2 - The Demands of Humanity

Summary

Chapter 2 studies the movement of various material forms of medical knowledge about cinchona – bottled compound wines, or powdered bark – by setting out the structure, volume and reach of world commerce in cinchona. Based on trade statistics, pharmaceutical inventories and medical treatises as well as the extensive Spanish administrative record on the subject, the chapter charts the bark’s availability across the Atlantic World by means of commerce and contraband as well as concomitant, non-commercial forms of distribution – charitable giving, medical relief programmes and diplomatic gift exchange. Preparing the ground for subsequent chapters concerned with the movement of consumption practices and expertise in indications, it exposes and examines both the bark’s geographic reach, along the veins of Atlantic trade, proselytizing, and imperialism, and its more elusive social reach within consumer societies.

The cinchona, placed in the dominions of his Majesty, […] is, on account of its virtue, a specific of the first necessity. Its extraction ought to attract tribute to Spain from all the nations (debe atraer a España el tributo de todas las Naciones): but it must be handled abiding by constant rules that preserve it in the abundance, goodness, and at the moderate price that humanity demands.

– Antonio Caballero y Góngora to José Gálvez, October 19, 1786.

On May 14, 1800, Luis François de Rieux (1768–1840), chief physician at the Royal Hospital in Cartagena de Indias, wrote to Miguel Cayetano Soler y Rabassa (1746–1808), then Minister of Finance of the Spanish Empire, to advise him about the importance of extensive, structured and equitable world trade in cinchona bark. Cinchona being, he wrote,

the most important, and the most usual remedy that medicine possesses (siendo la quina el Medicamento más importante, y el mas usual que posee la Medicina); humanity demands, and justly so, that this medicament of first necessity reach our hands without the fraud it has so often suffered hitherto, and at the most equitable price, in order that not even the poor, the most numerous in all the countries and the worthiest of a monarch’s piety, whose resources are scarce, be deprived of a remedy on the administration and faithfulness (fidelidad) of which the lives of men depend so many times.¹

Luis François de Rieux, ‘full of ideas […] about the rights of man […] acquired in France, where he had his cradle’, was by no means the only contemporary to aver that his efforts on behalf of cinchona originated in his concern for humanity.² On the contrary, the presumption to speak and act not only in the name, but for the betterment, of a universal humanity is one we find recurrently, in the treatises and decrees of Spanish colonial officials, British physicians and French naturalists alike – writers accounting for their endeavours in regulating or intensifying cinchona commerce, like Rieux, and also in investigating its therapeutic properties or locating inexpensive substitutes outside the Spanish American harvest areas.³ Part of a wider Enlightenment discourse, which consistently claimed both to address and represent the ideal collectivity of humanity,⁴ the equitable distribution of faithful, and inexpensive cinchona was, though by no means the only project of enlightened medicine,⁵ one that to many physicians, naturalists and colonial officials ‘merited the utmost attention’.⁶

Probing the enlightened discourse that cinchona was in the service of humanity, this chapter endeavours to situate, measure and define the ideal collectivity of beneficiaries invoked by cinchona’s advocates during the late 1700s and early 1800s. It exposes and examines how cinchona and knowledge of it travelled across and between societies within, or tied to, the Atlantic World by setting out the structure, volume and reach of trade in cinchona. Though scholarship on the general volume of Spanish bark trade,⁷ as well as the Crown’s inability to generate significant profits from it,⁸ is quite extensive, the geography of that commerce beyond Spain and within the various consumer societies around 1800 has hitherto received little comprehensive attention.⁹ Drawing on regional accounts of bark consumption as well as on trade statistics, medical treatises and the extensive Spanish administrative record on the subject, this chapter charts the bark’s material availability by means of commerce and contraband as well as concomitant, non-commercial forms of distribution – charitable giving, medical relief programmes and diplomatic gift exchange – between 1751 and 1820. Preparing the ground for subsequent chapters concerned with the movement of consumption practices and expertise in indications, the chapter outlines, in the first part, the catchment and volume of Atlantic trade in the bark. In the second part, the chapter sketches the trade’s routes and its reach, from the Spanish and Portuguese American possessions to North America and the Caribbean, Europe, northern and coastal Africa and the eastern Mediterranean, as well as the eastern reaches of the Spanish, Portuguese and Dutch empires in South and East Asia. The third part of the chapter is concerned with the trade’s social reach within these societies – with the inner contours of the ‘ailing mankind’¹⁰ that benefitted from that remedy. As various historians have argued, though medicine trade across the Atlantic basin was lively and extensive around 1800, a set of substances – rhubarb,¹¹ opium¹² and cowpox lymph¹³ – stood out for their exceptional importance, that is, their higher consumption and their wider reach.¹⁴ The Peruvian bark was commonly the most valued and used of them from the Americas.¹⁵ It was thus, the chapter holds, though perhaps not quite the single ‘most important, and usual remedy that medicine possesse[d]’, yet one of the best-known and most peripatetic medicinal substances to run through the warp and weft of Atlantic trade in pharmaceuticals during the late 1700s and early 1800s. Its journeys offer, as such, an important and rare window into the reach and workings of plant trade, epistemic brokerage and therapeutic exchange in that period.

