16
The Other `Narcotics': Cannabis and Cocaine
Two
other drugs have long been thought of, along with opium, as `dangerous
narcotics'. The same problem framework was applied to cannabis and
cocaine. Neither in fact can properly be called a narcotic drug.
Cannabis is closer to the hallucinogens than to any other drug
classification; cocaine is a stimulant. In the nineteenth century the
drugs, both late arrivals on the scene, played a quite minor medical
and social role in comparison to that of opium. They were nevertheless
associated with that drug, not least in the discussions of the concept
of addiction. They too had a part in the establishment of altered
perceptions of `narcotic' use.
Cannabis
Cannabis
itself has a quite bewildering variety of derivations, variously named.
The resinous exudation of the flowering tops and leaves is generally
known as hashish; material derived by chopping the leaves and stalks is
termed marijuana. But the variety of alternative terms in use was and
is testimony to the drug's established place in the culture of many
Eastern countries. Hashish was called esrat in Turkey (meaning simply a
secret production or preparation), kif in Morocco, or madjun when it
was made into a sweetmeat with butter, honey, nutmeg and cloves. It had
been known to the Chinese several thousand years before Christ and the
ancient Greeks and Romans had used it for both medical and social
purposes.1 In India, Persia, Turkey and Egypt it was in common use from
quite remote times. The word `assassin' supposedly derived from its use
in Syria in the twelfth century to designate the followers of the `Old
Man of the Mountains' or Hasan-IbnSabbah; they were called so because
hashish was in frequent use among them. The term possibly owed its
origin, too, to those Saracens who, \intoxicated with the drug, were
willing at the time of the crusades to go on suicidal expeditions into
the enemy camp.
Cannabis vas known in Europe well before the
nineteenth century. In 1563, Garcia de Orta noted its use in India.
Engelbert Kaempfer, the seventeenth-century German physician and
botanist, had described the plant and its medical uses in an account of
his travels in the Far East, Amoenitatum Exoticarum
Politico-Physico-Medicarum (1712), known in England through the efforts
of Sir Hans Sloane, president of the Royal College of Physicians.2 Dr
Robert Hooke brought it to the attention of Fellows of the Royal
Society in 1689. Indian hemp, which 'seemeth to put a man into a
dream', might, he thought, `be of considerable use for lunatics'. Berlu
in his Treasury of Drugs (169o) described its import from Bantam in the
East Indies.3 Such early accounts were, on present evidence, not
followed up and the drug was not used in medical practice. Its popular
usage was known. Pollen evidence indicates that hemp was cultivated in
Western Europe before the birth of Christ; there is evidence of it in
north-west England and southern Norway in Romano-British times. From
around A.D. 500, hemp cultivation was more abundant, and persisted
until quite recently. As contemporary court cases demonstrate, domestic
cultivation of the plant is not impossible. Streets and districts in
rural areas known as Hempfield are testimony to the former cultivation
of the drug.4
Cannabis, like opium, had its popular uses which have
been forgotten in the later medical emphasis. It was in the nineteenth
century, however, that medical usage of the drug began in England.
European, and particularly French, awareness of the intoxicating
properties of the drug had been stimulated by the Napoleonic conquest
of Egypt; the French administration of the country imposed heavy
penalties for selling, using or trafficking in it. `Travellers' tales'
of the East, as in the case of opium, also served to publicize the
drug.5 Dr William O'Shaughnessy, an Edinburgh-educated Irishman, had a
notable medical career. His studies of the blood in the English cholera
epidemic of 1831, although controversial at the time, laid the
foundations of intravenous fluid therapy, and his experiments with the
electric telegraph while in India led to the establishment of an early
telegraph network and a knighthood from Queen Victoria.6 It was while
he was out in India that O'Shaughnessy encountered the use of cannabis.
His paper `On the preparations of the Indian hemp, or gunjah (cannabis
indica); their effects on the animal system in health, and their
utility in the treatment of tetanus and other convulsive diseases' was
published in 1842 in the Transactions of the Medical and Physical
Society of Calcutta .7
O'Shaughnessy's careful survey of the uses of
the drug led him to an advocacy of it as an 'anti-convulsive remedy of
the greatest value'. While noting `the singular form of delirium which
the incautious use of the Hemp preparations often occasions ... the
strange balancing gait ... a constant rubbing of the hands; perpetual
giggling; and a propensity to caress and chafe the feet of all
bystanders of whatever rank', he nevertheless recommended that both the
extract and the tincture should be used by medical men.8 Peter Squire
of Oxford Street was responsible for converting cannabis resin into the
extract and distributed it to a large number of the profession under
O'Shaughnessy's directions. The extract and tincture both later
appeared in the British Pharmacopoeia, and the Society of Apothecaries
and other wholesalers included both in their wholesale production.9 The
drug was even cultivated commercially for a time near Mitcham.10
Cannabis
appears to have been quite infrequently used in medical practice.
Interruption of supply and uncertainty of action were the reasons
given. Dr Russell Reynolds, in his textbook, recommended its use for
sleeplessness (in particular in the treatment of delirium tremens), for
neuralgia and dysmenorrhoea.11 Seasickness and asthma also opened up
possibilities for the use of the drug. 12 Cannabis indica was also in
limited use as part of a possible treatment regime for opium eating, as
that condition became considered as one suitable for treatment. Dr
Mattison recommended the use of the fluid extract for the restlessness
and insomnia consequent upon the withdrawal of opium.13 But cannabis
was never anything of a rival to opium; its medical acceptability was
always far more limited.
