Transcripts For CSPAN3 The 20240704

Okay, were going to go ahead and get started with our final session. Jonathan jones is currently assistant professor in the department of history at the Virginia Military institute, where he teaches courses on the civil era and american medical history. And i will say this is not part of his official bio, but in the fall hell be moving into a position at James Madison university. So be closer and well have opportunities to collaborate more on things. His first book, manuscript opium slavery, the Civil War Veterans and americas first Opioid Crisis, is forthcoming with university of North Carolina press. The book is based on joness dissertation, which received the society of civil war historians 2021 and jay bailey dissertation prize as well as sue ann wise system wide inaugural chancellor, distinguished phd graduate dissertation award in 21 joness research has appeared in the journal of the civil war era, Washington Post and other outlets. He received his ph. D. From Binghamton University in 2020 and in 2022 2021, he was the inaugural civil war era postdoctoral scholar at penn States George and ann richards, civil war era center. So please join me in giving a very warm welcome to jonathan jones. All right. Well, thank you all for for being here. Thank you, professor najjar, for that introduction. Can everybody hear me okay . Good. Okay, perfect. Raise it up a little. Perfect. Yeah. There we go. Thats much, much better. Much deeper sounding. Okay. Thank you again, everyone, for being here. Thank you to everyone whos going to be tuning in on cspan. Mom, were on tv. Thats exciting. Yeah, well tell her. Its on on cnn or pbs. I know, but i have always been interested. The aftermath, the afterlife of the civil war. Ive always been curious about questions like how did the war with all of the carnage and the upheaval that weve been hearing about this morning, in this afternoon, how did these events affect americans, society and culture and medicine and most importantly, the individual people that survived this this mayhem after the conflict . But these are the questions that interest me the most as a civil war scholar, a civil war teacher. And these are questions that animate my Current Research project. The war is interesting, right . But what comes after the war is, to me, the real story and opioid addiction among Civil War Veterans, which the subject of my talk this afternoon illustrates. These interests. Its also the subject of my forthcoming book called opium slavery, the Civil War Veterans and americas first Opioid Crisis, which forthcoming with unci press in the near future. Sadly, i dont have any with me today, but please shoot me an email if youre interested. In the wake of the us civil war, there was an epidemic of opioid addiction among veterans and opium. Slavery is a social, a cultural and really a medical history of this epidemic. So id like to open up this afternoon with a story that illustrates some of the key themes of the book. Oh, hang on one second. Technical. There we go. Okay. So this story is the story of a man named alpheus chappell, and he is a confederate veteran from amelia county, virgia. Anduring the war, a capin in the 14th virginia infantry and chapel, never entirely got over th wounds that he sustained at the battle of gettysburg. As he explained in a tragic. 1886 letter, the captain was shot while storming union lines with general george picketts ill fated Virginia Division on the hot afternoon of july 3rd, 1863. All of the officers above chapels rank had apparently been shot, and so it fell to him to lead his unit through clouds of smoke and bayonets. But a white hot led mini ball or mini ball . If youre from texas like me, stop at chappell in his tracks and prevented him from completing the charge when it smashed into his left kneecap at full force and pancaked on impact with the bone, the ball angrily ripped through the cartilage and the soft tissue of chappells leg at the joint, tearing a massive exit hole in the leg. And so chappell dropped to the tall, dry grass in unspeakable pain. And that is where he lay until the dust settled that afternoon when retreating survivors of the 14th virginia chapels outfit dragged their captain back to a confederate Field Hospital from there, chappell hitched a ride back home, pennsylvania, into maryland and virginia, along with lees 17 mile long wagon train. With union troops nipping at their heels for much of the way. Every rut and rock in the road would have added to his agony and misery. Now, as weve heard today, civil war battles like gettysburg, antietam produced thousands and thousands of war stories, just like chapels. And all too often, these cases, they ended in grisly deaths from infection or blood loss exposure. You name it, theres a million ways to die in the civil war. So judging by outward appearances, we might consider chapel to be one of the lucky ones, because after all, he somehow managed to survive long enough to actually tell his story. In 1886, in the letter that we see here on the seen, but chapel didnt see it that way. He did not consider himself one of theucky ones because him survival in the long aftermath of the battle of gettysburg was a living hell. And that is because 23 years after gettysburg the unexpected consequences of chapel civil war wound still dominated the old soldiers day to day life as he explained in that tortured 1886 letter quote the put me on morphine and i stop that. In other words, chapel had become and remained hopelessly addicted to the morphine that surgeons had given him in that Field Hospital to treat the pain from his gettysburg wound. And that it kept on taking as he bounced along the route into pennsylvania, maryland and on and on. And so although the gunshot wound had long healed, the drugs given to the soldier during the healing process refused to release chapel from their chains, and he suffered it. Nor was chapel alone. Tens of thousands of Civil War Veterans became to opium and morphine, both during after the civil war. You may be aware that historians have actually long known about these individuals to a certain extent. Weve been aware for quite some time that scattered cases of Civil War Veterans occasionally became addicted to medicinal opiates, that they were introduced to during the war. In fact, for over a century, individual veterans like chapel have made occasional appearances in various mediums, ranging from early 1900s social science, literature, 1970s Television Shows about the civil war, which was a story for another day, and even congressional debates about todays ongoing opioid. As recently as a couple of years ago. Yet addicted Civil War Veterans like alpheus chapple are almost always relegated to the footnotes, literally in the story of the civil war. And for me, this is surprising, considering that the civil war era is among the best documented periods in us history with sustained interest in the conflict for over 150 years. So it goes without saying that today there are many Unanswered Questions about this. For example, why did addicted veterans become, addicted to opiates and how prevalent was drug abuse among these old soldiers . Was it merely a few scattered