About Morphine Use During the Civil War

[JohnW.]

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

I can't even begin to imagine what it would have been like in the field hospitals and the military hospitals in Washington City and Richmond without this drug.

 

[JPK Huson 1863]

Yes, it's a shame medicine has not been able to further isolate some way to render it not addictive. Wounds were such that they could continue to be painful for years, addictive or no, no other way to treat them. I can never read of the smuggling which went on, either, morphine to the South, without getting angry - it should have been allowed through as a humanitarian gesture, something which had nothing to do with war. Blockade or no, keeping some things, like medical supplies, in short supply ( or not having them at all ) caused torment. I'm sorry but that was barbaric, not some policy designed to end the war.

 

[nitrofd]

Morphine is an opioid so it I'll always be addictive.it was not just used by wounded soldiers as in her diary Mary Chestnut was a frequent user just to improve her spirits.

 

[James B White]

I'll just add... There are really two kinds of "addictive," the physical addiction which means that when you stop taking it, you feel like having the flu with anxiety attacks on the side. Not fun at all. Then it tapers off into just occasional nausea and flu-like symptoms for the next few weeks. Still not fun, but bearable. Then after a month or so, you're back to normal.

The other kind of "addiction" is a psychological addiction, where you have drug cravings.

I've had the first kind of addiction, but never the second kind. I can't imagine how much worse that would be. I don't know if it's because I was only taking morphine for pain and therefore when the pain went away, I didn't want it, but I've never craved it. My philosphy was, everybody gets the flu, but not everybody also has the benefit of no longer being addicted when they're through it. So I just put up with it, and was soon better, no cravings.

So I've wondered what exactly was going on when people talk about morphine addiction. Was it physical? Psychological? Both?

 

[67th Tigers]

Mass morphine addiction was propaganda put out by the temperance societies much later - in 1915 in fact. There is no evidence of it.

The only form of opium available to most was laudenum, which is fairly non-addictive. The 1915 myths were about intravenous injection of morphine sulfate solutions. Firstly the hypodermic syringe was an extremely expensive custom made bit of glassware at the time. Syringes would not become commonly available until disposable plastic ones were developed in the 1970's for the home injection of insulin. Secondly, morphine sulfate was applied topically to wounds - the surgeons used to rub morphine sulfate into raw flesh to numb the local pain. It was never injected.

 

[Waterloo50]

Mass morphine addiction was propaganda put out by the temperance societies much later - in 1915 in fact. There is no evidence of it.

The only form of opium available to most was laudenum, which is fairly non-addictive. The 1915 myths were about intravenous injection of morphine sulfate solutions. Firstly the hypodermic syringe was an extremely expensive custom made bit of glassware at the time. Syringes would not become commonly available until disposable plastic ones were developed in the 1970's for the home injection of insulin. Secondly, morphine sulfate was applied topically to wounds - the surgeons used to rub morphine sulfate into raw flesh to numb the local pain. It was never injected.

I think that Morphine is psychologically addictive because it has pleasant effects, such as alleviating feelings of fear and anxiety and causing a sense of euphoria. Users often require larger doses of the drug because they build a tolerance to it. There are reports of people suffering some pretty bad withdrawal from Morphine addiction, they are physical as well as psychological.

 

[James B White]

Mass morphine addiction was propaganda put out by the temperance societies much later - in 1915 in fact. There is no evidence of it.

The only form of opium available to most was laudenum, which is fairly non-addictive. The 1915 myths were about intravenous injection of morphine sulfate solutions. Firstly the hypodermic syringe was an extremely expensive custom made bit of glassware at the time. Syringes would not become commonly available until disposable plastic ones were developed in the 1970's for the home injection of insulin. Secondly, morphine sulfate was applied topically to wounds - the surgeons used to rub morphine sulfate into raw flesh to numb the local pain. It was never injected.

Isn't every use of opiates quite addictive, whether laudanum or something else? Do you have information that laudanum is "fairly non-addictive"?

I agree that morphine sulphate was first used by rubbing into wounds before hypodermic syringes were widely available,
but surely it was injected too. The usage of morphine, injected by a syringe, was fairly common in the 1880s-1890s, I thought. Freud recommended it, and Doyle had Sherlock Holmes use it.

