33

Women and Addiction in the

United States—1850 to 1920 1

Stephen R. Kandall, M.D.

INTRODUCTION

Beginning in the mid- to late 1980s, the United States was inundated

with a media blitz that focused primarily on crack cocaine. Attentiongetting headlines in the New York Times (1989a, 1989b) riveted the

public’s attention on drug-associated societal conditions such as violent

crime, homelessness, sexually transmitted diseases, overcrowding of jails

and prisons, flooding of emergency rooms and hospitals with drug-related

violence and illness, and loss of work productivity. By 1992 the aggregate

cost of this drug-related devastation was estimated to have exceeded

$300 billion annually (Califano 1992).

The often sensationalistic news coverage of the crack epidemic

during this period conveyed to many Americans the false impression

that drug use was a relatively new phenomenon. In fact, the legal use

of opiates in this country dates back more than 200 years (Musto 1973;

Morgan 1981; Courtwright 1982). Although epidemiologic data are

sparse, the mid- to late 19th century apparently witnessed a rapid increase in the medicinal and recreational uses of opiates. During that

same period, nonopiate drugs such as cocaine, chloral hydrate, chloroform, and cannabis came into vogue and were used in much the same

way as opiates.

In spite of increasing numbers of drug users during those years, quiet

acceptance and tolerance of drug use was the order of the day. However,

the changing social demographics of drug users, increasing knowledge

about the dangerous effects of those drugs, regulation of the pharmaceutical industry, and emergence of the United States as a true international

power during the latter part of the 19th century and early part of the

20th century acted synergistically to change the country’s attitude toward

drug use from tacit acceptance to intolerance. This “sea change” in

national attitude was legislatively formalized with passage of the Harrison

Anti-Narcotic Act of 1914 and two 1919 Supreme Court decisions, Webb

et al. v. U.S. [249 U.S. 96] and U.S. v. Doremus [249 U.S. 86], which
34

allowed the Federal Government to initiate a drug-fighting agenda

characterized by strict national and international legislation and repression of both addicts and physicians. This tough approach to drug control

has dominated American policy for the past 80 years, overshadowing

such modest demand-side initiatives as private sanitariums; drug treatment clinics, which operated primarily between 1919 and 1923; inpatient Federal drug treatment facilities at Lexington, KY, and Fort Worth,

TX, from 1935 to 1971; and beginning in the late 1950s, inpatient and

outpatient treatment, either with an aim toward abstinence or, beginning

in 1964, substitution maintenance with methadone.

WOMEN AND DRUGS: 1850-1914

In the past 25 years, a “new issue,” drug use by women, arose from

a matrix of escalating fear and frustration with the Nation’s inability

to win the “War on Drugs.” The irony of the discovery of drug use by

women was certainly not lost on historians. As early as 1782, it was

common practice for women of Nantucket Island to take “a dose of

opium every morning” (De Crevecoeur 1981). Anecdotal evidence

of increasing use of opium by women was provided by writers such as

Baltimore physician A.T. Schertzer (1870) and Massachusetts surveyist

F.E. Oliver (1872, pp. 162-177), who quoted a physician who said, “The

use of opium has greatly increased, especially among women.” Dr. J.B.

Mattison (1879a), who wrote and lectured extensively about drug use in

this country, expressed his concern about laudanum addiction: “How

many women are to-day sitting in a similar shadow is beyond our

knowing; but it is known that they swell largely the ranks of opium

habitués. . . . My personal experience is entirely confirmatory of this

statement.”

Opiates

The use of opiates by Victorian women, especially upper-class

women, was generally accepted by society and their physicians. In 1871

one physician specifically found that opiate addiction “among women

in high places is incredibly large” (Calkins 1871, p. 165). He described

the typical addict as “the lady of haut-ton, idly lolling upon her velvety

fauteuil and vainly trying to cheat the lagging hours that intervene ere

the ‘clockwork tintinnabulum’ shall sound the hour for opera or whist,
35

the quasi-lady of the demi-monde as well” (Calkins 1871, p. 163). In

1885 a physician in Trinity, AL, noted that “the weaker sex are slightly

in the majority, and of these, it is confined mostly to the higher and

middle class” (Duncan 1885). Although the number of upper-class

women who visited opium dens is not known, and probably was not as

large as portrayed by the press, the practice was certainly depicted in

news stories, lithographs, and later in the movies. Recreational opium

use was also practiced by literary and arty aspirants who were influenced

by the writings of Coleridge, De Quincey, and Southey and who “gradually wound themselves in the silken meshes of the fascinating net” of

addiction (Kane 1881, p. 22).