cases, individual cases like chapple or was he and others like him emblematic of a larger Public Health crisis afoot . What were the effects of addiction and veterans postwar lives and how did they try to mitigate those consequence . How did for their part, the american medical community, the doctors, the media, even government officials respond to this epidemic, if there was one. And finally, what does addiction to opioids among Civil War Veterans reveal about the Long Term Health consequences of the civil war, which unleashed so much suffering on survivors like chapel . And so taking up these questions for my book, i assembled a sample of about 200 individual cases, and the story that i just told is drawn from that sample. Roughly two companies of soldiers. I sourced these individual stories from 19th century medical journals, mental asylum records, some from right here in virginia, medical advertisements and the pension applications that weve been discussing off and on today, which are such rich sources of the period. And so what im going to do this afternoon is describe some of these sources and my Research Process as we move through the talk. But ultimately, im going to make four key points. First, im going to argue that the civil war did, in fact, cause an epidemic of opioid addiction among Civil War Veterans, not merely a few one off cases. Second, were going to assess the suffering that opium slavery. The 19th century term for addiction, visited on veterans and, their families. And im here to tell you that addiction truly dominated their lives to the point that few addicted ever got over the civil war or the aftermath of civil war battles. Third, were going to explore some were going to scratch the surface of some of the ways that American Physicians and the government reacted to the veterans opioid addiction crisis. And finally were going to describe how this research i hope will advance our understanding of the civil war to lead us to a more humanized accounting of the of the conflict. But lets start the beginning lets start at causation. What actually caused Civil War Veterans like chappell to become addicted to opiates . What sparked this epidemic . The civil war was a massive Health Crisis, actually the biggest Health Crisis up that point in American History. And the war truly caused mind bogglingly huge number. People to get sick, to suffer from pain. To put a number it. There were 1. 5 million casualties from the war that we know of. Out of 31 million americans. And so to put that in our terms, almost everyone knew someone or was someone got sick or shot or some kind of a physical Health Consequence from the war. In fact, recruits had a one in four chance of not coming back home at all, and many of those who did return came back shattered with Long Term Health complications. And so deal with this unprecedented Health Crisis. Doctors basically had to double down on tried and true medical therapies, which in the 19th century were opiates. Opium is actually humanitys oldest drug. Its a very, very old drug dating back to the stone age. Doctors had been prescribing opium and its various derivatives, which include a drug that we all know today called morphine. Still in use. And another kind of opioid known as laudanum, which is basically booze mixed with opium. So you can imagine the attraction of this drug. Theyve been giving these drugs for centuries in the lead up to the war. And in fact, they were among the most effective and only truly effective painkillers known in the late 1860s or in the in the mid 1860s. Doctors in the u. S. Learned to prescribe these drugs liberally in medical school and in apprenticeships and actually one antebellum medical student. I can never get over this this cover. A student at the university of michigan put it like this, quote, opium is a divine gift from heaven. And to literally illustrate that point in his medical dissertation kind of like an exam that medical students would take at the end of their degree, he drew an angel bearing opium poppy down from heaven to earth. Right. They took this literally. This is an intensely religious society. And so this isnt merely kind of a caricature. This was a literal belief that many doctors and also patients had that god had given them opium to ease their suffering by 1861, the year that the civil war broke out. Opium and its derivatives are again laudanum and morphine are actually the most commonly prescribed medications. The United States. And opium present in somewhere about 50 of all prescriptions the mid 1800s in the United States. These drugs were so popular because they were utilitarian. We often think of opioids, things like oxycodone and for example, as painkillers you go and get morphine after surgery. You might be prescribed oxycontin back pain. But in the 19th century, these drugs were for way more than just pain. In fact, by my count, and i had to actually count in the mid 1800s, opiates were used, treat around 150 different ailments, ranging from to cholera, pneumonia, insomnia and my favorite toothaches, especially among teething children. Its a good thing this is after lunch, right . Um, actually, i kind of think of opium in the 19th century as being a combination of tylenol, peptobismol and nyquil combined. Thats the function that it served in the 1800s. Now, you might be did they know about the downside of these drugs . Clearly, they had a lot going for them. But what about the risk of overdose and addiction . In fact, doctors did know going into the civil war that opiates were addictive and could kill you if took too much so emphatically. Yes, they were aware of these downsides. In fact, this knowledge actually goes back to the era, the american revolution, the founding of american medicine. I identified the Research Project several previously unknown and undescribed lived cases of individuals, one in the washington family addicted to laudanum and morphine, contained in the writings of benjamin rush, known as the socalled father of medicine. And so this is something that occurs before the civil war its widely known about. Its also deadly addiction and overdoses often appeared in. Coroners records in the antebellum era. So, for example, between about 1825 and 1845, opium was indicated as a cause of death in about 4 of the unexplained. St catch is that most people who suffered from these consequences of addiction and overdose before the civil war were not men. They, in fact, white women. Of course, you may know that descriptions of chinese opium smokers in the middle of the 1800s, as described in particular through the lens of american missionaries writings from china. These are also pervasive in the 1800s. Pop culture and medical culture. But both of these groups, women and chinese opium smokers, were so often portrayed as naturally dependent on something their addiction, rather their dependency to opiates, was not seen as hugely problematic. It seemed almost normal like it wasnt a big deal. And so, again, although addiction was known, it wasnt at the forefront of cultural medical concerns. Before the civil which would create for the first time in American History, a huge cohort of men who will become addicted. Its also mentioning that doctors, patients, health care, consumers had very little alternatives to opiates because. There were few other drugs. So effective as. And that became a fundamental principle in civil war, medical care. During the war Army Surgeons are going to rely very heavily on opiates to treat pain and diarrhea. So think of those and amputations that are stereotypical of civil war medicine. But also think of diarrhea and dysentery, which are in reality the most medical complaints of the civil war. Opiates are used to treat all these conditions and so predictably, opiate use goes off the chart. During the civil war, the union military, which kept medical records. So we know these these kinds of nitty gritty details. They used Something Like 2. 