Here's how to do it, from A Handbook of materia medica, pharmacy and therapeutics, 1890
https://books.google.com/books?id=I-tLvAFD6AYC&pg=PA21
"The medicines must be in solution, of neutral reaction and freshly prepared, the usual menstruum being distilled water; though spring water filtered will answer just as well, and much better than distilled water which has been standing several days, and exposed from time to time to the air. The solution is to be injected beneath the skin, by a hypodermic syringe, care being taken to avoid puncturing a vein.
"The most suitable localities for the injection are the external aspect of the arms and thighs the abdomen, the back, and the calves of the legs. On the external aspect of the thigh, just in front of ihe great trochanter, there is an area of some two inches square, over which the insertion of a fine hypodermic needle is not felt, so barren is the skin in that region of the sensitive nerve filaments
"After nearly filling the syringe with the solution to be used, the needle should be screwed on tightly; and with the instrument held in a vertical position, point uppermost, the excess of solution over the amount required should be ejected, thus expelling air-bubbles and filling the needle itself. A portion of skin should be grasped by the thumb and forefinger at the site selected for the injection, into which the needle should then be quickly inserted until its point has passed beneath the skin, when the piston may be pressed down slowly, delivering the solution so gradually as to avoid rupturing the tissue. If the solutions are freshly prepared with clean water, the needles kept clean and shirp, and the injection be made beneath the skin not into it, there will be no risk of producing abscesses with the agents ordinarily employed.
"Tablets for hypodermic use are prepned by the prominent manufacturers, each containing one dose. They may be readily dissolved in a teaspoon at the bedside, and are very convenient for the pocket, if put up in a case with a good hypodermic syringe, as may be obtained from Parke, Davis and Co., of Detroit. Their regular line of Hypodermic Tablets includes the agents named in the following list, put up in tubes of 25 each."

There's a long list of various medicines, including morphine sulphate at 1/8 and 1/4 grain,, and morphine sulphate and atropine. I'm not even going to try to figure out how to type the actual formula, but it's in the appendix.

This modern book https://books.google.com/books?id=jK11AwAAQBAJ&pg=PA343 talks about its rise and decline, and makes the interesting point that soldiers were starting to die of old age about the time that better drugs such as salicylcilates for minor aches and pains came into use. It mentions the nonhypodermic use of opiates during the war, but unfortunately doesn't specify whether use continued with a hypodermic syringe or not

From 1878
"The habit is sometimes formed by physicians' using morphine hypodermically and instructing patients in the use of the hypodermic syringe. Three such cases are reported by correspondents in this State, the amounts of morphine used being eight to ten grains per day. It is claimed by Dr. S. F. McFarland, in an article published in the New York State Medical Society's Transactions for 1877, that this form of administration is more liable to be followed by the habit than when opium is taken in any other way; and be cautious physicians against its indiscriminate use. He says, 'I have seen every available portion of the patient's body and limbs covered with abscesses, with positive evidences of septicemia, compelling him to return to its use by the stomach, as there was not a place left to insert the point of the syringe.'"

From Boston, 1889:
Morphomania...
"This is a disease of modern life, and of recent origin... But opium eating and opium smoking have never prevailed to any great extent among Western nations, while within a few years —since the time, in fact, when the hypodermic syringe first came into use, about the year 1859.... The painful disease persisting, the hypodermic injections are continued, but larger and still larger doses are soon required to produce the effect which small doses at first produced. The patient obtains a hypodermic syringe of his physician or of some druggist, and a quantity of morphine, the doses of which he readily learns (sometimes a prescription given him by his physician enables him to get a standard solution any number of times he desires), and he is now on the downward road; he has become a morphiomaniac. This is the way the vice comes to be generated; no one ever becomes a morphinist without some powerful motive; pain, mental distress, or insomnia. If physicians, say Levinstein, Zambaco, Erlenmeyer, would take more pains to search out and remove the original cause of morphine malady; if they would be very sparing in the use of hypodermic injections, never resorting to them till other and safer means have failed; if, moreover, they would see to it that these hypodermic injections shall never be administered by the patient to himself, but always by the medical attendant; and if, finally, apothecaries could be brought to exercise proper care and vigilance in dispensing morphine, never giving it except under a physician's orders, the evil would be virtually suppressed.
"While alcoholic abuses are especially prevalent in the lower walks of life, the morphine vice is almost peculiar to the higher, as it is in these classes especially that we meet with the nervous temperament and painful neurotic maladies (as migraine) excessive cerebral stimulation and all the developed passions and morbid cravings connected therewith."