In one sphere it did gain a foothold. The
utility of cannabis in the treatment of insanity was seriously mooted
in the last quarter of the century. Experimentation with the use of the
drug for this purpose was initially a French interest. It was the work
of Dr Jean Moreau at the Bicetre Hospital in Paris and his publications
of Du haschish et de l'alienation mentale in 1845, which drew attention
in France to the possibilities of its use for the insane. 14 In
England, trials of cannabis appear to have owed little directly to the
French example. They were part of the elaboration of more extensive
treatment and drug regimes at this time - and part, too, of the
reaction away from opium as a standby. Dr Thomas Clouston,
superintendent of the Cumberland and Westmorland Asylum at Carlisle,
won the Fothergillian Gold Medal of the Medical Society of London in
1870 for his `Observations and experiments on the use of opium, bromide
of potassium, and cannabis indica in insanity, especially in regard to
the effects of the two latter given together'15 Clouston's researches
inclined him to favour the two latter and his conclusions attracted a
fair amount of medical attention. Henry Maudsley himself, while
enthusiastic about Clouston's denigration of opium, was less sure about
the remedies he proposed to substitute. The question in his mind was
`whether the forcible quieting of a patient by narcotic medicines does
not diminish the excitement at the expense of his mental power'.
Maudsley had nevertheless used Clouston's method in a recent case,
where he had seen a rapid recovery. 16
But cannabis was also seen as
a cause of insanity. The connection between cannabis use and mental
illness, debated to this day, had its origin in English medical
discussions and in Indian and Egyptian evidence at the end of the
nineteenth century. The connection initially arose in observation of
the form of intoxication which the drug's use could give rise to. What
was seen as a form of poisoning was elaborated into a distinct variety
of insanity. As early as 1848 frequent use of the drug was said to
brutalize the intellect; it was in the 1870s that the argument was
developed.W. W. Ireland, writing in the Journal of Mental Science,
likened
the condition following the use of the drug to the delirium
of insanity. The alteration of notions of time and space and the
illusions of sight also, where short distances appeared immense, were
akin to the delusions of insanity. 11 The 'professionalization' of
varieties of insanity had its effect in the area of cannabis use.
Since cannabis was so little used in England, it was evidence from the East which most effectively gave support to the view.
It
was through British doctors' 'reports on the Cairo Asylum in the 1890s
that the connection between cannabis use and insanity was made in
England. The colonial implications of the drug had significant domestic
repercussions. But there was quite telling testimony which pointed to
the absence of a connection. Parliamentary and governmental
investigations on the East and India in the 1890s tended to cast doubt
on any link.18
This was very much the conclusion reached, on the
basis of a more scientific evaluation of the evidence, by the Indian
Hemp Drugs Commission of 1893-4. The Commission, set up to examine the
trade in hemp drugs, their effect on the social and moral condition of
the people, and the desirability of prohibiting cultivation, has, in
recent years, been rescued from obscurity. Its conclusions - that the
physical, mental and moral effects of hemp drugs used in moderation
were not adverse, that there was no evidence of cannabis use leading to
addiction and that prohibition would be unworkable - appeared
particularly relevant to the campaign to legalize cannabis in the
1960s, even though the blanket applicability of the Commission's
findings has been disputed. There was little domestic discussion of the
Commission's findings in the 1 890s, partly because they appeared to
have little relevance to English experience. There was no perceived
problem of domestic cannabis use. What the Commission did succeed in
doing, however, was to demolish the more facile medical belief in the
connection of cannabis with insanity. Its detailed analysis of how
those statistics connecting the two had been compiled decisively
demonstrated the haphazard way in which conclusions had been drawn.
Nine out of fourteen cases in the Dacca asylum attributed to hashish
insanity, for instance, were shown not to have been so caused. The idea
that hemp drugs were responsible for one third of all the cases of
insanity in India had to be seriously revised. In many cases
over-indulgence in hashish was not a cause, but merely a symptom of
some underlying predisposition to insanity. 19 Nevertheless the
insanity argument proved obstinately persistent. Dr Warnock,
superintendent of the Cairo Asylum, published a report of his work
there in 1895 which took no account at all of the findings of the
Indian Commission .20 Warnock's findings were taken up and incorporated
within popular and medical belief; the analyses of the Hemp Drugs
Commission were forgotten.
Discussion of hemp drugs and insanity was
part of an increased medical interest in the drug and its effects in
general in the 1 890s. Part of the expanding medical examination of new
and more effective remedies (which had led to the downgrading of opium)
was an attempt to examine cannabis more scientifically and in
particular to isolate an active principle. There had been attempts at
this ever since the drug's introduction in the late 1 830s, and there
were a bewildering variety of products, which included cannabis,
cannabene, cannabin tannin, cannabinine and others. But the active
principle of the drug had still to be isolated. The unreliability of
cannabis preparations remained a serious drawback to their general use
in medicine. Cannabinol was isolated by Wood, Spirey and Easterfield in
1895. Research into the drug's effects was continued in the medical
school at Cambridge. 21 The interest displayed in these years also
helped make the reputation of a medical man to be an important force in
the shaping of narcotic policy. Walter Ernest Dixon, a leading member
of the Rolleston Committee on Morphine and Heroin Addiction in the
1920s and a public opponent of penal narcotics policy on the American
model, worked on the pharmacology of cannabis indica while Salters
Research Fellow in the 1 890s. His conclusions were that activity would
vary greatly according to the type of preparation used. The mode of
ingestion had its different effect, too, and Dixon recommended smoking
the drug if an immediate effect was desired. `Hemp taken as an
inhalation,' he decided, `may be placed in the same category as coffee,
tea, and kola. It is not dangerous and its effects are never alarming,
and I have come to regard it in this form as a useful and refreshing
stimulant and food accessory, and one whose use does not lead to a
habit which grows upon its votary.' 22
Research of this type under a
medical imprint into the mental as well as the physical effects of
cannabis use had a striking parallel in the establishment of a
recreational hashish-using sub-culture at the same period. Use of the
drug in literary circles in many ways simply transferred to a
non-scientific setting the aims and methods of medical research into
the drug. Cannabis became part of the same sub-culture which
experimented with opium smoking. The doctrine of `art for art's sake'
which found expression in the drawings of Beardsley and the
aestheticism of Oscar Wilde involved an emphasis on sensation and inner
experience redolent of the Romantics. The 1880s and 1890s were a time
of interest in the paranormal and in psychic phenomena. Spiritualism
underwent a recrudescence; the Theosophical Society and the Society for
Psychical Research were both founded in the 1880s. Interest in the
occult and mystic phenomena were all part of the same tendency. It was
among the members of a mystic order, the Hermetic Order of the Golden
Dawn, and its literary associates, organized in 1891 into the Rhymers'
Club which met in The Cheshire Cheese in the Strand, that recreational
drug use was most common. It recalled the emphasis on experience and
the inner life of the Romantic poets and writers; and indeed, Coleridge
and Tom Wedgwood had tried a sample of `bang' from India in 1803.43
William
Butler Yeats, a member of both the 1890s groups, had smoked hashish
while in Paris. He and Maud Gonne had experimented in extra-sensory
communication, and she, while using cannabis for insomnia, had awoken
one night to find herself apparently translated to the bedside of her
sister Kathleen. Smoking hashish and drinking black coffee were
reported to be among the more defiant and unconventional activities at
the Rhymers' Club meetings; and several of the poets who congregated
there toyed with the drug. Ernest Dowson had experimented while at
Oxford, and did so again in the company of the writers Arthur Symons
and John Addington Symonds and some of Symons' friends from the ballet
one afternoon in Symons' rooms in Fountain Court, Temple. By the early
1900s, experimentation with theeffects of drugs on consciousness seems
to have been an accepted part of life in certain literary cum artistic
milieux. Smoking opium and hashish were perhaps most commonly favoured,
although Havelock Ellis (using Dowson and Yeats as guinea pigs) had
been experimenting with mescal.24 Drug-taking in this way was a quite
minor part of the artists' experience; the sub-culture as a `way of
life' was at this period very. much in the future.
Cocaine
Cocaine,
perhaps surprisingly, was not an important part of the teach for
experience in literary circles at the turn of the century. As a
separate alkaloid it had in fact only recently come into medical
practice. The coca leaf itself, from which the alkaloid was derived,
_was, like cannabis, a nineteenth-century novelty in European medicine.
The coca chewing of the Peruvian Indians had been known since the
discovery of the Americas, but, unlike tobacco, the coca leaf was never
introduced into European society. The attitude of the Spanish
conquistadores of Peru was perhaps important; coca chewing, like other
native customs, was regarded as a vice. The drug had been originally
regarded by the Incas as a symbol of divinity, and it hence became
known in Europe initially, as had cannabis and opium-eating, through
the medium of `travellers' tales' and later through more scientific
description and investigation. Many of these descriptions were
enthusiastic about the sustaining properties of the leaf. None was
perhaps more so than Abraham Cowley, an English physician and poet who
celebrated the virtues of coca in his Book of Plants (166x). Coca was
Endowed
with leaves of wondrous nourishment, whose juice sucked in, and lo the
stomach taken long hunger and long labour can sustain: From which our
faint and weary bodies find more succour, more they cheer the dropping
mind, than can your Bacchus and your Ceres joined.25
It was at
about this time - in the late eighteenth and early nineteenth centuries
- that a more scientific evaluation of coca began to prepare the way
for its introduction into European medicine. Joseph de Jussieu, a
botanist who had accompanied the French mathematician La Condamine to
Quito in 1735, sent specimens to Europe for examination; through him
the plant received the classification Erythroxylon coca. Poeppig, the
German naturalist, Martius, Dr Weddell, a French botanist who went to
South America in 1845, Clements Markham, von Tschudi, the Swiss
naturalist, and the English botanist Richard Spriuce - all commented on
the Indian use of coca. This examination of the drug was, like the
experiments with British opium and interest in the alkaloids of that
drug, another illustration of the growth of scientific inquiry and
specialization in the early decades of the century.26 The work of Dr
Paolo Mantegazza was important in establishing the potentialities of
coca for European medical use. Mantegazza, who had practised medicine
for some time in Peru, on his return to Italy, published in 1859 Sulle
virtii igieniche e medicinali della coca, in which, while describing
the hallucinatory effects which the drug had had on him, he recommended
it for a range of illnesses including toothache, digestive disorders
and neurasthenia. It was about this time that the drug's active
principle was isolated. The discovery of cocaine, the main alkaloid
contained within the coca leaf, is generally attributed to Albert
Niemann of Gottingen, although in 1855 Friedrich Gaedcke had produced
from a distillate of the dry residue of an extract of coca a
crystalline sublimate he called 'Erythroxylon'. It was Niemann who in
1860 isolated pure cocaine from leaves brought to Europe by Dr
Scherzer. Wilhelm Lossen described its chemical formula in 1862; the
isolation and description of other coca alkaloids followed later in the
century.27
It was not cocaine, however, but the properties of the
coca leaf which initially attracted most attention. The 1870s in
England in particular were the time when most medical discussion took
place; .the coca leaf was part of the general increase of medical
interest in new and apparently more scientific and exact remedies. Dr
Anstie had mentioned the drug in his Stimulants and Narcotics in 1864;
its moderate use seemed, he thought, `to have an influence upon
nutrition almost indistinguishable from that of ordinary food as to its
ultimate results 1.211 The work of Dr Alexander Hughes Bennett of
Edinburgh began more detailed investigations. The coca leaf was already
in general use as a stimulant and tonic in a variety of diseases;
Bennett's work with it, and with cocaine, a small quantity of which he
obtained from Macfarlan's in Edinburgh `after great difficulty',
demonstrated the similarity of the physiological actions of coca, tea,
coffee, guaranine and cocoa and of their active principles .29 There
followed a period of increased experimentation .30
In 1876, the
American pedestrian, Weston, used the coca leaf in walking trials in
London. He found the results disappointing; the leaves did not have the
expected effect, but instead acted as an opiate. He came to the
conclusion that the drug would in fact be detrimental in any trial of
physical endurance .31 Many medical men were, however, also trying the
drug in the same way. Foremost among them was the veteran Sir Robert
Christison, investigator of opium in the early decades of the century,
and now, in his old age, an advocate of the advantages of coca chewing.
Christison wrote in the British Medical journal in 1876 how he had made
two `walking trials' with coca (or cuca) leaves, one in 1870, the other
in 1875. His students at Edinburgh had experienced `the removal of
fatigue, and the ability for active exertion' through its use.
Christison himself had been enabled to walk fifteen miles without
fatigue; and his two ascents of Ben Vorlich in the Highlands were
exceptional for a man of his age. He wrote:
My companions ...
were provided with an excellent luncheon ... but I contented myself
with chewing two-thirds of one drachm of cuca-leaves ... I went down
the long descent with an ease like that which I used to enjoy in my
mountainous rambles in my youth. At the bottom, I was neither weary,
nor hungry, nor thirsty, and felt as if I could easily walk home four
miles... '32
For a time chewing coca became quite the rage among
medical men. Even Sir Clifford Allbutt took it with him on a walking
tour in the Alps in the hope of amazing his fellow climbers.
But
there was still much disagreement about the general therapeutic
possibilities of the coca leaf. Mr Graham Dowdeswell, for instance,
writing of his researches into its action in the Lancet in 1876,
concluded that its effect was so slight as to preclude any therapeutic
or popular value.$$ Yet other medical men were not averse to
recommending it for what would now be more exactly defined as
non-medical usage. 'Dr William Tanner was reported as praising it as a
cure for bashfulness - `it causes timid people, who are usually ill at
ease in society ... to appear to good advantage . . .'. A
doctor-sportsman was full of admiration for its effect in steadying his
aim: `Filling my flask with the coca tincture, instead of with brandy
... down went the birds right and left ...' 34
It was not until the
powers of the alkaloid as a local anaesthetic were fully understood
that the drug won complete medical acceptability. It was the early work
of Sigmund Freud, and of his friend and research colleague, Carl
Koller, in Stricker's laboratory in Vienna, which brought this about.
Freud's use of cocaine- is, because of his own enormous fame,
well-known. He first became interested in the drug and its properties
after reading a report of how Dr Theodore Aschenbrandt, a German army
physician, had issued cocaine experimentally to some Bavarian soldiers
during autumn manoeuvres. The results were promising. Freud obtained
some cocaine for himself from Merck's of Darmstadt and began to
experiment. Fifty milligrams in a glass of water left him cheerful and
energetic. In May, influenced by American reports of the drug's use as
a cure for morphine addiction, he began to administer cocaine to his
friend Ernst von Fleischl-Marxow, who had become addicted to morphine
to dull the pain of an amputated thumb. In his paper `On Coca' (`Uber
Coca') published in July 1884, he produced the first major positive
survey of the drug's therapeutic uses. Contending that it should be
regarded as a stimulant rather than a narcotic, he blamed past failures
on bad-quality preparations. From his own experience, he recommended
the drug for a variety of illnesses and specially for symptoms such as
fatigue, nervousness, neurasthenia and, most significantly, as a cure
for morphine addiction." Freud himself continued to experiment with the
drug for several years; he published five papers in all on it, the
last, `Craving for and fear of cocaine', in 1887.
What can almost be
termed Freud's love-affair with cocaine was an interesting episode in
his career, albeit one which he preferred to disguise in later life.
His enthusiastic advocacy owed something to his own personal
circumstances, in particular the desire as a young medical researcher
to establish a serious reputation and hence to be able to marry his
fiancee Martha Bemays (to whom he wrote enthusiastically of the
properties of cocaine) much earlier than he would otherwise have been
able. It is possible, too, that his use of cocaine (which certainly
continued to some degree after the last paper was published in 1887)
may have mediated his change from physiological to mainly psychiatric
interests. Certainly, as this change of emphasis began when he was
working with Charcot in Paris in 1885 and 1886, Freud was still using
cocaine regularly. Some interpretations relate his usage of the drug
more specifically to the release of his creativity.
Of more
long-term significance for medical usage of the drug, however, was the
re-discovery of cocaine's anaesthetic properties made by Carl Koller.
