Morphine
use and the problem, as medically defined, of hypodermic
self-administration were closely connected with the medical elaboration
of a disease view of addiction. Addiction is now defined as an illness
because doctors have categorized it thus (current medical definitions
of addiction or `dependence‘ are described by Griffith Edwards in the
Appendix). This was a process which had its origins in the last quarter
of the nineteenth century. Disease entities were being established in
definitely recognizable physical conditions such as typhoid and
cholera. The belief in scientific progress encouraged medical
intervention in less definable conditions. The post-Darwinian
revolution in scientific thinking encouraged the re-classification of
conditions with a large social or economic element in them on strictly
biological lines. From one _point of view, disease theories were part
of late Victorian ‚progress‘, a step forward from the moral
condemnation of opium eating to, the scientific elaboration of disease
views. But such views were never, however, scientifically autonomous.
Their putative objectivity disguised class and moral concerns which
precluded a wider understanding of the social and cultural roots of
opium use.1
De Quincey’s Confessions and the Earl of Mar case have
already indicated that such earlier medical discussions of addiction
did not concentrate on the elaboration of its theoretical background or
on the condition as an exclusively medical one.2 Doctors were still
very much on the periphery of the condition, not in control of it. It
was the addict and not the doctor who defined the terms of the
relationship. Doctors did treat opium eating in the early decades of
the century, but not in a very systematic way.
Some doctors gave
alcohol, reversing the traditional treatment for delirium tremens,
which required opium; there were reports of bread pills soaked in poppy
liquor and of maintenance on a lower dose. In many respects, however,
the doctor acted very much upon the patient’s wish. Some medical men
reported instances of quite huge doses of opium regularly taken without
considering it their prerogative to intervene. In other cases, the
doctor was called in only to treat disturbing symptoms, not to rid the
opium eater of the condition itself.3 Decisions on_ treatment and
medical intervention were, even in the middle of the century, often
very much up to the patient, not the doctor.4
But in the last
quarter of the century, medical men moved to the centre of discussions
on the whole nature of opium-eating. As the discussion of hypodermic
morphine has shown, the pioneers in this respect were mostly French and
German; the European influence on disease theories was initially
strong. The work of Levinstein and Erlenmeyer was known soon after
publication in English medical circles. English specialists continued
to take an interest in the reactions and investigations of their French
and German counterparts. Perhaps more significantly for later
developments, and a foretaste of the appraisal of American practice in
the x916-26 period, was the strong American influence which emerged
around the turn of the century. America had a large ‚drug problem‘ and
works dealing specifically with drug addiction per se, as opposed to
drink with drugs as a secondary subject, were first extensively
published there. T. D. Crothers‘ Morphinism and Narcomanias from Other
Drugs (1902) and J. B. Mattison’s The Mattison Method in Morphinism, A
Modern and Humane Treatment of the Morphin Disease (1902) joined Dr H.
H. Kane’s earlier work and the increasing notice being paid to American
practice and legislative control of narcotic addiction.5
English
experts and specialists were not, however, lacking. Most notable in the
early period was the work of Dr Norman Kerr. Kerr, a member and at one
stage chairman of the British Medical Association’s Inebriates
Legislation Committee, was closely involved in moves to secure the
compulsory detention of alcoholic inebriates, which never, however,
achieved complete success. His interest in narcotic addiction was an
offshoot of his prime concern for alcoholic inebriety. Kerr’s
Inebriety, Its Etiology, Pathology, Treatment and Jurisprudence (1888)
and his Inebriety and Narcomania were important in defining an English
version of disease theories.6 Kerr was also instrumental insetting up
the main debating forum in which medical elaboration of such theories
took place. In 1876 he joined with a group of doctors in forming the
Society for Promoting Legislation for the Control and Cure of Habitual
Drunkards, of which he was elected president. In 1884 the Society,
which had helped to press for the passing of the 1878 Habitual
Drunkards Act, changed its title and re-emerged as the Society for the
Study and Cure of Inebriety. Such early optimism proving unfounded,
from 1887 the Society renamed itself as the Society for the Study of
Inebriety. Its proceedings, later the British Journal of Inebriety,
provided an arena for debate and for elaboration of disease theories;
the Society’s establishment emphasized the increasingly specialized
nature of the whole question of addiction.
It was indeed a medical
`growth area‘ in the last decades of the century. No textbook was
complete without its section on the ‚morphia habit‘, ‚morphinism‘ or
`acute and chronic poisoning by opium‘ (replacing the sections in
earlier texts which had dealt with acute poisoning alone).‘ Addiction
was a new medical specialism; and there were plenty of doctors willing
to acquire and demonstrate the expertise. Jennings‘ numerous works
derived in large part from his experience in practice in France (he was
Paris correspondent of the Lancet for many years). There were medical
experts in England, too, whose discussions were based on English
practice. Clifford Allbutt, once the advocate of hypodermic morphine,
was most prominent, along with the group of medical men he gathered
round him, Humphrey Rolleston and W. E. Dixon most notably. Arthur
Gamgee, Emeritus Professor of Physiology at Manchester University, Sir
Dyce Duckworth of Bart’s and Harrington Sainsbury, Senior Physician at
the Royal Free, were important among the expanding numbers of
specialists in the early 1900s. Directors of nursing and inebriates‘
homes and those doctors connected with lunatic asylums also figured
largely at this time. Dr C. A. McBride, head of the Norwood Sanatorium,
which specialized in alcohol and drug habits, wrote The Modern
Treatment of Alcoholism and Drug Narcotism (1910); Sir Robert
Armstrong-Jones, medical director of Claybury Asylum, Sir James
Crichton-Miller, Lord Chancellor’s Visitor in Lunacy, and Dr Thomas
Clouston of the West Riding Lunatic Asylum also produced weighty
contributions. The establishment of another `expert‘ discipline was
further confirmation of the expansion of the profession.