This picture of female opiate addicts certainly did not represent the

full spectrum of female addiction. In 1867 Ludlow called attention to

the increase in opiate use among “our weary sewing-women” (Ludlow

1867, pp. 377-387; Day 1868, p. 283), and Day (1868, p. 7) listed

“women obliged by their necessities to work beyond their strengths” as

heavy opiate users. Oliver (1872, p. 168) found that bored rural women

who were often lonely and isolated resorted to opium “as the safest and

most agreeable remedy.” Opiates were also used by prostitutes; Calkins

(1871, p. 165) wrote that, of New York prostitutes, “two-thirds of the

class become habituated, eventually, to opium in some form.” Specific

mention of opiate-using prostitutes was also made by Marshall (1878),

Earle (1880, pp. 53-61), Hull (1885), and Duncan (1885). Opium use

appeared to be especially common among Chinese prostitutes in brothels and opium dens, in which women used drugs to combat fatigue,

stress, boredom, physical illness, and homesickness.

Anecdotal reports of female opiate addiction were supported by

the few available rudimentary epidemiologic studies of drug use in the

United States. Accurate statistics, however, were hampered because

women often concealed their drug use from friends and family. Earle

(1880) wrote that female opium eaters (users) often indulged in the

habit “for years without imparting their secret to their nearest friends.”

Mattison (1898, p. 202) felt that women often concealed their opiate

habits to protect themselves from “unkind and unjust judgment.” In

part because of the temperance movement, some women used narcotics

as a more acceptable alternative to alcohol “because of its greater secrecy

[sic] and less degrading effects” (Hamlin 1882, p. 427). Despite many

epidemiologic limitations, Marshall (1878) found that women made up
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56 percent of 630 opium users and 66 percent of the morphine users

identified in his Michigan survey and that women formed the majority

of addicts in 88 of the 96 towns that reported addiction statistics. Earle

(1880) found that 72 percent of the 235 opium users identified in Chicago were women. Hull (1885) estimated that 63 percent of opiate users

in Iowa were women, and Nolan (1881) believed that 80 percent of

opium users in Albany, NY, were women. Assuming that between

150,000 and 200,000 opiate addicts lived in the United States in the late

19th century and that between two-thirds and three-quarters of these

addicts were women, probably more than 100,000 women used opiates

chronically during that time.

The most important reason for the increase in opiate consumption

during the 19th century was the prescribing and dispensing of legal

opiates by physicians and pharmacists. A limited therapeutic

armamentarium available to medical personnel ensured that opiates

would be used to treat an almost limitless list of ailments (Chase 1873;

Faulkner and Carmichael 1892). Despite railing against the overprescription of medications by physicians, Oliver Wendell Holmes (1888)

specifically exempted opium, “which the Creator himself seems to

prescribe.” Other physicians, however, were cautioning that physicians

were prescribing opiates injudiciously, either inappropriately or for too

long or by placing the remedies in the hands of patients who were willing

to self-administer opiates without proper medical supervision. In this

regard, Kane (1881, pp. 219-220), a 19th century expert on addiction,

indicted physicians who were “culpably ignorant, and certainly deserving

of punishment”; druggists “who, in many cases, sell the drug without a

physician’s prescription”; and charlatans, “utterly without conscience,”

who used deceitful advertising practices and lies to ensnare hapless

victims. Even without the complicity of physicians, the general population had ready access to opiates in patent medicines and homeopathic

compounds (Faulkner and Carmichael 1892, pp. 514-517, 537-538).

An enormous industry supplying these products went unregulated until

1906 when the Pure Food and Drug Act was passed, representing an

initial attempt to curb the overuse of patent and proprietary medicines

(Young 1961, pp. 237-244).

