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The nineteenth century ushered in an era of widespread opium use. Chinese immigrants, who came to America hoping to find their fortune, began arriving in 1820. Largely working as indentured servants, these men, who were far from home and their families, worked at difficult jobs for many years. This challenging existence demanded the occasional release that was fulfilled by the communal activity of smoking opium. This quickly became a popular pastime for many Americans (including women) despite the fact that it served no legitimate therapeutic purpose. Eventually, opium-smoking dens were established in nearly every major city.
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During this same time period the phenomenon of “patent medicines” took the country by storm. A spate of proprietary “cures” promising to treat a broad range of maladies was sold by just about anyone who was interested in developing his own concoction. These “remedies” typically contained large amounts of alcohol, laudanum and morphine along with a host of other mystery ingredients. Most of these products were not actually patented, nor were they subjected to any regulation, which meant that ingredients and the amounts used were undisclosed. Predictably, their administration often lead to tragic results. Dosing babies with potent nostrums that promised to “cure colic,” resulted in many unintended infant deaths.
In spite of the inherent risks, patent medicine was big business. Mothers, who often served as their family’s primary health care providers, feared contraction of serious diseases like cholera, typhoid and typhus and endeavored to stave them off with these “miracle cures.” The near constant threats to mortality greatly contributed to the explosion of the patent medicine business and ignorance about the contents of these tonics put multitudes of people in peril.
Mrs. Winslow’s Soothing Syrup, Wolcott’s Instant Pain Annihilator and Dr. Kilmer’s Ocean-Weed Heart Remedy are just a few of the of countless products that were available to the consumer. An air of respectability was provided by way of a physician’s association or because it was marketed as a trustworthy family remedy. The false sense of security that these quack medicines evoked made people (particularly the poorer classes who had less access to physicians) extremely vulnerable to their outrageous claims. The purveyors of these potions preyed upon the fears of women and blatantly lied about the curative powers of their products. Shameless exploitation of consumers’ gullibility is responsible for much of the narcotic use and abuse that occurred during the 1800s. Growing concerns about these highly questionable products lead the New York Medical Society to form a committee to study them in 1827. The word “addiction” wasn’t part of the vernacular yet, but the phenomenon was understood.
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Thus we arrive at a pivotal point in history, which has often been credited as the genesis of nineteenth century opium/morphine abuse: the Civil War (1861-1865). Traditionally, many historians have attributed a high rate of opiate abuse to this bloodiest of American wars and its aftermath, but a deeper and more thorough examination of the data has lead many modern scholars to reach very different conclusions about the Civil War’s contribution to the problem.
That opium was dispensed in large amounts during the Civil War is undisputed. The Union Army physicians alone distributed nearly ten million opium pills, and close to three million ounces of opium powders and tinctures to its soldiers for any number of ailments. The instant benefit to soldiers who were in pain far outweighed any long-term consequences that might come from overuse and so, well-meaning wartime physicians (who had an average of two years of medical training), eagerly provided relief to the suffering.
These drugs were widely available and given out freely, but, unfortunately, army doctors were largely treating symptoms, rather than the causes of the problems. Soldiers took opiates to treat everything from the mundane (diarrhea) to the life threatening (debilitating battlefield injuries). One Union surgeon by the name of Nathan Mayer, who famously made diagnoses from horseback, would pour out an “exact quantity,” of powder (after assessing the patient’s condition) and let him lick it from his hand. Opium powder was also sprinkled directly into wounds to manage pain.
While it’s true that these medications were issued liberally, and this practice undoubtedly resulted in some cases of dependency, there is lots of evidence to suggest that the Civil War was not the largest contributor to opiate abuse during that period. For starters, in their landmark study, The Opium Problem (1928) Charles E. Terry (an early campaigner against drug addiction) and his wife, Mildred Pellens, determined that the majority of the opiate addicts in the nineteenth century were actually affluent, educated women who were given morphine prescriptions for ambiguous conditions like hysteria and melancholy. It is estimated that at one time sixty percent of addicts were women.
