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

Pages 67-85 | Received 12 Apr 1978, Published online: 14 Aug 2006

  • 1926 . Report of the Departmental Committee on Morphine and Heroin Addiction 11 – 11 . London Sir Humphrey Rolleston was President of the Royal College of Physicians at the time and a well-known committee-man and writer on medical topics. See, for instance, his entry in the Dictionary of national biography, and obituaries in Medical press and circular, 212 (1944), 223–224; St. Bartholomew's Hospital journal, 48 (1944–45), 190–191; St. George's Hospital gazette, 34 (1934–35), 23–24; British medical journal, 2 (1944), 452–454, 483; Lancet, 2 (1944), 487–488; and Times, 25 September 1944.
  • The tenor of press comment can be gauged from reactions to the Billie Carleton case in 1918–19, when a popular West End actress died supposedly of cocaine poisoning, actually of an overdose of veronal. Similar reactions were evoked by the Freda Kempton affair of 1922, involving a ‘night club dancer’ and a cocaine overdose. See, for instance, Daily mail 14, 16, 17, 18, 21, 27 December 1918; Daily express, 10, 11, 13, 15, 16, 21 March 1922.
  • Musto , D. 1973 . The American disease. Origins of narcotic control 54 – 68 . Yale 121–150.
  • Knight , A. 1973 . The milk of paradise in the patent remedy: a study of the uses of opium in eighteenth-century English society and literature , Columbia University . (unpublished Ph.D. dissertation: contains the most extensive survey of eighteenth century opiate use yet made. I am grateful to Judith Blackwell and Gerry Stimson for drawing my attention to it. There are more limited surveys of the same renowned addicts in, for instance, A. Hyter, Opium and the romantic imagination (1968, London; paperback edition), 25–26; and M. Lefebure, Samuel Taylor Coleridge, a bondage of opium (1974, London), 61–62.
  • Carlson , E.T. and Simpson , M.M. 1963 . Opium as a tranquilliser . American journal of psychiatry , 120 : 112 – 117 .
  • Crumpe , S. 1793 . An inquiry into the nature and properties of opium London
  • These travellers' tales were quoted by Lord Ashley (later Lord Shaftesbury) in a speech in the Commons against the opium trade Hansard 1843 68 3 cols. 377–379). Baron de Tott, Mémoires du Baron de Tott, sur les turcs et les tartares (1784, Amsterdam); S. Morewood, A philosophical and statistical history of the inventions and customs of ancient and modern nations in the manufacture and use of inebriating liquors; with the present practice of distillation in all its varieties: together with an extensive illustration of the consumption and effects of opium, and other stimulants used in the east, as substitutes for wine and spirits (1838, Dublin).
  • Berridge , V. 1977 . Fenland opium eating in the nineteenth century . British journal of addiction , 72 : 275 – 284 . ‘Opium eating and the working class in the nineteenth century: the public and official reaction’, British journal of addiction, 73 (1978), 107–112; and ‘Working class opium eating in the nineteenth century: establishing the facts’, forthcoming in ibid.
  • Milner to Wilberforce, 16 November 1793; quoted in Pollock J. Wilberforce London 1977 80 80
  • The Confessions was first published in serial form in 1821 in the London magazine. It was republished as a book the following year De Quincey T. The confessions of an English opium eater London 1822 the 1971 paperback Penguin edition also contains extracts from De Quincey's 1856 revision).
  • Quoted in Page H.A. Thomas De Quincey: his life and workings, with unpublished correspondence London 1877 244 244 See also ‘Confessions of an English opium eater’, British review and London critical journal, 20 (1882), 474–488.
  • Humorous treatment of the Confessions is to be found in the ‘Noctes Ambrosianae’, dialogues between several thinly-disguised characters, including the anonymous ‘English opium eater’ which appeared in Blackwood's magazine in the 1820s and 1830s: for example, 14 (1823), 485; 28 (1830), 391. The book was the subject of another humourous piece written by General Hamley for the Magazine in 1856 (‘A recent confession of an opium eater’, 80 (1856), 629–636; see also Blackwood's Magazine Medical tales from Blackwood Edinburgh 1968 19 35 H. A. Eaton, Thomas De Quincey, a biography (1936, London) discusses some of the reactions to the work's appearance.
