Hidden Opiates and Mercury

By Marieke Hendriksen, 10-2-12

About two weeks ago, I had coffee with the head of the conservation department of the National Maritime Museum. She asked me if I could mark the bottles and containers from the medicine chests in the database that had potentially hazardous substances in them. As I compiled a list of all the substances and their contemporary uses for my research project anyway, I promised her to do so.

Obviously, many of the substances in the chest can be hazardous if you would swallow an entire bottle at once, but the conservation department is particularly interested in substances that are either a health risk if not properly stored, such as mercury, and substances that are subject to legal regulations, such as opiates. Even if the opium is over a century old, you still need a license to keep it! And as a matter of fact, there are quite some hidden opiates and mercury in the medicine chests.

Some of them are quite easy to recognise, because their label reads something like ‘Hydr.’ (hydrargyrum; mercury), or ‘compound powder of chalk with opium’, and anyone who has ever read a Victorian novel will know laudanum should not be spoon-fed to infants – although one can imagine it would make them very calm. However, others are less straightforward. Grey powder, blue pills, Dover’s powder, paregoric elixir, and calomel or calamel all contain mercury or opium.

Dover’s powder for example, was a traditional medicine against cold and fever developed by Thomas Dover (1660–1742), aka Doctor Quicksilver. Its’ recipe i  Encyclopaedia Britannica: Or a Dictionary of Arts, Sciences and Miscellaneous Litterature of 1810 says:

“Sudorific, or Dover’s powder. E. Take of vitriolated tartar, three drams; opium, root of ipecacuanha powdered, of each one scruple. Mix, and grind them accurately together, so as to make an uniform powder.”

But Dover was certainly not the only or the last physician to subscribe mercury-based drugs to his patients. Medication with mercury as the active ingredient was used in the treatment of venereal and skin diseases up to the early twentieth century, and in the nineteenth century they could be found in both traveller’s and family medicine chests in abundance. Turnbull in his 1806 book The Naval Surgeon writes that John Clark  in 1773 was the first to use calomel (mercury chloride) in dysentery in ‘hot countries’.

John Savory, in his 1836 A Companion to the Medicine Chest wrote of calomel: “This mercurial preparation is more extensively and more usefully employed than almost any other article of the Materia Medica. But its principal use is as a purge, conjoined with other aperients; and for this purpose it is administered in doses of from three to six grains, combined with, or followed by, cathartic extract, rhubarb, senna, or other laxatives. (…) In affections of the liver, in various glandular diseases, and in some cutaneous eruptions, calomel is celebrated as an alternative; and, combined with diuretics, it singularly contributes to their activity. (…)..,and in croup no remedy proves so decidedly useful as calomel, in these combinations, administered after bleeding and purging.(…)”

These prescriptions make you wonder to what extent mercury poisoning influenced nineteenth-century society, as it acts as a neurotoxin in the human body, and interferes with the brain and nervous system. In children, it may affect development and cause learning disabilities; in adults it can affect fertility and memory, cause tremors, loss of vision and in severe cases lead to death…

For more on Thomas Dover and quicksilver doctors, see Swiderski, Richard M. Quicksilver : A History of the Use, Lore and Effects of Mercury. Jefferson, NC: McFarland, 2008.

Image: A late nineteenth century bottle of Dover’s Powder – advertised as fever medicine.

From: mariekehendriksen.nl

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"Opium-the Poor Child's Nurse"

By Rob Kennedy

This Harper's Weekly cartoon dramatizes the widespread use of opium in the 19th century, emphasizing its application as teething medicine or a soporific to the children of the poor.
Opium use dates back to antiquity, and existed in many cultures, although it was particularly associated with China and India. It was considered to be a medical cure-all until other painkillers and therapeutics began to be developed in the 19th century. In England and the United States in the mid-19th century, physicians prescribed opium readily, yet it could be purchased without a prescription. It was often an ingredient in pills, tablets, cough drops, lozenges, plasters, and other medicinal forms. Opium was used extensively in medicines for gynecological maladies, resulting in a high rate of addiction among women (three times higher than in men).

There was an awareness of the problem of addiction to opium, but druggists were usually ignorant about safe dosages. The invention of the hypodermic needle in the mid-19th century was considered a partial solution because it was erroneously supposed that intravenous use would not cause addiction. Opiates were administered by hypodermic needles to wounded or ill soldiers. The result in the United States was the addiction of thousands of servicemen during the Civil War.

Harper's Weekly reported on the prevalent use of opium in the late 1850's. The journal's inaugural issue of January 3, 1857, carried the essay, "A Recent Confession of an Opium-Eater," and in 1858 and 1859, the newspaper ran advertisements for Thomas de Quincey's Confessions of an English Opium-Eater . News stories and illustrations took readers into opium dens, as well as reported the Second Opium War in which Britain fought to keep open its lucrative opium trade after the Chinese government prohibited the narcotic.

Harper's Weekly alerted the public that the opium habit was spreading in New York City and across America. Custom houses reported 300,000 pounds imported in 1858, estimating 90 percent was intended for recreational use. It was a problem which affected all classes and ethnic groups, from Broadway to the Bowery. The effects of opium addiction could be noted in the "glassy eyes in Fifth Avenue drawing-rooms and opera-stalls," and in the babies of beggar-women. The infants' sleepiness was induced by laudanum (an opium derivative), which kept the children "fuddled continually, and permanently stupefied." It was, in fact, a common remedy used by American and British parents, especially poor ones, for infants who were experiencing teething or other pains.

