Florida senator, marco rubio in miami. Exploring the american story. Watch American History tv saturday on cspan 2 and find a schedule on your Program Guide or watch on line any time at cspan. Org history. Okay, were going to go ahead and ge. Okay, we are going to d go ahead and get started with our final session. Jonathan jones is professor at Virginia Military institute where he teaches courses on the civil war era and american medical history. I will say this is not part of his official bio but in the fall he will move into a possession at James Madison history. He will be closer and we will have opportunities to collaborate more on things. His first manuscript is forth coming with university of north carolina. The book is based on his dissertation that received civil historians 2021 and dissertation prize as well as snuys chance or distinguished ph degree graduate in 2021. His research appeared in the journal of the civil war era, washington post, other outlets, he received it from bingham university. 2021, he was the civil era scholar at penn state. So, join me in giving a warm welcome to jonathan jones. [ applause ] jones. All right. Well, thank you all. All right, thank you all for being here. Thank you professor for that introduction, can everybody here me okay . Good . Perfect. Raise it up a little. Okay, perfect there. There we go. That is much, much better, deeper sounding. Okay. Thank you again everyone for being here. Thank you to everyone who will be tuning in on cspan. Mom, we are on tv. It is exciting. [ laughter ] we will tell her it is on cnn or pbs. No, i have always been interested in the aftermath and the afterlife of the civil war. Always curious about questions like how did the war, with all of the carnage and the upheaval we have been hearing about this morping and this afternoon, how did the events effect American Society and culture and medicine. And most importantly, the individual people that survived after the conflict. These are the questions that interest me the most as a civil war scholar and teacher. These are questions that animate my Current Research project. The war is interesting, right, what comes after the war is, to me, the real story. And, opioid addiction among Civil War Veterans, the subject of my talk this afternoon, elevates my interests. And part of my book. The first Opioid Crisis that is forth coming with the press in the near future. I do not have any with me today but shoot me an email if you are interested. In the wake of the u. S. Civil war there was an epidemic of opioid addiction among veterans, and openium slavery is a medical history of this epidemic. So, i would like to open up this afternoon with a story that illustrates some of the key themes of the book. Okay. Just one sec. This is a story of a man named chapel. A confederate veteran. During the war, a captain in the 14th virginia inntry. He never got over the wounds he sustained at the battle of gettysburg as he explains in a tragic 1886 letter. The captain was shot while storming union lines with general pickets illfated Virginia Division on the hot afternoon of july 3rd, 1863. All of the offices above chapels rank had apparently been shot. It fell to him to lead his unit through clouds of smoke. A white hot led miniball stopped chapel 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 wall angerly ripped through the cartilage and the soft tissue of his leg at the joint tearing a massive exit hole in the leg. So, he dropped to the tall dry grass in unspeakable pain. That is where he lay until the dust settled that afternoon when retreating survivors of the 14th virginia, chapels outlet, carried him out. He hitched a ride 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 of added to his agony and misery. Now, as we heard today. Civil war battles produce thousands and thousands of war stories just like chapels. And all too often the cases they ended in grizzly deaths from infection or blood loss, exposure. You name it. 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. After all he somehow managed to survive long enough to actually tell his story in 1886 and the letter that we see here on the screen. But, chapel did not see it th way. He did not consid himself one of the lucky ones because, to him, survival in the long aftermath of the battle of gettysburg was a living hell. That is because 23 years after gettysburg, the unexpected consequences of chapels civil war wound still dominated the old soldiers day to day life. As he explained in that tortured 1886 letter. Quote, the doctors put me on morphine. I can not stop that. In other words, chapel had become and remained hopefully addicted to the morphine that surgeons given him in that Field Hospital to treat the pain from his wound and he kept on taking as he bounced along the route into pennsylvania and maryland and on and on. So, although the gunshot wound long sinced healed, the drugs refused to release chapel from their chains, he suffered from it. He was not alone. Tens of thousands of Civil War Veterans became addicted to opium and morphine. Historians have long known about these individuals to a certain extent scattered cases became ashes dicted to addicted. For over a century, individual veterans like chapel have made occasional appearances in mediums ranging from early 1900s social science literature, 1970s Television Shows about the civil war, a story for another day. And even congressional debates about todays ongoing Opioid Crisis as recently as a couple of years ago. Yet, addicted Civil War Veterans like chapel, are almost always relegated to the footnotes, literally, in the story of the civil war. For me this is surprising considering that the civil war era is among the best documented periods in u. S. History with sustained interest in the conflict for over 150 years. So, it go without saying that today, there are many, many Unanswered Questions about this phenomenal. For example, why did addicted veterans become addicted to opioids and how wases it . A few scattered cases . Individual cases like chapel, or was he and others like him emblematic of it afoot. How did they try to mitigate the consequences . How did, for their part, the american medical community, the doctors, the media, government officials respond to this epidemic if there was indeed, one . What is the addiction reveal about the longterm 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 200 individual cases. 