  • 1821 . The Medical intelligencer , 2 : 613 – 615 . and 3 (1822), 116–118, were both favourable reviews.
  • Anon. Advice to opium eaters London 1823
  • A detailed analysis of the case is given in Berridge V. Opium eating and life insurance British journal of addiction 1977 72 371 377
  • Christison , R. 1832 . On the effects of opium eating on health and longevity . Edinburgh medical and surgical journal , 37 : 123 – 135 . summarised in the Lancet, 1 (1831–32), 614–615. See also the further discussion in his Treatise on poisons (1832, Edinburgh); and The life of Sir Robert Christison, Bart. edited by his sons (1885, Edinburgh).
  • The influence of the ‘public health’ and ‘professional’ aspects of medical reactions to opiate use are considered in Berridge V. Victorian opium eating: responses to opiate use in nineteenth century England Victorian studies 1978 forthcoming
  • Pereira , J. 1842 . Elements of materia medica Vol. 2 , 1293 – 1293 . London G. B. Wood, A treatise on therapeutics (1856, Philadelphia and London), 733 expresses a similar opinion.
  • Mart , G.R. 1831–32 . Effects of the practice of opium eating . Lancet , : 712 – 713 . pt. 1 Mart was the only other investigator systematically to trace examples of English opium eating.
  • Little , R. 1850 . On the habitual use of opium . Monthly journal of medical science , 10 : 524 – 530 . Christison re-stated his views with fresh evidence, in his reply entitled ‘Supplement to the preceding paper on the habitual use of opium, more especially the mode of cure’, Monthly journal of medical science, 10 (1850), 531–538.
  • Quoted by Ashley Hansard 1843 68 3 col. 400.
  • Basham . 1846 . Case of delirium tremens from opium-eating . Lancet , 1 : 254 – 256 . F. E. Anstie, Stimulants and narcotics (1864, London), 245.
  • Particular examples of this tendency are Sonnedecker G. Emergence of the concept of opiate addiction J. mondiale pharmacie 1962 275 290 (1963), 27–34; and D. I. Macht, ‘The history of intravenous and subactaneous administration of drugs’, Journal of the American Medical Association (18 March 1916), 856–859.
  • The best account of the evolution of the hypodermic method and the many myths which surrounded its development is given in Howard-Jones N. A critical study of the origins and early development of hypodermic medication Journal of the history of medicine and allied sciences 1947 2 201 249
  • Rolleston , H.D. 1929 . The Rt. Hon. Sir Thomas Clifford Allbutt 45 – 45 . London
  • Allbutt , T.C. 1870 . On the abuse of hypodermic injections of morphia . The practitioner , 5 : 327 – 331 . The journal, edited at this period by Dr. F. E. Anstie, had earlier been one of the most enthusiastic advocates of the new method.
  • Levinstein , E. 1877 . Die Morphiumsucht Hirschwald or Morbid craving for morphia (1878, London). See also A. Erlenmeyer, ‘The morphia habit and its treatment’, Journal of mental science, 34 (1888–89), 116; his On the treatment of the morphine habit (1889, Detroit). T. D. Crothers, Morphinism and narcomanias from other drugs (1902, Philadelphia) continued the distinction between the two types.
  • For example A dictionary of medicine Quain R. London 1894 2 157 157 T. L. Brunton, ‘The influence of stimulants and narcotics on health’, in Sir M. A. Morris (ed.), The book of health (1883, London), 183–267. There was no generally agreed term for the condition at this period. As well as the older ‘opium eater’, and more specific ‘morphinist’, there were also ‘morphia habitués’ and ‘opiophagism’.