The predominance of women in the addict population rests squarely

with the use of opiate-containing medications of the late 19th and early

20th centuries. Women not only were treated for the same nonspecific
37

illnesses as men, but also were considered less capable of managing

painful conditions and thus more in need of medication. In the following

passage related to childbearing, Dr. R.V. Pierce (1895, p. 684) provided

an example of what could be considered a guiding principle of therapeutics in Victorian America:

Physically, and mentally, woman is man modified, perfected—

the last and crowning handiwork of God. When, therefore, this

structure so wonderfully endowed, so exquisitely wrought, and

performing the most delicate and sacred functions which God

has ever entrusted to a human being, is disturbed by disease,

when the nicely-adjusted balance of her complex nature deviates

from its true and intended poise, the most efficient aid should be

extended, in order that the normal equilibrium may be regained,

her health restored, and her divine mission, on which human

welfare so largely depends, be fulfilled. Its importance should

elicit . . . the most scientific administration of the choicest,

rarest, and purest medicinal elements in the whole range of

nature (Pierce).

The most common use of opiates by women to treat organic complaints was for “female problems.” Marshall’s 1878 survey revealed, “The

most frequent cause of the opium habit in females is the taking of opiates

to relieve painful menstruation and diseases of the female organs of

generation.” Mattison (1879a, p. 332) remarked that among women

“a large part of the deviations from health which induce the use of some

form of opiate, are dependent on disorders peculiar to their sex.” Dr. T.

Gaillard Thomas (1879, p. 316), president of the American Gynecological Society, wrote: “For the relief of pain, the treatment is all summed up

in one word, and that is opium. This divine drug overshadows all other

anodynes. . . . You can easily educate her to become an opium-eater, and

nothing short of this should be aimed at by the medical attendant.”

Pierce (1895, pp. 727-771) offered pages of testimonials from women

treated with his medications, many of which reportedly contained

opiates, for conditions such as “falling of the womb,” “paralysis and

uterine disease,” “indigestion, constipation, and uterine disease,” “female

weakness,” “severe flowing,” “vaginitis,” and “suppressed menstruation

and nervous debility.” Others used opiates liberally to treat painful
38

menstruation, abortion, miscarriage, and gonorrhea. As late as 1913,

“women suffering from dysmenorrhea . . . pass on the word that paregoric, laudanum, etc., is a specific” (Wholey 1913, p. 724).

In addition to being used in the treatment of an assortment of

physical ailments, opiates were also widely used to combat a vague

disorder known as neurasthenia, or nervous weakness, which was usually

ascribed to the new excitement, prosperity, and intellectual challenges of

urban America. Neurasthenia appeared to be a catch-all diagnosis for a

wide range of conditions, including tenderness of the scalp, spine, and

body; vague pains and “flying” neuralgias; flushing and fidgetiness;

variability of pulse and palpitations; weakening or legs giving way;

sensitivity to cold or hot water; sensitivity to weather changes; ticklishness; insomnia; nervous dyspepsia; partial memory failure; sexual exhaustion; depression and morbid fears; headache; pain and heaviness; floating

specks before the eyes; noises in the ears; and chills and heat flashes

(Beard 1878, p. 1; Mortimer 1901, p. 383).

Women were disproportionately affected by the diagnosis of neurasthenia. Beard (1871), an authority on the condition, wrote, “The

general law is that the more nervous the organization, the greater the

susceptibility to stimulants and narcotics. Woman is more nervous, has

a finer organization than man, [and] is accordingly more susceptible to

most of the stimulants” (Beard 1871, p. 511). In 1880 Earle explained

why women outnumbered men in his survey of opiate addicts: “This is

undoubtedly due to the fact that women more often than men are

afflicted with diseases of a nervous character, in which narcotic remedies

are used sometimes for a long period” (cited in Kane 1881, p. 25). An

upstate New York physician wrote in 1882 that women were more prone

than men to opium addiction because of their “more nervous organization and tendency to hysterical and chronic diseases” (Hamlin 1882,

p. 427). An 1886 medical textbook stated: “To women of the higher

classes, ennuyee and tormented with neuralgias or the vague pains

of hysteria and hypochondriasis, opium brings tranquility and selfforgetfulness” (Wilson 1886, p. 649).