3 million fluid ounces of liquid opiate. So morphine and laudanum and 10 million opium pills. In fact, a Union Government used a requisition, so much opium that they actually had to create for the first time in American History, government funded pharmaceutical labs to mass manufacture quantity of this drug to keep up with the rapid demand. Again, for the first time in u. S. History, for their part, the confederacy which has is enduring the civil war, an increasingly effective medical and blockade of other supplies. They tried to procure opium domestically by opium poppies on slave plantation in places like louisiana and virginia. When that failed, they even about halfway through the civil war to coax white southern women and children who are left on the home front to, cultivate private opium gardens and donate the poppies to local military hospitals. Of course, that failed and im happy to talk more about that later on. But again, suffice it to say that surgeons both in the north and in the south doled out liberally in ways that were conducive to facilitating addicts addiction. Ill give you an example, and that comes from one union hospital, a hospital called turners lane in philadelphia. Philadelphia turned into essentially a giant hospital complex. But at this hospital, turners lane, thats where the bad cases went the most severely. Individuals, particularly those who had nerve conditions. Their surgeons began experimenting with, hypodermic morphine with a newfangled way to deliver morphine instantly. And so they ended up giving in one year during the civil war, 40,000 morphine injections to wounded and six soldiers that passed this hospital. And in fact, it was so successful that doctors elsewhere started emulating what was done at turners lane after the war. And so, in a roundabout way, the civil war helps popularize the hypodermic syringe, which is, of course, today a mainstay american medicine. Now, these medicines were really, really, really important for civil war armies, soldiers simply could not have functioned or remained in the field, returned to duty without them. And the Confederate Army medical handbook put it like this. It wrote, quote, opium is the one. And dispensable drug on the battlefield. Important to the surgeon as to the ordnance and this image of civil war hospital worker kind of like an apothecary posing with medicine bottles to me really illustrates the centrality opiates to civil war medicine also happens to be one of my favorite civil war images because of the stare. Hes a very intense character. These are actual civil war prescriptions. Part of my work involved counting quantifying opioid prescribing and parsing out usage patterns in and outside civil war hospitals. So we look at the slide closely. We can see sections where there are red, underline ins. Those are prescriptions that are compounded of various different plant based drugs that include opium, opiates underlined in red. These are written in latin. So that can complicate things a little bit. Doctors handwriting is also notoriously bad, so imagine reading bad doctors handwriting in latin and thats a taste of the research. Method. Predictably, many soldiers going to become addicted during the war through surgeons prescriptions for pain and sickness. So, for example, alphas chapel, the story that i opened with today one of the most haunting examples that i found of. This phenomenon actually, though, comes from turners lay in hospital in philadelphia. And thats a Union Soldier who is wounded early on during the war in 1861, when he was over by a train. There are many ways to become injured during the war. That is his unfortunate fate. And so he spends the entire course of the war, four years in turners, in hospital, mostly bedridden. And during the process he undergoes six amputations or re amputation to amputate more and more and more of his leg to try to solve the cause of his pain. Again, in a span of four years after the final surgery in 1865, the mans surgeon that he was good enough to be discharged except that he had developed what the surgeon called a craving for opium. Other veterans learned to actually use opiates from not the doctors, but from their fellow soldiers, their best mates, their comrades. And so camp life. The intensity of camp life. The boredom of camp life. The unhealthiness of camp life. Served other veterans learn to actually use opiates from not doctors but from their fellow soldiers. There comrades. So life caught the intensity of camp life in the boredom of camp life and unhealthiness of gift life served as a culture is asian of drug use for a variety of reasons. I found civil war soldiers were oftentimes sent letters home to mom or their father or a sister asking to receive a packet of laudanum or opiate pills in the mail. Later on when they went back home and got sickly lookup veterans often instinctually reach for the open bottle. A behavior they learned during the civil war because they knew these medications would be very effective. Of course this is all unfolding do the during the temperance movement. Major concerns before, during and after the war about Substance Abuse among americans but particular among the rank and file of civil war armies. So the temperance crowd is going ballistic as they are observing this behavior. They worry deeply about creating an opiate epidemic in the ranks and after the war. These fears came true because selfmedication during and after the war was actually a major vector for addiction. One confederate soldier a man named george m. House of the ninth alabama infantry got into the habit of taking a dose of morphine right before going into battle. He was literally as he lined up preparing to go to combat would down morphine because he felt it would help calm his nerves. He felt jittery before combat and also help them cope with the carnage he was about to be asked to endure and also inflict. Passport several decades in 1881, i discovered his case on the patient register of a facility called the Charity Hospital in new orleans where he actually checked himself in seeking some kind of help for his morphine addiction. So again suffice it to say that selfmedication is a major pathway to addiction just like surgeons prescriptions. Although opiates were very free flowing and both civil war hospitals and camps, its worth mentioning that white veterans are far more likely to become addicted than black veterans. The black soldiers made up about 10 of the union