  • Jennings , O. 1890 . On the cure of the morphia habit London his ‘On the physiological cure of the morphia habit’, Lancet (1901), pt. 2, 360–368; ‘Chronic morphism and its treatment’, Lancet (1908), pt. 2, 1324–1326; The morphia habit and its voluntary renunciation (1909, London); The re-education of self control in the treatment of the morphia habit (1909, London); ‘The frequency of morphinism’, British journal of inebriety, 7 (1909–10), 193–196; ‘The hypnotic treatment of morphinism’, Lancet, 2 (1909), 1173–1174, 1706–1707; ‘Pantopon’, Lancet (1910), pt. 1, 1104; ‘The treatment of morphinism’, Lancet (1911), pt. 2, 506; ‘Heart tonics and Vichy water in the treatment of morphinism’, Medical press and circular, n.s. 88 (1909), 62–65; ‘The morphia habit, morphinomania, and other drug addictions: their cure without suffering. A study of different methods of treatment’, Medical magazine, 19 (1910), 271–278; ‘The retrospective diagnosis of hypodermic drug addiction’, Transactions of 17th International Congress of Medicine, sect. 19, pt. 2 (1913), 47; and ‘The pharmacodynamic law governing the painless cure of morphinism’, ibid., sect. 5, pt. 2, 167–168.
  • 1914 . Report of the Homes for Inebriates Association and 30th Annual Report of the Dalrymple Home at Rickmansworth 13 – 13 . London
  • 1858–1893 . Bethlem Royal Hospital. Admission registers (kept at Bethlem Royal Hospital).
  • Kane , H.H. 1880 . The hypodermic injection of morphia, its history, advantages and dangers New York
  • Richardson , B.W. 1883 . On the morphia habit and its treatment . British medical journal , : 1194 – 1194 . pt. 2 also ‘Morphia habitués and their treatment, Asclepiad, 1 (1884), 1–31. There are many other case histories of this type in the medical journals; for example, a discussion led by Dr. Foot at the Irish Royal Academy of Medicine, British medical journal (1889), pt. 2, 1221.
  • Tweedie , A. 1899 . George Harley, FRS 174 – 174 . London J. St. T. Clarke, ‘The sudden discontinuance of hypodermic injections of morphia’, Lancet (1879), pt. 1, 70.
  • Shyrock , R.H. 1957 . Nineteenth century medicine: scientific aspects . Journal of world history , 3 : 880 – 908 . ‘Medicine and society in the nineteenth century’, ibid., 5 (1959), 116–146. H. G. Levine, ‘The discovery of addiction: changing conceptions of habitual drunkenness in American history’ (paper presented to the Society for the Study of Social Problems, 1976, New York) also discusses the emergence of allied thinking about drink.
  • There is discussion about the connection between opium and drink in medical practice and popular usage in Berridge V. Victorian opium eating: responses to opiate use in nineteenth century England Victorian studies 1978 forthcoming The treatment of delirium tremens with opium is widely attested in medical journals. See also Royal College of Physicians, ‘Kings College Hospital case notes’, 1850, case of Thomas Jones, gentleman's coachman, with delirium tremen, where both opium and brandy were used.
  • Kerr , N. 1889 . Inebriety, its etiology, pathology, treatment and jurisprudence , second edition London ‘Opening address to the colonial and international congress on inebriety’, Proceedings of the Society for the Study of Inebriety, 13 (1887), 1–3; also ‘Inebriety as a disease’, ibid., 4 (1885), 4, The Proceedings of the Society were the main record of its activities in the early years. It later became the British journal of inebriety and finally British journal of addiction.
  • Harrison , B. 1971 . Drink and the Victorians 371 – 371 . London W. F. Bynum, ‘Chronic alcoholism in the first half of the nineteenth century’, Bulletin of the history of medicine, 2 (1968), 160–185.
  • Its organisation and activities are surveyed in Johnson B. Righteousness before revenue: the forgotten crusade against the Indo-Chinese opium trade Journal of drug issues 1975 5 304 326
  • 1896 . Medical debate in London . Friend of China , 16 : 129 – 131 . Kerr chaired this meeting, while Dr. George Harley, Dr. James Maxwell and others discussed the treatment of addiction, the concept of moderation, etc. (‘Meeting at Manchester Free Trade Hall’, Ibid. 5 (1882), 56; ‘The medical aspects of the opium question’, Friend of China, 13 (1892), supplement).