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, Asylum Records some, here from virginia. Medical advertisers and pensions that we have been talking about that were rich sources for the period. What i am going to do this afternoon is describe some of the sources and my Research Process as we move through the talk. But, ultimately i am going to make four key points. First, i am going to argue that the civil war did, in fact, cause an epidemic of opioid addiction among Civil War Veterans . Not merely a few oneoff cases. Second. We are going to assess the suffering that opium slavery visited on veterans and families, i am here to tell you that addiction dominated their lives to the point that few addicted men ever got over the civil war or the aftermath of the civil war battles. Third, we are going to explore some, scratch the surface of some of the ways that American Physicians and the government reacted to the veterans Opioid Crisis and finally we are 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 cost of the conflict. Lets start with the beginning, lets start at causation. What caused Civil War Veterans like chapel to become addicted to open yes, i opioids. It caused a huge number of people to get sick, to suffer from pain, to put a number on it, there were 1. 5 million casualties from the war that we know of, out of 31 million americans, to put it in our terms, almost everyone knew someone or was someone who got sick or shot or suffered some kind of a physical Health Consequence from the war. In fact, recruits had a chance of not coming back home at all. To deal with this Unprecedented Health crisis, doctors had to double down on tried and true medical therapies which in the 19th century were opioids. It is an old drug, dating back to the stone age, doctors have been giving out opium, and a drug morphine, still in use and another one that is booze mixed with opium. You can imagine the attraction of this drug. They have been giving these drugs for centuries in the lead up to the civil war. They were among the most effective and only truly effective painkillers known in the late 1860s or in the middle 1860s. Doctors in the u. S. Learned to prescribe these drugs liberally in medical school and apprenticeship. And one, i can never get over this cover. They put it like this. Quote, opium is a divine gift from heaven to illustrate that point in his medical dissertation like an exam that medical students would take at the end of their degree, he drew an angel burying an opium poppy down from heaven to earth, right . They took it literally. It is an intensely religious society. It is not a character, it is a belief that many doctors and patients had. God given them opium to ease their suffering. By 1861, the year that the civil war broke out, opium and the others, morphine, are the commonly prescribed medications in the United States. Opium was somewhere in all of the prescriptions in the United States. They were so popular because they were e till utillitarian. They were used for more than just pain. By my count, i had to actually count, in the middle 1800s they were used to treat around 150 different ailments from diarrhea to cholera to pneumonia, and my favorite, tooth aches among teething children. [ laughter ] it is a good thing this is after lunch, right . Actually, i kind of think of opium being a combination of tylenol, and pepto, combined. You might be wondering did they know about the downside of the drugs . Clearly they had a lot going for them but the risk of overdose . Addiction . Doctors did know going into the civil war that they were addictive and could kill you if you took too much. So, yes, they were aware of these downsides. This knowledge goes back to the american revolution, the founding of american medicine. I identified in the Research Project several previously unknown and undescribed cases of individuals including one in the washington family. Addicted to morphine in the writings of benjamin rush, known as the socalled father of medicine. This is something that occurs before the civil war is widely known about. It is widely deadly. Addiction and overdoses often appeared in coroners records in the antibellum era. It was 4 of the unexplained deaths in new york city. The catch, though, it is that most people who suffered from these consequences of addiction and overdose before the civil war were not men. They were, in fact, white women. Of course, you may know presumptions of chinese opium smokers in the 1800s as described in particular through the lens of american missionaries writing from china. They are pervasive in the 1800s pop culture and medical culture. But, because, both of these grew. They were so often portrayed. The addiction to opioids were not hugely culturally a problem, it seemed normal, not a big deal. It was known it was not at the forefront of cultural or medical concerns before the civil war which would create for the first time in American History a huge do hort of men who will become addicted t. Is worth mentioning that doctors, patients, Health Care Consumers had little alternative to opioids, there were few other drugs as effective as opium. It became a principal in civil war care. During the war Army Surgeons are going to rely heavily on opioids to treat pain and diarrhea. Think of the gunshots and amputations but also think as dediarrhea, diarrhea, opioids are used the union military, that kept medical records, so we know these nittygritty details, they used 2. 