Soldier’s disease

Soldier’s disease names a nineteenth-century wave of morphine addiction, especially among Civil War veterans, and serves in the book as a warning about how readily medical treatment can produce dependence—and how quickly a society can forget that history. The term’s significance extends beyond soldiers: it traces a changing boundary between patient and criminal, an old pattern of drugs offered as cures for drug-related harms, and the repeated failure to carry hard-won knowledge into a new epidemic.

Origins and the Civil War

The story begins with the poppy. During the Civil War, women grew poppies for wounded soldiers and harvested morphine from the dried juice inside the seed pods. Physicians treating injured veterans commonly left morphine and hypodermic needles behind, instructing patients to use them as needed. A treatment that followed the doctor home could thus become part of ordinary life after the injury, and dependence could begin within a practice presented as care.

The scale of addiction among veterans is uncertain. One historical estimate cited in the book places the number at about 100,000; later accounts more often use a range of 80,000 to 100,000, while an older estimate reached 400,000. The differences matter: the book gives a substantial estimate without treating a contested figure as settled fact. Its account also describes a recognizable material trace of dependence. Some veterans carried leather bags containing needles and morphine tablets, hanging from cords around their necks.

The effects were especially severe among white Southerners in small cities and towns. The war’s deaths and the economic uncertainty that followed the end of slavery formed part of the setting in which families encountered addiction. The book recalls an 1877 complaint that men impoverished by the war had turned to opium to drown their sorrows. Soldier’s disease therefore refers not only to a drug and its users, but to a crisis shaped by injury, bereavement, and upheaval.

From medical remedy to public warning

The name emerged amid a wider succession of claims that one form of opium-derived medicine could solve the dangers associated with another. In the nineteenth century, doctors used morphine to help patients withdraw from laudanum; later, heroin was used in attempts to get patients off morphine. In the book’s historical account, the cycle reveals a persistent difficulty: a drug may be treated as a remedy for dependence even as its own risks remain inadequately understood.

Heroin entered American drugstores about three decades after the Civil War, marketed as a cough remedy and as a cure for morphinism, the name then used for morphine addiction. Bayer promoted it as a new version of the same underlying molecule. It was sold without a prescription and offered not only to veterans but also to women with menstrual cramps and babies with hiccups. That broad reach makes the episode more than a story of soldiers: the remedy moved into ordinary domestic and medical use.

Warnings accumulated, but acceptance did not end at once. In 1906 the American Medical Association issued a sterner warning about heroin’s capacity to form a habit. By the 1910s and 1920s, heroin-related hospital admissions in New York and Philadelphia were rising. The language around the problem also shifted: what had been called soldier’s disease was described by New York City’s health commissioner as the American disease. The change in name registered an expanding crisis, no longer readily contained within the image of the veteran.

Criminalization and historical forgetting

The Harrison Narcotics Act of 1914 severely restricted the sale and possession of heroin and other narcotics; by 1924, heroin manufacture had been outlawed. Twenty-six years had passed since Bayer’s pill reached the market. As control tightened, the social identity attached to addiction changed as well. By the 1930s, many heroin users were working-class people, including children of immigrants, alongside jazz musicians and other creative workers. Criminal networks supplied drugs to people who depended on them and sought to stave off withdrawal.

The book contrasts this population with the earlier, more socially respectable users of opium and morphine, including people whose dependence had begun through medical treatment. As those users disappeared from public memory, addiction was increasingly associated with inner-city users labeled junkies, and the addicted were treated as criminals rather than patients. This reversal is central to the history of soldier’s disease: the drug-related harm remains, while the social category of the person suffering it changes.

That history, the book argues, became easy to lose. Newspaper warnings and earlier episodes receded into historical footnotes, leaving later generations to encounter familiar dangers as if they were new. The book places the late-1990s rise of prescription opioid addiction within this pattern of forgetfulness. At the same time, it shows how a new medical and commercial context could make the recurrence difficult to recognize: Purdue Pharma promoted OxyContin for a wide range of chronic pain, while company representatives advanced claims that addiction was exceptionally rare.

The 1996 introduction of OxyContin coincided with the campaign to treat pain as the fifth vital sign. New standards required hospitals to assess and treat pain, and the book describes how pressure to measure patient satisfaction encouraged liberal pain treatment. Pain scores could make an invisible experience appear quantifiable, even though the measure depended on subjective reports and did not, in itself, establish that increased opioid prescribing improved outcomes. Purdue saw the new standards as an opportunity to position itself as a source of pain-management materials, joining commercial promotion to a broader change in medical practice.

Other conditions reinforced that shift. Federal rules for pharmaceutical advertising had loosened, and prescription-drug advertising rose from $360 million in 1995 to $1.3 billion in 1998. Purdue targeted rural doctors who already prescribed competing painkillers, using sales visits and branded reminders to promote OxyContin’s potency and longer action. In the book’s account, these details do not make the nineteenth-century and modern crises identical; they show how a familiar confidence in medical remedies, coupled with weak recognition of risk, could help an old pattern return in a new form.

The term’s return in the modern crisis

Soldier’s disease also provides a frame for the book’s attention to individual losses and unresolved questions. Kristi Fernandez wants to understand how her son Jesse Bolstridge moved from being a high school football player and construction worker to dying of a heroin overdose. Her effort to make the sequence intelligible reflects the book’s larger inquiry: how can families and communities recognize the progression of addiction when its causes and consequences are dispersed across medical practice, drug supply, and public policy?

The book sets those family questions beside the limits of enforcement. In Jesse’s case, investigators believed his friend Dennis Painter obtained heroin from a local user-dealer supplied by the Jones–Shaw ring, but the time between the sale and Jesse’s death, and the many people around him in the interim, made the case difficult to prove. The gap between a family’s need for an explanation and the evidence available to prosecutors echoes the larger difficulty of assigning responsibility in a crisis with many links and actors.

The historical pattern also complicates the idea that treatment has a simple, permanent answer. The book notes that American doctors have repeatedly tried to use one opioid to manage dependence on another, and presents medication-assisted treatment as imperfect but scientifically among the best available tools for preventing death. This tension—treatment that can help, treatment that can be misused, and the risk of relapse when treatment stops—recalls the older effort to balance care against the harms of the drugs themselves.

The Epilogue bears the title Soldier’s Disease and returns the historical phrase to present-day lives. It includes Rosemary Hopkins, who first encountered OxyContin in 1998 and was in recovery on medication-assisted treatment under Art Van Zee’s care from 2009. The return of the term does not suggest that every era or person shares the same experience. Rather, it insists that the modern epidemic should be read with the past in view: a society can recognize dependence as a medical consequence in one generation, recast it as criminality in another, and then face the same questions again when a new drug wave arrives.