The story of Cinchona: from myth to medicine

Where Andes hides his cloud-wreathed crest in snow,
And roots his base on burning sands below;
Cinchona, fairest of Peruvian maids,
To Health’s bright goddess, in the breezy glades
Of Quito’s temperate plains, an alter reared,
Trilled the loud hymn, the solemn prayer preferred

Inaugural Dissertation upon the Cinchonas, their History, Uses and Effects, Hooker (1839)

The story of the cinchona tree is mysterious and remarkable. The bark of the tree eventually managed to influence the geopolitical machinations of colonial powers, accelerate the transition away from the embedded Galenic system of medicine and revolutionise the treatment of malaria. However, as this post will explore, the path was controversial and convoluted.

Learning objectives

1. Explore the confusion around the history of cinchona

2. Consider the societal factors that influence the perception of a medication

3. Reflect on how we can try to avoid the mistakes of the past

The amount of contradictory and uncertain information about cinchona can feel a bit meandering and sometimes frustrating. Therefore, I have attempted to compartmentalise the story into smaller chunks by dividing the blog post into different sections/time periods. The years may overlap in some sections but I hope this minor thematic simplification will help readability.

1630s: Fact or fiction

Cinchona is a genus of plants native to South America, originally part of the high forest of the eastern slopes of the Andes mountains from Venezuela to Bolivia. Stories of its medicinal properties became apparent to the Spanish in the early 1630s.

An illustration of a cinchona tree

Some sources report that Jesuit missionaries noticed that the indigenous Quechua population made tea from the bark of certain trees to manage individuals who were shivering. The bark was considered febrifugal, a term that appears to have gone out of fashion as it is sometimes considered synonymous with antipyretic. 

However, the legendary but disputed event that really brought the cinchona to European attention supposedly happened as follows…

Around the year 1630, Don Juan López de Cañizares (Corregidor of Loja) became ill with an intermittent fever in what is now modern day Ecuador. A Jesuit missionary named Juan López recommended a remedy that had helped him 30 years earlier in a village called Malacatos, south of Loja. He learned of the bark from Pedro Leiva, cacique of the Malacatos tribe. Levia had told the Corregidor that the tribe had used it for many centuries to treat fever. López tried the bark and quickly recovered.

Some time later, perhaps between 1631-1638, Doña Francisca Henríquez de Ribera, the Countess of Chinchón (the wife of the Spanish viceroy in Lima) became ill with a similar fever. The Corregidor sent some of the bark to the Count (Viceroy Don Luis Gerónimo Fernádez de Cabrera Bobadilla y Mendoza, Fourth Countif Chinchón) explaining its curative properties. The Countess agreed to try the remedy and was miraculously cured.

The Latin inscription means “At Lima, Chinchón’s wife lies sick, the cup wet with the marvellous bark routs the fever.” On the left is a native Peruvian bringing supplies of the bark from the jungle, in the centre is the count, and on the right is the countess.
An alternative depiction. The Spanish text reads: “Chinchón’s wife is sick in Lima and an infusion of the marvellous bark drives away the fever”.


Why are medical stories and myths so powerful?

The supposed details of the story are elaborated further…

“When this [the happy cure] was learned in the City of Lima, the people approached the Vivereine by intermediaries, not so much joyfully and congratucalanlatory, but supplicatingly, begging her to deign to help them, and say, if they would, by what remedy she had at last so marvellously, so quickly, recovered, so that they, who often suffered from precisely this fever could also provide for themselves… The Countess at once agreed. She not only told them what the remedy was, but ordered a large quantity of it to be sent to her, to relieve the suffering of the citizens, who often suffered from the fever. Nor did she only order this great remedy the Bark to be brought, but she wished to dispense it to the many sick with her own hands. And the thing turned out so well that just as she herself had experienced the generous hands of God in that miraculous remedy, so all the needy who took it marvellously recovered their health. And this bark was afterwards called Countess’s Powder…”

The dubious report of Sebastiano Bado, an Italian physician who claims to have got the story from a 1649 letter written by Antonius Bollis, a Genoese merchant who spent time in Peru. No such letter has ever been found.

The story of the Countess has become even more embellished with time which is perhaps unsurprising as the importance of the bark became more apparent. Bado reportedly said that the bark “proved more precious to mankind than all the gold and silver that the Spaniards had obtained from South America”.

But what of the the disease that the Countess experienced? It is purported that her supposed febrile illness was none other than malaria, itself likely to have been imported to the Americas through European contact and the Columbian exchange.

However, there was actually no mention of any serious illness regarding the Countess nor remedy in the official and meticulous diary of the Count of Chinchon. Rather, the Count himself is reported to have had intermittent fevers and was ‘bled’ by his physicians. Returning to the Countess, she never returned to Spain to personally disseminate her miraculous powdered bark but is instead reported to have died in Columbia in the year 1641. It has been suggested that the Countess may have had the fever prior to the diary starting 1631, although most authors seem to agree that the Countess legend (or at least some of it) is a fabrication.


What really happened?

The eventual importance of cinchona has led many authors to retrospectively ponder the origins of the tree. Over time, fact and fiction have been blurred. Even the term cinchona itself is a generic one and it is unclear exactly what species many of the historical texts refer to. This ambiguity has added to the mystery around the tree and its history.

There are still plenty of legends about cinchona though. Aside from the one about the Countess, other stories include those where sick lions were seen chewing in the bark of trees. Indeed, in one variation a febrile lion was observed drinking from a pond into which cinchona bark had fallen and immediately recovered. Another variation is that it was a person and not a lion who fell into the pond and woke up revived. Over time it had been embellished so that this person was a Spanish soldier with malaria who was left to die by his garrison, managed to crawl to a shallow pond to quench his thirst, noticed that a tree split by lightning had fallen into the water, tasted the water which was very bitter and he was soon cured. As pointed out by George Urdang, “every one familiar with folklore knows that very soon the one or the other story had to be invented in order to satisfy the deeply rooted human need for the extraordinary embellishment of the extraordinary.”

Wood-engraving by Charles Laplante, c. 1867. Credit: Wellcome Library, London.

The stories may have been false, yet the tree was real. The bark and its derivatives eventually came to be known by various names, perhaps both because of uncertainty regarding the precise origin and the differing preparations created to appeal to diverse markets.

