The hypodermic syringe is one of those cultural artefacts that, while relatively mundane when considered in purely instrumental terms, nonetheless excites a range of passions: curiosity, desire and longing on the one hand; outrage, fear and loathing on the other.
Hypodermic morphine & the birth of addiction medicine- 1860
The needle is an object that has been invested with enormous symbolic significance;
it acts as a carrier of multiple social and cultural meanings – as
fetish and taboo. Although, considered in the abstract, it is merely a mechanism
of drug delivery — a capacity it shares with the whiskey glass —
one can hardly imagine a successful politician raising the syringe aloft
to toast victory. Cheers!
Historians of medicine are in general agreement that Dr Alexander Wood of
Edinburgh was the inventor of the syringe, building his work on that of
others. Alexander Wood first used morphine in conjunction with a hollow
needle syringe to treat neuralgia in 1853.
He published the results in the BMJ in 1855 and 1858, the latter date providing
the breakthrough in terms of publicity. The syringe used by Wood was made
by Fergusson’s medical instrument makers of Giltspur Street, London.
Charles Hunter
The instrument was refined by Dr Charles Hunter in 1860. Hunter also did
much to popularise its use. He was the first to insist that the action of
injected morphine was a systemic one, while Wood believed that the drug
required to be injected locally to the pain in order to bring relief.
Wood and Hunter conducted a bitter argument in the medical press throughout
the 1860s concerning the real action of morphia. Hunter attempted to found
an entire theory and practice of medicine based on the use of the needle.
Dissemination
In the 1860s, the syringe rapidly became popular, its use spreading throughout
Britain, continental Europe and the United States. It was put forward as
cure for countless conditions.
A multitude of chemicals were injected into the hapless bodies of the clientele.
The French physician, Dr Lafitte, treated patients by his new method of
“les injections hydriques”; this treatment consisted of hypodermic
injections of ordinary water. It was found to be most efficacious.
Hypodermic morphia
The most successful application of the syringe at this time entailed the
rapid and measured delivery of opiates — specifically morphine —
into the bodies of patients.
Though the morphine alkaloid had been isolated in 1804 by Friedrich Sertuerner,
it was only when it was combined with the needle that its use became truly
popular. It was believed that the habituating properties of opium were absent
from this new drug and the scientific method of administering it. The hunger
for opium was seen as an “appetite”, and the metaphor was deployed
literally: it was believed that in by-passing the stomach, the syringe avoided
the perils associated with addiction.
In 1868, Francis Anstie made the following claim in The Hypodermic Injection
of Remedies...
“…of danger, there is absolutely none…The advantages of
the hypodermic injection of morphia over its administration by mouth are
immense…the majority of unpleasant symptoms which opiates can produce
are entirely absent…its is certainly the fact that there is far less
tendency with hypodermic than with gastric medication to rapid and large
increase of the dose, when morphia is used for a long time together.”
Medical Men- the new priesthood
Control over drugs was a crucial element in the professionalisation of doctors and pharmacists. In 1856, the British Medical Association was founded. In 1858, the Medical Reform Act set up the General Medical Council, standardising medical training and establishing the medical register, which was published annually and listed all qualified practitioners.
Professionalization
During the decades following the mid 19th century, medicine established itself as a discipline grounded in scientific knowledge. Virchow, Koch, Lister, Bichat, Claude Barnard and others laid the foundations of germ theory, cellular pathology and so on. Anaesthesia and antisepsis became available, greatly reducing the horrors of the hospital experience.
However, most day-to-day medical practice was still concerned with the alleviation of symptoms. In addition, working-class people could not afford the services of physicians, and relied on self-medication, the apothecary’s shop and local rural healers.
Medicine men
For a range of practical purposes, doctors also took over many of the functions of the priesthood, which had in the pre-modern era provided much of the available healthcare.
