RETRO FILES / HOW AN 18TH CENTURY DOCTOR FIRST USED QUININE TO SAVE ALEXANDER HAMILTON’S SON

Not only good against diseases like typhus and malaria: gin and tonic is also an effective stress-inhibitor after work.  Why? Read this article on the early medicinal role of quinine.

GUEST BLOG / By Rebecca Rego Barry via The Public DomainReview with gratitude and thanks.

In 1797, fifteen-year-old Philip Hamilton was burning up with an ordinary, unidentified childhood disease of the time, such as typhus or scarlatina, and appeared to be mere hours from death. The attending family physician, David Hosack, who mostly rejected customary treatments like bloodletting and doses of mercury, took a risk and immersed the boy in a steaming bath with Peruvian bark stripped from the cinchona tree dissolved in it. 

Quinine and other alkaloids are extracted from the bark of the Cinchona tree, which is grown best in the tropics.  Quinine is a valuable antimalarial agent  and  muscle relaxant  compound.  It is used today ranging from a cardiac  depressant (antiarrhythmic) and as a bitter agent  in the  beverage (soft drink) industry.

Peruvian bark was a remedy widely used for malaria, although doctors of the time were unsure why or how it worked (it was the quinine). Hosack then added alcohol to the bathwater and employed smelling salts before swaddling the boy in blankets and putting him back in bed. He repeated this again and again until the fever broke. Philip’s recovery surprised even Hosack, and the boy’s father, Alexander Hamilton, was ever grateful.

Just seven years later Hosack would treat the elder Hamilton, with less success. Hamilton had asked Hosack to accompany him to Weehawken, New Jersey, where, as we can all now recount — or perhaps even sing — Hamilton was fatally shot by Aaron Burr. In the megahit Broadway show Hamilton, Hosack goes unnamed. He is referred to as a “doctor that [Hamilton] knew”, and a song about the rules of dueling includes a lyric about the attending doctor who “turned around so he could have deniability”

For a country in the grip of Hamilton-mania, perhaps it is this connection to the fêted founding father that has rekindled interest in Hosack, a politically neutral but socially well-connected professor and physician who lived mainly in New York City from 1769–1835. That, and a 2018 biography called American Eden: David Hosack, Botany, and Medicine in the Garden of the Early Republic (Norton) by Victoria Johnson, the first biography of him since 1964. Hosack (pronounced Hozz-ick) is not a household name, and, until now, has been “largely forgotten,” according to the scholar Elizabeth Rohn Jeffe. This opportunity to take a fresh look at such a noteworthy figure reveals much about early American medicine, particularly Hosack’s mission to “unlock the saving power of nature”, as Johnson puts it, through the scientific study of botany and the cultivation and use of plant-based medicines.

David Hosack engraving
by A.B. Durand, 1835
via The Public Domain Review.

Hosack grew up in British-occupied New York. His father was a Scottish immigrant, and his mother a New Yorker with English and French ancestry. As a child he was sent away to school in New Jersey, and from there enrolled at Kings College (now Columbia University) in Manhattan. In 1788, he apprenticed himself to Dr Richard Bayley, at just the right historical moment to witness the Doctors’ Riot, a public revolt against Bayley and his staff who were accused of exhuming, stealing, and dissecting cadavers. Hosack, a proponent of anatomical dissection, was physically attacked in the scuffle, and at least a few died.

From there, Hosack made his way to Philadelphia where he earned a medical degree at the University of Pennsylvania under the famous Benjamin Rush, with whom he would remain lifelong friends, even when they disagreed on curatives. (By many accounts, Rush was “addicted to the virtues of bloodletting.”) Although Hosack was newly married with an infant son, he decided his next step was a two-year solo trip to Edinburgh and London, where he could continue his medical training.

Why did he need further training, and why in Britain so soon after the Revolutionary War? As John C. Greene writes in the Journal of American History: “[P]roud though the Americans were to be independent of Europe for medical instruction, they realized that a medical degree from Philadelphia, Boston, or New York was not the equivalent of training at Edinburgh, London, or Paris.”  If Hosack wanted to compete with the likes of Rush, Samuel Bard, or John Warren, the leading figures of American medicine, he had to study abroad, as they had.