World Bark Trade

According to the trade series compiled by Antonio García-Baquero González in his classical Cádiz y el Atlántico (Cádiz and the Atlantic), Spain imported a total of more than 223,932 arrobas – equalling 2,575 tons, on average 83 tons per annum – of cinchona from all of its Spanish American ports between 1747 and 1778, alongside various other medicines: 64 tons of various purges, 5 tons of copal, 3.9 tons of balsams, 7 kilograms of contrayerba and 4 tons of sarsaparilla.¹⁶ At the time, most of the bark came to Cádiz – Spain’s key port for the monopoly trade with the Americas from 1717 to 1778 – from the Viceroyalty of Peru, from whence it would have sailed the route around Cape Horn.¹⁷ The exploitation of America’s natural resources by the Spanish Crown had reached unprecedented heights by the second half of the eighteenth century, principally under the rule of Charles III (1716–1788, r. 1759–1788),¹⁸ and the Crown’s efforts to increase cinchona imports had by then already borne fruit. According to García-Baquero, between 1717 and 1738 Spain had only imported a total of some 24,293 arrobas – 279 tons, some 13 per annum – of cinchona.¹⁹ In recent years, various historians, adducing additional documentary evidence, have adjusted García-Baquero’s figures upwards, suggesting that Cádiz imports may have been, at least for some periods of time, significantly higher than the amounts established to date. Studies have suggested that 314 tons reached Cádiz in 1755,²⁰ a year for which García-Baquero had counted 291 tons, 23.4 tons in 1769,²¹ a year for which García-Baquero had calculated 5.4 tons, and more than 259 tons per annum between 1761 and 1775,²² a 14-year period for which García-Baquero had assumed an average of 63.5 tons per annum. These figures may be precipitate, but they suggest that García-Baquero’s are, at the very least, conservative figures. In the era of free trade between 1778 and 1796, when other peninsular ports were allowed to trade with Spanish America, cinchona commerce flourished along with an overall growth in imports from Spanish America.²³ Spanish merchants, according to recent historical studies, handled an average of more than 321 tons of cinchona per annum between 1775 and 1779, some 137 tons in the 5 years between 1780 and 1784, an average of 451 tons per annum in the years 1785 to 1789, and 224 tons per annum between 1790 and 1794.²⁴ Warfare would have caused serious temporary disruptions in the flow of trade, as the historian Miguel Jaramillo Baanante has argued, and may well account both for the decline in imports over the 5-year period between 1780 and 1784 – Spain entered the Anglo-French War (1778–1783) in 1779 – and their steep rise between 1785 to 1789, owing to stocks that would have accumulated during the war.²⁵ As Jaramillo Baanante has suggested, the normal volume would have oscillated around the 224 tons of the subsequent 5-year period (Figure 2.1).²⁶ Peninsular ports received the largest share of Spain’s bark imports. Other lesser, official transportation routes, however – along the continent’s shores to ports in the Viceroyalties of New Spain, to the Spanish Philippines, or the United States²⁷ – would have added to the roughly 220 to 230 tons of cinchona traded legally and formally every year during the late 1700s.

Figure 2.1 Volume of official cinchona exportations to peninsular ports, with 5-year averages.

Adapted from Miguel Jaramillo Baanante, ‘El comercio de la cascarilla en el norte peruano-sur ecuatoriano: evolución de impacto regional de una economía de exportación, 1750-1796,’ in El Norte en la Historia Regional. Siglos XVIII-XIX, ed. Scarlett O’Phelan Godoy and Yves Saint-Geours (Lima: IFEA-CiPCA, 1998), graphic 1.

There is agreement among historians that the amounts of cinchona handled by Spanish merchants were but a fraction of the overall volume of bark trade. Though the exact routes and the volume of illegal trade in cinchona elude us – the difficulty of following cinchona onto a contrabandist’s vessel or through the bustle of a marketplace renders any mapping or quantification necessarily fragmentary – the paper trail in Spain’s archives leaves little doubt that foreign merchants handled a significant volume of contraband and that Spain faced ‘much difficulty’ in closing the trade’s many ‘gateways and entries’.²⁸ Portuguese, British, Dutch and French contrabandists, overcoming the Spanish government’s efforts to restrict trade with its colonies, frequently acquired cinchona directly from the harvesters in the Viceroyalties of New Granada and Peru. The inhabitants of the Dutch colonies of Surinam, Berbice and Essequibo in Guyana, for instance, were often accused of entering the Orinoco River ‘under the pretext of fishing’, and of trafficking cinchona in exchange for clothes with the harvesters.²⁹ For the latter, the attraction of selling their yield to smugglers and other unauthorized buyers presumably lay both in their more liberal pay and lesser concern with quality. As the governor (corregidor) of Loja, Pedro Xavier de Valdivieso y Torre (d. 1786, r. 1773–1784), put it, Loja bark cutters could always be sure to sell their yield to contrabandists who, ‘unconcerned with [the bark’s] quality (sin reparar en calidad)’, paid ‘three, and four pesos for an arroba’,³⁰ where Crown officials would confiscate barks on account of their supposed worthlessness, and ‘pretend to burn them’.³¹ Several of the foremost cinchona merchants in Cuenca and Loja were also repeatedly accused of engaging in contraband with foreigners.³² The Archbishop and Viceroy of New Granada, Antonio Caballero y Góngora (1723–1796, r. 1782–1789), was convinced that ample contraband in cinchona passed through the territories occupied by the Guajiros – one of many areas in the Americas the Spanish Crown controlled but nominally – along the River Hacha.³³ The Guajiros, ‘the most troublesome tribe in the viceroyalty of New Granada’ in the eyes of contemporary observers, were ‘numerous and bold’, and as ‘a commercial tribe’ were known to have ‘considerable intercourse with the British and Dutch, who provide them with goods, slaves, and fire-arms’.³⁴ Another gateway for cinchona smugglers that Spanish officials found it difficult to close was the border with the Portuguese Viceroyalty of Brazil. Officials frequently reported that Portuguese contrabandists shipped cinchona out of the Andes via the Marañon River in quantities sufficient to ‘fill the entirety of Europe with it’.³⁵ With its source in the Andes, the Marañon runs northwest along the eastern base of the Andes before it turns eastward to meet the Ucayali River, together forming the Amazon River, which flows into Portuguese territory. Other instances of contraband apparently happened outside the harvest areas, at the stopovers along cinchona’s shipping routes. Theft of legal exports was common, with the bark’s lightness and low volume – it was usually shipped in the shape of fine, dried chippings – making it an easy target for small-scale smuggling. Spanish pharmacists often complained that boxes of cinchona reached them half empty, with evident traces of having been opened elsewhere – their nails removed or their leather straps cut – and with the cinchonas in them ‘replaced with other rotten, dirty’ barks.³⁶ In the late 1700s, Spanish officials persistently sought to avoid the exportation of cinchona through the empire’s Caribbean ports. The Caribbean, with its many isolated beaches and coves, and with the major European colonial powers controlling multiple non-contiguous territories, was at the time the ultimate place for merchants to transgress the policies and statutes that impeded their ability to transact exchanges with one another.³⁷ The exportation of cinchona via Ocaña, on the Magdalena River northwards to the Caribbean port of Santa Marta, for instance, though it was comparatively inexpensive, was usually discouraged because it had the disadvantage of attracting contraband from ‘foreign islands’.³⁸ So was the bark’s extraction through the ports of Portobello or Cartagena.³⁹ The British colony on the island of Grenada in the south-eastern Caribbean – ceded to Britain by the treaty of Paris in 1763 – was generally thought to serve as a key entrepôt for contraband trade with cinchona,⁴⁰ as was Curacao, the most important Dutch transhipment port for illicit trade.⁴¹ In other cases, shipments of cinchona coming from Spanish America were taken by British galleons. A Spanish shipment was taken just outside Cádiz in 1804,⁴² and the same occurred with a shipment destined for Bordeaux in 1793, the contents of which went to public auction in Liverpool.⁴³

