Guest Posts: ““A Mind Prostrate”: Physicians, Opiates, and Insanity in the Civil War’s Aftermath”

Front page of Volume 21 of the American Journal of Insanity

~Jonathan Jones is a 2017-2018 Research Fellow and is a Ph.D. Candidate in History at Binghamton University. We would like to extend our thanks to him for permission to repost this piece.

Dark rumors of Civil War veterans’ addiction to morphine and opium riveted Americans during the Civil War’s aftermath. Many observers believed the so-called “morphine habit” was a kind of “insanity” to which veterans were particularly susceptible, made so by the dangerous medical practices of Civil War military physicians that exposed soldiers to addictive opiates during and after the war. As one addicted veteran explained in his 1876 memoir, opiates left an alarming number of the Civil War’s survivors with “a mind without elasticity or fertility – a mind prostrate.”[1] “The evil is like an epidemic,” reported another author in 1878. “It is in the atmosphere.”[2]

My dissertation, “‘A Mind Prostrate’: Physicians, Opiates, and Insanity in the Civil War’s Aftermath,” is the first full-length investigation of the Civil War-era opiate addiction epidemic. I argue that opiate addiction cost addicted veterans dearly because the condition was stigmatized and gendered, seen by many Americans as a vice afflicting the insane, the effeminate, and those lacking self-control. Opiate addiction therefore left addicted veterans emasculated and stripped of entitlements like pensions, and for these outcomes veterans and their families blamed the medical profession. Veterans’ opiate addiction—and in particular iatrogenic, or, physician caused addiction—therefore threatened the credibility of the American medical profession, compelling physicians to embark on a constellation of progressive reforms intended to end the addiction crisis while bolstering “regular” medicine’s standing in the public eye.

My research utilizes unpublished, underutilized records of physicians, hospitals, asylums, and pharmacies in conjunction with recently digitized medical journals to investigate the opiate crisis. The Civil War-era medical manuscripts held by The College of Physicians of Philadelphia, Yale University libraries, and the American Philosophical Society, which I visited in as a CHSTM Research Fellow in 2017-18, made inimitable contributions to the evidentiary base of my dissertation. These manuscripts both allowed me to test my preliminary dissertation findings, and molded my argument in exciting new directions.

Historians have recognized the iatrogenic origins of Civil War veterans’ opiate addiction since the 1970s.[3] Yet no full-length studies of the Civil War-era opiate addiction crisis exist, and the few articles on the subject rely merely upon impressionistic sources. Anecdotal evidence suggests that Civil War military surgeons doled out opiates for pain and sickness by the syringe-full. For example, one Union army doctor sheepishly admitted in 1866 that during the wartime years he relied upon opiates “as an all-healing panacea, which in all quantities always does good, and can never do harm.”[4] Consequentially, military doctors fell under a wave of criticism after the war, blamed by members of the public for causing veterans’ addiction by overprescribing addictive opium and morphine for pain and sickness. Historians often replicate this criticism. A trope routinely invoked in the historiography of Civil War-era medicine is that of syringe-wielding army surgeons, who inadvertently caused an epidemic of opiate addiction through medical carelessness or ignorance.[5]

Such analyses clearly indicate physicians as the source of many veterans’ addictions, but reveal little about how the personal consequences of addiction for veterans, or how doctors attempted to resolve the ensuing crisis. Historians’ understanding of the Civil War-era opiate addiction epidemic is therefore one-dimensional. The iatrogenic origin of veterans’ opiate addiction is clear, but not the aftermath. Consequentially, we still know very little about the personal costs of opiate addiction in the Civil War-era or the systematic medical responses to the opiate addiction epidemic—gaps in our knowledge with particular resonance as the American medical community grapples with today’s opioid epidemic.

Several questions in particular remain unanswered. Did physicians realize opiates were addictive before the addiction epidemic began? If so, why did doctors continue to prescribe the drugs? What did opiate addiction, which was stigmatized and gendered, cost veterans at a personal level? How did physicians respond to criticisms after the Civil War that doctors were the culprits behind opiate addiction? What measures did physicians take to rectify the opiate addiction crisis? How did the episode affect the trajectory of American medicine? Without answers to these questions, historians’ view of opiate addiction in the Civil War era is opaque. This lack of clarity obscures our view of what Civil War-era Americans saw clearly: veterans’ opiate addiction and the medical community’s responses to it lie at the very heart of the medical legacy of the Civil War.