Not until the late-19th century was opium use identified with the underworld of prostitutes, gamblers, and criminals, more than with medical therapy. By the turn of the century, opium addiction was recognized as a worldwide problem. The first U.S. federal law regulating drug use was the Harrison Narcotics Act of 1914.

Image Artist: Unknown

From: nytimes.com

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"Opium-the Poor Child's Nurse"

By Rob Kennedy

This Harper's Weekly cartoon dramatizes the widespread use of opium in the 19th century, emphasizing its application as teething medicine or a soporific to the children of the poor.

Opium use dates back to antiquity, and existed in many cultures, although it was particularly associated with China and India. It was considered to be a medical cure-all until other painkillers and therapeutics began to be developed in the 19th century. In England and the United States in the mid-19th century, physicians prescribed opium readily, yet it could be purchased without a prescription. It was often an ingredient in pills, tablets, cough drops, lozenges, plasters, and other medicinal forms. Opium was used extensively in medicines for gynecological maladies, resulting in a high rate of addiction among women (three times higher than in men).

There was an awareness of the problem of addiction to opium, but druggists were usually ignorant about safe dosages. The invention of the hypodermic needle in the mid-19th century was considered a partial solution because it was erroneously supposed that intravenous use would not cause addiction. Opiates were administered by hypodermic needles to wounded or ill soldiers. The result in the United States was the addiction of thousands of servicemen during the Civil War.

Harper's Weekly reported on the prevalent use of opium in the late 1850's. The journal's inaugural issue of January 3, 1857, carried the essay, "A Recent Confession of an Opium-Eater," and in 1858 and 1859, the newspaper ran advertisements for Thomas de Quincey's Confessions of an English Opium-Eater . News stories and illustrations took readers into opium dens, as well as reported the Second Opium War in which Britain fought to keep open its lucrative opium trade after the Chinese government prohibited the narcotic.

Harper's Weekly alerted the public that the opium habit was spreading in New York City and across America. Custom houses reported 300,000 pounds imported in 1858, estimating 90 percent was intended for recreational use. It was a problem which affected all classes and ethnic groups, from Broadway to the Bowery. The effects of opium addiction could be noted in the "glassy eyes in Fifth Avenue drawing-rooms and opera-stalls," and in the babies of beggar-women. The infants' sleepiness was induced by laudanum (an opium derivative), which kept the children "fuddled continually, and permanently stupefied." It was, in fact, a common remedy used by American and British parents, especially poor ones, for infants who were experiencing teething or other pains.

Not until the late-19th century was opium use identified with the underworld of prostitutes, gamblers, and criminals, more than with medical therapy. By the turn of the century, opium addiction was recognized as a worldwide problem. The first U.S. federal law regulating drug use was the Harrison Narcotics Act of 1914.

From: nytimes.com

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Illnesses and Opiates

From: nchealthandhealing.com

People remember the Civil War for its tragically high casualty rates—about 970,000 in all, or 3 percent of the population. But among soldiers, disease actually killed far more than battlefield wounds.

Many soldiers fell sick in military camps. Constant exhaustion, lack of adequate clothing, exposure to severe weather and a diet of poorly cooked food made soldiers susceptible to a host of infectious diseases. Worst of all, drinking water contaminated by open latrines caused outbreaks of typhoid fever, which caused the most fatalities.

The most common problems, though, were diarrhea and dysentery. “No matter what else a patient had,” wrote one doctor, “he had diarrhea.”

Civil War–era doctors had few effective ways to cure illness. But they knew that morphine and other opiates (drugs derived from opium) could temporarily relieve the symptoms of a wide variety of ailments. So they readily prescribed them in liberal doses. Opium, which has constipating effects, was used for diarrhea and dysentery. Doctors also prescribed it to relieve violent convulsions from malaria. Because of its effectiveness as a painkiller, opium was commonly rubbed into or sprinkled on severe wounds.

Opiates are highly addictive. As a result of their treatment, a number of Union and Confederate soldiers acquired lasting drug habits. For example, William Anderson Roberts, a private in the 14th Regiment North Carolina Troops, spent a great deal of time in military hospitals. In 1862, he wrote this to his family from Moore Hospital:

“Of all the lonesome places on earth it is a evening in a Hospital. There is a deep gloomy melancholy settling down on my mind. I have taken an Opium pill to counteract the influence of depression of spirits. Opium, that sweet restorer of man as he was before the fall. The King of all medicines. The great restorer of ease and peace to both mind and body. Thanks to the great giver of all good things for that great gift.”

Roberts survived the war and returned home at its end. But he fought his addiction to opium until his death in 1900.

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Prescription Drug Abuse History

From: narcanon.org

The abuse of prescription drugs in America goes back more than a hundred years to the abuse of laudanum, a mixture of opium and alcohol. This was an early remedy for pain, sleeplessness, anxiety, coughing and diarrhea. In the 1800s, laudanum was used by doctors across the country. But it was quite addictive.

