Providentia

Freedom-Mad

If slavery was a contentious issue in the United States during the years leading up to the Civil War, it was also big business.  According to the 1860 United States Census, there were nearly four million slaves across the entire country and the growing Abolitionist pressure made slaveowners increasingly paranoid.  Despite landmark Supreme Court cases such as the Dred Scott decision, the Underground Railroad provided a means for escaping slaves to flee to Canada where slavery had been abolished.   Since slaves often resented the harsh and inhumane treatment they received, rebellions and disobedience were common problems for slaveowners.  Since slaves were considered valuable property, punishments that led to slaves being left unable to work were avoided  where possible. 

Public whippings were a common sight and many misbehaving field slaves were required to wear metal collars (often with spikes).  Laws protecting slaves were weak at best and only sporadically enforced.  It was typically left up to each slaveowner to set whatever punishments they deemed suitable.  This often meant that considerable latitude was allowed and slaves often died from the harsh treatment they received (usually in front of other slaves to "set an example").   It hardly seems surprising that the stereotype of the vicious Southern slaveowner only helped support the Abolitionist movement.  The character of Simon Legree in Harriet Beecher Stowe's book, Uncle Tom's Cabin, came to be seen as representing Southerners as a whole (despite Legree being a displaced Northerner in the book).   As the Southern states became increasingly isolated, the problem of dealing with disobedient and escaping slaves took some surprising directions. 

As a prominent medical doctor who studied under Benjamin Rush, Samuel A. Cartwright was certainly considered a credible authority on the subject of disease.   Practicing across many of the southern states, he finally settled in New Orleans in 1858.  After examining numerous cases of runaway slaves, Dr. Cartwright concluded that the cause of  this "rascality" in slaves was biological in nature.  In describing what he felt to be a disease affecting slaves of African descent ("the Negro race"),  Cartwright coined the term "drapetomania"  which he took from the Greek word "drapetes" (a runaway slave).   When he first presented this proposed medical condition in a paper delivered to the Medical Association of Louisiana in 1851, Cartwright characterized it as being caused by masters who "made themselves too familiar with slaves, treating them as equals".  

Since the Bible called on slaves to be submissive to their masters, Cartwright viewed obedience as being the natural state for slaves.  He stressed that "If any one or more of them, at any time, are inclined to raise their heads to a level with their master or overseer, humanity and their own good requires that they should be punished until they fall into that submissive state which was intended for them to occupy. They have only to be kept in that state, and treated like children to prevent and cure them from running away."   For extreme cases, he advocated the surgical amputation of some, or all, of the escaped slave's toes to prevent further escape attempts.

Drapetomania was presented as a form of "mental alienation" that put it on par with other recognized mental disorders of the time - although the treatment was very different.  Cartwright advocated the use of "whipping the devil out of them" as a "preventive measure" for slaves who were seen as being a high risk for escaping.  For other health problems affecting slaves, including pneumonia, Cartwright insisted that they only affected "bad, vicious, ungovernable negroes" who, presumably, brought their poor health on themselves by failing to abide by their master's orders.   He was also a firm believer in the superiority of the slave system to all other economic systems based on heavy labour.  In visiting Europe in 1832, Cartwright commented that European peasants were far less efficient and "slowly motioned" than the slaves back home.  He also condemned the peasants for their laziness stating that "the only active persons I have seen are the waiters and servants about hotels"  (you have to hope that he tipped them properly at least). 

While he viewed slaves as being necessary, Samuel Cartwright had little regard for their natural intelligence.  In discussing the mental and physical sluggishness of slaves, Cartwright dismissed concerns about poor diet.  Instead, he attributed it to insufficient air to the brain which resulted in a "hebetude (blunting) of mind and body".   His term for this was Dysaesthesia Aethiopica, a condition which he felt was unique to "the Negro race".  Along with mental stunting, the condition could be identified by "lesions of the body discoverable by the medical observer which are always present and sufficient to account for the symptoms".  Treatment for this disease included having the patient "well washed with warm water and soap; then to anoint it all over with oil, and to slap the oil with a broad leather strap; then to put the patient to some hard kind of work".   After receiving the proper treatment,  the slave would "look grateful and thankful to the white man whose compulsory power ... has restored his sensation and dispelled the mist that clouded his intellect." 

