Evaluating Cinchona bark and quinine for treating and preventing malaria

Part 1: Evaluation of Cinchona bark in the 17th and 18th centuriesWe know a lot about malaria: the epidemiology of the disease and the genome of the parasites that infect us.We have made great advances, with new and effective drugs, methods to control the vectors, rapid diagnostic tests and the potential for effective vaccines.We have seen malaria gradually disappear from temperate climates by the 1950s.Despite all these advances, the disease still remains a cause of widespread poor health in many tropical areas.Although we know malaria causes fever, to this day defining when a fever is caused by malaria remains a challenge.The clinical signs of fevers, including those caused by malaria, have been known for centuries, if not millennia (see Aulus Cornelius Celsus 1 as an example).From the beginning of the 18th century, however, malaria gradually emerged -from at least 128 different fevers recorded between 1774 and 1794 by Vicq d'Azyr (see Peter) 2as a distinct clinical entity within the still complex group of intermittent (periodic) fevers.3 During the 18th century, albeit with some continuing ambiguity, 4 malaria gradually became accepted as a defined set of intermittent fevers responding to 'therapeutic tests' using Cinchona bark or, from the 1820s, by using quinine.But difficulties in the diagnosis of genuine malaria persisted until the causal parasite and vectors had been recognised at the end of the 19th century.After examining clinical and statistical data on malaria gathered during the 19th century, the Malaria Commission of the League of Nations concluded that few of the data were sufficiently reliable to be used in comparative studies.5 The principal writer of the report, Nicolaas Swellengrebel, 6 pointed out that a shift in the meaning of the word malaria had occurred: from 'mal-aria' (bad air) as the cause of many fevers, to the name of a disease (plasmodiosis) reflecting the causative parasites -Plasmodia.From its first documented use by the Spanish in Peru around 1630, the history of Cinchona bark is a !