The American Civil War (a.k.a. The War Between the States) was long and terrible. Beginning in 1861, the four-year war is still the deadliest in American history with an estimated 620,000 soldiers killed and an indeterminate number of civilian casualties. Approximately ten percent of all Northern males and 30 per cent of all Southern males were killed in the fighting and the social and political costs left their mark on the United States for generations afterward.
As one of the first "modern" wars with heavy artillery and other weapons of mass destruction, physicians on both sides of the conflict were faced with unprecedented medical challenges in dealing with wounded soldiers. Military surgery was still in its infancy and antiseptic practices were largely unknown so casualities remained high despite the best efforts of doctors and nurses. To deal with patient suffering, doctors relied on two medical innovations that had only become available a few years previously: the hypodermic needle and morphine sulphate. First developed in 1804, the opium derivative received its name from the Greek god of dreams, Morpheus, and widely advertised to physicians as a safe and effective analgesic. Given that surgery was often traumatic due to the lack of proper anesthesia, the use of morphine (spurred on by the development of the hypodermic needle in 1857) began to spread. Opium pills were also widely dispensed when hypodermic needles were unavailable. During the Civil War, solders were often dosed with enormous amounts of morphine or opium to kill the pain of amputations and other surgeries. While the potential for addiction was already known at the time, simple humanitarian concerns ensured that soldiers remained liberally dosed with morphine and whatever other analgesics were available.
Anecdotal accounts of Civil War doctors on both sides dispensing opium seem descriptive enough. One Confederate doctor, William H. Taylor, gave a plug of opium to every patient reporting pain depending of whether or not they were constipated. A Union doctor, Nathan Mayer, diagnosed patients from horseback. If the wounded soldier needed morphine, Mayer would pour out an "exact quantity" into his hand and had the patient lick it off (not a recommended method, by the way).
Since medical epidemiology was still unknown, actual statistics relating to morphine addiction remain scarce. Some sources have suggested that as many as 400,000 veterans were left addicted to morphine due to their wartime experiences. These addicts were readily identified by the characteristic leather thong around their necks to which a small bag was attached. The bag carried a supply of morphine sulphate tablets as well as a hypodermic needle. Upon their discharge from the army, this was all that was given to the returning soldiers to ease their return to society (no Veterans' Administration services in those days). In recognition of the medical issues that these veterans faced, the term "Soldier's disease" was coined (as opposed to "Soldier's Heart" which was an early name for Posttraumatic Stress Disorder).
But how prevalent a problem was Soldier's Disease? As some historians have noted, there were few descriptions of widespread morphine addiction during the 19th century. The existence of thousands of morphine addicts in the United States following the end of the Civil War would have likely made far more of an impact than later medical authorities noted. Veterans certainly had good reason to conceal their addiction since public exposure might have cost them their service pension (drug addiction was not a recognized medical condition). The greatest social impact of the war and the addicts who survived it was likely from 1865 to 1900 when most addicts had died off.
While the explosive growth of opium addiction from 1865 to 1895 was certainly noted, the few drug addiction surveys undertaken during this period showed that women were more likely to be addicts than men. Many of these women addicts had become addicted to the opiates that had been legally prescribed for them by their physicians (often as treatment for "female problems"). Although 19th century newspaper editorials expressed alarm over substance use, it almost always focused on opium and the insidious "opium dens" which were seen as a threat to American society (there were often racist overtones to these editorials given that they focused on how "white women" could be ensnared into smoking with "Chinese men").
Despite concerns relating to morphine addiction (and the thousands of addicts who had supposedly been released into society after the war), physicians continued to prescribe morphine for their patients. As a catch-all medical solution for a wide variety of problems (which could range from headaches to diarrhea), hypodermic-wielding physicians likely created more addicts than the typical opium den. In an 1880 medical text titled The Hypodermic Injection of Morphia, the author stated that "here is no proceeding in medicine that has become so rapidly popular; no method of allaying pain so prompt in its action and permanent in its effect; no plan of medication that has been so carelessly used and thoroughly abused; and no therapeutic discovery that has been so great a blessing and so great a curse to mankind than the hypodermic injection of morphia".