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Malaria and quinine

Gorgas knew, even before arriving in Panama in 1904, that the real enemy was not yellow fever, but malaria. Malaria (“bad air”) did not kill its victims as yellow fever did, but disabled them for weeks at a time several times a year, sapping them of their energy and costing the canal enterprise dearly from employee absenteeism. In 1906, 821 out of each thousand workers suffered from malaria. Despite protests from Chief Engineer Goethals and members of the Isthmian Canal Commission (who did not believe in the mosquito theory), Gorgas was undaunted and continued mounting his attack on mosquitoes until the morbidity rate from malaria was reduced by 90% when the canal was completed. The yearly cost for the sanitation effort was $2 million and Gorgas calculated that otherwise more than 70,000 workers would have died during the American ten-year period of canal excavation. The actual number of deaths was 6,630 compared to 22,000 during the nine-year period of the French effort.

Malaria incidence chart among Panama Canal workers. Simmons, J. S., Malaria in Panama, Baltimore: The Johns Hopkins University Press, 1939.

Quinine, an extract from the bark of the cinchona tree in Peru, was an indispensable component of Gorgas’ attack on malaria. Forty-thousand doses of quinine were administered daily to canal employees, at a dose of 10 grains (650 mg) of quinine sulfate three times daily. Because of its bitter taste and adverse effects such as hearing loss, blindness and cinchonism (headache, dizziness, ringing of the ears and vomiting), compliance was poor. To make quinine more palatable, tonic water was made available to employees. Tonic water contained 10 grains of quinine in 2.5 ounces of solution and was given to new employees morning and night three times a week for the first two weeks and once a week thereafter.

Cinchona calisaya, flower, source of quinine. Köhler Medizinal-Pflanzen, 1887.

Quinine, red bark. Wellcome Images, London.

Henry S. Sappington (1776-1844), a Missouri physician, wrote a book on the theory and treatment of fevers and sold “Sappington’s Anti-fever Pills,” a popular remedy containing quinine.

Henry S. Sappington, 1834 portrait by George Caleb Bingham. Friends of Arrow Rock Museum, Arrow Rock, Missouri.

The Theory and Treatment of Fevers by John S. Sappington, 1844. Clendening History of Medicine Library and Museum.

Last modified: Mar 12, 2019
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