inteed, there are some people, some estimates that the civil war itself produces 100,000 opium addicts. but there isn't any hard data on that. indeed cartwright wrote an article about that and suggests there must have been something going on there but what happened to them after the war, what happened, how do we track them, very difficult to know. they did call, though opium addiction soldier's disease because there seems to have been some prevalence. an interesting side note, the union enforces a naval blockade of the southern coast with greater or lesser inefficiency and also a land blockade along the military front.

one of the things they would not prescribe was medicine which was controversial and even was at the time because they were not only denying it to the armies but to the civilian population. which would seem unhumanitarian. they couldn't treat malaria which was endemic in the south. they couldn't get opium to manufacture laudanum or anything else. they did encourage them to grow poppies and there was some provision of poppy seeds for them to grow poppies and give instructions on how you cut the mrours and get the opium out. it never amounted to much because they couldn't grow enough to really make it worthwhile and matter. [ inaudible ] >> the northern doctors were

growing their own poppies and urging other doctors to do it. >> yeah. a lot of hands up. i didn't see where they were. so, yeah, for a lot of reasons doctors prescribed opium or opiate products a lot because there just wasn't really anything else to do for a lot of ailments. given this, how did doctors and the general public regard 19th century opiate the addicts and here we're not talking about those people addicted to smoking op opium but addicted to laudanum, morphine, linda? >> they were viewed as medically diseased. in need of treatment.

not censured in criminalization. >> because these were nice, middle class ladies, they were not bad people. they just happened to be unfortunate enough to get addicted. >> there was fairly significant support for maintenance. so that people who were addicted to at least get through their day and function. >> even if you weren't getting mo morphine from your doctor, again, you could get all of these patent med sibs which were laced with opium soap you could maintain yourself even if you couldn't get prescription morphine. >> there's an apprentice and his boss is very against alcoholism. then an addict comes in and

surprises him. he's been a good customer for 20 years. why would i want to stop the business. there had to have been this idea of money as well. why lose this loyal customer of 20 years to another -- to a rival businessman? >> well, it particularly when nobody could do much for them. >> cartwright mentioned some doctors would go into middle and upper class homes and administer some opiate and suddenly the patient is immediately better and this would create having this doctor come back.

>> cartwright points out the average addict, how many of you have read or seen eugene o'neill's long day journey into night? if you ever get a chance to see it, it's a tremendous work of art. he didn't want it published until after his death but his wife recognizing how great it was let it be performed i think two years after his death. so you can't trust anyone. in the play is never seen in the play but is the shadowy figure upstairs and she's an opium addict, probably a morphine addict.

this is a sort of heartache and contention. probably more of you have read "to kill a mockingbird" which is standard high school fare. also a great movie with gregory peck. there is a widow who supposedly sits with a pistol in her lap and is really mean. i guess scout's brother, jim -- jim is his name, i think? gem. destroys her garden out of spite or anger. his punishment is he has to go and read to her every day and she acts really weird. it transpires that he's reading to her because she's trying to wean herself off of morphine before she dies. she doesn't want to be -- die addicted and beholden to anything and she's struggling with this addiction. so she really is, as cartwright

points out, is really the classic 19th century opium addict. she is a southerner and it was more prevalent in the south than in the north. she's a woman, well to do middle class. and is addicted because of a painful illness. so this really is reflected in literature and in popular culture. if you have not read or seen any i would encourage you. it is well worth the time. 1880, 1890, the average addict is a white middle class female, what happens in the next 20 or 30 years? >> doesn't irwin come on the scene at that point? >> well, comes under the scene in 1898 and it's in patent

medicines as we've seen. >> because it was essentially superpowerful morphine, wasn't it? >> yeah, so i mean, it goes from being this -- the drug of the upper class women to, because of how cheap it was, you got it at this point kind of coming into the criminal element and the lower class. >> okay. but remember at this point from 1898 roughly through the 20th century heroin is not what you think of. it's in cough syrup. it's in elixirs of various kinds. it's most probably taken orally and not injectable like morphine. >> yeah? >> in one of our other readings, double mention of addiction, it mentions doctors start to recognize two different forms of addition.

basically the middle class people who were prescribed these medications by doctors, but they were basically viewed as innocent victims of this whole situation. and volitional were people of different races who chose to become addicted. >> right. so more of recreational use as opposed to medicinal use. what developments account for this? by 1920 the average addict is no longer a white middle class female. it's probably a working class or lower class male. probably with a criminal background and perhaps a different racial group. what legal changes account for -- i mean, this is a tremendous change and a very short time. >> demographic.

this is when the labor is coming in and the -- and the smoking of opium is becoming more prevalent. and because they are lower class laborers then lower class laborers of other ethnicities are encountering the chinese taking this form of addiction. because of demographic and socioeconomic factors the lower economic class you are the more li likely there is to be crime in your area, in your neighborhood, whatever you want to say about it so we have this increased access of the criminal element.

