decorated initial 'T'he earliest British medical writing that characterized excessive drinking as a disease was Thomas Trotter's (1804) An Essay, Medical, Philosophical, and Chemical on Drunkenness and Its Effects on the Human Body. Trotter's notion remained undeveloped for years. British medical writers treated the topic desultorily and unevenly. Some physicians who were active in the temperance and teetotal movements, such as William B. Carpenter and Norman Kerr, went on to write and speak about the "medical" side of the problem. Although isolated forays into the field were made in the middle decades of the century, the medicalization of habitual drunkenness and drug habituation did not gather momentum until the 1870s.

Key elements of a modern notion of addiction appeared in two scandals about medical treatment, one a debate about whether or not doctors should prescribe alcohol to their patients. Some patients, it was argued, went on to develop drinking habits. This certainly seemed to be the case when physicians began prescribing morphine and the newly-improved, cheap hypodermic needles with which to inject it. At first glance, hypodermic morphine seemed to be medicine's contribution to nineteenth-century technology - advocates such as Francis Edmund Anstie and T. Clifford Allbutt claimed it would be as important as gaslight or the railway. The speed with which medicines could take effect was impressive. But the patients who injected themselves quickly built up a tolerance, and seemed to develop new symptoms that only a repetition of the dose could relieve. Meanwhile their original complaints often went unabated. Physicians were quick to take back the syringe and suggest dosage guidelines as well as offer descriptions of "narcotized" patients. Although physicians had little understanding of how morphine worked, they argued that only they could safely administer it. The sensations of well-being the syringe produced could only be generated as a cure for pain, not for the production of pleasure.

The debacles over medicinal alcohol and morphine suggest that addiction emerged in the nineteenth century in part because professional medicine did, too. First there is the obvious point that in the process of treating them, doctors undoubtedly gave some patients actual habits. Beyond this, however, is a more complicated relationship of cause and effect that involves knowledge of the effects of drugs. Historians of medicine have long identified a "revolution in Paris medicine" beginning around 1800, in which the patient's own well-being became less important than the observation of the disease unfolding inside his or her body. As medicine became more empirical (based on observation and ascultation), more scientific (conducted on hospital populations where various remedies could be compared to control groups), and more precise (dependent on standardized technology and measures) throughout the nineteenth century in Britain, physicians were transformed from the status of aristocrats' servants to knowledgeable authorities on disease. Whereas in the eighteenth century, their patients' subjective feelings were paramount, in the nineteenth, the patient's feelings increasingly became irrelevant, since the doctor was the one who knew what signs to look for. This meant that the doctor was the one with the authority to cure ailments. Patient self-medication was to be discouraged. Addiction lies at the heart of this gradual shift in knowledge, institutions, and attitudes, because it could only come about in a world in which self-medication was the illicit alternative to legitimate medical practice. After the rise of medicine, no one - not even doctors - could legitimately treat themselves. In this way, popular and folk cures and comforts, such as poppy head tea, gradually disappeared as medical knowledge became institutionalized. In the nineteenth century, this medical knowledge grew geometrically, bringing drug and alcohol use into the fields of "morbid psychology" and physiology alike. The recent introduction of anti-addiction drugs brings us full circle, back to the origins of addiction in medical treatment.

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Last modified 7 September 2002