During the Civil War, military hospitals viewed opioids as essential drugs. Doctors and nurses used opium and morphine to treat soldiers’ pain, stop internal bleeding, and reduce vomiting and diarrhea caused by infectious diseases. However, this led some soldiers to develop an opioid addiction, either during the war or afterwards, when they sought medical treatment for wounds or war illnesses.
For many Civil War veterans, opioid addiction ruined their lives. The addiction of the veterans made them tired and emaciated, and could lead to a fatal overdose. In some cases, opioid addiction could threaten a veteran’s ability to receive a pension. In 1895, a Union veteran named Charles L. Williams said in a request to a soldier’s home that he was “totally incapable of earning a living” because he had “contracted [the] the use of opium during the war.
By the time Williams addressed the soldiers’ home, the scope of the problem had extended beyond veterans: America was in the midst of its first major opioid crisis, fueled by the increase in injectable morphine that some doctors had started to administer during the Civil War. . The special plight of veterans has helped bring attention to the problem, raising awareness among doctors and the general public of the dangers of opioid addiction.
Opioids as a medicine of war
The use of opioids has a long history in the United States. Before the Civil War, doctors routinely prescribed pills of opium and laudanum, a mixture of opium and alcohol. These opiates, or natural opioids, were available in many pharmacies without a prescription. At the start of the war, both the Union and the Confederation considered it important to supply their hospitals with medicines. A Confederate medical manual stated that “opium is the only drug indispensable on the battlefield, important to the surgeon, like gunpowder for ammunition.”
In addition to opium and laudanum, some Union doctors have also started using the hypodermic syringe, a relatively new invention, to inject another opioid, morphine, directly into soldiers’ veins.
Union physician Anson Hurd treated wounded Confederate soldiers after the Battle of Antietam at this makeshift field hospital (September 1862).
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These doctors “realized that this invention which had not really been very widely used in the United States could now be a godsend in hospitals, because it delivers morphine immediately”, explains Jonathan S. Jones, professor of history. at the Virginia Military Institute and author of the next Opium Slavery: Civil War Veterans and America’s First Opioid Crisis. Injectable morphine provided faster relief than opium pills and laudanum, but was also more likely to lead to addiction.
In addition to soldiers, Civil War medics themselves took opioids to treat infectious diseases and cope with the stress of working in army hospitals, leading them to develop addictions before and after. the war. A Union surgeon named JM Richards would later recall how he developed chronic diarrhea during the war and “eventually resorted to frequent doses of morphine as the only sure way to control the difficulty.”
Notably, most black veterans have not developed addiction to opioids, due to disparities in the medical care provided to black and white men. “Overall, black soldiers were consistently denied the same standard of medical care as white soldiers,” Jones said. Doctors did not provide black soldiers with the same level of opioids as white soldiers, who began to label their addiction – seemingly without irony – as “opium slavery.”
Veterans struggle to quit opioids after war
When the veterans returned home after the war, they continued to take opium and injectable morphine, which became much more accessible in the 1870s.
“By the late 1870s virtually every American physician had a hypodermic syringe,” says David T. Courtwright, professor emeritus of history at the University of North Florida and author of Dark Paradise: A History of Opioid Addiction in America. “And this was clearly the main driver behind the surge in opioid dependence in the 1870s, 1880s, and early 1890s.”
Jones argues that the Civil War helped “mainstream” the use of the hypodermic syringe. Doctors who used it during the war taught their colleagues injectable morphine, which led more and more doctors to prescribe it to veterans and other patients after the war. Companies took note and started selling injectable morphine directly to consumers.
“You can easily get syringes and morphine; you can even buy them by mail from Sears and Roebuck, the department store, ”says Jones (later the Sears and Roebuck catalog also sold heroin). The availability of injectable morphine led to a full-blown opioid addiction crisis in the 1880s, and one of the groups that helped highlight this crisis were Civil War veterans, who had been addicted ever since. decades.
In the early 1880s, physician and prominent opioid expert Thomas Davison Crothers met an anonymous Union veteran with an opium addiction who had started taking the drug to treat the chronic diarrhea he developed during the war. He told Crothers that after two months he recovered from the illness, but continued to use opium intermittently for the next two decades.
Crothers observed that this man struggled to stop taking opioids because he had developed an addiction. Stories like these have helped inform medical thinking about opioid addiction as a public health problem, an issue the United States continues to struggle with today.
