In celebration of the Jesuit powder: a history of malaria treatment

Tuesday, 13th of October 2015

In celebration of the Jesuit powder: a history of malaria treatment

Natalie Harrison

Published Online: 10 August 2015

The Lancet Infectious Diseases,Volume 15, No. 10, p1143, October 2015

DOI: http://dx.doi.org/10.1016/S1473-3099(15)00246-7

In July 2015, the first malaria vaccine was given the green light by European regulators. Just a few weeks earlier, Marco Corsi had given a lively SS, LF (short science, a little fun) talk at the Chelsea Physic Gardens in London about the history and treatment of malaria as part of a summer series of talks about the uses of medicinal plants, shrubs, and trees. His talk painted the rich history of the disease, from the Middle Ages when malaria (Italian for bad air) was believed to be caused by vapour from stagnant water, to the first recorded effective treatment using the powdered cinchona bark in the 17th century.

Malaria is an odd disease in that the treatment for it was found almost 300 years before its cause and mode of transmission was discovered. The history lesson of Corsi began with the cinchona tree, a tree native to the tropical Andes forests of South America, originally discovered by the Quechua people who used its bark as a muscle relaxant to treat fevers and shivering. It was named after the Countess of Chinchón, the wife of Spanish viceroy of Peru, who was said to have recovered from malaria by bathing in a small pond under a cinchona tree. What was in the trees bark that had made the water so bitter and said to have cured the countess? The toxic alkaloid quinine, an effective antimalarial that is still used as a first-line treatment in much of Africa. The first Europeans to appreciate the medicinal properties of the so-called fever-tree bark were Spanish Jesuit missionaries. In the 1630s, Jesuit Barnabé de Cobo brought the bark from Lima to Spain. Corsi joked that one of malarias more famous victims, Oliver Cromwell, might have been saved had it not been for the religious association of the powder: “Could Cromwell be saved from malaria? To give him the Jesuits powder—never!”

It was almost 200 years before the active ingredients of cinchona bark were isolated. In 1820, two French chemists (Joseph Pelletier and Jean Bienaimé Caventou) isolated and extracted quinine from cinchona bark. However, Corsi crowned an English trader Charles Ledger and his Amerindian servant Manuel Incra Manami as the men who “gave quinine to the world”. In the 1860s, Ledger and Manami spent 4 years collecting cinchona seeds in the Andes in Bolivia. At this point, to maintain their monopoly on cinchona bark, Peru and surrounding countries had started to outlaw the export of its seeds and saplings, by penalty of death sentence. On one of his seed-collecting trips, Manami was arrested, imprisoned for 20 days for refusing to reveal who he was collecting for, and beaten so severely that he died. The seeds he had collected did get sent to London (and were initially rejected by the director of Kew Gardens—“bad business” in the opinion of Corsi) and were purchased by the Dutch Government. In 1865, the Dutch Government cultivated 20 000 trees of the Cinchona ledgeriana in Indonesia, and by the end of the 19th century, produced 90% of the worlds quinine. Today, although artesunate is recommended as the treatment of choice for patients with severe malaria, quinine is still used in resource-limited settings and in women in the first trimester of pregnancy.

The story of the cinchona tree resonates perfectly with the message of the Lancet Commission on planetary health: the health of humanity is intrinsically linked to the health of the environment. Corsis talk and the history of malaria should serve as a reminder that human health depends on crossing boundaries in health care and considering the natural systems upon which health depends.

The Chelsea Physic Garden is one of the oldest botanic gardens in Europe and one of the most important centres of botany and plant exchange in the world. For more information see http://chelseaphysicgarden.co.uk/