military. The army and the navy. You would think addiction would occur relatively frankly among black veterans on par with white soldiers and white veterans but i found that this is not the case. The reason for this is that american doctors before the civil war are mostly white and they have been trained in medical schools that are teaching a white supremacist curriculum. The ongoing belief that is implemented during the war is that lack soldiers, black bodies could not actually feel pain on par with wounded white soldiers. Of course this belief is a form of medical racism and dates back to slavery when it was developed by southern doctors as a way to ward off abolitionist critiques of whipping. Fastforward to the civil war, because his idea black soldiers were far less likely to receive opiate painkillers from their surgeons. For example in case there was a black Union Soldier whose foot was severed in half by shrapnel. But he was not given morphine specifically because his surgeon claimed that the man was not suffering much pain. Of course for a white soldier this sort of injury in the standard of care would have been morphine early and often as we saw in chappells case but that was not the case typically for black soldiers. The same is also true of diarrhea elements. Mortality from diary sicknesses among white troops in the army was relatively low at 17. 3 . And cant trust the death rate for black troops was almost 34 nearly double the rate of white soldiers. So historians reading that sister stick, the staggering disparity was really emblematic of the racism of the civil war era medicine teaches us that not only were civil war doctors not giving out opiate painkillers but also not prescribing opiate antidiarrheals to the black troops under their care. Im sizing this so much because its a parallel with todays Opioid Crisis that has been ongoing for ongoing 20 years at this point as we are talking in 2023. Lack american still today are widely under prescribed opiate painkillers. Again we see some of the past in the present moment. But in any case after the civil war ends in 1865, many veterans returned home with life threatening in life altering medical proms. Missing limbs, gunshot wounds, gastrointestinal afflictions. And the doctors continued to liberally prescribed to ailing veterans after the civil war and of course this also facilitated addiction. For example one duct to cut george jones of cincinnati, enthusiastically embraced hypodermic morphine giving 2300 injections of morphine to a single pain patient over the coasts of course of 20 months. That sounds shocking but keep in mind that the context is this predates modern american pharmaceutical and drug laws. In the 19th century there really no legal standards for doctors to follow when prescribing opiates. Also no laws to prevent consumers from buying a prescription from a doctor and refilling it an unlimited amount of times for years and years and for the record you also didnt need a prescription because drugs are available both overthecounter and by the mail from gilded age stores like sears where he could buy a hypodermic needle kit and a vial of morphine for about 1. 50. Conditions for Public Health crisis were ripe including in virginia. In standing, virginia, pharmacists dispensed about 79,000 doses of opium in a year during the late 1870s. So this raised some attention in the National Media in the New York Times dispatched an investigator who ended up labeling stanton the socalled great opium city of virginia. I commute to work through stanton so every time i do, i think about that. According to the times, hoping eating which is another 1800s way of saying opioid addiction. They say it was like a epidemic. In virginia and elsewhere and addiction epidemic was born among Civil War Veterans. I was caught off guard as i was tracing the trajectory of this epidemic how long this addiction crisis actually lasted. It was not limited to the immediate aftermath of battle or even to the 1870s. It was in fact a really Long Term Health consequence of the civil war. For example one confederate veteran appears in louisiana at one of the early drug rehab clinics that are ultimately opened up by the federal government. Thats in the early 1920s. He told doctors there that he had been addicted to morphine and had been taking daily since the civil war more than five decades before. Of course the majority of the mans life. Another veteran who i write about in my book, egg guy named perry bowser became addicted to opium at vicksburg hospital in 1864 where he had been checked in for a diarrheal disease. Fastforward to 1915 and he died in a soldiers hospital operated by the National Home for disabled volunteer soldiers of something the doctors called chronic morphine. He lived about two thirds of his life addicted to the drug. Of course for us to label something in hindsight and epidemic requires not just a large number of cases but also people in the past to recognize that an epidemic is a foot. So in fact during the gilded age, addicted veterans were rightly recognize so much so that they were reported on and become somewhat of a stereotype in the media and even in fiction. One boston pharmacist summarized the stereotype in 1872 when he reported to the state board of health that was investigating the phenomenon that quote veteran soldiers as a class are addict into opiates. This morphine addiction, civil war Veterans Crisis actually left a longlasting impression on American Culture cut drug laws and medicine as well. Not just a stamp on the lives of individuals like alfonse chappell. The First American novel about drug addiction was published in 1881 featured as its protagonist a morphine addicted Civil War Veteran. Not someone else. Of course today this is a huge genre of american literature. Looks like it dope sick regular make the New York Times bestseller list. The first one of these pretrade in the civil war. During the progressive era in 1914 when congress debated crating for the first time federal regulations on drugs like opium and other narcotics, Civil War Veterans came up over and over again as congressman debated these new and far reaching laws on the floor of the house. When they refer to this moment on is the socalled soldiers disease. The pervasiveness of the addicted Civil War Veteran is surprising however to historians of drugs because it runs counter to the narrative of what is called drug history. History of drug use and abuse and regulation in the United States. Typically when historians think of opioid addiction in the 1800s, the people come to mind the most are usually chinese immigrant opium smokers or the white women who statistically made up the majority of addicted individuals as i mentioned a few moments ago. And its true that there were a lot of americans who met those descriptions. Besides Civil War Veterans using opium in the postwar era as well. For example in the book i write about a woman from virginia who use morphine to cope with the stress of living in a war zone. Her husband leaves the army in 1865 and returns home and is horrified to find that shes addicted to laudanum. He proceeds to force her into detox cold turkey. This creates real problems in the