Evaluating Cinchona bark and quinine for treating and preventing malaria.

Whereas the efficacy of Cinchona bark and quinine for treating intermittent fevers had become widely accepted by the turn of the 18th and 19th centuries, their role in preventing fevers had not been convincingly established. However, as early as 1711, Vallot et al. had reported in the Journal de la santé du roi Louis XIV that he had learned from experience that long term administration of Cinchona bark prevented relapse of fevers. Long after the King had been declared cured after treatment for intermittent fevers, he was prescribed bark to prevent further attacks. At that time, people all over Europe lived with mild malaria, and travelers, sailors and soldiers experienced severe fevers in Africa, Central America, and India, where fevers were often named after the place where they had been observed (Coromandel, Guzzarat, Bengali, for example). The role of armed forces in the development of prophylactic use of Cinchona bark was important. The Count of Bonneval claimed (albeit without any quantitative evidence) that bark had been used with success in 1717 during the siege of Belgrade (quoted in Rey). However, most historical sources suggest that it was not until the end of the 18th century that European armed forces became aware of the importance of acute malaria for naval and ground operations. Both of the British naval surgeons sharing the name ‘James Lind’ wrote about bark for prophylaxis as well as for treatment of intermittent fevers (agues). Alan Magill states in an article on the Centers for Disease Control website that, in 1768, Lind recommended that ‘every man receives a daily ration of Cinchona powder’. We have been unable to locate these words in the 1768 edition of ‘scurvy’ Lind’s ‘An essay on diseases incidental to Europeans in hot climates’. Lind does note in the book that: