Introduction
The
most acute anxieties of the 1960s `drug epidemic' have quietened. Drug
stories appear less often, and more prosaically, in the newspapers. Yet
attitudes towards the use of `dangerous drugs', and `narcotics'
in particular, remain restrictive. The legislative control of drugs and
public reactions to their use is more stringent than the restrictions
on those other recreational substances, tobacco and alcohol. The Misuse
of Drugs Act (1971), the latest of a long line of `Dangerous Drugs'
Acts, continues the practice of control through fines and imprisonment
under the aegis of the Home Office. Since 1968, heroin and cocaine have
been available to addicts only through treatment clinics, where doctors
licensed by the Home Office may prescribe.(1) For other `recreational'
substances, the system of control is much less stringent. For alcohol,
the equivalent's, are the liquor licensing laws, the duty on whisky and
the sale of alcohol in pubs and supermarkets. For tobacco, they
are the health warnings on cigarette packets and the no-smoking
carriages in trains. The contrasts in reaction are instructive.
Regulations
and legislation applicable specifically to `dangerous drugs' were not
passed until the early decades of the twentieth century. The 1916
Defence
of the Realm Act regulation 40B dealing with cocaine and
opium and the 1920 Dangerous Drugs Act were the first legislative
measures to establish narcotics as a matter of social policy.(2)
But it was in the previous century that the basesof control were laid
down, and new and restrictive ways of looking at opium established.
The nature of the drugs(3)
This
book is concerned with the factors involved in that process, with the
advent of legislative control over opium in the nineteenth century,
with the growth of a view of opium as a `deviant' activity and with the
factors which went to make it so. But first it is necessary to be armed
with some basic knowledge of the pharmacological, therapeutic and
addictive properties of opiates and of some other drugs. The paragraphs
which follow attempt to compress a lot of the relevant science into a
short space. The aim is not to produce a scientific section of
pharmacology, but to deal specifically with issues which are relevant
to an understanding of social reactions and perplexities. And although
more is known about these scientific issues than a century ago, it must
of course be bornein mind that current concepts are no more final than
the nineteenth-century ideas which were their predecessors.
A simple classification
To
anyone who has no specialized knowledge, the great variety of
substances which act on the mind create a rather bewildering situation.
Is every drug different or is there some simple way of grouping these
substances? There is in fact a simple classification which can help to
guide one through the seeming complexities there are just four
different basic categories of mind-acting drugs.
1. Opiates.
Opiates (or opoids in the American phrase) are drugs of the morphine
type, which have the common property of relieving pain and inducing
euphoria. Opium is of importance because of the opiates it contains.
2.
Cerebral stimulants. This group includes cocaine, a drug which came
into the story during the latter part of the nineteenth century.
Amphetamines are the familiar present-day representative of the
stimulants. These drugs cause excitement and increased mental and
physical energy. They can give rise to brief psychotic illness.
Although there are no remarkable physical withdrawal symptoms, the
stimulants can be highly addictive.
3. Cerebral depressants. Here
can be grouped together a variety of substances which have the common
property of inducing sedation and sleepiness : there may also be
disinhibition so that the drug appears to be causing stimulation and
excitement. Alcohol provides a prime example. In the latter part of the
nine-teenth century, chloral, a synthetic depressant, began to enjoy a
vogue and gave rise to problems of misuse.
4.
"Psychomimeticsubstances, or hallucinogens. Cannabis is probably best
placed in this group, although it also has depressant properties.
Mescaline is another member of the group, which became known in England
during the nineteenth century, while LSD is the well-known modern
example. Members of this group have the capacity to induce complex
changes in the way the world is perceived and given meaning -
experiences which are in short described as transcendental. Acute
psychotic disturbances may also result.
Thus the nineteenth
century was engaging with a range of drugs which nicely represented the
complete spectrum of drug types - opium as the source of opiates,
with
morphine and heroin later added, alcohol as the pervasive depressant
and chloral as the new medical substance, cocaine as the first
encounter of this society with a powerful stimulant, cannabis as a
psychomimetic which received quite a lot of attention and mescaline as
an exotic.
