France on Drugs: Opium, Morphine, Cocaine, Hashish, Chloroform & Ether in the 19th Century with Dr. Sara Black

Gary:  Today’s special episode is an interview with Dr. Sara Black. Dr. Black received her Ph.D. from Rutgers University and is currently a professor at Christopher Newport University. She is a historian of medicine in modern France researching the history of drugs at the intersection of medicine and culture. She joins me to discuss her new book Drugging France: Mind-Altering Medicine in the Long Nineteenth Century, which is all about the study, medicalization and proliferation of opium, morphine, ether, chloroform, cocaine, and hashish.

Thank you so much for being on the program, Doctor Black. Your book, Drugging France: Mind-Altering Medicine in the Long Nineteenth Century is a truly fascinating book and a fascinating topic, one which is guaranteed to drum up interest. I bet lots of other academics are kicking themselves for not studying mass drug use. Normally I would ask my guests what brought them to this topic and you can answer that if you want. But I think a better question in this case may be: why has the historical study of drugs in France been so limited, given that you claim it was such an important part of medicine, culture, economics, politics, society, the state, womanhood and war? I don't know, did I miss anything?

Black: I don't think so. Absolutely, I’m happy to answer both questions. Actually, my interest in this topic stems from a longstanding fascination that I've had with visiting historical pharmacy museums like, for example, the apothecary shop in colonial Williamsburg. And so in a visit meant there many years ago I was so fascinated with seeing the rows and rows of jars containing all sorts of bizarre medicines and thinking about how different life would have been for the people who didn't have access to our modern medicine. You know what would that have looked like in terms of their everyday experience? Now in terms of French drug history, its face similar challenges to the history of drugs more broadly, our perspectives on drugs from the 20th century, the War on Drugs, et cetera, has shaped how historians have approached drugs in the past and the kinds of questions that they ask. So historians have tended to focus on issues of addiction and deviance, basically asking how did drugs like opium and cocaine come to be demonized as dangerous drugs of abuse to be regulated by the state now? Now, while addiction and deviance are certainly part of the story. My book asks what I believe to be, at least for me, a far more interesting question, which is: how did these drugs become such commonplace commodities in the first place before they were demonized and regulated? So I'm particularly interested in the medical history of these drugs rather than starting with addiction or pleasure-seeking. My book, Drugging France begins by tracing the normalization of these pain, relieving mind-altering drugs in the medical market place and then within French society as a whole. It demonstrates that the 19th century was this foundational moment when French citizens increasingly turned to psychotropic drugs, so drugs that acted on the mind and the body to manage the everyday miseries of modern life. It was a time when, if you had a headache you didn't have to suffer in silence any more. You could take an opium pill or some laudanum to relieve your pain pretty consistently and reliably. So. This gave French citizens newfound control over pain, which changed their expectations about medicine and transform their experience of everyday life.

Gary: That is a truly remarkable topic. I can't stress how much you must make other historians jealous because you picked up on this. Speaking of famous apothecaries, and I personally like to visit such oddities as this, have you been to the one in New Orleans, the Historic Apothecary?

Black: I unfortunately haven't. I was last in New Orleans when I was about five years old, so my interest postdated that trip, but I'm very much- it's on my list for when I go to New Orleans.

Gary: Well, I was going to say, while you're there, be sure to visit the Napoleon House. Otherwise it was previously known as the Girod House, because I believe a distant relative of mine who was the Mayor of New Orleans, tried to secrete Napoleon off of Saint-Helena and bring him to New Orleans. So I don't know if he's a relative of mine. I like to think every cool, famous Girod is. I like to think that I'm somehow related to French football captain Olivier Giroud. But let's not get too off topic. Let's get back to drugs. The drugs you primarily deal with are opium, morphine, ether, chloroform, cocaine and hashish. Can you tell us about each drug as they existed in 19th century France?

