Quinine Substitutes in the Confederate Army

Military Medicine, Jun 2007 by Hasegawa, Guy R

During the Civil War, the unreliable supply and high cost of quinine forced the Confederate Army to use alternative treatments for malaria. Many quinine substitutes were mentioned in the literature of the time, but relatively few were advocated by Confederate officials and even fewer are described in surviving records. Medical supply officers often issued substitute remedies when quinine was requisitioned. Most alternative treatments were made from indigenous plants such as dogwood, willow (a constituent of which gave rise to aspirin), and tulip tree. High hopes were held for Georgia bark, which was thought to be closely related to cinchona, from which quinine was derived. Documentation of the effectiveness of quinine substitutes is scanty but is most plentiful for the external application of turpentine. The quinine substitutes were generally considered useful but not as effective as quinine. The Confederate Surgeon General's Office was active in seeking out and supplying troops with quinine substitutes.

Introduction

Quinine, an alkaloid derived from the South American cinchona tree, was well recognized by the middle 180Os as the of choice for treating malaria.1 The outbreak of the Civil War and the imposition of the Union naval blockade made it urgent for the South to find quinine substitutes. Malaria (often called intermittent or periodic fever) reduced Confederate military manpower considerably and, even if cinchona bark (Peruvian bark) or quinine could be obtained from blockade runners or other sources, the price was constantly rising.

Dozens of antimalarial treatments, most of them derived from indigenous plants, were mentioned in the literature of the time, but the number of remedies advocated by Confederate medical officials was much smaller, and documentation of wartime use exists for only a handful. This article summarizes the use of quinine substitutes in the Confederate Army and illustrates how its medical decision-makers coped with a vexing supply problem.

Potential and Actual Quinine Substitutes

Approximately two dozen possible quinine substitutes were described in an 1861 article by physician-scientist and future Confederate surgeon Joseph Jones2 (Fig. 1). However, it was not until March 1862 that, in recognition of the high cost of imported drugs, the Surgeon General's Office (SGO), Confederate Army, issued a pamphlet on indigenous medicinal plants thought to be useful.3 The pamphlet listed several plants that would eventually be given to soldiers for malaria but identified only Salix spp. (willow) as useful in treating periodic fever. Accompanying the pamphlet were instructions for surgeons to inform the SGO about the clinical value of various classes of indigenous drugs in use (antimalarial and antipyretic drugs were not among those specified) and about the "curative virtues" of obscure remedies of the same classes.4 Shortly after the pamphlet's distribution, Surgeon Francis Peyre Porcher (Fig. 2), a botanist, was ordered to cultivate and to study promising medicinal flora and to enlarge the pamphlet.5 Porcher's efforts resulted in the book Resources of the Southern Fields and Forests,6 which was first published in 1863. The 601-page book described numerous Southern plants with supposed antimalarial properties but provided little guidance on their selection and use.

Jones and Porcher based their selection of remedies (Table I) on the medical literature, personal experience, and anecdotal information. Almost all of the plants they mentioned appeared in the Dispensatory of the United States of America,7 a standard pharmaceutical reference of the day, as agents of definite or possible value. In March 1863, the SGO issued a table of indications, formulations, and dosages for indigenous remedies, along with the amounts to be stocked in the field or in general hospitals; that document identified only Pinckneya pubens (Georgia bark) as an antiperiodic.8 The table of indigenous remedies supplemented the medical department's standard supply table, which included quinine and other conventional items.

Indigenous plants for Army use were typically collected by citizens in response to handbills and newspaper announcements published by Army medical purveyors (supply officers). Inspected and purchased plant materials were then processed in Army drug-manufacturing facilities called medical laboratories (several of which were distributed throughout the South) and were issued to Army hospitals and troops in the field.9

The incompleteness of Confederate records makes it impossible to determine with certainty all of the quinine substitutes that were actually used. In a postwar update of his quinine-substitute article, Jones10 mentioned only Cornus jlorida (dogwood), alone or in combination with other agents, and Georgia bark as being given to Confederate soldiers. The details of treatment in that article are disappointingly brief, in light of Jones's position as an Army medical scientist to whom the effectiveness of indigenous medications was to be reported. The bulk of information about quinine substitutes comes from wartime documents prepared by Confederate surgeons and orders issued by Confederate Surgeon General Samuel Preston Moore or Chief Purveyor Edward W. Johns.