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.