It was also part of an interesting division of addiction for people living in the 1800s. The usual laudanum addict was a Caucasian woman. Men had their own substance of addiction - alcohol. But women were not supposed to visit bars or saloons or be seen drinking so they could visit their doctors for their addictive substances. And they did, for problems with pregnancy, childbirth, menstrual cramps or emotional problems.
Morphine Use Grows

The commercial manufacture of morphine started in Germany in 1827, and the drug became the painkiller of choice during the American Civil War. While there are conflicting accounts of the degree to which morphine contributed to cases of addiction after the war was over, it has been reported that there were ten million opium pills handed out to army surgeons during the war, and that morphine was widely used for the terrible shrapnel wounds suffered by soldiers.

In fact, the doctor who invented the Coca Cola formula developed a morphine addiction during the Civil War and was looking for a solution. He added the recently-developed drug cocaine to his new drink and began to sell it at a pharmacy in Atlanta. Because there were few laws regulating the contents of foods or drugs, it was perfectly legal for him to do so.

In fact, the act of "prescribing" drugs like cocaine or morphine was essentially up to the consumer. Morphine and cocaine injection kits, complete with the newly invented syringe and a supply of the medication, were available from Sears catalogs.

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Did the Civil War Create a Lot of Morphine Addicts?

By Chris

A question posed in 1999 asked, “I’ve often read that there were 500,000 morphine addicts running around after the Civil War. Is this true? If so, did narcotics have a deleterious effect on the Old West? How many cowboys were wacko on these then-legal drugs?”

According to one interesting source, the answer was… maybe:

Still, even allowing for exaggeration by drug alarmists, you have to think the Civil War had some impact. Narcotics were handed out like candy by army surgeons, who were surrounded by suffering and had few remedies to offer other than painkillers. Nearly ten million opium pills were issued to Union soldiers, along with 2.8 million ounces of other opium preparations; no doubt opium use was fairly common on the Confederate side, too. One doctor reported keeping a wad of “blue mass” (a powdered mercury compound) in one pocket and a ball of opium in the other. He’d ask soldiers, “How are your bowels?” If the answer was “open” (due to diarrhea), the soldier got opium, if “closed” (presumably because of constipation), mercury. Opiates were used to treat not just wounds but chronic campaign diseases such as diarrhea, dysentery, and malaria. Narcotics became even more popular after the war as invalided veterans sought relief from constant pain.

That said, soldiers weren't the only or even the major users of drugs, nor was drug abuse more prevalent in the Old West than in the rest of the country, as you suggest. On the contrary, casual use of hard drugs was widespread. Several surveys in the midwest in the latter 1800s found that the majority of opiate addicts were women who took drugs for neuralgia, morning sickness, or menstrual pain. Mary Chesnut, whose diary was read to haunting effect in Ken Burns’s Civil War documentary series, was a regular user. Narcotics could be found in the patent medicines of the day as well as in commonly prescribed medications like laudanum and paregoric, inexpensive opiates that could be ordered through the Sears catalog.

As we know morphine sulphate was liberally given to soldiers during the war. Post Civil War era gave birth to what was called the “Soldier’s disease.” There are sources that claim up to 400,000 veterans of the Civil War left the army with some level of addiction. After the war opiates were widely used to cure any form of ailment. Drugs were so widely used you would order them from your Sears and Roebuck catalog. However, there are no studies that were taken from 1865-1900 that would account for any significant portrayal of soldier addiction. In 1886 former Confederate soldier Dr. John Pemberton invented Coca-Cola; which contained a small amount of cocaine. Pemberton was a pharmacist and was even wounded in the Battle of Columbus.

In 1915, Jeannette Marks, first alerted the nation of the potential for as many as 400,000 post war veterans being addicted. To this day historians disagree about the impact of drug addiction after the war, with the number ranging anywhere from 45,000 to 400,000.

From: soldierstudies.org

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About Morphine Use During the Civil War

By Susan Sosbe

Morphine, along with opium and laudanum, was widely used in the Civil War to relieve soldiers after surgical procedures were performed in field hospitals. Despite the side effects of using morphine, it is still a commonly used analgesic and is held up as a comparison for all other acute pain relievers.

Morphine was first discovered by Friedrich Wilhelm Adam Serturner when he managed to isolate the alkaloid in the opium poppy in 1805. He often experimented with his discovery on himself, noting both the benefits and the negative aspects of morphine. Although not much interest was shown in his discovery at first, chemists and physicians soon showed an interest in his findings. He received an award for the discovery of morphine in 1831.

Morphine was named after Morpheus, the Roman god of dreams. It is the active ingredient found in opium. Its use in the early stages of the Civil War consisted of using it in powder form and sprinkling it or rubbing it directly on the wound site. In later years, syringes, which had become more reliable in the 1850s, were made more readily available to surgeons in field hospitals, and it was injected into the patient's body in liquid form.

As with the use of other opiates, there was a danger of addiction and overdose in soldiers who were given morphine. It has been noted that in some hospitals during the Civil War, the medicine supplies were guarded by armed men to keep addicts from stealing. Other side effects from the use of morphine were vomiting, nausea, respiratory depression, cough suppression and sedation.

