In this part we deal with quinine wine. We do not believe that the quinine wines available today were developed to help against malaria and are still produced according to the original recipes – a look at old sources does not allow any other conclusion.
In the previous chapter, we quoted extensively from those sources which either stated in what quantities quinine was administered or in what quantities it was contained in quinine wine. Here they will not be quoted again, but merely summarised. A conversion to the amount of quinine base contained in each case is also made so that the values can be compared.
Since quinine is a basic amine, it is always in the form of a salt. This makes the dosage of quinine very complicated, as each of the salts has a different weight. The following amounts of each form are the same: 100 mg quinine base = 169 mg quinine bisulphate = 122 mg quinine dihydrochloride = 122 mg quinine hydrochloride = 121 mg quinine sulphate = 160 mg quinine gluconate. [18] Kindly, most sources indicate which salt to use in the formulation. Where there is no precise indication, but only of ‘quinine’, we have assumed that it is quinine sulphate. The basis for this decision is an 1882 text dealing with this subject, which states: »I therefore think when any article is sold with a label describing it as containing so much “quinine,” we are justified in considering the word “quinine” to signify sulphate of quinine«. [29-34]
Furthermore, today uncommon units of measure are used. We convert as follows (rounded):
Sometimes a wine bottle is also given as the quantity. Instead of simply stating here that this quantity probably corresponded to around 750 ml, we would like to quote from a study of English beer and wine bottles from the years 1735-1850, because this illustrates the difficulties that arise: „At the beginning of this study I assumed that a range of “quart” capacities would cluster around the reputed quart of 757 mL. However, a preliminary series of capacity measures taken soon after the study began made it clear that this was not the case. Bottles identifiable visually as “quarts” ranged in capacity from 675 mL to 1250 mL. … It also seemsthatthequartswereused as standardsinsteadofthegallonsbecausethecapacitiesofthehalf-pints,pints, half-gallons, and gallons, when multiplied or divided by two or four,reflectedthose ofthequarts.Because oftheclosenessofthevarious officialquartsand chopins, andbecausethebottlemakersdonotappeartohavetriedtomakequartsofofficialsizes,itisdifficulttoknowwhichsystemsofmeasurearerepresentedbythe“quart”capacities.MostwereprobablyrepresentativeoftheEnglish wine,beer,orimperialmeasurement system. … Wine merchants in England devised a system that compensated for the varying bottle capacities. This system was based on a dozen quart bottles that, ideally, should have held three gallons of wine. As the bottles generally did not hold a full quart the three gallons were taken as a substitute and the number of bottles per dozen was adjusted accordingly so that the “dozen” could be anywhere from 12 to 18 bottles.“ [26-110][26-111] „In the weights and measures enquiry conducted in the early 1840s several witnesses attested to the fact that, in spite of the passage of the imperial system in 1824, the range of sizes still in use continued to be large. The Inspector of Weights and Measures at Bristol noted that the wine trade used a scale of bottles from No. 12 down to 18. His capacity evidence is confusing as he seems to switch back and forth between the imperial system and the Queen Anne wine gallon but he states that “A dozen of the No. 15’s contain 2 gallons imperial [757 mL per bottle”] (Great Britain. Parliament. Sessional Papers 1842: 358). Apsley Pellatt commented that “from the corn mon quart bottles blown as one size are picked sizes, as various in content as 13 up to 16 to the 12 imperial quarts, but such sizes can only be selected when cold by measuring every bottle with water” (Great Britain. Parliament. Sessional Papers 1842: 364). In the same report Barret and Clay reported that respectable wine merchants used three bottle sizes: small 4’s which held 27.5 ounces (781.36 mL), 5’s which held 27 ounces (767.15 mL) when the quantity to make room for the cork was thrown off, and 5’s which held 26.5 ounces (752.95 ml.) when filled brimful.“[26-112]
Based on this, we are certainly not entirely wrong when we estimate the volume of a wine bottle at 750 ml for our purposes.
The recipes
So what is the quinine content of the recipes found, what was the daily amount to be taken, and for what purposes? To answer this question, let us summarise our findings, which we cited in detail in the second part of this series. The order of the information is: year and source; quinine base in wine in mg/l; daily dose of quinine base in mg; purpose.
