opium and the people

the ideology of opium: opium eating as a disease
on the same level dose of the drug, had been accepted unquestioningly even by the earlier medical writers on the
subject. In fact, the whole debate on opium eating and longevity had presupposed the existence of just such a class of
addict. But disease theories encompassed the moderate as much as the uncontrolled addict. Allbutt himself, who had
had a patient who took a grain of opium every morning and evening for the last fifteen years of his life and who was
`never ... so presumptuous as to endeavour to suppress' the habit, nevertheless concluded that `the familiar use of
opium in any form is to play with fire, and probably to catch fire' .26
Views like his were not unquestioningly accepted. Discussion of moderate addicts was conspicuous in debates over the
IndoChinese opium trade; there is evidence that many doctors agreed with the opinion of Dr C. R. Francis in 1882. Dr
Francis quoted the case of a friend who was a stable addict. `Yielding to the popular prejudice against opium-eating,
Mr A. has repeatedly endeavoured to break it off ... Doubtless he would succeed in time, as others have, but cui bono?
He enjoys excellent health, is able to do a good day's work (mental as well as physical), and is entirely free from a
variety of minor troubles having a nervous origin which used to annoy him before he began the opium.'27 Moderate as
much as uncontrolled addicts were equally diseased. Medical intervention was appropriate even if, as many of the case
histories demonstrated, the addict lived a normal life in every other respect.
Disease theories, far from marking a step towards greater scientific awareness and analysis of the roots of dependence
on narcotics, in many respects marked a closing of avenues, a narrower vision than before. The theories themselves
were a hotch-potch of borrowings from developing medical science and established morality. The lack of definition of
the term `addiction' itself emphasized this. Even by the early years of the twentieth century, few specialists cared to use
the term. Dr Huntley did so. Others still used `inebriety', morphinomania, morphinism or opium eating; the morphia
habit and morphia habitues were common. Drug or morphine addiction was not in wider usage until the years before
the First World War. Specialists in inebriety disseminated a confused and illogical series of opinions masquerading as
theory. A continuing belief in free will and individual responsibility coexisted uneasily with the model of disease and
infection which doctors sought to impose. The condition could be self-induced and yet also be the result of hereditary
defect; it was nevertheless somehow still, in medical eyes, a doctor's proper responsibility._ Morality and medical
science should apparently have been at odds; yet disease theory was very much a mixture of the two. The addict's
sickness was mental; his `neurosis' was in effect a deviation from the norms of established society, even though
doctors rigorously excluded the social dimensions of addiction from their own disease formulation.
Disease theory had its effect, too, on methods of treatment. It was, in fact, the elaboration of such medical attitudes to
addiction which, of necessity, entailed a parallel emphasis on control and cure of the addict. In the first half of the
century, in the absence of any developed disease view, the question of treatment had barely been considered, although
Christison and those who saw opium eating as compatible with longevity also saw nothing inhumane in abrupt and
immediate withdrawal 28 Categorization of the condition as a bad habit justified some degree of punishment; and the
continuing moral element in developing disease theories ensured an increased emphasis on abrupt methods. This
originated in the work of the continental experts - Levinstein's description, in his Morbid Craving for Morphia, of the
addict's treatment, confined in a locked and barred room and guarded night and day by (preferably male) wardernurses,
was particularly memorable.29 The abrupt method was originally much favoured by English addiction
specialists; it became known in some circles as the `English treatment'. 30 Ironically enough, those who presumed to
deal with the condition within a framework of greater scientific objectivity and medical progress adopted methods
entailing a fair degree of moral reprobation. The general move to abrupt withdrawal in fact implied a stricter moral
reaction than the earlier treatment regimes. Dr J. Clarke of Leicester, recounting the case a a doctor's wife injecting
twenty grains of morphine a day, from whom he had withdrawn the drug suddenly and abruptly, advised this
procedure, even though the patient herself had wanted gradual withdrawal and had proved `rebellious ... loading me
with invective at each visit, asserting her increasing pain and exhaustion ...'.31 The expanding group of doctors with an
interest in treatment regimes agreed with him; the moral response was nowhere more plainly demonstrated.
Rapid reduction over two or three days was advocated by Erlenmeyer; gradual reduction over a longer period was also
increasingly popular and was associated with Dr J. B. Mattison, Director of the Brooklyn Home for Narcotic Inebriates
in New York, and with Dr Oscar Jennings. The abrupt method was never completely abandoned. In 1910, Dr C. A.
McBride, Superintendent of the Norwood Sanatorium, still considered it `the most satisfactory of all... sh ort, sharp and
decisive'.32 But it was increasingly recognized that such methods were usable only in cases where the habit was of
recent origin, or the addict young and strong enough to bear them. Rapid, semi-rapid or gradual methods were more
popular; and drug treatments widely used. Other disease entities involved drug regimes; and the search for a
pharmacological antidote to the addiction disease was also under way. Addiction was often still seen in the medical
texts as a form of poisoning -'acute poisoning' described accidental or conscious overdosing, `chronic poisoning' the
establishment of dependence on opium or morphine. Drug treatments were therefore sometimes surprisingly close to
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