Some of the side effects of morphine were also some of the benefits during the Civil War. In addition to the relief of pain, morphine was also used for sedation of patients, allowing them to get the rest that was necessary for recovery, if they were lucky enough to avoid infection from their wounds.

With the discovery of morphine, and the overall benefits of using it to relieve pain after surgery, it became widely used in the medical profession. It was still used in the field during both World Wars. Unfortunately, it was also discovered that due to its highly addictive properties, many soldiers of the Civil War left the field as addicts. It is estimated that 400,000 Civil War soldiers became addicted. Because of this, the addiction to morphine became known as the "soldier's disease."

From: ehow.com

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Under the Influence: Marching Through the Opium Fog

by James Street, Jr.
From: 4thus.com

By the beginning of the civil war, there was probably some opium of some form in most household medicine cabinets. In The Plantation Mistress, a 1982 study of women's life in the antebellum south, author Catherine Clinton writes that she found home remedies, all containing opium, for many common illnesses. She observes,

”Laudanum was commonly used throughout the antebellum era, prescribed with unfortunate frequency for 'female complaints'.....contrary to the 20th Century image....., the late 19th Century profile indicates that addicts were disproportionately upper-class, Southern, white and female."

The women of the Jefferson Davis family, treated by a Dr., liberal in his dosages, became dangerously addicted."  Most people using opiates did not become addicted.

Confederate society figure Mary Chestnut, writing in her diary in Richmond, Virginia, during July 1861, told of her refusal to take laudanum, a tincture of opium mixed with alcohol and water. "I have no intention of drugging myself now." she asserted. "My head is addled enough as it stands, and my heart beats to jump out of my body at every sound." Later, in March 1865, Mrs. Chestnut was a refugee in Lincolnton, N.C. She was accidentally given an overdose of Dover's powder, a mixture of opium and ipecac. She slept for 2 days and nights. After her Dr. remarked that she was hard to kill, Mrs. Chestnut speculated,” Maybe I was saved by the adulteration so often complained of in Confederate medicine."

When called to the colors, whether Union or Confederate, doctors who used opiates liberally on civilian clients continued to use them liberally on their military patients. William H. Taylor was an assistant surgeon in the Confederate Army of Northern Virginia, an organization known for its rapid marches. After the war he wrote that he had simplified sick call on the march to one basic question: How are your bowels? If they were open, I administered a plug of opium; if they were shut I gave them a plug of blue mass (an unstable mercury compound)." A Federal surgeon devised an even speedier sick call method. He performed diagnosis from horseback, dispensing morphine powder by pouring it into his hand and letting the patient lick it.

Morphine, injected by the recently developed hypodermic syringe, was the preferred form of opium for treating the wounded. And though syringes were scarce, even in the better-equipped Federal armies, 29,828 ounces of morphine sulphate was dispensed to Union soldiers. That figure seems almost trifling compared to the almost 10 million opium pills and 2,841 million ounces of other opiates administered by Federal medical authorities by 1865. While not as ubiquitous in the Confederate army, opium was in reasonable supply until the very end of the war, thanks to captured medical stores and imports smuggled through the naval blockade of the southern ports. Though opiates were used profusely in the treatment of illnesses, it was in relieving the pain of wounds and surgery that they were most effective. The desire for that relief cause many injured soldiers to become opiate addicts, for pain lingered long after medical treatment in those days. And after the war it was easy to find veterans who suffered agony from war wounds or war-related illnesses for the rest of their lives. In his book, "Dark Paradise: Opiate addiction in America Before 1940", David Courtwright quotes from an 1868 study titled The Opium Habit, with suggestions as to the remedy: "Maimed and shattered survivors from a hundred battlefields, diseased and disabled soldiers released from hostile prisons, anguished and hopeless wives and mothers, made so by the slaughter of those dearest to them, have found, many of them, temporary relief from their sufferings in opium."

Just as the Civil War army surgeon was a ready source of alcohol for non-medicinal purposes, so was he or his staff a handy source of opiates--not just for sneaky scroungers but for high-ranking officers too. If a general wanted opium pills, what surgeon would deny him the relief he sought, when the surgeon probably prescribed them in the first place? A surgeon had only to turn to his medicine chest to satisfy such a request, or the officer could help himself from the open stock usually arrayed on shelves in the unit's medical quarters.

Dr. Charles Beneulyn Johnson, a Union regimental medical steward, described the contents of the medical chests. "During a campaign our stocks of medicines were necessarily limited to standard remedies." He recalled, among which could be named opium, morphine, Dover's powder, quinine, rhubarb, Rochelle Salts, Epsom salts, castor oil, sugar of lead, tannin, sulphate of copper, sulphate of zinc, camphor, tincture of iron, tincture of opium, camphorate, syrup of squills, simple syrup, alcohol, whiskey, brandy, port wine, sherry wine etc. Upon going into camp, where we were likely to remain a few days, these articles were unpacked and put on temporary shelves made from box lids; on the other hand, when marching orders came, the medicines were again packed in boxes, the bottles protected by old papers, etc." Johnson continued, "Practically all the medicines were in powder form or in the liquid state. Tablets were not yet come into use and pills were very far from being as plentiful as they are today...." The doctor noted, "....one of the very few pills we carried in stock...was composed of two grains of camphor and one of opium. Asafetida, valerian and opium and its derivatives (sic) were about all (we) had to relieve nervousness and induce sleep."