`Disease‘
was generally defined in terms of deviation from the normal. A hybrid
disease theory emerged in which the old moral view of opium eating was
re-formulated in `scientific‘ form, where social factors were ignored
in favour of explanations in terms of individual personality and
biological determination. Most medical texts recognized that the
majority of the addict case histories they cited were iatrogenic in
origin. Medical administration of the drug, or self-administration by a
patient unwisely given control of the hypodermic needle for an original
painful condition, was a prime cause of addiction.8 The physical
dimensions of the disease were mentioned. Benjamin Richardson, Weir
Mitchell and others were experimenting with opium (pigeons were in
common use) to establish its effects on the human organism. The
phenomenon of tolerance was recognized and commented on, along with the
allied symptoms of withdrawal.‘ Levinstein’s description of abstinence
symptoms was particularly detailed, for, as he noted, `although persons
who suffer from morbid craving for morphia show different symptoms,
some of them beginning to feel the effects of the poison after using it
for several months, while others enjoy comparatively good health for
years together, there is no difference between them as regards the
consequences upon the partial or entire withdrawal of the narcotic
drug.10 His description of the restlessness, perspiration, palpitations
and profound physical disturbance of the withdrawal period was
particularly compelling.
Yet the straightforward physical side of
addiction took increasingly second place to a strong psychological
emphasis. Disease was defined not so much in physical as in mental
terms. It was, according to Crichton-Miller, ‚organismal and
psychical‘, but the latter was generally of more interest. The two-fold
distinction applicable to morphine addicts emphasized the difference.
The morphinist wanted to be cured and would assist in a planned
withdrawal of the drug; the morphinomaniac did not really want to be
cured and had therefore to be treated as a lunatic. In the former, the
habit was under control; in the latter, the craving was irresistible.
Morphinomania was of most interest to the specialists, but in England
the concept also formed part of the all-embracing analysis of
`inebriety‘. The `morphine disease‘ was less an entity in its own
right, which it more definitely was in the specialist texts of
continental origin. In England it was part of a more general
consideration of alcohol, in which narcotic addiction formed a
subsidiary part. Diffusion of the concept of inebriety owed much to the
work of Norman Kerr and the Society for the Study of Inebriety. Its
application to narcotic addiction was an offshoot of their work to
apply medical criteria to what had previously been regarded as much a
social problem as a vice. The Habitual Drunkards Act of 1878, confirmed
and extended by the Inebriates Act ten years later, had established the
beginnings of a medical framework and treatment structure. In less
concrete terms, the work of the Society and of the British Medical
Association committee had laid the foundations for a disease view of
alcoholism. Narcotic addiction was caught up in the process, for, as
Kerr explained, inebriety, `an undoubted disease, a functional
neurosis‘, could be classified with reference to the intoxicating
agent. `We thus have alcohol, opium, chloral, chloroform, ether,
chlorodyne, and other forms of the disease.‘ Continental terminology
was incorporated in the term – alcoholomania, opiomania, morphinomania,
chloralomania and chlorodynomania were, Kerr told the Colonial and
International Congress on Inebriety in 1887, all variants of this
disease.11
The connection between alcohol and opium owed much to
historic precedent, for in medical and social terms the two had long
been linked. But the linking of opium with alcohol in the supposedly
scientific concept of `inebriety‘ meant that the drug, as much as
alcohol, was viewed very much in the context of the temperance views
which informed the work of medical men in this field. In England, the
temperance and prohibitionist movement so dominated discussion of the
drink problem that true scientific studies of alcoholism took place in
the nineteenth century only on the continent.12 It was perhaps
significant in this connection that the toast at the first meeting of
the Society for the Study of Inebriety should have been to `The
Temperance Organizations‘. There were strong organizational links
between the medical specialists in inebriety and morphinomania and the
temperance movement. The connection with the developing anti-opium
movement, campaigning on a primarily moral platform against Britain’s
involvement in the Indian opium Made with China, was equally marked.
Many of the growing group of medical specialists moved easily between
temperance, anti-opium and medical organizations studying inebriety.
The moral and often absolutist views of the anti-opium movement were
not transported wholesale into the medical arena. But there was
considerable cross-fertilization. The organizational and conceptual
links between the two will be more fully discussed in the following
chapter. Specialists like Kerr recognized that there were difficulties
in equating alcoholic-with narcotic inebriety; organic lesions were,
for instance, rare in the latter. But the temperance and anti-opium
connection was a strong influence on the emergence of a hybrid medical
and moral theory.
Despite the wish to move from the dark ages, when
inebriates were (according to Kerr) `vicious and depraved sinners‘,
medical specialists in the subject found it difficult to accommodate
the element of free will still apparent. Inebriety appeared to a great
extent self-induced. In fact Dr Hill Gibson, giving a paper on
`Inebriety and Volition‘ to one of the first meetings of the S. S. L,
could still conclude, against the medical view, that the condition was
`not a physical disease, but a moral vice‘. 13 Moral values were
inserted into this apparently `natural‘ and `autonomous‘ disease
entity. Addiction, clearly not simply a physical disease entity, was a
`disease of the will‘. It was disease and vice. The moral weakness of
the patient was an important element in causation; the disease was
defined in terms of `moral bankruptcy‘, `a form of moral insanity‘,
terms deriving from similar formulations in insanity. According to Dr
Thomas Clouston, both morphine addiction and alcoholism were the
product of `diseased cravings and paralysed control‘ – a paralysed
control over a craving for drink, or opium, or cocaine, could be a
disease as much as suicidal melancholia, he wrote. 114 Moral judgements
were given some form of spurious scientific respectability simply by
being transferred to a medical context. The moral emphasis in causation
meant that symptoms were described in terms of personal responsibility,
too. It was not the physical or even the mental dimensions of disease
which were stressed, but the personal defect of the addict. Allbutt
considered that `plausibility and disorderliness‘ were symptomatic of
the earlier stages. There was an utter disregard of time and no
standards of truthfulness?