Samuel Cartwright was also lyrical about the other perceived shortcomings of African slaves.  He dismissed the music that slaves enjoyed stating that "there is nothing in the slave's music addressing the understanding; it has melody but no harmony; his songs are mere sounds without sense or meaning".   It was Cartwright's belief that all children were white at birth and that racial differences only became apparent in later infancy. 

There seems little indication that Cartwright's views were taken seriously by physicians outside the Southern states and he came under considerable criticism by his medical colleagues.   Wihin months of his 1851 article on drapetomania in the New Orleans Medical and Surgical Journal, a spirited rebuttal was published in that same journal.  The author of the rebuttal, Dr. James Smith, argued against Cartwright's use of a fancy-sounding disease label to pathologize unwanted behaviours (in this case, escaping slaves).   Cartwright's supporters defended his views by citing research taken from the 1840 census which suggesed that mental impairment and insanity were also common among Negroes in Northern states as well.   While skeptics were quick to point out that the available data was decidedly biased,  Cartwright's racist theories served their purpose and received strong support from his fellow slaveowners. 

While Samuel Cartwright never lived to see slavery abolished (he died in 1862),  his racist views continued to influence political and social attitudes long after his death.  Pseudoscientific evidence was frequently used to justify the passage of "Jim Crow" laws supporting racial segregation well into the 20th century.  The growth of the eugenics movement, spurred on by erroneous beliefs about genetics, craniometry,  and, eventually, intelligence testing added to the furor surrounding racial superiority as well.

Samuel A. Cartwright was only the beginning...

 

 

 

Intimate Partner Violence and African American HIV-positive Women.

The medical outcomes of women infected with HIV are typically worse than those of HIV-positive men. HIV-positive women report high rates of intimate partner violence, and there is evidence that traumatic events have a negative impact on health status. In addition, African American women make up 1 of the fastest growing groups of HIV-positive individuals. A study recently published in Psychological Trauma: Theory, Research, Practice, and Policy examined the impact of intimate partner violence on HIV medication adherence, HIV-related physical health outcomes, and health-related quality of life in 40 HIV-positive African American women. The results were that women who had experienced intimate partner violence had worse HIV-related health as indicated by reduced CD4 counts and increased HIV viral load. In addition, posttraumatic stress disorder symptoms were related to both intimate partner violence and health-related quality of life. Lastly, HIV medication adherence mediated the relationships between intimate partner violence and the HIV-related health outcomes. Implications for further work and clinical interventions to address intimate partner violence, medication adherence, and health-related quality of life in this population are discussed by the authors.

For the abstract.

Treating Chronic Fatigue Syndrome

A new study published online in the Lancet presents the results of a comprehensive research project examing the benefits of cognitive behaviour therapy and graded exercise therapy in the treatment of chronic fatigue syndrome.  Despite ongoing controversy over its nature, cause and treatment, chronic fatigue syndrome (CFS) is believed to affect millions of people worldwide.  Generally defined by a persistent fatigue unrelated to exertion, not substantially relieved by rest and accompanied by the presence of other specific symptoms for a minimum of six months, the disease (or diseases) appears multi-systemic in  nature and is classified by the World Health Organization as a disorder of the nervous system.   There is currently no reliable diagnostic test or biomarker. 

