Morality and medical science: Concepts of narcotic addiction in Britain, 1820–1926

Summary

This paper examines the evolution of ideas about narcotic addiction. In the eighteenth and early nineteenth centuries, addiction was not viewed as a medical condition, but as a ‘bad habit’. The contemporary reaction to De Quincey's Confessions (1821) demonstrates the general lack of medical involvement. The question of opium eating and longevity, first generated by the Mar case, brought increased medical interest and an embryo connection with the anti-opium crusade. In the second half of the century, addiction was more fully ‘medicalised’ through the profession's involvement in the question of hypodermic morphine and the allied development of a disease theory of addiction. The ‘problem’ of hypodermic morphine owed much to medical perceptions; and the disease theory, too, was not scientifically autonomous. Medical thinking developed in close alliance with moral biases, temperance and anti-opium beliefs. Treatment structures and methods were elaborated in line with increased medical interest. In the early twentieth century there was a distinct move on the part of the government, and the Home Office in particular, to defeat the ‘disease’ view, and to substitute a penal policy. The 1926 Rolleston Report marked not simply a reassertion of the earlier moral-cum-medical emphasis, but a recognition of partnership between doctors and the state in which the limited nature of narcotic addiction at first ensured a liberal reaction.