3 million fluid ounces of liquid opioids like morphine. And 10 million pills. In fact, the Union Government used requisition so much that they had to create it for the first time in miles an hour history governmentfunded pharmaceutical labs to mass manufacture quantities of this drug to keep up with the rapid demand, again, for the first time in u. S. History. For their part, the confederacy that has, it is enduring during the civil war an effective blockade, they tried to get it by getting poppyseeds. When it failed they attempted halfway during the civil war to coax white southern women and children left on the home front to have opium gardens and donate them to military hospitals, of course that failed and i am happy to talk more about that later on. Again, surgeons in the north and the south dueled them out liberally in way that were conducive to facilitating addiction. I will give you an example. That comes from one union hospital, turners lane in philadelphia. Philadelphia turned into essentially a giant hospital complex. At this particular hospital turners land that is where the bad cases went. Severely wounded individuals, particularly those who had nerve conditions. There, Union Surgeons began experimenting with morphine, a way to deliver it instantly. And, so, they ended up giving in one year during the civil war, 40,000 morphine injections to wounded and sick soldiers that passed through this hospital. And, in fact, it was so successful that doctors elsewhere started emulating what was done at turners lane after the war. So, in a roundabout way the civil war helped make it popular. Today, mainstay of american medicine. Now, these medicines were really, really, really, really important for civil war armies, soldiers could not have functioned or remained in the field, returning to duty without them. And, the Confederate Army handbook put it like this. Opium is the one indispensable drug on the battlefield, important to the surgeon as gunpowder. And this knowledge of a imagine illustrates it. It happens to be one of my favorite civil war ages because of the stare, intense character. These aracal civil war prescrtis. Part of my work involved counting, quantifying opioid data and finding a pattern in and outside of civil war hospitals, we can see sections where there are red underlines, those are prescriptions of various plantbased drugs including opium, under lined in red. Written in latin. It can complicate things a little bit. Doctors handwriting is bad. So, imagine reading bad doctors reading in latin and that is a taste of the research method. Predictably many soldiers are going to become addicted during the civil war through prescriptions. For example, chapel, the story i opened with today. One of the most haunting examples that i found with this phenomenal, it comes from turners lane hospital in philadelphia. That is a Union Soldier wounded in 1861. Run over by a train. Many ways to become injured during the war. That is his unfortunate fate. He spends the entire course of the war, four years, mostly bedridden and they have to amputate more and more and more of his leg to solve the pain in a span of four years. After the final surgery in 1865, the mans surgeon reported that he was good enough to be discharged accept that he had developed what the surgeon called a craving for opium. Other veterans learned to use opioids from not doctors but fellow soldiers. So, camp life, the intensity of camp life, the boardum, boredom of camp life, a finding soldiers would send letters home to their mom or father or sister asking to receive a packet of opium pills in the mail. Later on when they went back home and got sick later in life, veterans often reached for the opium bottle. A behavior they learned during the civil war because they knew the medication could be effective. Of course, all unfolding during the temperance movement. There is concern about Substance Use among americans but particularly the rank and file of civil war armies. So, they are going ballistic as they are observing this behavior. They worry about creating an epidemic in the ranks and after the war. These fears came true. Selfmedication during and after the war. One soldier, a man named george m house of the 9th alabama infill infilltry he would go and prepare to go into combat, down morphine because he found it calmed his nerve. He felt jittery and it helped him cope with the carnage he was about to be asked to endure and inflict. Fast forward several decades, 1881 i discovered his case on a patient register of a facility called the Charity Hospital in new orleans where he had checked himself in seeking some kind of help for his morphine addiction. So, again, selfmedication is a major pathway to addiction just like surgeons prescriptions. Although opioids were free flowing in civil war hospitals and camps, it is worth mentioning that white veterans are far more likely to be addicted than black veterans, black soldiers played up 10 of the union military, the army, the navy. So you would think addiction would of occurred relatively frequently among black veterans, perhaps on parwith white soldiers and veterans. I actually found this was not the case. The reason for this is that american doctors, before the civil war, are mostly white and they were trained in medical schools t