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Quinine
  1. M K Davies,
  2. A Hollman

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Cinchona officinalis (family Rubiaceae) is a tree from the Andes whose bark contains the alkaloids quinine and quinidine. “Jesuit's bark”, as it was called, was discovered in Europe after 1630 to be valuable in treating malaria. It also became widely used for fevers in general, and in 1749 de Senac found by chance that “Long and rebellious palpitations have ceded to this febrifuge”. The alkaloids had been isolated by 1860 but their proven use in arrhythmias came about only because of the astute observation in 1912 of a Dutchman with attacks of palpitation who had found for himself that he could halt an attack when he took 1 g of quinine. Probably he took quinine for malaria. He was a patient of Professor Karel Wenckebach who confirmed paroxysmal atrial fibrillation with an ECG and related the episode later (JAMA 1922;81:472–4). Wenckebach often tried quinine but succeeded in only one other patient. Then W von Frey in Berlin studied all four cinchona alkaloids and found that quinidine was the most effective. In 1920 Thomas Lewis pioneered the use of chest leads to record precisely the atrial rate in atrial fibrillation and showed that it was slowed by quinidine. Referring to his hypothesis of circus movement Lewis proposed that normal rhythm was restored because quinidine closed the gap between the crest and the wake of the circus wave.

Cinchona belongs to the huge family Rubiaceae that has over 10 000 species worldwide, but emetine from ipecacuanha and caffeine from coffee are the only other drugs within it. It contains the beautiful shrub Gardenia named by Linnaeus to honour the Scotsman Dr Alexander Garden who was a physician and botanist in Charleston, South Carolina around 1780.

The stamp showing Cinchona officinalis came from the United Nations (Geneva Headquarters) in 1990 as part of the set depicting medicinal plants.

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