Cocaine, Chloral Hydrate, Chloroform, and Cannabis

Dr. G. Archie Stockwell (1877) first documented the medical use

of cocaine in the United States in his article in the Boston Medical
39

and Surgical Journal, which extolled cocaine’s stimulant properties to

physicians. During the next decade cocaine enjoyed wide usage in the

treatment of “wasting diseases,” dyspepsia, and opiate addiction; somewhat later as an anesthetic, physical stimulant, mental stimulant, and

diuretic; and most importantly in the treatment of hay fever, colds, and

sinus conditions. Women shared in the “therapeutic benefits” of this

new wonder drug (Walker 1884; Jarvis 1884; Turnbull 1885). As with

opiates, cocaine was widely used to treat gynecologic complaints such

as painful intercourse, cervical endometritis, urethritis, dysmenorrhea,

postpartum cervical lacerations, cracked nipples, and vomiting of pregnancy. As Mortimer (1901, p. 384) noted, “If the patient be a woman,

the gynaecologist locates the concentration of troubles in predominant

functions.” Mortimer (1901, pp. 390-391), in his comprehensive History

of Coca, also wrote regarding mental stress that “women are more commonly the sufferers of neurasthenia than are men” and that at least half

of the physicians surveyed “advocated the use of coca for cases of neurasthenia.”

Coca and cocaine were also widely available to the general public in

commercial folk medicines, home remedies, tonics, soft drinks such as

Coca-Cola, and coca-wine preparations such as Vin Mariani. In addition, social use of cocaine was also abetted by doctors, as acknowledged

by a Cincinnati physician who “had fashionable ladies come to him to

get hypodermic injections of cocaine to make them lively and talkative”

(Whittaker 1885, pp. 177-178).

Chloroform also came into fashionable use toward the end of the

19th century. In 1894 an undercover reporter for the New York Herald

wrote that a doctor was quite willing to treat the reporter’s “nervousness”

with the gas, with assurances of a cure (cited in Silver 1979, p. 68). In

1901 the Boston Globe (November 17, 1901) reported that upper-class

society women were attending “oxygen parties” in which nitrous oxide

was inhaled to liven up the festivities (Silver 1979, p. 680). Chloral

hydrate, produced since 1869, was readily available to combat fatigue,

tension, and pain. In women, chloralism could be induced as a result

of liberal usage in obstetric practice (Etheridge 1872, pp. 524-525), by

sedation of “invalid women made weaker by family cares,” and following

treatment for gynecologic complaints (Kane 1881, pp. 149-150). Chloral

hydrate was also used to treat neurasthenia in women and to ease their

pain and disappointments, as with Edith Wharton’s heroine, Lily Bart, in
40

The House of Mirth, for whom “the thought of the chloral was the only

spot of light in the dark prospect” (Wharton 1984, pp. 299-300).

Cannabis was widely prescribed between 1840 and 1900 for many

ailments such as tetanus, neuralgia, convulsions, rheumatism, asthma,

bronchitis, and for “women’s diseases” such as gonorrhea, uterine hemorrhage, dysmenorrhea, labor pains, and postpartum psychoses (M’Meens

1860, pp. 94-95). Mattison (1891, p. 266) believed that cannabis was

useful in the management of headache, “the bane of American women.”

Cannabis was also reputedly useful in the treatment of neurasthenia, and

at least one major textbook used by almost one-third of U.S. medical

schools offered cannabis indica as a safer alternative to chloral or

morphine (Strumpell 1888, p. 770). The medicinal use of cannabis fell

into disrepute by the end of the century because of its variable results,

difficulty in dose regulation, and potential for abuse and habit. Recreational cannabis use, however, which had begun about 1840, continued.

Kane (1883) wrote in Harper’s Monthly of his experiences in a New York

hashish house, which catered to clients who were “both male and female

. . . of the better classes.” Kane described magnificently ornamented

rooms “reserved for persons, chiefly ladies, who wish to avoid every

possibility of detection, and at the same time enjoy their hashish and

watch the inmates of this room.”