Cocaine and cannabis
As
we have seen, these two very different drugs made an appearance in
nineteenth-century history, and they will receive some attention in
this book. Their importance was, however, very minor compared with the
opiates, and here it seems appropriate to dispose of questions relating
to their pharmacology and their place in therapeutics very briefly. The
coca leaf comes from a shrub known as Erythroxylon coca, which grows in
Peru and other parts of South America. When chewed it can be used as a
stimulant, and it is still widely used in the Andes for this purpose.
Cocaine is the alkaloid obtained from the leaves of the coca bush, and
was first isolated by Niemann in 1860. It is a white powder which can
be sniffed, or dissolved and injected. Medically it had its importance
as a very effective surface anaesthetic.
Cannabis is the general
term used to describe the various products of the plant Cannabis
sativa. The major natural products are known by many names in different
parts of the world, but consist primarily of two types of material -
the resinous exudation of the flowering top and leaves, often known as
hashish; and the material derived by chopping the leaves and stalks,
collectively called marijuana. The activity of both is largely due to a
tetrahydrocannabinol, or T.H.C. In the nineteenth century, cannabis or
its extracts enjoyed some medical popularity for their analgesic and
sedative effects.
Opium, opiates and their preparations
For
many of the remedies which make up the doctor's armentarium the history
of therapeutics is firstly that of a plant product with medical use
going back for thousands of years. Then follows the isolation, chemical
identification and extraction in the nineteenth century, or sometimes
as late as the twentieth, of the therapeutically active ingredients of
that plant. The final stage of development may then be the production
and marketing of a synthetic drug identical with the natural product,
or of a drug with alterations in chemical structure which result in a
substance which in some way improves on nature - the synthetic may for
instance be more potent than the original plant extract, or have fewer
untoward effects. The pharmacological history of opium and opiates
provides an example of this type of general technological sequence.
Opium
is the plant product. Its effects on the human mind have probably been
known for about 6,000 years, and it had its early and honoured place in
Greek, Roman and Arabic medicine.
Opium is the name given to the
brown tacky substance which is obtained after drying the milky exudate
which oozes when the poppy capsule is incised. The original plant
material yielded a crude substance containing all kinds of organic
material and extraneous matter. Crude or not, it was this material
which, eaten, made up into a drink or smoked, provided the drug in
effective form over the millennia, and it was still only in this
traditional plant form that the drug was available at the start of the
nineteenth century.
The opium poppy - the species cultivated for
opium production - is Papaver somniferum, a white poppy growing to a
height of certain other varieties of this plant. The poppy is, or has
been, grown chiefly in Asia Minor, China, Iran and some Balkan
countries.
In the nineteenth century, many preparations based on
opium, or patent remedies with opium as their active ingredient, were
to be found listed in textbooks and on sale. Among the best known and
most widely used were : laudanum, otherwise known as tincture of opium,
made by mixing opium with distilled water and alcohol; paregoric, or
camphorated tincture of opium ('paregoric' is derived from the Greek
word for `soothing' or `consoling'); Battley's Sedative Solution, known
officially as `liquor opii sedativus', opium mixed with calcium
hydrate, alcohol, sherry and water; Dover's Powder, a preparation first
made and used by Dr Thomas Dover and consisting of opium, saltpetre,
tartar, liquorice and ipecacuanha. Although a patent preparation,
Dover's Powder was widely used in hospital practice in the nineteenth
century. Chlorodyne was the best known of the opium-based patent
medicines. It was originally made up by Dr John Collis Browne and
marketed by J. T. Davenport of Great Russell Street, London. Its main
constituents in the nineteenth century were chloroform and
hydrochlorate of morphia, although some analysts also detected a small
quantity of Indian hemp. Godfrey's Cordial was a `children's opiate',
made according to various recipes, but based on laudanum. Other
children's soothing syrups included Mrs Winslow's Soothing Syrup,
Atkinson's Infants' Preservative, and Street's Infants Quietness.