  • Harrison , B. 1970 . The British prohibitionists 1853–72. A biographical analysis . International review of social history , 15 : 375 – 467 . He was also, on his mother's side, related to, and named after, Sir Humphrey Davy, a friend of Coleridge and Southey (Sir H. Davy, Fragmentary remains, literary and scientific (1858, London), 42–43).
  • Clouston , T.S. 1890 . Diseased cravings and paralysed control . Edinburgh medical journal , 35 : 508 – 521 . 689–705, 793–809, 985–996. C. A. McBride, The modern treatment of alcoholism and drug narcotism (1910, London), 130–134 also emphasised this ‘moral decay’. J. B. Mattison, The Mattison method in morphinism. A modern and humane treatment of the morphin disease (1902, New York) contained a similar emphasis.
  • Allbutt , T.C. 1897 . “ Opium poisoning and other intoxications ” . In System of medicine Vol. 2 , 874 – 920 . London
  • Sainsbury , H. 1909 . Drugs and the drug habit 219 – 219 . London
  • Jennings , O. 1890 . On the cure of the morphia habit London
  • Kerr , N. 1889 . Inebriety, its etiology, pathology, treatment and jurisprudence , second edition 148 – 148 . London
  • Sainsbury , H. 1909 . Drugs and the drug habit 259 – 260 . London
  • Rolleston , H.D. 1906 . “ Alcoholism ” . In A system of medicine Edited by: Allbutt , T.C. and Rolleston , H.D. Vol. 2 , London in part 1
  • Allbutt , T.C. and Dixon , W.E. 1906 . “ Opium poisoning and other intoxications ” . In A system of medicine Edited by: Allbutt and Rolleston . Vol. 2 , London part 1
  • Campbell , H. 1922 . Morphinism and its treatment . Medical press and circular , 114 : 134 – 137 . n.s.
  • 1914 . Morning post , 3 June R. Armstrong-Jones, ‘Drugs of addiction. A menace to the nation’; 5 June, T. E. Knowles Stansfield, ‘Drugs of addiction’; 10 June, R. Armstrong-Jones, ‘Drugs of addiction’.
  • As typical of contemporary concern over popular self-medication with and habituation to opiates, see, for example ‘Laudanum drinking’ and ‘The sale of laudanum’ British medical journal 1891 82 83 pt. 1 363–364. Concern crystallised in 1892 with a Treasury action (in part inspired by pressure from the B.M.A.) against the manufacturers of Dr. Collis Browne's chlorodyne, which established that it had to be sold with a poison label (‘Important decision under the Pharmacy Act, 1868’, Pharmaceutical journal (3), 22 (1891–92), 928–940). There is further discussion of this question in V. Berridge, ‘Opium over the counter in nineteenth century England’, Pharmacy in history (forthcoming, July, 1978).
  • Allbutt , T.C. 1897 . “ Opium poisoning and other intoxications ” . In System of medicine Vol. 2 , 883 – 884 . London
  • Huntley , W. 1896 . Opium addiction: is it a disease? . Proceedings of the Society for the Study of Inebriety , 50 : 1 – 16 .
  • One of the earliest extensive discussions came in 1851. “Medicus” Teetotalism and opium-taking Lancet 1851 pt. 1, 694 asked for advice as to the ‘reform’ of a long-established opium eater. Most replies recommended gradual withdrawal, some with alcohol as a ‘cover’ (D. M. Burnir, ‘Opium taking’, Lancet (1851), pt. 1, 711; “Medicus”, ‘Opium taking’, Lancet (1851), pt. 2, 45; T. Piddick, ‘Opium taking’; Spes, ‘Opium taking’, ibid., 71, 21).
  • Christison , R. 1850 . Supplement to the preceding paper on the habitual use of opium, more especially the mode of cure . Monthly journal of medical science , 10 : 531 – 538 .