This strong moral component ensured a
disease theory which was individually oriented, where the addict was
responsible for a condition which was somehow also the proper province
for medical intervention. Opium eating was medicalized; but failure to
achieve cure was a failure of personal responsibility, not medical
science. Many of the specialists, Jennings perhaps most notably, placed
great emphasis on the cultivation of self-control as part of the
treatment regime. Health was equated with self-discipline. It was the
`voluntary renunciation‘ of the morphia habit and the `re-education of
self-control‘ which were important. The will of the patient to be cured
(already expressed in the morphinist/ morphinomaniac distinction) was
what mattered. But the personal failings involved in the definition of
the condition were also seen in quite clear social terms. It was the
relationship between the `diseased‘ individual and society which also
concerned the doctors, the addicts‘ deviation from the norm and the
social connotations of personal failings. Clouston saw as important the
addicts‘ diminished volition, the impairment of a `higher and finer
sense of duty‘ and the desire for activity of any kind. 16 Crothers
pointed out that he was rarely an innovator or leader in any department
of work.
The strong element of free will and personal responsibility
remaining in the disease of the will concept co-existed uneasily with
its claimed medical and scientific basis. It was in illogical alliance,
too, with the psychological influence within the disease theory, the
classification of addiction as, if not a form of insanity, a type of
mental disease of some more minor type. According to Kerr, the `disease
of inebriety resembles in many particulars the disease of insanity‘
(although Allbutt reported that he had not found insanity to be a
consequence of morphinism). Physiological theories of mental
functioning, the belief that insanity, like other disease entities, had
its source in localized brain lesions, and that variations in mental
and moral characteristics were a function of physical defects in the
structure of the nervous system, helped addiction specialists to bridge
the gap between moral and medical approaches. To Clouston, the lack of
control which characterized addiction was indicative of malfunctioning
brain structure. Despite the widespread use of the term ‚morphinomania‘
(more commonly used than the milder ‚morphinism‘), the connection with
more severe forms of mental illness was never fully established.
Levinstein had maintained that it was not a `mental alienation but a
human passion .. .‘. And despite the clear parallels between treatment
methods – the admission of narcotic inebriates to lunatic asylums, the
establishment of inebriates‘ asylums – it was difficult to classify
addicts as fully insane. What developed instead was a view of the
condition as a functional rather than an organic abnormality. Addicts
were `abnormal‘ or `neurotic‘ rather than insane. Their condition was a
failure of the higher ethical brain according to Crothers, a `toxic
psycho-neurosis‘ in Jennings‘ words.“ The belief in the addict’s
neurotic instability had, too, a strong moral focus. The addict was
`abnormal‘ in the literal sense that he deviated from generally
accepted norms of conduct and thought.
The personal responsibility
ascribed to the disease of addiction found expression in the idea of
`constitutional predisposition‘ with predisposing and exciting causes.
It was the individual’s own constitution which was directly
responsible. Kerr, for instance, in the 1 880s, had itemized sex, age,
religion, race, climate, education, pecuniary circumstances, marriage
relations, temperament, diet and a host of other possibilities as
predisposing causes.18 In later works, at a time of increasing concern
in the wake of the revelations of physical standards at the time of the
Boer War and of concern for `national efficiency‘, the hereditary
influence was stronger. Addicts were among the `unfit‘, whose
appearance in many areas presaged, it was thought, national decline.
Criminality, insanity, homosexuality and poverty were among the
conditions re-classified in this biologically determined way. The
hereditary influence was also present in the analysis of addiction.
Harrington Sainsbury’s Drugs and the Drug Habit (19o9) emphasized the
necessity of good racial stock, of increased education and welfare
provision, to prevent the spread of addiction.19 Allbutt and Dixon,
writing in the System of Medicine (19o6) on `Opium Poisoning and Other
Intoxicants‘, pointed to a `hereditary craving for intoxicants‘, with
sometimes also nervous disease or insanity in the family tree of the
neurotics who formed the bulk of addiction cases .20
By allocating
such a large place to biological predestination, doctors confirmed the
need for their intervention, as men of science, but abandoned any
attempt at a wider understanding of the social and environmental roots
of the condition. Addiction became seen as an exclusive condition
rather than, as in the earlier discussions, a bad habit which anyone
might fall into. The influence of `constitutional‘ or `hereditary‘
predisposition with _predisposing and exciting causes substituted
narrow individual perceptions couched in terms of personal failure for
any extensive analysis of the social roots of opium use. Like the
eugenic movement itself, from which many of the biological arguments
derived, their bias was a professional one.21 Formulation and
application were always limited to those addicts whom doctors were
likely to treat. The disease of narcotic inebriety, or morphinism, in
medical eyes at least, was very much class-based. According to a letter
from Dr J. St Thomas Clarke, medical attendant at Mrs Theobald’s
Establishment for Ladies, in the British Medical journal in 1882, the
better classes of society furnished a `considerable proportion‘ of
morphine cases .22 From this type of professional observation came a
disease theory applicable only to the middle-class patient Crothers‘
formulation, which saw physical and nervous exhaustion among `hard
working physicians, clergymen, active business men, lawyers, teachers‘,
who `early became neurasthenic and cerebrasthenic‘ as likely to lead to
a generation of children who became morphine addicts, was typical.22
Jellinek, in discussing the dissemination of a new form of disease
theory of alcoholism in postwar America, has pointed out that
recognition of the condition as an illness was related to the extent of
its occurrence in the upper social classes .24 In England, much the
same spirit prevailed; and the large number of doctors or those with
some medical connection among those afflicted provided added impetus
for establishing a framework based on illness and disease.