The
active therapeutic principle in many plant medicines has the chemical
structure of an alkaloid. Morphine (or morphia) was the first alkaloid
to be isolated. It was named after Morpheus, the god of sleep. Many
other alkaloids of opium were later identified, but those other than
morphine which are of medical interest are few in number, and include
codeine, as well as the much less popularly familiar substances
thebaine, papaverine and noscapine.
The next stage in technology was
in this instance not development of a synthetic, but what is called a
semi-synthetic - a substance produced by a chemical process which,
taking a natural alkaloid as starting point, modifies in some way the
structure of the original substance. Taking morphine as the starting
point, a potent semisynthetic which can be produced by a remarkably
simple chemical process is heroin. Heroin was first produced in 1874 at
St Mary'sHospital in London. It was rediscovered in Germany in the
1890s and marketed by Bayer under the trade name heroin. This probably
derived from the German 'heroisch', or large and powerful in medical
terminology. It was not used in medical practice in England in the
nineteenth century. Weight for weight, heroin is several times as
powerful in its drug action as morphine. There have subsequently been
developed a host of fully synthetic opiates - drugs such as methadone
and pethidine - but these play no part in the nineteenth-century story.
Actions of opiates
Opiates
can produce a great, variety of effects which will be modified by
expectation, but of prime importance to medicine is their ability to
relieve pain. Any young medical student who sees for his first time the
acute relief which an injection of morphine can bring about when, say,
a person with a badly broken leg is brought into an Accident Department
must have a sense of being in the presence of something almost magical.
Very severe pain is brought rapidly under control, and from being in a
state of agony and apprehension the patient is calm and at ease.
Opiates are used in daily practice throughout the world for trauma and
accident, for the relief of post-operative pain, in childbirth, and for
the control of the pain of advanced cancer and some other very painful
conditions. The difference here between the present and the nineteenth
century is that, though they are still essential drugs for relief of
pain (it is almost impossible to think of medical practice without the
availability of opiates), these drugs are now used almost exclusively
by doctors and, by them, much more conservatively and with stricter
criteria for their deployment and dosage. Today opiates are, for
instance, not drugs to be prescribed or self-prescribedfor toothache or
for ordinary menstrual pain - aspirin and similar non-narcotic
analgesics do that sort of job adequately and without the same dangers.
But aspirin was not introduced until 1899, and the popularity of
opiates for all manner of pain relief in the nineteenth century can be
seen in one sense as related to lack of any alternative.
Closely
allied to the pain-relieving effect of opiates is their ability to
influence mood. This effect is again a property of great value to
medicine and very much the therapeutic ally of the pain-relieving
effect; even when the severe pain of a spreading cancer is not fully
abolished by the drug injection, the mood effect can make the residual
pain more tolerable and generally produce a lessening of emotional
distress. The patient is in a way emotionally distanced from what is
happening, and floats as it were on the surface of his experience. The
drug has a euphoric effect. It is difficult to describe a complex
feeling in precise words, but the tranquil pleasantness of this
experience can be very positively enjoyable. This effect is not exactly
equivalent to sedation, for neither do the opiates bring about the type
or degree of drowsiness that barbiturates produce, nor do the
barbiturates produce the same type of euphoria as the opiates. The
euphoric effect of opium is what was meant by the nineteenth-century
term the `stimulant' use of the drug. As we have seen, opiates are in
present terminology not classified as stimulants, and to apply this
word to a class of drugs which produce drowsiness and passivity today
seems rather bizarre. The word obviously had a different connotation in
the last century, and may be taken as broadly meaning the
pleasure-seeking use of the drug. In general the effects of the
opiates, like those of any other drug, can vary enormously according to
the expectation of the user and setting in which the use takes place.
