Rebel Med

This page provides information on disease and medicine during the Civil War Era in Texas.

Disease

For every Confederate soldier killed in combat, three would succumb to illness.  Bacterial infections and disease carrying mosquitoes were not yet discovered.  It was especially worse among rural- born Southerners, who had no immunity built up against a vast armada of diseases.  

The early months of the war were the worst as thousands of men were herded into training camps.  Measles plagued the Texas units with a vengeance. Though few died from measles alone, the subsequent complications brought on other ailments that killed hundreds.  During the summer of 1861, one out of seven came down with measles in Virginia.

The biggest killer was dysentery and diarrhea.  Poor sanitation and a constant diet of bacon fat was a guarantee for hard times on a hospital cot.  The treatment was as dangerous as the disease.  The prescribed treatment was usually "Blue Mass," a mercury laced pill or liquid used for everything from tuberculosis to childbirth.  The ingredients varied, but all the pills contained a heavy dose of mercury.  A daily dose of two pills provided a patient with over a hundred times the daily mercury limit set by today’s EPA.  In other words, patients were being slowly poisoned.

In the deep, humid South, the ever present mosquito led to malaria.  Unlike the other diseases, physicians had an effective treatment for its effects, Quinine.  Though it was effective, it was not available in great quantities because of the naval blockade.  Malaria was so prevalent, that most Confederates were probably unaware they had it and simply went about their duties in misery.

Pneumonia was second on the disease hit parade.  It killed Stonewall Jackson and countless others.  Growing up, you were always told to change out of your wet clothes when you came out of the rain.  In the Confederate Army, where there was a dearth of tents, clothing and blankets, men slept out in the open.  You stayed perpetually damp and therefore at risk of getting sick.  The only relief was to huddle up to a campfire and look forward to the dry summer months.

The most common medical treatments for disease were: liquid opium or laudanum,  whiskey, and bleeding; a medieval practice that entailed cutting a patient’s arm open and collecting a pint or two in a bowl.  All of these usually led to addiction or a further weakened state. In a world where medical science had advanced little since the Dark Ages, the best way to fight illness was prayer, dry weather and a good immune system. 

The Civil War’s Dark Narcotic

Morphine Use During the Civil War

Dr. Erin Barnhart, M.D.

Donald L. Barnhart, Jr.

Francis Goolrick was at her wits’ end.  Her husband John could no longer practice law, their finances were severely diminished, and their social status plummeted.  To avoid the shame her husband brought to their family, she resigned from the presidency of her local United Daughters of the Confederacy chapter.  After thirty years of morphine addiction, he had a complete breakdown, forcing Francis to consider leaving him with their children unless he sought medical care.   “But I must, I must,” she wrote her brother.  “I can bear neither for myself or the children, this life any longer.”  A Confederate Civil War veteran, John Goolrick’s addiction and subsequent collapse was a common thread among Civil War veterans wounded during the war.  Treated with morphine, the Civil War’s cure-all for battlefield wounds and camp illnesses, they often became addicts or by its period sobriquet - opium eaters, travelers on a road to recovery with no end.

Since the time of the Pharaohs, opium has been a staple in medical treatments world-wide.  Often used as a pain-reliever, it was administered by liquid or powder, with often little regard for  dosage.  During the early 1800’s, a German apothecary apprentice, Friedrich Wilhelm Adam Serturner, isolated the active ingredient from the stalk or straw of an opium poppy.  He called his discovery “morphium,“ named after Morpheus, the Greek god of sleep.  Lacking in scientific research skills and willing test subjects, Serturner recklessly tested his morphium on himself, eventually becoming addicted to it.  In 1827, commercial production of morphium (later renamed morphine) began in Darmstardt, Germany by a pharmacy that years later became the pharmaceutical giant Merck.  Four years later, the prestigious Institute of France awarded Serturner the title, “Benefactor of Humanity.“  Knowing first-hand the side effects of his creation, he warned, “I consider it my duty to attract attention to the terrible side effects of this new substance I called morphium in order that calamity may be averted.”  Little did he know, the calamity was just beginning.