lives of many women. But because Civil War Veterans had such a prominent and elevated place in postwar society during the gilded age in politics and the media and in healthcare, their addictions mattered more to doctors and government officials even though they represented the minority of the addicted people. So this is one of the reasons why i describe this Opioid Crisis amongst the war veterans as americas first Opioid Crisis. It was the first recognized Opioid Crisis. If we think about an epidemic being to a certain extent in the eye of the beholder, people saw Civil War Veterans addiction while not seeing other folks addictions. So that is how the addiction epidemic started with the civil war and affected Civil War Veterans here but what was it like for these veterans to actually be addicted to these really powerful and really terrible drugs on a day to day basis . This is a major part of my study investigated the historical experience and perception of addiction. To answer this question i followed my sample of about 200 individuals through sources that were previously unavailable or underutilized and overlook by historians. For example rare medical records from mental asylums. Pension records from the u. S. Pension bureau and former Confederate States like virginia that in the last decade or so have really taken off with historians but theres so many that we are only now beginning to mind the gems that live in these records. Also newly medical journals which represent a boon to digital history since. What i learned from this process was essential that addiction cost veterans like alfonse chappell everything. A accosted livelihood, their selfesteem. Military entitlements like pensions. It cost them their families who abandoned them in many cases and often times it cost them their freedom and even their lives. So one major reason for this suffering is the cultural perception of opie and slavery. Opium slavery. The word addiction was not commonly used until after the year 1900. So searching for vocabulary to describe what they were experiencing and what they were seeing that 19th century americans routinely referred to opium addiction as slavery to opium. But this phrase and the lived experience of that phrase defied cultural ideals about manhood and whiteness and morale they sort ran counter to what Civil War Veterans were supposed to be. Addiction for that reason was widely seen by the civil war generation as a mass going. There are several reasons for this. First is that before the war most addicted americans had been women so the condition took on characteristics most associated with women such as dependency or so did seated in the 19th century. Speaking of dependency and self control, society in the gilded age dictates men are supposed to be selfcontrol. They are supposed to be able to make decisions and carry out those decisions without any kinds of problems. That being dependent on opium and having to take the drugs multiple times per day no matter what whether you want to quit or not ultimately is the opposite of independence. Resolving to quit and then failing to make it through the withdrawal ordeal was also seen as a failure of selfcontrol. Another example of this is pain relief. Ideas about pain relief. Because according to civil war era. Was there hierarchy of people that experience pain in different ways. And so according to gilded age doctors, only the hypersensitive bodies of white women are thought to actually need longterm painkillers. White men were supposed to be painkillers at the moment of surgery but not six months later. So for an old soldier was civil war wound from 20 years ago to need morphine every day or worse for someone with a lingering case of chronic diarrhea that medicine in the 1800s cant cure, this was a culture anathema. Even these individuals of sellie struggling with serious medical complications. Another emasculating nature of addiction is impotence. A common it threatened mens mescaline and a bigger meaning it had that escalated the urgency of the crisis in the gilded age. And made it takeout racial undertones. In the context of gilded age fears about immigration and white racial decline. In the gilded age there are folks out there that are raced scientists. The infamous Charles Beard is famous for disk covered nurse the knee up. They were opioid addiction would permit american men from having children and that slowly overtime coupled with immigration this crisis might spiral out of control and lead to a nonwhite nation. So again when you couple the obvious implications of a white confederate veteran like alfonse chappell being enslaved to anything let alone opioid addiction, this is a crisis that threatened to go off the rails very quickly. My favorite example though is actually the visual effects of opioid addiction and what it did to Civil War Veterans physical appearance. Years and years of opiate use change their bodies directly. Extreme weight loss and fatigue. The side effects made them look different than how men were ideally supposed to look. Gilded age men were supposed to be these barrel chested strong Teddy Roosevelt looking guys. That lifted weights and had a large circumference in their torso like the guy we see on the left. But addiction in reality meant that Civil War Veterans defied that ideal. Some veterans in my sample lost over 50 pounds during the course of their addiction and so that appeared skeletal the man we see here on the left hand side of the slide. George w. Gardner a u. S. Navy veteran from the support addicted to hypodermic morphine lost what a full third of his body weight when he appeared in september and 90 1890 went at a hospital weighing just 100 pounds. Gardner skin like that of many veterans was covered with needle puncture marks from his head down to his toes and his doctors were horrified by this. Because they believe that not only was gardner sickly looking but these needle puncture mark indicated a lack of manly self control. Eventually the effects of a diction got so bad that men ultimately became unable to work. Fatigue, weight loss and being unable to focus without morphine and also the financial cost of these drugs added up and when this happened veterans wives typically stepped in to take over the breadwinning. Accentuating the dependency of addiction. Not only did the veterans become dependent on the drug but also other people to take care of them. For example Union Veteran John Patterson who was a physician by trade described how open addiction ruined his medical practice after the war and left him bedridden and under the care of his wife. He wrote quote i could not sleep until an injection of morphine was a mystery. My wife would get up at all hours of the night and use the syringe on me. My health became so poor that i was confined to my room and at last to my bed. I could not eat until i used morphine let alone practice medicine. This in version of the social order. The version of the body was profoundly look down upon and again it contributes to the lived consequences of addiction in veterans day to day lives after the civil war. Because addiction was so stigmatized and frowned upon, veterans often became isolated from their families and from