Nature's Pharmacy: Ancient Knowledge, Modern Medicine

Cinchona (Quinine)

History
Cinchona is best known as the source of quinine, which for centuries was the most widely employed anti-malarial remedy in the world. The bitter tasting bark has been used by the indigenous people of Peru for many centuries, and is still a frequently used remedy for fevers, digestive problems, and infections. In 1633, a Jesuit missionary in Peru learned of the bark and its healing properties. In that same year, the first recorded use of cinchona appeared in a book written by an Augustinian monk:

"A tree grows which they call the fever tree in the country of Loxa, whose bark, the color of cinnamon, is made into a powder amounting to the weight of two small silver coins and given as a beferage [sic] that cures the fevers and tertains; it has produced miraculous results in Lima."

By 1640, the drug was employed for the treatment of fevers in Europe. However, the conservative medical community viewed the new drug with disdain because its use did not conform to the teachings of an early Greek physician, Galen; others viewed it with suspicion because the Jesuits controlled its use. For these reasons, the bark was relegated to quackery and used in secret remedies for many years. The first official recognition of cinchona came in 1677 when it was included in an edition of the London Pharmacopoeia as "Cortex Peruanus." By the late 17th century the powdered bark was being used as a cure for malaria around the world.

By 1820, researchers were able to isolate quinine from the bark. This led to the commercial production of quinine starting 1827. The popular cocktail, gin and tonic, was originally concocted to hide the flavor of the quinine. By the 19th century, so many trees had been harvested from South America, the genus was threatened with extinction. The effect of quinine alkaloids on certain cardiac arrhythmias was first tested in 1914 by Karel Frederik Wenckebach, a Dutch Internist. In 1918, scientist W. Frey found that quinidine was the most effective in patients with atrial fibrillation. Today, quinine from cultivated Cinchona is available from central Africa, Indonesia, and South America, where the tree has been reestablished.

Historical Uses

• As an anti-malarial remedy
• To treat fevers, digestive problems and infections
• To relieve leg and muscle cramps
• To treat cardiac rhythm problems

Warnings
Quinine should be taken only under medical supervision. It should not be taken during pregnancy. Excessive use causes "cinchonism," which, in extreme cases, leads to coma and death. Use is restricted in some countries.

Modern Medicinal Uses
Quinine was the principal remedy for malaria until World War I. Soon thereafter pharmacologists created a successful synthetic drug, chloroquinine. However, from the 1960s on, resistance of the malarial parasite to chloroquinine, the synthetic drug, has brought about a need for quinine once again in preventing and treating malaria. Cinchona in a highly processed form, along with quinine and quinidine, are commonly used in drug therapies for heart disease.