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Historical Implications of a Failing Heart Part 2
Lisa H. Wright coooolll.. Reply 1 Like Follow 1 hour ago. Elizabeth Evans Thank you so much Reply 12 Like Follow 1 hour ago. Thomas T. Dennis this is absolutely worked.. Many thanks Reply 2 Like Follow 1 hour ago. Opium, although often used in conjunction with quinine, 1 had also been used alone in intermittent fever. Malaria's effect on Confederate Army manpower depended on where troops were posted but could be profound. In contrast, the monthly average was cases per 1, men serving near Mobile, Alabama, for the year starting July 1, , and cases per 1, men serving in the river batteries below Savannah, Georgia, in One report for and showed , cases of disease or injury, excluding gunshot wounds, among Confederate troops east of the Mississippi River.
Malaria accounted for , It is no wonder, then, that effective antimalarial therapy was sought. The use of indigenous plants and other treatments as quinine substitutes did not signify a movement against allopathic medicine. Many of the conventional drugs used during the era, including quinine, were derived from plants, and Confederate medical authorities were merely seeking usable remedies that did not have to be smuggled into the South.
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To some, another goal of finding native remedies was to help eliminate dependence on outsiders, including the North, when peace was restored. The identity of all agents given in place of quinine is unknown, as is the exact reasoning behind the selection of those that were to receive serious trial. The Army's widespread use of dogwood, poplar, and willow seems entirely justified, given the substantial literature suggesting their effectiveness.
It is not clear, however, why the three barks were so often combined, because each had a reputation for being effective when used alone. Perhaps, compared with a single bark, the combination was thought to be more effective or safer or to have a wider spectrum of activity against fevers that were far from uniform in clinical presentation.
Despite the relatively scanty evidence supporting Georgia bark, its supposed similarity to cinchona probably raised hopes that it would prove to be the quinine of the Confederacy. Although the SGO did not initially solicit surgeons' input in identifying obscure but worthy quinine substitutes, the trial of external turpentine resulted from the SGO's willingness to consider Surgeon Kennedy's glowing endorsement of that treatment.
Enthusiastic testimonials were more common for cottonseed tea, 52 , — 54 for example, but no evidence has been found for that remedy being given serious consideration. Numerous factors made it difficult for Confederate surgeons to draw conclusions about the effectiveness of treatments. Evidence was in the form of case reports or anecdotes rather than controlled studies, and the former accounts were confounded by inconsistent diagnoses and nonuniform nomenclature for diseases, plants, and medicines.
Soldiers receiving medical attention commonly had more than one ailment and received multiple drugs concurrently, and patients with just a single diagnosis often received more than one medication. Variability in medications also confused matters. The standard for judging quinine substitutes was quinine itself, but the quality of quinine, especially in the South, was not constant.
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A Confederate pharmacist reported that the ruses used in smuggling led to labeling mix-ups between quinine and morphine and that adulteration of imported quinine was common. The quality of quinine substitutes was probably inconsistent. The potency of plant material varied with growing conditions, season of collection, and harvesting and processing techniques. Infusions, decoctions, and tinctures of plant material were sometimes used interchangeably, but these formulations might not be equally potent, because water and alcohol could differ in the efficiency with which they extracted the components of the vegetable substrates.
Liquid formulations were often concentrated by applying heat, but the effect of heat on the chemical stability of active constituents was usually not known. Moreover, the potency of medicines could decrease over time, especially if the products were stored at the high temperatures common in the South. The overall view of Confederate surgeons seemed to be that many of the agents given for malaria were useful but did not equal quinine in effectiveness.
Porcher, 56 with all of his expertise in indigenous flora, seemed unsure whether the war had uncovered useful alternatives to quinine. Regardless of how effective the quinine substitutes were, their use demonstrated the resourcefulness with which the Army medical department addressed a serious threat to the health of Confederate troops. The SGO sought expert advice, considered input from surgeons, sought to collect information about the remedies' clinical value, and established a system through which indigenous plants were collected, processed, and issued.
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Medical purveyors practiced therapeutic substitution when they issued indigenous remedies in place of the requisitioned quinine. Shortages of other drugs were handled in a similar fashion.
The end of the war brought the removal of barriers to the importation of quinine and other goods into the South. The unsure supply and high cost of quinine in the Confederacy necessitated the use of alternative treatments for soldiers with malaria. Efforts to supply effective quinine substitutes were directed by the SGO and carried out by medical purveyors, who collected material, primarily indigenous plants, for preparation and distribution.
Among the quinine substitutes described in surviving records, most were generally considered helpful but not as effective as quinine. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Historical Implications of a Failing Heart - National Museum of Civil War Medicine
Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Potential and Actual Quinine Substitutes. Dogwood, Poplar, and Willow Bark. Georgia Bark. Other Indigenous Plants. External Application of Oil of Turpentine.
Hasegawa, PharmD. Oxford Academic. Google Scholar. Article history.
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View Large. Google Preview. Indigenous remedies of the Southern Confederacy which may be employed in the treatment of malarial fever. Surgeon General's Office. Addendum to special orders no. Search ADS.
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Indigenous remedies of the Southern states, which may be employed as substitutes for sulphate of quinine in the treatment of malarial fever. List of ingredients used and results of manufactures, quarter ending 30th Sept, Private and Official Papers of U. Latimer, — Association of Defenders of Port Hudson. Report of additional cases of febris intermittens, treated with extract Pinckneya pubens. On the external application of oil of turpentine as a substitute for quinine in intermittent fever, with reports of cases. Letter to J. Gaston, A. Lane, F.
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