?

 Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria

Quinine, as a component of the bark of the cinchona (quina-quina) tree, was used to treat malaria from as early as the 1600s, when it was referred to as the "Jesuits' bark," "cardinal's bark," or "sacred bark." These names stem from its use in 1630 by Jesuit missionaries in South America, though a legend suggests earlier use by the native population.

 The Truth About Tonic Water

Quinine is still used to treat malaria today, although doctors typically reserve it for cases when the pathogen responsible for the disease displays resistance to newer drugs. However, you'd have to drink almost 20 liters of today's dilute tonic water daily to achieve the daily dose typically prescribed for malaria.

Articles of Interest

A History of the G&T: Quinine & Malaria

The origins of tonic water ultimately lie in mankind’s age-old fight against malaria. Or at least the discovery of quinine does (and just as well too). Quinine is the key ingredient that creates the gentle bitterness in tonic water and is theorized to be toxic to the malarial pathogen by interfering with the parasite’s ability to dissolve and metabolize the red protein in blood responsible for transporting oxygen.

Chloroquine, Past and Present

Chloroquine's fame is as an antimalarial drug, and the history of antimalarials starts of course with quinine. That's the active compound in cinchona bark, whose medicinal properties had long been known among the natives of South America in the tropical parts of the Andes - the Incas and the people(s) that the Incas absorbed into their empire. It doesn't seem to have been used by them as a malaria treatment per se, but rather was known as a treatment for shivering, brought on by either low temperatures or by malaria itself.

Early Modern Times - God Save the Quinine

After Cromwell, however, the British realised the curative properties of quinine: the Royal College of Physicians listed cinchona bark as an official malarial medicine in 1677. Europeans frantically sought out cinchona in South America, scraping the bark to take on their ships and ravaging the cinchona tree population. The supply of Jesuit’s bark was only restored by planting the right seeds in their plantations, as the use of quinine became an essential tool of tropical colonialism. The global demand for cinchona was, then, the basis of ‘powderful’ overseas empires.

Evaluating Cinchona bark and quinine for treating and preventing malaria

By the end of the 17th century, the notion that Cinchona bark was specific for fevers had become progressively firmly established, and several early therapeutic ‘trials’ have been documented, for example, at the Chinese court and at the court of Louis XIV of France.

High first dose quinine regimen for treating severe malaria (Review)

Authors’ conclusions: Quinine loading dose reduced fever clearance time and parasite clearance time. Data are insufficient to directly demonstrate an impact of loading dose on risk of death.

History of antimalarials

Quinine remains an important and effective treatment for malaria today, despite sporadic observations of quinine resistance.

Jesuits' powder and quinine

The powdered bark of the South American cinchona tree is the source of quinine - the mainstay treatment for malaria for centuries. The structural elucidation of this fascinating molecule can be traced back to the work of German chemist Paul Rabe just over 100 years ago.

Quinine and Empire

When Winston Churchill attributed it with saving “more Englishmen’s lives, and minds, than all the doctors in the Empire,” he wasn’t referring to a military tactic or peace treaty. Instead, his accolades were reserved for the gin and tonic.

The antimalarial drug quinine interferes with serotonin biosynthesis and action

The major antimalarial drug quinine perturbs uptake of the essential amino acid tryptophan and patients with low plasma tryptophan are predisposed to adverse quinine reactions; symptoms of which are similar to indications of tryptophan depletion.

The Imperial Cocktail

How the gin and tonic became the British Empire’s secret weapon.

The Sacred Bark: A History of Quinine

Quinine, the alkaline derived from the bark of the quina-quina tree, would prove the most effective treatment for malarial fever and infection in human history. In the decades after the bark of the tree was exported to Europe, every state with imperialist aspirations wanted access to quinine.

What Does Gin And Tonic Have To Do With Malaria Prevention?

As explained by the campaign initiator, Fever Tree, ‘the quinine that gives tonic water its gentle bitterness was also an important anti-malarial ingredient, used for centuries to ward off this deadly disease.’ This is certainly true. However, bad news for all Gin &Tonic lovers, drinking tonic water will not protect you from contracting malaria.

What to know about quinine in tonic water

Some people use tonic water to help treat nighttime leg cramps, but there is little evidence to suggest that this is effective.

“The Popular Dose with Doctors”: Quinine and the American Civil War

During the American Civil War the North and South developed different strategies to treat malaria.

Resources

Cochrane

Quinine loading dose reduced fever clearance time and parasite clearance time. Data are insufficient to directly demonstrate an impact of loading dose on risk of death.

Quinine

Flavoring: Tonic water, quinine water, bitter lemon. This drug can cure malaria and is used as a bitter flavoring in a few soft drinks. In 1994, the U.S. Food and Drug Administration banned quinine from over-the-counter drugs used to treat leg cramps, saying it was not safe and effective for that use. Then in 2006 FDA ordered companies to stop marketing unapproved products containing quinine. And in 2010 and 2012 FDA warned against using the only approved quinine-containing anti-malaria drug for any purpose other than to treat malaria. The higher levels used in drugs are more likely to cause adverse reactions than the low levels used in food, but to be on the safe side, pregnant women and the elderly should avoid quinine-containing beverages.

GoodRx

Quinine (Qualaquin) comes from the bark of the cinchona tree, and because of this, common side effects are grouped together into a term called cinchonism.