Though the magnitude of illegal smuggling and theft of legal imports is, by nature, elusive, there is evidence to suggest that it by far surpassed the volume of Spain’s official trade. ‘From the newspapers’ and trade bulletins that were published in ‘London, Amsterdam, and elsewhere’, from the ‘observations of foreign commerce confirmed by men very versed in it’, and from the ‘large amounts of the most select cinchona that were extracted furtively’ and traded ‘by the British, the Dutch, the French, and the Danish’, Spanish officials estimated that from the total volume of trade with ‘a plant that grows only in the dominions of His Majesty’, Spanish merchants handled, by the late 1700s, possibly half, possibly one-third, or as little as one-sixth.⁴⁴ Contemporary estimates of the overall harvest yields in some measure support these proportions. José Ignacio de Pombo (1761–1815), a spokesman of Cartagena’s merchant guild, estimated that by the year 1800 the overall quantity of cinchona harvested in the Viceroyalties of New Granada and Peru amounted to some 2.5 million libras – that is, 1,150 tons –⁴⁵ five times the 220 to 230 tons handled legally, and officially, by Spanish merchants in the late 1700s and early 1800s. Contemporary observers’ estimates may have been a long guess, but other figures corroborate their sense that the volume of illicit trade in cinchona was a multiple of the legal volume. In 1776, a year in which, according to García-Baquero, 395 tons of bark reached Cádiz, just the 38 most important Cuenca merchants, forced to declare their possessions by royal decree, were found to be holding 618 tons of bark harvested in the Cuenca area – a significant portion, but surely not equal to the overall amounts extracted from the two Viceroyalties.⁴⁶ Calculating even with the by all accounts moderate estimate of foreign, illicit trade surpassing Spanish trade by a one-to-two ratio, the total bark trade volume would have oscillated around 450 tons per annum in the late 1700s and early 1800s. That estimate matches the calculations of Manuel Hernandez de Gregorio, the King’s Apothecary, who wrote in 1804 that free trade in the bark then amounted to between 800,000 and 1 million libras – that is, some 368 to 460 tons – and that it appeared to him ‘to increase further proportionate with an upsurge in [the bark’s] uses’.⁴⁷ Calculating with less moderate estimates, the overall bark trade volume may well have amounted to, or surpassed, de Pombo’s 1,150 tons. At any rate, as with other export sectors on the Atlantic seaboard of the New World – tea, cotton or tobacco – with cinchona, ‘contraband dwarfed legal exchange’.⁴⁸

Towards the early 1800s, the Spanish American territories were threatened with losing even their natural monopoly on the bark. While the Caribbean cinchonas that resulted from the British and French commercial quest for substitutes were for the most part quickly discarded,⁴⁹ the cinchona species discovered on Brazilian territory in 1805 as the result of a two-decades-long quest were more auspicious. During the 1790s in particular, the Portuguese Crown had not only naturalists but also colonial bureaucrats, clergymen and militia sergeants search Brazil’s ‘hinterlands’ (sertões) and make inquiries among the ‘persons of greater discernment’ about trees resembling cinchona in appearance – prints of cinchona trees were issued for that purpose – in taste, or in terms of usage, that is, plants that were employed as febrifuges.⁵⁰ By decree of the prince regent, Dom João VI (1767–1826, r. 1799–1826), tree bark taken for cinchona was dispensed in ‘the hospitals, even the military ones, of these realms’ in 1804 to gain ‘a proper understanding of its virtues’ (o devido conceito das virtudes), by having doctors and surgeons conduct ‘exact, and repeated observations’ by means of a general, extensive administration, to decide ‘the use, and consumption’ of the ‘bitter Brazilian barks’.⁵¹ Even though tree bark taken for cinchona from the captaincies of Pernambuco, Oeiras do Piauí, Maranhão and Bahia was gathered and shipped to the metropolis, the Portuguese court and the empire’s military and naval hospitals from the 1780s onwards, both historians and contemporaries have tended to assume that none of the plants discovered before 1805 was a cinchona variety.⁵² According to the historian Vera Regina Beltrão Marques, it was only in 1805 that two cinchona varieties – Cinchona macrocarpa and Cinchona pubescens – were found in Rio de Janeiro. They were classified in 1806 and reconfirmed in 1811 by a commission consisting of, among others, Bernardino António Gomes (1768–1823).⁵³ It appears that, at least temporarily, these Brazilian and, in some measure, also some Caribbean barks, albeit in small amounts and with a low profile, entered commerce – as cinchonas, or as creditable substitutes – and added further to the between 450 and 1,150 tons of cinchona in circulation.⁵⁴