  • Levinstein , E. 1877 . Die Morphiumsucht 110 – 118 . Hirschwald
  • Gamgee , A. 1908 . On chronic morphinism and its treatment . Lancet , : 794 – 796 . pt. 2
  • Mattison , J.B. 1892 . The treatment of the morphine disease . Proceedings of the Society for the Study of Inebriety , 33 : 1 – 16 . O. Jennings (footnote 30); T. C. Allbutt and W. E. Dixon (footnote 52). For the variety of methods advocated, see, for instance, W. K. Anderson, ‘A case of morphinomania’, The practitioner, 88 (1912), 881–885; and his ‘Morphinomania’, ibid., 92 (1914), 440–443. The following works contain discussions of different treatment methods and drug regimes, illustrating the range and variety of medical debate on the subject: H. C. Drury, ‘Morphinomania’, Dublin journal of medical science, 107 (1899), 321–344; N. Kerr (footnote 40); A. W. Foot, ‘On morphinism’, Dublin journal of medical science, 88 (1884), 457–472, 531–533.
  • McConnell , J.F.P. 1888 . The uses of cannabis indica . The practitioner , 40 : 95 – 98 . Anon., ‘Cocaine in morphinism’, British medical journal (1885), pt. 2, 1112; and ‘Morphinism. Meeting of the Royal Academy of Medicine in Ireland’, British medical journal (1889), pt. 2, 1221. Many treatments also patently derived from contemporary investigations into opium poisoning; see, for example, M. S. P. Strangman, ‘Morphinomania treated successfully with atropine and strychnine’, British medical journal (1907), pt. 1, 1173–1174. Both atropine and strychnine were in use in medical practice for the treatment of opium poisoning.
  • 1907 . A reputed cure for the opium habit . British medical journal , 2 : 1086 – 1087 . 1380 ‘The Malay anti-opium plant’, British medical journal (1910), pt. 1, 337–338; see also Pharmaceutical journal (4) 24 (1907), 77; (4) 25 (1907), 566.
  • Daily graphic, 7 August 1903 The Saint George Association for the cure of the morphia habit Lancet 1912 1 1241 1242
  • Kane , H.H. 1882 . The De Quincey home method, by means of which any individual can cure himself promptly, painlessly, and permanently of the opium, morphine, or chloral habit and alcoholic inebriety New York
  • For some discussion of this contemporary tendency, see Jones G. Stedman Outcast London , 1976 Peregrine edition Oxford 1971 322 336
  • In, for example British medical journal 1895 58 58 pt. 1 H. Crichton Miller, ‘The treatment of morphinomania by the “combined” method’, ibid. (1910), pt. 2, 1595–1597; J. Q. Donald, ‘The treatment of morphinomania by the “Combined” method’, ibid. (1911), pt. 1, 401; and N. Kerr (footnote 40)
  • ‘Some of the difficulties caused by the limited extent of the inebriates acts are detailed in P.R.O. H.O.45/9989, 10454. This covers cases both of chlorodyne drinking, which fell within the Act, and those of morphine and cocaine addiction, excluded by the legal definition of ‘intoxicating liquor’ Parliamentary papers, 1893–94 XVII, Report from the Departmental Committee on the treatment of inebriates 1388d 1389, 1340a, Appendix II, ‘Memorial from inebriates legislation’; 1895 XXVII, Report from the Departmental Committee on habitual offenders (Scotland), 59–60; 1908 XII, Departmental Committee on the Inebriates' Acts, 830; and 1908 XXXV, Royal Commission on the care and control of the feeble minded, 414).
  • P.P. A Bill to consolidate and amend the Law relating to inebriates 1912–13 II 1913, III, Inebriates Bill; 1914, III, Inebriates Bill.
  • 1884–85 . Reports of the Homes for Inebriates Association and annual reports of the Dalrymple Home at Rickmansworth London onward contain details of the major inebriates home taking drug addicts and also some analysis of the numbers admitted.
