The cinchona tree, the source of quinine, provided the best treatment for malaria until the 1940s. But this “miraculous cure” from the forests of the Andes grew in a place where the deadliest form of malaria didn’t exist until colonial expansion brought the disease to the Americas.
The Andean fever tree (Cinchona spp.) has a long history as a medicinal plant. The tree grows high in the cloud forests of the Eastern Andes bridging Ecuador, Peru and Bolivia. It’s best known as a ‘miraculous’ cure for malaria, first as “Peruvian bark”, then as quinine, extracted from the bark. Yet it grew far from the malarial areas of coastal South America.
Cinchona bark was first recorded as a medicine in Loja, Ecuador in the early 1600s, but there are no known records of its use for malaria before the Spanish conquest. It was unlikely to have been used for malaria prior to the arrival of the Europeans, because the colonisers brought the most fatal form of the disease with them in their own bodies and those of the African peoples they enslaved. It is thought that a fusion of the superior botanical knowledge of Indigenous healers with the search for better treatments for this newly arrived disease resulted in the novel ‘cure’.
Malaria is now known to be caused by a blood-dwelling parasite of the Plasmodium genus. The parasite eats up red blood cells and replicates around the body, causing severe fever, anaemia, fatigue, weakness, coma and, if untreated, eventual death. Blood-sucking Anopheles mosquitoes, which breed in stagnant water, such as marshes, or uncovered water containers in areas with a poor water supply, spread malaria from infected individuals to a new host through their saliva. A combination of high concentrations of mosquitoes and humans infected with Plasmodium results in the disease spreading rapidly.
Malaria has been known since antiquity and was prevalent across Africa, Asia and Europe. The name malaria means “bad air”, as it was thought to be caused by pestilential fumes arising from swamps. In many areas malaria was eradicated by draining the marshy habitat where mosquitos bred. This image shows an “anti-malarial” brigade in the UK in the early 20th century, setting out to clear ditches of stagnant water. Malaria still affects over 241 million people in South America, Asia and Africa, particularly in remote areas with limited access to healthcare.
Until the 19th century, South America was the only source of the precious cinchona bark, which was shipped around the world to be powdered and taken in decoctions or wine. In 1820 the active agent in the bark, an alkaloid called quinine, was isolated by French pharmacists Joseph Bienaimé Caventou (1795–1877) and Pierre-Joseph Pelletier (1788–1842). The supply of anti-malarial cinchona soon became essential for empire-building, as it helped support the health of colonists in their pursuit of new tropical lands and riches.
In 1878 Henry Wellcome, seen here on the left with his South American guide, travelled to Ecuador as a young pharmaceutical agent to source bark supplies and observe the harvesting practices. In his account of the trip, he recalled how some harvesters would tragically “fall victims to the deadly fevers while bearing upon their backs the very specific intended for the relief of the sick in distant lands” and that one collector told him they were “...now made human sacrifices to furnish health to the white foreigners”. Wellcome would go on to sell quinine manufactured by Burroughs, Wellcome and Co., his company.
Growing far from European shores but in high demand, the precious cinchona bark was traded across the Atlantic until the mid-1800s. Between 1850 and 1860, the Dutch and British organised expeditions to South America to take away cinchona seeds and saplings in order to create their own plantations. The used the “humanitarian” excuse of “rescuing” the tree for the “benefit of mankind” from destructive overharvesting. Although the Spanish in control of the area gave permission, these expeditions were undertaken undercover because collection was against the wishes of locals, who knew their livelihoods would be stolen.
Eventually, millions of trees were transplanted to vast British-Indian and Dutch-Javanese plantations, supplanting the local flora, which was razed and burned to make way for the cinchona trees in these regions. Throughout the latter half of the 19th century, many trials on the hybridisation of cinchona occurred to produce trees that were both high in alkaloids and suited to the environments of India and Java. The British aimed to provide anti-malarial medicines for domestic and colonial use, and this continued into the early 20th century, with mixed success.
In Asian colonial plantations, local people, sometimes whole families, worked as indentured labourers, growing, harvesting and processing cinchona bark into quinine and other alkaloids. To fill labour shortages, prisoners were drafted in, and non-local people were transported in with the promise of land in return for their work. Dutch plantations eventually dominated trade after the Quinine Agreement of 1913 created the first global pharmaceutical cartel. By the early 20th century, British-Indian plantations produced little in comparison, but sections of the Indian plantations still exist today, run by some of the same families who were originally paid with land.
In 1942, during World War II, the Japanese invaded Indonesia, by now the main source of cinchona bark, resulting in a quinine shortage around the world. In the tropics, more soldiers were dying from malaria than bullets, and the hunt for a new treatment was on. Chloroquine was developed by the Americans as an alternative antimalarial agent. People mistakenly believe that chloroquine and hydroxychloroquine are “synthetic quinine”, which they are not, though they are chemically similar. Chloroquine eventually replaced quinine as the main treatment for malaria, as it had fewer side-effects. Quinine is still produced as a flavouring for tonic water and remains an important medicine for drug-resistant malaria.
Centuries of demand for cinchona bark have damaged the fever tree’s native habitat. Overhavesting means that species of the tree are harder to find in its original home, though conservation data is lacking. Manú National Park in Peru (above) is one of the few places you can see indigenous cinchona trees. Throughout history, plants such as the cinchona tree have provided and continue to provide important treatments for diseases. As modern plant-based drug development continues and indigenous habitats disappear, it is more important than ever to protect those that remain, and to prevent the exploitation of these biological resources and the peoples who live with them.