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

Lithograph from 1876 of Rosengarten and Sons’ manufacturing plant in Philadelphia, one of two companies that made quinine during the Civil War. The Confederate army lacked access to quinine, so Southern doctors tried to find a replacement in indigenous plants. (Free Library of Philadelphia, Print and Picture Collection)

Lithograph from 1876 of Rosengarten and Sons’ manufacturing plant in Philadelphia, one of two companies that made quinine during the Civil War. The Confederate army lacked access to quinine, so Southern doctors tried to find a replacement in indigenous plants. (Free Library of Philadelphia, Print and Picture Collection)

A Handbook and a Laboratory

Before the end of 1863 Porcher published Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural: Being Also a Medical Botany of the Confederate States; with Practical Information on the Useful Properties of the Trees, Plants, and Shrubs. He organized the book for field use despite its 600-page length and included Latin and common names for about 3,500 plants and trees. The book instructed soldiers—and the officers who supervised them—to collect and dry plants and forward them to the South’s medical purveyors. Porcher’s detailed and encyclopedic instructions and advice used patriotism to appeal to its readers: “These a bounteous Providence has vouchsafed to a Confederacy of States, starting forth upon their career under new and happier auspices, and with independence and self-reliance forced upon them by an almost sacred necessity.”

Porcher believed his book provided a “repertory of scientific and popular knowledge as regards the medicinal, economical, and useful properties of the trees, plants, and shrubs found within the limits of the Confederate States.” His native plants would be as valuable as their more expensive foreign counterparts and would benefit the South’s doctors and farmers both during and after the war.

To complete his book in only a year Porcher put his mother and wife to work as assistants, consulted the best available libraries on botany and chemistry, and enlisted such colleagues as Joseph Le Conte, a well-known chemistry professor who worked at the medical depot in South Carolina (and who later cofounded the Sierra Club in California). Unlike the North, the South lacked the chemical ability to synthesize quinine from its alkaloid, but Porcher believed that he had found reliable native substitutes, including yellow poplar bark, tulip tree bark, holly, black alder, hazel alder, and knotgrass. Other promising substitutes included boneset (thoroughwort) and dogwood. For the former, Porcher recommended using an ounce of dried herb in a pint of boiling water to make a tea that would prove “quite sufficient in the management of many of the malarial fevers that will prevail among our troops during the summer.” Porcher cited dogwood bark as having “been employed with great advantage” in South Carolina, particularly as a substitute for cinchona, with the added benefit of reducing fever “of a typhoid character.”

But the exigencies of war limited Porcher’s inquiry. He found it impossible to test these plants in clinical trials. In some cases he was forced to rely on anecdote, folk tradition, or the recommendations of others.

Surgeon General Moore eagerly awaited Porcher’s book and wasted no time getting it into the hands of Confederate physicians. Based on Porcher’s work Moore recommended various substitutes mixed with whiskey—dogwood, poplar, and willow bark—to achieve the same effect as quinine. Newspapers published extracts and lists of needed plants to encourage citizens to help. The Confederate government also sent circuit riders to collect plants. Yet despite Porcher’s stature and Moore’s recommendations, some physicians rejected Porcher’s work, distrusting substitutes for quinine and other drugs. Others believed that plant-based medicines catered to fringe medical practitioners who refused to use “chemicals,” or synthesized medicines.

The Civil War provided a rigorous testing ground for which drugs worked and which did not. None of Porcher’s quinine recommendations proved successful, and the South struggled through the war years with what quinine it could smuggle or capture. The lasting legacy of Porcher’s book is as a layman’s guide to Southern botany, and it is still cited today. In the end Northern soldiers took their quinine rations and suffered less from Southern diseases than did their Confederate opponents, despite the hopes and predictions of Southern newspapers.

John Michael Maisch (Wellcome Library, London)

Drug Agent

Unlike Francis Peyre Porcher, John Michael Maisch had plenty of quinine. After French chemists first isolated the alkaloid from cinchona bark, Philadelphia-based Zeitler and Rosengarten (later Rosengarten and Sons) had the foresight to hire French chemists and within three years of the discovery were selling quinine. Powers and Weightman, which merged with Rosengarten after the war, also processed quinine with other in-demand drugs, such as opium. Both firms obtained cinchona in bulk at low cost and processed it to obtain the quinine, which was then extracted into sulfate. Maisch, working for the Union army, ensured the purity of the drug, developed standard doses, and oversaw the packaging and labeling of the drugs for distribution to the army medical depots. This was no small task: physicians in the field told many stories of useless or adulterated drugs that came to them from purveyors.

By the end of the war Maisch’s laboratory produced 160 different medicines, and his lab claimed to have saved the government a million dollars through its work. Maisch effectively directed the federal government’s first drug-manufacturing and regulatory operation. Not surprisingly, some people attacked Maisch’s laboratory as governmental excess that competed with private business. Yet Maisch’s work showed that his laboratory, in working closely with pharmaceutical firms, stimulated business.

The diseases Northern soldiers encountered in the South forced the North to industrialize its quinine production, which in turn required an emphasis on quality control and sophisticated channels of testing and distribution. The Civil War, although a time of incalculable destruction, provided the ingredients and conditions necessary to create the nation’s first example of modern large-scale drug manufacturing as well as the first government-run drug-testing laboratories.—Robert D. Hicks

 

Robert D. Hicks is director of the Mütter Museum and Historical Medical Library of the College of Physicians of Philadelphia.