The use of quinine for treatment and control of malaria in The Netherlands.

The manufacturing of quinine in The Netherlands began shortly after 1820; large scale production started with the foundation of the Amsterdam Chinine Factory in 1881. The quantity of sold quinine in the Province of North-Holland leads retrospectively to the conclusion that an epidemic of malaria had occurred around 1880. At the start of a new epidemic in 1899, it was demonstrated that quinine killed the bloodforms of tertian malaria immediately. However, 50% of the patients experienced a relapse, particularly after interruption of treatment. The length--f the course did not change the chance of relapse. With the beginning of another epidemic in 1919, scientific work and education of the people started in an organized fashion and patients were urged to use quinine only at the prescription of physicians. Because of the inability to prevent relapses, an alternative to quinine was badly needed. In 1930 plasmochin became available, which proved to be useful in combination with quinine. It was not until 1934 that the asymptomatic carriers were recognized as a problem for control because their unobserved parasitic relapses were considered a major source of infection for mosquitoes. In 1939 it was proposed to apply autumnal quininization, which meant a scrupulous screening of the population. The early forties brought yet another major epidemic. Both quinine and Quiniplex were used until the fifties, when endemic malaria disappeared. The new schizonticidal drugs came too late to challenge the primate of quinine in the era of temperate zone Plasmodium vivax in The Netherlands.