That the drug had this local anaesthetic effect had been known for some
time. In 1862, for instance, a researcher called Schroff had noticed a
numbing effect when he put some on his tongue; six years later, a
Peruvian doctor, Thomas Moreno y Maiz, suggested that it might be a
useful local anaesthetic. In the 1870s both Charles Faurel and von
Anrep had noticed the anaesthetizing effect it had on the mucous
membranes. Bennett, too, in his 1873 report had observed this property
without fully realizing its significance .36 Koller's application of it
to surgery was made while working at Vienna with Freud. Koller had been
concerned with finding a suitable anaesthetic for eye surgery; the
Richardson ether spray then in use was unsuitable for such delicate
operations. The general narcosis which resulted prevented the patient's
active co-operation, and the subsequent nausea and vomiting often
damaged the work which had been carried out. As with many important
discoveries much controversy surrounded this one - Freud later
declared, for instance, that had he not left Vienna one weekend in
September 1884, to see his fiancee, he too would have shared in the
discovery; Koller denied that his discovery of the effect of cocaine on
the eye was due to the fact that a drop fell into his own eye
accidentally. In September 1884, he experimented with the drug on the
eye of a frog and of a guineapig. `I found the cornea and conjunctiva
anaesthetic,' he reported, '... insensitive to mechanical, chemical,
thermic and faradic stimulation. Afterwards, I repeated these
experiments on myself, some colleagues and many patients.' Koller's
paper on the subject and a practical demonstration of the experiment
were given at the Heidelberg Ophthalmological Society in September
1884.37
The anaesthetic properties which Koller thereby disclosed
were eagerly seized upon by a profession which had long sought an
adequate and safe means of performing such delicate surgery. The use of
the drug was extended into other areas. In New York in October 1885,
Leonard Corning, a neurologist interested in local medication of the
spinal cord, successfully anaesthetized the lower extremities by
injecting cocaine between the eleventh and twelfth dorsal vertebrae. In
1889, August Bier of Kiel reported on six operations he had performed
using spinal anaesthesia, and the method soon became quite common.
Early experiments on nerve blocking or conduction anaesthesia, by
injecting cocaine into the path of a sensory nerve trunk to
anaesthetize the fibres of its peripheral distribution, were made by
William Stewart Halsted in New York in the winter of 1884-5. Halsted's
experiments were given little publicity; the method of nerve-block
anaesthesia which he pioneered was only generally adopted around the
turn of the century.
Even more extraordinary was the wave of
popularity which cocaine enjoyed among the medical profession at large
once Koller's discovery became known. In England in the mid-1880s, the
pages of the medical journals were crammed with enthusiastic
demonstrations of the uses of the drug; doctors flooded into print in
its praise and each contribution purported to establish a different
usage to which this wonder drug could be put. There were sixty-seven
separate pieces about it in the first 1885 volume of the British
Medical Journal. Its utility as a local anaesthetic in operations on
the vagina and urethra, in dentistry, ophthalmic surgery, in
vaccination, in operations on the nose and larynx, vomiting, mammary
abscess, in cancer, scalds, circumcision, neuralgia, hay fever, senile
gangrene and even in the removal of a needle from a foot were all
canvassed. Nymphomania, sea-sickness - there seemed no limit to the
possibilities. The usual medical controversies over the exact mode of
action of the drug began.
The drug made its mark in a popular
non-medical way, too; cocaine and coca were used as patent medicines.
The name of Mariani was most commonly associated with coca products. W.
Golden Mortimer even dedicated his History of Coca `The Divine Plant'
of the Incas (1901) to Angelo Mariani, the Parisian chemist and
entrepreneur who was successfully selling coca extract not only as Vin
Mariani, but also Elixir Mariani, Pate Mariani, Pastilles Mariani and
The Mariani (a non-alcoholic variety). Mariani's were not the only
commercial coca products on the market. In 1888, Messrs Ambrecht,
Nelson and Co. of Duke Street, London, had several varieties of coca
wine, including sweet malaga (used by ladies and children) and a
Burgundy coca wine for gouty and dyspeptic cases; there was also coca
sherry and coca port. In 1894 there were at least seven firms producing
coca wines for the domestic market.38
The medical disapproval of
opiate-based patent medicines which had found expression even in the
seventies and eighties did not initially extend to coca products. The
Lancet was recommending them `with confidence' in cases where a
restorative was needed; their appearance and listing in medical
journals betokened their general acceptability. The line of division
between `medical' and 'non-medical' products as well as usage was not
closely defined. William Martindale, for instance, whose supplement on
cocaine in the third edition of his Extra Pharmacopoea in 1884 had done
much to advertise the' uses of the drug as a local anaesthetic and much
else besides, was producing his own brand of pastilles `intended for
the temporary relief of hunger, thirst, fatigue, exhaustion, distaste
for food, or nervous depression and weak digestion'. 39 In the 1890s
Burroughs Wellcome likewise had cocaine tabloids for what would now be
regarded non-medical use. These `voice tabloids', composed of cocaine,
chlorate of potash and borax, were said to `impart a clear and silvery
tone to the voice. They were easily retained in the mouth while singing
and speaking ... used by the leading singers and public speakers
throughout the world. 140
But medical approval began to wane in the
1890s. Commercial coca products were separated from their previous
semi-medical status and were incorporated in the general medical and
pharmaceutical campaign against the availability of all patent
medicines." This was part of a remarkable medical volte face on the use
of cocaine in general. The euphoria of 1884-5 was soon replaced by an
appreciation of the dangers which such unrestrained use could give rise
to. The use of cocaine to treat morphine addiction was strongly called
in question. Freud had praised the drug for its utility in this way.
