H22 Barking up the right tree: history of quinine

Abstract

Abstract Quinine is considered to be one of the most important medical discoveries of the 17th century through its use in treating malaria. Since then, its applications have expanded, and quinine continues to be one of the most widely used drugs in dermatology. Quinine is found in the bark of the Cinchona tree found in the jungles of the Andean region of South America. The exact nature of its discovery remains unclear; however, there are tales of the Spanish Countess of Chinchon being cured of a recurring fever by using liquid containing Cinchona bark. This prompted her to return to Spain in 1638 with the seeds and precious bark; in 1742, botanist Carl Linnaeus named the tree Cinchona in her honour. During the early 17th century, the bark was ground into a powder and mixed with wine. In 1820, French scientists Pierre Pelletier and Joseph Caventou developed the processes to extract quinine from Cinchona bark, improving the potency of the medicine. In the 19th century, as the role of quinine in treating malaria spread, Europeans in the British colonies started planting Cinchona trees to avoid importing large amounts of the drug. Owing to its bitter taste, quinine was mixed with sugar and soda, creating the first tonic water. The tonic water was mixed with gin to make the bitterness of quinine more palatable. Winston Churchill claimed that this drink ‘saved more Englishmen’s lives, and minds, than all the doctors in the Empire’ (Simonetti O, Contini C, Martini M. The history of Gin and Tonic; the infectious disease specialist long drink. When gin and tonic was not ordered but prescribed. Infez Med 2022; 30:619–26). The first documented use of quinine to treat dermatological conditions was produced by Payne in 1894, who reported the successful treatment of skin lesions in discoid lupus erythematosus (Payne J. A postgraduate lecture on lupus erythematosus Clin J 1894; 4:223–9). In 1951, a case series in the Lancet of 20 patients with lupus erythematosus and rheumatoid arthritis who were successfully treated with quinacrine, led to the extensive use of antimalarials to treat skin and joint conditions (Page F. Treatment of lupus erythematosus with mepacrine. Lancet 1951; 258:755–8). This was later succeeded by chloroquine: a synthetic analogue was first synthesized in the 1930s by Hans Andersag. However, it was noted to have significant toxicities, which led to the production of hydroxychloroquine, a similar drug with a much-improved side-effect profile. After 400 years, quinine and its synthetic derivatives continue to play a major role in managing dermatological conditions.