Among the aphorisms attributed to that barely literate but extraordinarily effective Confederate, Lieutenant General Nathan Bedford Forrest, is one that states, "War means fighting and fighting means killing." Not all civil war generals could muster so direct such an approach to war and violence. Many preferred to try any means of defeating an enemy except fighting. These were usually the same generals who could not overcome their troops' natural desire to remain where they were, so long as they were safe. Historian T. Harry Williams called this phenomenon the "inertia of war," that moment when "the general's own army, begins to offer resistance....when the whole inertia of the war comes to rest on his will, and only the spark of his own purpose and spirit can throw it off... a commander has to have in his make-up a mental strength and moral  power that enables him to dominate whatever event or crisis  may emerge on the field of battle."  But were the war's inert generals fundamentally flawed leaders or was there another reason for their lapses into feebleness?  When cataloging the attributes of a successful general, Marshall Maurice Saxe, France's great military mind of the early 18th Century, presented the usual list including bravery, intelligence etc. then he added one more, health. It is doubtful that the outcome of the Civil War would have been any different if all the generals had been healthy. But the fact is they were not, and perhaps much of their erratic and lethargic behavior can be ascribed to their frail state of health--and to opium, the panacea their doctors described at every turn.

Braxton Bragg's health should have excluded him from any consideration for a field command. By 1861, when the first shot of the war was fired at Ft Sumter, Bragg had developed a long list of chronic ailments, including malaria, dyspepsia (deranged or impaired digestion) and boils. His wife and friends were aware that the greater the pressure on him, the more he complained and the more likely he was to develop boils, headaches and other painful maladies. His behavior as commander of the Confederate Army of Tennessee was as mystifying to his contemporaries as it is to current scholars. And Bragg's penchant for turning away from victory, quitting battle when he had the upper hand, was the basis for a story that when he died, he went to heaven: as he approached the Pearly Gates, they opened; then Bragg retreated.

Some critics and historians offer stupidity, incompetence or cowardice as reasons for Bragg's failures. But his blunders may have resulted from his health and the rudimentary, even primitive level of medicine prevalent during the war.  Bragg's behavior showed signs of opiate use. In the field, he appeared to withdraw as battle developed, to lose track of where he was. He became unable to adapt his plans to changing situations on the battlefield.  But Bragg certainly was not stupid, as evidenced by the swiftness of his September 1862 movement from Tennessee into Kentucky, to wrest the Bluegrass State from Union Major General Don Carlos Buell. He was not a coward, as his record during the Mexican War and the Battle of Shiloh demonstrated. But, as he was promoted to higher command, Bragg became more distant from the troops, appearing to avoid active command during battle. His behavior could have been the result of a combination of poor health and the use of opiates. Bragg may very well have believed the unfounded contents of his Dec.31,1862 telegram to President Davis--that he had won victory after the first day of the Battle of Stones River. Opium-induced euphoria could have induced such an effect, leading him to believe what he so desperately wanted to be true. Euphoria could have led Bragg to back away from Buell's troops after capturing the entire Federal garrison at Mumfordville, Kentucky in Sept. 1862 and seizing Frankfort, the state capital. That same euphoria may have prompted his dispatch to Richmond before the Oct. 1862 Battle of Perryville, Kentucky, claiming his army had joined with Major General Edmund Kirby Smith's when Smith's force was actually more than 100 miles away. Bragg's skewed visions of success, his paranoia towards his officers after each defeat , could have been the result of his medical care.

The gallant John Bell Hood, aggressive, vigorous and effective while with the Army of Northern Virginia, became a victim of delusions after a series of shattering wounds struck him. He left his finest attributes and his common sense on the surgeon's table. The pain from the stump of his right leg must have been horrendous when he rode strapped to his saddle. The bouncing and jolting, the abrasive rubbing of the stump against the rough cloth of a dressing or pad could not have been endured without some sort of pain-reliever.. An opiate was the standard prescription. The drug would have made Hood sleep at Spring Hill while the Federals escaped his trap. The pain was a terrible burden to inflict on Hood, but it was even worse to inflict Hood on the Army of Tennessee.

Union Major General Joseph "Fighting Joe" Hooker's affinity for spirituous liquors and spirited women was a matter of record by the time he led the Army of the Potomac to battle at Chancellorsville, Virginia, in May 1863. If Hooker was truly an alcoholic, and if he kept his pledge not to drink while commanding the army, it is highly likely he was treated with opiates to help him through withdrawal (opiates were commonly used to treat delirium tremens). This medical scenario may account may account for his poor battlefield performance. Or, there may have been another.  Hooker's plans for the Battle of Chancellorsville were excellent. It was his leadership that faltered as he became more and more lethargic. The general admitted this much himself. Then, on May 3, Hooker claimed that, while he stood on the porch of a house, he was hit on the head by a column that was knocked loose by a cannon shot. He claimed he was in great pain. The Medical Director of the Army of the Potomac, Doctor Johnathan Letterman, later substantiated Hooker's claim, but failed to mention the extent of the injury, the amount of pain and whether any alcohol or morphine was administered.. But Hooker's behavior the rest of that day indicates he may have received an intoxicating prescription, for he abandoned control of his army to sleep in his tent. Opium, in smaller doses than whiskey, is an effective soporific.