A tree grows which they call “the fever tree” in the country of Loxa, whos bark, of the colour of cinnamon, made into powder amounting to the weight of two small silver coins and given as a beverage, cures the fevers and tertians; it has produced miraculous results in Lima.

The 1633 account from Antonio de la Calancha, an Augustinian monk. Tertians refers to the classic pattern of fever with malaria.

We do know that the cinchona tree was also called the ‘fever-tree’ but it was also known as the quina-quina. Readers with an interest in etymology may have already made the association with quinine. Indeed, quinine was the active component of the bark and physicians today know it is still indicated for the treatment of malaria. Remaining with etymology for a moment, the word ‘quinine’ comes from the Spanish quina ‘cinchona bark’ and from Quechua kina ‘bark’.

Source: Google definitions from Oxford Languages

However, quinine was not isolated until much later in the story. Instead, it was the cinchona bark and its crudely refined derivatives that were used for many years. The reputed properties made cinchona highly valuable, not only to treat individuals with fever but also to realise the ambitions of European colonialism at the time. It acquired many names including (but not limited to): Countess’s powder, Jesuits’ bark/powder, Jesuitarum, Pulvis Jesuiticus, Cardinal’s bark/powder, Pulvis cardinalis, Popish powder, quina bark, sacred bark, kina-kina, China-China, China bark, Peruvian bark (Cortex peruanus or peruvianus), Cincona red and even the ‘bark of barks’ (Cortex cortocorum). These various names themselves shine a light and help explain the story. For the purposes of this post and to highlight the ambiguity surrounding the cinchona bark in the past, I will generally refer to it as the bark.

1640s: Movement to Europe

I would like to say it gets less confusing but the tale of cinchona making the journey from South America to Europe is no less mysterious than those regarding its supposed origin.

“There are probably few events of history about which so many legends and false statements have grown as about the history of cinchona. Many writers have tried to discover its origin, and how first it came to our hemisphere, and for lack of precise information have endeavoured to supplement their scanty resources by calculations or guesses of their own. Those calculations, once set in type, have been willingly accepted by succeeding authors.”

Keeble (1997)
More propaganda depicting a personification of Peru offering a branch of cinchona to Science (from a 17th century engraving).


Why is decolonising the medical curriculum important?

One possible version of events is as follows: The Quechua, the Cañari and the Chimú indigenous peoples that inhabited modern-day Peru, Bolivia and Ecuador knew of the properties of the bark. Jesuit missionaries are said to have crushed the bark into a thick, bitter powder that could be easily digested, even mixed into a liquid (commonly wine).

It is unclear exactly who brought the bark to Europe and when. There is mention that the bark was possibly used in Spain by 1639 to treat Dr Miguel de Barreda, Professor of Theology at the University of Alcalá de Henares. Fathers Venegas and Messia who travelled in 1632 are potential candidates for introducing the bark. However, more confusion is that there may have been only one such Jesuit Father, Alfonso Mesias Venegas. Unlikely candidates include Dr Juan de Vega (who never returned to Spain), Father Bernabé Cobo (who is not known to have returned to Europe), the Count of Chinchón (who returned to Spain in 1641), and again the Countess of Chinchón herself (who never returned to Spain).

The activity of the Jesuits has no rest, the Jesuit Father Alfonso Mesias Venegas introduced quina into Italy in 1642, Cardinal de Lugo became interested in the new drug and at the Congress of the Order in 1649, the powder of the quina bark is distributed through the good offices of the Brothers who returned to their Provinces, and thenceforward people began to talk of the ‘Powders of the Cardinal’, this being the name by which the powder of the quina bark was designated. Appointed Pope, with the name of Innocent X, Cardinal de Lugo ordered Gabriel Fonseca, in 1668, to examine the curative effects of quina and after the issue of his report, it was provided in the Pharmacy of the Medical College.

Revista de la Casa de la Cultura Ecuatoriana, Dr Virgilio Paredes-Borja (1946)

Jaramillo-Arango states that the most plausible theory regarding the question who brought cinchona back to Europe seems to be that a chance traveller or navigator may have brought samples or even a cargo of the real fever bark with to Spain or Italy as a speculation and the Jesuits were the ones who first deliberately sent or brought it to Rome.

In Rome, where malaria was endemic at the time, Spanish Jesuit and Cardinal Juan de Lugo promoted the use of the Jesuits’ powder. It is said that Lugo ‘gave it gratis to the fevered poor, on condition only, that they did not sell it and that they presented a physicians’s statement about the illness’. Following a number of Jesuit congregations in Rome over the decade, knowledge of the bark spread throughout Europe as the delegations returned home. It was reportedly being used in Jesuit colleges in Genoa, Lyon, Louvain and Ratisbon from 1650.

Cardinal de Lugo (1583–1660) orders the use of cinchona in the hospital of Santo Spirito, Rome.


What are the relationships between medicine and religion?

Pietro Paolo Puccerini, apothecary at the Jesuit’s Collegium Romanum is  also reported to have successfully treated many patients with tertian and quartan agues leading to the bark’s reputation spreading. By 1651 it had entered the The Schedula Romana, containing details on how to prepare the recipe:

Two ‘dragmae’ of finely ground and sieved Bark to be mixed in a glass of strong white wine three hours before the fever is due; and as soon as the shivers begin, or the first symptoms are noted, the patient is made to drink the whole infusion thus prepared, and put to bed. It is to be noted, that in the event of tertian fever this bark can be administered, as stated above, when the fever has persisted for many days. The constant use of this remedy has cured practically all the patients who have taken it, having at first well cleared the bowels. For four days after no other medicine whatsoever must be taken. It must be used only on the advice of the Physicians, who may consider whether it is timely and appropriate to administer it.

Instructions for the use of the bark called fever bark, The Schedula Romana (translation from Jaramillo-Arango)

1650s: Popes and prejudice

By 1647, the bark was arriving regularly from Peru to Italy. However, the associations with the Jesuits created religious and political intrigue, if not outright hostility from some. High profile treatment failures, especially Archduke Leopold of Austria (who was upset that a single dose only resolved his fever for a month) led to physicians being commissioned to denounce the remedy. The negative publicity was compounded by the failure of the miraculous bark to (unsurprisingly) curtail a bubonic plague epidemic in Rome in 1655. Such events caused a serious credibility problem for the bark.

