The Hidden Epidemic: Opiate Addiction and Cocaine Use in the South, 1860-1920; by David T. Courtwright (1983) -- ONE OF THE MANY MEMORABLE CHARACTERS IN HARPER LEE'S novel, To Kill a Mockingbird, is an aged morphine addict, Mrs. Henry Lafayette Dubose. Mrs. Dubose was a cantankerous widow who lived in Maycomb, a small, fictitious Alabama town. She had been addicted many years before by her physician, who gave her morphine to ease her pain. Informed that she had only a short while to live, she struggled to quit taking the drug, for she was determined "to leave this world beholden to nothing and nobody."'
There were tens of thousands of real-life Mrs. Duboses scattered throughout the postbellum South. With the possible exception of the Chinese, southern whites had the highest addiction rate of any regional racial group in the country, and perhaps one of the highest in the world. At the same time southern blacks had a relatively low rate of addiction, at least with respect to opiates. Blacks, when they used drugs at all, tended to use cocaine. It has been alleged-and heatedly denied-that black cocaine use manifested itself in a major crime wave around the turn of the century. Even discounting these reports, it is apparent that the postbellum South had an unusually severe narcotic problem characterized by racial preferences for different drugs.
Documenting this pattern of drug use is difficult since users tended to conceal their practices for fear of social or legal reprisals. There are, nevertheless, a few sources of statistical data. The most important of these is a by-product of the 1914 Harrison Narcotic Act, which was designed to regulate the sale and distribution of narcotics, defined primarily as the opiates and cocaine. The fateful weakness of the Harrison Act was its failure to resolve the issue of maintenance; that is, could a physician legally supply an addict with drugs for the sole purpose of supporting his or her habit? After years of pressure from the Treasury Department the Supreme Court finally decided in March 1919 that physicians might not maintain addicted patients.
Consequently many addicts, denied a legal source of opiates, were forced to turn to the black market. However, many municipalities, for both practical and humanitarian reasons, responded to this crisis by establishing narcotic clinics, which were designed to supply narcotics to, and in some instances to treat, addicted persons. But the federal government continued to pursue its antimaintenance policies, and within two years it had succeeded in closing nearly all the clinics.2 Fortunately, however, their records survived, and in 1924 two United States Public Health Service officials, Lawrence Kolb and Andrew G. Du Mez, tabulated the number of addicts attending clinics in thirty-four cities in twelve states. The data for eleven southern cities are set forth in Table1 and 2...
...Further evidence for higher southern use is found in pharmacy records. A survey of the records of thirty-four Boston drugstores published in 1888 revealed that, of 10,200 prescriptions sampled, 1,481 or 14.5 percent contained some type of opiate.7 Unfortunately, there was no comparable study of prescriptions for a major southern city. However, a sampling of the contents of two surviving record books of New Orleans pharmacists dating from the 1870s and 1880s shows that fully 24.5 percent of these prescriptions contained opium or morphine-ten percentage points more than the Boston average.8 While a limited, two-city comparison does not prove that an entire region had a higher rate of addiction, it at least corroborates the differences in clinic registration. Taken together, the statistical evidence indicates that the South suffered an inordinately high rate of opiate addiction in comparison to other regions of the continental United States.
The burden of addiction was not borne equally, however. Whites were over-represented among opium and morphine addicts, blacks underrepresented. In 1885 Dr. James D. Roberts of the Eastern North Carolina Insane Asylum, after making a number of inquiries, reported that he knew "of but three well authenticated cases of opium-eating in the negro."9 In Jacksonville, nearly three-quarters of the opium and morphine addicts were white, even though whites made up slightly less than half of that city's population. Commissioner Brown noted that not over 10 percent of Tennessee's registrants were black, even though blacks made up roughly one-quarter of that state's population.'0 In Shreveport, 91.5 and in Houston, 95.5 of the clinic patients were white, remarkable statistics in view of the substantial black population in those areas." The high overall southern rate of addiction, together with the relatively low number of black addicts, suggests that postbellum southern whites, as a group, suffered an exceedingly high rate of opiate addiction.
The South suffered more casualties than the North; there were therefore relatively more wounded or shell-shocked soldiers who were candidates for addiction during or after the conflict.22 The Civil War also had an enormous psychological impact on the South; with the realization that a way of life was irretrievably lost came a lingering, pervasive depression, especially among the planter elite. One knowledgeable New York opium dealer thought he saw a connection between the South's increased opiate consumption and its postwar malaise. "Since the close of the war," he remarked in 1877, "men once wealthy, but impoverished by the rebellion, have taken to eating and drinking opium to drown their sorrows."23 Women, too, he might have added; they had their own war-related troubles, and the opiates were especially attractive as a semi respectable substitute for alcohol.