To examine the comparative benefits of four different treatments in treating CFS patients, a prospective research project was launched by a team of researchers from the University of  London and the University of Edinburgh.  Known as the PACE study (Pacing, Graded Activity, Cognitive Behaviour Therapy: a Randomized Evaluation), the project was designed as a parallel-group randomized trial comparing the relative benefits of cognitive behaviour therapy (CBT),  graded exercise  therapy (GET),  adaptive pacing therapy (APT),  and standardised specialist medical care (SSMC).   SSMC  typically involves providing patients with information on their condition and advice on coping strategies.  APT focuses on helping patients structure their activities to match their reduced energy levels.

Using a sample of 640 patients meeting Oxford criteria for CFS,  the study participants were randomly assigned to treatment groups receiving SSMC alone or SSMC in conjunction with one of the other three treatments.    Patients in the parallel treatment groups received monthly individual therapy sessions as well as group therapy sessions every three months.  Approximately 75 per cent of the study participants were women with a mean age of 38 years.  Average duration of CFS symptoms was 32 months.  Results after one year have shown that  those  participants who received CBT and GET in conjunction with conventional medical care showed  moderate  improvement over the participants in the other two groups.  Over 60 per cent of patients reported reduced fatigue and improved functioning while 30 per cent reported no change.  Despite the preliminary nature of the results, the study authors emphasize that it provides robust evidence of the  value of CBT and GET in  treating chronic fatigue patients.  The results also show that adaptive pacing strategies, often advocated by patient groups, have no apparent benefit in treating CFS.

In an accompanying Lancet editorial, Dr. Gijs Bleijenberg and Dr. Hans Knoop of Radboud University Nijmegen (Netherlands) Medical Centre stated that, "Although the PACE trial shows that recovery from chronic fatigue syndrome is possible, there is clearly room for improvement with both interventions (cognitive behaviour therapy and graded exercise therapy)"    They also emphasize that CBT and GET provide symptom relief only but do not address the underlying cause of CFS. 

For the study

The Mathematician In The Asylum

As one of the leading French mathematicians of his generation and author of two books on elementary geometry, Jacques Hadamard was always fascinated by new mathematical ideas.   When he received a mathematical proof in the mail from a previously unknown mathematician named Andre Bloch, Hadamard was mesmerized by its elegance.  The proof related to a branch of elementary geometry involving paratactic circles, systems of two circles with orthogonal planes with the intersection being the common diameter of the two circles and cut according to a harmonic division.  According to Bloch, parataxy remained invariant under inversion and any inversion with respect to a point situated on one of them transforms them into a circle and it's axis.

Hadamard was so intrigued by Bloch's discovery that he immediately decided to invite him to dinner.  Since he had no other way of contacting Bloch, Hadamard wrote to the return address of 57 Grand Rue, Saint- Maurice with the invitation.  Bloch wrote back that a visit would be impossible but asked the great mathematician to visit him instead.  It was only when Jacques Hadamard finally took him up on his offer that he discovered why Bloch was unable to come to him:  57 Grand Rue, Saint-Maurice was the address of the Charenton lunatic asylum (now the Esquiral hospital) where Andre Bloch was an inmate.   He had been involuntarily committed to the hospital following a brutal murder in 1917 and would never be allowed to leave.  Although Hadamard was astonished by his discovery, he and Bloch talked at length about mathematics and he learned more about the inmate's story.

Born in 1893 in Besancon, France, Andre Bloch was one of three sons of an Alsatian Jewish watchmaker and his wife.  Orphaned at an an early age,  Andre and his brother Georges were in the same class despite Georges being younger.  While Andre was a poor student at first, he and George entered the Ecole Polytechnique together but only finished their first year when World War One broke out.  Both brothers were drafted and Andre served in the artillery as a second lieutenant.  Although George and Andre were both wounded in the war (Georges lost an eye while Andre fell from an observation post) only George was discharged and allowed to return to school.   Due to linging injuries, Andre was hospitalized several times and eventually placed on indefinite leave.