What he found there startled and inspired him. In Edinburgh, he was “mortified by [his] ignorance of botany with which other guests were conversant.” He contemplated the fact that though many of the known medicines were derived from roots, leaves, and petals — e.g., infusions from the leaves of menyanthes to soothe herpes sores, or a cough syrup made from arborvitae tree resin — his medical training thus far had not prepared him in the area we might now call botanical pharmacology. In medicine, as in science as a whole, America was still in the process of catching up with its European counterparts, still relying on them “for inspiration and ideas, for models of scientific achievement . . . for books and instruments, and for museums and herbaria.” Hosack pondered the contribution America could make in terms of undiscovered species and yet-to-be-discovered medications.

In London, Hosack met William Curtis and spent much of 1793 botanizing under his tutelage at the Brompton Botanic Garden. Curtis, a former apothecary, author of Flora Londinensis, and founding editor of the Botanical Magazine (which is still in circulation), tended the 3.5-acre garden in the manner of a medicinal garden attached to a medieval monastery. He was particularly interested in how plants of the same order had overlapping medicinal properties and in identifying new species with greater therapeutic value. According to biographer Victoria Johnson, Hosack’s time with Curtis prompted him to question whether “plants or lancets” were the better approach to illness.

But Hosack’s proverbial walk in the park finally came to an end, and he returned to New York — on a ship plagued by typhus — in 1794 to set up his practice. His wife awaited him, but their son had died during his absence. Nevertheless, as a newly minted fellow of the Linnean Society, he immediately began advocating for botanical education. As Johnson writes, he realized “what the nation needed . . . was a new kind of garden — a botany classroom, chemical laboratory, apothecary shop, plant nursery, horticulture school, and lovely landscape all rolled into one.” His first salvo was a request for citizen scientists to compile New York state’s first hortus siccus, or dry garden (herbarium), and begin the process of cataloguing native plants for research and experimentation. This idea didn’t get far, and Hosack was understandably too busy to follow up. Within a year, he became professor of botany at Columbia, performed the first hydrocele operation in the United States, and ministered to the sick and dying during the 1795 yellow fever outbreak in New York City.

Like Philadelphia in 1793 and 1794, New York in the summertime was prone to the deadly epidemic, of which very little was understood by contemporary physicians. As bodies piled up, doctors scrambled to ascertain best practices. Benjamin Rush, who had tended to victims in Philadelphia, encouraged venesection and doses of mercury. Hosack, on the other hand, having tried Rush’s remedies, preferred the gentler treatments that he had earlier used on Philip Hamilton and on Nathaniel Pendleton’s one-week-old infant. He washed sufferers with vinegar, wrapped them tightly, and had them drink tamarind water (from the tamarind tree) and diluted Virginia snakeroot to induce sweating. Hosack’s biographers agree that it wasn’t so much what Hosack did that saved his patients, as what he did not do — further weaken them with purging or bleeding. As Hosack himself wrote,

"I have generally pursued the sudorific treatment during every visitation of yellow fever since 1794. With due respect for the opinions and views of other practitioners, I am no less convinced of the injurious consequences to be apprehended from the indiscriminate use of the lancet and mercury in this epidemic form of fever."

Hosack’s pregnant wife survived the scourge only to die in childbirth in early 1796 (prompting him to found the city’s Lying-In Hospital for expectant mothers). In yet another busy year, Hosack was nominated to teach materia medica (early pharmacology), as well as botany, at Columbia. He was also invited to join the practice of the renowned Dr Samuel Bard, who, it seems, also preferred less invasive medicine; when Hosack and Bard both contracted yellow fever in 1798, they healed themselves with infusions of boneset (Eupatorium perfoliatum), followed by teas made from catmint, sage, and snakeroot.

Whether it was the deaths of his own children — a third child died of scarlet fever in 1801 — or his success at saving the lives of others, or the encouragement of Bard, at the turn of the new century, Hosack refused to waste more time without a garden that could produce the botanicals he believed the nation needed.