One popular statistic states that “four hundred thousand soldiers were addicts after the war,” but this statement has come under fire in recent years. One expert asserts that “army disease” or “soldiers disease,” which has been widely interpreted to mean “opium addiction,” was popularized by historians who were simply mistaken. He states that these terms actually refer to the large numbers of soldiers that were stricken with malaria, dysentery and typhoid.
Critics of the long-standing theory also argue that the hypodermic needle was introduced too late (it came to America in 1856) to make much of a difference during the war. To wit, medical records show there were only 2093 needles for 11,000 Union doctors (and even less for the Confederate doctors). Scholars claim that the scarcity of needles available to inject morphine (the quickest path to addiction) would have prevented the creation of so many addicts during and just after the war.
By 1881, most doctors were indeed using hypodermic needles, and because the frequency of visiting patients was often hampered by long travels on horseback, doctors were largely inclined leave a needle and a vial of medicine to be used by the patient during the interim. This practice could certainly facilitate unchecked abuse. David Courtwright, who is a recognized expert of the history of opium abuse, summarizes what the invention of the hypodermic needle meant to physicians and their patients: “For the first time in the entire history of medicine near-instantaneous symptomatic relief for a wide range of diseases was possible. A syringe of morphine was, in a very real sense, a magic wand.” This development obviously had a significant impact on patients who were in pain, but it also had a profound effect on doctors, who, for the first time ever were able to relieve suffering.
In addition to a thorough re-examination of the historical record, reliable anecdotal evidence about the lack of opium abuse is provided by beloved American poet, Walt Whitman. Whitman, who visited 80-100,000 patients in over six hundred hospitals during the Civil War wrote of the soldiers wanting items like tobacco or candy, but never once mentions anyone being addicted to (or even asking for) opium or morphine.
No one disputes that Civil War hospitals were rife with opium use, but more experts are starting to believe that abuse wasn’t as rampant as it has previously been reported. One thing is certain however…the Civil War represented a major turning point in the perceptions of drug use and abuse.
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Post-war addiction causes and rates are under scrutiny, but there is at least one affluent, educated American woman who is known to have been dependent on morphine. Prior to living in the White House, Mary Todd Lincoln suffered from migraine headaches for twenty years. For this chronic condition, she probably took paregoric or laudanum. Once she became the First Lady, however, she had access to better medical care, which meant prescriptions for morphine. This undoubtedly led to her deeper dependence on the drug. It should come as no surprise that her habit reached new heights after her husband’s assassination. There are accounts of her purchasing a bottle of laudanum, drinking it on the street and then walking right back into the shop to buy another.
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After slavery was abolished, many white southerners were wiped out financially and turned to drug use as a way to deal with the overwhelming trauma of the war. On the contrary, blacks were less inclined to partake because the Confederacy’s defeat was a cause for happiness and celebration.
Between 1860 and 1880, opium abuse became a national crisis and it was thought that physical dependency could result from continuous use over a period of ten to fourteen days. Beginning in 1870 the professional community began to recognize the possibility of iatragenic morphine addiction (addictions that were caused unwittingly by doctors) and discussion about this phenomenon began to appear in books, journal articles and published speeches. In 1892 The Journal of the American Medical Association called for a ban on imports of smoking opium.
These actions hadn’t come too soon…In 1874 a London chemist by the name of C.R. Wright boiled morphine to synthesize yet another extremely potent derivative, which was called diacetylmorphine. This substance was later refined by Bayer, the German pharmaceutical company, and sold under the name of heroin. This new product was marketed as a cure for a variety of problems including (incredibly) morphine addiction and as a children’s cough syrup!
The opium epidemic reached its peak in 1895 and it had become abundantly clear that overprescribing physicians were primarily to blame for the situation.* By this time it was standard practice to replace one addictive drug with another, which only enabled the addict to continue down the path of abuse. Also in play during this period is the process of withdrawal, whose symptoms mimic other illnesses, and generally results in more opium based prescriptions! Educating doctors was now the key to turning things around. The concept of “addiction” (derived from the Latin root addicere, meaning to adore or surrender oneself to a master) would enter into the lexicon via professional literature of the mid 1890s.
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Next week: Medical advancements, governmental intervention and the work of muckraking journalists catalyze a movement towards regulation and standardization of medicines and a reduction of addicts.