On November 17, 1917,  while Andre Bloch was visiting with his aunt and uncle at their family home in Paris,  he attacked his brother, aunt, and uncle at a family meal. After knifing all three of them to death, he then ran shouting into the street where he was arrested without resistance.  Given that the country was still at war and the case involved two army officers, there was little publicity involved.  Andre was quietly committed to the Charenton asylum for the duration of his life.

His reason for the murders remains unclear although he would later justify his action by telling his doctors that he had been fulfilling his eugenic duty.  As he explained it, the laws of eugenics were indisputable and his actions had been clearly necessary given the family history of mental illness.  In all other respects, he seemd perfectly sane and he devoted his time to working on various mathematical proofs.  This was all the more remarkable considering that he was entirely self-taught.  He wrote to various prominent mathematicians on a range of different topics in theoretical and applied mathematical proofs.  Everything that he knew about mathematics was learned about through the mathematics books which had been provided to him and the mathematics journals to which he subscribed (including the Bulletin des Sciences Mathematiques).  Along with Jacques Hadamard, he also maintained regular correspondence with George Polya, Georges Valiron, Charles Emile Picard, and Paul Montel.  Although he always gave the Charenton hospital as his return address without revealing his actual circumstances, Bloch's status as an inmate became an open secret.  Since many of the letters are still in existence, they represent a fascinating look at Bloch's contributions to the field of mathematics.

Along with four papers on holomorphic and meromorphic functions (which have since become standard), Andre Bloch wrote papers on function theory, number theory, geometry, and algebraic equations among other topics.  He was also keenly interested in the elections at the Academie des Sciences and expressed hope that he would eventually be allowed to present his work in person at the College de France and the University of Strassbourg.  Bloch allowed however that "in all probability, that will not be for quite a while".    Even during the Nazi occupation, Bloch continued to publish but was careful to write under assumed names to avoid calling attention to his Jewish origins (the irony of having to hide from his fellow eugenicists was probably lost on him though).   According to available records, Andre Bloch was a model inmate and lived his life in monastic fashion with little interaction with the other inmates or staff.  He did all his work at a small table installed for him at the end of a corridor and even avoided going out onto the hospital grounds stating that "Mathematics is enough for me".    According to family members, Andre Bloch's main enjoyment came from his mathematics work and long games of chess with staff or inmates.

As for the murders that led to his being sent to the asylum, he never showed any real remorse.   In his classic book, Des Hommes Come Nous, prominent psychiatrist Henri Baruk devoted part of one chapter to the "Mathematician of Charenton" (Bloch wasn't named in the book).   Baruk commented on his patient's "rational morbidity" in describing how the murders had been necessary to eliminate that branch of his family that he considered defective.  Even late in life, Bloch would argue that his actions had been "a matter of mathematical logic.  There had been mental illness in my family.  The destruction of the whole of the branch had to follow as a matter of course".  When his physician protested, Bloch accused him of "emotional language" and insisted his actions were based on his philosophy of "pragmatism and absolute rationality". 

After developing leukemia, Andre Bloch was admitted to Saint-Anne Hospital for an operation and died on October 11, 1948.  Shortly before his death, Bloch had been notified that he had been awarded the Becquerel prize by the Academic des Sciences (the prize was given to him posthumously several months after his death).  He is still remembered for his numerous contributions to mathematics including Bloch's theorem,  Bloch space, and Bloch's constant.  

Would his contributions have been more extensive if he hadn't been confined for most of his life?  Did his traumatic experiences in the war lead to his explosive violence?  These are questions that will likely never be answered.  Still, Andre Bloch's case represents a fascinating example of how even institutionalized psychiatric patients can continue having an influence on the world if their determination (or obsession?) is great enough.