The machine-reader is terrible, but I tried to clean it up. All you people with migraines, you'll be glad to know you're of the higher walk of life.

But anyway, it shows that by 1889, there was a fear of morphine addiction by the syringe, self applied. That's all I'm fighting with machine readers of period text today. Whew.

 

[nitrofd]

I was just looking at Gen.John Bell Hood's medical report starting with the amputation of his leg at Chickamauga.the largest dose of morphine that he was given was 1/2gram normally at night to let him sleep better.by September 30th he was down to a 1/4 gram.he was given a Quinine and iron along with the morphia as the doctor writes s o I assume he was given these meds orally.during October he was increased back to 1/2 gram as he was having trouble sleeping.after Oct.13th there is no record of morphine for him.as for the iron the doctor wrote that he would get 40-60 drops a day.I believe all med were oral.

 

[James B White]

I was just looking at Gen.John Bell Hood's medical report starting with the amputation of his leg at Chickamauga.the largest dose of morphine that he was given was 1/2gram normally at night to let him sleep better.

1/2 gram would be .5 gram or 500 mg? Is that right? I always get conversions backwards or sideways. If that's right, that's a massive amount of morphine. I've never been given more than 250 mg spread out over the day, not all at once, and that was a couple years ago, only for a few days, and I was used to morphine.

I wonder if he was given 1/2 grain instead? That would be about 32 mg, a small amount, just about right to help him sleep. (Again, recheck my conversion.) Really, that's quite low for someone who just had his leg amputated, though I've never been through that. Maybe he was just tough, or maybe it hurts less than I expect. Or maybe he was given 500 grams of medicine that wasn't very pure, in a way that his body absorbed poorly (orally). I take morphine orally, but I don't know if modern medicines are improved so they work better orally. Need to look that up.

If the original is written gr, it's easy for modern doctors to transcribe it as grams rather than grains, because they're used to grams.

Edited to add: Okay, here's all I know, but this is still modern medicine. This article, Routes of Opioid Analgesic Therapy in the Management of Cancer Pain, says, "the dose of an opioid given orally to a patient with cancer pain must be three times the intravenous or intramuscular dose of morphine."

So orally would still be roughly three times any other route. (Assuming cancer pain is similar to amputation pain--no idea, and I really don't want to find out, LOL!)

But in other words, the difference between a grain and a gram can't be explained by oral vs other methods, because 500 is still huge compared to 3x32.

I'd still like to find a period answer to the question about how strong oral administration was vs IV or rubbing in the wound, to make sure modern morphine isn't altered somehow to make it more bioavailable.

 

[nitrofd]

1/2 gram would be .5 gram or 500 mg? Is that right? I always get conversions backwards or sideways. If that's right, that's a massive amount of morphine. I've never been given more than 250 mg spread out over the day, not all at once, and that was a couple years ago, only for a few days, and I was used to morphine.

I wonder if he was given 1/2 grain instead? That would be about 32 mg, a small amount, just about right to help him sleep. (Again, recheck my conversion.) Really, that's quite low for someone who just had his leg amputated, though I've never been through that. Maybe he was just tough, or maybe it hurts less than I expect. Or maybe he was given 500 grams of medicine that wasn't very pure, in a way that his body absorbed poorly (orally). I take morphine orally, but I don't know if modern medicines are improved so they work better orally. Need to look that up.

If the original is written gr, it's easy for modern doctors to transcribe it as grams rather than grains, because they're used to grams.

It is written out as gram.besides making it easier to sleep it was for the pain in his stump as it had a lot of puss any they were cleaning it several times a day while changing his bandages.