Opium
and the opiates are also sometimes classified, along with other drugs,
as narcotics. Technically narcotic drugs are those which have a
sedative and sleep-inducing effect. The description of opium's
pain-relieving and mood-altering effects already given indicates that
this `narcotic' designation is not wholly accurate. The term `narcotic'
has also been applied in control legislation to drugs like cannabis and
cocaine which do not have any true family resemblance to the opiates,
and the word might indeed be seen as something of a vehicle of
confusion. So much then for a brief account of the two medically most
important actions of opiates - pain relief and mood effect. The
pharmacological element in the history of nineteenth-century opium use
can largely be seen in terms of the history of these two attributes of
the drug: the history of a pain reliever which had no rival or
substitute ,and of an euphoriant and tranquillizer with a usage which
was in part `medical' but which easily crossed over the borderline to
what was then termed the `stimulant' use of the drug. These two
aspects, pain relief and mood alteration, are thus the essential and
primary pharmacological themes for understanding the nature of the
actual drug with which society was dealing. They are the fundamental
attributes of the drug which proposed its use and brought reacting
social processes into play, and this whether it was the story of
`infant doping', the use of opium by Romantic poets and Fenland
labourers, the enormous and uncontrolled sale of opium as a popular
remedy, or the medical utility of the drug.
Opium before the nineteenth century 4
A
knowledge of the utility of opium was not, of course, confined to the
nineteenth century, or even particularly novel at that time. The
properties of the drug, and its use as a `stimulant' and in dealing
with pain, had already been widely known for many centuries. References
to the juice of the poppy occur in the Assyrian medical tablets of the
seventh century B.C., and in Sumerian ideograms of about 4000 B.C. the
poppy is called the `plant of joy'. Mesopotamia saw the growth of the
opium poppy, and in both Egypt and Persia doctors treated patients with
opium from at least the second century B.C. In fragments of the
veterinary and gynaecological papyri and in the Therapeutic Papyrus of
Thebes of 1552 B.C., opium is listed among other drugs medically
recommended. From Egypt, growth of the poppy plant spread to Asia Minor
and from there to Greece. Descriptions by Theophrastus and Dioscorides
show that the toxic effects of the drug were already well-known. Even
the famous nepenthe of Helen is likely to have been an opium draught.
Homer states in the Odyssey that when Telemachus visited Menelaus in
Sparta and memories of the Trojan war and the death of Ulysses made
them depressed and tearful, Helen brought them as a drink a drug
dissolved in wine which had the power to bring `forgetfulness of evil'.
Although the effects of the drink have been attributed to hashish
rather than to opium, Helen's draught seems to have produced the
euphoria of opium rather than the excitement of the other drug. Roman
medicine was as familiar with opium. Galen was enthusiastic about the
virtues of opiate `confections' or mixtures, and Virgil mentioned it as
a soporific both in the Aeneid and in the Georgics. It was so popular
in Rome that, as in nineteenth-century England, it was sold by ordinary
shopkeepers and itinerant quacks. The Arab physicians used opium
extensively, writing special treatises on its preparations; Avicenna
himself, who recommended it especially for diarrhoea and diseases of
the eye, is said to have been an opium addict or at least to have died
from an overdose of the drug. Arab traders spread the use of opium over
a much wider area - to Persia, India and China. When they penetrated
into the eastern part of the Roman Empire - into Egypt, North Africa
and Spain - they took opium with them. During the Mohammedan conquest
of the tenth and eleventh centuries, the opium trade was firmly
established in Europe, and returning Crusaders, too, brought back
knowledge of the Arabs' use of thedrug.
By the sixteenth century at
least, then, opium was well established in Western European medicine.
The famous German physician Philippus Aureolus Theophrastus Bombast von
Hohenheim, better known as Paracelsus (1490-1540), owed much of his
success to the way in which he administered opium to his patients. He
is said to have carried opium in his saddle pommel and to have called
it the `stone of immortality'. His followers were as enthusiastic:
Platerus of Basle strongly recommended it in 1600, and Sylvius de la
Boe, a well-known Dutch physician, declared that without opium he could
not practise medicine. In England the drug had early been used, chiefly
for its narcotic properties. In the middle of the fourteenth century
John Arderne used salves and elixirs containing opium to procure sleep
and also apparently, externally applied, as a form of anaesthetic
during operations : `he schal slepe so that he schal fele no
kuttyng...'. The drug's soporific and narcotic qualities reappear in
Chaucer's Canterbury Tales and in Shakespeare, in particular in the
famous passage from Othello:
Not poppy, nor mandragore,
Nor all the drowsy syrups of the world,
Shall ever medicine thee to that sweet sleep
Which thou ow'dst yesterday.