For these trade volume figures to become meaningful, and to ascertain how many people contemporaries’ ‘humanity’ comprised, it is critical to understand how much cinchona was generally administered to a sufferer. While vernacular manuals, domestic recipe collections and medical treatises almost invariably offered precise counsel on the individual doses of bark required and their rate of application, sources rarely fixed an overall requisite quantity of cinchona to be administered. Rather, recipe collectors, physicians and apothecaries in different parts of the world were in agreement that the quantity of bark necessary for a cure was ‘very different in different cases’.⁵⁵ Several writers advised, in case the suggested dose did not cure the sufferer, to ‘repeat the same procedure’,⁵⁶ administer a second or third dose,⁵⁷ or simply continue the administration of the medicine at regular intervals for as long as necessary. As Lady Eleanor Dundas (d. 1837) of Carron Hall put it in her recipe book, one was to ‘repeat the medicine’ ‘untill [the Patient] misses the fit’, or as the authors of the Edinburgh new dispensatory phrased it, ‘till the paroxisms cease[d]’ and the sufferer’s ‘appetite, strength, and complexion return[ed]’.⁵⁸ The authors’ method of adjusting dosage to the sufferer’s condition not only responded to differences in the ‘obstinacy’ (Hartnäckigkeit), or rebelliousness of fevers, and other ailments. It also complied with the period’s general emphasis upon the variability of individual constitutions and the resultant necessity of tailoring dosage to the patient’s individual needs.⁵⁹ To ascertain standard dosage, at least approximately, one can only rely on the authors’ references to the maximum quantities administered, the average doses dispensed or the doses found most beneficial in the clinical observations and experiences conducted at the time to evaluate treatments. Most Spanish American medical treatises, advice literature and recipe collections, for instance, advised doses ranging from half a drachm – less than 2 grams – to 1 ounce – some 29 grams – that is, less than 16 grams on average.⁶⁰ In Europe, with bark of low quality or in particularly violent illnesses, physicians occasionally saw themselves forced to administer by their own standards extravagant doses to effect a cure.⁶¹ Experienced medical practitioners implicated in putting different or newly discovered varieties of cinchona on trial to gain ‘a proper understanding of their virtues’,⁶² however – at the Lyon Grand Hôtel-Dieu hospital, the Spanish Court or London’s Royal College of Physicians – generally recommended, like their Spanish American counterparts, doses ranging from half a drachm to one or two ounces.⁶³ So did medical practitioners in societies within or adjoining Europe’s colonial, evangelizing and commercial entrepôts in North America, the eastern Mediterranean or western Africa. From surgeons in Portuguese Angola who prescribed an ounce and a half of the bark⁶⁴ to Ottoman doctors in Bursa who administered doses ranging from 8 to 16 drachms, that is, 25 to 50 grams,⁶⁵ to physicians in the West Indies who generally administered 2 ounces of the bark,⁶⁶ medical practitioners the Atlantic World over would have agreed that more than 2 ounces of bark was an unduly large dose and that less than half a drachm was too low a prescription. Assuming that doses fluctuated around an average of 30 grams in societies rimming the Atlantic basin, the around 450 to 1,150 tons of bark traded per annum could have been administered in 15 to 38 million sickness episodes every year in the decades around 1800. At a time when Europe had a population of some 80 to 90 million – England, the Netherlands, the Habsburg territories, France, the Italian peninsula and Spain had 71.7 million inhabitants in 1750 and 121.7 million in 1850 – and the world a population of between 771 and 954 million inhabitants,⁶⁷ the bark might, potentially at least, have reached a rather substantial portion of humanity.

Geographies of Consumption

There is overwhelming evidence that the bulk of these hundreds of tons and millions of doses of cinchona would have gone into the broader European markets, with a shifting tangle of Amsterdam,⁶⁸ Marseille,⁶⁹ Hamburg,⁷⁰ London⁷¹ and Genoese merchant houses – the latter supplied ‘not only all of Liguria’ with cinchona from Cádiz, but also the remainder of the Italian Peninsula, the Swiss Confederacy and part of the Levant⁷² – redistributing the bark from its ports of entry across Europe. By the late 1700s and early 1800s, cinchona was part of the standard medical repertoire across Europe, from the electorate of Hannover⁷³ to the Kingdom of Portugal,⁷⁴ from the Dutch Republic⁷⁵ to Habsburg Transylvania.⁷⁶ It was available not only in trading hubs and capitals, but also in more provincial towns and cities such as Portuguese Évora,⁷⁷ Bender, in the Ottoman principality of Moldavia⁷⁸ and Brunswick, in the Hannover Electorate.⁷⁹ The bark held pride of place among medicinal imports from the Americas in many areas. It made up 40 per cent of all direct American drug imports into England after 1720, for instance,⁸⁰ and was among the most common and renowned of all foreign remedies – arriving, other than from the Americas, from the Levant or the territories bounding the Indian Ocean – in European pharmacies and dispensaries like the Hôtel-Dieu de Carpentras⁸¹ or the Hospital Escolar da Universidade de Coimbra.⁸² Indeed, the value and weight of cinchona imports into important transhipment ports like Cádiz,⁸³ Hamburg⁸⁴ and London⁸⁵ were often greater than those of any other – or most, in the latter case – medicinal substances, and invariably larger than those of any other American medicine, be that ipecacuanha, ‘Virginian snake-root’ or guaiacum. In some parts of Europe ‘not a single’ foreign plant remedy was employed ‘as often and in such large quantities’ (so oft und dabei in so grosser Menge) as cinchona, as the Mainz doctor Johann Claudius Renard put it in 1809,⁸⁶ or, as the Milan author Luigi Castiglioni (1757–1832) phrased it, ‘could compare to cinchona (kina-kina), […] for the extensive use made of it to this day’.⁸⁷ Levels of cinchona consumption were high, even ‘absurd’ (ungeheuer) in some parts in the eyes of contemporaries.⁸⁸ In peninsular Spain, with a population of 10.4 million in the late 1700s,⁸⁹ domestic consumption amounted to at least 20 tons per annum by 1792,⁹⁰ enough for 1.3 million doses. The amounts of cinchona imported into England during the 1750s, in turn, provided between 300,000 and 1,186,000 doses, and between 112,000 and 449,000 doses during the 1770s,⁹¹ at a time when England had but around 6 million inhabitants.⁹²

Cinchona was widely available across the Spanish and Portuguese American possessions, too. It could be obtained from any well-stocked pharmacy in the Viceroyalties of New Granada,⁹³ New Spain⁹⁴ and Peru – in Lima, but also in provincial towns like Trujillo, Pisco, Ica, Huancavelica, Moquegua and Cuzco⁹⁵ – as well as in Brazil, where cinchona and cinchona-based compound medicines were sold from Rio de Janeiro to Bahia and from Pernambuco to Maranhão.⁹⁶ Contemporary estimates suggest an annual consumption of some 12,000 libras,⁹⁷ around 344,000 doses, for the entirety of Spanish America, at a time when these dominions had about 13.5 million inhabitants.⁹⁸ Internal consumption in the Viceroyalty of Peru would appear to have been comparatively low, too, amounting to between 0.4 and 1.4 tons of cinchona – between 25,000 and 86,000 doses per annum – that is, less than 1 per cent of the overall exports.⁹⁹ Actual consumption may have been higher than official figures suggest, however. Given that colonial officials often complained that the bark was sold on the streets and ‘on Fridays in the marketplace’ in cities like Santa Fé, and in the ‘villages adjacent to the hills’ where it was harvested,¹⁰⁰ we may venture to presume that cinchona was distributed through a variety of formal and informal channels in Spanish and Portuguese America by the late 1700s and early 1800s. It was likely employed in far more than the – 25,000, 86,000 or 344,000 – sickness episodes per annum that official trade figures would have allowed for.

