The art of intoxication
Authors: Phil Withington
Journal: The Lancet (2014)

William Harvey is celebrated as the English physician who first showed, through anatomical experiment and observation, how blood circulated round the body and challenged the Renaissance medical establishment and the Galenic principles upon which it operated. As his friend Thomas Hobbes later observed, "he is the only man, perhaps, that ever lived to see his own doctrine established in his lifetime". If any single figure can be said to personify the medical revolution of the 17th century then it is perhaps Harvey. He was not, however, innovative merely in his "doctrines". The 17th-century biographer John Aubrey noted that "I remember [Harvey] was wont to drink coffee; which he and his brother Eliab did, before coffee-houses were in fashion in London". This was when coffee was less the civil beverage of Enlightenment discourse, more an exotic, new, and intoxicating brew. Aubrey also hinted that Harvey partook in a more dangerous habit, announcing in Brief Lives that "It is now fit, and but just, that I should endeavour to undeceive the world in a scandal that I find strongly runs of him, which I have met amongst some learned young men". This was "that he made himself a way to put himself out of his pain by opium". Aubrey wrote that although Harvey may well have concocted a "preparation of opium and I know not what, which he kept in his study to take, if occasion should serve", it was in fact the "palsy"—a stroke—that killed him. Aubrey nevertheless conceded that "I do not deny that it was not according to his principles upon certain occasions to…". That is, Harvey seems to have enjoyed an opium habit that Aubrey (quite literally) could not name. On the face of it there is no meaningful correlation between Harvey's brilliance as a physician and his precocious embrace of coffee and opium—two intoxicants that only became fixtures in English diet and medicine in the decades after Harvey's death in 1657. Certainly, I would not argue for a connection between "genius" and "drugs", or to speculate that Harvey's restless intelligence was somehow drawn to, or required, caffeine and opiates. What I want to suggest, rather, is that for Anglo-American culture at least, Harvey's predilections are suggestive of some of the more general ways in which the "art of medicine" has historically influenced what we might call the "art of intoxication". In the era when Harvey made his opium preparations, "art" retained its original meaning, inherited from the ancients, of learned behaviour and skills that transcended the natural talents of a person. Such skills might indeed be in painting, poetry, or philosophy; but they might equally be in telling jokes or simply behaving appropriately in particular social settings. It was this more social sense of art that Samuel Johnson described in his Dictionary, as "an habitual knowledge of certain rules and maxims by which a man is governed and directed in his actions". Viewed on these terms medicine was an art; but so, too, was intoxication. During Harvey's lifetime the primary sense of "intoxicate" as "envenoming" and "poisoning" was expanded to include "drunkenness" and "making drunk". Indeed, it was partly due to Harvey's experiments that this expansion in meaning occurred. As late as 1618, the physician John Bullokar conventionally defined "intoxicate" as "To betwitch, to amaze, to extremely dull one's spirit". But, by 1646, Harvey's friend and populariser, the physician Thomas Brown, could explain that "the prevalent intoxication is from the spirits of drink dispersed in the veins and arteries, from whence by common conveyances they creep into the brain, insinuate into its ventricles, and beget those vertigoes, accompanying that perversion". This meant that "the head may be intoxicated by a medicine at the heel. And so the poisonous bites of serpents, although on parts at distance from the head, yet having entered the veins, disturb the animal faculties, and produce the effects of drink, or poison swallowed". This conflation of drink and poison, and the mechanics by which they worked on the body, subsequently entered common knowledge. This shift in meaning of intoxication coincided with the remarkable increase in the variety and volume of potential intoxicants. The 17th century saw an expansion in the trade in alcohol—in beers, wines, fortified wines, and spirits—and the first great influx of nicotine, caffeine, and opiates. But even more striking was the development and codification—primarily through the new print technology—of new and myriad rituals, conventions, and "rules and maxims" for consuming this proliferation of intoxicants. This was the era, for example, in which oaths and healths became the usual ritual by which men and sometimes women drank when in company; which saw the popularisation of complicated verbal drinking games; which saw the proliferation of drinking clubs and societies with laws and conventions based on classical rituals like the symposium; which saw a whole new material culture emerge around using and sharing tobacco pipes and snuff boxes; and which saw new systems of manners and discourse inform the consumption of hot caffeine beverages. Harvey not only changed our understanding of how intoxication