 

[JohnW.]

It is written out as gram.besides making it easier to sleep it was for the pain in his stump as it had a lot of puss any they were cleaning it several times a day while changing his bandages.

Usually the oral dose of a narcotic is about 3 times the amount you would administer intramuscular due to first pass metabolism by the liver. So with MS, 10 mg IM would be 30 mg po (oral).

 

[James B White]

So he really was getting 1 gram or 500 mg? Wow. I'm hoping that was less pure than modern morphine. Because that's a lot. But if his stump was infected, he was probably in a lot of pain. If he worked up to that dose from the time he was injured, and it was less pure than modern morphine, makes more sense.

Usually the oral dose of a narcotic is about 3 times the amount you would administer intramuscular due to first pass metabolism by the liver. So with MS, 10 mg IM would be 30 mg po (oral).

That's what the article I found said, but it's talking of course about modern morphine formulations. I'm curious--do you think period morphine was much more impure than modern morphine? And does modern morphine have anything in it to help the stomach/liver absorb it better? I'm trying to guess how period morphine dosages compared to modern morphine dosages, apples to apples, y'know?

 

[nitrofd]

So he really was getting 1 gram or 500 mg? Wow. I'm hoping that was less pure than modern morphine. Because that's a lot. But if his stump was infected, he was probably in a lot of pain. If he worked up to that dose from the time he was injured, and it was less pure than modern morphine, makes more sense.

That's what the article I found said, but it's talking of course about modern morphine formulations. I'm curious--do you think period morphine was much more impure than modern morphine? And does modern morphine have anything in it to help the stomach/liver absorb it better? I'm trying to guess how period morphine dosages compared to modern morphine dosages, apples to apples, y'know?

No the maximum dose was a 1/2 gram.

 

[nitrofd]

I am not sure but I do not believe the standard for producing morphine is not as good as the way it is produced today.true we have no idea of its actual strength back then.

 

[James B White]

No the maximum dose was a 1/2 gram.

Oops, you're right. Told you I was terrible at conversions. But 1/2 gram is still 500 mg, as I posted in post #9, correct? I believe I was right that 500 mg is a lot of morphine, unless it was impure, gradually worked up, absorbed much less than modern morphine, etc.

 

[DaveBrt]

Confederate Railroad Bureau head Lt. Col. Frederick W. Sims died of a morphine overdose in 1875 One newspaper report includes the following:

"...we know that by advise of his Savannah physician he was in the habit of injecting morphine into his arm for rheumatism, which he always suffered on taking cold. He has been known to consume a considerable quantity of morphine in this way, and he may have accidentally used too much."

 

[E_just_E]

This is an interesting graphical representation of the History of opiods.

Morphine and laudanum should not be confused. The raw material is opium, laudanum is a mixture of opium with ethanol and morphine is the active compound of opium, chemically extracted. Laudanum was easily made and available and fairly low dose, morphine not so. Without clinical trials and effective dose studies, dosing was all over the place back then and I suspect that a lot of deaths in hospital settings have happened due to OD, but there was no way to diagnose it. But we are talking pain management and palliative care here...

 

[James B White]

Without clinical trials and effective dose studies, dosing was all over the place back then and I suspect that a lot of deaths in hospital settings have happened due to OD, but there was no way to diagnose it.

Absolutely. And yes, it's important to realize the differences. Opium and the things it contained: laudanum, Dover's powders, it's easy to find a dozen or more in a formulary:

https://books.google.com/books?id=h-4jAQAAMAAJ&pg=PA335

...and then morphine formulated for oral or injection...