their communities. For example take the case of john and fanny golding of fredericksburg, virginia. John as a teenage shoulder was shot in the leg during the battle of petersburg in 1864 and eventually the confederate veteran became addicted to morphine to cope with the pain. Of course the couple kept the addiction secret because this is a very stigmatized reality and fanny worried that johns weakness and folly would eventually get out into the papers because as it happens they were somewhat of a prominent family in fredericksburg. So john promises over and over again throughout the 1880s and 90s that he will quit every time he relapses. Multiple times. Causing a rift to develop between the married couple. Finally in 1896 fanny returned home to their house one afternoon and found him overdosed on morphine after promising just a few days before yet again to quit. She snapped and fled to washington, d. C. Where she declared publicly that she was going to file for divorce over his inability to quit the morphine. In a rare letter describing opiate addiction from her perspective or from the perspective of an addicted veterans wife, danny wrote that john quote will beg and implore me not to do this but i must. I must for i can bear neither for myself or our children this life any longer. And so ultimately the family, the family stepped in to talk fanny and down from the ledge but that raise the question of what to do with this Civil War Veteran. Families that had the means financially typically opted for what was called home care because they are trying to keep this addiction secret. So for months they took him out to the countryside outside of fredericksburg to his brothers farmhouse and literally locked him in a room in the dark to force him to detox cold turkey. The hired nurses and armed guards to keep him there to keep others from following the sounds to hear what was going on in the house. This was obviously an awful ordeal that john barely survived and of course it ripped a massive hole in the fabric of the family that never healed. Pensions are another great example of the tangible costs of addiction for veterans. After the civil wars we learn today the u. S. Government and individual Confederate States such as virginia created massive pension programs for Civil War Veterans and their families in these ultimately will set the stage for 20th century welfare policies. Very important programs in the evolution of the federal government. But access to these entitlements was contingent upon an applicants standing in the community and the person who was processing their applications perception of the persons moral fiber and manliness. And so opium slaves, people addicted to opium are usually denied pensions if it was discovered during the application process that they were addicted. Take for example daniel martin. A union army veteran was so unequivocally denied a pension when he applied for one that someone at the Pension Bureau in washington, d. C. Literally pasted the gilded age equivalent of a sticky note onto the cover of his pension application stating quote this claimant is a morphine user. That was put there in case he appealed later on which he did and it was denied. The Pension Bureau often, wind than an applicant might be addicted during the medical examination process so often times they would dispatch these sort of elite pension examiners then known as special investigators to dig into applicants who are suspected of being addicted to their personal life and their businesses also to physically examine the body to discover the secrets. So individual states would oftentimes do this as well and this is what i suspected would have happened to alfons chappell who i opened up with this afternoon. This is the confederate captain was shot through the knee at picketts charge. Decades after gettysburg his debilitating wound and morphine addiction left him in chronic pain and unable to work. So chappell had been a modestly wealthy man before the civil war had this face 20 years out of the war had become desperately poor. His station was so badly reduced that he could not even afford to buy morphine. A basic necessity for the addicted veteran just like food and water and shelter. And so as chappell explained in that mate 1886 letter quote i cant stop taking morphine but he continued on. I cant get it often except people give it to me. And so in the those dire circumstances chappell applied for a competitor pension from the commonwealth of virginia in 1880s hoping that a onetime payout from the state might make his life more bearable and might help to support his wife and children. But over and over again his application was inexplicably denied for reasons that were not stated and that chappell could not seem to wrap his head around. So he wrote that letter that i drew upon hoping that the recipient who was a former confederate general named william artery and a big win in richmond and hoping he could help them procure a pension. I cant see democrat the auditor dont pay me, chappell pleaded a letter but if you can do me any good general you will confer on me a great and lasting blessing for i can never wanted worse at this time. And for me that quote speaks volumes of the experience of the suffering that addicted veterans felt in their postwar lives. For the record the denial of benefits even extended to the families of addicted veterans. For example during his presidency in the 1880s, over cleveland vetoed dozens of individual pensions awarded by congress to the widows of Civil War Veterans who had overdosed to death in the 1880s. And in these fetal messages which are full of Grover Clevelands personal thoughts about the morality and manliness of addiction, cleveland criticize veterans for inability to bear the pain like a man should without overindulging in morphine. So this got personal for the president and for those who could not procure pensions. I see this kind of gatekeeping as a historian of medicine and drugs as well is the civil war historian is an early way of the government policing drug use and abuse. Denying a man a pension because he is deemed unworthy is after all a way to attach some kind of a penalty to drug use even though the act itself is not yet illegal at this point in u. S. History and will be until the 1910s. Pensions i argue are a precursor to the United States current set of drug laws. Im happy to talk more about that in the q a. As if losing out on pensions and being forced into a closet to detox without medical sistance as if these werent bad enough, many addicted veterans ended up in prison or worse a mental asylum where they were effectively incarcerated for decades. In 1882 a virginian named henry j. Garrett and x competitor committed to it so the ins danton called the Western State hospital. For what doctors described as ill health and opium use. He died at the asylum in 1898, the turnofthecentury and that means he was held in a one room effectively a jail cell for 17 years because of his addiction. All this without the act actually being a crime. It goes without saying that these assignments are not nice places. You could be chained up or tortured or made to work on the prison farm. A farm that helped