THE NATION’S RESPONSE TO THE

DRUG PROBLEM, 1850-1914

During the mid-to-late 19th century, the general public tolerated

and accepted drug use by both sexes. Although the majority of opiate

addicts and a significant percentage of other drug users were women,

the prevailing stereotype of the opiate addict—white, middle or upper

class, Southern, female—combined with the view that these addicts

were “acceptable” and nonthreatening, helped perpetuate the large

numbers of women in the shadows of addiction. At the same time,

however, three major societal forces were transpiring to curtail drug

use in the United States: (1) education of physicians and pharmacists as

to the dangers of certain drugs and restriction of the prescribing practices

of health personnel; (2) legislative initiatives in response to profound

sociodemographic changes in the U.S. population of addicts and users;

and (3) international pressures that were moving the United States to

control its domestic drug problem.
41

Education of Physicians

Although many physicians continued their unregulated practice of

prescribing opiates and other addicting drugs, other physicians were

becoming aware of the dangers of those drugs. One Alabama physician

wrote that excessive prescribing of opiates was “malpractice” and that

“many otherwise noble women will be driven to prostitution from its

effects” (Duncan 1885, p. 248). An American Text-Book of Gynecology

(Baldy 1898, p. 105) condemned the use of such drugs in the treatment

of dysmennorhea: “He who is compelled to resort frequently to opium

and stimulants, must be considered devoid in diagnostic ability, and

consequently ought not to be entrusted with the management of such

cases.” Treating neurasthenia with addictive drugs came under scrutiny

as well. An 1886 textbook advised that “all drugs hold a secondary

position [to rest] in the relief of a pure neurasthenia” (Pepper 1886,

p. 357). A 1903 textbook still found it necessary to warn, however, that

“powerful opiates should be avoided” in the treatment of neurasthenia

(French 1903, p. 699). Other renowned physicians, including William

Osler and S. Weir Mitchell, also warned that such drugs held no place

in the treatment of neurasthenia. One segment overrepresented among

addicts was the wives of physicians. As noted by Mitchell (1904,

pp. 98-99), “If there be one set of women more liable than another to

become victims of morphia or chloral, it is the wives of physicians. Every

winter I see four or five, and always it is true that the habit has arisen out

of the effort of the husband to attend medically on his wife.”

Cocaine, despite its wide popularity and usage, had its detractors.

From his experiences and those of other physicians, Mattison (1887)

described cases of cocaine toxicity in women who were treated for

gynecological diseases, chronic bladder infection, dental problems, and

hay fever. One woman died from “cocaine poisoning” after “freely using

a four percent solution, for toothache,” and an 11-year-old girl died

after an injection of cocaine to treat her fainting fits. A New York City

physician described cocaine toxicity in a woman being treated for a

lacerated cervix and another being treated for neuralgic headache.

Warnings were also circulated that cocaine produced “unseemly” or

indecent behavior. One dentist wrote that his 16-year-old patient had

experienced “a paroxysm of the most intense pleasurable excitement”

that was due to the “aphrodisiac quality of cocaine” (Cornell 1891,

p. 152).
42

Physicians were also recognizing the dangers of hypnotics such as

chloral hydrate. Mattison (1879b, p. 12) meticulously cataloged the

dangers of the drug in patients, including a 38-year-old woman who

developed partial paraplegia; older women who developed skin eruptions; a 19-year-old girl who acquired a “dull and pasty complexion”; and

a woman who developed pallor, double vision, a staggering gait, and

stupor. Kane (1881, pp. 168-204) similarly found chloralism to be

common among women treated for conditions such as rheumatism,

facial neuralgia, cancer of the breast, “reflex uterine irritation,” “insomnia and nervousness of prolapsis uteri,” “periodical mania,” and “cardiac

disease, hemiplegia, and dementia.” Another of Kane’s patients, although not supervised by him personally, died from chloralism during

treatment for “dipsomania.”

During the late 19th century, physicians began to appreciate the

adverse effects of opiate-taking by pregnant women. Kane (1881, p. 44)

wrote that “the excessive use of this drug by one or both parents, but

especially the mother, in case she is able to carry her child to full term,

will modify disadvantageously the physical, mental, or moral development of the child thus born.” The earliest mention of “congenital

addiction” was reportedly made by F.B. Earle (1888). Subsequent reports

in the 1890s delineated the syndrome of neonatal withdrawal, and in

1894 a physician wrote of the need to treat opiate-exposed infants after

birth with morphine or “they are apt to suffer collapse, and their condition may end in death” (Fischer 1894, p. 199). In 1913 Pettey described

not only the clinical signs of “congenital morphinism” but also the

relationship of those signs to the amount of maternal narcotics taken

and an appropriate regimen of treatment for the infant (Pettey 1913,

p. 331).

