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Surgery was around prior to the discoveries of efficient pain killers and sedatives. However, surgeries still occurred but with a lot of emotional and physical stress to the patients. The time between told that a patient needs to endure and surgery and the time that they were to have the surgery was a time that anxiety could soar¹. The surgeons job was to make this time as short as possible because the distress would only get worse once inside the "theatre"(operating room)¹. It is these horror of accounts of patients lying in excruciating pain from the palpation of these surgical instruments that a need to reduce pain and suffering nearly became a necessity².

1. https://www.ncbi.nlm.nih.gov/books/NBK481552/
2. https://www.bbc.com/future/article/20200624-how-agonising-surgery-paved-the-way-for-anaesthetics

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The discovery of codeine in the 1830s came as the need for a pain suppressant grew. Morphine was available but highly addictive. Codeine was a less powerful drug that is found in opium but can be man-made¹. It was first isolated in 1830 in France by Jean-Pierre Robiquet, to replace raw opium for medical purposes¹. It is used mainly now as a cough remedy¹. They succeeded in finding a replacement for the morphine for other medical uses but the addictive qualities of an opiate are very hard to erase¹. Especially for those who were already addicted as well as those who were in insufferable pain. They would do anything to get rid of the pain which led them to opiates¹.
1. https://www.drugfreeworld.org/drugfacts/painkillers/a-short-history.html
2. https://www.si.edu/stories/six-cold-and-flu-medicines-youre-not-taking-today

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William Morton uses ether anesthesia in 1846

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William Morton uses ether anesthesia in 1846

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William Morton the first successful public showing of the use of ether anesthesia during a surgery at Massachusetts General Hospital¹. William Morton had watched his former dental partner unsuccessfully demonstrate the anodyne properties of nitrous oxide gas¹. This gave was for Morton to find a more reliable pain killing chemical¹.Morton first used the anesthesia in a tooth extraction procedure successfully in 1846¹. Then in October 1846, he successfully administered ether to a patient undergoing a tumor operation¹.

1. https://www.britannica.com/biography/William-Thomas-Green-Morton

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This article was most recently revised and updated by

William Thomas Green Morton, (born August 9, 1819, Charlton, Massachusetts, U.S.-died July 15, 1868, New York, New York), American dental surgeon who in 1846 gave the first successful public demonstration of ether anesthesia during surgery. He is credited with gaining the medical world's acceptance of surgical anesthesia.

Morton began dental practice in Boston in 1844. In January 1845 he was present at Massachusetts General Hospital, Boston, when Horace Wells, his former dental partner, attempted unsuccessfully to demonstrate the anodyne properties of nitrous oxide gas. Determined to find a more reliable pain-killing chemical, Morton consulted his former teacher, Boston chemist Charles Jackson, with whom he had previously done work on pain relief. The two discussed the use of ether, and Morton first used it in extraction of a tooth on September 30, 1846. On October 16 he successfully demonstrated its use, administering ether to a patient undergoing a tumour operation in the same theatre where Wells had failed nearly two years earlier.

Unfortunately, Morton attempted to obtain exclusive rights to the use of ether anesthesia. He spent the remainder of his life engaged in a costly contention with Jackson, who claimed priority in the discovery, despite official recognition accorded to Wells and the rural Georgia physician Crawford Long.

Amy Tikkanen.

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William Thomas Green Morton | Dentistry, Anesthesia & Surgery

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William Thomas Green Morton, American dental surgeon who in 1846 gave the first successful public demonstration of ether anesthesia during surgery. He is credited with gaining the medical world's acceptance of surgical anesthesia. Morton began dental practice in Boston in 1844. In January 1845 he