The three generals mentioned here were not the only ones to experience radical behavior changes during battle, changes that may indicate the use of opium or alcohol. Bragg, Hood and Hooker were merely the highest ranking examples. Opiates may have contributed to the timidity of Confederate Lieutenant General Richard Stoddard Ewell, who in July 1863 dashed boldly into Gettysburg, strapped to his horse and minus a leg, and chased the Federals out of town, but then sank into inertia. And what of Bragg's enemy, Buell, who after an accident with his horse sat out the Oct. 1862 Battle of Perryville behind his lines? There are others, too.  This is not to imply that all the Civil War's military leader's were alcoholics or drug addict's.

Ulysses S. Grant was certainly known as a two-fisted drinker, but liquor did not keep him from forging victories. Perhaps a more important observation about Grant is that he was never forced by poor health to rely on the services of a surgeon. That fact alone may have been a blessing for the Union.  Due to the state of medical arts and sciences during the Civil War, some officers, tenuously steadied with alcohol or opiates, managed to hold positions of great responsibility even though they were unfit for any military service.

Others were retained after suffering debilitating wounds or illnesses, when they should have been discharged or assigned non-combat roles. But instead, history was sometimes made by men who saw their battlefields through the cloud of intoxication.

Source: Civil War Times May 1988

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Opium Abuse in Barnwell, SC

From: historyengine.richmond.edu

On May 7, 1850, Dr. John William Ogilvie traveled eight miles to a plantation in Barnwell County, SC in response to a reported overdose of Laudanum, or a tincture of opium. The patient had attempted suicide, swallowing the tincture at 4:15 that morning. Arriving at 7:15 AM, Dr. Ogilvie found him still alive. Apparently in a state of melancholy, the patient was conscious and calm, but expressed regret that the doctor had come as he still wished to die. Dr. Ogilvie, however, proceeded to treat the patient without any apparent difficulty. Initially, he administered ten doses of zinc sulphate solution, five minutes apart. The patient began to vomit fifteen minutes after the last dose, and Dr. Ogilvie smelled and saw the drug in his regurgitated fluids. The doctor then proceeded to put a tube down his patient's throat and forced four pints of warm water into the man's stomach. Dr. Ogilvie left at 10:45 AM, his patient stabilized and quickly recovering.

Depression was one of the most serious consequences of opium addiction, and so Dr. Ogilvie's patient might well have been a long-term abuser of the drug. Up until the twentieth century, most opium abusers became addicted to the drug after having it prescribed as a pain treatment. Pharmacists often dispensed it without a prescription, or the doctor would leave an additional supply with the patient's family. The drug was not only pleasurable, but also highly addictive and widely available. Historically, southern whites were the most susceptible to opium addiction, and prior to 1900, the addiction primarily affected the middle- and upper-class. Country physicians actually had the highest rate of addiction among nineteenth century professions. Although Dr. Ogilvie's notes do not suggest that he was an opium abuser himself, he was likely very familiar with the addiction, which perhaps accounts for his successful and evidently calm response to this suicide attempt.

The most significant incidence of opium abuse in the United States occurred during the Civil War, when an estimated 400,000 soldiers became addicted to the drug. Opium and morphine were two of the few painkillers that wartime surgeons could access; they prescribed it as an anesthetic for major surgeries and amputations, as well as for the treatment of painful diseases. Dependency was likely heightened by soldiers' traumatic experiences during the war, which often led to depression. David Courtwright suggests that a more gradual increase in abuse between 1830 and 1860 affected the rate of addiction during and after the Civil War. This growth was the consequence of several cholera and dysentery outbreaks during that time period-including one between 1847 and 1851, just before this patient's attempted suicide-as these diseases were regularly treated with opiates. During the nineteenth century, the abuse of drugs like laudanum and morphine was not unusual or frowned upon, as Dr. Ogilvie's notes suggest. As a result, addiction became more commonplace because nobody thought it was important to regulate these substances. It was not until the significant abuse during and after the Civil War that doctors began to take drug abuse seriously and medical opiate addiction finally began to disappear.

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Opium in the Civil War

Under the Influence: Marching Through the Opium Fog 

by James Street, Jr.

By the beginning of the Civil War, there was probably some opium of some form in most household medicine cabinets. In The Plantation Mistress, a 1982 study of women's life in the antebellum south, author Catherine Clinton writes that she found home remedies, all containing opium, for many common illnesses. She observes, ”Laudanum was commonly used throughout the antebellum era, prescribed with unfortunate frequency for 'female complaints'.....contrary to the 20th Century image....., the late 19th Century profile indicates that addicts were disproportionately upper-class, Southern, white and female. The women of the Jefferson Davis family, treated by a Dr. liberal in his dosages, became dangerously addicted." Most people using opiates did not become addicted.

