Pharmaceuticals and Exhaustion: Opium’s Rise in the Early Years of the Civil War
Dheeksha Senthur
Spring 2022
The Civil War was the most catastrophic war in American history, resulting in the unprecedented battlefield fatality of approximately 752,000 people (Reilly, 2016). With advances in military technology such as the Minié bullet, the early years of the war from 1861-1862 saw thousands of casualties that medicine was ill-equipped to handle (Reilly, 2016). Consequently, opium became a staple treatment, with The Medical and Surgical History of the War of the Rebellion (MSHWR) noting 10 million opium pills and 2.84 million ounces of opioids were issued to the Union army alone, with likely a similar number in the Confederate army (Albin, 2002). Such large quantities of opioids being issued raise the question of the pharmaceutical industry’s role and the physicians’ decision to issue opioids above other medications. The stage for physician overutilization of opium in the early years of the Civil War, precipitating the post-bellum opioid crisis, was set due to democratized pharmaceutical markets and physician overwork.
The democratized pharmaceutical markets of the Civil War era resulted in opium becoming the preferred treatment of physicians, leading to opium overuse and fostering the post-bellum opioid crisis. During the mid-nineteenth century, unregulated medical markets, consisting of sectarian providers, patent medicine sellers, and unlicensed “doctors,” provided an array of practitioners and services to the public, competing with traditional, or allopathic, physicians (Jones, 2020). American medicine was an amalgam of conflicting allopathic, homeopathic, and private laboratory systems and institutions (Flannery, 2017, p.120). These conflicting systems led to divisions in ideas such as bloodletting and prescribing minerals like antimony and calomel, mercurous chloride, which, interestingly, was generally opposed by homeopathic institutes and thus, often replaced with alternative medicines like Culver’s root (Flannery, 2017, p.120). The Union army medical corps excluded homeopathic physicians and practices but promoted prescribing minerals and mercury products as battlefield treatments (Flannery, 2017, p.120; Rutkow & Rutkow, 2004). The Confederate army, impelled by Union blockades that prevented foreign drug supplies like opium from reaching Southern ports, turned to indigenous Southern plants and homegrown poppies for opium as drug substitutes (Flannery, 2017, p.177). Due to this laissez-faire medical marketplace, roughly two-thirds of medications in the Union and Confederacy were botanicals with very few effective treatments (Reilly, 2016, p.138). Because dysentery and diarrhea constituted a quarter of all seven million cases of disease in the Civil War, separate from battlefield injuries, and limited but controversial medications like mercurous chloride and emetics were available at the time, opium appeared as a better option for these diseases, making it a staple treatment, overall, in the Civil War (Lande, 2020, p.484). Although doctors did question opium and its derivatives as a remedy, in comparison to available pharmacopeia, its painkilling properties, and its accessibility in various forms– from tinctures to powders– opium and its derivatives were preferred (Lande, 2020, p.487). Due to democratized, unregulated medical markets producing and promoting a variety of ineffective drugs, opium became the preferred drug in the hospital, leading to its overutilization.
Furthermore, due to understaffing in hospitals in the early years of the Civil War, medical personnel were burdened with unprecedented workloads, exacerbated by the sheer number of battlefield casualties, limited medical supplies, and disorganization of field hospitals, which were repurposed from homes, churches, or barns (Reilly, 2016, p.138). With 175,000 extremity wounds to Union soldiers, 30,000 of which resulted in amputations, and pervasive diseases such as malaria and gastrointestinal disorders, medical personnel, some of whom were inexperienced, were overwhelmed with thousands of wounded patients (Reilly, 2016, p.140). As Dr. Edward Craighill, a physician who worked in Pringle House Hospital, a house repurposed into a Confederate hospital, describes after the Battle of Manassas, he “attended to [his] wounded, making them as comfortable as [he] could. [He] had not a mouthful since breakfast,” considering “sleep if possible” for “there was a strenuous day ahead of [him] next day” (Backus, 2021). This parallels Dr. William Child’s description in a letter penned from a Union Battlefield Hospital near Sharpsburg, Maryland, which states, “Day before yesterday I dressed the wounds of 64 different men… Yesterday I was at work from daylight till dark - today I am completely exhausted - but shall soon be able to go at it again. The days after the battle are a thousand times worse than the day of the battle – and the physical pain is not the greatest pain suffered” (“Antietam,” n.d.). A Confederate soldier recalled being told by a young, “apparently inexperienced” surgeon treating thirty-two wounded Union soldiers “dreadfully mangled by cannon shot” at the Henry Matthew House that “the [surgeon’s] officers had sent him no help. He was there alone” (“After the battle,” 1861). Consequently, opium would become “important to the surgeon as gunpower to the ordinance” as a Confederate military handbook stated (“A manual of military surgery,” 1863). This is illustrated in the Military Medical Surgeries and Essays prepared for the United States Sanitary Commission, which recommended army surgeons carry vials of opium pills among their “pocket instruments'' to supplement other medications such as quinine, a frequently-used drug for malaria, and to treat illnesses ranging from intestinal issues to sleep, “an important consideration” (Hammond, 1864). Soldiers with postoperative chronic pain and discharged veterans often self-administered opium and morphine using hypodermic syringes (Albin, 2002).
With the relative ease of opioid usage in pills, laudanum, and morphine injections, along with its observed efficacy, opiates were the preferred treatment of choice that ameliorated the suffering of soldiers and permitted medical personnel to treat patients more quickly. Due to the unexpected casualties wrought by battles on understaffed hospitals, particularly with many civilian and inexperienced doctors in the early years of the Civil War from 1861-1862, opium’s ease of administration allowed doctors to treat patients with opium easily and quickly or allow soldiers to treat themselves with hypodermic syringes (Reilly, 2016, p.139). Additionally, because the war occurred prior to germ theory, doctors could only treat patient symptoms, therefore, opiates were used for their effective analgesic properties and accessibility, allowing doctors to work efficiently in time-sensitive conditions where battles such as the Battle of Antietam brought more than 23,000 casualties and an average of 425 soldiers died per day over the war (“Number of military facilities,” 2021). This overworking contributed to opium becoming a widely-prescribed drug in the war, facilitating the Civil War opioid crisis.
The pharmaceutical markets of the early Civil War era and overwork during the war set the stage for physician overreliance on opium and its derivatives, ultimately advancing the post-bellum opioid crisis. The medical markets encouraged an environment that produced ineffective and detrimental medications, resulting in physicians turning to opium for disease management. Overwork from unforeseen casualties, exacerbated by the disorganization of hospitals in the years 1861-1862, also indirectly resulted in opium prescription with its ease of administration and accessibility. These two subtler factors helped foster an environment conducive to the overutilization of opium and to a post-war opioid crisis.
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