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James Young Simpson did not discover chloroform like many believe, instead he was introduced to chloroform and its effects by a man named David Waldie who understood its anesthetic properties¹.The true man to discover chloroform was Eugene Soubeiran in France in 1831 and also by Justis von Liebig the following year¹. David Waldie explained his experiments with regards to chloric ether, but one day in 1847, Simpson and his two assistants because unconscious while inhaling chloroform¹. They evidently proclaimed chloroform to be much stronger than ether and wrote a pamphlet describing how chloroform should be used in dental work, opening abscess and in obstetrics¹.  He also published a paper on the London Medical Gazetter, where he spoke about administering chloroform to 80 individuals¹.  In the years after there were many to object this anesthesia in obstetric practice for religious reason but that was eliminated when Queen Victoria receive anesthetic agent when she gave birth to her ninth child¹.
1.https://www.mayoclinicproceedings.org/article/S0025-6196(11)63340-5/fulltext

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James Young Simpson and the Introduction of Chloroform Anesthesia in Obstetric Practice

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Sir James Young Simpson did not discover chloroform and its anesthetic properties, as many mistakenly believe; however, he did have an important role in the introduction of chloroform anesthesia into the fields of midwifery, obstetrics, and surgery.

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Opium pills, morphine injections, and laudanum during the Civil War (1861-1865)

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Opium pills, morphine injections, and laudanum during the Civil War (1861-1865)

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The U.S. Civil War sparked a massive epidemic of opiod use and addiction across the country¹. Not only were these drugs so readily available during the war but after, so many veterans could not live without it¹. With all of the horrific diseases that terrified men in combat and the wounds that haunted the men at night, life was far from healthy for these men¹. Additionally, many army doctors who were pushed into service had little to not training at all so they would rely on the fundamental options of opiated for mitigating pain and suffering¹. Surgeons gave out opiates willingly to soldiers during and after the war because of their suffering¹. Not only were these drugs addictive but they were and are very dangerous drugs that leas to many overdose death in the 1860s¹. Addicted veterans never received the help they needed because of the stigma of addiction¹. Unfortunately, this was the reality of most veterans who were prescribed a drug that was helping them but also hurting them entirely¹.

1.https://library.medicine.yale.edu/blog/great-risk-opium-eating-how-civil-war-era-doctors-reacted-prescription-opioid-addiction

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Harvey Cushing/John Hay Whitney Medical Library

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The U.S. Civil War (1861-65) sparked a massive epidemic of opioid addiction among those who fought and survived the bloody conflict.

The war mobilized millions of soldiers, hospital workers, and freedom-seekers, bringing people into contact with unfamiliar microbes, insects, and animals. This mass movement of bodies and pathogens resulted in extreme outbreaks of measles, smallpox, typhoid fever, and other deadly, terrifying diseases. Brutal technological innovations like the Minié ball caused ghastly, agonizing wounds, and men who survived often spent the rest of their lives in chronic pain.

Military surgeons tasked with patching up wounded soldiers and treating the sick had their jobs cut out for them. Often-times army doctors were simply civilians pressed into service by circumstance, and they fell back on fundamental therapies to mitigate sickness and suffering. Opiates, the most common medicines in antebellum America, thus became defensive weapons in Civil War's medical arsenal, "important to the surgeon as gunpower to the ordinance," according to one military medical handbook.

Opium pills, morphine injections, and laudanum (a blend of opium and alcohol) were some of the Civil War's most widely used medicines. Opiates were marvelous painkillers-morphine and synthetic opioids are still standard palliatives today-and the medicines were also surprisingly useful for suppressing symptoms like diarrhea and coughing. Civil War armies could not have functioned without opiates, which surgeons doled out widely during and after the war to ailing soldiers.

Opiates are addictive, however, and doctors' prescriptions all-too-predicably led to addiction for Civil War veterans. Not only was opiate addiction dangerous and unhealthy, resulting in thousands of overdose deaths between the 1860s and the early twentieth century, but the condition was also deeply stigmatized in Civil War America. Most Americans considered addiction to be an unmanly and immoral vice. Addicted veterans deserved punishment, not sympathy, according to contemporary observers. Consequently, addicted veterans faced terrible outcomes, a theme I explore in a recent journal article investigating the experience of opiate addiction for veterans.

Naturally, many addicted veterans blamed the doctors who first introduced them to opiates. But how did doctors react to veterans' blame? Did they reject charges of culpability, or admit that prescriptions lay at the root of Civil War America's opioid crisis? Did the crisis affect how doctors practiced medicine, and if so, what did any changes mean for the course of American medicine?