A substantial share of British, Portuguese, French, Dutch and Spanish cinchona imports was re-exported to these Atlantic realms’ imperial, commercial and evangelizing entrepôts – primarily in the Caribbean and North America, along the African coast and in South and East Asia.¹⁰¹ The British, Dutch and French West Indies were important consumer markets for the bark.¹⁰² So were the British and French North American colonies – or, after 1776, the United States – with New England pharmacies, Louisiana hospitals’ provisions and plantation medicine chests in the antebellum South encompassing cinchona as a staple.¹⁰³ Portuguese merchants shipped bulk quantities of cinchona and cinchona-based medicines to its Lusophone enclaves along the African coast – to Mozambique, Benguela and Luanda, western Africa’s largest slaving port – and to Timor, Goa and Macao, leased from China in 1557.¹⁰⁴ So did the Dutch West and East India companies (Vereenigde Oost-Indische Compagnie, or VOC; Geoctroyeerde Westindische Compagnie or WIC), which transported cargoes of cinchona to the Dutch Antilles, the Guyana colonies, the forts and lodges on the Gold Coast of West Africa and the Dutch East Indies.¹⁰⁵ British trade companies, according to contemporary statistics, re-exported in the five years from 1789 to 1793 some 123,779 pounds of cinchona – between 3.7 and 1.9 million doses – to Britain’s ‘colonial possessions in the East and West Indies’.¹⁰⁶ Spanish American exports of cinchona ointments, powders and extracts and of unprocessed red, white and orange bark from Acapulco via the Manila galleon,¹⁰⁷ in turn, though by all accounts small in comparison to Cádiz-bound freights, were presumably both destined for the Spanish settler population on the Philippines and resold to China via Cantonese merchants, whose intermediation allowed traders from Spain and Spanish America to participate in Asian commercial networks.¹⁰⁸

Indeed, cinchona was widely consumed not only in Europe’s colonial, evangelizing and commercial entrepôts in the Atlantic World but also far beyond. Its use was popular and prevalent wherever Iberian and English, Dutch or French imperialism, proselytizing and trade intersected with, or submitted to the rules of, other – Levantine, Mediterranean and Cantonese – trade networks. The bark came to the knowledge of Chinese physicians from the cosmopolitan, populous maritime entrepôt of Canton and from the ‘barbarians at Macao’¹⁰⁹ – a term that presumably encompassed both Portuguese settlers and members of the Jesuit order who, before their expulsion from all Portuguese territory after 1759, had popularized cinchona from their pharmacy at St Paul’s College (Colégio de São Paulo) in Macao.¹¹⁰ Other than through the veins of Portuguese medicine trade,¹¹¹ Chinese sufferers would also have procured the bark through Spain’s Asian commerce in the bark, a sector that Spanish officials were eager to expand in the late 1700s.¹¹² Cinchona was also among the few goods imported into Nagasaki, Japan’s only governmentally sanctioned point of entry for foreign merchants, by the Dutch East India Company. Following the expulsion of the Portuguese in 1638, only Chinese merchants and representatives of the Dutch East India Company were allowed to enter Japan to engage in trade, and the commodities brought were dictated by the – usually rather explicit – requests and regulations of the shogunate.¹¹³ In the Maghreb, cinchona had long been a valued remedy, which its inhabitants obtained through the region’s long-standing participation in Mediterranean trade and contraband with Genoa, Catalonia, Marseille and Venice – and later, Britain, Denmark and France – and also from the Spanish pharmacies in Melilla and the Peñón de Alhucemas, just off the Moroccan coast. Madrid’s Royal Pharmacy often supplied Spanish apothecaries directly with the necessary medicaments – among them, at times, several hundred kilograms of cinchona.¹¹⁴ Other ‘oriental nations’, according to Spanish cinchona merchants’ complaints, procured ‘this excellent febrifuge’ through English and other European exporters at the Smyrna market, in the Ottoman Empire.¹¹⁵ According to Ottoman physicians, the bark had at first been known only in Constantinople,¹¹⁶ but by the early 1700s, ‘sailors and other travellers had popularized it far beyond […], in other towns and lands’.¹¹⁷ The city of Smyrna on the Aegean coast was not only, according to contemporary observers, itself an important consumer market for the bark, but also a cosmopolitan entrepôt whence cinchona was ‘distributed (se derrama) throughout the Asian portion of Turkey (la Turquía Asiática), in very large quantities (en muy gruesas quantidades)’.¹¹⁸ Smyrna had long attracted factors from Amsterdam, London, Marseille and Venice as well as Ottoman Armenian and Jewish merchants. It remained, by the late 1700s and early 1800s, an important entrepôt provisioning Anatolia and the Syrian and Persian markets with produce from western Europe.¹¹⁹ The population of the sprawling Ottoman Empire – extending, at the time, from Bosnia in the west to the Mesopotamian provinces of Basra, Baghdad and Mosul in the east – also procured supplies of the bark through the port of Cairo. Hundreds of kilograms reached the Ottoman palace from that Mediterranean entrepôt every year in the early 1800s.¹²⁰ The volume of Chinese, Moroccan, Japanese and Ottoman cinchona commerce, in part because it largely consisted of contraband, is elusive, but there can be little doubt that consumption and demand, ‘in the countries in Africa and Asia (los países de África y Asia)’ where cinchona was known, and which European merchants frequented, was significant.¹²¹ As Miguel de Jijon y León (1717–1794) put it in 1776, the bark was ‘of the greatest necessity and, use, all over the world’ (de tan precisa necesidad y uso en todo el Mundo), but ‘particularly among the Asians’ (especialmente entre los Asiáticos)¹²² – a term that encompassed, by the late 1700s, not only the inhabitants of the Chinese and Mughal empires and Tokugawa Japan but also men and women of Arabic, Turkish or Persian extraction (Figure 2.2).¹²³

Figure 2.2 Some of the world’s principal commercial entrepôts and urban consumer markets for cinchona in the late 1700s and early 1800s.

