Quinine, malaria, and empire

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Quinine reached Britain (not to mention the rest of Europe) by way of Jesuit missionaries in South America. Browse around the internet and you’ll read that quinine is the dried, powdered bark of a tree that grows in the Andes and that it was discovered in the seventeenth century: The Jesuits, you’ll read, may or may not have used it to treat a Spanish countess’s malaria. Or the countess may or may not have discovered its uses herself. She may or may not have brought it back to Europe with her. 

Had the bark’s uses been discovered long before that by the people who were known as Indians thanks to Columbus having put too much trust in a glitchy SatNav (or GPS, since he was headed for the Americas)? 

Um, yes, according to biologist Nataly Canales. She says the bark was known to the Quechua, Cañari, and Chimú peoples long before any countesses or missionaries barged onto the stage.

Irrelevant photo: a begonia

Once it got to Europe the bark was added to a liquid–usually wine–and drunk as a treatment for malaria.

Now let’s put quinine on the shelf and talk about malaria for a few paragraphs.

I don’t know about you, but the random reading I did when I was younger (and I spent a shocking amount of my life being younger) left me with the impression that at least the British and probably Europeans in general were exposed to malaria as a result of empire. In other words, I assumed they caught it when they left their nice, safe home climates and broke into other people’s (warmer, mosquito-prone) countries, taking them over.

Not so. Malaria in Europe predates predates the British Empire, the Spanish Empire, and while we’re at it, the Roman Empire. It was around in the ancient Mediterranean and it was also around in marshy, fenny parts of England from the fifteenth to the nineteenth century, and in London itself for at least for part of that time.

Starting in the early nineteenth century, it went into decline in England. Lots of causes have been proposed, from swamps being drained to an increase in the number of domestic cattle, which meant mosquitoes could bite creatures that weren’t able to swat them. Any combination of those reasons is possible. I found a perfectly respectable article that told me no one’s sorted the reasons into piles yet or measured which one is larger. 

Was malaria present in England before the fifteenth century? Probably. In “The Nun’s Priest’s Tale,” Chaucer writes about tertian fever–a recurring fever that was probably malaria. That takes us back to the fourteenth century and we won’t chase it any further back than that or we’ll never get out of here.

Malaria was also called ague or intermittent fever, and ague appeared in any number of the crumbly old novels I read when I spent all that time being younger. I had no idea what ague meant, I just accepted it as some vague kind of sickness and went on as if I understood more than, in fact, I did.

Those characters had malaria. And although some caught it by breaking and entering in other people’s countries, some caught it right there at home.

In fact, Europeans may have exported the disease to the Americas. That’s not certain, but a second strain of malaria was definitely imported with the slaves Europeans dragged over from Africa.

The long-standing European belief was that malaria came from bad air—mal’aria–and that made a kind of sense. Folks had noticed that it was associated with stagnant water, vapors, swampy places. They were missing a piece of the puzzle, but as far as it went, it was good observation.

By the seventeenth century, the English were treating malaria with the latest wonder drug, opium, which both doctors and patients agreed cured pretty much everything: pain, fever, financial embarrassment, although it only cured that last problem if you were selling the stuff, not if you were taking it or buying it.

Opium was also used as an antidote to poison. Like I said, it cured everything.

Then along came quinine and–well, there was a problem. It came from the hands of Jesuits–in fact, it was called the Jesuit powder–and England wasn’t just Protestant, it was aggressively Protestant. Puritan-flavored, Cromwellian Protestant. And Cromwellian Protestants didn’t want a Catholic-flavored drug, even if it would cure a serious problem. 

Cromwell himself is thought to have died of malaria and he might (it’s not certain) have refused to take any of that dread Jesuit powder. Andrew Marvell (another staunch Puritan and a poet; nothing to do with the comic books) also had malaria and might have died from an accidental overdose of opium that he might have taken for it instead of quinine. 

Sorry–lots of mights in there. History’s full of things we don’t know for sure, and one of them is whether anyone dangled Jesuit-inflected quinine in front of them. (“Here, kid, the first one’s free.”) The consensus, though, is that Cromwell, at least, refused it. In a definitely very probably likely kind of way.

Opium wasn’t the only treatment for malaria. I’m not sure when Europeans gave this one up as a lost cause, but at some point the remedies they tried included throwing the patient head-first into a bush. The idea was the patient should get out quickly and leave the fever behind.

Britain’s full of thorny bushes, and I know that because I’ve met every one of them personally, so I’m going to go out on a limb and guess the British gave this remedy up early.