These are questions I address in my book manuscript, "Opium Slavery: Veterans and Addiction in Civil War America," which is based on my dissertation (Binghamton University, 2020). In 2020-21, as a postdoctoral fellow at Penn State's Richards Civil War Center, I am revising my book for publication. My research for this project benefited immensely from a Ferenc Gyorgyey Research Grant awarded by the Harvey Cushing/John Hay Whitney Medical Library in 2018-19. The library's inimitable collection of nineteenth-century American medical records provided a major component of my evidentiary base, allowing me to investigate how the Civil War veterans' opiate addiction epidemic refracted into medical practices and thought in the late-nineteenth century U.S. In particular, the Medical Historical Library holds incredibly rare clinical records that provide insights into how the Civil War-era opioid crisis altered the fundamentals of medicine, like prescribing patterns.

As I argue in my book, American physicians were deeply troubled by prescription opium and morphine addiction among veterans. Doctors were widely blamed for causing the post-Civil War opiate addiction epidemic by overprescribing opiates, and this blame was dangerous for physicians, who had a perilous position in the extraordinary competitive Gilded Age medical marketplace. The nineteenth-century American medical marketplace was remarkably democratic, and sick people could turn to a bewildering array of medical practitioners for health care. Throughout the Civil War era, physicians struggled to outcompete sectarian practitioners, patent medicine sellers, and so-called "quack" doctors. Something had to be done about prescription drug addiction, many physicians worried, because the problem threatened the profession's reputation and commercial standing.

Consequently, I argue, during the 1870s and 1880s, ex-military surgeons-men like Jacob Mendes Da Costa of Philadelphia's Jefferson Medical College-urged their colleagues to prescribe opiates sparingly, thus creating fewer cases of opiate addiction. Not to be overlooked, this shift away from opiate medicines was a radical reversal of nineteenth-century American therapeutic practices, which relied heavily on opiates to treat all manner of ailments. Da Costa was a former Union army surgeon famous in his day for conducting research on cardiac distress among Union army soldiers and veterans. In an influential 1871 medical journal article, Da Costa urged his colleagues to refrain from prescribing opiates to men suffering from chronic pain, warning that there was "great risk of making the patient an opium eater"-a dual risk for patients' health and physicians' reputations.

I suspected that Da Costa, for his part, practiced what he preached. That's what brought me to Yale's Medical Historical Library. Considering his firsthand knowledge of addiction, I wanted to investigate how Da Costa's prescribing patterns might have differed from his peers in reaction to witnessing addiction among soldiers. After the Civil War, Da Costa set up shop in Philadelphia, where he taught clinical medicine at Jefferson Medical College. At Yale during the spring of 2019, I quantified Da Costa's patient records from the Jefferson Medical College's public teaching clinic in Philadelphia. They document the medical histories of thousands of individuals suffering from a wide variety of painful conditions. The records include detailed prescriptions, and a sample of 1,945 cases dating from October 1870 to October 1875 indicate that Da Costa and his trainees prescribed opiates to just 371 patients, or 19%. By comparison, Yale historian John Harley Warner has found that about 42% of prescriptions from a comparable public hospital in Boston during the 1870s contained opiates-more than double the rate of Da Costa's Philadelphia clinic. In other words, Da Costa and his medical trainees relied much less heavily on addictive opiate medicines than their contemporaries.

Considering Da Costa's vocal warnings about prescription opiate addiction-knowledge he gleaned by observing addicted Civil War soldiers and veterans-the Jefferson Medical Clinic records reveal that the Civil War veterans' opiate addiction epidemic had important ripple effects on American medical practices. Opiate medicines, long-time staples in the doctor's black bag, soon declined precipitously in American medicine. As I argue in my book, ex-army doctors like Da Costa, who were alarmed by veterans' prescription opiate addiction, led the movement away from opiates.