The Civil War also provides a clue as to why blacks had a relatively low rate of addiction; Confederate defeat was for most of them an occasion of rejoicing rather than profound depression. This was almost certainly not as important, however, as the fact that blacks generally lacked access to professional medical care. Because they were poor, because they were discriminated against, and because there were relatively few doctors of their own race, blacks could not avail themselves of physicians' services as often as did
southern whites.25 While this may have exacerbated their high rates of morbidity and mortality, it at least conferred an ironic benefit: freedom from iatrogenic, or physician-caused, opiate addiction.
Two other factors also help to explain the lower black rate of addiction, although these should be considered of secondary importance. First, blacks tended to be younger than whites. In 1890, for example, the median age of blacks was 18.1 years; whites, 22.5 years.26 Stated another way, relatively more whites survived to
middle age and beyond. This is significant because many of the chronic diseases commonly treated with opiates (such as arthritis, rheumatism, or delirium tremens) were conditions observed primarily among older patients, Mrs. Dubose again serving as a prime example. Second, it is now known that southern blacks, for a
variety of complex genetic reasons, suffered fewer and less severe cases of malaria.27 Since malaria was one of the chronic diseases treated symptomatically with opiates, this also conferred a slight advantage on blacks, from the standpoint of avoiding addiction.
The low rate of opiate addiction among southern blacks, however, does not necessarily mean that they were entirely drug free. Although opiates were by all odds the leading drug of addiction during the nineteenth and early twentieth centuries, other drugs, notably cocaine, were also overused. In the mid-1880s many American physicians, encouraged by the glowing reports of Sigmund Freud and other cocaine enthusiasts, administered the drug for a wide variety of ailments; cocaine, like opium and morphine, became something of a panacea. Within a few years, however, more conservative physicians launched a counterattack, warning their colleagues in articles and speeches of the danger of creating "cocainists."29
Just as these animadversions began to have an effect growing numbers of blacks were beginning to use cocaine for other, essentially nonmedical, reasons. It appears that blacks were introduced to cocaine sometime in the late 1880s or 1890s when New Orleans stevedores began taking the drug to help them endure long spells of loading and unloading steamboats, a task at which they labored for up to seventy hours at a stretch.30 In this respect they resembled South American natives, who chewed coca leaves to increase their nervous energy, avoid drowsiness, and "bear cold, wet, great bodily exertion, and even want of food ... with apparent ease and impunity."3' Whether these stevedores took to cocaine on their own initiative, or whether they were introduced to the drug by their foremen, is not known. It is known, however, that the use of cocaine by black laborers soon spread from New Orleans to other parts of the South, to cotton plantations, railroad work camps, and levee construction sites.32 "Well, the cocaine habit is might' bad," ran one work song, "It kill ev-ybody I know it to have had.""I Other blacks sniffed cocaine, not as a stimulus to work, but as a form of dissipation.34 Altogether, there were proportionately more black cocaine users than white. In Jacksonville, for example, area blacks had a rate of cocaine use almost twice that of white residents in 1912.11 Southern police chiefs who responded to a national survey on drug use in 1908 and 1909 stated that there were relatively more black cocaine users than white, an opinion shared by their northern colleagues. Prison statistics, although fragmentary, are consistent with the belief that cocaine was more popular among blacks than whites.
Less clear are the behavioral implications of cocaine use by blacks. From 1900 to 1914 several white authorities claimed that blacks, crazed by cocaine, went on superhuman rampages of violence. ". . . many of the horrible crimes committed in the Southern States by the colored people can be traced directly to the cocaine habit," charged Colonel J. W. Watson of Georgia in 1903.36 Others who sounded variations on this theme included New Orleans district attorney St. Clair Adams, Vicksburg municipal court judge Harris Dickson, New Jersey physician Edward Huntington Williams, and Dr. Hamilton Wright, a leading member of the United States Opium Commission.39 Police officials were also concerned with cocaine's exciting effects. "When negroes get too much of it," wrote Louisville police chief Jacob H. Haager, "they are inclined to go on the war-path, and when in this condition they give a police officer who attempts to arrest them . . . a hard time."
In recent years a number of authors have flatly denied these allegations. David F. Musto, a psychiatrist and historian, has argued that "These fantasies characterized white fear, not the reality of cocaine's effects ...... "1" Richard Ashley has also dismissed them as "fear-mongering fantasies," while Joel L. Phillips and Ronald D. Wynne conclude that "No reputable researchers have uncovered any statistical or other type of evidence to indicate that the use of cocaine resulted in a massive (black) crime wave." Why, then, did so many contemporaries make the link between blacks, cocaine, and crime? One possible explanation is that they had ulterior political motives. Hamilton Wright, for example, may have used the cocaine stories in an effort to secure the support of Negrophobic southern congressmen for pending antinarcotic legislation. Similarly, Edward Williams was an antiprohibitionist who, by suggesting that when blacks were denied liquor they switched to cocaine, may have been attempting to persuade the public that alcohol was the lesser of two evils. Beyond discrediting the testimony of Drs. Williams and Wright, Musto has also suggested that, in general, the cocaine stories served as a further excuse to repress and disfranchise blacks and as a convenient explanation for crime waves.