The
working-class addict appeared very little in the case histories; in the
more extreme instances, the existence of any number of addicts outside
the professional class was denied. Sir Ronald Armstrong-Jones of
Claybury Asylum took a strictly materialist view of class difffences in
the incidence of addiction. In his view, morphine addicts were more
numerous among the `private class‘ in Claybury, for
… there is
generally a physical difference between the brains of those in the
private and the rate-aided class … not only is the brain-weight
heavier, but there is also in the private class an added complexity of
convolutional pattern, and these differences, of necessity, carry With
them psychological and physiological concomitants, which mean a higher
sensitiveness and a greater vulnerability. 26
Few doctors saw
addicts of this `rate aided‘ type and disease theory was not formulated
with them in mind. Working-class opiate use was still a matter of
continuing professional concern, as oves against opiate-based patent
medicines and the `chlorodyne scare‘ in particular made clear. But this
was a question of availability and the limitation of sale rather than
of disease and treatment. For the middle-class morphine addict
there was medical care and expensive in-patient treatment;
working-class addiction was mostly a matter of curtailment of supply.
The
idea of the exclusive addict denied, too, any possibility of
alternative patterns of consumption. The existence of the moderate
stable addict, the consumer who could exist without apparent personal
or physical deterioration for years 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) warder-nurses, 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 methods of dealing with an opium
overdose. Drs McBride and Mary Strangman, advocating atropine in the
1900s, were only adopting a commonly-used method of treating opium
poisoning. 33
The number and variety of alternative drug treatments
increased considerably in the last decades of the century; the
controversies between advocates of different regimes were intense and
often acrimonious. Tedious and repetitive in detail as they sometimes
were, grandiose in the claims advanced for rival methods, they
nevertheless demonstrated a form of collective professional
self-affirmation. The scientific nature of medical concepts was somehow
underlined by increasing specialization and the emergence of different
schools of thought. Many English specialists favoured the use of
bromides. Norman Kerr, originally a devotee of abrupt methods, but a
convert to gradual diminution over a period of a month or five weeks,
used potassium and sodium bromide to subdue nervous irritability.
Allbutt and Dixon recommended bromides with caffeine; Mattison used,
for sleep, bromides, codeine and cannabis indica. Neil Macleod
described in the 1890s how bromide poisoning had cured cases of opium
addiction. Some doctors favoured cannabis as an alternative.
Obersteiner thought coca a suitable treatment; Erlenmeyer favoured
chloral. Even the newly discovered heroin found its place in treatment
regimes. Methods rose and declined with surprising rapidity. Cocaine,
much valued in the 1880s, was the subject of dire medical warnings by
the early 1900s.34
That the subject could give rise to such heated
debate was itself proof of its definition as a separate specialist
entity and of the value of the medical contributions made within it.
Yet the drug treatment for the addiction disease was accompanied, like
the disease theory itself, by a continuing moral side. The analysis of
the condition had emphasized the addict’s deviation from acceptable
social norms. Treatment, by way of reaction to this, placed emphasis on
those same values of society. Self-control and selfhelp were
consequently important. The patient’s condition was seen to a large
extent as the result of personal moral failure; cure should involve the
cultivation of changes in personal characteristics. To this end,
experts like Crichton Miller recommended treatment by the combined
method, both medical and moral. Hypnotism enjoyed a vogue; and Kerr,
too, emphasized the ‚bracing-up‘ of self-control. The inebriate’s
conscience was to be approached by the inculcation of family and
community duties. `In opium inebriety,‘ as he noted, `religion has
wrought marvels.’35 Jennings, too, favoured a moral as much as a
medical approach. His writings were marked by an increasing emphasis on
the personal qualities of the addict rather than on the purely medical
drug treatment necessary. The Morphia Habit and its Voluntary
Renunciation and The Re-Education of Self-Control in the Treatment of
the Morphia Habit were his later works. Affirming that the success of
therapeutic measures depended on the mentality of the patient, Jennings
saw the restoration of will as most important. The `re-education of
impulsivity‘ was what mattered. Sainsbury, too, emphasized the
remoulding of character – `first in order of treatment will be the
personal appeal, by any and every means adapted to reach the higher
nature of the sufferer, whose will-power, buried under a heap of
collapsed intentions and broken purposes, must be dug out‘.36 The moral
leadership of the specialist, too, was crucial in intractable cases. In
the last resort `scientific‘ treatment rested on moral concepts and the
inculcation of self-control.
Treatment methods remained a mixture of
the physiological and the psychological. Physical antidotes were
recommended – it was not uncommon, for instance, for the removal of
decayed teeth to be suggested, should the pain from them be an exciting
cause of morphinism. Kerr proposed the wearing of flannel next to the
skin, should the exciting cause be depression from exposure to cold.
Many suggestions within the treatment regimes were social rather than
medical. Activities which reflected acceptable social values were
recommended. The values of air, exercise, cleanliness (Turkish baths in
particular) and activity were recognized, together with `very moderate
and progressive cycling, or automobiling‘.
There even remained a
place for self-treatment and quack remedies. Commercial entrepreneurs
devised saleable packages which continued the opium/alcohol connection.
The ‚Normyl‘ cure for Alcohol and Drug Addictions (twenty-four days‘
medicine in twenty-four bottles) was composed of 75 per cent alcohol
with strychnine. The Teetolia Treatment (‚After years of Drink and Drug
Taking – cured in four days‘) had alcohol and quinine. There were the
Keeley Cure and the St George Association for the Cure of the Morphia
Habit, a cure itself based on morphia with a large amount of salicylic
acid. The Turvey Treatment for Alcoholism and Narcomania-`earning the
gratitude of the nation, the support of the Ministry, the thankfulness
of hundreds of our most successful business and literary men of the
day‘ – offered a treatise together with a private consultation.37 None
quite matched the imaginativeness of Dr Kane who, in America, was
publicizing his De Quincey home method.
Kane was a medical man with
an established reputation in the discussion of disease theories and
methods of treatment. In England, too, on occasion the dividing line
between quackery and mainstream medical science could still be unclear.