feed the asylum patients. For free. So basically the sicilies became like super prisons. But like pensions during the gilded age i argue that asylums also functions of the bus states de facto means of policing addiction long before the current set of drug laws that govern these kinds of things today were ever enacted. You have a winning what about the doctors. What did they do for the crisis because although addiction is widely framed as a personal failure on the part of veterans got veterans themselves will vociferously blame the dock doors. They want to pivot and save the prescribing victims result. The surgeons gave me that morphine and i cant stop that. So physicians worry deeply about the effects of the opry crisis which threatened to undermine the reputation of the medical profession. Doctors had a lot to lose and so something had to be done which is how the Civil War Veterans Opioid Crisis actually spark major innovations in american medicine. The 1880s and 1890s salt one civil war surgeon called a revolt against opium and against the overprescribing of opioids. Prescription rates plummeted as doctors witness the addictive potential of opiates to the point that by 1900 opium was no longer the widely prescribed drug in the u. S. It had been supplanted by supposedly less addictive alternatives. Drugs like cocaine and heroin. The irony. Developing addiion treatments for the record was also paramount for doctor developing and monetizing these Addiction Treatment so some the first drug rehab clinics in american story emerged out of this postwar addiction crisis. Foexample the pinal hospital of richmond, virginia which was chartered by the commonwealth for the reclamation of opium users in 1876 at the behest of doctors who were so alarmed by what they were saying in their patients. Many of them were former confederate veterans. Scores and scores of these facilities like the pinal hospital opened up throughout the postwar decades everywhere from new york city to virginia and on up to texas and even california. There were none before the civil war and again these are really the first iteration of e dern American Drug rehabs so we continue to see th effects of this crisis today. Equally poant for Patent Medicine rae cures or Snake Oil Cures for addiction. These were prolific and big business during the gilded age. So what i discovered is the civil wars addiction crisis actually spawned an entire sub industry of Patent Medicine cell is dedicated to curing addiction especially among Civil War Veterans. For the record that medicines are those snake oil over the counter miracle cures that a traveling salesman would often roll into town and sell you or you could buy them through the mail. So after the civil war a group of Civil War Veterans spotted a Business Opportunity here. They realize that veterans were desperate for a cure. No regulations on Patent Medicine so if you could convince someone that your medicine was secure for addiction there was a bonanza to be had. Thats exactly what occurs. Ultimately this spiraled into a multimillion dollar business in the gilded age and so here we see some classified advertisements being marketed to Civil War Veterans in the periodical, the national caribbean, right alongside a pension lawyer whod sell you services to help navigate the process. To wrap it up, my hope for this research and my hope for the book opium slavery is by telling this underreported several war stories that it will help us historians and the American Public to better understand the tragic but also the surprising ways that wars like the civil war affect people in the postwar period first of all i hope this project will call attention to the civil wars Opioid Crisis because it provides muchneeded Historical Context for todays ongoing Opioid Crisis. I also think this story illuminates the civil wars transformative medical legacy both for individuals how the war ultimately shaped and reshaped the institutions of american medicine like the Patent Medicine industry and the rehab industry as well. But finally most importantly i think this story reminds us to take the aftermath of civil war battle seriously and do not skip over them when we are retelling the story of the civil war because until very recently historians assume that most Civil War Veteran simply moved on. And let the war behind them. Opioid addiction in my view most of all shows the opposite. That many survivors of civil war battles never truly got over the war because they lived with his physical social and cultural effects every day for the rest of their lives. So with that i would drive to a conclusion that im happy to take questions. Thank you. I think we have a question here in the back. We will start in the back. Werg about the introduction of hydrogen thermic needles to supply opium, is there any kind when you were First Talking about the introduction of hypodermic needles to supply opium, is there any kind of statistics. Documented or just personal observations on how many patients died until they got the dosage right since it was going hypodermic . Make a great question. One of the frustrating things about american medicine in the civil war and postcivil war decades is that there are very few systematic records. So there are so many mysteries about this story that we just cant know that as a history nothing frustrates me more than not knowing so i had to make my peace with not knowing the overdose rate for example. We do have rather than quantitative records that say this percentage of people using opium died on accident of overdoses, we do what are called qualitative evidence. So, stories of individuals like alfonse chappell. Effectively what i had to fall back on our personal accounts by veterans like chappell but also personal accounts by doctors of what they were seeing in their medical practices comparing those two similar sources from both before the civil war. Again that is frustrating but we get impressions that opry use was rampant among Civil War Veterans. An unfortunate and surprising but underreported phenomenon after the civil war. Thats a great question. Thank you. Thank you for taking my question. So you were talking a little earlier about how pensioners were denied to opioid addicts if you will. What was a primary means of how the federal government can to note about their addiction . A great question. And also a frustrating method question for historians. This is a phenomenon that because of all the reasons weve been chatting about, people desperately try to keep it a secret to the point they would lock their detoxing relatives in closets four months to keep the newspapers from finding out about. That raises the question that you are articulating, how did the Pension Bureau find out the secret that people were trying to keep. That the special investigators. Thats where the special investigators came in and there purpose and the reason they exist and do the job they do is to clampdown on pension fraud. Theres not a whole lot of pension fraud in my view realistically at the civil war but the fear that the federal government is wasting money on fraudulent pension claims so these core of again i think of them like super investigators, they would come