Physician Albert Wymer Henley was serving as a surgeon in the Confederate States Army in the American Civil War (1861-1865) when he began using morphine.
During the conflict, the then lieutenant of the Mississippi 36th Infantry Regiment contracted typhoid fever and suffered from chronic diarrhea. In 1863, at the age of 28, he was captured by Union forces and held prisoner for several weeks, which further weakened his health.
“On the advice of distinguished physicians . . . I had to use opiates on account of the complications of formidable and painful diseases,” Henley wrote in 1878. “It was either death or opium. I naturally preferred the latter. But if I could predict the future, I would have gladly chosen the first option.”
When he made that confession, Henley had been battling morphine addiction for 15 years. “God only knows how many times I tried to free myself and how many times I failed,” wrote Henley, who described his condition as “cruel slavery.”
Henley died in 1893, aged 58. His case is one of thousands of soldiers treated with morphine and other opioids during the Civil War who became addicted in what historians describe as the first major drug epidemic in the United States.
Today, more than 150 years after the end of that war, the country faces a new drug epidemic, which began in the 1990s and which, according to the most recent data, left more than 100,000 dead from overdoses in the period between April 2020 alone. and April 2021.
According to historians, there are several parallels between the two crises, among them the fact that both began with legal medicines prescribed by doctors, extended over several decades and left thousands dead.
Historian Jonathan Jones, a professor at the Virginia Military Institute, researched medical files, personal diaries, records of military service and pension claims, among other documents from the 19th century, to reconstruct the lives and deaths of 200 soldiers who became dependent on opioids during the Civil War.
“Most died of causes linked to opioid abuse,” Jones tells BBC News Brazil.
His research into the origin and impact of that crisis resulted in the book Opium Slavery: The Civil War Veterans and America’s First Opioid Crisis (“Opium Slavery: Civil War Veterans and America’s First Opioid Crisis”, in free translation), scheduled for release in 2023.
Morphine by mail
“Opioids were already widely used in the United States before the Civil War,” Jones points out.
In the 19th century, opium and derived substances, such as morphine and laudanum (a mixture of opium and alcohol), were common medicines in the country, sold without restrictions and recommended by doctors to treat a number of health problems, such as headache, menstrual cramps, fever, cough, diarrhea and insomnia.
“There were so many ways to consume,” notes Jones. “You could inject opium or morphine and also use both in powder or pill form.”
The historian points out that the substances were legal, accessible and cheap, in addition to serving as an ingredient in a number of other medicines. In department stores such as Sears, Roebuck & Co, it was even possible to order kits with the drug and syringes and receive the goods in the mail.
“It wasn’t until the early 20th century that narcotics began to be regulated in the United States,” recalls Jones.
Amputations and sequelae
But with the outbreak of the Civil War in 1861, opioids, and especially morphine, were used more widely to relieve the pain of the wounded, and there was an explosion in the number of prescriptions.
The conflict between the Union and the Confederate States left more than 700,000 dead. Many of the survivors had to overcome serious injuries, amputations and permanent sequelae.
Poor sanitation on the battlefields led to diarrhea, dysentery and other diseases that weakened soldiers and could be fatal, and which were also treated with opioids.
In addition, some soldiers used the substances to self-medicate and combat fear and stress before battle.
“Millions of Civil War soldiers suffered horrific physical injuries, gunshot wounds, amputations, really traumatic injuries. And there wasn’t much the doctors could do other than give them painkillers,” says Jones.
‘Indispensable as gunpowder’
Various accounts of the time illustrate how opium and morphine were administered in enormous amounts to treat the wounded.
Physician Silas Weir Mitchell, who was a surgeon at Turner’s Lane Hospital in Philadelphia, wrote about how, in just one year, nearly 40,000 injections of morphine were given to soldiers at that facility.
Mitchell highlighted cases such as that of a Union soldier who was injected with high doses of morphine three times a day during the four months he was hospitalized.
Jones quotes a medical manual used by Confederate forces that “opium is the most indispensable drug on the battlefield, as important to the surgeon as gunpowder is to the artillery.”
According to the manual, military surgeons should use opioids to relieve the pain of the wounded, treat vomiting, diarrhea, internal bleeding, inflammation from gunshot wounds and muscle spasms in amputees, and even to sedate patients.
‘Opium Eaters’
When these fighters returned home, they continued to use morphine and other opioids to relieve pain and chronic problems resulting from the war.
“Many of these injuries never healed, they were injuries that caused lifelong pain,” Jones points out.
A report by the Massachusetts State Health Commission in 1872 stated, “Soldiers who acquired the habit in military hospitals are still dependent on the use of opium.”
