Quinine Permits Exploration, Colonization
Source: Burroughs Wellcome advertisement for Quinine Bisulphate, 1910.
About the Author: The pharmaceutical firm of Burroughs Wellcome was established in London in 1880 by two Americans, Silas Burroughs and Henry Wellcome. The company was known for high standards of quality control and for innovative (for the time) uses of advertising. In addition, it established its own research laboratories to develop new drugs and vaccines.
Quinine, the first effective treatment for malaria, was also the first disease-specific medicine in the Western medical arsenal. Unlike earlier medicines that only masked or relieved the symptoms of diseases, quinine was capable of bringing about either a temporary or permanent cure, depending upon the type of malarial infection.
Quinine first cured a European of malaria in 1638 when the wife of the viceroy in Lima, present-day Peru, was given a northern Andean remedy to save her life. Quinquina, as it was known in the Andes, came from the bark of a native tree. Upon her return to her estate in Spain, the Countess of Cinchon employed the ground-up bark to contain and cure the malaria around Cinchon, a few miles southeast of Madrid. However, no one quite understood why quinine was effective or how the patient was cured. In 1820, the French chemists Pierre-Joseph Pelletier and Jean-Bienaimé Caventou isolated two alkaloids from the bark of the cinchona tree. They named the white crystal quinine, and the brown liquid cinchonine.
Malaria was so widespread throughout the world that there was an enormous demand for a cure. In the course of the 1820s, chemical manufacturing firms sprang up to produce quinine and cinchonine. The latter became known as the poor man's quinine because it sold for a fraction of quinine's price. Quinine gained an international reputation as the effective cure for malaria. The high demand for it led to robust profits, with many of the modern pharmaceutical corporations tracing their roots to the quinine industry.
Quinine was easily portable. European colonists regularly consumed it as prophylaxis (prevention), permitting them to carry on explorations, missionary work, and military activity in areas where malaria was endemic. Unfortunately, the taste of quinine was repugnant, even to British taste buds. The British government recommended that quinine be taken in a mixture to disguise the taste. In India, the British took quinine dissolved in water, with gin added, thereby creating the famed drink of gin and tonic.
Beginning in the twentieth century, quinine was employed in mass public health campaigns, known as quininization, in an effort to stop the misery caused by malaria. The policy was first adopted in Italy, with considerable success. Unfortunately, quininization was expensive and quinine could not prevent relapses for all forms of malaria. Governments decided instead to switch their funds to efforts to eradicate the female Anopheles mosquito, the animal vector responsible for the spread of malaria.
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Cinchona bark is not easy to obtain and this difficulty made quinine a challenge to produce. In 1944, synthetic quinine was developed by American scientists. When synthetic quinine proved to be very effective against malaria with fewer side effects, the need for natural quinine subsided.
As mosquito control efforts became more sophisticated, scientists expected that the combination of quinine and fewer malaria-spreading mosquitoes would eradicate malaria. However, governments scaled back malaria control efforts before the mosquito was eliminated, partially due to evidence that insecticides containing the chemical DDT, while effective against the mosquitoes that cause malaria, also killed fish and birds. Additionally, the mosquito evaded door-to-door spraying efforts by avoiding indoor walls and ceilings, and instead, bit workers in the field. The ease of global travel brought malariainfected travelers to countries that had not seen a malaria outbreak in decades. In South Africa, malaria returned in 1997, after a fifty-year absence.
Complicating the situation, forms of the malaria parasite that are not affected by synthetic quinine and other anti-malarial drugs emerged in Southeast Asia in the 1990s. Scientists forecast that quinine-resistant malaria could spread to Africa, where ninety percent of the world's cases of cerebral malaria occur. The death rate from malaria in Africa could double to seven million per year as a result. A Chinese herbal medicine, artemether, that can treat resistant malaria was discovered by Western scientists in the mid-1990s, but it is not readily available.
Drug firms have been slow to develop artemether because they cannot apply for patents on a drug that is already used in traditional Chinese medicine and has already been described in the scientific literature. Therefore, no firm would have the sole rights to the drug that would guarantee healthy profits. One French company currently manufactures the drug from scrub wormwood extracts, however, the cost of the drug is twice as much as quinine. In poverty-stricken African countries, few could afford artemether.
In late 2005, the Bill and Melinda Gates Foundation announced a$258 million gift for fighting malaria in the developing world. Almost one third of the money will support efforts to develop a vaccine to protect children against a severe form of malaria, while the remaining funds will be used to speed the development of new drugs to treat people that are already infected with the disease and to develop effective new pesticides. Scientists also have returned to pesticides containing DDT for use against mosquitoes in limited areas in some African countries where malaria is endemic (naturally occurring).
Hobhouse, Henry. Seeds of Change: Five Plants That Transformed Mankind. New York: Harper & Row, 1986.
Rocco, Fiametta. Malaria and the Quest for a Cure that Changed the World. New York: HarperCollins, 2003.