If pregnant women were being held up to scrutiny, even more

concern was voiced concerning the administering of opiates to children

by mothers, their usual caretakers (Sharp 1986; Baker 1994). An article

in The Boston Medical and Surgical Journal (Dangers of giving opiates . . .,

1834, p. 174) noted: “It is remarkable, when we consider with what

unguarded rashness medicines containing opium are given by mothers

and nurses to young children, that fatal accidents do not more frequently

occur.” These accusatory admonitions appeared in the medical literature

throughout the century. Chase (1873, p. 596) warned about opiates that

“their extensive use in the form of ‘Soothing Sirup’...has resulted in the
43

untimely deaths of thousands of children.” Marshall (1878) offered the

estimation that the sales popularity of Mrs. Winslow’s Soothing Syrup

would be enough “to kill a half million of infants not accustomed to its

use” (O’Donnell and Ball 1966, p. 51). Faulkner and Carmichael (1892,

p. 535) said of the same dangerous preparation that “it would scarcely be

possible to estimate the number of children which it sends to the grave

before their second year.” Even the dangers of breast-feeding were noted

by the American Pharmaceutical Association in 1903 when it stated that

“the nursing babe absorbs medicine from its mother’s breast as it draws its

nourishment; it becomes an habitué with its birth” (Eberle and Gordon

1903, pp. 479-480). Because the prevailing wisdom held that “in childhood the mother is in large measure responsible for the ductile being in

her care” (Mitchell 1904, p. 111), it is clear that women were being held

increasingly responsible for the effects of drugs and medications they took

during pregnancy or administered to their young children.

Legislative Initiatives

Together with efforts to educate physicians and much less successful

attempts to treat opiate addiction and overuse of other drugs, a Federal

legislative agenda to control drug use was developing. Much of this

antidrug agenda was based on the desire to counter the social and

economic threats posed by minorities, such as Asian immigrants and

African-Americans. To further this legislative initiative, women began

to be portrayed as targets of drug-crazed, sexually predatory minority

men. The sensationalistic Hearst-dominated lay press ran frequent

stories of women lured into Chinese opium dens or the white slave trade.

San Francisco authorities feared that “many women and young girls . . .

were being induced to visit the dens, where they were being ruined

morally and otherwise” (Kane 1882, p. 1). Hamilton Wright, one of the

architects of American drug policy in the early 1900s, claimed that “one

of the most unfortunate phases of the habit of smoking opium in this

country [was] the large number of women who have become involved

and were living as common-law wives or cohabitating with Chinese in

the Chinatowns of our various cities” (Wright 1910, p. 44). In response

to the increasing use of cocaine by African-Americans, testimony was

offered in 1910 before the U.S. House of Representatives that AfricanAmericans “would just as leave rape a woman as anything else and a

great many of the southern rape cases have been traced to cocaine”
44

(cited in Morgan 1981, p. 93). In 1911 Wright stated that cocaine “is

used by those concerned in the white slave traffic to corrupt young girls,

and when the habit of using the drug has been established, it is but a

short time before such girls fall to the ranks of prostitution” (New York

Times, March 12, 1911). These concerns linking women, sex, and drugs

eventually resulted in passage of the White Slave Traffic Act (Mann

Act), which regulated “interstate and foreign commerce by prohibiting

the transportation therein for immoral purposes of women and girls”

(U.S. Senate 1910, pp. 61-63).

In addition to a press more concerned with sensationalism than

accuracy, a young Hollywood, creating silent picture fans by the millions,

had adopted opium and cocaine use as popular themes (Starks 1982;

Brownlow 1990). Beginning in 1894 with a 30-second kinetograph

titled “Chinese Opium Den,” which was made for Thomas Edison,

Hollywood produced more than 200 known films dealing with the drug

theme. The theme of women as vulnerable targets of drugs was used in

many films, such as “Morphia—the Death Drug” (1914), “The Secret

Sin” (1915), “The Rise of Susan” (1916), “The Devil’s Needle” (1916),

“The Girl Who Didn’t Care” (1916), and “The Devil’s Assistant”

(1917). Even after passage of the Mann Act, films such as “Traffic in

Souls” (1913), “White Slave Traffic” (1913), and “The White Slave”

(1913) suggested the extent to which the film industry clung to a

sensationalized and lurid treatment of the enslavement of women

through drugs.

