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A Bitter Pill to Swallow

By “Awake!” correspondent in Zaïre

“I THINK you have malaria,” remarked the doctor. My severe stomach pains and a headache told me not to argue with him. He promptly gave me an injection of quinine in liquid form, along with instructions on how much quinine to take during the next few days. Happily, the treatment worked and before long I was back to normal.

That experience, and the fact that I was living in a major quinine-producing area, heightened my interest in this substance. Millions of people living in tropical lands where malaria is prevalent swallow bitter quinine pills daily. But just what is quinine? Where is the substance obtained? And what are its uses? I was determined to find out.

Getting to the Source

Quinine is a substance derived from the bark of cinchona trees. These were growing on the eastern slopes of the Andes when the Spanish came to South America in the sixteenth century. The explorers found that the Indians were using the bark of the tree for medicinal purposes. Soon these Europeans were chewing cinchona bark. Was it a delicious treat? Certainly not! The bark had an unpleasant, bitter taste. But chewing it was effective as a remedy for fever.

Soon the search was on for other ways to get the medicinal substance out of the bark and make it easier to take. A few years after the initial discovery by Europeans, it was found that if cinchona bark was soaked for a time in wine the medicine was drawn out by the wine. This was drained from the bark and consumed. Obviously, that was a much easier way to take the medicine, since the bitter taste was either neutralized or disguised by the wine. But because of the difficulty of extraction and the fact that all the bark had to be brought from South America, quinine remained available only to the wealthy and privileged.

By the mid-nineteenth century the cinchona tree had started dying out in South America. But it was being planted in Java, and for many years Indonesia was the main supplier of quinine. Other tropical countries also have produced quinine in an effort to control malaria. During 1938 the cinchona tree was introduced in the Kivu region of the Republic of Zaïre. In recent years this area has become a large supplier of quinine.

Visiting a Cinchona Plantation

In Zaïre we certainly are in a good place to learn more about quinine. Why, many large cinchona plantations are laid out neatly in the rolling, green countryside on the shores of Lake Kivu, in the eastern part of Zaïre! Come along as we visit one of these establishments.

Our guide, the plantation manager, explains that it is best to start our visit by seeing the beginning of the cinchona plant. So, our first stop is the nursery. To get there, we wind our way through the woods and plantings of cinchona to the bottom of a valley. It is an ideal place for a nursery. The soil is very rich, having been washed down from the hills. There is a flowing stream for a steady supply of water. The area also is warm and well protected.

Right in the center is an enclosure with grass walls. Inside there is row upon row of long low sheds also made of grass. All the sheds are open on one side. But sacking hangs down the front so that just the right amount of light can enter. As we look into one of these sheds, we see neatly arranged beds covered with thousands of very fragile plants. After the soil of the bed is prepared, the seeds are simply scattered on the top, where they germinate. Each bed, which is about a meter (39 inches) wide and several meters long, is seeded with only 2 grams (.07 ounce) of seed, approximately 4,000 to 5,000 grains. Our mouths drop open in amazement as the guide explains that one kilo (2.2 pounds) can cost up to $700. But our astonishment is allayed somewhat when we are told that a kilo can contain as many as one million individual seeds.

The new seedlings are watered with a fine mist so as to avoid harming the tender plants. When they reach a height of 10 centimeters (4 inches) they are transplanted for the first time, but are still protected from the sun and hard rain. Not until the plants are a year and a half old are they finally put out into the open fields.

Leaving the nursery, we climb the hills into the plantation itself. We wonder why all the plantations we have seen are on the slopes of hills, and very steep ones at times. Our guide informs us that while the cinchona tree likes lots of water, it does not like waterlogged soil. The climate here in Kivu supplies the rain​—about 80 inches (2 meters) a year—​and the slope of the hill provides the drainage. The plantation we are visiting reaches an altitude of about 6,600 feet (2,011 meters) above sea level.

