In 1861 the United States descended into civil war. History is written by the victors, and thus many key facts have been memory-holed in favor of a slavery-centered narrative. Sadly lost in today’s ‘civil war history’ is the story of our nation’s first opioid epidemic, Pfizer’s rise as a prominent pharmaceutical company, and the federal government’s hand in both those events.
This story starts before the war, when two German immigrants (Charles Pfizer and Charles Erhart) started a chemical company in Brooklyn in 1849. The company had moderate success with its first product, an anti-parasitic drug that was compounded into a candy-like toffee. However, Pfizer was just one of dozens of other companies in the US manufacturing chemicals and pharmaceuticals at the time. Pfizer would use the Civil War to bring itself to prominence and profit, much as ‘defense’ companies do today.
Wars have always produced injuries and disease, however a key invention just prior to the Civil War led to exceptionally gruesome wounds. The Minié ball, named after the French army officer who invented it, was a new bullet that expanded when fired while still maintaining relative accuracy. Previous bullets were more likely to travel through bodies, but the Minié ball would lodge inside tissue, creating sucking chest wounds and other fatal injuries. Not only were battlefield injuries horrific, but there were also deadly diseases like measles, dysentery, and malaria, the latter being endemic in the South where the war was mostly fought. Thus, there was a great need for pain killers, antiseptics, anesthetics, and anti-diarrheal medications by both the Union and Confederate armies.
It was already known before the Civil War that opium and morphine (which is roughly ten times stronger than opium) would alleviate pain and stop diarrhea. Prior to the Civil War, opium and morphine were typically administered by mouth, however the advent of the hypodermic needle in 1853 popularized intravenous (IV) administration. In fact, giving IV morphine became popular because it was thought to be less addictive than consuming it by mouth. Additionally, opioids were thought to have antiseptic properties, and morphine powder was applied topically to wounds.
Therefore, the Civil War produced a great demand for opium and morphine. Companies like Pfizer rushed to fill the demand – but only for one side of the conflict. Due to Abraham Lincoln’s naval blockade, no medical supplies were able to reach the South. The Confederacy had to make its own drugs. Without the industrial infrastructure of the North, the South turned to its agricultural economy to aid its troops. The government of Jefferson Davis enlisted farmers to grow opium poppies and cinchona trees (quinine, an anti-malarial drug, can be extracted from the bark of the cinchona tree). A loosely and hastily-constructed network of ‘laboratories’ in Colombia, South Carolina and Montgomery, Alabama processed the raw ingredients into powders that could be used on the battlefield.
Meanwhile in the North, Pfizer and the future Bristol-Myers Squibb built and expanded factories in New York and Philadelphia. In fact, Squibb was founded by Edward Robinson Squibb, a naval doctor who served in the Mexican-American war. Also formulating their future business model during this time was Union Colonel Eli Lilly, a cavalry commander for an Indiana regiment. (Lilly first tried being a farmer after the war, but he failed in that venture and so then he started a pharmaceutical company.)
Whether made in a lab or grown on a farm, opioids were freely dispensed by both armies’ doctors to soldiers for injury, disease, and “nostalgia,” which was the Civil War-era term for what we now call PTSD. There are stories of army doctors patrolling fields after battles, dispensing morphine powder from satchels without bothering to dismount and examine the wounded. Morphine also was used for phantom limb pain after amputations, and also given at low doses thought to stimulate tired men for battle.
Although opioids were used by both sides, the Union commanded the lion’s share of anesthetics used for amputations and other painful procedures. Chloroform was the preferred method of battlefield anesthesia, since it is less flammable than ether. Yet due to the naval blockade, Confederate doctors and their soldier patients were often without chloroform. Limited amounts were captured from Union supplies by Stonewall Jackson and his men during the Shenandoah Valley campaign.
All in all, an estimated 10 million doses of morphine, 5.3 million opium pills, and 2.8 million ounces of opium dissolved in alcohol (known as laudanum) were administered to Union soldiers alone. Since the South’s production of opium and morphine was more organic and harder-to-measure than industrial manufacturing, figures for Confederate troops are not well known. Regardless, at the end of the war there were an estimated 400,000 veterans now addicted to opioids. The first opioid epidemic in the US was labeled as “Old Soldiers Disease.”
While nearly a half-million veterans were silently suffering from addiction (acknowledging chemical dependence was verboten due to social stigma and fears of losing army pensions), the future kings of big pharma were healthy as ever. Before the Civil War there were just over 80 companies in the US manufacturing chemicals and pharmaceuticals. After the war there were over 300. Pfizer’s revenue doubled between 1860 and 1868, and a precedent had been set for a chummy relationship with the US government during wartime. Indeed, Pfizer became the US government’s preferred pharmaceutical hand during that time. That relationship has only grown since the Civil War, with “most of the penicillin that [went] ashore with Allied force on D-Day made by Pfizer,” and now the COVID-19 vaccines today.
Looking back 150 years ago we see one country invading another, starting a war fought by common men who have nothing to do with the origins of the conflict. Bodies fall in fields while companies see profits rise. The government responsible for death, destruction, and addiction rewards corporate instead of civilian loyalty. The masses suffer while bureaucrats and politicians, free of consequences, rest comfortably and rewrite history.
How many times will we let this happen?
Sources:
Shooting Up by L. Kamienski
Pharmacy in the American Civil War by G.R. Hasegawa
Medicine During the American Civil War by J. Paciorek
source: https://paracelsusdoc.substack.com/p/you-can-thank-the-civil-war-for-pfizer?s=r
Correction by Dr. Saleeby: "Previous bullets were more likely to travel through bodies, but the Minié ball would lodge inside tissue, creating sucking chest wounds and other fatal injuries."
A correction to this point. The Minie ball has a pointed end and a blunt rear when gunpowder is ignited the blunt end expands to grab the rifle grooves in the barrel and start spinning, this increases is exit muzzle velocity and as it spins it has more accurate trajectory. It has a longer range and impacts harder on it's target. The older round balls were slower and caused less damage. For example it may only bruise a bone, while the Minie ball would shatter bone. If it were a chest wound the Minie ball would go all the way thru the body and one is more likely to survive that would; conversely the round ball would lodge in the chest and cause more damage crushing tissue and leading to infection. In gut wounds the older round ball would increase survivability as it would only contuse tissue often and not pierce intestinal linings; the Minie ball however would tear intestinal linings, spilling gut contents attributing to more infections and more deaths. These observations are from a Union Surgeon's diary from the Am Civil War. So the opposite is true about the impact of the Minie ball vs the older round shot in this statement.
Also the South survived the war from a medical perspective when the Union blockage prevented medications coming into the CSA from Europe and also the north, by recruiting Dr. F.P. Porcher (Charleston, SC) to write a book of herbal medicines found in the region. This book: "Resources of the Southern Fields and Forests" gave the Southern Medical Corp an upper hand in treating the sick Southern civilian and military population. https://docsouth.unc.edu/imls/porcher/porcher.html