In 1889, nearly 25 years after the end of the war, physician James Adams wrote of the “large number” of veterans who still suffered from chronic diarrhea. “As was to be expected, many became opium eaters,” said the doctor.
Even among those who completely recovered from the wounds and illnesses contracted in the war, many were already addicted and continued to use opioids, which continued to be easily obtained, without restrictions.
Crisis of national proportions
Before the Civil War, doctors and even many ordinary Americans already knew that opioid consumption could lead to addiction. “But the number of cases hadn’t exploded yet. People knew the problem existed, but it wasn’t urgent yet,” notes Jones.
After the war, however, the problem became an epidemic of national proportions. There are no exact numbers, but according to historians, hundreds of thousands of Americans faced opioid addiction in the late 19th century.
Although the crisis also affected the general population and especially women, the attention of the press and society was focused on ex-soldiers who had become dependent.
“These veterans had a special place in American society, they were celebrated, they were put on a pedestal. [de drogas] made the news”, points out Jones.
body covered in wounds
Testimonies from the time illustrate the physical and mental suffering faced by these ex-combatants. It was common for them to need to use opioids daily for decades, in ever-increasing doses, as drug tolerance grew.
Many suffered from fatigue, nausea, constipation, indigestion, extreme weight loss and impotence and were covered in sores at the injection sites. As they could not work, they depended on family and friends.
“I could not sleep until I received an injection. My wife had to wake up at all hours of the night to give the syringe. My health was so poor that I was confined to a bed,” wrote in 1871 the physician John Patterson, who had fought by the Union and began using morphine in the war, on the prescription of another doctor.
Records from a military hospital in the State of Indiana describe the physical condition of sailor George Gardner, who fought with Union forces, when he was admitted to the institution in 1891.
According to the document, Gardner had lost a third of his weight, coming in at just 45 kg, and had wounds from injection marks that covered “the entire surface of his body, from the neck down”. He died of an overdose two years later.
‘Pain is no excuse’
But instead of sympathy, the drama of these soldiers provoked criticism. Ex-combatants, once respected for their sacrifices during the war, came to be humiliated and seen as immoral, weak and lacking the will to quit.
According to Jones, overdose deaths were reported to be the fault of the addicts and not the doctors who had prescribed the drug.
“It’s amazing how similar the reaction of the public, the media and even the government after the Civil War is to what we’ve seen over the last two decades in relation to the current opioid crisis,” he compares.
Many were imprisoned or committed against their will to institutions for the mentally ill, where abuse was common. The stigma surrounding drug addiction also made it difficult for them to receive a pension or access to public housing.
An example is the case of Clinton Smith. Wounded by a gunshot wound during the war, he came to rely on morphine to fight chronic pain and died of an overdose in 1884, two decades after the conflict ended.
When his wife, Eliza Smith, won the right to receive a military pension, then US President Grover Cleveland condemned the veteran for his inability to bear pain without resorting to drugs and vetoed payment to the widow. According to the president, pain was not an “excuse” for taking morphine.
Miraculous cures and blows
Many tried to get rid of addiction on their own, but most could not stand the symptoms of the sudden absence of narcotics in the body and ended up relapse. This failure was condemned by the society of the time.
“If I didn’t take morphine, I was completely prostrate. I was very hot one moment and very cold the next,” described Joseph Darrow, who had fought with Union forces, in an 1868 deposition.
“I tried so many different drugs and failed that I became completely discouraged and gave up in desperation,” confessed Darrow, then 35, who said he had been “a slave to the habit of using morphine” for six years.
The supposed cures for addiction soon turned into a multi-million dollar industry. Hundreds of treatment clinics sprang up across the country, but these were expensive and inaccessible to most addicts.
Many ended up victims of scams and false “miracle antidotes” which were advertised in large numbers in newspapers at the time and actually contained opioids, further aggravating the problem.
“There was a lot of fraud back then, when neither drugs nor the practice of medicine were regulated,” Jones points out. “People took advantage of the desperation of addicts.”
Too late
According to Jones, over time and the sheer number of addicts, many war veterans have come to resist recrimination and insist that their plight was the fault of the doctors who had prescribed the opioids.
“By the 1890s, the situation began to change, and people became more sympathetic to drug-addicted veterans,” says the historian.
“It was also at this time that the US government began to ban the use of opium among Chinese immigrants,” Jones points out, noting that these immigrants replaced former soldiers as the target of society’s criticism.
But, according to Jones, despite the sympathy they gained at the end of their lives, ex-combatants who faced addiction never received help.
“It’s really a very tragic story,” says Jones. “The crisis only ended when they died, whether from an overdose, from other problems exacerbated by opioid abuse or old age.”
“Gradually, the government, doctors and consumer protection activists began to adopt measures that helped to solve the epidemic, but it was too late for Civil War veterans”, he says.
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