This juncture is precisely where spending time working in the collections of Consortium members benefited my research. Before setting out the CHSTM members’ archives, my preliminary dissertation research suggested answers to these enduring questions. Analysis of Civil War-era medical journals—only digitized in the past few years by the Medical Heritage Library—reveals that physicians proposed radical, innovative measures during the 1860s, 1870s, and 1880s in order to resolve the opiate addiction epidemic and mitigate the erosion of physicians’ reputation brought upon by the crisis.[6] Foremost among these measures, in an effort to end the opiate crisis through professional self-regulation, young, elite ex-Union army physicians called for their colleagues to prescribe fewer opiates, substitute them with less-addictive painkillers, and even ban opiates altogether. Proponents of these measures hoped they would result in less iatrogenic opiate addiction. These were truly radical proposals, considering that opium and its derivatives were some of the nineteenth century’s most important and widely-used drugs, beneficial not only as painkillers but also as medicines for everything ranging from diarrhea and cough to lockjaw and rabies. Additionally, physicians sought to “medicalize” opiate addiction by treating it as a disease of the body, rather than a moral failing, breaking with antebellum precedent. To this end, they encouraged addicted veterans to avoid asylums, which were associated with moral and mental degeneracy, and instead enter specialized medical facilities called “inebriate clinics.” These clinics—which we might consider to be the first American drug rehabilitation centers—offered innovative medical treatments for addiction, such as physician-supervised withdrawal and drug replacement therapy.

But how readily did ordinary physicians actually accept and implement the radical reforms proposed by their elite counterparts? This remains an open question because published medical journals, my primary sources before hitting the archives, speak mainly to medical theory, not practice. They cannot conclusively indicate how proposed reforms were actually enacted in post-Civil War clinics, asylums, hospitals, and pharmacies. To this end, the Civil War-era medical manuscripts in the collections of The College of Physicians of Philadelphia, Yale University’s libraries, and the American Philosophical Society will go a long way resolve this limitation in my initial research. Daybooks, account ledgers, and prescription logs kept by both military and civilian physicians working in clinics, hospitals, and asylums throughout the period contain a wealth of medical data that would allow me to test my preliminary findings. Yet despite their value, these sources are severely underutilized by historians of the Civil War era, who have traditionally employed narrative texts like letters, memoirs, and military reports to study Civil War-era medicine.

These manuscripts contain quantitative data that enabled me to test my preliminary findings. The College of Physicians of Philadelphia’s large collection of Civil War-era physicians’ daybooks, ledgers, case notes, and medical school lecture notes were particularly useful toward this end. I employed manuscripts like the William W. Rutherford and A. T. Dean Account Books to quantify the conditions for which doctors prescribed opiates before and after the Civil War, paying close attention to changes over time. By 1861, the beginning of the Civil War, American doctors employed opiates for approximately 140 unique medical conditions. During the addiction crisis many doctors called for the profession to move away from the widespread prescribing of opiates, and this number plummeted. Other manuscripts, such as the William L. Du Bois Prescription Records, indicate that the opiate prescription rate declined from an antebellum high of over fifty percent to a mere sixteen percent by 1876, a decade after the opiate addiction epidemic began.[7] These patterns suggest that at least some reforms proposed in medical journals to resolve the opiate addiction crisis were disseminated in practice to ordinary practitioners, confirming aspects of my preliminary dissertation research.

My time as a Research Fellow also spurred my dissertation research in new, exciting directions. While working at Yale’s Medical Historical Library, I stumbled across a stash of pamphlets and advertisements for patent medicines marketed to addicted people as “cures” for opiate addiction. As I thumbed through these manuscripts out of curiosity, the language in which opiate addiction cures were marketed captivated me. I came to realize that patent medicine proprietors were not simply selling medicinal “cures” to addicted veterans. Instead, advertisements were also selling veterans a way to redeem their masculinity from opiate addiction. Patent medicine proprietors intentionally marketed their wares in the language of masculinity because they understood that addicted men, including veterans, were emasculated by opiate addiction. To Civil War-era Americans, opiate addiction signaled femininity, physical weakness, and, most of all, unnatural dependence—all antithetical to Victorian manhood. Redeeming one’s masculinity by ending a man’s “slavery” to opiates, as doctors often described addiction, was thus a major selling point for patent opiate addiction cures. For example, Samuel B. Collins marketed his “Painless Opium Antidote” using testimonials from veterans who supposedly cured their opiate addictions by way of Collins’s wares. Byron McKeen, a Confederate veteran from Galveston, Texas testified in 1872 that Collins’s Painless Opium Antidote that “now, I feel myself no longer a slave, but a free man.”[8]

Without the opportunity to visit the archives of consortium members, I would not have had access to the William W. Rutherford and A. T. Dean Account Books, the William L. Du Bois Prescription Records, or Samuel B. Collins’s patent medicine advertisements. Ultimately, by providing access to medical manuscript collections of Civil War-era physicians’ daybooks, account ledgers, prescription registers, and patent medicine advertisements, a CHSTM Research Fellowship allowed me to verify my initial dissertation findings and to pivot my research in exciting new directions.