Limits to Distribution

Cinchona not only reached geographically disperse societies. The social depth of its consumption was just as varied and wide. Among the world’s ruling elites, cinchona was widely known by the late 1700s and early 1800s. The shogunate in Japan,¹²⁴ the Tsar and his kin in Russia¹²⁵ and the Kangxi Emperor in China¹²⁶ valued and kept supplies of the bark for their own use. So did some ruling families in British and Mughal India: Muhammed Ali Khan, the Nawab of Arcot (1717–1795, r. 1749–1795), for instance, had the British physician Paul Jodrell (1746–1803) administer the bark – to good effect – in the treatment of his youngest son.¹²⁷ The Moroccan ‘Alawi court likewise prized cinchona. Gift exchange was assiduous between Charles III and the Sultan of Morocco, Mohammed Ben ‘Abd Allāh al-Khatib (1710–1790, r. 1757–1790), with Spain and Morocco alternately making and breaking diplomatic arrangements between 1767 and the Aranjuez Convention in 1780.¹²⁸ When the sultan chose his gifts from Spain in 1771, his list encompassed books about astronomy and globes, sweet cinnamon pepper and nutmeg bark, and also a number of plant-based remedies from Spanish America that the Sultan – who relied on Spanish medicine for his family’s health – apparently was accustomed to using: jalap root, various balsams and ointments ‘to reduce fleshiness’ and to close wounds, and cinchona.¹²⁹ Following the time-honoured practice of sumptuary gift-exchange in Eurasian diplomatic etiquette, under Charles III the Spanish court gave away hundreds of kilograms of select cinchona, usually together with tobacco, vanilla and chocolate, from the Royal Pharmacy every year as gifts to foreign ministers, allied courts and the monarch’s relations.¹³⁰ On the Italian Peninsula, the king’s finest cinchona reached the courts of Naples and Sicily, Tuscany and Venice,¹³¹ the Duchy of Parma and Piacenza in northern Italy¹³² – with their dependent territories under Spanish Bourbon rule from 1732 to 1808 – and the Pope and the Spanish ambassador at the Holy See, ‘out of filial affection’.¹³³ Charles III also regularly bestowed cinchona upon Holy Roman Empress Maria Theresa (1717–1780, r. 1740–1780) in Vienna, who could not thank him enough for a ‘gift of such a precious medicine, so rare when one wants it of excellent quality’.¹³⁴ Maria Anna Sophia of Saxony (1728–1797), widow of the Bavarian Elector Maximilian III (1727–1777, r. 1745–1777), often reminded Charles III of his duties as her brother-in-law, if his regular remittances of cinchona and Spanish tobacco, both so ‘vital for her health’, were ever overdue.¹³⁵ Already under the Spanish monarch Ferdinand VI (1713–1759, r. 1746–1759), gifts of cinchona had reached the courts of the Netherlands¹³⁶ and Denmark.¹³⁷ French, Habsburg and Portuguese ambassadors at the completion of their tour of duty at the Spanish court usually received cinchona among their presents,¹³⁸ and when the Ottoman ambassador Ahmet Vâsif Efendi (c. 1730–1806) left the Spanish Court in 1788 to return to Constantinople, Charles III bestowed upon him diamonds, vicuña cloth, a golden chest adorned with diamonds on green enamel, fine crimson cloth and ‘two arrobas of cinchona in four small boxes’.¹³⁹ In 1784, on the occasion of a Treaty of Neutrality signed with the Ottoman Empire, Charles III sent a small Spanish fleet to Sultan Abdülhamid I’s (1725–1789, r. 1774–1789) court in Constantinople with a series of precious gifts.¹⁴⁰ ‘Amongst other things for the Sultan’, the gifts included gold tableware, silver artefacts, embroidered satin and velvet cloth, and chocolate, vanilla, tobacco and cinchona laid out in ‘curious boxes’.¹⁴¹ Charles III had long sought good relations with the Ottoman Empire to institute direct trade links with the Levant, avoiding British and French intermediaries, and he and his ministers may well have taken advantage of the occasion to showcase cinchona as a Spanish product. At the same time, however, they would have taken a great deal of care in selecting the gifts for the Ottoman sultan to avoid any blunder in a long-awaited diplomatic alliance. They must have been materially certain the sultan would be familiar enough with the bark to recognize it instantly as a precious medicinal substance and that it would delight him as much as the gold, chocolate or velvet they bestowed along with it. By the late 1700s and early 1800s, cinchona bark was a medicinal substance sufficiently renowned to be valued, and prized, by the upper strata of Ottoman, Habsburg and Mughal societies alike, but also one that, so it would seem, was not so abundantly available of excellent quality as to render a gift in them unnecessary or unwelcome.

Cinchona’s close association with gold, satin and velvet was not imaginary or purely symbolic. Though Spain did not capitalize significantly on the bark – even between 1782 and 1796, cinchona amounted only to 1.4 per cent of all of Spain’s imports in value¹⁴² – the bark cost practitioners and sufferers a high price. Cádiz merchants sold the bark at 8 reales per libra between 1747 and 1762, at a time when stimulants like coffee cost 1.6 reales per libra in Cádiz and when chocolate sold for 2.5 reales per libra. Bark prices rose further over the later decades of the eighteenth century. Cinchona sold at 16 reales per libra in 1778, at 23 reales per libra in 1793, and at 28 reales per libra by 1794.¹⁴³ Prices soared on occasion, owing to temporary dislocations in supply and demand¹⁴⁴ or the sudden rise in popularity of particular bark varieties. In 1786, ‘coloured cinchona bark’ (quinas coloradas), harvested in the provinces of Cuenca, Riobamba, Guaranda, Alausí and Guayaquil, became so popular that English merchants paid up to 60 reales per libra for it in Cádiz.¹⁴⁵ Cádiz prices were a multiple of the amounts paid in the harvest areas, in transfer sites like Piura and Paita and in Lima,¹⁴⁶ and merchants, apothecaries and itinerant barber-surgeons added further markups to the cost of cinchona bark when reselling it to medical practitioners and end consumers. Apothecaries in cities like Rome or Lisbon, according to contemporary observers, ‘made double or triple profits’ (hacen una ganancia del doble, à del triple), from reselling cinchona, or cinchona-based medicines.¹⁴⁷ Bark prices were affordable, and appeared ‘very reasonable’,¹⁴⁸ to the upper and middle echelons of various consumer societies at the time – the gentry, clergymen or civil servants, and also many craftsmen, merchants, physicians, lawyers and freehold farmers – but surely not to the poor – the men and women whose resources were scarce, as de Rieux had phrased it. In late eighteenth-century England, at a time when a shilling a day was a fair wage for a worker, customers paid from 18 pence to 9 shillings for a pound of cinchona – a ‘variation founded upon a supposed comparative difference in their respective goodness’.¹⁴⁹ Similarly, in Portugal, the price of what physicians considered a curative dose of the best cinchona oscillated between 400 and 600 réis,¹⁵⁰ when skilled workers – carpenters, masons and painters – made 300 to 400 réis a day and labourers and farmhands between 120 and 200 réis.¹⁵¹ In the electorate of Mainz, red cinchona bark, then the most esteemed by local physicians, cost 55 Gulden a pound, while bark of lesser quality still cost between 9 and 25 Gulden.¹⁵² A worker’s, even an artisan’s, annual income then amounted to some 80 to 100 Gulden at most¹⁵³ and ‘only the wealthy’, according to the Mainz doctor Johann Renard, could at all afford red cinchona. ‘Families without fortune, artisans, manufacturers, people with a small income or families with many children’ could generally not, says Renard, afford any bark.¹⁵⁴ The authors of popular medical advice manuals and charitable pamphlets – John Haartman (1725–1788), whose ‘Clear Advice’ (Tydelig Underrättelse) addressed poor Finnish parishioners, or the Swiss Samuel Auguste André Tissot’s (1728 – 1797) 1761 ‘Advice to the country folk, with regard to their health’ (Anleitung für das Landvolk in Absicht auf seine Gesundheit) – unanimously recommended cinchona as the only secure remedy in fevers, but were well aware that the ‘common people’ (das gemeine Volk) would, for pecuniary reasons, often be unable or ‘reluctant to undergo a treatment’ (wird sich nicht so leicht dieser Cur unterwerfen) that resorted to the bark.¹⁵⁵