Eventually, England settled down enough to realize that taking quinine for malaria didn’t necessarily turn you into a (gasp) Catholic (and didn’t leave you full of thorns) and it accepted the drug.

All of this mattered because malaria was and is, to varying extents, debilitating. The extent depended on the strain. Some strains killed people and others didn’t. Britain’s version was on the milder end of the spectrum, but many strains were capable of leaving individuals, whole regions, and armies debilitated. Some historians tag malaria in the fall of the Roman Empire. It wanders into discussions of the American Civil War, World War I, World War II, and assorted other historical turning points. The European colonization of Africa was slowed by malaria. Europeans had no immunity to it, while some (although not all) Africans did. If you inherit two copies of a particular genetic mutation, you have sickle cell anemia, but if you inherit only one it protects you against malaria. 

By the nineteenth century, Europe was in the process of eradicating malaria, so the Britons who went abroad to build and serve the empire (not to mention to build their own fortunes and serve themselves) were moving from a relatively low risk of the disease to a higher one. Which explains my impression that malaria was something they got in the hot countries where they practiced breaking and entering. 

In India, the British Empire ran on quinine. In the nineteenth century the active ingredients was isolated and purified, and Britons in the Indian colony mixed it with sugar and soda water, called it tonic, and took a dose of it daily as a preventive. 

In 1858 it was first made commercially, and from the colonies it eventually took over the home market.

At about this same time, gin was overcoming its reputation for dragging people into sin and degradation. It became respectable enough for British colonial officials to pour a bit into their tonic water. Or possibly a bit more than a bit.

For medicinal purposes only, you understand.

In 1880, the malaria bug was finally identified. It was a nearly transparent, crescent-shaped beastie. Then, as the world was falling off the edge of the nineteenth century and into the twentieth, the anopheles mosquito was identified as its carrier.

Quinine remained the treatment of choice, as it had been for four hundred years, but the stuff had–and has–side effects that range from mild headache, nausea, and hearing problems to severe vertigo, vomiting, marked hearing loss, loss of vision, hypertension, and thrombosis, asthma, and psychosis.

Its use is not recommended if you take a long list of drugs that you can’t pronounce anyway.

All of which explains why other drugs are often used for malaria these days and why so many websites tell you not to use it to treat leg cramps–although a few swallows of tonic water won’t leave you psychotic and vomiting by the side of the road. 

54 thoughts on “Quinine, malaria, and empire”

      • Of the two main studies reporting failure the one published in The Lancet was shown to be false and withdrawn, while the Oxford trial, supposed to replicate the claims of Dr. Raoult in Marseilles, did not use the drug as early treatment nor in conjunction with the zinc cocktail, as in Raoult’s work, but was tested in large doses on elderly patients in an advanced state of illness, twenty eight of whom died. Given that some had other medical problems, a number might have died in any case, but such laxity in conducting a trial would lead me to seek a prosecution for gross negligence manslaughter.

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        • I didn’t follow up on it, but I just saw another article–presumably another study–drawing a blank with chloroWhteverthehellquinine. And one about the sloppy research resulting from the frantic pace that researchers are (understandably, although perhaps not wisely) working at.

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          • Sloppiness can’t be tolerated….reminds me of the late Keith Miller’s phrase when asked how he, as a test cricketer, coped with pressure.
            Pressure, said he, the ex wartime pilot, is when you have a Messerschmidt up your backside.
            Applying fighter planes to researchers’ backsides might be no bad idea…give them a sense of the lives they put at risk.

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  2. It was certainly a problem in the Netherlands, because of the marshy conditions there, and, because of the close contact between the Netherlands and England due to the wool trade etc, was known here too. I’ve read books about the 17th century which refer to “Jesuits’ powders” – and the Dutch, with their 80 years’ war against Spain, disliked the Jesuits even more than the English did!

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  3. Towards the end I was afraid that I was going to have to give up one of my favourite tipples, but it seems not, which is a relief.

    I too learned late in life (within the last five years) that malaria was fairly common in Europe. It was one of the reasons why it was quite hard in the Middle Ages to keep a pope in Rome, which was particularly prone to it.

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  4. I had always thought that a minute amount of quinine was included in gripe water, used for settling babies’ stomachs, but apparently it isn’t – or wasn’t. Our first born did do quite well on tonic water though, and there were times we were sorely tempted to add some gin to it! We didn’t – we just drank it ourselves to dull the sound of the crying 😉

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  6. I love irony – Protestants – especially those of a Cromwellian bent, as you put it – wouldn’t imbibe anything coming from a Catholic source and, in the mid-nineteenth century, they refused assistance to hungry Catholics unless they first changed their allegiance!