  • P.P. Royal Commission on the care and control of the feeble minded 1908 XXXV 531 535 For example, Report of the Home for Inebriates Association & 30th Annual Report of the Dalrymple Home at Rickmansworth (1914 London), 13.
  • Kerr , N. 1889 . Inebriety, its etiology, pathology, treatment and jurisprudence , second edition London Kerr noted that there was no provision for the poor addict and advocated compulsion in this connection.
  • Armstrong-Jones , R. 1915 . Drug addiction in relation to mental disorder . Journal of mental science , 61 : 37 – 64 . also in British journal of inebriety, 12 (1915), 125–148. ‘Bethlem Admission Registers’ (footnote 33), 1858–1893. Dr. W. A. F. Browne, consultant at the Crichton Institution, Dumfries, recorded that he had treated 22 cases in the 40 years prior to 1875 (W. A. F. Browne, ‘Opiophagism’, Journal of psychological medicine, n.s. 1 (1875), 38–55).
  • May 1859 . Billesdon Poor Law Union. Letter Book May , 24 I am grateful to Jean Raymond for this reference.
  • 1878 . The estate of pauperism and laudanum drinking . Lancet , : 325 – 325 . pt. 1
  • The background to the complex negotiations surrounding the Shanghai Commission of 1908 and the three Hague conferences between 1911 and 1914 is detailed in Public Record Office, Foreign Office papers, F.O. 371, 218, 222, 423, 414, 614, 616, 846, 847, 848, 850, 1075, 1076, 1331, 1332, 1334, 1598, 1599, 1601, 1924, and in the confidential print on opium (F.O. 415, 1–13). P. D. Lowes, The genesis of international narcotics control (1966, Geneva) deals with the Shangha meeting. Taylor A.H. American diplomacy and the narcotics traffic, 1900–1939 Durham, N. C. 1969 presents the American point of view.
  • Full details of the passing of DORA 40B are in Berridge V. War conditions and narcotics control: the passing of Defence of the Realm Act regulation 40B Journal of social policy 1978 7 285 304
  • P.P. Report of the Committee on the Use of Cocaine in Dentistry 1917–18 VIII The committee's evidence was, at Delevingne's suggestion, not published (H.O. 45, 11013). ‘Addiction’ here is used in the sense of 1916–17. Most medical authorities now accept that there is no ‘addiction’ to cocaine although the question of psychological dependence is still a matter of discussion.
  • 10–11 Geo. V. cap. 46, 1920, An Act to regulate the importation, exportation, manufacture, sale and use of opium and other dangerous drugs.
  • 1921 . British medical journal , : 96 – 96 . pt. 1 ibid., (1922), pt. 2, supplement, 85.
  • The Kempton case and press reaction was typical Daily mail The arrest of Edgar Manning, a coloured drug trafficker, also brought demands for the flogging of traffickers (Hansard, 153 (1922), 1014, 1549–1550, 1988).
  • Intense professional opposition is detailed in, for example, British medical journal 1921 240 241 pt. 1, 315, 360, 361, 398, 474–475; Supplement, 25, 29, 37, 41, 43, 49, 54, 63, 64, 74, 75, 77–79, 82, 210–211, 229. The Home Office was eventually forced, in the face of growing parliamentary opposition, to appoint a committee to consider amendment to the regulations.
  • 1923 . Times , March 21
  • Rolleston . 1926 . Report of the Departmental Committee on Morphine and Heroin Addiction 11 – 11 . London The background to the setting up of the Committee and the Home Office persuasion of a reluctant Ministry of Health (which wanted to proceed by case law rather than definite policy) is detailed in Ministry of Health papers, MH 58, 275–278 and H.O. 45, 451–408.
  • Honigsbaum , F. 1970 . The struggle for the Ministry of Health, 1914–1919 London details the background to its establishment. Smith Whitaker's ‘defection’ to the N.H.I. Commission is discussed in J. L. Brand, Doctors and the State. The British medical profession and Government action in public health 1870–1912 (1965, Baltimore), 223. Adams's Memorandum is in M.H. 58, 275.

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