Medical enthusiasm for `quack remedies‘ was one example. There was
Hopeine (morphia, coloured with oil of hops) and Argemone Mexicana. But
in England, strongest medical interest was reserved for the Malayan
anti-opium plant, or Combretum sundaicum. Interest was for a time
intense. But, as Jennings pointed out, the only active principle
contained in the leaves was a small amount of tannin; medical use of
the drug seems to have died out as its inutility was demonstrated.38
McBride
had hoped that the Malayan plant could be used in some form of
out-patient rather than in-patient treatment. His hopes were
disappointed; and the development of disease theory was in general
accompanied by a strong institutional trend, a desire to segregate the
addict which had its parallel in custodial treatment of the insane,
criminals and the poor.39 The only advocacy of greater control of the
user of opium and some form of consistent professional intervention
prior to the last quarter of the century had come from within the
public health movement. Professor Alfred Taylor had suggested to the
Select Committee on the sale of Poisons Bill in 1857 that those
consumers who needed regular doses of opium should be issued with a
certificate which would last for six months and would be used to obtain
supplies from chemists in the neighbourhood. This view gained some
support among other professional witnesses to the Committee, but was
never at this stage put into practice. Control of the user of the drug
in this way was a twentieth-century phenomenon. In the late nineteenth
century, it was directly institutional control which was favoured. The
German experts on addiction had recommended . institutional confinement
– Levinstein, for instance, had his own morphine institution in Berlin
in the 1870s – and from the beginning of discussion of treatment
methods in England there were moves towards confinement. Abrupt
withdrawal on a long sea voyage was one procedure .40 W. E. Gladstone’s
addicted sister Helen was sent to Germany as part of her cure. The
necessity of physical confinement of the addict and disciplinary
treatment were themes running through most discussions from the 1 880s
to the First World War. Addiction specialists were virtually unanimous
in wishing to enlarge the area of medical control; it was rare to find
one who argued against the use of retreats or asylums.
But efforts
to extend this treatment advice into a full-scale system of established
control met with some difficulty. Action under the Inebriates Acts and
in particular attempts compulsorily to confine non-criminal addicts met
with only a limited amount of success. Despite the textbook equation of
alcoholic with narcotic inebriety, the legislative terms `habitual
drunkard‘ and `inebriate‘ (the term established, largely at medical
suggestion, by the 1888 Inebriates Act) covered only liquor which was
drunk. Both the 1879 Habitual Drunkards Act and the 1888 Act provided
for the voluntary detention of inebriates in retreats established under
the Act and licensed by government-appointed inspectors. But the
definition of `intoxicating liquor‘ under the Act covered only that
which was drunk, and not the injected drug. This was a point which
became clear as the result of a number of cases in the 1890s. In 1893,
for instance, it was established, as the result of a Liverpool case,
that chlorodyne was included as an intoxicating liquor within the
meaning of Section 3 of the Act.41 It soon became clear that the
injected drug did not. In 1889, Charles Park, a dentist from
Morayshire, was admitted to High Shot House at St Margaret’s Twickenham
after requesting treatment for drug taking under the Inebriates Act.
But Park was injecting morphia as well as cocaine. When he assaulted an
attendant and broke out of the home, the Superintendent found it
legally impossible to force his return .42 Existing legislation
certainly did not cover the intractable injecting addict who refused to
accept the medical definition of the needs of his condition.
There
had always been an element of compulsion within the system – although
committal was voluntary, once the patient had entered the retreat, he
was committed for quite a considerable period. Detention was never for
less than six months. A year was said to be necessary in ordinary
cases, and sometimes even two years if the habit was deeply rooted. If
the addict (or alcoholic) escaped during that period, he could be
brought back, as the Twickenham case demonstrated. There were attempts
to strengthen this element of compulsion. The eugenic influence in
general scientific thinking, and in disease theory in particular,
brought with it a trend towards compulsory segregation, also manifested
in the continuing contemporary discussion of the forcible segregation
in labour colonies of the unemployed and ‚undeserving‘ poor. Social
Darwinist thought put forward policies of `conscious social selection‘
to eliminate the unfit. From the late 1880s, British medical men were
arguing for the establishment of compulsory committal under the
Inebriates Act, and also for the extension of that term to cover
injected drugs as well as those which were drunk. The Inebriates
Legislation Committee of the British Medical Association and the
Society for the Study of Inebriety were the main propagandist bodies,
Norman Kerr the link between the two.
Throughout the 1890s and early
1900s, Kerr argued the case for compulsion and extension of definition
before numerous official committees. The dimensions of the problem, as
with hypodermic morphine, were never established. In 1892, the
Inebriates Legislation Committee of the B.M.A. for the first time began
to press for the inclusion within the Act of `forms of intoxication
other than the alcoholic form. Chloral, opium and other varieties of
habitual drunkenness …‘.43 The Committee, chaired at this time by
Norman Kerr, presented evidence to the Departmental Committee on the
Treatment of Inebriates in the following year which argued both for
compulsory committal of habitual drunkards and for `provision for the
care and detention of inebriates in opium, morphine, chloral,
chloroform, ether, cocaine or any other narcotic‘.44 Kerr, who had been
in favour of compulsory detention since the 1 880s, argued the case
before the Committee and cited American experience in its favour. But
only the principle of compulsion was accepted in the Committee’s 1894
report; and compulsory committal for criminal inebriates alone was part
of the subsequent Inebriates Act.45
It was left to a private
member’s Bill to make the first effort at inclusion of drug-taking. In
1901, an abortive Bill was introduced by Dr Farquharson, a member of
the Inebriates Legislation Committee, which would have amended the term
`habitual drunkard‘ to include `a person who, not being amenable to any
jurisdiction in lunacy, is notwithstanding, by reason of habitual use
of opium or any other drug, at times dangerous to himself or others, or
incapable of managing himself and his affairs‘.48 The Bill was
withdrawn, but the principles advocated by the medical profession were
finally accepted by the 19o8 Departmental Committee on the Inebriates
Acts. This accepted that habitual drunkenness should cover drug-taking
as well as drinking and suggested the establishment of a form of
gradual compulsion. It was to be possible for an inebriate to make a
voluntary application for the appointment of a guardian. The guardian
would decide where the inebriate was to live, deprive him of
intoxicants and warn sellers of drink and drugs against supplying him.