[1] Unknown, Opium Eating: an Autobiographical Sketch by an Habitué (Philadelphia: Claxton, Remsen, and Haffelfinger, 1876), vii.

[2] “The Opium Habit: Some extraordinary Stories of the Extravagant Use of the Drug in Virginia–Correspondence of the Cincinnati Inquirer,” The New York Times (March 2, 1878), 2.

[3] A point made most prominently by: David T. Courtwright, “Opiate Addiction as a Consequence of the Civil War,” Civil War History 24, no. 2 (June 1978): 101-111.

[4] Anonymous, “Editorial,” Buffalo Medical and Surgical Journal V (1865-1866), 34.

[5] An illustrative example is James McPherson, Battle Cry of Freedom: The Civil War Era, 1st Ballantine Books ed., Oxford History of the United States vol. 6 (New York: Ballantine Books, 1989), 486-87.

[6] Available via the Medical Heritage Library’s database “Historical American Medical Journals,” http://www.medicalheritage.org/content/historical-american-medical-journ….

[7] Antebellum rates in John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge, Mass.: Harvard University Press, 1986), Table 1 and Table 2.

[8] Theriaki: A magazine Devoted to the Interests of Opium Eaters, 1 no. 1 (July 1872), 53.

Teaching #HistSex with the MHL

~This post courtesy Anna J. Clutterbuck-Cook, Reference Librarian, Massachusetts Historical Society.

Photo is by Kathleen J. Barker. Used with permission.

Each summer, the Massachusetts Historical Society’s Center for Teaching History hosts a series of workshops for K-12 teachers seeking to incorporate primary sources and contemporary historical scholarship into their curriculum. For the first time this year, the Center offered a three-day workshop in teaching LGBT History. As one of the Society’s reference librarians, with some background in history of sexuality research, I volunteered to spend a morning with the group sharing topic-specific research strategies. In addition to talking about the Society’s own catalog and collections, we discussed the challenges of historically-specific terminology. I introduced them to the Homosaurus, a controlled vocabulary of terms related to lesbian, gay, bisexual, and transgender lives, and we talked about the genres of material that might contain information about human sexuality: personal and family papers, visual materials, legal records, religious tracts, and medical literature.

 

After my presentation and a tour of the Society’s library, showcasing our own collections, the final third of the morning was spent on a research exercise in which I invited the sixteen workshop participants to search three different access tools: the Massachusetts Historical Society’s online catalog, the Digital Transgender Archive, and finally the Medical Heritage Library’s collections via the MHL’s full text search tool. My instructions were to

 

  1. Think of a research question or topic related to the history of sexuality.
  2. Brainstorm a handful of search terms (up to a dozen) related to your topic.
  3. Use these search terms in each of the three access tools.

 

To take the example search I performed for the group as a whole, we began with the question, “How did teenagers learn/think about sex in the 19th century?” Then, we brainstormed possible search terms, including:

 

  • Sex education
  • Teenager
  • Adolescent
  • Puberty
  • Family life
  • Marriage preparation
  • Premarital sex

 

Then, we performed a search in each of the three search tools listed above: the MHS catalog, the Digital Transgender Archive, and the Medical Heritage Library’s full-text search. For the Medical Heritage Library’s full-text search, we began with a broad search for “sex education” in literature published between 1800 and 1900. Because the MHL provides a full-text search, however preliminary, the search results were much different from the results in the DTA and MHS catalog and prompted fruitful conversation about how both the content of a collection and its access tools shape our approaches to finding materials.

 

The goal of this exercise was to prompt our workshop participants to think about how different types of tools produce different search results depending upon the controlled vocabularies used, the contents of the archive, and the type of search being conducted. These questions may seem basic to archivists and librarians who spend their workdays developing and using different types of search tools, but for many of our participants the discussion of historical terms and controlled vocabularies prompted them to think in entirely new ways about how to locate materials related to the history of sexuality in archival repositories and digital collections.

 

The Center for Teaching History plans to run this workshop again next summer and I look forward to expanding on this exercise, hopefully giving our participants a chance to delve into the actual items their searches uncover.

Tuberculosis, Public Health, and Big Data

In case you missed it, last week we were proud to host five posts from Tom Ewing’s Data in Social Context class at Virginia Tech. Each post was written by a group of students who selected and researched a topic centered on tuberculosis and public health data in the United States around the beginning of the twentieth century. The data they used came from the Medical Heritage Library collections and we were privileged to talk to the students via Skype and be able to work with them on their drafts.

The posts are collected here for ease of reference — we highly recommend all of them! Continue reading

Guest Post: The Impact of Tuberculosis on Adults as Measured by Philadelphia’s Vital Statistics

Today we are pleased to feature five guest posts from Tom Ewing’s Virginia Tech Introduction to Data in Social Context class! This final post is from E. Thomas Ewing and Nicholas Bolin.