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  7. Fascinating stuff….apparently tonic water still contains quinine, but not so much. I always remember the main character [layed by the very lovely Virginna McKenna) in the Second World War drama “Town Like Alice” asking for quinine at every village the women got marched into.

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  8. As you say, Opium in the form of Laudanum was the cure for everything in Victorian times. Yes, the drugs to prevent malaria do have side effects. My husband was given a whole list of side effects when he had to take Lariam for a trip to Africa. Thankfully he has a strong constitution and got away with none.

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  9. My Mum always claimed that it was the quinine in the tonic in the gin and tonic that gave her a headache… I am slightly skeptical, to be honest, but she did switch over to drinking gin and lime or a while.

    I drink tonic water (separate from my gin as well as in it) to relieve restless legs, I mix it with with soluble(ish) magnesium citrate, its not great as a drink, but it works.

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  11. Interesting facts here! We didn´t seem to have a problem with malaria in Canada, that I know of. I didn´t know there was quinine in tonic water. You learn something every day, especially if you read your posts. Thanks!

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    • I seem to remember some brand in the US using the word quinine on the label, which is the only I knew about it to start with.

      You got me curious about Canada and malaria, so I looked it up and found this link: https://www.thecanadianencyclopedia.ca/en/article/malaria

      “Early settlers in Ontario experienced a disease called ‘fever and ague,’ which ravaged the first European settlements such as Newark [Niagara-on-the-Lake] and Cataraqui [Kingston]. The disease occurred as far north as the present site of Ottawa, and interfered seriously with the construction of the Rideau Canal in the 1830s. Most instances of ‘fever and ague’ were what we now know as malaria.

      “The variety that existed in Ontario, benign tertian malaria, rarely was fatal but caused regularly recurring bouts of severe fever, shaking chills and anemia, and thus severely sapped the energy of its victims. Fortunately, the symptoms could be controlled by taking Peruvian bark, or cinchona, which later was found to contain quinine.”

      It goes on from there. Thanks for raising an issue I hadn’t thought of.

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  12. So I’m a tad bit confused here – is it okay for me to have a vodka with tonic and perhaps even a splash of lime? I would switch to gin but I don’t like the taste. Oh well, I think we used to call our malaria-like illnesses the Epizooti when I was growing up in Texas.
    The one doctor in the area treated every illness the same: a shot of penicillin and a diet of soups, broths, jellies and jellos. Seriously. You either survived or you didn’t.
    Which is kind of like Covid – you either survive or you don’t.
    On that note, have a great weekend!

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  13. Well, since quinine is ineffective against Covid when will they begin with Opium ? Or have they already and I missed it. Might explain a few things.

    Have you heard the latest conspiricy theories ? Trump doesn’t really have Covid – that is his excuse to get out of any more debates. Then he will come back and announce “See- just a cold.”

    But some of us believe in Karma

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  14. Fortunately Australia is malaria-free but venture north or west and there be malaria dragons. Remember when people could fly to other countries? Every year a few hundred Aussies would come home kissed by the malaria fairy (along with a few other conditions unmentionable in this G-rated blog). Now, not so much. See, the pandemic has its benefits. ;-)

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    • I remember reading, back in not just the prepandemic ages but in the preblog ages, about some soldiers with malaria being repatriated to Britain, and some idiot sent them to an area with the anopheles mosquito. At a time when the mosquito’s role was known.

      We humans aren’t that smart about our traveling, are we?

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  15. Very interesting. The list of side effects seems mild compared to those rattled off in today’s drug advertisements. Love the work ague. I didn’t know it. This is going to become a stand-in for my current use of the term “general malaise” which I’ve used for years after reading a signpost outside Joshua Tree National Park, warning that rodents in the area carried the plague. After reading your post, I’m thinking that a vodka tonic might be just the thing for battling Covid, or at least the latest news concerning such.

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    • Vodka tonic? It’s the new opium. It cures the most amazing range of diseases–or at least dials back your anxiety about them for a while.

      That sign was written by someone who really knew how to welcome visitors, wasn’t it?

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  17. My mum swore that Quinine in tonic water was the one thing that helped her pain. Im not sure to this day (mum has been gone now for 7 years) if she added any booze to it :) I bought some the other day Tonic Water with quinine added and I did add some Gin. I think I prefer my Gin on its own!

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    • It’s an old line from, I think, Prohibition–or maybe from the pre-Prohibition temperance campaigners. It wasn’t okay to drink, but a sip or two for medicinal purposes? Well, that was different.

      Although admittedly, they weren’t gin and tonic drinkers.

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