 

Sniffing Glue

Although volatile substance inhalation is prevalent in many contexts and presents a serious threat to public health, this pernicious form of substance misuse remains poorly understood.   In the United States alone, nearly 16% of 8th graders report lifetime inhalant abuse and the long-term consequences can be dire given the neurotoxic nature of many of these substances.  The question of why people seek and misuse inhalants may be addressed by examining phenomenological accounts of inhalant intoxication, yet few investigations of inhalant intoxication experiences are reported in the literature. An article published in a recent issue of Experimental and Clinical Psychopharmacology employed a structured interview to assess inhalant intoxication experiences of 267 low-, moderate-, and high-frequency inhalant users. Low-frequency inhalant users reported predominately hedonic (pleasureful) experiences during inhalant intoxication, whereas high-frequency users reported a mixture of hedonic and aversive experiences. Aversive experiences such as depressed mood, suicidal ideation, and chest pain were commonly reported by high-frequency users but were relatively rare among low-frequency users. High-frequency users also experienced significantly more euphoria, talkativeness, and grandiosity during inhalant intoxication than low-frequency users. Hedonic and aversive experiences during episodes of inhalant intoxication are relatively common among high-frequency adolescent inhalant users.

For the abstract

U.S. Lawmakers Seeking Psychoactive Bath Salts Ban

Should certain brands of bath salts be banned as narcotics?

Although legal in most jurisdictions, the bath salt packets marketed under brand names such as "Ivory Wave" and "Vanilla Sky" contain ingredients including mephedrone and methylenedioxypyrovalerone.    Since the packets carry warning labels describing the contest as "not safe for human consumption", they are not subject to federal regulation.  Following hundreds of incidents nationwide involving bath salt consumption over the past several years, formal bans on the selling of  implicated bath salt products have already gone into effect in the states of Kentucky, Florida, Louisiana, and North Dakota, among others. 

New York Senator Charles Schumer has proposed a bill to make bath salts a federally controlled substance. In  a February 1 statement, Senator Schumer stated that "These so-called bath salts contain ingredients that are nothing more than legally sanctioned narcotics, and they are being sold cheaply to all comers, with no questions asked, at store counters around the country.  The longer we wait to ban the substance, the greater risk we put our kids in,  These so-called bath salts are dangerous drugs masquerading as a harmless product. They offer a cheap and deadly high, and we need to move immediately to get them off the shelves."  

Officials at the Office of National Drug Control Policy have reported that bath salt intoxication can result in hallucinations, paranoia, suicidal thoughts, and even death in some recent cases.  Mimicking the effects of cocaine and LSD, the variable chemical content of the bath salt products sold can often have unpredictable results despite their popularity as a source of legal "highs".  The versatile nature of the bath salts means that they can be ingested in a variety of ways including snorting, injecting, smoking, or eating.   In the first month of 2011 alone, there have been 248 bath salt-related calls to poison centres nationwide (up from 291 calls in all of 2010).  Hospitalizations, suicides, and cases of criminal assault relating to bath salt intoxication have also been reported.   

Emergency room physicians treating patients admitted for mephedrone and methlenedioxypyrovalerone intoxication have reported on the severe nature of the psychosis presented.  Use of sedatives such as Valium have had little success in some cases.  Mark Ryan, director of the Louisiana Poison Center has commented that ""If you take the very worst of some of the other drugs -- LSD and Ecstasy with their hallucinogenic-delusional type properties, PCP with extreme agitation, superhuman strength and combativeness, as well as the stimulant properties of cocaine and meth -- if you take all the worst of those and put them all together this is what you get. It's ugly".   Although the ban in Louisiana has had some success in reducing calls relating to bath salt ingestion, Ryan has noted that calls are resuming.  Given that the products are still legally available in other states, users often circumvent bans through online vendors and interstate shipping. 

Despite calls for federal regulation, it may take years for a comprehensive nationwide ban to go into effect.

For more information.