Bullein's
Bulwarke of Defence against all Sicknesse, Soarenesse and Woundes of
1579 likewise recommended the white poppy, which 'hath all the
vertues', and
opium made from the black poppy, `which is cold and
is used in sleeping medicines : but it causeth deepe deadly sleapes'.
The stock-in-trade of a Lancashire apothecary of the same period had
its half ounce of opium (valued at sixpence).
Opium was to be found
too in the four great standbys of the medicine of that period:
mithridatum, theriaca, philonium and diascordium. The last-named, a
product of the early sixteenth century, mentioned among its principal
ingredients cinnamon, cassia wood, scordium, dittany, galbanum, storax,
gum arabic, opium, sorrel, gentian, Armenian bole, Lemnian earth,
pepper, ginger and honey. Such preparations remained popular as general
palliatives and antidotes, but opium was used more specifically, too.
It was Paracelsus who first used the term laudanum to describe an
efficacious opium compound, but his was probably in solid pill form.
The alcoholic tincture which is now known as laudanum was originated by
the English physician Thomas Sydenham in the 1660s. Sydenham's
enthusiasm for the drug is well-known and his praise unstinting:
...here
I cannot but break out in praise of the great God, the giver of all
good things, who hath granted to the human race, as a comfort in their
afflictions, no medicine of the value of opium, either in regard to the
number of diseases it can control, or its efficiency in extirpating
them ... Medicine would be a cripple without it; and whosoever
understands it well, will do more with it alone than he could well hope
to do from any single medicine.
With this widespread use of
opium, addiction was known, but quite rarely discussed and generally
calmly accepted. Thomas Shadwell, the Restoration dramatist and
poet, was an opium addict whose habit was a matter for jest rather than
concern. Shadwell was the subject of Dryden's MacFlecknoe, the Prince
of Dullness, who `never deviates into sense'. But neither Dryden nor
Tom Brown, who wrote a mock epitaph on Shadwell, considered him in the
modern terminology of addiction, nor did they apparently consider his
use of opium had any effect on him or his readers:
Tom writ, his readers still slept o'er his book,
For Tom took opium, and they opiates took.
In
general, the reaction to sustained opium use at this time was calm, and
indeed the subject was rarely discussed. Dr John Jones's Mysteries of
Opium Reveal'd, published in 1700, was one of the earliest books
specifically to treat addiction, but its tone was not hysterical. In
fact Jones, although listing unpleasant physical and mental symptoms
from excessive doses, was also inclined to emphasize the pleasurable
aspects of opium use, those which the nineteenth-century writers might
have termed its `stimulant' effects. After taking opium, '... if the
person keeps himself in action, discourse or business, it seems
... like a most delicious and extraordinary refreshment of the spirits
upon very good news, or any other great cause of joy ... It has been
compared (not without good cause) to a permanent gentle degree of that
pleasure which modesty forbids the name of ...' Medical authors, too,
in the eighteenth century, such as George Young in his Treatise on
Opium published in the 175os and Dr Samuel Crumpe in his Inquiry into
the Nature and Properties of Opium of 1793, stressed the main features
of addiction and the possibilities of withdrawal, but with no sign of
moral condemnation or alarm. Crumpe himself reported that he had taken
opium frequently and had experienced its euphoric effects.
Nevertheless, the majority of descriptions at this time still saw opium
eating or smoking as a peculiarly Eastern custom. In Dr Russell's
History of Aleppo for instance, or the tales of Baron de Tott, the
Eastern opium eater was a regular feature of the travellers' tales of
the period, an object of interest and wonder, but not of condemnation.
Opium and history
At
the opening of the nineteenth century, then, doctors and others still
thought of opium not as dangerous or threatening, but as central, to
medicine, a medicament of surpassing usefulness which undoubtedly,
found its way into every home. It is with the way in which these
attitudes changed and the restrictions placed on opium use during the
course of the nineteenth century that the rest of this book will deal.