Black: Of course so. Opium is one of the world's oldest pain remedies. It was cultivated in Mesopotamia as early as I think, 3600 BCE and it's a narcotic drug which was the basis of countless different 19th centuries pharmacy remedies, so from pills and powders to laudanum and opium extracts. So it treated pain, it treated insomnia, various other mental conditions as well. Morphine is an alkaloid derivative of opium, so they're related. So it's a highly concentrated and highly potent form of the drug which was typically injected under the skin for swift and effective pain relief, and it became really widely popular in the second half of the 19th century. Cocaine is another alkaloid like morphine, but it's a derivative of the South American coca plant and it was used as a local anesthetic in surgery and gynecology, among many other things. Ether and chloroform are both anesthetic gases which revolutionized surgery in France and across the world. So for the first time these gases allowed surgeons to make their patients unconscious before they cut into them, which the patient very much appreciated. And hashish is a North African cannabis pace and it became popular in France in the 18 forties after the colonization of Algeria. Now all of these drugs were used to some extent in medicine, some more than others, but individual consumers used them not only to relieve pain but also to enhance pleasure and alter consciousness. So, they were remarkably flexible and valuable commodities.

Gary: Why and how did these drugs become such a widespread part of society in 19th century France?

Black: Well, each drug has a somewhat unique trajectory, but I argue that overall it was the development of new therapeutic knowledge about these drugs and the industrialization of pharmaceutical production. So in order to prescribe these mind-altering drugs to their patients, doctors had to understand them, to figure out what their effects were over the mind and the body, and to do this they frequently experimented on themselves, on their own bodies. So for example, in 1847, when the French Academy of Sciences heard that either might be able to eliminate pain and consciousness during surgery, doctors got together all over Paris and took turns inhaling ether and stabbing each other with scalpels to see if it hurt or not. So, this was really fascinating and bizarre research, an interesting mixture of individual curiosity and scientific discovery, because of course this kind of experiment was really amusing for the doctors involved. It was interesting to see how your mind changed under the influence of these drugs. But this self experimentation also gave doctors a really unique understanding of the effects of these drugs over the human mind and it enabled them, you know, in a time when they didn't understand all of the effects of these drugs, to figure out really important information like, for example, what a safe dose of particular drugs might be. So the research was important and also in some cases very dangerous because you could very easily asphyxiate yourself if you inhaled too much ether and not enough oxygen. Now the other part of this story is the industrialization of pharmaceutical production. With new mechanized production techniques in hydraulic factories, the French pharmaceutical industry was able to produce increasingly standardized and reliable remedies. The isolation of alkaloids like morphine and cocaine offered more concentrated and localized pain relief, and using them as the base ingredient in other pharmaceutical remedies meant that each dose you took would contain a standard amount of the alkaloid, so it would be similarly potent in each dose. So instead of having a pharmacist mixed-up laudanum or opium pills himself using opium of varying, sometimes dubious, quality and potency, so you'd have drugs of very different potencies, he could purchase these items wholesale from pharmaceutical manufacturers, along with many other products as well. So industrialization enabled pharmacies to produce more standardized, reliable remedies and it enabled them to offer their clients a much wider variety of commodities than ever before.

Gary: A major theme of the book is how state-licensed medical professionals use drugs to establish their authority over the medical profession, away from religious healers, folk healers and lay healers. Tell us about the use of drugs as a form of power.