1823 [1-52]; – ; dose: 54 – 536; prophylaxis and treatment of fever.
From such a list we can only see something if we create and look at different diagrams.
Quinine base in wine
Let’s start with the question of how much quinine base was present in quinine wine.
Quinine base in wine.
The average value of the minimum value of all sources is 3699 mg/l, for the maximum value it is 4242 mg/l, or averaged at 3970 mg/l. However, these are not the values we should use for our consideration. If we look at the curve, we see that the value will be too high because of the last two or three sources. If we do not take these into account, we get an average value around 2500 mg/l. But regardless of which of these average values we choose, we must note that the quinine wines as they are available today, with a maximum quinine content of 300 mg/l, contain considerably less quinine base than the wines used in the 19th century. Even the wine with the lowest quinine content contained 531 mg/l quinine base.
If it is now said that today’s quinine wines were developed to be taken as a malaria prophylaxis and that the recipes have remained unchanged to this day, one must assume that this statement is probably not true. Either the formulation has been changed, or these wines were never intended as prophylaxis. The latter is also supported by the fact that we have not found any historical source that suggests this; rather, the wines were mixed with quinine on their own.
We would like to postulate the following: People took quinine as a prophylactic or as a tonic, after all they were used to the bitter taste, and so quinine wines with a low quinine content were produced as a stimulant, not as a medicine, and sold under a brand name.
Quinine base as prophylaxis
Let us now turn to the next question: How much quinine base was taken as prophylaxis?
Quinine base as prophylaxis.
Here the diagram is less uniform. This is partly due to the fact that often no clear distinction was made between prophylaxis and fever treatment. For example, one indication is that one should take 54 mg to 536 mg of quinine base as prophylaxis and for the treatment of fever. The lower value will certainly have been meant as prophylaxis, the upper one for acute fever. Nevertheless, we have adopted both values in this diagram if no clear distinction was made in the prescription.
If we look at the average of the minimum value, the quinine base is 228 mg; the average of the maximum value is 331 mg.
If one now wanted to take this amount as quinine wine, a quinine content of 3699 mg/l would result in a wine quantity of 61.6 ml with a dose of 228 mg, and up to 89.5 ml with a dose of 331 mg. A modern quinine wine with (at most) 300 mg/l quinine base would be 760 ml to 1103 ml. That again, enjoyed as a daily amount of wine, would be a bit much. Another argument that these quinine wines were not intended as medicine or that a significant recipe change has been made.
Quinine base for fever
What is the situation now with the treatment of fever?
Quinine base for fever.
It should be noted with regard to this diagram that we have always estimated the higher value as fever treatment in the case of unclear prescriptions, as already mentioned in the previous example. The average maximum value is 849 mg quinine base. This amount sounds realistic, as the current recommendation is to take at least 800 mg to 1000 mg of quinine base daily. [27]
In order to ingest 849 mg of quinine base, one would have to drink 2.83 litres of a wine that is legally permissible today (with 300 mg/l quinine base). Such a quinine wine cannot therefore be used to treat malaria; the quinine it contains is too weakly dosed.
Conclusion
Based on this analysis, we must conclude that the advertising claim that today’s quinine wines were developed as a malaria prophylaxis or to treat fever cannot be true. We have not found any historical evidence for this, and quinine wine seems to have always been produced by the people themselves. Rather, it was probably the case that people had a taste for bitter wines; quinine wines were developed to satisfy this consumer need, purely as a means of enjoyment.