Confederate society figure Mary Chestnut, writing in her diary in Richmond, Virginia, during July 1861, told of her refusal to take laudanum, a tincture of opium mixed with alcohol and water. "I have no intention of drugging myself now." she asserted. "My head is addled enough as it stands, and my heart beats to jump out of my body at every sound." Later, in March 1865, Mrs. Chestnut was a refugee in Lincolnton, N.C. She was accidentally given an overdose of Dover's powder, a mixture of opium and ipecac (what??!!). She slept for 2 days and nights. After her Dr. remarked that she was hard to kill, Mrs. Chestnut speculated,” Maybe I was saved by the adulteration so often complained of in Confederate medicine."

When called to the colors, whether Union or Confederate, doctors who used opiates liberally on civilian clients continued to use them liberally on their military patients. William H. Taylor was an assistant surgeon in the Confederate Army of Northern Virginia, an organization known for its rapid marches. After the war he wrote that he had simplified sick call on the march to one basic question: "How are your bowels? If they were open, I administered a plug of opium; if they were shut I gave them a plug of blue mass (an unstable mercury compound)." A Federal surgeon devised an even speedier sick call method. He performed diagnosis from horseback, dispensing morphine powder by pouring it into his hand and letting the patient lick it.

Morphine, injected by the recently developed hypodermic syringe, was the preferred form of opium for treating the wounded. And though syringes were scarce, even in the better-equipped Federal armies, 29,828 ounces of morphine sulphate was dispensed to Union soldiers. That figure seems almost trifling compared to the almost 10 million opium pills and 2,841 million ounces of other opiates administered by Federal medical authorities by 1865.

While not as ubiquitous in the Confederate army, opium was in reasonable supply until the very end of the war, thanks to captured medical stores and imports smuggled through the naval blockade of the southern ports. Though opiates were used profusely in the treatment of illnesses, it was in relieving the pain of wounds and surgery that they were most effective. The desire for that relief cause many injured soldiers to become opiate addicts, for pain lingered long after medical treatment in those days. And after the war it was easy to find veterans who suffered agony from war wounds or war-related illnesses for the rest of their lives.

In his book, "Dark Paradise: Opiate  Addiction in America Before 1940", David Courtwright quotes from an 1868 study titled The Opium Habit, with suggestions as to the remedy: Maimed and shattered survivors from a hundred battlefields, diseased and disabled soldiers released from hostile prisons, anguished and hopeless wives and mothers, made so by the slaughter of those dearest to them, have found, many of them, temporary relief from their sufferings in opium."

Just as the Civil War army surgeon was a ready source of alcohol for non-medicinal purposes, so was he or his staff a handy source of opiates--not just for sneaky scroungers but for high-ranking officers too. If a general wanted opium pills, what surgeon would deny him the relief he sought, when the surgeon probably prescribed them in the first place? A surgeon had only to turn to his medicine chest to satisfy such a request, or the officer could help himself from the open stock usually arrayed on shelves in the unit's medical quarters.

Dr. Charles Beneulyn Johnson, a Union regimental medical steward, described the contents of the medical chests. "During a campaign our stocks of medicines were necessarily limited to standard remedies." He recalled, among which could be named opium, morphine, Dover's powder, quinine, rhubarb, Rochelle Salts, Epsom salts, castor oil, sugar of lead, tannin, sulphate of copper, sulphate of zinc, camphor, tincture of iron, tincture of opium, camphorate, syrup of squills, simple syrup, alcohol, whiskey, brandy, port wine, sherry wine etc. Upon going into camp, where we were likely to remain a few days, these articles were unpacked and put on temporary shelves made from box lids; on the other hand, when marching orders came, the medicines were again packed in boxes, the bottles protected by old papers, etc." Johnson continued, "Practically all the medicines were in powder form or in the liquid state. Tablets were not yet come into use and pills were very far from being as plentiful as they are today...." The doctor noted, "....one of the very few pills we carried in stock...was composed of two grains of camphor and one of opium. Asafetida, valerian and opium and its derivatives (sic) were about all (we) had to relieve nervousness and induce sleep."

Among the aphorisms attributed to that barely literate but extraordinarily effective Confederate, Lieutenant General Nathan Bedford Forrest, is one that states, "War means fighting and fighting means killing." Not all civil war generals could muster so direct such an approach to war and violence. Many preferred to try any means of defeating an enemy except fighting. These were usually the same generals who could not overcome their troops' natural desire to remain where they were, so long as they were safe. Historian T. Harry Williams called this phenomenon the "inertia of war," that moment when "the general's own army, begins to offer resistance....when the whole inertia of the war comes to rest on his will, and only the spark of his own purpose and spirit can throw it off... a commander has to have in his make-up a mental strength and moral power that enables him to dominate whatever event or crisis may emerge on the field of battle."

But were the war's inert generals fundamentally flawed leaders or was there another reason for their lapses into feebleness? When cataloging the attributes of a successful general, Marshall Maurice Saxe, France's great military mind of the early 18th Century, presented the usual list including bravery, intelligence etc. then he added one more, health. It is doubtful that the outcome of the Civil War would have been any different if all the generals had been healthy. But the fact is they were not, and perhaps much of their erratic and lethargic behavior can be ascribed to their frail state of health--and to opium, the panacea their doctors described at every turn.