In 1903 it had been considered whether the 1902 Licensing Act, which
dealt with the sale of intoxicating liquor to habitual drunkards, could
be applied to the sale of drugs to addicts. The matter had proceeded no
further; but the proposal reappeared in the 19o8 report, where supply
after warning to any form of inebriate was to be an offence against the
Act. If, too, in the guardian’s opinion, his powers of control were
insufficient, provision was to be made for compulsory measures to be
taken .47
The proposal was an interesting one, to be unearthed again
during the discussions of the Rolleston Committee on Morphine and
Heroin Addiction, when Dr Branthwaite, a committee member and an
ex-inspector under the Inebriates Acts, suggested the institution of a
form of legal guardianship. But by 19o8, the use of inebriates
legislation to extend medical control in the area of drug taking was
already a faint hope. Several inebriates Bills were introduced between
1912 and 1914 conferring both guardianship and gradual compulsion and
extension of definition. None were successful; and the whole question
of inebriety was, even before that date, being increasingly
incorporated within the bounds of lunacy legislation. The idea of
guardianship had in fact originated in the lunacy laws. It had long
been possible to confine both drunkards and drug-takers made
certifiably insane by their habits. Section 116 of the 1890 Lunacy Act
had allowed a form of guardianship, too, which was on occasion applied
to drug addicts. The Lord Chancellor’s Visitor dealt with both lunatics
found by inquisition and with those not so found. In either case, an
order could be made for `the commitment of the estate of the lunatic .
. .‘. The person dealt with, according to Section 116, did not have to
be certifiable, but simply `through infirmity arising from disease or
age incapable of managing his affairs‘.48 Such provision had allowed
for the control of the property of addicts; and in the 1900s, the
British Medical Association began to press not simply for an extension
of the Inebriates Acts, but for all this rather piecemeal legislation
to be brought within the ambit of the lunacy laws. Legislative
rationalization in part, this was also confirmation of the deviance of
drug-taking already marked in disease theories.
The influence of the
idea of `moral insanity‘ continued to be strong. Dr James Smith
Whitaker, Secretary of the British Medical Association (and later a
member of the Rolleston Committee), recommending the extension of the
duties of the Board of Commissioners of Lunacy to habitual inebriety
and drug habits before the Royal Commission on the Care and Control of
the Feeble-Minded in 19o8, argued that drug habits could be classified
as cases of unconfirmed mental disease and brought either under
guardianship or compulsory committal – `the whole procedure,‘ he
considered, `should be made analogous to that under the Lunacy Acts,
with suitable modification in recognition of the fact that the persons
in question are not insane, though suffering from moral infirmity‘. The
1913 Mental Deficiency Act did indeed include `any sedative, narcotic
or stimulant drug or preparation‘ within the definition of
`intoxicant‘. Such `moral imbeciles‘ could be sent to an institution
for defectives or placed under guardianship.49
This was a clear
outcome of the custodial influence within the eugenic movement, the
desire to control and regulate not just the demonstrably insane, but
those whose `feeble-mindedness‘ was in some cases demonstrated only by
a refusal to conform to established values. Smith Whitaker had argued d
for the inclusion of drug-taking within the lunacy model on the grounds
that this would do away with any possible compulsory criminal
committal. Compulsion was in fact to be applied to all – but in his
eyes, the medical certification required was adequate safeguard for the
patient. The argument of possible criminal committal – of addiction
dealt with within a penal model – was used to extend the area of
medical control and to substitute a system of medical treatment little
different in many respects from a prison regime.
Prison appears to
have been in reality a very minor way of dealing with addicts. In 1896,
for instance, the Scottish prison commissioners reported two cases
treated in prison in Glasgow for the morphia habit.50 Many addicts
could have been sent to prison for offences unconnected with their
condition. The absence
of published medical comment on the incidence
of prison confinement of addicts was an indication possibly of its
relative rarity and, too, of lack of medical interest in the
non-professional side of the question. It was mostly the working-class
addicts who went to prison.
Confinement in lunatic asylums prior to_
1914 was also quite rare., 51 Institutional confinement, for all
practical purposes in this period, was limited to the voluntary
facilities provided by the Homes for Inebriates Association and
government-inspected by Home Office appointees under the Acts. Fourteen
homes were licensed under the Acts by 1898, although not all took drug
addicts. The Dalrymple Home at Rickmansworth, founded in 1884 after a
public meeting at the Mansion House in 1882 had set up the Association
of the Dalrymple Home for Inebriates (later the Homes for Inebriates
Association), was the most important and took in the largest number of
addicts .62 Kerr, consulting physician at the Home, had argued strongly
for it; his view was that inebriates should be treated in special
homes, not in lunatic asylums. Theory and practice neatly coincided and
the establishment of the Home gave added weight to medical views. Two
of its medical superintendents, Dr Branthwaite and Dr Hogg, were
influential not only in pre-war discussions of inebriety and lunacy,
but later, too, in the 1920s, when they were prominent in the Rolleston
deliberations. The regime of the Home had clear overtones of social
control and the re-moulding of character and habits which had
characterized the textbook discussions.“
Expanding private provision
offered little for the narcotic addict without fairly substantial
means. Like disease theory itself, treatment facilities were limited to
professional people. Fees at the Dalrymple Home varied between two and
five guineas a week, and an analysis of patients by social class (not,
in this instance, limited to drug addicts) shows solicitors, doctors
and actors with, at the very lowest, clerks and a tailor.54 This was a
matter of some concern to those involved in the Act’s operation. Kerr,
who saw the lack of provision for the poor as `a national reproach‘,
recommended the establishment of industrial homes for the treatment of
inebriety, where the poor inebriate could be put to work while
undergoing his cure.55 The treatment and confinement of the
working-class addicts evoked, as in Kerr’s case, a harsher response;
and the demands for compulsory committal derived part of their vigour
from recognition of this lack in existing legislation. Medical control
over such addicts was always limited in extent. Those who did enter
homes found they could barely afford them. One case reported in the
British Medical Journal in 1904 concerned a female chlorodyne addict in
a home which cost her brother seven shillings a week.56 But there was
no public institution for the purpose apart from voluntary committal in
a lunatic asylum or confinement in the workhouse. For the pauper
addict, there was little alternative.