Black: Doctors use drugs as tools to legitimize themselves as professionals in the eyes of their patients. They enthusiastically and frequently prescribed opiate-based remedies, and particularly morphine, because it had such a dramatic impact on their patients, and patients would be more inclined to seek their help again in the future if they had experienced effective pain relief. So doctors tried to position themselves as the gatekeepers of these powerful drugs in order to improve their reputations in the eyes of their patients. Now, theoretically, in France, only doctors could prescribe drugs like opium, because they had a legal monopoly over medical prescriptions. However, in practice they had to contend with a wide variety of other unofficial healers, from folk healers and rural areas to nuns and religious healers, who provided remedies to patients who might not be able to afford or access doctor's services. And of course, the longstanding traditions of self-medication and family medicine meant that in practice, patients themselves often sought out these drugs on their own. For example, in my research I came across popular pharmacy manuals which would contain instructions for individuals and descriptions of which remedies were useful for treating particular conditions. So this enabled them to kind of bypass the doctor altogether. And they also included instructions for preparing basic opium remedies like poppyhead tea yourself at home. So while morphine and other drugs enhance the reputation of doctors in the eyes of their patients, because they believed them to be more competent and capable of treating their pain, the actual consumption of these drugs overflowed the boundaries of medical supervision and even in cases where doctors prescribe drugs like morphine to patients, they didn't always act as they expected them to. So doctors didn't really understand that morphine addiction was a problem. They didn't understand morphine addiction as a kind of illness until the late 1870s and early 1880s, and by that point they had become kind of very used to prescribing this drug for several decades, right they prescribed it enthusiastically, inadvertently spreading addiction in the process. So morphine offered the kind of swift and effective pain relief that kept patients coming back for more. But it also undermined the doctor's authority because it exposed their role in spreading addiction and their relative inability to treat addiction once it was established.

Gary: The 19th century was one of profound anxiety with social thinkers particularly concerned with insanity. How did French medical professionals approach using mind-altering drugs on themselves and patients?

Black: Many of the drug researchers look at in this book worked at one of the large asylums in Paris, Salpêtrière and Bicêtre, and they were fascinated with exploring the effects of these drugs on the mind to figure out whether they could be used to treat mental illness. Of course, self-experimentation was one of the most straightforward ways of determining how drugs like opium or hashish affected the mind. So, doctors like Jaques-Josephe Moreau de Tours consumed hashish themselves very frequently with friends, with colleagues at home anywhere, and described the bizarre hallucinations they experienced under its influence. Moreau theorized that any drug that could produce a temporary state of insanity in a sane person might in turn produce sanity in a madman. So in addition to extensive self-experimentation, he also conducted a lot of clinical experimentation on his mental patients. Other asylum doctors, like Auguste Voison or Jean-Martin Charcot, the famous neurologist, experimented with morphine, ether and chloroform on hysterics and other patients at Salpêtrière Hospital, and this research had quite mixed results, like Moreau’s hashish research. So high doses of morphine seemed to help some patients but not others, and the patients that consumed these high doses quickly became addicted to morphine, so much so that one intern claimed a veritable revolution would break-out on the asylum words if they withheld morphine from their patients. So, doctors tried to take precautions to ensure that their experiments didn't harm themselves or their patients. But in the case of morphine, at least they tended to accidentally cause this widespread addiction.

Gary: Another major anxiety that France faced in the 19th century were fears of degeneration. Many social thinkers worried about the country's low birthrate. Meanwhile, heavy drug use was often associated with both sex and impotency. How did drugs and sex come together in an age before rock-and-roll

Black: So sex and drugs became associated with one another very strongly in the popular imagination. Opium in particular had long had a reputation as an aphrodisiac, so much so that prostitutes and mistresses supposedly used it to enhance their clients or their lover's pleasure, and later on, cocaine gained a similar reputation at the turn of the 20th century. Medical researchers were curious about this aphrodisiac power and in fact one medical student I encountered in my research actually engaged in self-experimentation with opium to test its influence on his sexual performance. So, needless to say, that was a very interesting medical thesis. Interestingly, researchers found that while opium might enhance desire in the short-term with prolonged use, it tended to undermine the body's sexual physiology, causing impotence and disrupting menstruation in cases of more severe addiction. So this really created a difficult situation. At a time of heightened concerns about degeneration and depopulation, a large population was viewed as a measure of national strength, but birthrates were declining and social reformers were concerned about France's status compared to Germany, particularly after their humiliating loss in the Franco-Prussian War of 1870. Drug use, and particularly morphine addiction, was considered to harm both the quality and the quantity of the population. It was considered to be a degenerate vice that was associated with pleasure-seeking and immorality, but it also had very real reproductive consequences, as it could impact menstruation, inhibit sexual function and divert sexual energies away from reproduction. So, while its aphrodisiac reputation might lead to more sex, it was not the right kind of reproductive sex that was going to help the nation. This was quite paradoxical too, because, of course, the very substance associated with sexual pleasure and desire in the popular imagination actually crippled the reproductive capacity of drug addicts overtime and, in so doing, threatened the demographic future of France.

