HISTORICAL INTRODUCTION TO MALARIA 
5 
treating the abundant intermittent fevers 
from which the British army suffered in 
its southern campaign. At any rate, its 
use in the United States appears to have 
become widespread subsequent to the revo¬ 
lution. 
Quinine was prepared commercially in 
Philadelphia as early as 1823, three years 
after its isolation (Hogstad 1931). The 
earliest report of its employment in the 
United States that has come to our atten¬ 
tion is by Henry Perrine (1826), a phy¬ 
sician of Natchez, Miss. He employed from 
6 to 12 grains every 2 to 3 hours at any 
period of the fever, continued until its 
symptoms in pulse and skin were subdued, 
repeating if the return of the fever was 
suggested. Editorial comment in 1850 
(Fenner 1850), credits Perrine and other 
Natchez physicians with the use of quinine 
as early as 1823. McGown (1849) states 
that Dr. Thomas Fearn of Huntsville, Ala., 
employed quinine during the epidemic of 
fatal fevers which prevailed at that place 
during 1824 and 1825, and gives him the 
credit as the first to use large doses of this 
alkaloid. Although the use of the alkaloid 
for the treatment of intermittents appears 
to have become quite general during the 
next two decades, some physicians were 
reluctant to employ it in remittent fevers. 
However, by this time daily doses of from 
15 to 30 grains, given during the remission 
in the former, were regarded as a desirable 
practice. 
Quinine soon became an ingredient of 
proprietary fever remedies, one of the earl¬ 
iest of which, Dr. Sappington’s “Anti- 
Fever Pills, ’ ’ was extensively sold through¬ 
out the Mississippi Valley and the South¬ 
west during the 30’s and 40’s (Terry 
1931). 
According to Terry, Dr. Sappington, as 
early as 1844, advised the prophylactic 
use of quinine. This possibility, however, 
did not appear to attract much attention 
until the decade immediately before the 
Civil War. Merritt (1861) claims that 
while surgeon to a mining company in 
Panama in 1850 he obliged all employees 
to take a daily dose of 5 grains before 
breakfast. The crews of the vessels oper¬ 
ated by the Panama Railway Company 
were required in 1853 to take quinine while 
in the port of Aspinwall (Anon. 1861). 
De Saussure (1860) reported its successful 
employment as a prophylaxis among the 
negro slaves engaged in the construction 
of the Charleston and Savannah Railway. 
It was extensively, although not systemati¬ 
cally, employed for this purpose during 
the Civil War. 
Mass treatment of infected persons as a 
public health measure was attempted in a 
large area in the Mississippi delta by Bass 
from 1916 to 1918. From the experience 
gained in 1916-17, a regimen of quinine 
administration was developed which be¬ 
came widely known as the “Standard 
Treatment.” This was gratuitously dis¬ 
tributed to infected persons in the study 
area in 1918 when 40 per cent of the popu¬ 
lation experienced malarial attacks. In the 
following year only 4 per cent of the popu¬ 
lation had attacks. However, when the 
people were subsequently urged to pur¬ 
chase the treatment, the consumption of 
quinine was disappointing, which probably 
explains why the program never gained 
ground (Bass 1920). 
The XIXth century witnessed many ex¬ 
amples of the deliberate application of 
drainage for the prevention of intermittent 
and remittent fevers. We have no means 
of appraising the volume of such work, but 
sufficient accounts are preserved in the lit¬ 
erature to indicate that it was considerable. 
One of the earliest significant instances is 
afforded by the action of the city of Savan¬ 
nah, Ga., with relation to rice culture. In 
1817, at a town meeting, the city appropri¬ 
ated $70,000 to purchase the right of cul¬ 
tivation of rice, in wet culture of such of 
the tidal swamps as were adjacent to the 
city. The policy was sustained at a refer¬ 
endum in 1821. A marked reduction in 
deaths from “autumnal diseases” imme¬ 
diately resulted (Daniell 1826). The in¬ 
terest in the subject of defective drainage 
as a cause of excessive mortality is shown 
by the systematic medical survey of the 
state of New York reported in 1832 (Anon. 