As the medical profession grew in power and social status, it assumed not only the role of health care provision, but the charisma of scientific knowledge. An arcane language developed, which the laity could not understand, as well as uniforms, sacred instruments, control over institutional spaces, the power to define what was and was not real...
As the church had once controlled the instruments for altering consciousness (the sacrament, rituals, sacred texts and knowledges, specialised architectural spaces), the doctors now sought to control access to drugs.
The escaped syringe
The use of hypodermic morphine spread amongst the rich, since these were
the clients of doctors. Many of these paying clients expected the doctor
to leave the syringe and the morphine in the patient’s own hands,
and the new technology was quickly diffused. Patients would be trained to
inject themselves, or, often, to have their servants inject them, as and
when they wished.
Many of the early morphia habits were the result of medical treatment, and
it took some years for the realisation to set in that the initial optimism
surrounding hypodermic opiates was to some extent misplaced – or,
at least (for the relief of pain at this time was no small achievement in
itself), that there was a price to pay for this fast route to tranquility.
Quotes from T.C. Allbutt in 1870 appeared in On the abuse of hypodermic
injections of morphia...
“Among the numerous essays and records concerning the hypodermic use
of morphia which have been published of late…I cannot call to mind
one in which its possible dangers have been considered.”
“Gradually…the conviction began to force itself upon my notice,
that injections of morphia, though free from the ordinary evils of opium
eating, might, nevertheless, create the same artificial want and gain credit
for assuaging a restlessness and depression of which it was itself the cause.”
Allbutt was a physician and MP, and his intervention was the first to widely
publicise the addictive character of hypodermic morphia.
Drug cultures
Allbutt’s views were by no means universally held. Throughout the 1870s, the use of hypodermic morphine continued to proliferate. But the medical climate was changing. Since morphine was so much more concentrated than opium, withdrawal symptoms were correspondingly severe, and eventually became impossible to ignore.
Jewelled syringes cases were manufactured in order that cultured ladies might carry their beloved instruments with them when visiting the new shopping emporia in London, or visiting a country relative. The poor, meanwhile, continued for the most part to eat their opium and drink their laudanum.
Morphinomania
In 1878, the English edition of Die Morphiumsucht appeared. Written by Berlin physician Eduard Levinstein, the book was translated as The Morbid Craving for Morphia. It contained the first elaborated disease-theory of opiate addiction, with sections on aetiology, symptoms, treatment and prognosis.
Levinstein insisted that this “morbid craving” was a fully-fledged disease, comparable to dipsomania. This foundational text influenced a clutch of British and American doctors, and provided the basis for a new medical specialism – addiction medicine, or, as we would now call it, drug treatment.
The Society for the Study of Inebriety
One of the foremost of UK addiction doctors was Norman Kerr, who was a founding member of the Society for the Study of Inebriety when it formed in 1884. Author of Inebriety and Narcomania, Kerr was also a member of the Society for the Suppression of the Opium Trade, a temperance pressure group which sought to use political means to end the Anglo-Indian opium trade to China.He regarded all forms of addiction as morbid, and sought to bring about legal changes which would allow the enforced incarceration of drunkards and narcomaniacs.
Norms and deviance
Dr Kerr’s conception of disease was that, in essence, a disease was constituted by a deviation from the norm. It should be apparent how readily this biological or physiological model can apply itself to what are, in fact, social, cultural and political norms.
This slippage of the disease model is precisely what occurred — and has continued to underpin our society’s responses to drugs ever since — whether the responses be clothed in the vocabulary of law or medicine. As Dr Thomas Clouston claimed during the late 19th century...
“Physicians are priests of the body and guardians of the physical
and mental qualities of the race.”
“He (the addict) rejects all the adjuncts and supports of social life-
orderliness, cleanliness, the appearance of his person and his clothes.
He prefers to be among a class of society less moral, less educated, less
refined and less evolved generally…How all the manias take the polish
off a gentleman!”
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This article is written by Christopher Hallam, a freelance writer and researcher who works closely with exchangesupplies.org in the field of drug policy reform.