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

A census map from 1870 displays the proportion of malaria-based deaths compared with total deaths in the United States at the time. In the reddest areas at least 14% of the deaths were attributed to malarial diseases. (Library of Congress)

A census map from 1870 displays the proportion of malaria-based deaths compared with total deaths in the United States at the time. In the reddest areas at least 14% of the deaths were attributed to malarial diseases. (Library of Congress)

Malaria and Quinine

A single female Anopheles mosquito was born in a stagnant pool of water, emerged, and joined millions of others following soldiers in camp and on the march during the warm 1862 summer. She dropped onto a soldier’s neck and injected her proboscis into his flesh. Sporozoites (parasites) transmitted from a previous meal—from another soldier’s infected blood—entered the new victim’s bloodstream, carrying parasites into the liver of the soldier. During an incubation period of one to two weeks the merozoites (transformed sporozoites) grew within blood cells, causing sickness. As the parasites multiplied, they slowed the flow of blood and brought on fevers, profuse sweating, violent shivering, aches, nausea, and chills. Symptoms lasted for many hours and returned periodically, even daily.

Not until 1880 would a physician discover the single-cell Plasmodium parasites that cause malaria, and their carrier would not be confirmed as the mosquito until the end of the century. Although malaria was usually not fatal, during the Civil War its symptoms debilitated whole regiments of soldiers, while malaria’s perceived close cousin, yellow fever, was deadly.

Just as the war began, Scientific American published an anonymous essay on what was then known and unknown about malaria, reflecting both an outlook recognizable to modern eyes and an older medical ideology. The origin of the word malaria—bad air—reflects this ideology. The essay observes frankly,

What malaria is nobody knows. It may consist of organisms, either animal or vegetable, too minute for even the microscope to detect or it may be some condition of the atmosphere in relation to electricity, or temperature, or moisture; or it may be a gas evolved in the decay of vegetable matter. The last is the most common hypothesis, but it is by no means proved. . . . There is no doubt, however, that malaria is some mysterious poison in the atmosphere.

The essay describes various types or stages of “malarious disease,” from its mildest symptoms—intermittent fever or “dumb ague”—to its most common, “the ordinary fever and ague,” which produces violent shivering. The unknown author wrote that two substances had proven effective in either preventing or curing malarious disease: one, “a harmless vegetable substance,” cinchona bark, which has been known for centuries, and its quinine derivative; and the other, “one of the most terrible and deadly of the metallic poisons,” arsenic. Quinine did not cure the disease, but suppressing its symptoms was enough to keep a Civil War army on the march and in combat.

Astute military commanders made sure their soldiers took quinine prophylactically. Medical discipline was not easy to enforce: some, perhaps many, soldiers dosed themselves with patent medicines or other remedies that proved ineffectual and even dangerous. The command “fall in for your quinine” forced soldiers to leave their cooking fires and line up for their whiskey-laced ration. Soldiers even improvised words to the bugle tunes announcing sick call:

Dr. Jones says, Dr. Jones says:
Come and get your quin, quin, quin, quinine,
Come and get your quinine,

In his memoir of the war Union army Surgeon John Shaw Billings wrote, “Quinine was always and everywhere prescribed with a confidence and freedom which left all other medicines far in the rear. Making all due allowances for exaggerations, that drug was unquestionably the popular dose with doctors.”

The Northern Solution

Surgeon General Moore’s Northern counterpart, Union army Surgeon General William Hammond created the U.S. Army Laboratory to ensure the purity of drugs and to create standards for drugs purchased by medical purveyors (agents authorized to purchase raw materials for medicines) and distributed to the various theaters of war. Young, brilliant, and abrasive, Hammond reformed a superannuated army medical department still organized as it had been during the War of 1812. To meet the demands of a modern war Hammond assigned like-minded doctors to head the two laboratories established to assay drugs for purity and distribute them to the North’s fighting forces. To outsiders the laboratories—one in Astoria, New York, and the other in Philadelphia, but together making up the U.S. Army Laboratory—would have resembled strange manufacturing plants. The Philadelphia laboratory, for instance, also manufactured ordinary civilian clothing and towels. Its buildings housed steam engines, boilers and distillation equipment, administrative offices, chemistry apparatus, and storage for raw and repackaged materials. Soldiers, chemists, women, and the girls who sewed the clothing came and went.

Powers and Weightman, one of only two pharmaceutical firms in the United States to produce quinine during the war, leased some of its space to Hammond’s Philadelphia laboratory. The lab required an energetic chemist who would quickly get the place running and ensure that the North’s 30 medical depots got their supplies promptly. John Michael Maisch, a young German “of tall and commanding appearance,” was the choice. Maisch grew up in Hanau, Germany, entered the military, and was sentenced to prison for revolutionary speech during the Revolution of 1848. He escaped and came to the United States in 1849, virtually penniless. Maisch, a superb autodidact, learned pharmacy through his mentor, Philadelphia pharmacist Edward Parrish, and his School of Practical Pharmacy. Despite his lack of formal credentials Maisch eventually took over the chair of materia medica (a discipline focused on the therapeutic uses of medicine) at the College of Pharmacy of the City of New York. Hammond’s new Philadelphia laboratory, managed by Maisch, worked intimately with Powers and Weightman and other firms to produce quinine in reliable quantity for the North. Porcher, by contrast, had no such resources.