These historical roots of contemporary events have already attracted a
certain amount of attention. The `drug consciousness' of the 196os was
in particular marked by an interest in historical material which could
provide `relevance' for the contemporary debates. Often this was quite
superficial. A reference to the mid-nineteenth-century opium wars, or a
mention of De Quincey's Confessions of an English Opium Eater, did duty
as historical input to the debate. This interest in the historical
dimension was particularly noticeable in the United States. The
discussions which took place there in the 1960s over the direction
which American drug-control policy should take were marked by continual
references to, and analyses of, the past. The struggle to graft disease
ideas of addiction, the view of the addict as a patient rather than a
criminal, on to a policy which still stressed a penal approach
established in the 1920S was rooted in historical as well as scientific
and medical discussion. Detailed and valuable work was done on the
historical roots of American narcotic policy. 5 The historical
background was used as a vantage point from which to criticize current
American policy. In the work of the anti-psychiatrist Thomas Szasz,
perhaps the best-known exponent of such views, historical material was
used to criticize both penal and medical approaches to drug control.
Szasz's Ceremonial Chemistry (1975) argued that heroin and marijuana
are different from alcohol and tobacco not for chemical but for
ceremonial reasons and put forward a view of medicine as social
control, not an agent of progress .6
To any historian, the
deficiencies of many such polemical approaches are obvious. The lack of
a certain socio-cultural or class perspective in Szasz is notable.
Easily accessible historical examples from a variety of cultures and
social structures have often been a substitute for a more rigorously
researched analysis of drug use in a particular society. In another
sense, too, the history of narcotics has been misused in the
contemporary debates. There has been a tendency to read the
preconceptions and values of the present too directly into the past. A
recent study of the historical origins of social policy makes very much
this point. Matters have been looked at `through the wrong end of the
telescope; taking insufficient account of the difficulty of
understanding past events in the very different context of their
time'.7 Those concerned with present policy have been too intimately
involved with the assessment and selection of material from the past.
Facts and opinions to a large extent divorced from their historical
context have been used to provide `relevance'. Narcotic history has
been used in a mechanistic way to justify particular departures in
policy or specific ways of looking at drugs. The statistics of the past
have been quoted in comparison with those of the present with little
realization of the pitfalls of historical data, the very different
cultural and social situations of drug use in historically distant
societies.
Writers on opium and other narcotics, seeing a problem of
contemporary drug use, have discussed opium in the past within the same
problem framework. But what most needs analysis is not the dimensions
of a problem - the statistical and epidemiological approach has spilled
over in historical discussions from its dominance of contemporary
scientific writing on drug use - but the definition of it. It is the
establishment of attitudes and perceptions, of shifts in focus and ways
of looking at drug use which should concern us. The description just
given of opium use before the nineteenth century is an indication of
rather different reactions to opium and its regular use. The
nineteenth-century story makes this differing reaction more explicit.
How did a drug like opium, on open sale in Britain in the early
nineteenth century, its use widespread for what would now be termed
'non-medical' as well as `medical' reasons, come to be seen as a
problem? In the 1850s, opium could be bought in any grocer's or
druggist's shop; by the end of the century, opium products and
derivatives and opium-based patent medicines were only to be found in
pharmacists' shops. Regular opium users, `opium eaters', were
acceptable in their communities and rarely the subject of medical
attention at the beginning of the century; at its end they were
classified as `sick', diseased- or deviant in, some way and fit
subjects for professional treatment. It is these broader questions A
shifts of focus which need explanation, the establishment of a whole
new way of looking at drug use which requires analysis.
An obvious
explanation would lie in the inherently dangerous properties of the
drugs themselves, the obviously profligate way in which they were used
when freely available. This, indeed, is the type of drug-centred
explanation which has often been adopted. The restriction of opium use
has been seen as little more than a public health matter. The public
health issues which concerned nineteenth-century society are considered
in Chapters 7 and 8 of this book, and indeed some accounts of opium use
and restriction have dealt with them alone. The testimony of official
reports and inquiries has been taken at face value rather than analysed
as a product of the values and perceptions of the society of the time.