Fleischl, to whom he had administered the drug, himself became
dependent on it in place of morphine 42 The whole pattern of events was
very similar to the earlier medical enthusiasm for, and subsequent
partial rejection of, hypodermic morphine. With cocaine, the process
was completed in a very much shorter time. By 1887, the British Medical
journal could comment that the `undeniable reaction against the
extravagant pretensions advanced on behalf of this drug had already set
in' .43 The work of Dr J. B. Mattison in New York was noted in the
British medical press; he had warned that there was a genuine danger of
replacing an opium or morphine with a cocaine habit if the drug was
used in this way. Dr Albrecht Erlenmeyer, too, who at the height of the
cocaine craze had himself reported on his use of cocaine to treat eight
persons addicted to morphia, was by 1888 warning against the method and
melodramatically categorizing cocaine as the `third scourge of
mankind', after alcohol and opium.44 Soon such warnings came thick and
fast. The dependence on the drug of Halsted, pioneer of its anaesthetic
use, was not known in England .45 Nevertheless a close connection was
established between morphine and cocaine by warnings against the
treatment of morphine addiction with cocaine. Cocaine's subsequent
classification as a narcotic owed much to this early connection as well
as to the later international implications of cocaine abuse.
The `cocaine habit' was; through the connection with morphine, incorporated within the general disease view of addiction.
But
the lack of physical symptoms associated with use and withdrawal from
the drug engendered a harsher medical response. Disease theories were
always notable by the reformulation of moral views in scientific form;
and the `vice' categorization was strongly applied to cocaine. To
Allbutt, it was `slavery worse than that of morphine'; bondage was a
hopeless matter. This appears to have been the almost universal
reaction of the addiction specialists.46 Cocaine, it is now recognized,
engenders no physical addiction or abstinence sickness. What was
particularly worrying to the medical writers on the cocaine habit in
the nineteenth century was the greater element of free will, of
pleasure rather than pain, in the use and withdrawal from the drug.
Crothers noted that no other narcotic made such a pleasing impression
on the brain - it was `a foretaste of an ideal life 1.41 The cocaine
user seemed more of an autonomous, non-medical personality than the
morphinist or opium addict; and the medical response was harsh.
Treatment methods retained a punitory aspect after cocaine had been
abandoned for morphine addiction. Abrupt and immediate withdrawal was
more generally acceptable for cocaine. Numbers of users were in any
case small, and few underwent treatment, since the cocaine addict was,
like the morphine injector, not covered by the terms of the Inebriates
Acts.
But the non-medical cocaine user was quite a rarity at the
turn of the century. Recreational cocaine use was spreading in the
United States and Europe in the 1890s. In England, it was cannabis and
opium smoking which were favoured. Cocaine was apparently confined to
even more limited circles. Conan Doyle's famous (and often-quoted)
portrayal of Sherlock Holmes's use of the injected drug - the `7 per
cent solution' - was indicative more of the medical use of it which
Conan Doyle (and through him, Watson), as a doctor himself, had
encountered. It was noticeable, too, that references to the great
detective's use of cocaine (and possibly morphine, too) became steadily
more disapproving as time went on. In A Scandal in Bohemia (1886), at a
time when cocaine was still in favour as a 'wonder-drug', and in The
Man with the Twisted Lip, in the following year, Holmes's use of the
drug was treated with a certain amount of levity. Holmes, according to
Watson, was `alternating from week to week between cocaine and
ambition.. .'. But through The Five Orange Pips, The Yellow Face and
The Sign of Four, Watson's attitude grew steadily more disapproving,
until in The Missing Three-quarter (1896) Holmes himself could refer to
the hypodermic syringe as `an instrument of evil', while Watson spoke
of a `drug mania' which had threatened his friend's career. Conan
Doyle's portrayal of his character's cocaine use was a good indication
of changed medical attitudes to the drug; but it was no index of
recreational cocaine use. 48
In America at this period, such use was
spreading down through the social scale; cocaine was becoming a drug
with a dubious social reputation. There was less of this in England.
Lower-class usage was not at all noticeable until the First World War
.49 There was less of a domestic `scene' at this time. The drug use of
Aleister Crowley and of his friend and mentor, Allan Bennett, are
perhaps the only examples of self-conscious recreational cocaine use in
the 1890s. Crowley, at this time living in Chancery Lane, with Bennett,
who had been trained as an analytical chemist, was initiated to the
Order of the Golden Dawn in 1898. Both men experimented with many
drugs, cocaine among them, at this time. Crowley later wrote of
Bennett, who suffered acutely from asthma, that `his cycle of life was
to take opium for about a month, when the effect wore off, so that he
had to inject morphine. After a month of this he switched to cocaine,
which he took until he began to "see things", and was then reduced to
chloroform.' It was Bennett's wholehearted devotion to the
consciousness-expanding potential of drugs (he later became a Buddhist
monk in Ceylon) which led Crowley to a life-long advocacy of their use,
especially cocaine and heroin, in the pursuit of ritual and sexual
magic.50 Crowley apart, the cocaine `scene' was almost non-existent.
References
1.
Details of the several varieties and products of the plant are in A. B.
Garrod and E. B. Baxter, The Essentials of Materia Medica and
Therapeutics (London, Longman, 9th edn 1882), pp. 360-62; and
'Preparations of Indian Hemp', Pharmaceutical Journal, 3rd ser. 4
(1873-4), pp. 696-7. For its early history, see I. Hindmarch, `A social
history of the use of cannabis sativa', Contemporary Review (1972), PP.
252-7; and T. Brunner, `Marijuana in ancient Greece and Rome? The
literary evidence', Bulletin of the History of Medicine, 47 (1973), PP.