Soldier's Disease (Part 2)

Continued from Part 1

Not only did the demand for morphine create a steady market for the drug, it also created a strong demand for hypodermic needles as well.  The 1897 Sears and Roebuck catalogue advertised a hypodermic kit (including a syringe, two needles, two vials, and a carrying case) for a mere $1.50 (quite a bargain, really).   Patent medications, largely unregulated at the time, were advertised for the treatment of a wide variety of complaints and, naturally, morphine and opium were popular ingredients.  The self-medication that these patent medications made possible certainly aggravated the problem of substance abuse but the lack of formal government controls helped drive sales.

It seems inevitable that alternatives to morphine would become available as medical researchers learned more about the chemical composition of opium.  Codeine was first isolated in 1832 by French chemist, Pierre Robiquet, although it proved not to be as popular as morphine.  The real breakthrough came in the 1870s when  English chemist C.R.A. Wright first isolated the opiate compound that would later be marketed under the brand name of heroin.  When Bayer Pharmaceuticals released their product some time later (the name heroin was taken from the German word for heroic, heroisch), it was billed as a perfectly safe alternative to morphine. 

And heroin was hardly the only new product available.  With the development of chloroform, nitr0us oxide, and vari0us other anesthetics, pain-free surgery and dentistry became all the rage.  At the same time, however, there was a growing fear of the social dangers surrounding opiates (including morphine and heroin).  Following the Spanish-American War and the American annexation of the Philippines in 1898,  public alarm over opium addiction became even more widespread.   As a result of U.S. pressure,  the first International Opium Commission was held in Shanghai in 1909.  A sec0nd meeting was held in 1911 and the first c0mprehensive policy regulating opiate use was signed.

In the United States, anti-drug lobbyists began agitating from more stringent safeguards.  Hamilton Wright was appointed as America's first Opium Commissioner in 1908 and, after attending the Shanghai meeting, would comment that "Of all the nations of the world, the United States consumes most habit-forming drugs per capita. Opium, the most pernicious drug known to humanity, is surrounded, in this country, with far fewer safeguards than any other nation in Europe fences it with".    Once again, drug abuse was linked to racial unrest as Wright went on to comment that "cocaine is often the direct incentive to the crime of rape by the Negroes of the South and other sections of the country" (while cocaine is not an opiate, the drug reformers insisted on classifying it as a narcotic as part of their platform). 

Newspaper editors and academics alike weighed in on the dangers of drug addiction and the horrendous social costs involved.   Racism was readily apparent and the editorials were filled with accounts of "drug-crazed, sex mad negroes" and "Chinamen" seducing white women on drugs.  Various drug "experts" testified on the proliferation of drug-addicted "Negroes" stalking and attacking white women while under the influence.     By 1914, forty-six states had passed legislation regulating or banning opium, morphine, or heroin. The fact that World War One had just broken out in Europe became a factor as well since experts began raising c0ncerns about the cases of Soldier's  Disease that had arisen from the Civil War and the possibility of American involvment in the new year leading to more cases.  

In 1915, Jeannette Marks published a highly influential article in the American Journal of Public Health describing the "hydra-headed drug curse" following the Civil War and expressed alarm that the problem would shortly resurface.  She was als0 the first to suggest that there had been as many as 400,00 morphine addicts following the war although she was given to exaggeration (she had also estimated there being 4,000,000 drug addicts in the U.S. in 1915).    While other experts disputed her estimate, the consensus that drug regulation was needed seemed clear enough.  After quiet deliberation, the Harrison Narcotics Tax Act was signed into law on December 17, 1914.  Technically focusing on taxing narcotics (again, cocaine was included), the act also imposed still penalities for the sale and importation of all narcotics.  Although morphine and other opiates could still be prescribed by a physician, the anti-drug era had begun in force.  

As for Soldier' Disease, its popularity as a diagnosis began to level off during the 20th century when substance abuse in the military became better understood.  Despite the role of the diagnosis in helping to shape U.S. drug policy and the numerous wars that have been fought in the past century, the use of a distinct diagnosis for returning soldiers addicted to pain medication has been largely discarded in the clinical literature.   While drug experts continue to disagree on the actual number of Civil War morphine addicts (the estimates range from 45,000 to 400,000).  Still, the controversy remains over how any valid estimate could ever be made given the lack of reliable data from that era. 

