15 July 2013

Accidental Discoveries: Quinine

By Anita Davison

No one would undertake to bring into England a medicine coming from the Spanish colonies, sponsored by the Vatican, and known by the abhorrent name of the Jesuits’ powder’ Oliver Cromwell

Oliver Cromwell
In my novel about Elizabeth Murray, I included a connection between the family which concerned the question, ‘Did Oliver Cromwell take quinine, or ‘Devil’s Dust’ for his malaria in secret, or did he hold out against his belief it was a Jesuit plot to undermine the Anglican church?’

In the 17th Century, Malaria was widespread in Northern Europe and had been for two hundred years. Malaria,now known as a disease of the tropics, badly weakened the Roman Empire and Emperor Nero drained the swamps near ancient Rome, in order to rid the city of that bad-air disease. Known as ‘marsh fever’, or the "Ague", it was endemic in places like the Cambridgeshire Fens and the Kent and Essex marshes.

The name means "bad air," because people originally believed the disease came from bad swamp air. Cold winters reduced the incidences of fever, and although William Shakespeare was born at the start of a cold spell lasting several years, he mentioned the disease in eight of his plays.

Cromwell wasn’t the only famous sufferer. Charles II contracted it,as did the Dauphin of France, son of Louis XIV, and Alexander the Great. In the summer of 1623, ten cardinals and hundreds of their attendants died in Rome while gathered to elect Pope Urban VIII.

Galen, or Claudius Galenus of Pergamum [131-201 AD] a Greek physician, believed that the vomiting that accompanied malaria was the body's attempt to expel poisons, and that ‘humoral balance’ could be restored by bleeding, purging, or both. The bleeding supposedly rid the body of "corrupt humors." This treatment was accepted without question for the next fifteen hundred years, but was rarely a cure. It made the anaemia caused by malaria much worse, and additional purgatives often killed off most sufferers. Only the poor, unable to afford medical help, were more likely to survive

One 13th Century ‘cure’ developed by Albertus Magnus, a German Dominican friar,  was to allow insects to devour 77 small cakes made from a dough prepared by mixing flour and the patient's urine. Another was for the matron of a noble family to cut the ear of a cat, add three drops of its blood to brandy along with some pepper and administer it to the patient. Rubbing the patient's body with chips from a gallows on which a criminal had been recently executed was yet another method. Needless to say these were ineffective.
Alexander The Great

Evidence suggests that malaria did not exist in the New World before the arrival of the Spanish in the 16th Century. There they found the natives had used powdered Cinchona bark to treat fevers for hundreds of years, using it as a muscle relaxant that halted shivering due to low temperatures.

One tale attributed to its discovery, was the natives noted that sick mountain lions chewed on the bark of certain trees. Another, that a member of a Peruvian Spanish garrison, overcome by malaria, was left behind to die by his comrades. Tortured by thirst, he crawled to a shallow pond, where he drank the water before falling asleep. He woke to find his fever had disappeared, and then he remembered that the water had a bitter taste from a tree trunk, split by lightning, that had fallen into the pool.

The fourth Count of Chinchón was appointed by Philip IV to rule the Spanish South American Empire and arrived with his wife, Señora Ana de Osorio, in Lima in 1629. Shortly afterwards, the countess became severely ill with tertian fever and was given the tree bark. The countess recovered,and ordered a large quantity of the bark to be given to the sick. The grateful sufferers, now cured, named the new remedy los polvos de la condeça, "the countess' powder." In 1639, according to Bado, the countess returned to Spain, bringing a large quantity of bark with her.

Spanish Jesuit priests got natives to harvest the bark, and that for every tree they cut down, the worker had to replant five trees, arranged in the shape of a cross.

By 1645, the bark was taken to Rome, but because it was supported by the Vatican it was not accepted in England, regarded the ‘Devil’s Dust’ as a Popish plot against the Anglican church. Also, the use of a hot, bitter drink to someone experiencing high fever conflicted with Galenic medicine and common sense, so the bark took a while to be accepted.

The Austrian governor general of the Netherlands, Archduke Leopold William was given cinchona with excellent results by his physician. But when the malaria recurred a month later, the archduke blamed the cinchona, refused to take more and subsequently died. This didn’t help cinchona’s reputation in Europe, and the doctors pronounced it "fixed the humors" while reducing the fever, making recurrence and certain death likely.

Robert Talbor

Robert Talbor entered St. John's College but dropped out at the age of twenty-one, becoming apprenticed to a Cambridge apothecary from whom he first learned of cinchona. Aware the bark was effective but unpopular, he set himself up in London as a "feverologist" by treating malaria patients with his 'secret remedy'.

This was an infusion of cinchona powder in wine and opium to disguise the bitter taste, which cured many sufferers in the Fens and Essex marshes. To avoid his use of 'Jesuit's bark' becoming known, he made slurs against it, and warned:  "Beware of all palliative Cures and especially of that known by the name of Jesuits powder..... for I have seen most dangerous effects following the taking of that medicine."
Charles II

Charles II appointed Talbor Physician Royal in 1672 and he was knighted in 1678. The Royal College of Physicians tried to have Talbor prosecuted for practicing medicine without a license, but Charles II protected him, and took his remedy when he fell ill with malaria in 1679.