344-55.
2. J. P. Dolan, `A note on the use of cannabis sativa in the
seventeenth century'. Journal of the South Carolina Medical
Association, 67 (1971), PP. 424-7
3. Quoted in R. Hunter and I.
MacAlpine, Three Hundred Years of Psychiatry 1S35-1860 (O.U.P., 1963),
pp. 216-17; F. A. Fluckiger and D. Hanbury, Pharmacographia. A History
of the Principal Drugs of Vegetable Origin, Met With in Great Britain
and British India (London, Macmillan, 1879), PP. 547-8.
4. H.
Godwin, `The ancient cultivation of hemp', Antiquity, 41 (1967), pp. 42
and 137-8, examines evidence for the cultivation of the drug. See also
E. Porter, op. cit., pp. 44-5 and 375, and Notes and Queries, 181
(1941), P. 119.
5. See, for instance, 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 (Dublin, W. Curry and W. Carson, 1838), p. 115.
6. His
career is described in J. B. Moon, `Sir William Brooke O'Shaughnessy -
the foundations of fluid therapy and the Indian telegraph service', New
England Journal of Medicine, 276 (1967), pp. 283-4.
7. W. B.
O'Shaughnessy, `On the preparations of the Indian hemp, or gunjah;
their effects on the animal system in health and their utility in the
treatment of tetanus and other convulsive diseases', Transactions of
the Medical and Physical Society of Calcutta, 8 part 2 (1842), pp.
42161. O'Shaughnessy's work was also noted in the British medical press
in 1839, e.g. W. B. O'Shaughnessy, `New remedy for tetanus and other
convulsive disorders', Lancet, 2 (1839-40), P. 539.
8. W. B. O'Shaughnessy (1839-40), op. Cit.
9.
P. Squire, A Companion to the Latest Edition of the British
Pharmacopoeia (London, J. and S. Churchill, 11864), P. 45. Society of
Apothecaries Laboratory mixture and process book, 11868-72, op. cit.,
Ms. 8277. The Society was making extract of cannabis in 1868 and both
extract and tincture in 1871.
10. Pharmaceutical journal, 6 (1846-7), pp. 70-72.
11.
J. Russell Reynolds, `On some of the therapeutical uses of Indian
hemp', Archives of Medicine, 11 (i861), pp. 154-60; and J. Russell
Reynolds, ed., A System of Medicine, op. cit., vol. 2, pp. 88, 91, 749,
vo1. 5, P. 74o.
12. See, for instance, its recommendation in R.
Greene, `Cannabis indica in the treatment of migraine', Practitioner, 9
(1872), pp. 267-7o; F. F. Bond and B. E. Edwards, `Cannabis indica in
diarrhoea', ibid., 39 (1887), pp. 8-10; and R. Greene, `The treatment
of migraine with Indian hemp', ibid., 41 (1888), pp. 35-8.
13. J. B. Mattison, `Cannabis indica in the opium habit', Practitioner, 35 (1885), P. 58.
14.
This also led through the collaboration of Moreau and Theophile Gautier
to the foundation of the Club des Haschischins for the nonmedical
experimental use of the drug. See P. Haining, ed., The Hashish Club
(London, Peter Owen, 1975), vol. I.
15. T. S. Clouston,
`Observations and experiments on the use of opium, bromide of
potassium, and cannabis indica in insanity, especially in regard to the
effects of the two latter given together', British and Foreign Medico-
Chirurgical Review, 46 (1870), PP. 493-511, and 47 (1871), pp. 203-20.
16. H. Maudslcy, `Insanity and its treatment', Journal of Mental Science,
17
(I87I-2), pp. 3111-34. See also T. W. McDowall, `Cases in which mental
derangement appeared in patients suffering from progressive muscular
atrophy', ibid., r8 (1872-3), p. 39o.
17. W. W. Ireland, `On thought
without words, and the relation of words to thought', Journal of Mental
Science, 24 (1878-9), p. 429.
18. Reported in P.P. 1893-4, LX V I:
East India (Consumption of Ganja), pp. 88, 158-62; see also J. H. Tull
Walsh, `Hemp drugs and insanity', Journal of Mental Science, 40 (1894),
pp. 21-36; also pp. 107-8. See also British Medical Journal, 2 (1893)
pp. 630, 710, 813-14, 868-9, 920, 969, 1027, 1452.
19. Indian Hemp
Commission. For an analysis of its conclusions, see O. J. Kalant,
`Report of the Indian Hemp Drugs Commission, 1893-94 a critical
review', International Journal of the Addictions, 7 (I) (1972), PP.
77-96.
20. Quoted in T. S. Clouston, `The Cairo Asylum : Dr Warnock
on hashish insanity', Journal of Mental Science, 42 (1896), pp. 79o-95.
21.
C. R. Marshall, `The active principle of Indian hemp', Lancet, r
(1897), pp. 235-9. There were further attempts at this in the early
1900s, surveyed in Pharmaceutical Journal, n.s. 15 (19o2), pp. 1129-32
and 171.
22. W. E. Dixon, `The pharmacology of cannabis indica', British Medical Journal, 2 (1899), pp. 1354-7.
23.
R. B. Litchfield, Tom Wedgwood, The First Photographer (London,
Duckworth, 19o3), p. 1135; and J. Cottle, Reminiscences of Samuel
Taylor Coleridge and Robert Southey (London, Houlston and Stoneman,
1847), P. 463.
24. Cannabis use among this circle is more fully
described in V. Berridge, op. cit.; see also S. Levenson, Maud Gonne
(London, Cassell, 1976), pp. 80-81 and 85; V. Moore, The Unicorn.
