“The Popular Dose with Doctors:” Quinine and the American Civil War

Many Civil War commanders required that their soldiers take quinine prophylactically. A woodcut from the March 11, 1865, Harper’s Weekly shows quinine rations being distributed to Union troops. (CHF Collections)

Many Civil War commanders required that their soldiers take quinine prophylactically. A woodcut from the March 11, 1865, Harper’s Weekly shows quinine rations being distributed to Union troops. (CHF Collections)

In 1862, the second year of the American Civil War, Southerners took satisfaction in knowing that invading Union army troops would succumb to tropical diseases endemic to the South’s bayous, swamps, and coastal regions. Just wait until summer, Southern newspapers predicted.

The first test of this theory came in April 1862 in Shiloh, Tennessee, where Union General William T. Sherman’s forces met the enemy in a bloody battle. Before and after the fight, typhoid, diarrhea, scurvy, and the fevers associated with malarial diseases ravaged troops on both sides. One physician wrote, “The pestilential atmosphere of the country about Shiloh was producing an amount of sickness almost without parallel in the history of the war.” In May, Sherman mustered only half of his 10,000 troops because the other half were sick.

At Vicksburg, the disease-ravaged Union navy and army failed in its first attempt to capture the strategically important Southern city on the Mississippi River. One soldier observed that the gallinippers—slang for mosquitoes—were so thick about the camp that they “filled the air like rain drops.” Mosquito nets, called bars, were not yet widely available, and soldiers exploded gunpowder cartridges in their tents to keep the pests away, unaware that they were the source of much of the illness gripping the encampments. (It would be another 20 years before doctors began to suspect mosquitoes were to blame for malaria and yellow fever.) Almost three-quarters of the besieging Union troops were dead or too sick to work. Vicksburg’s defenders were no better off, described by a Union army commander as “haggard & care-worn.” One of the defending officers wrote, “The command suffers greatly from intermittent fever, and is generally debilitated from the long exposure and inaction of the trenches.”

Pestilential Warfare

Southern military physicians, all of whom were titled surgeons, took no satisfaction in the malarial outbreaks that decimated the ranks of their opponents. Disease takes no sides. South Carolina Surgeon Francis Peyre Porcher, who knew intimately the devastation caused by tropical diseases, attended to sick and wounded soldiers in several hospitals before his assignment to the Naval Hospital in Norfolk, Virginia. His patients arrived in Norfolk from all theaters of war, and when he looked eastward to the sea, the distant masts of blockading Union ships reminded him of supply shortages and the medicines he badly needed. Porcher worried especially about the scarcity of quinine, the closest thing to a miracle drug known to Civil War physicians.

Malaria, yellow fever, and other tropical diseases had several symptoms in common, including fevers, chills, and nausea. In the early stages of these diseases Civil War physicians gauged the illness by the frequency of recurring fever, hence “intermittent,” “remittent,” “tertiary,” or “quotidian” fevers. Physicians of the time did not connect mosquitoes to malaria, but they did know quinine was a sure way to ease its symptoms. The problem was getting and administering the drug, especially getting it in quantity.

The Southern Solution

Quinine is an alkaloid synthesized from the bark of cinchona, a tree native to South America. The Northern blockade of Southern ports made importing quinine difficult, and smuggling from Northern or European sources proved unreliable. Northerners had intercepted quinine in the heads of girls’ dolls and found it stuffed within the intestines of slaughtered animals. The need for quinine was desperate. One South Carolinian wrote to her mother, “I write now to beg you to send in your next letter a quarter of an ounce of quinine. You know, in this climate, life depends upon quinine—and though large quantities come in every ship, it is taken up so immediately for the army that it is exceedingly difficult for private individuals to procure it even at a very high price.”

Confederate Surgeon General Samuel P. Moore, the man in charge of creating an entire medical infrastructure for the South, needed large quantities of quinine to relieve Southern soldiers of fevers, and he needed them fast. A 50-year-old veteran of the Mexican War, Moore knew the success of his army depended at least in part on a reliable supply of quinine. But where could he find it?

Moore’s solution was to search for quinine equivalents among the flora of Southern fields and forests. He issued a directive to Confederate physicians to gather specific plants and send them for processing. But what plants native to the South would make good medicines?

In 1862 Moore summoned Porcher, a studious man in his late 30s, from his hospital duties for a special assignment. Porcher had all the credentials Moore needed. He was a descendant of the botanist Thomas Walter, who in 1788 published the first catalog of flowering plants in South Carolina. Porcher had graduated at age 19 from what is now the University of South Carolina with a thesis on botanical medicine, A Medico-Botanical Catalogue of the Plants and Ferns of St. John’s, Berkeley, South Carolina, and took his medical degree from the Medical College of the State of South Carolina. In his 15 years of doctoring he had studied in France and Italy, founded a medical journal and a preparatory school for medical students, and joined the faculty of the Medical College. He was fascinated by the medicinal applications of plants, and his wide-ranging experience as a physician equipped him with the analytical skills required for the job.

Although Moore had already put out a call for the collection of medicinally useful plants, he proposed that Porcher survey all Southern plants, shrubs, and trees and document all practical uses. Discovering a substitute for quinine was the priority.