>> there are still pockets of it in the upper class. because it's ritualistic, it's not easy to do. it's not quick to do. what you are saying, it does become more of the criminal element and it begins to change for a variety of reasons. but who else? maria? >> banning opium so the use of opium was going down but then people turned to other drugs. like heroin and in the 1920s. >> it's controlled and it's -- the access is limited and they have to go through illegal means to get access to it. the doctor is not going to give it to you but the tough guy down the street will.

>> trying to put taxes on it so it's tougher to get. the smuggling aspect which they thought if we tax it or put strict regulations, this will deter people from doing this. it forced different methods. it would do the same thing. >> nate? >> two of the things we were talking about, the medical learned about how the symptoms were coming about so they weren't necessarily prescribing the exact same thing for everybody and then they had new developments with what kind of medicine was available so maybe they wouldn't prescribe opium but aspirin or something new like that. that was what cartwright was talking about. even with all those laws you saw all kinds of opium use.

>> yes. and i think this is an important point that there are medical changes, many of them, in the sense that now physicians have much more of a sense of what is causing diseases and how to treat the cause of the disease not just the symptoms. there are other therapies available, other drugs available that are not addictive like aspirin. something like syphilis, there are things that can cure you and not just treat the symptoms. understanding of diseases also leads to improvements in public health so the water is better. people are not getting sick from microbial born infestations of water or food. there is less of a need to

prescribe opium because the symptoms are not always there, because public health is better, other therapies are available. doctors are also wising up that if you leave morphine and a syringe with patients, they're going to get addicted. if you give too much laudanum, they will get addicted. they are more circumspect in how they prescribe drugs and this is leading to less addiction. yeah, chris? >> is it maybe physicians are starting to realize that they are partially to blame? the webb vs. the united states case talks about the legal aspect of it. do they come to the conclusion they are the big problem, they themselves realized or maybe the public is scrutinizing them about all the additiction, that they strung these people along? is that the case as well? >> i don't think they're beating their breasts and mea culpa, but they're changing their ways.

this is not good practice. they begin to do other things. i don't think they want to be publicly lambasted. because of new therapies and new knowledge essentially about it. >> cartwright makes a point on the middle of that big paragraph on 49 about how physicians themselves became addicted. >> yes. >> so there was a big problem within the medical community of these officials. >> yes, and that's one point he makes that we've talked about before. if there is one lesson of history from the history of drugs is that access and availability is the best predictor of increased addiction and, hence, physicians, pharmacists, very high rates because they could get the stuff. yes? >> even though the medical field did have a big role in it, i think legal isn't getting the

credit they deserve. on page 9, cartwright talks about in new york specifically several laws passed throughout the stage you're talking about in the early 1900s that made other drugs a lot more difficult to get. and so as a result of that he lists cocaine users as being driven towards heroin because it's cheap and it offsets the symptoms of withdrawal from cocaine. i think legal does play a big role. you're going from -- it's difficult to get this drug. what's the easiest thing we can get our hands on? >> there is a substitution and sort of complimentarity to it. as other people point out there are laws passed which either tax drugs prohibitively or, in effect, as with the harrison

act, make it impossible to get them legally and this means if you're going to get them, you're going to get them illegally on the black market. this is an entirely different situation than if you're a middle class person going to your doctor getting a prescription for something and you happen to get addicted to it. even if that's how, you would have to go to the black market to get the stuff to keep from you going into withdrawal because you can't get if legally or medicinally anymore. what about demographic? what's happening in this period? who is using drugs? what kind of -- who is using opiates? what kind of opiates are they using?

so, in other words, as the addiction is on the downturn because doctors are prescribing less, what happens to the covert of people who in the 19th century became addicted that way? >> they're dying out. >> yeah, they're dying out. so the medical addicts are largely dying out and they're not being replaced by new medical addicts at anywhere near the same rate because of the changes in medical practice. what happens to the people who are smoking opium? [ inaudible ] well, some of them are going back home, but it's also much harder to get smoking opium than it is other forms of opium. and so, again, the population

that's smoking opium and addicted to it in that form is shrinking as well. and not being replaced. >> on 111 the middle of the full pa paragraph, only the chinese and a few relatively wealthy whites remain steadfast opium smokers and this is 1915 that cartwright's talk iing about so the smoking of opium becoming a fad essentially, a cultural affectation of the wealthy. >> chris? >> go ahead. >> that's why i was thinking that maybe it was shifting away from the medicinal use to leisure, pleasure, you are prescribing so much, you had this commonality with other people by doing this.

