Quinine was first known to be used by the indigenous peoples of Peru, Bolivia, and Ecuador to halt “shiverings” or fevers. It is not known how long they knew of this remedy, but when the Spanish Jesuit missionaries in the 1570’s became aware of this treatment they brought it back to Europe. The remedy was a mixture of the bark of the cinchona trees and sweetened water because the taste of the mixture was very bitter.
The extract of the cinchona bark, called Jesuit’s or Peruvian Bark, was quickly adopted to treat malaria in Europe during the 1600’s. The incident that promoted the popularity of quinine was the curing of King Charles II of Scotland. Eventually, the Dutch were able to successfully smuggle cinchona tree seeds out of Peru in the 1800’s because the Peruvian authorities did not want to lose the monopoly of selling the cinchona bark. The Dutch grew the trees on Indonesian plantations and soon became the world-wide supplier of quinine. The quinine chemical was isolated from the cinchona bark as the active ingredient by French scientists Joseph Pelletier and Joseph Cavantou in 1820.
Quinine has played a significant role in history. It is said that it made possible the colonization of Africa by Europeans because quinine was a cure for the ever-present malaria. During World War II, Allied powers were cut off from their supply of quinine when Germany conquered the Netherlands, and Japan controlled the Philippines and Indonesia. The US had obtained four million cinchona seeds from the Philippines and began operating cinchona plantations in Costa Rica. Additionally, they began harvesting wild cinchona bark during the Cinchona Missions. The Cinchona Missions (1942-1945) were a series of expeditions led by the United States to find natural sources of quinine in South America during World War II. Sadly, such supplies came too late, as tens of thousands of US troops in Africa and the South Pacific died of malaria due to the lack of quinine.
Today quinine is not used as an antimalarial because safer and more effective drugs were developed to treat malaria such as chloroquine, hydroxychloroquine, atovaquone, artemisinin, doxycycline, and clindamycin, to name a few. But quinine was used for malaria well after World War II and was available as an over the counter (OTC) medicine to treat leg cramps. In 1994 the FDA banned the sale of quinine in OTC medicines because of serious side effects, but it is still available in prescription form as Qualaquin. The side effects of quinine (lowering blood counts, blood clotting disorders, and affecting the heart rhythm) were judged to be too dangerous to treat leg cramps, however, the side effects were acceptable when treating malaria.
Another important drug developed from the cinchona bark was quinidine, a sister chemical of quinine, only slightly different. This drug was widely used for decades to treat heart arrhythmias, but has been replaced by more effective drugs. It was discovered in 1912 by Dr. Karel Wenckebach, who was treating a Dutch merchant for atrial fibrillation. The merchant could not understand why an effective treatment of this heart disorder had not been developed and told Dr. Wenckebach that he knew how to restore his heart to proper rhythm and would come back the following morning with a normal rhythm, which he did. The merchant told Wenckebach that he noticed that his heart rhythm problems eased and ceased when he took a dose of quinine.
Dr. Wenckebach reported this observation as a passing comment in a 1914 book on arrhythmias. Four years later, Dr. Maximiliam von Frey, a German physiologist, reported that quinidine was the most effective of the four principle cinchona alkaloids for controlling arrhythmias. The drug quinidine soon became one of the main antiarrhythmics used in medicine for many decades. There are other drugs used more commonly today to treat heart rhythm problems such as amiodarone, flecainide, various beta-blockers like sotalol, carvedilol, and metoprolol.
History has shown that quinine, the extract from the cinchona bark, has played a significant role in the advancement of civilization through its ability to make colonization possible, and was a crucial factor in the armed conflict of World War II. Also, when you include the discovery of quinidine for heart arrhythmias, it shows the importance of not discounting the layperson’s observations that occur to their bodies when taking medications. Talk to your doctors about what you observe when you take your medication.
Stay informed and stay healthy.
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