Drawing a connection among women, sexuality, and drugs thus

became an important way to generate public revulsion of drug use by a

population of users that was becoming increasingly minority, poor, and

urban. This dramatic transformation of U.S. drug users fueled a

crescendoing effort to pass antidrug legislation, an effort that had begun

with an antiopium municipal ordinance in San Francisco in 1875.

Although many State antidrug laws were passed during the next

40 years, local laws were generally unsuccessful in curtailing drug use.

National legislation to control opium smoking had been introduced in

1880 and 1884, and although both bills died in committee, committee

members realized that tax mechanisms could be used to control the flow

of drugs, a strategy that would bear fruit with the 1914 passage of the

Harrison Act.
45

International Pressures

In addition to the mounting national pressures to control the drug

problem, the U.S. was seeking recognition as an international power and

attempting to solidify its influence globally. The pace to control the

international flow of drugs accelerated in 1909 with the first meeting of

the Shanghai Commission. The United States felt pressure to put its

own drug affairs in order and accordingly established “an Act to prohibit

the importation and use of opium for other than medicinal purposes” in

February 1909. Although subsequent meetings in The Hague and

Geneva were intended to tighten these controls, critics such as Ellen La

Motte felt that these measures leaked “like a sieve” (La Motte 1924,

p. 175).

The Harrison Act and Its Repercussions

By the beginning of the 20th century, the Nation had come to view

drug addiction as against its best interests. As the stereotypical picture

of the addict changed from the sympathetically viewed, white, genteel

Southern woman, who had been iatrogenically addicted, to that of an

urban, poor, minority male, it became easier for society to view addicts as

unproductive, escapist, and self-centered. The mythology of perceived

threats to women posed by drug-using African-Americans and Asians—

violence, seduction, rape, enslavement—that was promulgated by the

Government, overstated by the press, and glamorized by the movies,

served the national antidrug agenda well. As the country moved toward

a policy of restriction and repression of drugs, it used both the “women

in danger” scare and the reality of thousands of addicted women, not as

an issue to generate sympathetic treatment, but rather one by which

antidrug legislation could be passed.

In spite of earlier failures at passing national antidrug legislation,

Wright convinced New York Democratic Representative Francis Burton

Harrison to sponsor a new bill. This bill, which became effective in

March 1915, was primarily a tax act, calling for the elimination of

nonmedicinal narcotics and the use of revenue stamps and recordkeeping to monitor drug flow through medical channels. The Harrison

Act initially generated considerable confusion. Some saw the Act as

an information-gathering mechanism, whereas hard-liners believed it

empowered Federal police to regulate the selling of narcotics within
46

the States. During this period, male and female addicts found themselves in a world of shrinking drug supplies and skyrocketing prices. It

was not until March 1919, when the Supreme Court ruled in Doremus

that the Harrison Act was constitutional and in Webb that physicians

could not prescribe narcotics solely for maintenance, that it became

clear that the Nation was prepared to fight the drug war with strong,

repressive methods.

During these years the number of female addicts declined because of

changes in prescribing practices by physicians and pharmacists, regulatory measures such as the Pure Food and Drug Act of 1906, and legislative pressures creating a male-dominated drug underworld that many

women were reluctant to enter. Some Southern drug registries, such as

those in Jacksonville, FL, and Tennessee, continued to find that women

formed the majority of narcotic addicts. In other addict populations,

however, men were beginning to clearly outnumber women. A 1914

survey of 1,000 inmates at the Manhattan City Prison found that “male

habitués greatly outnumber the female” (Lichtenstein 1914, pp. 964-

965). Those women inmates had been previously employed as actresses,

nurses, saleswomen, and stenographers and included “some of the very

richest of our people.” A 1915 survey at Philadelphia General Hospital

found that 25 percent of heroin addicts were women (Farr 1915), and a

similar survey the following year found the female representation to be

30 percent (McIver and Price 1916).