The social impact of tuberculosis in the late nineteenth century was distinguished by the relatively high mortality rate among adult populations. This social impact can be graphically illustrated in a chart showing the relative number of deaths over a six year period in the city of Philadelphia due to the ten most common causes for the adult population, aged 20-50 years. Of these causes, tuberculosis accounts for nearly half — or the same number of the other nine causes combined. Of the approximately 33,000 adult deaths from all causes in this six year period, tuberculosis accounted for more than one-third (35.8%), more than three times as many deaths as other leading causes (typhoid fever, pneumonia, and accidents and injuries). As this graph suggests, the vital statistics collected and analyzed by government agencies, preserved by medical libraries in published form, and now widely accessible through the Medical Heritage Library in digital form are both an excellent source of data for analysis with modern tools and a basis for thinking about the ways that public officials used statistical analysis to identify health concerns and recommend appropriate policies. Continue reading

Guest Post: Tuberculosis in California: A Statistical Analysis From 1880-1910

Today we are pleased to feature five guest posts from students in Tom Ewing’s Virginia Tech Introduction to Data in Social Context class! This post is from Jack Fleisher, Jae Ha, Joey Hammel.

We chose to explore tuberculosis in California because of a few interesting characteristics. One of these characteristics was the phenomenon of California being seen as a beacon of health and longevity in the late 1800s, and as a result, attracting many individuals sick with tuberculosis thinking that moving there was their best hope to recover and alleviate their disease.  We suspected that this would drive up the tuberculosis rates as the increase in the population of those previously diagnosed would raise the death rate above where it would be for the Californian-born population.   Continue reading

Guest Post: Tuberculosis in Boston: The Impact of Socioeconomic Factors

Today we are pleased to feature five guest posts from students in Tom Ewing’s Virginia Tech Introduction to Data in Social Context class! This post is from Brian Yuhas, Claire Ko, Emma Rhodes.

The discussion of socioeconomic factors and their impact on tuberculosis came about as a result of our inadequate knowledge of the disease and our wish to delve deeper into how this disease influenced everyday life in the 1890s. Our research focused on whether economic status had an apparent effect on the deaths that occurred in Boston due to tuberculosis in the late nineteenth century. Did similar population densities have the same tuberculosis rates among different classes? Did wards with higher tax revenue experience higher or lower tuberculosis death rates? Through the 1890s Vital Statistics report for Boston, we were able to come to some conclusions about the correlation between wealth and likelihood of death due to tuberculosis in the city. Continue reading

Guest Post: The Experiments of Dr. Robert Koch: A Reconsideration of the Scientific Method for Evaluating Treatments for Tuberculosis

Today we are pleased to feature five guest posts from students in Tom Ewing’s Virginia Tech Introduction to Data in Social Context class! This post is from Christian Averill, Robbie D’Amato, Nathan Gibson, and Jonathan Silbaugh.

During the nineteenth century, a widespread desire for a cure for tuberculosis prompted intense interest in any claims of a medical breakthrough in diagnosing and treating this disease. When German physician Robert Koch announced in 1882 that he had discovered that the cause of the disease was a bacillus known as M. Tuberculosis, his discovery was widely celebrated as a major medical breakthrough. Eight years later, however, his claims to have discovered a cure for tuberculosis aroused more substantive questions about the veracity of his claims as well as the methods, findings, and analysis advanced to support these claims. This post examines some of the evidence involved in this discussion with the goal of evaluating Koch’s claims relative to standard procedures used now to discover, test, and approve cures. Continue reading

Guest Post: “Phthisiophobia”: The Tuberculosis Clinic in New York City and Popular Anxieties about Public Health Dangers

Today we are pleased to feature five guest posts from students in Tom Ewing’s Virginia Tech Introduction to Data in Social Context class! The first is from Allyson Manhart, Andrew Pregnall, and Harshitha Narayanan.


TB_Infirmary_OpenToPatientsAt the beginning of the twentieth century the Treasury Department of the United States classified pulmonary tuberculosis as a “dangerously contagious disease” which meant that any immigrant found to have tuberculosis coming to the United States would be denied entrance. The ban led to a swift reaction from the physicians of the New York Academy of Medicine, many of whom argued that the ban created unnecessary fear of those with tuberculosis.
Continue reading

The Final Week!

Yesterday started the countdown of the final week of our 2014 user survey!

We’re closing it down on November 25th — that’s next Tuesday.

To date, we have over 50 responses, well over our totals in the previous two surveys. Thank you.

If you haven’t taken the survey yet or if you have students or colleagues who should know about the MHL or do use the collection, please take the survey yourself and pass the link on. 

We use this information for planning our future development so every answer is important to us: tell us what you need, what you use, and how you use it so we can get you more of it in the future.