worked on the body, he also lived in an era undergoing a veritable renaissance in the art of intoxication. Harvey's use of coffee and opium coincided with this profound shift in English intoxication, consumerism, and sociability. It also highlights at least three ways in which the art of medicine has shaped the modern arts of intoxication. First, since at least the triumph of tobacco in the early 1600s, the role of medicine in promoting the use of new intoxicants is a well-known feature of modern western societies. Tobacco was introduced into Europe as a "universal panacea" that worked according to the Galenic paradigm. It was only later that its other, more sociable, uses became predominant, with medical writers as quick to condemn tobacco's wider consumption as to trumpet its curative qualities. Harvey's tipple, opium, became a medical staple for two centuries before the late Victorian backlash; much later, the initial entry point for cocaine into Europe in the 1880s was doctors and their wealthy patients. A similar cycle of prescription and proscription continued thereafter. Second, Harvey points to the precarious tension between two kinds of intoxication that were inextricably linked in the 17th century. One was purposeful intoxication, whereby intoxicants were consumed expressly for the changes in consciousness they effected: "making merry" or "drinking hard", to use the language of Harvey's contemporaries. The other was immanent intoxication, whereby consuming an intoxicant for one set of reasons—whether beer for nourishment or opium for physic—the imbiber was nevertheless exposed to the risk of drunkenness or addiction. Third, the disquiet surrounding Harvey's opium habit points to a historical conception of "addiction" that served as the flipside of acceptable intoxication—as the stick, that is, with which to beat those who could not or would not learn intoxication's arts. Given these tensions, it is unsurprising that a key aspiration of the Renaissance "art of intoxication" was controlled and moderate consumption. To be able to retain demonstrable levels of self-discipline and independence in the midst of either immanent or purposeful intoxication was a fundamental social skill. Contrariwise, to become dependent on a substance, the slave to one's appetites, or oblivious to one's surroundings was the hallmark of "addiction". This Harvey's contemporaries understood in the classical sense to mean "the act of devoting, or giving up" and "the state of being devoted" at the expense of everything else. And there is much evidence that this concept of addiction was widely recognised in this period. Just as the minor legal official Anthony Carthorne was described in 1629 as a man "much addicted to drunkenness and to haunt and frequent alehouses very disorderly", so the church minister John Warter confessed in 1678 that "he hath unseasonably frequented taverns and alehouses…and hath been addicted to drinking of strong beer and wine and ale". Although by no means national figures like Harvey, both Carthorne and Warter, and many others like them, were the subjects of local public scandal on account of their addiction. One consequence of the medical revolution that Harvey helped instigate is that medical practitioners now have the confidence to be our lifestyle policemen, largely on the grounds that they know what is empirically good or bad for our health. Yet if the example of Harvey tells us anything, it is that a medical understanding of how bodies and minds work cannot be so easily separated from society and morality. More particularly, that the arts of medicine and intoxication have always intersected in unexpected ways, and that they continue to do so. Modern medical notions of addiction largely focus on biological and psychological tendencies rather than the inability to behave according to learned "rules and maxims". But the essential "problem" denoted by the word—an all-consuming "devotion", a "giving up"—remains the same, as does the potential for stigmatisation. Just as the capacity of the pharmaceutical industries and medical professions to produce and introduce new drugs is truly remarkable, so is the popular appropriation of these new substances for recreational and other uses. Indeed, it is in part thanks to the efforts of medical science that the opportunities for immanent and purposeful intoxication have proliferated rather than diminished since Harvey made his "preparations of opium" more than 350 years ago. It seems important, therefore, that medicine understands itself not to be the final solution to the problem of intoxication so much as an ambivalent player in what history shows to be a perennial struggle over the place of intoxication in society; to recognise that, whether deliberately or inadvertently, medical practitioners have long been implicated in the arts of intoxication. Phil Withington is co-director of Medical Humanities Sheffield and leads a research project on Intoxicants and Early Modernity (http://www.intoxicantsproject.org), funded by the Economic and Social Research Council. Phil Withington is co-director of Medical Humanities Sheffield and leads a research project on Intoxicants and Early Modernity (http://www.intoxicantsproject.org), funded by the Economic and Social Research Council.