Women addicts were increasingly socially stigmatized and faced

either the difficult task of maintaining their habit or the even more

daunting task of ridding themselves of addiction. Some women continued their drug use through purchasing patent medicines. Despite passage

of the Pure Food and Drug Act, from 1902 to 1912 the production of

patent medicines increased by 60 percent and profits in the industry rose

from $100 million to $160 million (Young 1961, p. 248; Young 1967,

p. 57). Other women of economic means, or those who could be maintained on small doses of drugs, continued to receive drugs from private

physicians. Still other women resorted to subterfuge. New York narcotics official Sara Graham-Mulhall told of a young woman who arrived in

the city and was treated for a supposedly painful condition by “no fewer

than four physicians, no one of whom knew of the others prescribing.”

When the current physician explained that she had to be registered and

treated only once, “she does not return to him, but applies to another
47

doctor, who innocently prescribes for her” (Graham-Mulhall 1921,

p. 107). Nurses and physicians’ wives continued to represent a large

number of female addicts. Lichtenstein (1914, p. 962) wrote that he

had “treated many nurses addicted to morphine taken hypodermically.”

An Iowa physician noted that morphine addiction was a “bad example

which is especially true of physicians’ wives” (Macklin 1919).

An unknown number of female addicts undertook the difficult

task of self-withdrawal to avoid resorting to the underworld for drugs.

Dependence on the underworld meant an increased likelihood of

becoming a prostitute to support a drug habit. A 1915 medical editorial

noted, “Houses of ill fame are usually their sources of supply, and one

has only to think of what repeated visitations to such places mean to

countless good women and girls—unblemished in most instances except

for an unfortunate addiction to some narcotic drug—to appreciate the

terrible menace” (Editorial comment 1915, p. 800).

A final option for female addicts lay with the drug treatment

clinics. In the summer of 1919, following the Doremus and Webb

Supreme Court decisions, the Internal Revenue Service urged the

establishment of clinics to deal with the “drug panic” that had suddenly

developed. These clinics proliferated, numbering 44 before they were

closed by 1923. The largest of the clinics, based in New York City,

existed for less than 1 year between 1919 and 1920. Between June

and December 1919, the New York City clinic treated 1,532 women,

who made up 23 percent of the 6,579 registered addicts. More than

90 percent of the women were younger than 40, and about 75 percent

were white. Women represented about one-quarter of the New Haven,

CT, clinic population and about one-third of of the Cleveland and

Los Angeles clinic populations (Terry and Pellens 1928, p. 473).

The clinic in Albany, NY, saw an equal number of men and women,

and other clinics were treating many more men than women.

One of the most successful and best documented drug treatment

clinics existed in Shreveport, LA, between 1919 and 1923. Women

made up about one-quarter of the 760 addicts of whom records were

available for review (Waldorf et al. 1974). Reflecting the geographical

differences that persisted among addicts in the North and South, 89 percent of the women cited a medical reason for their addiction. Illustrative

case reports among the women included a store clerk treated with morphine for syphilis, a nurse addicted to morphine for gallstone pain, a
48

housewife treated for chronic asthma and rheumatism, a housewife

addicted following an operation for gangrene, and an aging widow

addicted for the management of cancer pain (Waldorf et al. 1974).

The drug treatment clinics were never popular with the Narcotics

Unit of the U.S. Department of the Treasury, because they ran counter

to the repressive posture developing within that unit. Although many

of the clinics were not competently operated, a few sympathetically

run clinics had provided female addicts with a safe, inexpensive way

to procure narcotics. If they so chose, such women could maintain an

orderly lifestyle without reliance on the underworld or on men, as either

peddlers or sexual partners. As the last clinics closed and the United

States entered the Classic Era of drug control, some women addicts

were able to find treatment in private sanitariums; other, less fortunate

women were placed in prisons or State psychiatric hospitals; and the

majority became reliant on the criminal underworld, facing shadowy

lives of social marginalization, degradation, and shame.

NOTE

1. This material is abstracted from Dr. Kandall’s book Substance and

Shadow: A History of Women and Addiction in the United States—

1850 to the Present (Kandall 1996).

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AUTHOR

Stephen R. Kandall, M.D.

Professor of Pediatrics

Albert Einstein College of Medicine

Chief, Division of Neonatology

Beth Israel Medical Center

7 Baird Hall

First Avenue and 16th Street

New York, NY 10003

(212) 420-4170 (Tel)

(212) 420-4590 (Fax)

skandall@bethisraelny.org (E-mail)