Gary: Perhaps the most important use of many of these drugs was for pain relief. You draw an interesting comparison when you note that two of the most important uses for drugs were for women delivering babies and for male soldiers suffering injuries on the battlefield. Explain the variance in drug applications and attitudes for these vastly different medical conditions.

Black: Of course. So, anesthetics revolutionize surgery, as I mentioned earlier, in France and across the world in 1847. Almost overnight surgery was transformed from an agonizing ordeal requiring speed and brutality into a much calmer, more precise procedure. Patients could now experience surgery unconscious and blissfully unaware of any pain. Now in battlefield surgery, between the Crimean War in the 1850s and World War, one wounded soldiers were offered pain relief during procedures without question. In some cases they were even given morphine injections to spare them pain while they waited to be treated. So soldiers were really only forced to endure surgery without pain relief if the army was running out of supplies. So very quickly patients came to expect and demand anesthesia for surgical procedures, and doctors were, for the most part happy to oblige them as long as they had enough chloroform. So, soldiers and patients in general came to view pain relief during surgery as a fundamental individual right.

In childbirth. On the other hand, doctors were sometimes more reluctant to offer women pain relief. They cited the Biblical idea that women should give birth in pain, supposedly as a punishment for Eve's original sin. However, there were some supporters of childbirth anesthesia in the medical community. These doctors argued that women should be given pain relief because they were providing such an important reproductive service to the French nation. This argument had particular resonance, given contemporary concerns about low birth rates and depopulation, and of course, there were laboring mothers who began to advocate for their own pain relief as well. One woman I came across in the archives refused to push until her doctor had given her a sufficient dose of chloroform. So traditionally, both soldiering and childbirth involved a considerable degree of pain and while childbirth anesthesia caused more controversy, anesthesia fundamentally transformed these two gendered acts of suffering for the nation over the course of the 19th century.

Black: You describe 19th century France as a nation on drugs in your opening paragraph. Is France still a nation on drugs, and what long term connections do you see between the time period you study and the modern day French healthcare system?

Gary: Yes, absolutely. France has continued to be a nation on the drugs in the sense that French citizens routinely turn to psychotropic, pharmaceuticals to treat their pain, anxiety, depression and manage many other symptoms as well, and it's become so common and expected that most people don't even give it a second thought. Now, of course, there are many new substances for dealing with less severe pain in France and across the world. Of course, ibuprofen, paracetamol and other over the counter medications, but opiates are really commonly consumed as well. For example, in 2015 about 17% of French citizens were reimbursed by the national health insurance for some kind of opioid pain reliever. Self medication and addiction continued to be part of French medical culture too. While the prescription opioid crisis has not been quite as severe in France as in the US, there has been an uptick in hospitalizations relating to prescription opioids in recent years. In the 19th century, doctors positioned themselves as gatekeepers of morphine and other drugs, claiming to be able to protect the public from harm. But then as now, these drugs frequently eluded medical efforts to define and restrict their use. So while the democratization of pain relief in the 19th century fundamentally transformed French citizens experiences of everyday life, it also created new challenges that French society is still working to overcome.

Gary: The book Drugging France: Mind-Altering Medicine in the Long Nineteenth Century. It is one of the most entertaining and truly engaging books that I have read for this podcast. I did not expect to be reading about doctors watching each other tripping out, but it was something that I needed in my life, so thank you very much for your work and for being on the show, Doctor Black.

Black: Thank you for having me. It was a pleasure.

Gary: As always, donations keep the podcast going, so if you would like to make a one time donation or become a patron, please consider doing so. Thank you very much for your continued support.