Heroin: from painkiller to plague

While in other countries the public was still falling for the mumbo-jumbo of “quacks” and frauds, Scots, who enjoyed free access to the local infirmary, had learned to trust their doctors – a huge step forward in the prevention and treatment of disease. Doctors were as eager to prescribe new drugs as patients were willing to try them. Many such drugs were derived from opium. Morphine had been isolated in 1805 and became generally available by the 1830s. Half a century later, heroin was a further step forward.

One reason for this open-mindedness was that opium had long been known in Scotland, arriving in or about 1693. Medical students in Scotland needed at that time to go to Holland to qualify as doctors. One of the most brilliant, Archibald Pitcairne, described in the thesis that won him his degree at the University of Leiden how opium “thinned the blood” and so made people fall asleep. Despite offers of a Dutch professorial chair he returned to Edinburgh to set up a surgery in the Lawnmarket. He was usually drunk after lunch and used to tickle patients with gibes against the ranting Presbyterian clergy of the day. If he decided a condition merited treatment with opium, the patient would come out feeling all the happier.

With other colleagues, Pitcairne soon became involved in founding the Royal College of Physicians in Edinburgh. In 1699 the college published a pharmacopoeia, or handbook of the contemporary remedies available and their uses. It still contained plenty mumbo-jumbo – prescriptions for boiling up horses’ testicles, the skulls of men who had died by violence and the urine of prepubescent boys – and some elixirs required items hard to obtain in any era, such as dragon’s blood or manna. There were alarming ingredients such as absinthe, arsenic and hemlock. Amid the rest were two drugs still with us three centuries later: cannabis and opium. The latter was often dissolved in wine – white Spanish wine for preference, says the pharmacopoeia – to make laudanum.

Such drugs had to be imported from Holland, which was then, as it is now, a centre for their distribution to the rest of Europe. This traffic across the North Sea was cut off, though, once Scotland joined the British Empire and its closed trading system in 1707. The Union would affect medicine in Scotland just as it affected everything else. One indirect result was to encourage medical specialisation at the Scottish universities to supply a public need not met elsewhere in the United Kingdom. By the turn of the 19th century Scotland was educating more doctors than any other country and sending them out around the globe. Serious medical research went on too. One of its tasks was to identify which precise elements in the pharmacopoeia caused the decisive effects the doctors sought. In that way morphine and then heroin were refined out of opium.

The Union also opened up wider contacts between Scots and peoples in distant parts of the globe. Many of the nation’s boldest sons went to India, where opium had been in universal use for centuries. Indians dosed themselves with it for the everyday relief of all types of ailments, much as modern westerners take aspirin if under the weather. Soldiers and traders from Scotland tried opium and liked it – so much so that some wondered if papaver somniferum, the poppy that produced it, might be transferred from the baking plains of the Ganges to the cold, rainy hills of home. Then, when they returned with their fortunes made, they would not have to miss their fix. One, James Howieson, managed to grow the poppy at the country house he bought, Crossburn near Lanark. “To the amateur gardener and the members of his family,” he wrote, “the cultivation of the poppy and preparation of the opium to an extent sufficient for the supply of himself and neighbouring poor with the valuable medicine, might constitute a rational and delightful amusement.”

Nearby, John Young, another veteran of India, hoped to make Scottish opium a commercial proposition. He succeeded in planting a large field of poppies and potatoes together. The yield per acre was 56lbs of opium. The Caledonian Horticultural Society awarded Young a prize. He found local lads could be readily trained to harvest the raw material of the drug: “Children may with ease be soon taught to make the incisions and take off the opium, so that the expense will be found exceedingly trifling.”

While Scotland never did become a producer of opium, that didn’t stop Scots using it, including the most famous. Sir Walter Scott, lamed by polio as a child, suffered pain for the rest of his life, enough to interfere with his high-speed production of novels. While he was struggling to finish The Bride of Lammermoor in 1817 he started taking opium. It gave him instant relief but he found it hard to stop. Thomas de Quincey, an English author who settled in Edinburgh to partake of the Enlightenment, had no trouble feeding his drug habit here, writing about it openly in his Confessions of an English Opium-Eater.