William Butler Yeats' Search for Reality (New York, Macmillan, 1954) P.
25; A. Symons, Studies in Prose and Verse (London, J. M. Dent, 1964),
p. 265; H. H. Ellis, `Mescal: a new artificial paradise', Contemporary
Review, 73 (1898), pp. 130-47. The painter Augustus John describes some
of his drug-taking experiences in this artistic milieu in A. John,
Chiaroscuro (London, Jonathan Cape, 1952), pp. 177-9.
25. Quoted in
W. Golden Mortimer, History of Coca, `The Divine Plant' of the Incas
(1st edn 1901; San Francisco, Fitz Hugh Ludlow Memorial Library edn,
1974), pp. 26-7.
26. For details of the early scientific evaluation
of the coca leaf, see R. Ashley, Cocaine: Its History, Uses and Effects
(New York, St Martin's Press, 1975), PP. 4-6; W. R. Bett, `Cocaine,
divine plant of the Incas. Some pioneers - and some addicts',
Alchemist, 21 (1957), pp. 685-9; `Cocaine', Chambers' Journal, 63
(1886), p. 145.
27. L. Grinspoon and J. B. Bakalar, Cocaine. A Drug and its Social Evolution (New York, Basic Books, 1976), pp. 19-2o.
28. F. E. Anstie (1864), op. cit., p. 144.
29.
A. H. Bennett, `An experimental inquiry into the physiological actions
of theine, guaranine, cocaine and theobromine', Edinburgh Medical
Journal, r9 (1873), PP. 323-41; see also `The physiological action of
coca', British Medical journal, 1 (1874), p. 510.
30. For example,
E. H. Sieveking, `Coca, its therapeutic use', British Medical Journal,
r (1874), p. 234; A. Leared, `The use of coca', ibid., p. 272; J. A.
Bell, `The use of coca', ibid., p. 305.
31. Weston's use of the drug
was reported in British Medical Journal, 1 (1876), pp. 271, 297-8,
334-5, and Lancet, r (1876), pp. 447, 475
32. R. Christison,
`Observations of the effects of the leaves of erythroxylon coca',
British Medical Journal, 1 (1876), pp. 527-31.
33. G. Dowdeswell, `The coca leaf, Lancet, r (1876), pp. 631-3, 664-7.
34. 'Cuca for bashfulness', Doctor, 7 (1877), p. 113; `A new use for Coca', Lancet, 2 (1876), p. 449.
35.
For Freud and cocaine, see W. R. Bett, op. cit., pp. 685-9; W. Golden
Mortimer, op. cit., pp. 413, 428; L. Grinspoon and J. B. Bakalar, op.
cit., pp. 32-3; R. Ashley, op. Cit., pp. 21-8; and C. Koller,
`Historical notes on the beginning of local anaesthesia', Journal of
the American Medical Association, go (1928), pp. 1742-3; S. Freud, The
Cocaine Papers, R. Byck, ed. (New York, Stonehill, 1974), reprints
Freud's writings on cocaine.
36. W. F. van Oettingen, `The earliest
suggestion of the use of cocaine for local anaesthesia', Annals of
Medical History, n.s. S (1933), PP. 2758o.
37. This sequence of
events is reported in many sources, e.g. B. P. Block, `Cocaine and
Koller', Pharmaceutical Journal, 18o (1958), p. 69; C. Koller (1928),
op. cit., pp. 1742-3; H. K. Becker, `Carl Koller and cocaine',
Psychoanalytic Quarterly, 32 (1963), PP. 3o9-73; and G. Sharp, `Coca
and cocaine studied historically', Pharmaceutical journal, r (19o9),
pp. 28-30.
38. Reported in British Medical journal, 2 (1888), p. 1344, and 2 (1894), p. 1052.
39. `Coca pastils', Lancet, 2 (1884), p. 1078.
40. Advertisement in Everybody's Pocket Cyclopaedia (London, Saxon, 1893).
41. See, for example, R. Hutchison, `Patent medicines', British Medical Journal, 2 (19o3) P• 1654.
42. British Medical journal, r (1885), p. 1183.
43.
'Cucaine habit and cucaine addiction', British Medical journal, I
(1887), p.1229; A. Erlenmeyer, `Cocaine in the treatment of
morphinomania', Journal of Mental Science, 3r (1885-6), P.. 427.
44. A. Erlenmeyer, `The morphia habit and its treatment', ibid., 34 (1888-9), p. 116.
45. Halsted's dependence on cocaine was in fact translated to a physical addiction to morphine.
46.
N. Kerr (1889), op. cit., p. 122; T. S. Clouston (189o), op. cit., pp.
18o6-9; W. Lawton, `Stimulants and narcotics and their users and
abusers', Pharmaceutical Journal, I (19o8), pp. 268-9, 544-6 and 56970.
47. T. D. Crothers, op. Cit., p. 282.
48. Cited in A. Conan Doyle, The Complete Sherlock Holmes Short Stories (London, John Murray, 1928, 1976 reprint).
49.
V. Berridge, `War conditions and narcotics control: the passing of DO
RA Regulation 40B', journal of Social Policy, 7 (1978), pp. 285-304
50.
A. Crowley, The Confessions of Aleister Crowley, ed. J. Symonds and F.
Grant (London, Jonathan Cape, 1969), p. 18o, and J. Symonds, The Great
Beast. The Life and Magick of Aleister Crowley (London, Macdonald,
1971), pp. 17, 23-4.