Around the same time Jesuit powder had reached England. Kenelm Digby, who fled England during the Civil War (his father was also part of the infamous Gunpowder Plot), returned in 1655 and brought news of ‘the bark of a tree that infallibly cureth all intermittent fevers. It comes from Peru, and is the bark of a tree called by the Spaniards kina-kina.’ The first written record of its use in England was in 1656 by Northamptonian Dr John Metford, apparently curing a pregnant woman of quartan fever with the bark.

However, prejudice remained and Bruch points out that Jesuits’ powder was too much of a Catholic invention to be trusted by such a Prostestant country. Again, negative associations were exacerbated though other events, for example, the death of a London alderman named Underwood following an overdose of the bark. Some considered it a papal poison. Indeed, it frequently reported that Oliver Cromwell refused to use the powder, allegedly describing it as a ‘Popish remedy’ and died of a fever (possibly malaria) in 1658. A month after Comwell’s death, a Catholic cloth merchant named James Thompson (who had returned to England from Antwerp with Jesuits’ powder) placed an advertisement in the Mercurius Politicus magazine:

…are to give notice, that the excellent Powder known by the name of the Jesuits Powder, which cureth all manner of Agues, Quotidians, Tertian or Quartan, brought over by James Tompson Merchant of Antwerp, is to be had at Mr. Wilfords in Angel Court, just over against Sepulchre’s Church in the Old Baily or at the shop of Mr. John Crook, at the sign of the ship in St. Pauls Churchyard, a bookseller, with directions for using of the same.

The advert appeared four times (July 1st, July 29th, October 28th, and December 16th 1658), with the final advert adding the line: ‘Which Bark or Powder is attested to be perfectly true by Doctor Prudjean and other eminent Doctors and Physicians who have made experience of it’.

Who was Dr Pridjean? It was seemingly Sir Francis Prujean (1593-1666), of who Pepys wrote: “Diary, 24th October, 1643 –  that he acquired great honour by his attendance on Catherine, the queen of Charles II, in a severe attack of spotted fever, and that her majesty’s recovery was universally ascribed to a cordial prescribed by him at a critical moment, “which in her despair did give her rest and brought her to some hopes of recovery.” He was also President of the Royal College of Physicians of London between 1650-1653. So, Prujean was quite an advert for the bark.

The first known illustration of the Cinchona tree in European literature.
Source: Thomae Bartholini Historiarum anatomicarum et medicarum rariorum centuria V. et VI. Accessit Joannis Rhodii Mantissa anatomica (1661).


Are there any parallels with the historic credibility of cinchona with contemporary drugs or vaccines?

However, the reputational damage to Jesuits’ power had become too much for it to gain significant traction as a remedy at this point. Even Thomas Sydenham, known for a number of superlatives and sometimes considered the ‘father of English medicine’ or even ‘The English Hippcrates’  was initially unfavourable about the bark. Nevertheless, his friend, Cambridge Professor of medicine, Robert Brady is credited to have made the first prescription for Jesuits’ bark in England dated 1660. By 1666, Sydenham had begun to slowly change his mind and published his renowned book Methodus curandi febres describing the bark, eventually advocating the use of bark for the treatment of ague in future works. However, the bark challenged the traditional Galenic system of medicine. This added another layer of hesitancy and suspicion about the Jesuit’s bark beyond that of pure religious prejudice.

Perhaps if another origin story was given to the bark, could it change attitudes? It is reported that in 1675 Fryer mentioned that the drug was from India. Whether or not Fryer really thought this or not is unclear.

1660 – 1680: The secret of the “debauched apprentice”

Enter Robert Talbor (sometimes also known as Tabor or Talbot). Born about 1642 in Ely, he apprenticed to a Cambridge apothecary named Peter Dent but left in 1668 without a degree. He began practising in marshy malaria ridden Essex where he reported developing a cure for the agues or “marsh fever” through observation and experiment. In 1672 he published his ‘Pyretologia’ which ambiguously describes his secret remedy while simultaneously warning against the use of Jesuits’ powder, particularly in non-expert hands:

And let me advise the world to beware of all palliative Cures and especially that known by the name of Jesuits’ Powder, as it is given by unskillful hands for I have seen most dangerous effects follow the taking of the medicine incorrected and unprepared… Yet this Powder not altogether to be condemned; for it is a noble and safe medicine, if rightly prepared and corrected, and administered by a skilful hand; otherwise as pernicious a medicine as can be taken.

Pyretologia : a rational account of the cause and cure of agues, with their signes, diagnostick & prognostick (1672). Image source:

As Keeble suggests, Talbor’s last caveat raises the suspicion that he is protecting his position. Indeed, Talbor goes on to say of his secret method that he will only reveal it once he has “made some little advantage to myself” for his troubles. And he certainly was going to take advantage… Talbor ended up making a fortune. The Royal College of Physicians tried to prosecute him for practising without a licence, but the King intervened.


How did a University drop-out trump the established medical hierarchy and orthodoxy?

What was Talbor’s secret? In a fortuitous turn, the subsequent sequence of events were seemingly revealed when a copy of Le Clerc’s 1702 book, Histoire de la Médecine was purchased by medical historian Rudolph E. Siegel in the early 1960s. The copy he brought probably once belonged to Joseph Constantine Carpue (1746-1846). Of interest, on the fly-leaves there was a note written in French by an even earlier owner, perhaps in response to an allusion to cinchona in Le Clerc’s book. The note gives an extraordinary and seemingly relatively contemporary insight into Talbor and cinchona fits into his story:

I feel obliged to report how Quinquina became finally established all over Europe after it had been (it must be admitted) practically concealed for 30 years by the efforts and the greed of certain people unworthy of such an honourable profession. Being very ill with an intermittent fever which I contracted in Flanders and which afflicted almost our entire army during that year, the woman attending our quarters brought to me a very poor man who had cured several of my servants. He appeared to me so assured of this fact that, seeing that there was nothing of the charlatan about him, I had no hesitation whatever in taking his remedy, although both it and he were quite unknown to me at that time. It was a powder steeped in a large glass of white wine, the whole of which he ordered me to drink three times in 24 hours. But the mixture was so thick that my stomach could not tolerate the weight more than two repeated doses.This however was sufficient to protect me from the fit in such a manner that I was able to embark on my week’s service at the Court of King Charles II, who however had to go by water to Sheerness, the most fever-ridden place in the whole of England. I told this to my little doctor, who gave me permission not only to go there, but also to amuse myself swimming, and even in debauchery if I felt inclined. Thus, when I went on board ship I could not avoid telling the whole story to the most inquisitive King in the whole world, who is also the greatest patron of empirics. At length he ordered me to bring the man to him and he made many experiments with the powder. Since the physicians could not guess what it was, the King gave him a pension of 300 pieces and a Knighthood and made him one of his personal physicians,solely in order to find out and eventually to publish a secret of such importance for the health of mankind.