The habit spread down the social scale, where the toiling masses in the mills had plenty of pain to kill. A sheriff of Glasgow, Archibald Alison, offered evidence to a parliamentary inquiry “that mothers, when they go to the mills, are in the habit of giving opium and gin to their sucking infants, to keep them quiet … and stop the calls of appetite while they are at work”. It was the same for the men: “They resort in great measure to laudanum which, in an adulterated state, is consumed in considerable quantities.” Still, they did this only when they could not get whisky, and the older method of deadening the senses was usually preferred. “I know opium is used to a certain extent,” said Alison, “but I think whisky [in Glasgow] supersedes everything.”

As the use of opium spread, so did the risk of addiction. There was a notorious court case after the death in 1828 of John Erskine, Earl of Mar. The Edinburgh Life Assurance Company made a routine investigation into the circumstances of his final illness. His housekeeper revealed he had been taking 50 grains of solid opium and an ounce of laudanum a day, when he set out for a walk or before he went to bed. Since he had never disclosed his habit to his insurers, they refused to pay out. When the case got to the Court of Session, the expert witness who made the greatest impression was Robert Christison, one of

the medical professors at the University of Edinburgh, who had won his greatest renown in giving the evidence that condemned

Burke and Hare, the Irish serial murderers in the West Port of the city. He was duly heard with respect.

Christison’s testimony showed him to be relaxed about drugs by today’s standards. Though the numbers using opium were growing, he had experience in all Edinburgh of only 10 people who might properly be defined as addicts. He did not believe even these patients would suffer irreparable damage to their health, let alone death. On the contrary, “a certain number of opium-eaters may attain a good old age”. Nor was deviant behaviour a necessary result of their habit: “In many instances, when the opium-eater is under the influence of the drug, no-one could suspect the fact.” If problems did arise, cold turkey was the right treatment: “The habit is easily broken, and there is no danger in suddenly breaking it.”

It was admirable that these great Scottish doctors had no hesitation in trying out the fruits of their research on themselves. Sir James Simpson did this with chloroform, falling senseless under the table at his home in Queen Street, Edinburgh. Christison did it with another new drug, this time from South America – cocaine. He became probably the first regular user of it in Britain. A lover of the Scottish hills, he demonstrated its sustaining qualities by chewing it on his more strenuous ascents. While a guest at Balmoral, he recommended it to Queen Victoria, and reportedly passed it on to a fellow guest there, a rising young politician called Winston Churchill.

With backing of this quality it was no surprise the use of the wonderful new drugs continued to spread, especially among respectable middle-class families with money to spend. In 1877 the Edinburgh Medical Journal published an article on the implications for health of changing social habits, saying opium “is regularly put on the table on the removal of the cloth after dinner”.

Like a week’s holiday in the Highlands or a penny-farthing bicycle, this was a sign of the modest beginnings of consumer culture. In the secure, hierarchical and disciplined society of a city such as Edinburgh the bourgeoisie could be trusted with any small risk. Maybe the downtrodden workers were not to be so trusted, but they could seldom afford the drugs: if sick, they would just have to hope and pray. It becomes easy to see exactly what Karl Marx meant when he said religion was the opium of the people.

So what went wrong in this scenario? Why is it that drugs regarded in the 19th century as a blessing on mankind have come by the 21st century to be defined as a curse?

Edinburgh must take some blame for the change and its consequences. Like the drug barons of today, the city’s pharmacists made huge profits out of the drugs they sold. With their top hats, black frock-coats and membership of the Free Church of Scotland, they saw it as a sign of divine favour when they were able to expand from mere retailing into manufacturing of their own. Duncan Flockhart set up a factory in Holyrood Road, Macfarlan’s at Canonmills and T&H Smith at Gorgie – the last is still there, under different ownership, and at Ian Rankin’s hand became the deadly backdrop to a case solved by Inspector Rebus.

By the end of the 19th century Edinburgh produced most of the world’s opiate drugs, heroin included. This was big business in the capital, one answer to the coal, steel and shipbuilding of the rival conurbation on the Clyde. The expansion could never have come about on the back of a Scottish or British market, only from exports.