out to a veterans house. They would physically tell the veteran to physically address and examine the bodies often times they would discover needle punctures like the image i showed on the slide that we will return to. This was hard to keep secret. Often times they would more effectively they would interview the acquaintances and friends and Business Partners of full and that would be another common way to uncover the secret that the special investigators were fishing for. Of course remember and keep in mind also because addiction is so stigmatized that relatives and community of these individual addicted veterans or not very inclined to be sympathetic. So when the Pension Bureau came asking, more often than not they would tell the dark secret that the veterans and the family were trying to keep a secret. A real tragedy. I asked in the first session what happened to the orphan schools. I happen to know a lot of the history about stantons insane asylum. Can you go back to the original picture of that place . Absolutely. And stay there until unfinished. Yes. So this is stanton, the great opium city. Thats right. This is the original insane asylum or whatever you want to call it. Thats the picture. Thats it. Just remember that picture and the Main Building is right in the center. The one thats a little bit probably three stories. So now what happened to that building, it turned into the lunatic asylum or insane. My partner ran that place for 40 years. And it closed. And then the state turned it into a jail. It was run as a jail. And then of course theres houses all over the place at this point. Now go to the last picture of it. Okay. This is a total reverberation of the jail. The rooms are the size of what the jails were. The rooms. And it is now a fourstar hotel. With luxury apartments for sale as well. However when you go there to stay, the bedroom is one of the jail cells in the bathroom is the other jail cell. So i went up to the coppola at the top. Its beautiful inside. But i would never stay there because not only were the insane people in jail people but it just made me feel creepy. But this is a beautiful hotel. The grounds are even much more beautiful. So some of our older, older buildings carry on the history and on up and i just want to share that with you. But i think maybe that asylum was due to opiates. He never mentioned that but is there a connection . A lot of these asylums are the patient populations in the gilded age in virginia and other states as well, populations are skyrocketing during the 1870s and 80s into the 90s. Early american psychiatrist and also government officials feared that just generally speaking and not because of opium but other reasons as well that the United States was experiencing an insanity crisis just like it was experiencing an opiate crisis. These facilities became overcrowded really fast and the conditions then deteriorated very quickly. And so i think that raises questions for us about what do we do with these old facilities. In the same way that a lot of historians are asking similar questions about what to do with the remnants of plantations today. Should these facilities the Luxury Hotels . I dont know. Devlin a lot of food for thought. I will add that these asylums also functioned i mention they function as kinds of prisons. They also experimented with ways to treat addiction in these facilities. So a lot of the cases of veterans that i write about in my book were kind of slowly weaned off of opiates but never released. So again these could be places where you could get cured but that didnt necessarily mean that you would be released into society. Its a place that you did not want to end up. Thank you. So have time for one last question. Take a got to bring up can you hear me now . Im a retired anesthesiologist who made my living giving these drugs. I was fascinated by your talk. I think you are right on spot and i think you should probably hopefully teach the medical students a little bit about some of these things. That would be something that i would hope is in your future. I do want to bring up something that you probably know about the audience doesnt. You take rets. I have two things to say. I would like to do in a short manner. You take rats and you train them to get opiates on one side and food on the other. And you know this but the audience doesnt. And they will preferentially go to the opiates to the point where they are starving and they will die and not go to the food and go to the opiates. So theres some information there that obviously is related to the human expense. I want to mention one of thing. I just loved your presentation. Theres a book out there you know about called empire of pain about the sachar family. The one about empires of pain and today that oxycontin is used and how they bypass all the rules and regulations and gave money to the people who should be checking on this. Thats a book that people should be reading. A fastening book. And now i will be quiet. Thank you very much but i appreciate that this is yet again another way we can see the civil war traces in our own times. An unexpected and tried to wipe it they go. I believe we are out of time but i appreciate it. [applause] thanks, jonathan. Before we officially adjourned here, one sort of logistical item. Two really. Authors are able to stick around for a little bit if you have a book you would like us to sign we are certainly more than happy to do that. I certainly hope that you have enjoyed this day as much as i have. I think that when i conceive of a conference and i know my wife incessantly says we should talk about this at our conference. She a very patient woman. But my goal was to walk away from here today understanding the very farreaching consequences of what happened on the battlefield and i hope that you feel like i do that we achieved that objective today. I do hope to see you all at future events whether its cool spring this summer or for collier in september. Our fall program in november. We are back here in the spring of 2024. I would like to thank all of our faculty who joined me today and helping to bring this vision to light. Thank you all. I would like to think my students, kayla, mr. Brooks, met who is outside. And jenny who have use their time and their talents and maybe their fear of failing my class to help as conference assistance today. So you will at least pass. Yes. Good job. And finally i want to thank all of you. Since i came to shenandoah as a visiting professor in 2014 and transition fulltime in 2017, this program has steadily grown over the years and so im happy to see people coming back and happy to see some new faces. Again, thank you very much for coming and for your support and i wish you all a great rest of your weekend and until we meet again. Thats it. We are adjourned. If youre enjoying American History tv then sign up for the newsletter using the qr code on the screen to receive weekly highlights of upcoming programs like lectures in history, american artifacts, the presidency and more. Sign up for the aha tv newsletter today and watch American History tv every weekend or anytime online at span. Org history. 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