Robert Talbor, Charles II, and cinchona – a contemporary document (1962)

The French note continues with the story:

My little fellow called himself Taber [Talbor]. He was quite ignorant, but so devoted to his project that he stayed especially in an unhealthy district in order to try out and improve his remedy. Having been hard pressed by the physicians of France (where the King had sent him in order to cure his niece) so that he might expose his ignorance in explaining the origin of fevers, he made this celebrated reply: ‘Gentlemen, I do not pretend to know anything about fever except that it is a disease which all you others do not know how to cure, but which I cure without fail.’

Robert Talbor, Charles II, and cinchona – a contemporary document (1962)
The conclave of physicians, detecting their intrigues, frauds, and plots, against their patients. Also a peculiar discourse of the Jesuits bark: the history thereof, with its true use, and abuse by Gideon Harvey (1683). Harvey was particularly critical (perhaps through jealousy) of Talbor and called him a “debauched Cambridge apprentice.”

Tabor became very rich in Europe, a notable highlight being his remedy (known as ‘le reméde anglais’) being used to treat the Dauphin in 1680. Louis XIV paid him 2000 Louis d’or (a handsome amount at the time), gave him a lucrative pension of 2000 livres plus a title to buy ‘Chevalier’ Talbor’s secret. Talbot agreed on the condition it only be disclosed after he [Talbor] had died. Talbor returned to England becoming a Fellow at St John’s College in 1681 and died later that year (aged about 40) hailed as the ‘Febrium Malleus’ (fever smasher).

The secret remedy was published in Paris in 1686 entitled ‘La connaissance certaine et la prompte et facile guerison des fieveres’ [Certain knowledge and the prompt and easy cure of fevers] and in England in the volume ‘The English Remedy or Talbor’s Wonderful Secret for Curing of Agues and Feavers etc’. Lee reports that the publication of the books increased the price of the bark considerably across Europe.

“The excellency of a Remedy is very often the cause why it is despised.” From the text of ‘The English Remedy or Talbor’s Wonderful Secret for Curing of Agues and Feavers’. Image:

Translated into English for publick good? As you can probably guess, Talbor’s secret remedy contained cinchona bark. It is reported that Talbor had learnt about it while apprenticed at Cambridge, developed an effective treatment regimen while working in an area where malaria was endemic and rebranded Jesuits’ powder with an English and non-Catholic identity, disguising the bitter taste with opium and wine. He is said to have given the remedy at the end of a fit of ague, or in quartans the night before the expected paroxysm, thereby reducing the risk of a relapse. Talbor recognised that cinchona worked in periodic fevers. Keeping his successful remedy secret allowed a lucrative monopoly to emerge. It is even said the Talbor tried to covertly buy all the cinchona bark he could to corner the market, thereby suppressing other remedies and raising the price considerably.

The French note elaborates on the feelings at the time:

It was very surprising to find that it [Talbor’s remedy] was nothing but Quinquina well disguised. It was only given, in contrast to the method of the physicians, immediately after the fit. One cannot imagine the confusion of the King’s physicians, whom he made great fun of, as was his way, because they had expressly forbidden me Quinquina as a useless and dangerous drug. But the joke was that, some years afterwards [1679], the King himself being dangerously ill at Windsor with an intermittent fever, the Council of State forced a dozen physicians to declare if Quinquina, which they were about to give the King, was not sometimes harmful or, at least, useless. To this they were obliged to answer promptly, and without an opportunity consulting amongst themselves beforehand, and each one frankly assured them that he had often tried it, even on small children, and always with success. After which, the King, already half cured, pressed Dr. [Richard] Lower maliciously, asking him how the very thing which was so bad for me had become so wonderfully good for him. The embarrassed doctor could only reply in a similar tone of railery, that this was a remedy from which only kings were worthy of profiting.

Elsewhere, physician Thomas Short is said to intervened and permitted Talbor to treat Charles II. The author of the note continues:

He [Talbor] became very rich in Paris as well as in Madrid. Having returned from there to Windsor where the Queen presented him her hand for the kiss according to the custom of our country, instead of kneeling down he stretched out his own hand which was completely covered with valuable rings given to him in those countries, from which one can judge both his arrogance and his stupidity. There,it seems to me, was a great victory for the empirics that they should be obliged at the same time to defend me against disease, and, what is still more dangerous, against the doctors too!

The writer of the note is unknown but Siegel reports he must have been a nobleman to introduce Talbor to the King. Talbor’s reputation today is controversial. It has even been alleged that Talbor “stole the knowledge of the bark from Robert Brady, Professor of Physic at Cambridge. Regardless, we can probably assume that Talbor’s secret, success and wealth made him an easy target for jealous medical colleagues keen to tarnish his reputation. He was sometimes called the ‘charlatan of Essex’.


What do you think of Talbor? Could he be described as duplicitous, a charlatan or a pragmatist?

Jarmamillo-Arango feels that from the point of view of medical ethics, Talbor’s general behaviour cannot be excused. At the same time we must acknowledge that he must have been a man of great natural gifts, brilliant intelligence and singular personal charm.

1680 – 1700: Academic acceptance

Talbot [Talbor] is the conqueror of death;
Daquin cannot resist him;
The Dauphin is convalescent
As everyone sings

A parody on a chorus in “Alceste” by La Fontaine.