In and beyond Europe’s colonial, evangelizing and commercial entrepôts in North America and the Caribbean, coastal Africa, the eastern Mediterranean and South and East Asia, prices would commonly have been even higher than in the metropolis. High taxes and markups, as well as warfare and the low value placed on the New England currency, made medicines shipped to the British North American colonies far costlier than they were in London.¹⁵⁶ Surgeons of the Royal Navy could not afford to purchase the Peruvian bark in the West Indies – it sometimes cost ‘two guineas a pound’, around 42 shillings, four times the price paid back home in England – and petitioned for an ‘allowance of bark from government, while upon that station’.¹⁵⁷ Portuguese traders in Angola complained they could not make enough money to pay for the medicines of which they were ‘in daily need’.¹⁵⁸ Indeed, the price of bottled ‘English Water’ (Água de Inglaterra), a cinchona-based patent medicine popular throughout the Kingdom of Portugal and its overseas dominions, was higher in West African captaincies than back home in Portugal or in Brazil. While the English Water was available at 1,000 réis per bottle in Portugal from around 1772,¹⁵⁹ it was resold to the public in Portugal’s American overseas dominions at up to 4,000 to 4,800 réis, and at up to 6,400 réis in Angola and Benguala (Figure 2.3).¹⁶⁰ As a consequence, in 1809 the Portuguese government sought to regulate the price at 1,600 réis for every big bottle and 900 réis for every small bottle for ‘private commissioners in the captaincies of Rio de Janeiro, Bahia, Pernambuco, Pará, and Maranhão etc.’, and at 2,400 réis for every big bottle and 1,300 réis for every small bottle in the captaincies of Angola and Benguala.¹⁶¹ The English Water was presumably more expensive in the West African captaincies since very few ships sailed there from Portugal directly. The inhabitants of Angola and Benguela would have received most of their supplies of English Water via Brazil.¹⁶² Prices were comparable or even more moderate than in the metropolis only in the southern Spanish American Viceroyalties. Cinchona was costly in pharmacies – in Lima, by the late 1700s, sufferers paid one real for a dose of powdered bark,¹⁶³ at a time when even higher earners like chaplains and physicians made but some 3,000 reales per annum¹⁶⁴ – but it was likely more affordable from other suppliers. Given that cinchona was administered in the potions of slave healers in Tucumán, in the Viceroyalty of Rio de la Plata,¹⁶⁵ and used in all kinds of fevers by Indian healers in the Quito Audiencia,¹⁶⁶ it was presumably available at a more favourable price from peddlers or herbalists, on the streets and in marketplaces, with ties to the harvest areas.

Figure 2.3 Approximate market prices in réis for bottles of ‘English Water’ (Água de Inglaterra) between 1772 and 1809, at a time when that medicine was fabricated in Portugal and exported to the West African captaincies of Angola and Benguella via Brazil.

Data from Sousa Dias, A água de Inglaterra, 45; Documentos régios; Enformes que deram os Medicos d’esta Corte, 56.