We will have to look at similar considerations for tonic water. First, let us turn to the history of tonic water containing quinine in the next part of this series.
https://archive.org/details/63610270R.nlm.nih.gov/page/n15?q=%22quinine+wine%22 Henry McMurtie: The gentleman’s medical vade-mecum and travelling companion: containing a concise statement of the most known and certain causes, symptoms and modes of curing every disorder to which he is liable, with directions for his conduct in case of accidents on the road or at sea, in plain English. Philadelphia, 1824.
https://archive.org/details/b28748517/page/260?q=%22quinine+wine%22 William Hamilton Kittoe: The pocket book of practical medicine : or, Manual for emergencies, containing a concise account of diseases incident to the human frame, with formula to meet the exigencies of the moment where medical aid is distant or not to be procured, remarks on some of the diseases of women and children, accidents, wounds, &c., poisons, bathing, climate, settlers in distant lands, sea voyages, &c., &c. London, 1844.
https://de.wikipedia.org/wiki/Wellington_Channel Anonymus: Narrative of a boat expedition up the Wellington channel in the year 1852, under the command of R. M’Cormick, R.N., F.R.C.S., in H.M.B. ‘Forlorn Hope,’ in search of Sir John Franklin. London, 1854.
https://archive.org/details/b22346909/page/10 Joseph Jones: Quinine as a prophylactic against malarial fever: being an appendix to the third report on typhoid and malarial fevers, delivered to the Surgeon General of the late C.S.A., August, 1864. Nashville, 1867.
In the previous chapter, we quoted extensively from those sources which either stated in what quantities quinine was administered or in what quantities it was contained in quinine wine. Here they will not be quoted again, but merely summarised. A conversion to the amount of quinine base contained in each case is also made so that the values can be compared.
Conversion factors
Since quinine is a basic amine, it is always in the form of a salt. This makes the dosage of quinine very complicated, as each of the salts has a different weight. The following amounts of each form are the same: 100 mg quinine base = 169 mg quinine bisulphate = 122 mg quinine dihydrochloride = 122 mg quinine hydrochloride = 121 mg quinine sulphate = 160 mg quinine gluconate. [18] Kindly, most sources indicate which salt to use in the formulation. Where there is no precise indication, but only of ‘quinine’, we have assumed that it is quinine sulphate. The basis for this decision is an 1882 text dealing with this subject, which states: »I therefore think when any article is sold with a label describing it as containing so much “quinine,” we are justified in considering the word “quinine” to signify sulphate of quinine«. [29-34]
Furthermore, today uncommon units of measure are used. We convert as follows (rounded):
Sometimes a wine bottle is also given as the quantity. Instead of simply stating here that this quantity probably corresponded to around 750 ml, we would like to quote from a study of English beer and wine bottles from the years 1735-1850, because this illustrates the difficulties that arise: „At the beginning of this study I assumed that a range of “quart” capacities would cluster around the reputed quart of 757 mL. However, a preliminary series of capacity measures taken soon after the study began made it clear that this was not the case. Bottles identifiable visually as “quarts” ranged in capacity from 675 mL to 1250 mL. … It also seems that the quarts were used as standards instead of the gallons because the capacities of the half-pints, pints, half-gallons, and gallons, when multiplied or divided by two or four, reflected those of the quarts. Because of the closeness of the various official quarts and chopins, and because the bottle makers do not appear to have tried to make quarts of official sizes, it is difficult to know which systems of measure are represented by the “quart” capacities. Most were probably representative of the English wine, beer, or imperial measurement system. … Wine merchants in England devised a system that compensated for the varying bottle capacities. This system was based on a dozen quart bottles that, ideally, should have held three gallons of wine. As the bottles generally did not hold a full quart the three gallons were taken as a substitute and the number of bottles per dozen was adjusted accordingly so that the “dozen” could be anywhere from 12 to 18 bottles.“ [26-110] [26-111] „In the weights and measures enquiry conducted in the early 1840s several witnesses attested to the fact that, in spite of the passage of the imperial system in 1824, the range of sizes still in use continued to be large. The Inspector of Weights and Measures at Bristol noted that the wine trade used a scale of bottles from No. 12 down to 18. His capacity evidence is confusing as he seems to switch back and forth between the imperial system and the Queen Anne wine gallon but he states that “A dozen of the No. 15’s contain 2 gallons imperial [757 mL per bottle”] (Great Britain. Parliament. Sessional Papers 1842: 358). Apsley Pellatt commented that “from the corn mon quart bottles blown as one size are picked sizes, as various in content as 13 up to 16 to the 12 imperial quarts, but such sizes can only be selected when cold by measuring every bottle with water” (Great Britain. Parliament. Sessional Papers 1842: 364). In the same report Barret and Clay reported that respectable wine merchants used three bottle sizes: small 4’s which held 27.5 ounces (781.36 mL), 5’s which held 27 ounces (767.15 mL) when the quantity to make room for the cork was thrown off, and 5’s which held 26.5 ounces (752.95 ml.) when filled brimful.“ [26-112]
Based on this, we are certainly not entirely wrong when we estimate the volume of a wine bottle at 750 ml for our purposes.