While there is much validity in these arguments, and while it is virtually certain that there was no massive wave of cocaine-related crime, there may be additional reasons why so many authorities made this association. One possibility is that they were simply repeating a legend, a legend based upon a few scattered incidents. It is not impossible to imagine that a "hitherto inoffensive, law-abiding negro," as Dr. Williams described him, chafing under accumulated slurs and outrages, might, under the influence of cocaine, vent his rage on a white person, especially a white policeman. Such an attack might represent genuine cocaine psychosis or simply relaxed inhibitions combined with long-standing grievances.
Given the supercharged racial atmosphere of the South, it would take only a few such episodes to fashion a full-fledged cocaine "menace." The fear of cocaine-sniffing blacks was thus not unlike the fear of slave rebellion which swept the South after Nat Turner's short-lived foray; both were exaggerated reactions to isolated but potently symbolic deeds. A second likely explanation involves the background of black cocaine users, especially those who lived in cities. As New Orleans police inspector William J. O'Connor put it, they often belonged to the "immoral and lower" elements of the black community.45 Some of them were, in other words, already involved in a range of criminal activities, and a white authority, aware that they also sniffed cocaine, could easily have inferred that cocaine caused the crimes: post hoc, ergo propter hoc.
Finally, there is a sense in which cocaine indirectly contributed to crimes against property. Regular cocaine use could be expensive, especially after restrictive state legislation increased its price; therefore many impoverished black users would have had to resort to petty crime in order to obtain the drug. Once again an observer-particularly one who had heard other cocaine-crime stories-could well have drawn the inference that the action of the drug itself, rather than the lack of money to purchase it, had inspired the deed. A similar mistake was made during the early 1920s, when it was commonly believed that heroin, rather than the addicts' compulsion to obtain it, was a direct incentive to crime.46 Thus, the widespread belief that cocaine caused blacks to commit crimes, which perhaps originated in one or two bona fide episodes, was sustained and expanded by a false sense of causation. The legend grew when Wright and Williams, both physicians with apparently impeccable credentials, used it to suit their own political ends.
Exaggerated fears of black cocaine rampages may also have had the effect of drawing attention from the real southern drug problem-opiates-and obscuring the majority of the real victims-white medical addicts. Opiate addicts were, in any event, ailing, secretive, and heavily tranquilized individuals, reluctant to come into the public eye. Their reluctance was due, in large measure, to unfavorable attitudes toward addicts. Prior to 1870 most Americans-including physicians-regarded opiate addiction as a vice, a bad habit indulged in by the weak-willed and the sinful. Even though they may have originally received the drug from a doctor, the addicts continued taking it, according to one Methodist minister, because "They learn to love the excitement which it produces ..... .
After 1870, however, a small but growing number of physicians, most of whom specialized in treating addicted and alcoholic patients, challenged this prevailing view. They argued that opiate addiction was a variety of a more general condition called inebriety and that inebriety was a functional disease triggered by an underlying mental disturbance. An individual who had, for example, either inherited or acquired a weakened, nervous constitution was thought to be more susceptible than a neurologically normal person. It followed that opiate addiction was not necessarily a vice but was more often a manifestation of a genuine disease. Advocates of this position, who established the American Association for the Cure of Inebriates in 1870 and began publishing a house organ called the Quarterly Journal of Inebriety in 1876, had considerable influence in both northern and southern medical circles.48 It is doubtful, however, that they drastically changed the attitudes of most ordinary men and women, whose understanding of such matters was shaped less by specialized journals than by gossip, stereotypes, and the strictures of evangelical Protestantism. So, as a practical matter, most addicts continued to conceal their condition from relatives and neighbors, even as medical interpretations of their plight were beginning to change during the closing decades of the nineteenth century.
Thus, the spread of opiate addiction through the South after 1860 was, in many respects, a hidden epidemic. The roots of this epidemic were the presence of endemic infectious and parasitic diseases and the lingering trauma, physical and psychological, of the Civil War. The principal reason for the unbalanced racial distribution of opiate addiction was that blacks generally lacked access to professional medical care. The age distribution of blacks and their partial immunity to malarial diseases may also have played a role. The epilogue of this story is that blacks were not significantly afflicted by opiate addiction until they left the South and began settling in large numbers in the drug-ridden tenderloins and ghettos of northern cities.
(source: The Hidden Epidemic: Opiate Addiction and Cocaine Use in the South, 1860-1920. Cartwright, David. 1983)