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, virginia. And during the war, a captain in th14th virginia inftry and chapel, never entirely got over the wous 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 screen, but apel didnt see it that way. He did not consider himself one of the lucky 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 investigated deaths in new york city. The 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