Book Review

Quinine's Predecessor: Francesco Torti and the Early History of Cinchona

N Engl J Med 1994; 330:723March 10, 1994

Article

Quinine's Predecessor: Francesco Torti and the Early History of Cinchona
By Saul Jarcho. 354 pp., illustrated. Baltimore, Johns Hopkins University Press, 1993. $55. ISBN: 0-8018-4466-5

Near the beginning of the 17th century, a weary herbalist characterized the boundless array of botanicals that he was required to master as a “sea of simples.” That immense body of botanical and medical knowledge, first collected by the ancients and then vastly expanded by Renaissance and early modern explorers and botanists, became obsolete only in the 19th century, when chemistry transformed drug therapy. The wealth of literature and lore that physicians and botanists mastered in the 17th and 18th centuries is now being investigated anew, but this time by historians of medicine and pharmacy.

Cinchona, also named Peruvian bark for its origin and Jesuit's bark for its probable first conveyers to Europe, is a crucial drug in the history of medicine. Long before quinine was isolated from it in 1820, the bark served as an effective drug for malaria and as such challenged the prevailing theory and practice of medicine. It was prescribed for fevers in general and intermittent fevers -- one of which was malaria -- in particular. Because the causes and taxonomy of fevers, as well as their therapy, were at the center of 17th- and 18th-century medical theory and practice, Peruvian bark, too, became a central concern. Historical interest in this drug is heightened by the fact that its introduction into Europe and subsequent adoption there provide an illustration of the ambiguities and intricacies of medical innovation.

The central figure in the European adoption of cinchona was an Italian, Francesco Torti (1658-1741). It was through his books that Peruvian bark became a part of the canon of European medicine. But the story is not a simple one of recognizing an innovation on first sight, as it rarely is in the history of medicine. Debates about the theory of drugs and fevers raged for almost 50 years before Torti was able to persuade the European medical community of the bark's efficacy.

Torti is not so much the focus of this book as the end point of the author's quest for the pivotal figure in the early history of cinchona and malaria. Before reaching Torti, the author takes readers on a long journey around the world, from 16th-century Peru to 17th-century Italy. Along the way he comments with learning and insight on all the major and many of the minor medical writers of the era. Not all readers will have the time or inclination to stop at every site on the tour; some may wish to begin with the preface, proceed through the four chapters about Torti, and conclude with the epilogue.

The chief value of this book is its lucid and detailed narrative, which shows the complexity of the process of cinchona's discovery, transmission, and adoption. Equally compelling is the author's prose: clear, pungent, and aphoristic, filled with insight and vigorous phrasing. For example, when commenting on a never-completed book on the bark, he says that “the undertaking, like many other enterprises of great pith and moment, was abandoned.” Later, he notes that the details of an Italian controversy over the bark “augment the embarrassment of those who regard medical history as a continuously harmonious and triumphant procession.”

Philip M. Teigen, Ph.D.
National Library of Medicine, Bethesda, MD 20894