For drug use must also be considered in relation to its social context;
individual and drug-centred explanations of use and control need
replacement by a consideration of the whole socio-cultural setting in
which such use was established. Most obviously, narcotics have been a
scapegoat for wider tensions within society. There were undoubtedly
problems associated with its open sale. The adulteration of the drug
and the high level of overdosing and mortality from opium were the most
obvious. Even these issues, however, were closely allied with the
social situation of opium users. The large number of deaths from opium
poisoning were the outcome of established popular traditions of
self-medication and the lack of continuing -accessible medical care.
The popular acceptability and utility of opium as an everyday remedy in
such a situation badly needs reconstruction; it has in the past
signally failed to emerge from the concentration on child `doping' and
poisoning.8
The perception of issues like these as part of an opium
`problem' owed more to structural change. The `problem' of opium was,
at various stages in the nineteenth century, seen very much as one of
lower-class use, as Chapter 9 makes plain. Opium use by the working
class was much more likely to be considered problematic than use of the
drug in any other class. The belief in working-class `stimulant' use of
opium helped justify the first restriction on the drug in the 1868
Pharmacy Act. Consumption of chlorodyne - as a patent medicine, a
preparation with much popular utility - brought further control in the
1890s. Fear of the spread of opium smoking among lower-class Chinese in
dock areas encouraged more restrictive attitudes. The question of who
used the drug was central; and the control of lower-class deviance was
undoubtedly important. The problem of opium use was in this sense the
outcome of the class basis of Victorian society. It was in part a
question of social control. Despite recent criticism of the unthinking
overall application of this concept, control of lower-class usage of
opium was at certain stages in the nineteenth century a clear aim in
the formulation of legislation.9
The changed perception of opium and
its use also demonstrated the establishment blishment of the
ideological and practical dominance of opium use by the medical and
pharmaceutical professions, the former in particular. The medical
profession was in the process of legitimizing its own status and
authority; opium was translated into a problem in the process. In a
practical sense, this was achieved by professional controls over
availability and use, as discussed in Chapters 10 and 11. The
restrictions of the 1868 Act the 'professionalization' of the sale of
patent medicines, the curbs on prescriptions - were part of the
establishment of a professional elite. Controls symbolized the
substitution of a new view of opium use for the popular culture which
had hitherto existed. It was notable, too, how the profession, in
helping to forge a problem out of opium use, concentrated attention
where it was least needed in objective terms. Once the 'stimulant'scare
was over, working-class use was largely ignored. Instead as Chapter 12
indicates, doctors concentrated on the question of hypodermic morphine,
where a small number of injecting addicts were magnified by the medical
perspective on the drug into the dimensions of a pressing problem.
The
medical dimension to the `problem' of opium use was more than a case of
professional strategy. There is a danger, in stressing the theme of
professionalization in connection with narcotics, that doctors come to
be seen as some autonomous body, working out their designs on opium in
an isolated way. This is one of the deficiencies of the approaches
which simply stress social control. For in reality the medical
profession merely reflected and mediated the structure of the society
of which it was the product. Social relations lay under the apparent
objectivity of medical concepts and attitudes. This was at its clearest
in the new ideological interpretation of narcotic use which began to be
established in the last quarter of the century. What Michel Foucault
has called `the strict, militant, dogmatic medicalization of
society...', found its expression in the nineteenth century in the
establishment of theories of disease affecting a whole spectrum of
conditions.10 Homosexuality, insanity, even poverty and crime were
reclassifieded in a biologically determined way. Concepts of addiction,
discussed in Chapter 13, of `inebriety' or 'morphinism' in the
nineteenth-century terminology, were part of this process. These
emphasized a distinction barely applied before between what was seen as
`legitimate' medical use and `illegitimate' non-medical use.
They
established an apparently objective system of ideas which in reality
had its foundation in social relations. For the `disease model' of
addiction arose through the establishment of the status of the medical
profession in society. It was formulated by a section of the middle
class, and the model of addiction
thus presented was peculiarly
attuned to the characteristics of addicts of the same status.
Lower-class addicts were notably neglected in disease theory. The
respectable
addicts to whom the theories were most often applied accepted their
provenance; and, at that level, the need for medical intervention was
rarely
questioned. The `problem' of opium use found a major part
of its origin in the establishment of this form of ideological
hegemony. Putting forward individual
rather than social
explanations, it nevertheless proposed the scientific objectivity of
disease views as a means of progress towards greater understanding.