What isn't in dispute however, is that substance abuse among military personnel continues to be a political minefield regardless of the actual medical needs of soldiers dealing with chronic pain or posttraumatic stress.  Despite research initiatives by the National Institute on Drug Abuse and the Department of Veteran's Affairs,  the substance abuse problems that returning soldiers face are still waiting to be solved.

Counting Suicides

In a recent editorial by Ian Rockett published in Crisis: The Journal of Crisis Intervention and Suicide Prevention, he notes that relatively few countries credibly keep statistics relating to how their citizens die. Thus, differential sophistication as well as sociopolitical and economic support of healthcare and systems to investigate deaths inevitably leave a large gulf between richer and poorer countries in accurately registering manner and cause of death. And when suicide is in question, the  stigma of self-harm combined with limited resources for conducting forensic death investigations likely produce large registration gaps among richer nations as well. In higher-income democratic countries, and probably in most other countries too, logic strongly suggests that suicide misclassification is overwhelmingly one-way. False negativity (i.e., undercounting) appears far more problematic for suicide etiology and prevention than false positivity. The editorial also discusses issues related to the documentation of suicide, both in highly developed and less developed countries, including suicide data reliability and validity and the importance of awareness of suicide as a public health problem. As the capacity for measuring, characterizing, and disseminating the true dimensions of this universal tragedy improves, so will the prospects for securing more adequate funding for research and prevention.

For the abstract

'Psychotic' Afghan Asylum Seeker Embroiled in Foster Child Controversy

When the Afghan refugee known only as "C.J." was found by British customs officers at the Port of Dover in 2008, he told them that he was only fifteen.  He told officials a thrilling tale of escaping from Afghanistan and spending eight months traveling overland, including hiding under a lorry in Calais, France.  He entered the United Kingdom when a kindly stranger gave him a train ticket to London.  Despite inconsistencies in his story and questions about his true age, CJ was "dispersed" to Cardiff, Wales and placed with a Welsh foster family which included young children. 

In a case presented to London's High Court, testimony about C.J.'s time with the foster family included reports of his extremely violent behaviour.  On one occasion, he was forcibly removed from the home by three officers and needed to be controlled with leg irons and handcuffs (he assaulted one of the officers).  After being taken to the Psychiatric Intensive Care Unit at Whitchurch Hospital, C.J. was diagnosed as being "floridly psychotic" including delusions of grandeur.  Even in the first week that he was in the foster family's care, he reportedly threatened to take the family's youngest daughter to Iran. 

Despite documents which C.J. had brought with him from Afghanistan, medical authorities and foster family members feel that he appears much older than his claimed age and is actually in his early twenties.  The legal case surrounding C.J. has been complicated by the question of whether he is in fact an adult.  The Cardiff City Council  has spent thousands of  pounds gathering expert evidence to prove his adult status.   While C.J. is adamant that he was born in 1993, the judge presiding over the case, Justice Duncan Ouseley, is openly skeptical about the birth documents that have been presented.  He has further stated that "he could be between 18 and 22, but I found just 17 impossible to accept and untruthfully alleged".   Following the three-day hearing, the judge concluded that C.J. is over 20 years of age. 

The case is still ongoing.

For more information.

Soldier's Disease (Part 1)

The American Civil War (a.k.a. The War Between the States) was long and terrible.  Beginning in 1861, the four-year war is still the deadliest in American history with an estimated 620,000 soldiers killed and an indeterminate number of civilian casualties. Approximately ten percent of all Northern males and 30 per cent of all Southern males were killed in the fighting and the social and political costs left their mark on the United States for generations afterward. 