Talbor’s secret had upset and exposed the established medical orthodoxy of the time. Indeed, the reasons behind Sydenham’s change of stance toward the bark has sparked some debate. Latham speculates whether Sydenham was told the secret of the bark by Talbor or perhaps he came to the knowledge by other means or even independently. Either way he goes on to say “what Sydenham gave away, Talbor sold.” Consider how the following passage by Sydenham highlights the conflicting medical ideologies facing physicians at the time:

As I was thinking over the inefficacy of such measures and purging, measures which by weakening the blood protract the disease, the Peruvian bark became my sheet-anchor; concerning which, in spite of the prejudices of many learned men, as well as those almost all the vulgar, I may safely affirm that I have neither seen nor suspected any evil effects, except only such as I noted in my chapter on Rheumatism, wherein I remark, that those who have undergone long courses of it, are liable to a certain sort of scorbutic rheumatism. This, however, is rare, and when it happens is easily cured… If I were only sure of the permanence of the effect as I am of the harmless character of Peruvian bark, I should look upon it as the prince of medicines; since it not only shows eminent efficiency in agues, but is also useful in affections of the stomach and womb.

The Works of Thomas Sydenham (1679)

Eventually, the clear benefits of cinchona could no longer be easily rebuked and consumers and clinicians in the European markets were now ready and primed to accept the medicinal benefits of bitter bark products. By 1677, cinchona bark was listed by the Royal College of Physicians in its Pharmacopoeia Londinensis under the name of “Cortex Pereuanm” despite general concerns that at the time that plants cultivated under a foreign sun would be damaging to the constitutions of people raised under colder skies. Knowledge of its benefits (and limitations) even entered popular culture at the time:

Carlos: Oh, Madam, Marriage!
Theodosia: Is to love as the Jesuit’s powder is to an Aguem it stops the fit and in a little time wears it quite off.

Shadwell’s A True Widow in 1679.

The bark’s reputation had been revived and spread, not only in Europe but across the known world. There are even reports that cinchona barks were brought to China by Jesuit missionaries in 1693 in order tocure Kangxi (r. 1661–1722), the second emperor of Qing China who suffered a serious malarial fever. Of course, we now also recognise that another anti-malarial drug, Artemisinin (Qinghaosu), had been used in traditional Chinese medicine for many centuries.

In 1702, Italian physician Bernardino Ramazzini, sometimes referred to as the father of occupational medicine, is reported to have declared: ‘surely after the use of this remedy has become known… it must be avowed that, concerning the doctrine of fevers and the method of curing them, a change (revolution) has been made comparable to that which all know followed, in military affairs, the invention of gunpowder’.

1700 – 1800: Commerce and counterfeits

The valuable properties of the bark obviously raised demand. Yet, the concept of malarial fever as a separate entity from other agues was not distinct. As Klein and Pieters note, “fever was a common disease… both malaria and quinine are notions that were unknown in the early modern world… in the context of the seventeenth century, what we would now identify as malaria was one of many illnesses that fell under the umbrella term “fevers”. Still, faced with a situation where a serious fever was present, the chance of cinchona working was probably better than no chance at all.

Lignum Febrium, a classificatory tree of fevers according to Italian physician Fransceso Torti (1658-1741). The tree diagram sought to distinguish fevers for which the bark was recommended. Torti highlighted that true intermittent agues needed to be distinguished from other fevers for the bark to be effective.

Klein and Pieters go on to suggest that the success of the bark was not in reference to science and medicine alone, but commerce and society. Indeed, the economic advantage was considerable: The Jesuits’ had a near monopoly on the miraculous medicine and acted as intermediaries between the new and old worlds. The Spanish declared the Andes “the pharmacy of the world”. The demand for cinchona outstripped supply. Initially, the Jesuits had taught the cascarilleros (bark cutters or barkers), to replant five cuttings in the form of a cross for every Cinchona that was felled. Predictably, this was not maintained and cinchona supply started to dwindle. This began the slow extinction of the natural cinchona forests because of overharvesting. In 1805, explorers documented 25,000 cinchona trees in the Ecuadorean Andes. The same area, now part of the Podocarpus National Park, counted just 29 trees in 2020.

The national tree of Peru and Ecuador is the cinchona. It is present on the Purvian Coat of arms and variant flag. Source:ú.svg


How do we reduce the environmental impact of health care?

The race was on to develop successful cinchona plantations elsewhere and outside of South America and break the monopoly and facilitate imperial ambitions. In the meantime, with cinchona prices rising considerably, it is perhaps unsurprising that other barks and bitter substances started to appear on markets.

In 1737, French explorer Charles Marie de La Condamine mapped the Amazon and identified three separate species of cinchona. He attempted to bring a sample of the trees back to Europe, but after nursing them for 8 months on the voyage, they were washed out of the boat into the sea and lost. In 1738 he published the description and figure of the tree in the Mémoires de l’Académie de Paris.

Drawing of a branch of the cinchona tree, with its leaves, flowers & fruits (La Condamine, Mémoire de l’Académie royale, 1738). Source:écorce_de_inquina

It is from these drawings that botanist, zoologist, taxonomist (and of course physician) Carl Linneaus is reported to have named the cinchona in 1742. The etymology of the word cinchona is a misguided affair. Deciding to name it after the famous Countess Chinchón of the myth, Linneaus made a spelling error, naming the tree Cinchona instead of Chincona. Although to his defence, Linnaeus may have read Bado’s Anastasis Corticis Pervviae, Sev China Chinae Defensio (1663) which contained the first account of the dubious Chinchon legend along with the spelling of Cinchon (perhaps to ensure a correct pronunciation by Italian readers). The cinchona name has stuck since despite numerous attempts to correct the spelling in accordance to Linneaus’ original intentions.

The increasing European acceptance of cinchona showcases the harsh economics of supply and demand. While attempts continued to get cinchona out of South America, finding various alternatives and imitations had the potential to be a highly profitable venture. Indeed, the market became flooded with supposed cinchona, its various preparations, imitations and fakes, efficacious or not. This was facilitated by the fact that transportation of cinchona was so poor being hampered by delay and packaging, that by the time it reached Europe it could more easily be mixed in with other barks without being detected by buyers.