He sought help from Columbia, to no avail, and then lobbied state officials, saying, “We spend large sums upon appropriations for teaching chemistry and medical philosophy — shall we be insensitive to the means of preserving health and curing diseases?” Finally, in 1801, he took matters into his own hands.

Engraving of Hosack’s Elgin Botanical Garden where the present day Rockefeller Center exists. By 1806 when Hosack issued his first Catalogue of Plants Contained in the Botanic Garden at Elgin, he had amassed 1,400 exotic species and 250 natives, and he used those collections “to conduct and supervise some of the earliest systematic research in the United States on the chemical properties of medicinal plants."

On September 1 of that year, Hosack purchased a 20-acre plot in what one biographer described as a “suburb, three and half miles from the populous center of New York City.” To describe it now, two words would suffice: Rockefeller Center. At the time, it was almost rural in appearance, with rock outcroppings, wild violets, and sweeping views of both rivers. He named it the Elgin Botanical Garden and immediately set to work plowing fields, harvesting indigenous flora, and collecting specimens from around the world. He hired laborers and gardeners and pushed forward with his plan to create the first botanic garden in the United States. The phrase “botanic garden” may, for twenty-first-century readers, call to mind a primrose path. Not so, writes Victoria Johnson: “[T]he Elgin Botanic Garden had less in common with a beautiful city park than with the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control, and CRISPR gene-editing laboratories.”

Indeed, by 1806 when Hosack issued his first Catalogue of Plants Contained in the Botanic Garden at Elgin, he had amassed 1,400 exotic species and 250 natives, and he used those collections “to conduct and supervise some of the earliest systematic research in the United States on the chemical properties of medicinal plants”, according to Johnson. He was experimenting with known remedies, e.g., mashed fig poultices to relieve infected flesh and sweet bay laurel tree oil to stimulate circulation, and researching the possibility for new ones with plants that grew in abundance nearby, like unicorn root and skullcap for bowel trouble and elderberries to make cough syrup. One of the garden’s least publicized advantages was the creation of a local supply of plants for medical use, which would become important after the passage of the Embargo Act that lead to the War of 1812.

Hosack’s 1811 catalogue, titled Hortus Elginensis, included 2,000 species, and it records the garden at its high point. After many negotiations, the New York state legislature had finally voted to buy Elgin in 1810, handing its management over to the College of Physicians & Surgeons, a medical school that Hosack had been affiliated with, off and on. (Elgin was later regifted to Columbia.)

At first, the handover was a relief to Hosack, who had been shouldering the financial burden for a decade, but within a few years, it became clear that the lack of institutional caretaking, coupled with the need for major geographic re-mapping as the city expanded, would be the death of Elgin. The seeds that Thomas Jefferson contributed in 1816 were too little, too late.

The zeal that Hosack showed for Elgin exasperated less forward-thinking colleagues, too. To them, a garden seemed “frivolous . . . severed from the bloody mess of clinical practice”, writes Johnson. Which is an arguable point, even if one considers the amount of botanical research conducted, or the fact that Hosack cultivated the garden while maintaining his position as one of the city’s top doctors — whose ligation of a femoral artery was the first documented in the United States. But it seems Hosack was considered “a little queer”, at least according to Scientific Monthly in 1929. A maverick, in today’s parlance, or, simply ahead of his time.

Hosack spent his later years with his third wife and their combined large family creating a new Elgin of sorts at his 500-acre estate in Hyde Park, New York. He retired from medicine in 1834 and died a year later. His legacy in botany was borne out in his grandchildren’s generation, when botanic gardens bloomed all over the United States. As his biographer concludes, “He had done more than any other citizen of the United States to call into being a generation of professional botanists where there had been almost no one.”

Today’s pharmacology and pharmaceuticals may be a world away from sneezewort yarrow powders and horehound syrups, but Hosack’s advice to get back to nature still resonates.

ABOUT THE AUTHOR

Rebecca Rego Barry writes about history, literature, and culture for several publications and is the author of Rare Books Uncovered: True Stories of Fantastic Finds in Unlikely Places (Voyageur Press, 2015).