Disease theory was perceived
by the expanding medical profession as a move to throw the light of
scientific theory into an area characterized by outmoded moral
judgements. Their medical ideology retained more than a trace of its
moral ancestry. It excluded social in favour of individualist and
biologically determinist explanations; yet in its operation and in the
thinking of addiction specialists, it resolutely emphasized social
values. It acted not simply as an agency of social control, but as one
of social assimilation, in which symptoms were defined in terms of
deviations from the norm and treatment involved inculcation in the
values of conformity and self-help. Scientific theory and medical
selfinterest coincided in mediating social norms. The elaboration of
theory and of treatment structures was also part of the process of
class and professional self-affirmation. The addict was separated out
as a distinctive type which only the medical profession was competent
to treat. The reality of the condition was affirmed, but medical values
were not scientifically autonomous; and the moral and class analysis
which, reformulated, lay at the basis of disease theory justified
increased medical intervention where the profession apparently even by
the end of the century had little to offer.
References
1.
The question of the social rooting of medical ideology is discussed in
K. Figlio, `Chlorosis and chronic disease in nineteenth-century
Britain: the social constitution of somatic illness in a capitalist
society‘, Social History, 3 (1978), pp. 167-97
2. See also Anon., Advice to Opium Eaters, op. cit., written by an exaddict.
3.
For details of the different modes of treatment, see, for instance,
Basham, `Case of delirium tremens from opium-eating; improved general
health, but terminating in dementia‘, Lancet, r (x846), pp. 254-6; also
ibid., r (1838-9), p. 68o; and J. Vaughan Hughes, `An opium eater‘,
Lancet, 2 (1859), P• 439.
4. W. Whalley, `Confessions of a laudanum
drinker‘, Lancet, 2 (1866), P. 35, where the patient’s family decided
on maintenance doses. A similar case was reported to the Select
Committee on Drunkenness, P.P. 1834, V I I I, op. cit., q. 1288.
5. T. D. Crothers, op. cit.,; and J. B. Mattison, op. cit.
6. N. Kerr, Inebriety, its Etiology, Pathology, Treatment and Jurisprudence (London, H. K. Lewis, 2nd edn 1889).
7.
Atypical example is the section on `morphinism‘ by Thomas Stevenson in
R. Quain, ed., A Dictionary of Medicine (London, Longmans, 1894), vol.
2, p. 157.
8. T. C. Allbutt (1897), op. Cit., p. 886; J. White `The
habit of opiumtaking as induced by hypodermic injections‘, British
Medical journal, 1 (1887), p. 627.
9. As in `Tolerance of large doses of morphine‘, British Medical Journal, r (1888), p. 449.
10. E. Levinstein, op. cit., p. 107.
11.
N. Kerr, op. cit., p. 64; N. Kerr, `Opening address to the Colonial and
International Congress on Inebriety‘, Proceedings of the Society for
the Study of Inebriety, 13 (1887), PP. 1-3•
12. Brian Harrison makes
this point about the influence of temperance thinking on disease views
of alcoholism in his Drink and the Victorians (London, Faber and
Faber,1971), p. 371. W. F. Bynum’s `Chronic alcoholism in the first
half of the nineteenth century‘, Bulletin of the History of Medicine,
42 (1968), pp. ,6o-85, also makes the point that most scientific
studies were continental in origin. See also H. G. Levine, `The
discovery of addiction; changing conceptions of habitual drunkenness in
America‘, Journal of Studies on Alcohol, 39 (1978), pp. 143-74.
13. `Inebriety and volition‘, Proceedings of the Society for the Study and Cure of Inebriety, r (1884), p. 40.
14.
T. S. Clouston, `Diseased cravings and paralysed control: dipsomania;
morphinomania; chloralism; cocainism‘, Edinburgh Medical Journal, 35
(1890), pp. 508-21, 689-705, 793-809, 985-96.
15. T. C. Allbutt (1897), op. cit., pp. 889-90. See also B. W. Richardson (1883), OP. Cit., p. 1194.
16. T. S. Clouston, op. cit., p. 793.
17.
T. D. Crothers, op. cit., p. 11o; O. Jennings, The Morphia Habit and
its Voluntary Renunciation, op. cit., p. 5. See also R. Armstrong-Jones
(1915), op. cit., P• 54.
18. N. Kerr (1889), op. cit., p. 149.
19. H. Sainsbury, Drugs and the Drug Habit (London, Methuen, 1909), p. 260.
20.
T. C. Allbutt and H. D. Rolleston, eds., A System of Medicine (London,
Macmillan, 1906), vol. 2. See also P.P. 19o8, XXXV: Royal Commission on
the Care and Control of the Feeble-minded, q. 3983
2L G. R. Searle,
Eugenics and Politics in Britain, 1900-1914 (Leyden, Noordhoff
Publishing Co., 1976), p. 59, notes that it was the professional middle
class which was the prime concern of the eugenics movement.
22. J. St Thomas Clarke, Letter, British Medical Journal, 2 (1882), p.540. 23. T. D. Crothers, op. cit., p. 6o.
24. E. M. Jellinek, The Disease Concept of Alcoholism (New Haven, Connecticut, Hill House Press, 1960), p. 193
25. R. Armstrong-Jones, `Drugs of Addiction‘, Morning Post, 10 June 1914.
26.
T. C. Allbutt (1897), op. cit., p. 884. See also W. Huntley, `Opium
addiction: is it a disease?‘, Proceedings of the Society for the Study
of Inebriety, 50 (1896), pp. 1-t2; T. S. Clouston (1890), op. cit., p.
796, for similar views.