Indeed, another tree already being exported to Europe was called the Peruvian Balsam Tree (Myroxylon peruiferum). (Un)helpfully, it was also known as Quinaquina or the Quina-Quina tree and was similar to the cinchona and also reputed to have febrifugal properties. It was often difficult to distinguish between the various different barks and bark that had already been used (thereby losing most of its therapeutic activity) was also resold.This was all probably too tempting for unscrupulous merchants with large stocks of out-of-favour or recycled barks and an eye for profit.

As demand grew, however, lack of experience of the bark, uneven consignments, incorrect identification, and the frequent and deliberate pollution of the product by adding the bark of other trees, all ensured the argument over its value was kept alive well into the 19th century.

Products of the Empire: Cinchona: a short history

An important alternative that emerged was the Angostura bark. Also from South America, it too developed a reputation as an febrifugal matching that of cinchona. It was apparently used in Madrid by Mutis as early as 1759. Like cinchona, Angostura unsurprisingly also became popular in Europe although there still appears to be some debate as to the true origin of this newer bark. Consider the account of Augustus Everard Brande, at that time the apothecary to the Queen:

There is a considerable variety in the external appearance of the Angostura bark, owing however, probably, to its having been taken from trees of different sizes and ages, or from various parts of the same tree, as the states and other properties perfectly agree… Of the natural history of the Angustora bark, we are hitherto completely ignorant: and I have in vain turned over and carefully examined many hundred weight, hoping to find the fruit, or some part of the tree which produces it. I found, indeed, one imperfect leaf, resembling the Bruceal but from this nothing can be inferred. It has, by some German botanists, been considered as the bark of a species of Magnolia – probably the Glauca. But the bark, both of that and the Grandiflora, differ completely from the Angostura… I have, I confess, formed a very favourable opinion of its virtues, and consider it as a generally safe and powerful tonic and antiseptic medicine; as an excellent febrifuge…

Every endeavour has been used to obtain an account of the place of its growth… but hitherto in vain: their supposition is that it grows near the river Oronoko. I find Angostura to be merely the Spanish term for a narrow pass between mountains…

Experiments and Observations on the Angostura Bark, Augustus Everard Brande (1791)

Brande goes on to mention that some, including botanist Joseph Banks had noted Angustora’s resemblance to Brucea antidysenterica, synonymous with Brucea ferruginea. More confusion arises as the specimens of bark being tested although nominally the same appear to be very different. It seems that although various bark products were being sold in Europe, it seemed that the true identity of exactly what was being sold and purchased was a bit of a lottery and was so for some time. I suspect this was permissible since few people knew the nature of the original tree(s) since they were usually from far away exotic places. Perhaps this added to the myth and the appeal. What could possibly go wrong?


What systems are in place to verify the authenticity of medicines?

1800 – 1820: Barking up the wrong tree

In an excellent account by John Buckingham in his book Bitter Nemesis, he notes that in 1803, Dr Rambach, the state physician of Hamburg was tasked to investigate a child death following the use of Angostura. Rambach noted that the bark being sold in Hamburg was a mixture of two different barks, one true Angostura and the other a potentially poisonous imitation or false Angostura. In 1804, Hamburg apothecaries were threatened with fines if they sold Angostura without official inspection and approval and in 1808 Rambah suggested that the false Angostura was either from Strychnos nux-vomica or similar. Further fatalities occurred around Europe and contamination of the Angostura noted in almost every sample taken from apothecary warehouses in different central European countries. Finally in 1815, the governments of Bavaria, Austria, Baden, and Wueremburg ordered all the Angostura bark in the possession of chemists to be seized and physicians asked not to prescribe it.

It was still not clear where the false Angostura originated and how it managed to contaminate European markets. Husemann gives one version:

One can imagine that zealous efforts were made to track down the source of the false Angostura. It was initially possible to trace this to Holland and it turned out that the Dutch were the actual forgers. Pursued by Holland one goes on to England and thence to the native land of the bark, the East Indies; From there a quantity of the false Angostura had been sent to England, and as John Bull did not know what to do with them, he sent them to the far more shrewd and unscrupulous Mynher, who immediately placed them under a quantity of Bonplandia trifoliata [synonymous with Angostura trifoliata] bark, without caring whether human lives would be endangered by this act. It must be admitted, however, that the druggists had absolutely no scruples in professing that there were two varieties of Angostura, of which they sold one, the fake, at first half cheaper than the genuine one, later the price of the latter rose fivefold, while the wrong one fell below the old price. The druggists also did not conceal the origin and the fatherland, but described them in their price courants as “East Indian” Angostura. This circumstance could easily have led the investigators to the tree to which the poisonous bark belonged. But that by no means happened…

Intoxications caused by the bark of Strychnos nux vomica, Husemann: Strychnine poisoning (1857). Translated via Google Translate. Husemann attacking both the Dutch and English (conjuring up the stereotypical English John Bull) as well as highlighting the financial benefits of introducing fake products into a marketplace at the expense of safety.

Cases such as this along with a desire to get an authentic medicine (or at least one that wasn’t toxic) added pressure to increase genuine supply. The late 1700s and early 1800s were also a time where there was increased interest in isolating the active principles of the barks. There were multiple failed attempts to get seeds and decent specimens out of South America. However, they were plagued with practical issues, not only with the true identities of the specimens involved but also the degradation that would occur in transit between the natural source and the chemist’s laboratory or prospective plantation. Kaufman and Ruveda provide an excellent summary:

In 1746 the Count Claude Toussaint Marot de la Garaye obtained a crystalline substance in France from the [cinchona] bark which he termed “sel essentiel de quinquina”. A few years later, the two French chemists Buquet and Cornette intro- duced a new “sel essentiel de quinquina”; however, both proved to be the inactive calcium salt of quininic acid. In another failure, the Swedish physician Westerling announced in 1782 the discovery of the active principle, which he called “vis coriaria” and later shown to be “cinchotannic acid.”