The Civil War brought new challenges to the American medical profession that couldn’t have been imagined back then.  Modern medicines and surgical methods were decades away.  Prior to the war, most doctors had never seen a bullet wound, much less treated one.  They were more accustomed to delivering babies.  After the war started, battlefield wounds to the extremities were often treated with the only method possible - amputation.  Wounds to the head or torso were generally fatal, left to the sufferance of the wounded and their families.  Bacteria that caused disease and infection was still unknown in the United States.  For pain relief, Civil War physicians relied heavily on opioids such as morphine.  A Confederate handbook explained it in martial terms, “Opium is the one indispensable drug on the battlefield - important to the surgeons as gunpowder to the ordnance.” After the first year of the war, both the Union and Confederacy improved field and ambulatory care, using more and more opioids in the process.  Though the number of battlefield survivors increased, their appetite for opioids increased as well.

Because of the Union’s access to maritime trade, their physicians had easier access to morphine derived from opium poppies grown abroad in Turkey, Persia and India.  In addition to their overseas sources, an unlikely second source was obtained from a pacifist Christian sect, The United Society of Believers.  Nicknamed the Shakers, they cultivated their opium poppies at their settlement in Mount Lebanon, New York.  The Confederacy had to rely on high-priced smugglers, captured Union supplies and blockade-runners to replenish their medical stores.  They tried to grow poppy fields, but the crops proved inferior, lacking in morphine content. 

The most common form of morphine used during the Civil War was morphine sulfate, a white feathery crystal dusted onto wounds or dissolved into a liquid.  Stored in small glass vials with tiny cork stoppers, the liquid was often injected using a crude type of hypodermic syringe.  So crude in fact, that an incision had to be made in the skin prior to injection.  To this day, morphine sulfate is still considered a first line treatment for moderate to severe pain. Recently developed semisynthetic opioids such as oxycodone are more potent in oral or pill form, but as a painkiller in hypodermic form (intravenous or intramuscular), morphine sulfate is still the most commonly used.

Morphine was also used to treat the effects of diarrhea and dysentery.  At the staggering rate of 711 per 1,000, more Union troops came down with diarrhea or dysentery than any other disease.  The same rate likely applied to Confederate troops.   Though the diarrhea subsided after morphine was administered, severe constipation followed.  Normal muscular contractions in the digestive tract are greatly reduced by morphine, leading to a loss of appetite followed over time by an emaciated frame and less immunity from disease.  Because of the severity of digestive illnesses among Civil War soldiers, such a side effect was often overlooked.  A former Union prisoner of war, imprisoned at the notorious Andersonville prison-of-war camp, suffered from chronic diarrhea, leading to his addiction to morphine.  Suffering from constipation, he tried to break his morphine habit.  He recalled anonymously in his memoir, Opium Eating: An Autobiographical Sketch:

 “The affinity between the brain and the stomach is most plainly demonstrated by the disease of the opium habit; the appetite feeds as much on the brain as on the stomach.  I could not work; I could do nothing but look, and that in a blank and dazed way; and being compelled to work, I took a small dose, thinking that would quiet the enemy and give me peace, and that thereafter I could probably worry it through. Cruel illusion!”

Late in the Civil War and especially after, morphine superseded its medical use to its more harmful, unintended use - an addictive narcotic.  In 1890, there were about 313,000 addicts in the United States, many of them were Civil War veterans.

 There are two main components of opioid addiction: physical and psychological.  

The physical component involves the opioid receptors that are present on the neurons or nerve cells throughout the body, including the brain, spinal cord and digestive tract.  The receptors are micro-sized docking stations at the ends of the neurons that opioids adhere to after being administered to a patient.  With repeated use, a patient starts to develop a tolerance for the opioid or morphine within a relatively short period of time.  Because of the tolerance, he will need more morphine over time, administered on a more frequent basis to get the desired pain relief, often leading to addiction and an increased risk of overdose. 

The psychological component refers to the increased activity of the neurotransmitter dopamine by neurons within the central region of the brain, specifically the ventral tegmental area and nucleus accumbens.  Dopamine is a chemical messenger that helps neurons communicate with each other in the brain and elsewhere in the body.  It is stored within the neurons and is released in response to a variety of signals such as pain, hunger, and fear.  

