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Quinine, the great antimalarial medicine, was the first disease-specific treatment in the Western medical arsenal. Unlike earlier medicines that only masked or relieved the symptoms, quinine was capable of bringing about either a temporary or permanent cure, depending on the type of malarial infection.
Quinine, the first Western medicine to be targeted at a specific disease, was widely employed in western Europe and North America for generations before the germ theory of disease. In the nineteenth century it was the principal line of defense against the major public health threat of malaria in the United States and parts of Europe.
In 1820 the French chemists Pierre-Joseph Pelletier and Jean-Bienaime Caventou isolated two alkaloids from the bark of the cinchona tree. They named the white crystal quinine and the brown liquid cinchonine. These and other successful laboratory experiments by Pelletier and Caventou mark the beginning of modern alkaloidal chemistry.
In the course of the 1820s, chemical manufacturing firms sprang up in the U.S., the Netherlands, Great Britain, France, and Prussia to produce quinine and cinchonine. Cinchonine became known as the “poor man’s quinine”; it sold at a fraction of the price of quinine and became part of patent medicine formulations. Quinine gained an international reputation as the effective cure for malaria, and the high demand for it yielded robust profits. Many of today’s major international pharmaceutical corporations have roots in the quinine industry.
Most early consumers were in the U.S. and in western Europe, where malaria was one of the principal public health problems of the nineteenth century. Through the course of European colonial expansion and experience with the disease environment on the African coasts, malaria eventually came to be understood as a global disease. Quinine was extremely portable, and from the middle of the nineteenth century onward it was regularly taken as a prophylaxis, allowing European explorers, missionaries, and troops to carry out their activities in areas where malaria was endemic. In India, the British learned to take their quinine dissolved in water, with gin added, thereby creating the gin and tonic. Some authors have assigned a primary significance to the role of quinine in the European conquest of the tropics, but recent scholarship suggests that a variety of other public health practices, such as mosquito screening and latrine digging, were at least as important in reducing the rates of sickness and death in the tropics.
Beginning in the early twentieth century, quinine was employed in mass public health campaigns, known as quininization, designed to reduce drastically the toll of malaria through universal chemical therapy. This policy was first adopted in Italy, with considerable success. But the expense of the policy, in combination with the fact that quinine could not prevent relapses of all forms of malaria, led to a return to individual therapy and a focus on environmental interventions to destroy the anopheles mosquito, which carries malaria, and its habitat.
Quinine proved its importance to the military during the early twentieth century. Quinine could be crucial to keeping troops fit to fight, and reducing the enemy’s access to the drug could produce military victory. During World War I, the Allied powers cut off the supply of quinine to the Germans and thereby produced great suffering along the Eastern Front. The Germans undertook an emergency scientific research program to find a synthetic substitute, but did not succeed until the 1920s.
Following World War I, the League of Nations Malaria Commission attempted to survey the global status of malarial infections and to estimate the amount of quinine that would be necessary to intervene effectively. The estimated quantity was in excess of the world’s supply, and the initiative to treat the world’s populations chemotherapeutically was dropped. This early survey and the problems encountered with mass chemotherapy, however, anticipated both the creation of the World Health Organization and the later problems of the global HIV pandemic.
The world’s market supply of quinine during the 1920s and 1930s came to be controlled by an Amsterdam-based cartel known as the Kina Bureau, which succeeded in assuring a reliable supply of quinine at prices that allowed growers to avoid excessive competition. This system was shattered by the Japanese conquest in 1942 of the Dutch East Indies, where extensive cinchona cultivation was practiced. The Japanese captured the cinchona plantations that had produced most of the raw material for quinine production. Allied casualties mounted rapidly in the Pacific theatre of the war, and a major scientific research program was launched in the U.S. to find a synthetic substitute.
Since World War II, synthetic antimalarial drugs have largely replaced quinine. Today, quinine remains a highly effective antimalarial drug, and in cases of synthetic drug-resistant malaria, it is the drug of last resort.
Bibliography:
- Curtin, P. D. (1998). Disease and empire. New York: Cambridge University Press.
- Duran-Reynals, M. L. (1946). The fever bark tree: The pageant of quinine. Garden City, NY: Doubleday.
- Harrison, G. (1978). Mosquitoes, malaria, and man. New York: E. P. Dutton.
- Rocco, F. (2003). The miraculous fever tree: Malaria and the quest for a cure that changed the world. New York: HarperCollins.
- Taylor, N. (1945). Cinchona in Java: The story of quinine. New York: Greenberg.
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