After 1900 the Far East was the most lucrative destination for Edinburgh’s drugs. Britain had already fought and won two opium wars to force open a Chinese market for the narcotic in its raw state from India. With the more powerful heroin, that market mushroomed. The drug was an aid to the schemes of imperialist powers as they gathered round the twitching body of the old Confucian China, which they expected to partition into colonies. The Japanese, who had earlier opened themselves to the west and industrialised, joined in this ghoulish feast on the living flesh of an oriental neighbour. Occupying Manchuria, they sought to demoralise the local population by pumping it full of drugs. And Japan bought these drugs from Scotland.

The second biggest market lay in America. Then, as now, the US banned cultivation on its soil of the opium poppy (as of the coca plant) and destroyed any illegal cultivation that could be discovered. There was a chink in Uncle Sam’s armour, though. After the civil war millions of freed black slaves languished round their old plantations in the south, regarded by the whites with no less contempt than before; up to 1920 hardly any had escaped by migrating to the cities of the north. This population was like that of the collapsing Chinese Empire, crushed and hopeless. For it, too, drugs offered a way out.

It was never possible to close off to the outside world a city such as New Orleans, a major port at the mouth of the Mississippi and gateway to the interior of the continent. The constant movement of foreign shipping brought drugs here, and the drugs found their way into the dancing dives, drinking dens and cathouses of this exceptionally wicked city.

The influence of opiates on the development of new forms of music – jazz and the blues – cannot be determined, but was there beyond doubt. At the same time this offered the first urban environment for illegal drugs, and the crime, disease and destitution that went

with them.

Washington pressed all friendly countries for co-ordinated action to control the traffic. A conference convened at The Hague in 1912 to discuss a draft treaty. Worried Scots were asked to instruct the diplomats representing Britain: “You will of course prove how thoroughly the manufacture of morphia is a Scotch, indeed an Edinburgh industry, and thus how the clause in the treaty injures a Scotch interest.” Still, the conference came to an agreement Edinburgh could live with, the basis of international control of drugs down to this day. Afghanistan never signed it.

The First World War was about to put an end to the massive securities of Victorian Scotland and the freedoms that went with them. One was the unregulated manufacture and use of opiates. Probably few of the thousands of Scots lads who joined up in 1914 had experience of drugs, but the horrors of the trenches soon gave them an incentive to try. It had long been a tradition of Scottish regiments to go into battle drunk. In this conflict, too, troops were handed big tots of rum before they went over the top. Soldiers are realists, and they must have asked themselves what the difference was from an opiate that lasted longer in its effect and did not knock them out or leave a hangover.

Like New Orleans, the western front could not be closed off. Regiments constantly came and went. Parcels were sent from home. The military authorities became aware that opiates were getting through to the men. In the end the only way to stop this completely would be to make them illegal in the home country. That was what happened in 1916. In Britain opiates were first banned not by legislation but under defence regulations, only confirmed in the Dangerous Drugs Acts of the 1920s.

So this country too replaced a Victorian regime of liberty with one of control and, if necessary, of suppression – in drugs as in many other spheres of life. In the long run it had the same effect in Edinburgh as it had in New Orleans, not of getting rid of drugs but of making them inseparable from human degradation. They were driven underground, yet in a city that made them and knew about them they could never be stamped out.

There were odd prosecutions in Edinburgh for the possession or supply of heroin right through the 20th century, but by the late 1980s the problem was mounting. At the start of the decade less than 1% of prosecutions in the High Court had involved drugs; now the proportion reached 27%, undeterred by a tripling in the mean length of sentence handed down to offenders. The court was on average convicting one user a day.

Early in the next decade the peak of the problem did pass – but only because so many of the users were dead, having contracted Aids from sharing needles. The junkies of Irvine Welsh’s Trainspotting were heirs to generations in Edinburgh who had used opiates sensibly and safely. It is worth questioning why those earlier generations could handle the stuff so much better than his –

and ours. n

Edinburgh, a History of the City by Michael Fry is published by Macmillan, priced £25. Michael is grateful to the staffs of the Edinburgh City Archive and the library of the Royal College of Physicians for their help in the preparation of this article.