The recipes
So what is the quinine content of the recipes found, what was the daily amount to be taken, and for what purposes? To answer this question, let us summarise our findings, which we cited in detail in the second part of this series. The order of the information is: year and source; quinine base in wine in mg/l; daily dose of quinine base in mg; purpose.
From such a list we can only see something if we create and look at different diagrams.
Quinine base in wine
Let’s start with the question of how much quinine base was present in quinine wine.
The average value of the minimum value of all sources is 3699 mg/l, for the maximum value it is 4242 mg/l, or averaged at 3970 mg/l. However, these are not the values we should use for our consideration. If we look at the curve, we see that the value will be too high because of the last two or three sources. If we do not take these into account, we get an average value around 2500 mg/l. But regardless of which of these average values we choose, we must note that the quinine wines as they are available today, with a maximum quinine content of 300 mg/l, contain considerably less quinine base than the wines used in the 19th century. Even the wine with the lowest quinine content contained 531 mg/l quinine base.
If it is now said that today’s quinine wines were developed to be taken as a malaria prophylaxis and that the recipes have remained unchanged to this day, one must assume that this statement is probably not true. Either the formulation has been changed, or these wines were never intended as prophylaxis. The latter is also supported by the fact that we have not found any historical source that suggests this; rather, the wines were mixed with quinine on their own.
We would like to postulate the following: People took quinine as a prophylactic or as a tonic, after all they were used to the bitter taste, and so quinine wines with a low quinine content were produced as a stimulant, not as a medicine, and sold under a brand name.
Quinine base as prophylaxis
Let us now turn to the next question: How much quinine base was taken as prophylaxis?
Here the diagram is less uniform. This is partly due to the fact that often no clear distinction was made between prophylaxis and fever treatment. For example, one indication is that one should take 54 mg to 536 mg of quinine base as prophylaxis and for the treatment of fever. The lower value will certainly have been meant as prophylaxis, the upper one for acute fever. Nevertheless, we have adopted both values in this diagram if no clear distinction was made in the prescription.
If we look at the average of the minimum value, the quinine base is 228 mg; the average of the maximum value is 331 mg.
If one now wanted to take this amount as quinine wine, a quinine content of 3699 mg/l would result in a wine quantity of 61.6 ml with a dose of 228 mg, and up to 89.5 ml with a dose of 331 mg. A modern quinine wine with (at most) 300 mg/l quinine base would be 760 ml to 1103 ml. That again, enjoyed as a daily amount of wine, would be a bit much. Another argument that these quinine wines were not intended as medicine or that a significant recipe change has been made.
Quinine base for fever
What is the situation now with the treatment of fever?
It should be noted with regard to this diagram that we have always estimated the higher value as fever treatment in the case of unclear prescriptions, as already mentioned in the previous example. The average maximum value is 849 mg quinine base. This amount sounds realistic, as the current recommendation is to take at least 800 mg to 1000 mg of quinine base daily. [27]
In order to ingest 849 mg of quinine base, one would have to drink 2.83 litres of a wine that is legally permissible today (with 300 mg/l quinine base). Such a quinine wine cannot therefore be used to treat malaria; the quinine it contains is too weakly dosed.
Conclusion
Based on this analysis, we must conclude that the advertising claim that today’s quinine wines were developed as a malaria prophylaxis or to treat fever cannot be true. We have not found any historical evidence for this, and quinine wine seems to have always been produced by the people themselves. Rather, it was probably the case that people had a taste for bitter wines; quinine wines were developed to satisfy this consumer need, purely as a means of enjoyment.
We will have to look at similar considerations for tonic water. First, let us turn to the history of tonic water containing quinine in the next part of this series.
Sources
explicit capitulum
*