>> mm-hmm. >> page 63, actually the bottom of 62, after 1870 he says a new type of addict began to emerge and he's talking specifically about the white opium smoker and that they were drawn in directly from the underworld from pr prostitutes, petty criminals, pimps and hangers on and that they were profiled as actually being a different class of people, that physicians didn't care about them, they were pleasure seekers and not medically induced addicts. but what you see after this is the implementation of the harrison act and other legal actions that virtually deride the opium -- smoking opium supply so that after 1914 and through the 1920s you see this

turn to subcutaneous hypodermic injections because they can't get smoking opium, so they turn to other forms of opiates. >> mm-hmm. yeah. so the 19th century demographic profile has either died out or changed or switched to other forms of opiates. and they're not being remrplace at the same rate. who is replacing them? who is the average opium addict by, say, 1920? frank? >> it's people who know the opium addicts. it says on 121 there's a little passage here, it says today the numbers of new addictions through physicians' prescriptions is small. the majority of cases now result from association with other addicts. and then it goes a little bit further in the first sentence back to our regular text here.

it says predominantly male urban poor. so they get addicted through other people, and they're in the lower class now again. >> right. they're not women and men. it's not distributed all over the place. it's not predominantly a southern and rural phenomenon. it's an urban male symptom of poverty in cities. and this is much more problematic socially and politically and legally than if it's the nice old lady who got addicted because she broke her hip or something and, you know, that -- you can explain that away. no one is worried about that. if it's young, poor men in the cities who are drug addicts and criminals, that's something to worry about. and, indeed, people do begin to worry about it. how does this changing face of

addiction, the fact it's not middle class women, lower class men, how does this influence social perception and legal responses to opium addicts, dan? >> well, the issue of social perception the text on 110 states that this is now the term where junkie comes from because you have these lower class urban men who need to find a way to fuel their addiction so they're picking through junk piles and selling scrap metal and so on. and so the term junkie comes from junk man so it's got this social perception of dirty, gritty, nasty, something very unpleasant, something that you don't want to be around. >> nate? >> on page 139 he talks about how there's kind of a double standard of private care for the rich upper class, people who are

addicts versus basically institutionalism for anyone else that's poor and it's kind of a strange factor that they consider if you're upper class and addicted they consider the fact that you're upper class first and an addict second whereas for poor people who are apparently committing crimes, it's not they are a criminal first and a drug addict. that's causing them to be a criminal in some capacity. >> think back to the article we read and how at first it's associated as an upper class diagnosis which is less reprehensible than intem prance which is associated with the lower class. it seems there's a similar dynamic going on here. frank? >> like what you said, nate, the upper class as being upper class first and addict second, it's because the lower class -- when

they're committing these crimes, it's kind of a fuel for their addiction, and that's where the drug is bad for that and that's where the legal ramifications came in as opposed to the upper class where, first of all, their addiction is seen as accidental, the old lady broke her hip kind of thing and, second, if they do need more of the drug, they have it within their own means to get that supply. they're not going next door and robbing somebody to supply their addiction. so i think that's where the stigma comes in for it being okay for the upper class to be addicted but not okay for the lower class of who it affects. >> dan? >> the legal response i was looking for it and i can't -- i haven't been able to find it. i definitely got a sense that there was an issue of social control, that with these being lower class people going out and committing crimes to serve their

heroin addiction, the impression that i got from cartwright was that there was a sense among lawmakers that, woohoo, now we've got a way to put legal shackles on these people. we can make it difficult for them to get their drugs and the issue of social control comes around. i can't find exactly what it was that made me think of that cartwright. >> there are 1,000 or so much in the big cities and lawmakers are using this to scare people saying this is how many we have now and they would dig deeper and find out, no, you're way off. you're way off by thousands and stuff like that. >> the real overestimation. >> on page 142 one of the problems is how to define the criminal. was it the opium causing the crime or did the crime cause

them to be the criminal? i can't say that right. and police records to establish one way or the other, an index of criminality prior to addiction is a technique fraught with peril. it is entirely possible that an addict may have committed crimes before using opiates and not been apprehended. >> yes, so this really is sort of where i was going with that, i guess we moved that. go back here. the social perception and legal response, when it was the middle class or the upper class, they're not really causing social problems and the problem is you can keep it behind closed doors when it's urban, male, poor, not so much. and you begin to have conversations and discussions among doctors and lawmakers and law enforcement officials about what exactly is addiction. is it a moral flaw that makes

these people -- they're morally flawed to begin with. that's why they take drugs and this leads to crime or are they criminals and that's why they take drugs, or is it simply that anybody who takes the substance is going to become addicted? and depending on what you hope to do by way of social control, by way of medicalization, by way of social policy, sort of influenced which camp you went to. >> this idea of the moral flaws and so on and finding issues in the early to mid-'60s there was an attempt, excuse me, on the part of some people to connect the heroin culture with the gay subculture in new york city. >> mm-hmm. >> and trying to tie these two morally reprehensible communities and conflate them into one. >> mm-hmm.

sure. and there's also -- there was also at one point in psychoanalysis the notion that alcoholism was rooted in some deep homosexual tendency, that something was wrong, you had a controlling mother, and this is what produces this imbalance and this developmental thing. so there are all sorts of issues related to this that were simply not there in the 19th century that emerge in the early 20th century. captions copyright national cable satellite corp. 2008 captioning performed by vitac