When the dauphin, son of Louis XIV, became ill with fever, Charles II sent Talbor to the French court. With his son cured, the grateful king have Talbour the title of Chevalier Talbot, and paid him 3000 gold crowns, and a large pension in exchange for the secret remedy. Talbor agreed, on the condition the formula would not be revealed during his [Talbor’s] lifetime.
Le Grand dauphin

Talbor also cured Louisa Maria, Queen of Spain, the Prince de Condé, the Duc de Roche-Foucauld, and many other royals and aristocrats. His practices angered physicians in Paris and Madrid. "What is fever?" they asked. "I do not know," replied Talbor. "You gentlemen may explain the nature of fever; but I can cure it, which you cannot."

After returning to England, Talbor cornered the cinchona market by buying all the bark he could find, but did not live long enough to enjoy his wealth. He died in 1681 at the age of thirty-nine, and was interred in Cambridge's Holy Trinity Church. After his death, Louis XIV immediately released the formula, and in 1682 it was published in London.

Quinine is an alkaloid, and was isolated from the bark in 1820 by French chemists Pelletier and Caventou-a monument in Paris commemorates this achievement. Quinine is a powerful antipyretic, which lowers body temperature. Malaria sufferers experience bouts of extreme chills and then burning fever that can reach 107 degrees F.
Seeds of quinine plants were smuggled out of South America by Charles Ledger in 1865, and quinine plantations established in Java. This destroyed the South American monopoly and established a new Dutch monopoly. The native who helped Ledger, Manuel Incra Mamani, was jailed, beaten, and eventually starved to death for his participation in the scheme.

Malaria killed thousands of British troops fighting Napoleon in 1809 and many soldiers on both sides of the American Civil War.

In 1823, Dr. John Sappington of Philadelphia acquired several pounds of quinine and issued "Dr. Sappington's Fever Pills." He persuaded ministers in the Mississippi River Valley to ring the church bells every evening to alert people to take the pills

Construction by the French on the Panama Canal was halted in 1881 by malaria. The US took over the project in the early 20th century and their temporary control of mosquitoes by DDT allowed the work to be completed.

Approximately 60,000 U.S. troops died in Africa and the South Pacific from malaria during WWII. The world supply of cultivated quinine trees in Indonesia and Java was captured by Japan in 1942, while Germany acquired the quinine reserves in Amsterdam. Before the fall of the Philippines, the U.S. managed to remove four million seeds, germinating them back in Maryland and then transplanted in Costa Rica and other parts of Latin America. Also, a botanist, Raymond Fosberg secured vast quantities of Cinchona bark in 1943/44 for the Allies from forests and plantations in northern South America.

As for my original question, Did Cromwell take quinine, which was only available in France in 1645? It is still open to debate, but Elizabeth Murray’s father was at the French court with King Charles I during that time, so I like to think my heroine, who was reputedly a spy for The Sealed Knot, made the most of her opportunities.

Anita Davison is a Historical Fiction Author whose latest release, ‘Royalist Rebel’ a biographical novel set in 17th Century England, is released by Claymore Books under the name Anita Seymour


kathryn said...

Great article, Anita. I have a life-threatening allergy to quinine. You can imagine how I discovered it? No gin and tonic for me. I found this essay wonderfully informative. I hadn't realized there was such controversy around quinine--although I can attest that it should be approached with caution.

Debra Brown said...

That is an interesting post, Anita. It is interesting to learn where the term Cinchona (quinine) came from.

Accidental discovery involving quinine played a major role in the discovery of the field of medicine known as homeopathy.

A German physician, Samuel Hahnemann, was doing translation of medical papers and came across a statement that quinine cured malaria because it is bitter. He thought that was ridiculous because lots of bitter things do not cure malaria.

He decided to experiment by taking quinine himself to see what it did to him, if anything. He developed several symptoms- a "symptom picture", possibly like what Kathryn above gets. Maybe adverse symptoms are what caused the archduke to doubt the cure?

Hahnemann's curiosity was raised, and he decided to see what effect the quinine would have on patients who exhibited the same symptoms that he himself developed. He knew that diluting and shaking a substance raised its energies, so he did so before treating patients who had not taken quinine but who had quinine-like symptoms. To his amazement, the cinchona cured the patients.

He began to believe that "like cures like disease", or "homeopathy".

He and his students began testing other substances in the same way, "proving" them by taking them and recording symptomatic results. They would then dilute and shake the substance and administer it to patients with like symptoms.

Hahnemann also recorded the symptoms of persons who had been poisoned by arsenic. They often had burning pains relieved by warmth- warm drinks, etc. He diluted arsenic greatly to reduce its poisonous effect, diluting and shaking many times. He then administered it to victims of flu with the typical arsenic symptoms such as burning stomachs, burning vomit and diarrhea, etc. who were relieved by warmth. It cured.

Homeopathy was born, a strong kind of medicine in very dilute amounts which triggers the body to heal much like using a vaccination. I personally have had much success in using it, so am greatful to those who began to find quinine effective.

In homeopathy, quinine is referred to as Cinchona or China.

Anita Davison said...

Thanks for your comment Kathryn, and that's very informative, Debra, I will keep that as an adjunct to the article. My interest in quinine began when researching Royalist Rebel - Cromwell was rumoured to have taken it in secret due to it's 'Devil's Dust' reputation, but his malaria got so bad, especially after Worcester, he was desperate. Elizabeth Murray's father was at the exiled Queen Henretta Maria's court in Paris - so I invented a scenario where her family provides Cromwell with quinine, in secret, in exchange for certain favours - i.e. not decimating their estate or executing her father.
The fun part of writing historical fiction is you can play with the facts a little.

Antipatersoter said...

I've heard or read about Alexander giving his troops quinine...where does grow naturally. And is there evidence that he used Opium as a medicine and for his troops. If he brought it as far as India, it must have been for a useful reason.