Even though those whose resources were scarce in places like New England, Finland and Angola could generally have ill afforded cinchona, those within the reach of religious orders, private charity and increasingly systematic medical relief programmes would still have had access to the bark. The Spanish Crown, in conjunction with a wider reform in the state’s understanding of its responsibilities towards the population, developed a comprehensive system of free-of-charge medical attention during the late 1700s that encompassed the distribution of medicines from the Royal Pharmacy among religious convents, localities afflicted by epidemics on the Iberian peninsula, in its American empire and beyond,¹⁶⁷ and hospitals – at a time when hospitals were still fundamentally charitable institutions, places of shelter for those who were poor and ill or near death.¹⁶⁸ Cinchona remittances regularly reached the Discalced Franciscans of Ciempozuelos, whose vows of poverty prevented them from purchasing cinchona for their confreres,¹⁶⁹ ‘sick paupers’ (enfermos pobres) in Santa Fé’s San Juan de Dios Hospital,¹⁷⁰ and Jerusalem’s Franciscan monasteries, to cure tertian fevers among the ‘ailing friars that live in the convents of these holy sites’.¹⁷¹ The Spanish Crown was not the only government to dispense free cinchona to sick paupers. The Portuguese Crown was likewise frequently called upon, and granted, cinchona or cinchona-based medicines to sickly localities, from Estremadura¹⁷² to Angola.¹⁷³ Cinchona preparations were also distributed by the monarchs of Islamic societies, in which medical aid was likewise a recognized act of benevolence and charity.¹⁷⁴ When an epidemic was raging in the sultanate of Morocco in 1799 and 1800 – in Marrakesh, Tangier, Meknes and Tétouan, in particular – Sultan Mawlay Sulayman (1766–1822, r. 1792–1822) had it combated by means of cinchona-based preparations, courtesy of the Spanish monarch Charles IV (1748–1819, r. 1788–1808).¹⁷⁵ Religious hospitals also frequently expended large quantities of the bark: the charitable Hôtel-Dieu de Carpentras in southern France,¹⁷⁶ for instance, and Rome’s ‘Hospital of the Holy Spirit’ (Ospedale di Santo Spirito), which used some 6 tons of cinchona bark between 1778 and 1785.¹⁷⁷ Religious orders were important pharmaceutical suppliers of the bark in the late 1700s and early 1800s, too, and several of them would have dispensed the bark charitably: pharmacies pertaining to Capuchin monasteries in Solothurn, in the Basel diocese,¹⁷⁸ to the Cistercian order in Eger, in the Habsburg-ruled Kingdom of Hungary,¹⁷⁹ and to the Jesuit order, the networks of which stretched from Büren to Macao, from Lima to Rome and from Milan to Goa.¹⁸⁰ Medical poor relief programmes in northern Europe, where, from the Reformation onwards, provision of health care and poor relief came to be seen as the responsibility of the community as a whole,¹⁸¹ commonly avoided the more expensive foreign plant remedies and replaced them with cheaper, home-grown substitutes. Physicians were, however, frequently allowed and encouraged to administer cinchona and some other select remedies out of the public’s purse to sick paupers. Hamburg’s Paupers’ Pharmacopoeia, for instance, a paragon of pharmaceutical knowledge for the German territories at the time, encompassed expensive foreign drugs if they were considered indispensable or significantly more effectual than local substitutes. Quassia wood, Peruvian balsam, copaiba balsams and cinchona were thus administered to the poor on a regular basis.¹⁸² Since the lives of patients often depended upon it, as one contemporary physician phrased it, it was imperative that cinchona also be accessible to the poor.¹⁸³ In 1806, the charitable hospital in Mainz spent more than 1,000 Gulden, a small fortune at the time, for cinchona and cinchona-based remedies.¹⁸⁴ The world over, the distribution of free cinchona frequently also extended to men and women on whose utility or productivity masters and governments relied. Slaves in Ottoman households¹⁸⁵ and on plantations in the West Indies,¹⁸⁶ workers in Spanish mines¹⁸⁷ and servants on the Arabian Peninsula¹⁸⁸ were administered doses of the bark to restore their health and ability to work. From Marrakesh to Rome, from Jerusalem to Carpentras, in the late eighteenth and early nineteenth centuries, charity or economic expediency often entailed access to the bark even for those whose resources were too scarce to purchase it.

Rather than poverty or scarcity of resources as such, it was distance from the veins of cinchona’s passage – from colonial entrepôts, urban centres or charitable hospitals – that excluded men, women and children from the remedy’s consumption. Urban populations generally had better access to remedies on account of a higher concentration of wealth¹⁸⁹ as well as a greater density of suppliers – the number of fixed shops specializing in the distribution of drugs grew even faster than the medical profession between 1780 and 1900¹⁹⁰ – and particularly so to foreign plant remedies like cinchona. Outside the colonial urban centres in the Viceroyalty of New Spain – that is, Mexico City, Puebla, Guadalajara, Veracruz, Valladolid and Oaxaca –¹⁹¹ for instance, cinchona bark was barely available. Similarly, in Muscovy, though ‘generally employed’ for the cure of intermittent fevers in the capital, Moscow,¹⁹² along the Caspian Sea, on the Caucasian plains and in the Crimea, where apothecaries were scarce, ‘the poor and even many of the rich [were] unable to procure the bark’,¹⁹³ as they were in the commercially more isolated regions of north-western Europe. Finnish sufferers’ only source of supply for cinchona was Stockholm. Though severe ‘intermittent fevers’ (växelfeber) reigned in the south-western archipelago around Turku in the late 1700s – some 1,800 men, women and children died of these fevers between 1751 and 1773¹⁹⁴ – the district physicians who urged the administration of cinchona were well aware that most sufferers would be unable to procure the bark.¹⁹⁵ Even in states like Britain and in the Holy Roman Empire, in outlying rural areas where apothecaries were scarce, supply was more restricted and vulnerable, and particularly foreign drugs were not always to be had when wanted, by both patients and professionals.¹⁹⁶ In the rural areas near Mainz, as Renard put it, even those who could afford it, if they fell ill on their landed estates, could not rely on finding cinchona in ‘small village pharmacies nor in the pharmacies of the minor neighbouring towns’, nor in the medical supplies of country doctors.¹⁹⁷ By the late 1700s and early 1800s, many of the world’s royal courts, bazaars and port cities were part of a vibrant medical market that redistributed remedies like cinchona to ‘the four corners of the Earth’ (las cuatro partes del mundo).¹⁹⁸ More so even than a person’s social stratum, religious creed, or political belonging, it was his or her relative nearness to, or distance from, the boundaries and confines of that market that determined ‘what he or she could reasonably expect to have available as medical provision’.¹⁹⁹

***

Officials, physicians and naturalists concerned with the bark’s equitable distribution around 1800 were not the last to presume to speak and act in the name and for the betterment of a universal humanity. The British quest to smuggle and transplant cinchona seedlings during the 1850s, which put an end to the South American monopoly, was commonly portrayed as an act to rescue the tree from certain extinction at the hands of its ‘ignorant’, and ‘barbarous’ Andean keepers for the good of nature and mankind.²⁰⁰ Like these later schemes, which were, as historians have argued, about the good of British imperial troops and administrative personnel rather than humanity, governmental, commercial and scholarly efforts around 1800 were likewise in the service of a particular sort and sector of humanity. The boundaries of the universal humanity propagated in the treatises and decrees of Spanish officials, British physicians and French naturalists in late 1700s and early 1800s were, however, unlike later ones, neither national and imperial nor strictly social, religious or geographical. Millions of men and women around the Atlantic World and beyond, be they Ottoman courtiers, Hamburg paupers or Andean villagers, had by the late 1700s and early 1800s come to have access, and to assign a medical purpose, to dried shreds of cinchona tree bark. Rather, the contours of the bark’s availability were constricted and bound by physical and cultural distance from the veins of its passage: from the commercial, imperial and diplomatic ties and relationships that entwined its English, creole, Levantine and Portuguese distributors and that formed the trade’s volume, vigour and, above all, reach. The humanity propagated in the treatises and decrees of Spanish officials, British physicians and French naturalists encompassed a wide range of men, women and children, so long as they lived or moved in places tied to the wider world: in convents or at court, in hospitals or near seaports, beside marketplaces or in town. Cinchona reached societies from the North Sea Basin to the Gulf of Mexico and from the Gulf of Guinea to the Caribbean Sea, but it was commonly in the service of a rather particular sort, and sector, of humanity.