The research that led to these surprising findings would have been impossible without a Ferenc Gyorgyey Research Grant from Yale's Medical Historical Library. By facilitating access to Da Costa's rare clinical records, the grant played an essential role in my dissertation research and ongoing book project.
About Jonathan S. Jones
Jonathan S. Jones is the inaugural Postdoctoral Scholar in Civil War History at Penn State's George and Ann Richards Civil War Era Center in 2020-21, where he is currently preparing a book manuscript on opiate addiction in the Civil War era for publication. The project is derived from his dissertation on the same topic, defended at Binghamton University in June 2020. Jonathan's recent publications include an article in The Journal of the Civil War Era's June 2020 issue titled " Opium Slavery: Civil War Veterans and Opiate Addiction." After Penn State, Jonathan will be joining the Department of History at Virginia Military Institute (VMI) as an Assistant Professor starting in August 2021. Connect with Jonathan on Twitter at @_jonathansjones or at jonathansjones.net.

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The "Great Risk" of "Opium Eating": How Civil War-Era Doctors Reacted to Prescription Opioid Addiction

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The U.S. Civil War (1861-65) sparked a massive epidemic of opioid addiction among those who fought and survived the bloody conflict. The war mobilized millions of soldiers, hospital workers, and freedom-seekers, bringing people into contact with unfamiliar microbes, insects, and animals.

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Heroin as a remedy for Morphine Addiction (1898)

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Heroin as a remedy for Morphine Addiction (1898)

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Morphine was used in the American Civil War which led many veterans to become addicted¹. In 1874, chemists tried to find a less addictive form of morphine and instead created heroin and marketed as a treatment for tuberculosis as well as a remedy for morphine addiction¹. The only problem was the heroin had twice the potency of morphine making it much more dangerous to be on the streets especially since it was still a very addictive substance¹. It was also argued that veterans as well as doctors were prone to overuse the drug alike². The only way to slow this cycle of addiction was to educate doctors and strong advise against prescribing them².
1.https://www.capeandislandsems.org/the-truth-about-heroin/
2.https://www.smithsonianmag.com/history/inside-story-americas-19th-century-opiate-addiction-180967673/

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Inside the Story of America’s 19th-Century Opiate Addiction

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Doctors then, as now, overprescribed the painkiller to patients in need, and then, as now, government policy had a distinct bias

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Pierre-Jean Robiquet is my docent because he was a French pharmacist who isolated codeine. He had a very troublesome childhood which subsequently influence his learning and career paths significantly¹. Robiquet landed jobs in the pharmacy for the Navy and then the Army of the West until he later went on to finish his education and went to a laboratory that Fourcroy owned with Louis Nicolas Vauquelin where they fabricated chemical products¹. He went into the military for a while and then fully dedicated his career to buy a pharmacy. This then led to the hiring of a young pharmacist J.-B Berthemot who would be in charge of the operations of extracting opium. This is what later would lead to the isolation fo codeine¹. Robiquet published around 60+ papers in the areas of mineral chemistry, mineral and vegetable pigments, and extractive and analytical chemistry¹. Because of his techniques and work in the pharmaceuticals production and techniques for isolating them he would be a great candidate to further investigate new types of pain killers and sedatives.

1. https://www.sciencedirect.com/science/article/pii/S0187893X13725072

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Today- Prescribed opioids lead to 44% increased chance of long term use

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Today- Prescribed opioids lead to 44% increased chance of long term use

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Science advances sometimes way beyond what we can predict and opioids have sparked again with overdoes roughly tripling since 1999¹. The problem with such a powerful drug that has these addictive qualities we now question whether the suffering of a patient outweighs the proclaimed possible future they may endure¹. With such painful surgeries we know that the patents will have excruciating pain however, the pain of withdrawals is held in comparison. These very commonly prescribed drugs are heavily monitored but on the streets these drugs can be made and their effects are proven to eliminate the pain. Our bodies work towards eliminating the pain but addiction to this pain suppressant is beyond a cure, it is a death sentence for many¹. More than 80% of low-risk surgery patients are given opioids that are also the most commonly implicated  drugs in overdose deaths¹. If the drugs healthcare providers are prescribing are the ones killing other on the streets there is something that need to be fixed with its distribution and even being prescribed in general.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119469/
2. https://www.cdc.gov/opioids/basics/epidemic.html