It is World Malaria Day on April 25. An anti-malarial drug that left an indelible impression on those who consumed it is on everyone’s lips; its efficacy and benefits hotly discussed in the pandemic climate we find ourselves in. The synthetic modification of the “wonder drug” quinine known as hydroxychloroquine is being used by some countries as experimental treatment in the fight against COVID-19.
It was endorsed by USA President Donald Trump as a “game changer”, although no peer-reviewed study proves its efficacy. There is insufficient clinical data to promote or prevent its use.
Most wanted drug
A throwback on quinine would have to go as far back as the 1600s, according to Thiruvananthapuram-based Emeritus Professor of Neurology Dr K Rajasekharan Nair. “There was a time in history when quinine was a panacea for all ailments,” he says. Extracted from the bark of the cinchona tree, it became the most wanted drug in the world to treat malaria which was killing people. “Malaria did not have a medicine until 1635, when quinine, an alkaloid obtained from the bark of a cinchona tree, was found to be effective,” explains Dr Nair, who is also a medical historian.
Even after decades, Kochi-based Jacob Varghese Kunthara, a retired Professor in Botany, distinctly remembers the bitterness of the ‘koyina vellam’ that was administered to him at the General Hospital in Pala, Kerala. It was the early ’60s; the bitter liquid was quinine. Though malaria was on the decline in India by then, quinine was still used as the first line of defence against the dreaded disease. “Quite a few children those days, especially those who lived in areas where malaria was common, would associate fever with the bitterness of quinine,” Kunthara says. The bitterness has tinged most of her childhood memories too, says Priti S, a communications professional based in Kochi. “My father was in the Army, and when he was posted in areas known to have malaria, we were given a spoonful of quinine every morning as a prophylactic.”
It is believed that the Countess of Chinchon, wife of the Viceroy of Peru, was cured of malaria by taking an extract from the bark of a Peruvian tree in 1630. The tree therefore came to be known as Cinchona in her honour, as she took the initiative to introduce the medicinal plant to Europe and promote its cultivation, says Dr Nair. However, another story concerning its popularity is attributed to Jesuit priests who, after realising its medicinal value, encouraged its cultivation. A few believe that the tree was brought to Rome from Peru by Augustino, a Jesuit priest.
- Quinine’s bittersweet history is not complete without its role in cocktails. Gin and tonic can trace its roots to British colonisers in India, who mixed the anti-malarial quinine (with its bitter taste) with their gin. Today, tonic waters have low quantities of quinine in them and are mainly used as a flavour enhancer. “The resurgence of quinine in cocktails is an interesting trend that we have seen in the past few years. As palates are evolving, people are moving away from the previous trend of overly sweet drinks to more classic, sophisticated tastes,” says mixologist and Dewar’s India brand ambassador Greg Benson. “If anything, the rise of bitter ingredients represents a bit of liquid history as we can trace their use in drinks back to hundreds of years. These ingredients work really well with the cinnamon and honey notes,” he adds.
Whatever the story, quinine rose to popularity and its sale flourished. Its side effects, which included irregular heartbeat, loss of hearing and a lowering of the blood platelet count, created the need for an alternative. Later, synthetic modifications of it resulted in chloroquine and hydroxychloroquine, and quinine became obsolete. However, despite its side effects, quinine was preferred as a remedy for leg cramps until 1994, when the US government banned the use of quinine except in the treatment of malaria. As demand for natural quinine declined, the plantations of the cinchona tree declined too. Native to Ecuador, the cinchona tree was introduced to British India in the 1800s and was cultivated in the Nilgiris and Darjeeling. Cinchona is believed to have been cultivated along with tea and coffee in the hills of Munnar, now in Kerala, by the British who leased the land from Poonjar Raja (the king of the Poonjar region).
Currently, the only existing cinchona plantation in the country is in Darjeeling. According to Dr Samuel Rai, director, Directorate of Cinchona and Other Medicinal Plants, at present, the plantation covers 6,900 acres and produces 1,50,000 to 2,00,000 kilograms of cinchona bark annually, which is sold through a government auction. Started in 1862, the plantation used to have a factory that manufactured quinine sulphate. The factory, however, was closed down in 2001.
A cinchona tree can grow up to 20 metres, Kunthara says. Quinine is extracted from the bark of a seven or eight-year-old tree, when the yield is highest. In addition to quinine, over 35 alkaloids have been isolated from the cinchona bark, which are used for various purposes.