The moral prejudices of the profession were given the status of value-free norms.
This
was never a monolithic process. Many doctors, particularly those in
general practice (as opposed to the expanding numbers of addiction
specialists),
doubted the necessity for treatment and intervention
even if they accepted the conceptual framework of disease. And at the
lower levels of society, opium use
and self-medication was still
quite calmly accepted even at the end of the century. Theories of
disease were in any case rarely applied to the working-class addict;
the response here epitomized in the agitation over chlorodyne in the
189os simply emphasized that the availability of the drug should be
limited. The distinctive ideological shift had nevertheless already
taken place. Drug use was a developing social problem by the end of the
century. Opium was already contolled; certain of its users were
classified as `deviant' or`sick'." The rest of this book will examine
how and why this was the case.
references
1.
P. Laurie, Drugs. Medical, Psychological and Social Facts
(Harmondsworth, Penguin Books, 1974), gives a good introduction to
present-day use of and attitudes towards drugs.
2. The war-time
`emergency' leading to the introduction of the first stringent controls
is analysed in V. Berridge, `War conditions and narcotics control: the
passing of Defence of the Realm Act Regulation 4oB', Journal of Social
Policy, 7, No. 3 (1978), pp. 285-304.
3. This section on the nature of the drugs has been contributed by Professor Edwards.
4.
This section is based, among other works, on C. E. Terry and M.
Pellens, The Opium Problem (Montclair, New Jersey, Patterson Smith,
1970; first published 1928); L. Lewin, Phantastica. Narcotic and
Stimulating Drugs, Their Use and Abuse (London, Kegan Paul, 1931); M.
Goldsmith, The Trail of Opium (London, Hale, 1939); A. Hayter, Opium
and the Romantic Imagination (London, Faber and Faber, 1968); D. Macht,
`The history of opium and some of its preparations and alkaloids',
Journal of the American Medical Association, 64 (1915), PP477-81; and
R. S. France, `An Elizabethan apothecary's inventory', Chemist and
Druggist, 172 (1959) P. 50.
5. For examples of this approach, see D.
Musto, The American Disease. Origins of Narcotic Policy (New Haven and
London, Yale University Press, 1973); and T. Duster, The Legislation of
Morality (New York, Free Press, 1970). B. Inglis, The Forbidden Game. A
Social History of Drugs (London, Hodder and Stoughton, 1975),analyses
English drug use, although his book is not based on any substantial
original research. J. L. Himmelstein, `Drug politics theory : analysis
and critique', journal of Drug Issues, 8 (1978), pp. 37-52, adopts a
usefully critical approach to some of the historical/polemical analyses
of U.S. drug policy.
6. T. Szasz, Ceremonial Chemistry. The Ritual
Persecution of Drugs, Addicts and Pushers (London, Routledge and Kegan
Paul, 1975)•
7. P. Thane, Introduction, pp. 11-20, in P. Thane, ed., The Origins of British Social Policy (London, Croom Helm, 1978).
8.
Seethe paper by E. Lomax, `The uses and abuses of opiates in
nineteenth-century England', Bulletin of the History of Medicine, 47
(1973), pp. 167-76.
9. Social control has been criticized as an
analytical tool because of its associations with functionalism and a
static, not class-antagonistic social model, in particular by G.
Stedman-Jones, `Class expression versus social control?', History
Workshop, 4 (1977), pp. 163-70.
lo. 'M. Foucault, The Birth of the
Clinic. An Archaeology of Medical Perception (London, Pantheon Books
and Tavistock Publications, 1973), p. 32. Anyone working in the area of
medically defined deviance must be influenced by Foucault's ideas and
my debt to him in certain chapters will be obvious.
I1. Earlier
brief surveys of the main issues are in V. Berridge, `Opium and the
historical perspective', Lancet, 2 (1977), pp. 78-80; and V. Berridge,
`Victorian opium eating: responses to opiate use in nineteenth century
England', Victorian Studies, 21, No. 4 (1978), PP. 437-61.
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