Some of this stuff is hopeless, unless one is an advanced chemist. There are some major machine-reading goofs below, but any poor soul who is interested and can understand it, is welcome to head to the link and the original text. Or find another better one. But I'm done. No way can I figure out how this stuff was made and whether or if it was tested for strength or consistency
.
https://books.google.com/books?pg=P...vPAAAAMAAJ#v=onepage&q=opium morphine&f=false

Preparation [of morphine]. — 1. Opium is exhausted with cold water; the extract after evaporation to a syrup at a gentle heat, is heated while yet warm with a largo excess of carbouatu of sodium as long as ammonia continues to escape ; the resulting precipitate is collected after twenty-four hours, and washed with cold water; and when the wash-water is no longer coloured, the precipitate is treated with alcohol of 85 per cent., again dried, and . exhausted in the cold with very dilute acetic acid, care being taken not to add too much aaul at once, and to wait till each portion is neutralised before adding more. The solution is then filtered, decolorised with animal charcoal, and precipitated by ammonia, care being taken to avoid an excess ; and the precipitate, after being well- washed, is dissolved in boiling alcohol. The liquid on cooling deposits crystals of morphine, and an additional quantity may bo obtained by concentrating the mother-liquors. (Merck.)

2. Twenty pts. of opium cut in slices are boiled in sixty pts_. water for half an hour, or until all the slices are opened out; the liquid is then strained, and the residue is squeezed and again twice treated with fresh water in the same way. The united extracts are boiled down to half their bulk, then stirred into a boiling lime-lye composed of 3 pts. slaked lime and 40 pts. water; the liquid is boiled for a quarter of an hour, and then strained; and the calcareous residue is pressed and again twice 1 pts. water. The whole of the calcareous liquors are now boiled down to 40 pts. and mixed at boiling heat with 2 pts. sal-ammoniac; the heat is kept up for an hour, or as long as ammonia is given off; the liquid is then allowed to cool; and after eight days the morphine, which separates in the form of brown granules, is collected: the mother-liquor yields another crop if further boiled down and left to itself. The product may be purified by washing in cold water, solution in hydrochloric acid, repeated boiling with excess of milk of lime, and precipitation with sal-ammoniac. (Mohr, Ann. Ch. Pharm. xxxv. 120.) • 3. The process most generally employed is that of Robertson, modified by Robiquet and Gregory (Ann. Ch. Pharm. v. 87 ; vii.261).—Opium is macerated in water of 38°, till all the soluble principles are extracted; the solution is evaporated with carbonate of calcium, which neutralises the free acids; and when the liquid ia sufficiently concentrated, chloride of calcium is added, whereby a precipitate of meconate of calcium is formed, which carries down with it a considerable quantity of colouring matter. The opium bases remain in the solution as hydrochlorates, and the liquid, when again concentrated, first deposits more meconatc of calcium, and afterwards crystals of hydroehlorate of morphine mixed with hydrochlorate of codeine. These salts are easi'y purified by repeated crystallisation, with addition of animal charcoal.
The two hydroehlorates are next dissolved in water and treated with ammonia, which precipitates the morphine,leaving the codeine dissolved. The morphine is finally purified by crystallisation from alcohol.

Morphine prepared by either of the preceding processes is often contaminated with narcotino, from which however it may be freed by either of the following processes: —1. By digestion in ether, which dissolves narcotine much more easily than morphine.—2. By dissolving the mixed bases in hydrochloric acid, evaporating to the crystallising point, and pressing the crystals, which consist entirely of hydrochlorate of morphine, the narcotinesalt remaining in the unerystallisable mother-liquor.—3. By mixing the hydrochloric acid solution with common salt, which renders the liquid milky, and throws down tho narcotine after some days in crystalline agglomerations; the morphine may then bo precipitated by ammonia.—4. By pouring a weak solution of caustic potash into the dilute solution of the hydrochlorates; the morphine then dissolves in a slight excess of potash, while the narcotine is deposited as a curdy precipitate, which may be separated by filtration.

For a full account of the various methods used for the preparation and purification of morphine, see Gmelin's Handbook, xvi. 416-423.

This is an interesting graphical representation of the History of opiods.

I'm getting a link to "Twins' off-season moves and rumors report: 1/31/2017." Maybe not what you were planning to link to? But with my conversion issues, I can't really say anything, LOL.

 

[E_just_E]

I'm getting a link to "Twins' off-season moves and rumors report: 1/31/2017." Maybe not what you were planning to link to? But with my conversion issues, I can't really say anything, LOL.

Fixed, sorry about that. Try this one.