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OPIATE ADDICTION AS A CONSEQUENCE OF THE CIVIL WAR David T. Courtwright Opiate addiction increased markedly in America during the latter half of the nineteenth century. Estimates of the magnitude and duration of that increase vary; it is likely, however, that there were at least 200,000 addicts by 1900.' Traditionally, a substantial measure of that increase has been attributed to the Civil War. Sick and wounded soldiers, liberally injected with morphine, frequently became addicted, as did many veterans who, in the course of treatment for war-related injuries, were also given opiates. Proponents of this view often refer to the fact that morphine addiction earned the sobriquet "the army disease."2 In recent years a number of authors have challenged the importance of the war as a cause of nineteenth century opiate addiction . The most skeptical of these, Mark A. Quiñones, alleges that * Research for this article was supported in part by the Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas. 1 The figure 200,000 is conservative; many estimates run higher. A useful review of the evidence bearing on the extent of opiate addiction is Lawrence KoIb and A. G. DuMez, "The Prevalence and Trend of Drug Addiction in the United States and Factors Influencing It," Public Health Reports, 39 (1924), 1179-1204. 2 Among the numerous authors who have adopted some form of the traditional view of the Civil War as impetus to addiction are: John G. Bruhn, "Drug Use as a Way of Life," Postgraduate Medicine, 53 (1973), 185; Michael M. Cohen, "The History of Opium and the Opiates," Texas Medicine, 65 (1969), 78; Bingham Dai, Opium Addiction in Chicago (Montclair, New Jersey, 1970 reprint edition), 35; William Butler Eldridge, Narcotics and the Law: A Critique of the American Experiment in Narcotic Drug Control, 2nd ed. revised (Chicago, 1967), 4-5; Harris Isbell, "Historical Development of Attitudes Toward Opiate Addiction in the United States," in Conflict and Creativity, R. H. L. Wison and Seymour M. Farber (eds.), (New York, 1963), 157-158; Kenneth L. Jones, Louis W. Shainberg, and Curtis O. Byer, Drugs and Alcohol (New York, 1969), 67; John Kaplan, "A Primer on Heroin," in Stanford Legal Essays, John Henry Merryman (ed.), (Stanford, 1975), 279; Rufus King, The Drug Hang-Up: America's Fifty Year Folly (Springfield, 111., 1972), 16; David C. Lewis and Norman E. Zinberg, "Narcotic Usage: II. A Historical Perspective on a Difficult Medical Problem," New England Journal of Medicine, 270 (1964), 1045; Peter D. Lowes, The Genesis of International Narcotics Control (Genève, 1966), 90; Jeannette Marks, "Narcotism and the War," North American Review, 206 (1917), 880; David W. Maurer and Victor H. Vogel, Narcotics and Narcotic Addiction , 4th ed. (Springfield, 111., 1973), 8; Rolf E. Muuss, "Legal and Social Aspects of Drug Abuse in Historical Perspective: Is the Drug Abuser a Patient or a Criminal?" Adolescence, 9 (1974), 497; Earle V. Simrell, "History of Legal and Medical Roles in 101 102CIVIL WAR HISTORY the war was only "a convenient scapegoat for the growth of addiction in America."3 The objections raised by Quiñones and others involve essentially four points. First, addicted veterans are not mentioned as a distinct epidemiological group in the medical literature of the day. William H. Swatos, Jr., after examining a sample of nineteenth century journal articles, concluded, "No Civil War veterans were reported in these articles in such a way as to suggest that they formed a particular 'class' or group of addicts in the minds of these physicians."4 If the war was such an important factor, one would have expected quite the opposite. The second objection to the traditional view is that the hypodermic method of administering morphine, which, because of its potency and rapidity of effect, is the technique most likely to lead to addiction , was uncommon during the war.5 Morphine was applied topically , rather than injected. A third point involves opium import statistics, assumed to reflect domestic demand. The amount of opium imported per capita accelerated in the 1870's, rather than the late 1860's—timing which suggests that the events which triggered the increase in addiction transpired after the war.8 Finally, it...