27. C. R. Francis, `On the value and use of
opium‘, Medical Times and Gazette, r (1882), pp. 87-9 and 116-17. This
process has its similarities to the definition of other `exclusive‘
conditions, prostitution for instance. See J. and D. Walkowitz, `We are
not beasts of the field: prostitution and the poor in Plymouth and
Southampton under the Contagious Disease Acts‘, in M. Hartman and L. W.
Banner, eds., Clio’s Consciousness Raised (New York, Harper and Row,
1974); also J. Weeks, `Sins and diseases: some notes on homosexuality
in the nineteenth century‘, History Workshop, r (1976), pp. 211-19.
28. R. Christison (1850), op. cit., p. 538.
29. E. Levinstein, op. cit., pp. 110-18.
30. According to Allbutt (1897), op. cit.
31. J. St Thomas Clarke, op. cit., p. 540.
32. C. A. McBride, The Modern Treatment of Alcoholism and Drug Narcotism (London, W. Rebman, 1910), p. 280.
33.
M. S. P. Strangman, `The atropine treatment of morphinomania and
inebriety‘, Journal of Mental Science, 54 (1908), pp. 727-33.
34.
Some of these varied drug `antidotes‘ are described in N. Macleod,
`Morphine habit of long standing cured by bromide poisoning‘, British
Medical Journal, 2 (1897), pp. 76-7; C. A. McBride, op. cit., p. 334J.
Kramer, `Heroin in the treatment of morphine addiction,‘ Journal of
Psychedelic Drugs, 9 (1977), pp. 193-7, casts doubt on whether heroin
was in fact ever much used for this purpose in American medical
practice. See also `The use of cocaine in the morphia habit; a
warning‘, Lancet, 2 (1907), p. 811.
35. N. Kerr (1889), op. Cit., p.
295; H. Crichton Miller, `The treatment of morphinomania by the
„combined“ method‘, British Medical Journal, 2 (1910), pp. 1595-7.
36. H. Sainsbury, op. cit., p. 285.
37.
These cures were surveyed and criticized in the two British Medical
Association reports on patent remedies, British Medical Association
(1909), op. cit., pp. 166-8, and (1912), op. Cit., pp. 137, 14o. The
Turvey Treatment was regularly advertised in The Times, e.g. on 6
October 1914.
38. There were reports on the plant in all the leading
professional journals, e.g. ‚Combretum sundaicum‘, Pharmaceutical
Journal, 4th ser. 25 (1907), p. 566; also C. A. McBride, op. cit., p.
366.
39. For similar processes at work in other areas of `deviance‘,
see D. Rothman, The Discovery of the Asylum: Social Order and Disorder
in the New Republic (Boston, Little, Brown, 1971); G. Steadman Jones,
Outcast London. A Study in the Relationship between Classes in
Victorian Society (Oxford University Press, 1971); and A. T. Scull,
`Museums of madness; the social organization of insanity in nineteenth
century England‘ (unpublished Princeton Ph.D. thesis, 1974). R. M.
MacLeod, `The edge of hope; social policy and chronic alcoholism,
1870-1900′, Journal of the History of Medicine and Allied Sciences, 22
(1967), pp. 215-45, surveys the developments in inebriates legislation
and institutional confinement from the point of view of alcohol. See
also M. Ignatieff, A just
Measure of Pain. The Penitentiary in the Industrial Revolution 1750-1850
(London, Macmillan, 1978).
40. `Hospitals for morphinism‘, British Medical Journal, r (1885), PP. 55, 266.
41. Home Office papers, H.O. 45, 10454.
42. H.O. 45, 9989.
43. `Report of the Inebriates Legislation Committee‘, British Medical Journal, 2 (1892), p. 19o.
44.
P.P. 1893-4, XVII: Report from the Departmental Committee on the
Treatment of Inebriates, Appendix 2, `Memorial from the Inebriates
Legislation Committee of the B.M.A.‘. Norman Kerr’s evidence to the
Committee also made this point.
45. H.O. 45, 10225, Home Office
memorandum on 1898 Bill, and 61 and 62 Vict. ch. 60, 1898: An Act to
Provide for the Treatment of Habitual Inebriates. Deputations from the
B.M.A. and the S.S.I. had seen the Home Secretary in 1894 and 1895
asking for the inclusion of all drugtakers, and evidence on this point
was also given to the 1895 Committee on Habitual Offenders.
46. P.P.
1900, II: A Bill to Amend the Inebriates Act, 1879 to 1899, and to Make
Further Provision for the Control and Cure of Habitual Inebriates.
47.
H.O. 45, 10454, contains discussion of the possible use of the 1902
Licensing Act. See also P.P. 1908, XII: Departmental Committee on the
Inebriates Act, pp. 830-32.
48. 1890 Lunacy Act, 53 and 54 Vict. ch. 5, Sect. 108(3) and Sect. 116(1) (d).
49. P.P. 19o8, XXXV, op. cit., pp. 707-8, and 3 and 4 Geo. V ch. 28., 1913 Mental Deficiency Act.
50.
Quoted in P. P. 1896, X L IV: Eighteenth Report of the Prison
Commissioners for Scotland, p. 858. Published prison statistics,
however, did not generally itemize such cases separately. Only where
the prisoner was classified as insane and in need of treatment was a
drug habit revealed.
51. This is demonstrated by the small numbers
admitted in Bethlem Royal Hospital. See Bethlem Admission Registers,
1857-93, and R. Armstrong-Jones (1902), op. Cit., PP. 491-5, and (1915)
op. cit., PP. 42-53
52. Described at its inception in British
Medical Journal, I (188i), p. 594• 53. Homes for Inebriates
Association, Annual Report, 1885-6, p. 19. 54. P.P. 1890-91, X I X :
Report of the Inspector of Retreats under the Habitual Drunkards Act,
1879.
55. N. Kerr (1889), op. Cit., p. 387.
56. `Treatment of the chlorodyne habit‘, British Medical journal, r (1904), P. 932.