In a normal situation, peripheral neurons work in concert with your central nervous system.  If you are hurt, your body quiets the pain signals through the production of natural opioids called endorphins.  The endorphins adhere to the receptors, thus relieving the pain.  In the case of severe battlefield wounds, field amputations and the persistent effects of a debilitating disease, the endorphins are not enough.  Opioids, like morphine, fill the void.  Like the endorphins, it binds with the receptors to lessen the transmission of pain signals from the nerves and stimulate the release of dopamine from the neurons, leading to a feeling of relief and an addict’s most desired state - euphoria.  Unfortunately, morphine also penetrates the brain stem and digestive tract, causing slow respiration, constipation, lower blood pressure and decreased alertness.   Wounded soldiers felt relief from the immense, overwhelming pain, but with their neurons now accustomed to the effects of the morphine, they wanted more as soon as possible, a simple recipe for a vicious cycle of addiction.  Dr. Silas Weir Mitchell, a Union physician at Turner’s Lane Hospital in Philadelphia, recalled administering 40,000 injections in just one year.  Those with “intolerable” pain were the most likely to be given enough doses to become addicted.  He blamed surgeons who were “too weak, too tender, and too prone to escape trouble using the easy help of some pain-lulling agent.”  Instead of injections, Union Surgeon Major Nathan Mayer preferred a more simplistic dispersal method - on horseback, pouring the “exact quantity” on to the palm of his hand, reaching down, and letting the patient drink it.

Stopping morphine use after a few days will not cause withdrawal symptoms, but after a longer period, the symptoms become brutal.  Instead of euphoria, the patient experiences diarrhea, high blood pressure and feelings of dysphoria and anxiety.  Feeling like a very severe case of the flu, the withdrawal symptoms last for 3 to 7 days.  Although physical withdrawal is not life threatening, it feels that way to addicts.  Hence, the temptation to give up and go back to using.  Those at the highest at risk of overdose were often the addicts who quit “cold turkey” or went through a rehabilitation process, often under the guidance of a quack physician; who used a concocted remedy that included among its ingredients - opium.  Accustomed to a certain dose of morphine, but having lost their tolerance during the withdrawal process, former addicts often returned to their previously effective dose of morphine, now a toxic or lethal dose, an all too common occurrence among addicts today.  Dr. J. M. Richards, a morphine addicted Union surgeon wrote, “I was a confirmed morphine eater, that  fact could not be disguised.  The only way to avoid insanity, or death from mere intensity of pain, seemed to be to follow the path on which I had entered without ever again attempting to leave it.”

During the 19th century, opium addiction was viewed as a form of intemperance alongside drunkenness, not as a disease as it is today.  For the male Civil War soldier and veteran, addiction was the antithesis of masculinity and morality, which demanded self-reliance, independence, sobriety, and stoicism in the face of pain and danger.  If you were addicted, you were expected to endure the pain and tough it out.  Many opioid-addicted veterans did just that, toughed it out while trying to hold down a job and support a family.  If he couldn’t conquer his morphine addiction, he faced confinement in a mental institute.  Robert B. Anderson, a Confederate veteran of the 18th North Carolina Infantry and opium addict was cared for by this neighbors until they had him committed to the North Carolina Lunatic Asylum in 1889.  He was held there until his death in 1919.  To make matters worse, veteran pension applications could be denied if a veteran was judged to be an addict, placing a huge financial burden on his family.  James Ladson Hall, a Union veteran of the 99th Pennsylvania Infantry Regiment, was a successful tobacco merchant in Philadelphia.  Addicted to the opioid laudanum, he overdosed in 1870.  His widow was denied a pension twenty-eight years later.   Assisted living centers, such as soldier’s homes, would refuse admittance if the veteran was an addict.

Death from an overdose of morphine is quiet and calm, like going to sleep.  The breathing will gradually slow down and fluid will back up into the lungs.  As the body's oxygen levels drop from the decreased breathing, the heart will slow and eventually stop.  The prior agony the addict suffered may end peacefully but the tragic aftermath doesn’t.  Surviving widows with children were suddenly without a means of income, unless they got a job or were taken in by relatives.  In the Victorian Age, women, especially mothers, were not supposed to work but raise their families on their husband’s income.  As with many overdose and addiction-related deaths among Civil War veterans, the survivors suffer as well, the final victims of America’s deadliest war.