Antoine François Fourcroy systematically analyzed the bark by extracting it with water, alcohol, acids, and alkaline solutions. In 1790 he was finally able to obtain a dark red, resinous, odorless, and tasteless mass, which he called “chinchona red”. Fourcroy claimed this to be the essential pharmacologic constituent of the bark; however, in contra- diction to his affirmations, it was demonstrated that “chinchona red” was unable to cure malaria. Fourcroy also observed that the water placed in contact with the bark gave litmus a blue color—then a known property of alkalis— and that a green precipitate was produced when the infusion of the bark was treated with lime water. This French scientist was very close to entering the history books as the first to isolate quinine, but, surprisingly, he decided to abandon his research on the bark. Perhaps as a premonition, he com- mented that “doubtlessly, this research work will lead some day to the discovery of a febrifuge for the periodic fever that, once identified, will be extracted from different plants”.

In 1811 the Portuguese navy surgeon Bernardo Antonio Gomes extracted the bark of the gray variety with alcohol, added water and a small amount of potassium hydroxide, and observed the separation of a few crystals. Gomes called this substance cinchonine, which had been previously isolated by Duncan in Edinburgh from certain varieties of quina trees. Interestingly, it seems that the botanist Aylmer B. Lambert was also able to prepare the same compound; however, neither of them suspected the alkaline (alkaloidal) nature of the substance. In 1817 the German Chemist Friedrich Wilhelm Sertürner reported that morphine forms salts in the presence of acids, an observation that led him to the isolation of this important alkaloid. Driven by Sertürner’s findings, Jose- ph Louis Gay-Lussac commissioned his colleague Pierre Jean Robiquet of the Ecole de Pharmacie of Paris with the task of searching for useful applications of the reported strategy. Robiquet’s co-worker Pierre Joseph Pelletier was selected to conduct this study in collaboration with Joseph Bienaime Caventou…

The Quest for Quinine: Those Who Won the Battles and Those Who Won the War, Kaufman and Ruveda (2005)

1820s: Isolation and industry

Let us consider Pelletier and Caventou further. Bukingham suggests that after isolating strychnine from nux-vomica, the chemists also expected to also isolate it from false Angostura in 1819. However, they found a much more soluble substance. Initially thinking of the name Angosturine for this new alkaloid, thank goodness they changed their minds to avoid perpetuating the confusion with the unrelated true Angostura. Having said this, the name that stuck, brucine, was itself based on error. Indeed, at this point Pelletier and Caventou actually thought that the false Angostura bark was from African Brucea. One story is that nux vomica was reputedly placed on the drug market under the name Brucea antidysenterica. Buckingham explains:

Pelletier and Caventou had therefore isolated strychnine and brucine from different parts of the same plant. Both occur together in all parts of the tree, and the isolation of the substance they called strychnine on the first occasion, and of brucine on the latter, was partly due to higher concentrations of brucine in the bark and of strychnine in the seeds.

John Buckingham, Bitter Nemesis
Postage stamp with the images of Pelletier and Caventou, who first isolated strychnine and then brucine. Soon afterwards they also isolated quinine from cinchona bark. Source:

This is also a bit of a mystery since many sources cite strychnine as being derived from the Saint-Ignatius’ bean, which like nux-vomica is also part of the Loganiaceae family but is not the same. I’m still not sure which is truely correct, but I suppose it does once again highlight the confusion around the issue. The bark of Angostura is similar to Strychnos nux-vomica but true Angostura bark has a finer texture, is darker coloured, aromatic, pungent and less bitter than false Angostura (aka nux-vomica).

Buckingham goes on to say that “the bark of the nux vomica tree as well as the seeds had been used in Indian medicine, and it had reached the European market for many years past under the name of Lignum colubrinum” although there is again uncertainty about the authenticity of what was actually being sold in European markets. Indeed, Lignum colubrinum was itself sold as an imitation for yet another bark… For a more detailed look into the confusion about Lignum colubrinum which is also unhelpfully known as Strychnos colubrina, have a look at the article Identification and Clarification of Strychnos colubrina L. (Loganiaceae) which is beyond the scope of this blog but more specifically my comprehension.

In 1820, Pelletier and Caventou actually worked with cinchona which was more effective in treating malaria than the grey bark passed to them from Gomes:

The alcoholic extract did not produce a precipitate when diluted with water and basified with potassium hydroxide; instead, a pale yellow gummy mass formed. The compound, which was extraordinarily bitter in taste, was soluble in water, alcohol, and diethyl ether. The latter feature was a key difference between its behavior and that of Gomes’ material. Pelletier and Caventou cleverly demonstrated that the cinchonine isolated by Gomes was a mixture of two alkaloids which they named as quinine and cinchonine, thus successfully crowning a 70 year search.

The Quest for Quinine: Those Who Won the Battles and Those Who Won the War, Kaufman and Ruveda (2005)

This marked one of those incredibly important moments in medicine. Subsequent trials found that quinine was the active antimalarial while cinchonine was inactive. Pelletier and Caventou did not patent quinine nor the extraction process, allowing others to manufacture quinine, They did however establish a factory to extract quinine, an activity that is often mentioned as the beginning of the modern pharmaceutical industry. By 1826 they were producing in excess of 3500 kg of quinine annually, necessitating huge amounts of cinchona bark from South America.

‘Sappington’s Anti-Fever Pills’ marketed in 1832. John Sappington (1776-1858) imported cinchona from Peru, developed a quinine containing pill at a time when physicians in the US were weary and suspicious of it, perhaps a final hangover from the Galenic system.


How do you feel about modern medical patents and drug exclusivity?

1830 – 1870: Empire and export

The isolation of quinine understandably created even more pressure on supply and the identification of alternatives. In a rare case of a loose end actually being tied up in this story, in 1837, someone called Mr Piddington, perhaps the coroner of Calcutta, made what he thought was a new alkaloid. However…

In vol. iv. Trans. Med Phys. Society of Calcutta there is a paper by Mr. Piddington on the rohuna bark, and the sulphate of its bitter principle. Mr Piddington stated that he had applied the bark to the process described by Paris for preparing sulphate of quinine, and with perfect cuccess. He presented to the society a small specimen of the alleged sulphate of rohuna, and described in full detail the process of its preparation. In 1836, however, it was ascertained by the editor of this work that the salt prepared by Mr Piddington was sulphate of Brucine, and that the bark he operated on was that of the nux-vomica tree. On inquiry in the bazars it was found that in several shops the nux-vomica was sold for the rohun.

