It was 1793. George Washington was President. Philadelphia was the U.S. capital. Dr. Benjamin Rush, a Philadelphia physician and former surgeon-general of Washington’s army, was the de facto head of the Department of Health of the new country.

When a yellow-fever epidemic hit Philadelphia, President George Washington fled to Virginia. Dr. Rush stayed behind and worked hard to quarantine and treat the sick. But his treatment, according to Ron Chernow in his biography of Alexander Hamilton, probably did more harm than good:

In treating yellow fever, Rush adopted an approach that now sounds barbaric: he bled and purged the victim, a process frightful to behold. He emptied the patient’s bowels four or five times, using a gruesome mixture of potions and enemas, before draining off ten or twelve ounces of blood to lower the pulse. For good measure, he induced mild vomiting. This regimen was repeated two or three times daily. (p. 449)

Secretary of the Treasury Alexander Hamilton stayed in the Philadelphia area, where both he and his wife caught yellow fever. But instead of submitting to Dr. Rush’s standard treatment, they found an old friend from the Caribbean, Dr. Edward Stevens, who quickly cured both of them using quinine, a treatment that he had learned about in Scotland and St. Croix. According to Chernow:

Having treated yellow-fever victims in the islands, Stevens dissented from the American dogma of bloodletting and bowel purges, which he thought only debilitated patients. He argued for remedies that were “cordial, stimulating, and tonic.” To strengthen patients, Stevens administered stiff doses of quinine called “Peruvian bark” as well as aged Madeira [a drink that has about 1 mg zinc per liter]. (p. 449)

Despite the best efforts of doctors Rush and Stevens, about 10% of the people of Philadelphia died of yellow fever, as compared to less than 1%, so far, in the countries hardest-hit by COVID-19 today: Belgium (0.7%), Spain (0.5%) and Italy (0.5%).

Politicization of Quinine in 1793

On September 11, 1793, after he and his wife had recovered from yellow fever, Alexander Hamilton wrote a letter to the College of Physicians in Philadelphia extolling Stevens’s treatment:

His mode of treating the disorder varies essentially from that which has been generally practiced -- And I am persuaded, where pursued, reduces it to one of little more than ordinary hazard.

Benjamin Rush read Hamilton’s letter and tried the quinine treatment on his patients for several days, but gave it up when he could not achieve Stevens’s results. According to Chernow:

Rush gave Stevens’s methods a fair chance for several days, tossing buckets of cold water on patients and injecting quinine into their bowels, but he could not reproduce Stevens’s results and reverted to the rigors of bleed-and-purge. (p. 450)

Benjamin Rush and Secretary of State Thomas Jefferson were part of a political faction that eventually become the Democratic-Republican Party, so they opposed anything recommended by Treasury Secretary Hamilton, leader of the faction that eventually became the Federalist Party. Chernow writes:

An unfortunate medical dispute erupted between the “Republican” method of Rush and the “Federalist” alternative of Stevens. Rush was not averse to casting the controversy in political tones. “Colonel Hamilton’s remedies are now as unpopular in our city as his funding system [Federal take-over of state debts from the Revolutionary War] is in Virginia and North Carolina,” he declared. (p. 450)

Jefferson and Hamilton

Unfortunately for Dr. Rush, the main result of this stand against quinine was that he lost his medical practice. Chernow writes:

Though Benjamin Rush blamed Alexander Hamilton for yellow-fever deaths, the public ended up blaming Rush. After a second yellow-fever epidemic in 1797 and more copious bloodletting, Rush lost so many patients that President Adams rescued him by appointing him treasurer of the U.S. Mint. (p. 451)

The similarity between the drug used by Dr. Stevens in 1793 and the one used by Dr. Vladimir Zelenko in 2020, when COVID-19 raged through a New York Hasidic community, is remarkable. Dr. Zelenko’s hydroxychloroquine (HCQ) in 2020 is simply an advanced synthetic form of the quinine used by Dr. Stevens. Dr. Stevens learned about it first hand in the Caribbean. Dr. Zelenko learned about it through Internet research about treatments used in South Korea and France.

Both drugs are zinc-ionophores, meaning that they open cell walls so that zinc can get into them. Once inside, zinc can attach itself to viral strands, and thus slow virus replication, giving the body’s immune system a chance to catch up. Dr. Zelenko’s prescribed cocktail only requires 5 days of treatment:

·      Hydroxychloroquine. 400mg first day and 200mg per day for four days

·      Zinc. 220mg once daily for 5 days

·      Zithromax (to prevent bacterial pneumonia) 500mg daily for 5 days

Politicization of HCQ in 2020

On Sunday April 5, President Trump suggested at his daily press briefing that HCQ may be able to work against COVID-19. He said:

We bought a tremendous amount of … hydroxychloroquine, which I think is, you know, it’s a great malaria drug. It’s worked unbelievably, it’s a powerful drug on malaria. And there are signs that it works on [COVID-19], some very strong signs….

The reaction from Democrats was just as strong as the reaction of Democratic-Republicans when Alexander Hamilton endorsed quinine as a treatment for yellow fever. Democrat state representative Karen Whitsett found this out the hard way soon when she recommended HCQ after it cured her of COVID-19. The Detroit Democrat Party now threatens to censure her and deny her any future party endorsements.

Just as Benjamin Rush did with quinine 217 years ago, today’s U.S. health bureaucracy has been throwing cold water upon HCQ. The National Institutes of Health (NIH) sponsored a study in which the Veterans Administration administered HCQ to zinc-deficient patients without simultaneously administering zinc.  Making their test of HCQ even less fair, they assigned sicker patients to the HCQ group and healthier patients to the control group. As could be expected, the HCQ group actually did worse than the control group.

At present the U.S. health bureaucracy is not recommending any treatment for COVID-19, so Dr. Zelenko’s cocktail could be the best choice for primary-care physicians to prescribe when symptoms first appear.

Research by Benjamin Rush and the NIH shows that there are two non-treatments that primary care physicians should avoid prescribing: (1) injecting quinine into bowels while drenching the patient in cold water, and (2) giving HCQ to zinc-deficient patients without giving them zinc supplements at the same time.