The young plants are placed in very well-defined rows at a distance of one meter (3.3 feet) from each other. Whether you look straight ahead, to the side, or diagonally across the field, you observe that the plants are in perfect rows.

It is the bark that is harvested, not fruitage of any sort. Harvesting the bark starts during the third or fourth year of the tree’s life. At this point, the purpose is as much to thin out the plants as it is to obtain the quinine. Harvesting goes on until about the twelfth year, with branches and trees being cut down every year. Incidentally, if a tree is cut down, that does not mean that its replacement has to start with a seedling. The stump that is left will quickly sprout again and three or four shoots are left to mature. So, in this way the plant just goes on producing.

As we move along one of the plantation roads, cheerful bird songs gradually give way to a clattering noise. Farther along we come to its source. By the edge of the road, on their knees, we see a long line of young women and girls from surrounding villages. All are busy taking the bark off the trees and branches. Each has a rock in front of her and a stick about a foot and a half (46 centimeters) long. The trees are brought to the women by men and are cut into convenient lengths. Putting the tree or branch on a rock, the woman pounds it with the stick until the bark is loosened. She then peels it all off, carefully piling the bark on a big sheet. At the end of the day this will be weighed and tallied. Later, on the basis of this, she will be paid.

Next the bark is spread on large concrete drying areas where young boys sort out sticks and leaves that have no value and would only get in the way. After the bark is dry, it is put into large bags and is shipped to the processing plant.

Extraction of Quinine

Next we arrange to visit the local processing plant to see the actual extraction of the quinine from the bark. Since this is mostly a chemical process, I will not try to mention all the details. First, we see an entire truckload of bags being unloaded and weighed. Shipments from different plantations are kept separate until an analysis can be made of a sample. The quinine content can vary from 5 to 10 percent.

Once the quinine content has been established, the bark is sent through a mill and is ground as fine as flour. After this, the bark is put through the chemical process. It is mixed with various chemicals, such as sodium carbonate, sulphuric acid and caustic soda as it passes through different stages. Finally the quinine begins to manifest itself as a paste, which is then spin dried in a drier similar to those you find in a modern laundry.

Quinine’s Varied Uses

In this basic form much of the quinine is exported to different parts of the world. There it undergoes further processing, according to the particular needs of the country or pharmaceutical firm. In a single year the chemical plant we toured will process as much as 2,500 tons of bark, yielding between 120 and 150 tons of quinine. All the quinine needed in Zaïre is processed at this plant, and large quantifies are exported.

Combating malaria and some other diseases is not the only use of quinine. Since it is sensitive to light, quinine also is used in making film for your camera. Beer, especially Pilsner, may be prepared with the help of quinine. For that matter, some persons use tonic water as a mixer in alcoholic beverages in order to obtain quinine without having to swallow bitter pills. Various plastics also contain quinine.

Quinine in its pure state is being used less and less these days. On the other hand, the use of its derivatives is increasing. A person who is under treatment with basic quinine might find that his eyes, ears and stomach are adversely affected. This is not the case with the quinine derivatives.

Nevertheless, regarding quinine and a similar substance, The World Book Encyclopedia states: “Doctors today still use the drug quinidine to treat and correct certain disorders of heart rhythm. Quinidine has the same chemical formula as quinine, and differs from it only in the way the atoms are arranged in the molecule. Doctors believe quinine and quinidine may cause abnormalities in unborn children. For this reason, pregnant women should not take these drugs without first consulting a doctor.”

It is estimated that one third of the earth’s population is affected by malaria, especially in the tropical regions of the Americas, Asia and Africa, and that perhaps as many as two million people die from its effects each year. In 1975 the World Health Organization announced that its program to eradicate malaria has failed. Undoubtedly, therefore, the reddish-brown bark of the cinchona tree still has a large role to play in alleviating the debilitating effects of malaria. At any rate, I hope our inspection tour makes it a little easier for malaria sufferers to swallow this bitter pill.