The British and Foreign Medical Review, or Quarterly Journal of Practical Medicine and Surgery (1843)

Indeed, another doctor (professor at the Calcutta Medical College), Dr William Brooke O’Shauhnessey discovered the true nature of the quinine substitute which was actually from nux-vomica and therefore prevented a large quantity of the material being delivered to Indian hospitals. Rambach’s early supposition was proved right that the false Angostura he encountered in Hamberg many years previously was indeed nux-vomica, or at least what he thought nux-vomica was at the time. Little consolation for those who died at the time.

Back in South America, cinchona was being over harvested but was highly profitable. Colombia, Ecuador and Peru banned the export of seeds which predictably encouraged smuggling efforts.

Samples and seeds of cinchona often perished from on long sea journeys. The invention of the Wardian case (a sealed protective container for plants) by doctor Nathaniel Bagshaw Ward facilitated further attempts to smuggle cinchona out of South America.

It was only a matter of time. Some seeds were eventually smuggled out and the Dutch began trying to cultivating cinchona in Indonesia while the British attempted the same in India through an expedition led by Sir Clements Markham in 1860. However, cinchona was a challenge to grow in different climates and these early attempts did not yield a worthwhile (i.e profitable) amount of quinine.

Cinchonas exposed not only some of the commercial temptations of British Empire, but also featured as amongst Empire’s many ideological justifications. Particularly, in the immediate aftermath of the Sepoy mutiny of 1857, cinchonas were upheld as emblematic of benevolent Victorian governance. The arrival of cinchonas in British India was presented as ushering in ‘the pleasantest episode of British rule’ which would be characterised by the charitable dispensation of medical relief to the colonial poor.

Malarial Subjects: Empire, Medicine and Nonhumans in British India, 1820–1909. Deb Roy (2017)
Photograph of a cinchona nursery at Munsong in British Sikkim.
Source: ​​

On the other hand, the relative importance of quinine in facilitating colonisation has been brought into question when the French Empire is examined. Uncertainty around the dose and frequency of quinine along with its bitter taste caused reluctance in using it as a prophylaxis. Unlike the British who famously mixed quinine with gin, sugar and, lime (the gin and tonic), the French mixed it with wine (the apéritif quinquina).

Dubonnet was first sold in 1846 in response to a competition to persuade French Foreign Legionnaires in North Africa to drink quinine. British businessman Erasmus Bond sold the first commercial tonic water in in 1858. Swiss scientist Johann Schweppes sold Indian Tonic Water in 1870.

1870 – 1940: One monopoly for another

The monopoly situation started to change in 1864 when alpaca expert Charles Ledger managed to acquire seeds of the high-quinine plant Cinchona calisaya from his servant Manuel Incra Manamia. Ledger subsequently smuggled them out of Bolivia. After initially offering to sell them to the British Government, who refused to buy them (perhaps due to previous bad experiences with the poor yield of exported seeds), it was the Dutch who purchased the seeds and cultivated them very successfully in Java. This ended the South American monopoly on cinchona. In 1871, Mamani attempted to collect further seeds, was caught and imprisoned, beaten and then died for his part in the scheme. Ledger is reported to have supported Manuel’s family but lost his money in the Australian banking crash of 1891 and died in 1905.

Fortunately for them, the species used by the Dutch, later named Cinchona ledgeriana, yielded much higher quinine content compared to the usual bark (11-13% vs <3%). British plantations in India eventually folded. By the 1930s the Dutch were producing enough quinine to supply 97% of the worlds requirements. It was said that “whilst, in practice, the production of quinine took into account the law of supply and demand, millions of sufferers are [and continue to be] so poor that they would be unable to purchase quinine at even the approximate cost of production.”

The Dutch monopoly came to an end with the Japanese occupation of Indonesia in 1942. Quinine reserves were also captured by the Germans in Amsterdam. It is reported that US Colonel Arthur Fischer managed to leave on the last flight out of the Philippines with a tin can full of cinchona seeds which were then used to establish plantations in Costa Rica and Ecuador. As part of the war effort, synthetic processes were instead developed to create antimalarials. Chloroquine eventually became the drug of choice but has subsequently resulted in widespread resistance. Ongoing efforts to develop a malaria vaccine have come to some fruition but there are issues with supply, cost and sustainability.

History of Chloroquine-Resistant P. falciparum Malaria.

Today, quinine is perhaps best known by many physicians as a medication used for night cramps and by consumers as a tonic mixed with gin. Tonic water now has limits on how much quinine can be added and the increasing amount of sweetness used make it much less bitter than those used in the 1800s.

Pictures from my local supermarket. The recipe for the modern day Angostura bitters remains a secret. Does it contain Angostura? Apparently it doesn’t. It was originally used as a medicinal product created by revolutionary army surgeon Dr Johann Siegert in 1824 while stationed in the town of Angostura (in Venezuela). It is now more commonly used by bartenders rather than being dispensed by health professionals. On a similar note, the more modern Fever-Tree aromatic tonic water is reported as containing Angostura bark from somewhere in South America. I guess some things never change.

Does history repeat itself or can we learn from the mistakes of our past? Are medicines, money and monopoly inexorably linked? Please consider sharing your thoughts in the comments section.


Political and religious intrigue, economic factors, ideologies of empire, and personal ambition all contributed to the story of cinchona. The manufactured mystery around its discovery and properties shines a light on the behaviour of patients, doctors and those involved in the markets of health care. Despite the noted benefits of cinchona, it took considerable time for societies and the medical orthodoxy to adapt to the challenge it posed. In the interim, charlatanism and exploitation were given an opportunity to flourish with all the usual consequences. The physicians of today still work with the legacy of colonialism and scarcity of resources in medicine but through understanding the lessons of the past, they can influence and improve the global health care systems of today.

Further resources

Fundamental errors in the early history of cinchona: Part 1

Plants against malaria. Part 1: Cinchona or the Peruvian bark

A cure for the ague: the contribution of Robert Talbor

Robert Talbor, Madame De Sévigné, and the introduction of cinchona

‘Fairest of Peruvian Maids’. Malarial Subjects: Empire, Medicine and Nonhumans in British India, 1820–1909.

Saga of malaria treatment

The quest for quinine: Those who won the battles and those who won the war

A critical review of the basic facts in the history of cinchona

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