Braxton Bragg's health should have excluded him from any consideration for a field command. By 1861, when the first shot of the war was fired at Ft Sumter, Bragg had developed a long list of chronic ailments, including malaria, dyspepsia (deranged or impaired digestion) and boils. His wife and friends were aware that the greater the pressure on him, the more he complained and the more likely he was to develop boils, headaches and other painful maladies. His behavior as commander of the Confederate Army of Tennessee was as mystifying to his contemporaries as it is to current scholars. And Bragg's penchant for turning away from victory, quitting battle when he had the upper hand, was the basis for a story that when he died, he went to heaven: as he approached the Pearly Gates, they opened; then Bragg retreated.

Some critics and historians offer stupidity, incompetence or cowardice as reasons for Bragg's failures. But his blunders may have resulted from his health and the rudimentary, even primitive level of medicine prevalent during the war. Bragg's behavior showed signs of opiate use. In the field, he appeared to withdraw as battle developed, to lose track of where he was. He became unable to adapt his plans to changing situations on the battlefield. But Bragg certainly was not stupid, as evidenced by the swiftness of his September 1862 movement from Tennessee into Kentucky, to wrest the Bluegrass State from Union Major General Don Carlos Buell. He was not a coward, as his record during the Mexican War and the Battle of Shiloh demonstrated. But, as he was promoted to higher command, Bragg became more distant from the troops, appearing to avoid active command during battle. His behavior could have been the result of a combination of poor health and the use of opiates. Bragg may very well have believed the unfounded contents of his Dec.31,1862 telegram to President Davis--that he had won victory after the first day of the Battle of Stones River. Opium-induced euphoria could have induced such an effect, leading him to believe what he so desperately wanted to be true. Euphoria could have led Bragg to back away from Buell's troops after capturing the entire Federal garrison at Mumfordville, Kentucky in Sept. 1862 and seizing Frankfort, the state capital. That same euphoria may have prompted his dispatch to Richmond before the Oct. 1862 Battle of Perryville, Kentucky, claiming his army had joined with Major General Edmund Kirby Smith's when Smith's force was actually more than 100 miles away. Bragg's skewed visions of success, his paranoia towards his officers after each defeat , could have been the result of his medical care.

The gallant John Bell Hood, aggressive, vigorous and effective while with the Army of Northern Virginia, became a victim of delusions after a series of shattering wounds struck him. He left his finest attributes and his common sense on the surgeon's table. The pain from the stump of his right leg must have been horrendous when he rode strapped to his saddle. The bouncing and jolting, the abrasive rubbing of the stump against the rough cloth of a dressing or pad could not have been endured without some sort of pain-reliever.. An opiate was the standard prescription. The drug would have made Hood sleep at Spring Hill while the Federals escaped his trap. The pain was a terrible burden to inflict on Hood, but it was even worse to inflict Hood on the Army of Tennessee.

Union Major General Joseph "Fighting Joe" Hooker's affinity for spirituous liquors and spirited women was a matter of record by the time he led the Army of the Potomac to battle at Chancellorsville, Virginia, in May 1863. If Hooker was truly an alcoholic, and if he kept his pledge not to drink while commanding the army, it is highly likely he was treated with opiates to help him through withdrawal (opiates were commonly used to treat delirium tremens). This medical scenario may account may account for his poor battlefield performance. Or, there may have been another. Hooker's plans for the Battle of Chancellorsville were excellent. It was his leadership that faltered as he became more and more lethargic. The general admitted this much himself. Then, on May 3, Hooker claimed that, while he stood on the porch of a house, he was hit on the head by a column that was knocked loose by a cannon shot. He claimed he was in great pain. The Medical Director of the Army of the Potomac, Doctor Johnathan Letterman, later substantiated Hooker's claim, but failed to mention the extent of the injury, the amount of pain and whether any alcohol or morphine was administered.. But Hooker's behavior the rest of that day indicates he may have received an intoxicating prescription, for he abandoned control of his army to sleep in his tent. Opium, in smaller doses than whiskey, is an effective soporific.

The three generals mentioned here were not the only ones to experience radical behavior changes during battle, changes that may indicate the use of opium or alcohol. Bragg, Hood and Hooker were merely the highest ranking examples. Opiates may have contributed to the timidity of Confederate Lieutenant General Richard Stoddard Ewell, who in July 1863 dashed boldly into Gettysburg, strapped to his horse and minus a leg, and chased the Federals out of town, but then sank into inertia. And what of Bragg's enemy, Buell, who after an accident with his horse sat out the Oct. 1862 Battle of Perryville behind his lines? There are others, too. This is not to imply that all the Civil War's military leaders were alcoholics or drug addicts.

Ulysses S. Grant was certainly known as a two-fisted drinker, but liquor did not keep him from forging victories. Perhaps a more important observation about Grant is that he was never forced by poor health to rely on the services of a surgeon. That fact alone may have been a blessing for the Union. Due to the state of medical arts and sciences during the Civil War, some officers, tenuously steadied with alcohol or opiates, managed to hold positions of great responsibility even though they were unfit for any military service.

Others were retained after suffering debilitating wounds or illnesses, when they should have been discharged or assigned non-combat roles. But instead, history was sometimes made by men who saw their battlefields through the cloud of intoxication.

From: "Civil War Times" May 1988

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