As one of the first "modern" wars with heavy artillery and other weapons of mass destruction, physicians on both sides of the conflict were faced with unprecedented medical challenges in dealing with wounded soldiers.  Military surgery was still in its infancy and antiseptic practices were largely unknown so casualities remained high despite the best efforts of doctors and nurses.  To deal with patient suffering, doctors relied on two medical innovations that had only become available a few years previously:  the hypodermic needle and morphine sulphate.    First developed in 1804, the opium derivative received its name from the Greek god of dreams, Morpheus, and widely advertised to physicians as a safe and effective analgesic.   Given that surgery was often traumatic due to the lack of proper anesthesia, the use of morphine (spurred on by the development of the hypodermic needle in 1857) began to spread. Opium pills were also widely dispensed when hypodermic needles were unavailable.    During the Civil War, solders were often dosed with enormous amounts of morphine or opium to kill the pain of amputations and other surgeries.    While the potential for addiction was already known at the time, simple humanitarian concerns ensured that soldiers remained liberally dosed with morphine and whatever other analgesics were available.

Anecdotal accounts of Civil War doctors on both sides dispensing opium seem descriptive enough.  One Confederate doctor, William H. Taylor, gave a plug of opium to every patient reporting pain depending of whether or not they were constipated.  A Union doctor, Nathan Mayer, diagnosed patients from horseback.  If the wounded soldier needed morphine, Mayer would pour out an "exact quantity" into his hand and had the patient lick it off  (not a recommended method, by the way). 

Since medical epidemiology was still unknown, actual statistics relating to morphine addiction remain scarce.  Some sources have suggested that as many as 400,000 veterans were left addicted to morphine due to their wartime experiences.  These addicts were readily identified by the characteristic leather thong around their necks to which a small bag was attached.  The bag carried a supply of morphine sulphate tablets as well as  a hypodermic needle.  Upon their discharge from the army, this was all that was given to the returning soldiers to ease their return to society (no Veterans' Administration services in those days).  In recognition of the medical issues that these veterans faced, the term "Soldier's disease" was coined  (as opposed to "Soldier's Heart" which was an early name for Posttraumatic Stress Disorder). 

But how prevalent a problem was Soldier's Disease?  As some historians have noted, there were few descriptions of widespread morphine addiction during the 19th century.  The existence of thousands of morphine addicts in the United States following the end of the Civil War would have likely made far more of an impact than later medical authorities noted.  Veterans certainly had good reason to conceal their addiction since public exposure might have cost them their service pension (drug addiction was not a recognized medical condition).  The greatest social impact of the war and the addicts who survived it was likely from 1865 to 1900 when most addicts had died off. 

While the explosive growth of opium addiction from 1865 to 1895 was certainly noted,  the few drug addiction surveys undertaken during this period showed that women were more likely to be addicts than men.  Many of these women addicts had become addicted to the opiates that had been legally prescribed for them by their physicians (often as treatment for "female problems").  Although 19th century newspaper editorials expressed alarm over substance use, it almost always focused on opium and the insidious "opium dens" which were seen as a threat to American society (there were often racist overtones to these editorials given that they focused on how "white women" could be ensnared into smoking with "Chinese men").

Despite concerns relating to morphine addiction (and the thousands of addicts who had supposedly been released into society after the war), physicians continued to prescribe morphine for their patients.  As a catch-all medical solution for a wide variety of problems (which could range from headaches to diarrhea),  hypodermic-wielding physicians likely created more addicts than the typical opium den.   In an 1880 medical text titled The Hypodermic Injection of Morphia, the author stated that "here is no proceeding in medicine that has become so rapidly popular; no method of allaying pain so prompt in its action and permanent in its effect; no plan of medication that has been so carelessly used and thoroughly abused; and no therapeutic discovery that has been so great a blessing and so great a curse to mankind than the hypodermic injection of morphia".   

Continue to Part 2