19th century

In the book, the 19th century is not a remote prelude but an early record of recurring tensions in opioid history: therapeutic promise alongside dependence, commercial opportunity alongside public harm, and warnings that failed to overcome confidence in new drugs. The period’s story runs from opium commerce and morphine treatment to the invention of Heroin, showing how medical use and the boundaries of addiction were repeatedly understood, disputed, and misjudged.

Opium, commerce, and the uses of medicine

The book places 19th-century developments within a much older history of opium. Opium had long served both as an intoxicant and as a remedy; in the 19th century, it was also bound up with international conflict and American fortunes. Britain and China fought two wars over the trade. In the United States, opium was an ingredient in laudanum, an alcohol-based tincture used for illnesses and complaints ranging from yellow fever and cholera to headaches and general pain. The account makes the treatment’s reach concrete with Alexander Hamilton: after his 1804 duel, doctors administered laudanum to dull the pain of the bullet wound that had pierced his liver and lodged in his vertebrae.

In the 1820s, an unnamed leading Boston merchant organized an opium-smuggling operation off the Cantonese coast. The profits enriched Boston families named Cabot, Delano, and Forbes, and later helped build some of the country’s first railroads, mines, and factories. The episode places opium within the development of American wealth, not solely within the history of medicine or individual drug use. Commerce and treatment occupied different parts of the same history, and neither could be separated from the substance’s wider consequences.

Morphine, innovation, and dependence

Around this period, the German apothecary Friedrich Sertürner isolated the active ingredient in the poppy and named it morphium, after Morpheus, the Greek god of dreams. He recognized that morphine was far more potent than processed opium and described a progression from euphoria to depression and nausea. His observations included the effects on dogs: after becoming unconscious, they woke in an agitated state with fever and diarrhea. The account connects this experience to yen, a term used in China for the withdrawal state of people addicted to opium. In 1810, Sertürner published a warning that the new substance’s effects could lead to calamity.

Decades later, the Scottish physician Alexander Wood promoted the hypodermic needle, created in 1853, with the mistaken assurance that injecting morphine would not cause addiction, even though smoking or swallowing it could. The book emphasizes the contrast between Wood’s confidence in a new delivery method and Sertürner’s earlier warning about the drug itself. The needle changed how morphine could be administered; it did not make the compound harmless.

During the American Civil War and its aftermath, doctors treating injured veterans often left morphine and hypodermic needles behind, with directions to use them as needed. The book estimates that one hundred thousand veterans became addicted. Some carried leather bags containing needles and morphine tablets, but the history extends beyond the objects themselves: dependence was especially severe among white Southerners in small cities and towns, where families were coping with deaths in the war and economic uncertainty following the end of slavery. An opium dealer in New York also observed that men impoverished by the conflict had turned to opium to drown their sorrows. Taken together, these details present addiction as entwined with medical practice and social upheaval, rather than as a problem confined to one kind of user or one setting.

Medical acceptance and missed warnings

By the 1870s, morphine injections were popular among upper classes in Europe and the United States and were used for varied ailments, including menstrual pain and eye inflammation. With little regulatory oversight, patent medicines containing morphine or opium could be bought without a prescription at drugstore counters. If a doctor initially approved the practice, even injected morphine was widely accepted. Daily users were not necessarily stigmatized: because dependence could begin through medical treatment, it was understood differently from an illicit habit.

Virginia briefly became a site of debate over that easy availability. In 1884, the General Assembly considered regulating over-the-counter opium and morphine. A local newspaper condemned the proposed measure as class legislation. Richmond doctor W. G. Rogers responded with an appeal for regulation, describing people who had become dependent after prescriptions and could not stop despite recognizing the damage to their lives. The legislature rejected the bill, treating regulation as government overreach. In the book’s account, this refusal allowed the reach of morphine use to deepen and anticipates a recurring conflict: evidence of harm could be acknowledged, yet action to limit access could still be dismissed as an unacceptable intrusion.

That history of confidence and warning continued late in the century in the development of Heroin. In 1897, Bayer chemist Heinrich Dreser rediscovered the work of a British chemist who had synthesized diacetylmorphine in 1874 while seeking a nonaddictive alternative to morphine. Dreser saw potential in a drug more than twice as powerful as morphine, itself much stronger than opium. At a time when pneumonia and tuberculosis were leading causes of death and antibiotics did not exist, he believed it might suppress coughing as effectively as codeine without codeine’s known addictive qualities. Clinical testing began on rabbits and frogs, then included Dreser and Bayer factory employees. The following year, he presented the drug to the German medical academy as a treatment for respiratory and other conditions; Bayer promoted it as safe for family use, including for baby colic, and as a cure for alcoholism and morphine abuse. The promise of a nonaddictive substitute thus accompanied the arrival of a more potent drug.

Historical recurrence and the modern frame

The book’s historical account gains significance from its placement beside later opioid crises. It introduces the 19th-century record against what it calls the United States of Amnesia: the warning from Sertürner, the misplaced confidence in injection, and the rejection of regulation all show that claims of novelty or safety have a history. This comparison does not make the different episodes interchangeable. Instead, it gives readers a longer context for the gap between medical assurances, patterns of access, and the consequences of dependence.

That longer view also sharpens the book’s attention to who was believed, treated, or punished in later periods. In its account of Roanoke, heroin had been widely regarded as an inner-city drug and largely associated with a small, mostly African American group of users and dealers, while the growth of opioid addiction among white suburban families came to challenge that perception. The book also reports that 2014 research found doctors prescribed painkillers at substantially lower rates to people of color because they were less trusted not to misuse them; in that year, overdose deaths among young white people had risen to three times their 2002 rate, while the rate for people of color had changed relatively little. It contrasts this medical disparity with drug enforcement that fell disproportionately on Black and Hispanic people. These later examples do not establish a direct line from 19th-century practice to modern policy, but they extend the book’s examination of how ideas about drugs, patients, and risk shape access to care and exposure to punishment.