Last weekend saw World Gin Day; a chance to celebrate a drink which has exploded in popularity in the UK over the past few years. ‘Gin’ describes a liquor which is at least 40% alcohol by volume derived from grain distillation and primarily flavoured with juniper berries. It is the Dutch word for juniper, genever, which gives us the word ‘gin’. With the warm weather, many of us may be reaching for a relaxing beverage in the form of a gin with its most popular mixer: tonic. The story of this drink, with its myriad different garnishes and taste profiles, starts in the most unlikely place: fighting a deadly disease.
Malaria remains one of the biggest global health issues. According to the World Health Organisation in 2018 228 million people were infected worldwide with malaria, with 405,000 dying. Nearly half of the world’s population live in malaria-affected areas. The symptoms are vague; tiredness, muscle pains and periods of fever and shivering. Multi-organ failure can result.
The disease is caused by a single-celled organism called Plasmodium. This parasite has a complex life cycle which begins with a sporozoite stage which infects liver cells where they reproduce once: creating merozoites which are released when the infected liver cells burst. The merozoites in turn infect and reproduce inside red blood cells. The red blood cells burst and release more merozoites which infect yet more red blood cells and the cycle continues. This stage corresponds to the periodic fever the patient feels. At some point gametocytes rather than merozoites are produced. These are sexual (there are male and female forms). If a female Anopheles mosquito bites and drinks the blood of an infected patient it is the gametocytes which are ingested as well. Inside the stomach of the mosquito, they undergo sexual reproduction and form sporozoites. The next time the mosquito feeds it is these sporozoites she’ll inject into that person’s bloodstream and so the circle begins anew and another patient develops malaria.
Dr. Alphonse Laveran, a military doctor in France’s Service de Santé des Armées (Health Service of the Armed Forces).
Illustration drawn by Laveran of various stages of malaria parasites as seen on fresh blood.
Malaria was endemic in Europe; its name comes from medieval Italian for ‘bad air’ and was associated with swamps and other stagnant water. However, it was colonialism which would represent the biggest battle between imperial powers and malaria. The cause of malaria would first be identified in 1880 by a French army doctor, Alphonse Laveran, spotting the parasite down a microscope in the blood of patients.
As is often the case in medical history, however, a cure was sought long before the cause was identified.
It’s the early 17th-century in Peru. The Spanish Countess of Chinchón, Ana de Osorio, the wife of the Viceroy of Peru is ill with malaria. The locals present her with the bark of a local tree. The tale was that a local man, ill with malaria, drank from a pool of water contaminated with this bark and was cured. Although probably apocryphal, the bark had become a reliable cure for the natives. Ana de Osorio took the bark and was cured. On her return to Europe, she brought word of this tree. French scientists were able to isolate the compound responsible for defeating malaria and named it ‘quinine’ after the Inca word for the tree bark. The tree itself was named ‘cinchona’ in honour of the countess.
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The Scottish physician George Cleghorn (1716-1789), who had spent years studying fevers in Minorca (now Menorca), would hear of the properties of quinine and recommended that a solution of quinine in water be provided to British soldiers stationed in the Indian subcontinent. He was listened to and ‘Indian Tonic Water’ became a staple of colonial life. However, the solution was incredibly bitter. To make the drink more palatable by the 19th-century soldiers had started mixing it with sugar, lime, and; crucially, gin. The gin and tonic was born.
Portrait. Credit: Wellcome Library
Initially, the Peruvian authorities did all they could to protect their monopoly on cinchona plants and prohibited the exportation of its seeds. British businessman and alpaca farmer Charles Ledger, with the help of his manservant, was able to smuggle cinchona seeds out of the country. He sold them to the Dutch government who started growing cinchona in the Dutch East Indies.
By 1900 at least two-thirds of the world’s supply of quinine was grown in Java. Indonesia and India remain important cultivators of cinchona; it is also grown throughout Africa.
Modern tonic water has a quinine content far below the therapeutic dose and is produced for consumption only, not a cure. Quinine itself has been replaced with other drug treatments for malaria although it remains an option in cases of drug-resistance. Resistance has been identified in two of the four Plasmodium species which cause malaria and represents a public health challenge. Mosquito control and sanitation remain staples of attempts to control the disease. Gin and tonic remains a popular drink with its own international day: 19th October.
Disease has been a part of existence throughout the history of mankind. It therefore shouldn’t be surprising to find aspects of modern life which appear completely unrelated to healthcare with their roots in the history of medicine. When it comes to gin and tonic there are hints: the popular tonic water brand ‘Fever Tree’ chose its name in honour of the cinchona plant. Every time you have a ‘G&T’ you’re sampling a taste of that history.
Cheers.