Doctors, drugs, and addiction: Professional Integrity in Peril at the Fin de Siecle.
Sigmund Freud (1)
There was something strange in my sensations, something indescribably new and, from its very novelty, incredibly sweet. I felt younger, lighter, happier in body; within I was conscious of a heady recklessness, a current of disordered sensual images running like a mill race in my fancy....
R. L. Stevenson, The Strange Case of Dr Jekyll and Mr Hyde (2)
I am weary tonight and low in spirits.... If I don't sleep at once, chloral, the modern
I sometimes think we must all be mad and that we shall wake to sanity in strait-waistcoats.
Bram Stoker, Dracula (3)
In 1878, the narcotics specialist Dr Eduard Levinstein, superintendent of the asylum at Schoneberg, published Die Morphiumsucht nach Eigenen Beobacthungen (Morbid Cravings for Morphia), in which he warned that doctors who taught patients to inject themselves with morphine were 'the originators and propagators' of drug addiction. (4) His concerns reflected the opinions expressed by Dr Oscar Jennings, an English ex-morphine addict, who wrote extensively about this form of addiction in the 1880s and 1890s. (5) They were also echoed by the English physician Dr Clifford Allbutt, who was an early advocate of morphine and was one of several doctors who used cocaine as a stimulant on his walking tours, 'in the hope of amazing his fellow climbers'. (6) By the late 1870s, Allbutt's initial enthusiasm for morphine injections in the treatment of heart and digestive disorders had turned to extreme caution following clinical evidence, which demonstrated the connection between nervous disorders and the cravings the drug induced in frequent users. The opinions of such doctors indicate that by the fin de siecle, iatrogenic addiction--an addiction triggered by a doctor's prescriptions--had become a serious issue for the medical profession, while reactions to the self-experimenting doctor ranged from unease to outspoken criticism. (7)
In this essay, I examine the ambivalent role of the doctor in relation to addiction at the fin de siecle and consider how the professional integrity of the pioneering physician was undermined by his misunderstanding of the nature of this condition in relation to self-experimentation with drugs and in the treatment of his addicted patients. I argue that the doctor's flawed vision and impaired scientific objectivity is revealed through a style of writing that combines medical realism with the Gothic mode. This medico-Gothic mode also introduced an element of subversion through the doctor's personal relationship with drugs and addiction, which in turn undermined the perception of rational middle-class masculinity. My selected writings include letters and papers on the subject of cocaine written by Sigmund Freud in 1884-86, and the reports on addiction written by two fictional doctors--Dr Jekyll in Robert Louis Stevenson's The Strange Case of Dr Jekyll and Mr Hyde (1886), and Dr Seward in Bram Stoker's Dracula (1897).
The wider context of my analysis is the position of the doctor as a professional middle-class male upon whom was conferred significant power over drug distribution and the authority to create a new taxonomy of addictions that conflated aberrant sexuality and degeneration with psychiatric illness at a time when masculinity and the degeneration of the race were key discourses. The association of drug use with irrational and pathological behaviour is relevant to these discourses. Max Nordau's 1893 work, Entartung, published in English in 1895 as Degeneration, proposed that a rational civilisation was based on self-control and criticised the lack of self-will in those inclined to addiction:
A race which is regularly addicted, even without excess, to narcotics and stimulants in any form (such as fermented alcoholic drinks, tobacco, opium, hashish, arsenic) [...] begets degenerate descendants who, if they remain exposed to the same influences, rapidly descend to the lowest degrees of degeneracy, to idiocy, to dwarfishness. (8)
In many respects, the doctor appeared to be the very essence of self-made, professional, middle-class male rationality at the fin de siecle. Lawrence Rothfield, for example, observes that 'the physician of this era seems to point the way toward a professional utopia, a place where knowledge and power might be united and turned to beneficent social action [...] the medical man is transformed, both in himself and in the public imagination, into the ideal bourgeoisie, the cultured yet self-made man par excellence'. (9)
But the doctor was also regarded in a more sinister light. In particular, the Ripper murders of the 1880s, which journalists such as W. T. Stead thought were perpetrated by a sadistic medical maniac, gave rise to an unprecedented level of hysteria in the local and national press. The Ripper frenzy linked the profile of the killer with Stevenson's medical maniac, Dr Jekyll, while the dissection of the female victims anticipate the post-mortem mutilation of Lucy in Stoker's Dracula at the hands of Dr Seward and Van Helsing. The doctor and grotesque violence, it seemed, were conflated in the popular imagination. In the words of Andrew Smith:
That the medical profession was perceived in a sinister light is clear from an examination of press reports at the time of the Whitechapel murders. The image of the 'mad' doctor discussed in the press emerges from pre-existing anxieties relating to the conduct of medicine in general and journalistic anxieties about middle-class men in particular. (10)
Addiction, as an uncontrollable somatic and psychological state, lends itself in a profound way to the Gothic mode, which, as Fred Botting observes, 'signifies a writing of excess'. (11) The fact that doctors--historical and fictional--should select this mode to describe both their own drug use and relationships with their addicted patients is highly relevant to my argument, in which I position the physician at the heart of what I term the 'medico-Gothic narrative of addiction'.
Freud's personal use of cocaine, his published 'Cocaine Papers', and his letters to his fiancee Martha, in the decade before he began his psychoanalytical work, present a fascinating insight into the world of medical self-experimentation. Freud's hasty and misguided mission to proselytise the marvels of this new drug tarnished his reputation within the medical fraternity and led to the death of his friend, the physician Ernst von Fleischl-Marxow. Dr Jekyll, in Stevenson's Strange Case also engages with the fraught world of self-experimentation while Jekyll's transfiguration into Hyde provides a somatic metaphor for the physical and psychological state conferred by cocaine, as described by Freud below. Dr Seward, in Dracula, represents the flawed 'mad doctor' (doctor to the insane) at the fin de siecle, who, because he is unable to see beyond narrow medical boundaries, fails to save the life of his patient, Renfield, who manifests an addiction to 'food' through an excessive and bizarre appetite for insects and birds. Like Freud and Jekyll, Seward's self-medication is symptomatic of his impaired scientific objectivity, while his well-intentioned drugging of Mina renders her vulnerable to vampiric rape. In their writings, all three doctors demonstrate the narrative tensions that arise when the doctor is no longer an objective analyst but becomes implicated in the very condition he is seeking to cure.
The second half of the nineteenth century witnessed the rise of the medical practitioner as a coherent and powerful professional class. Professionalism implies an intellectual detachment from the patient and also a monopoly of social and economic control. In the case of the doctor, professionalism went hand in hand with the right to establish and maintain control over the supply and distribution of drugs. Accounts by medical historians, including Roy Porter and M. Jeanne Peterson, of the growth of the medical professional's influence in the mid-to late-Victorian period points to key legislation that formalised the profession's rapidly developing cohesion and its authority within the lay community with reference to its increasing power over patients whose 'sins' and aberrant behaviours they redefined as medical conditions, which doctors alone could cure. (12) The Medical Act of 1858 established the General Medical Council and the Medical Register, distinguishing for the first time between qualified and unqualified practitioners. The Medical Act of 1886 'denotes the legal and symbolic integration of medicine and surgery, and the integration of general practitioners in the institutional structure of the profession.' (13) Earlier, under the Poison and Pharmacy Act of 1868, the supply of drugs in Britain was regulated for the first time. This Act was not particularly effective, as the legislation regulated sales of generic poisons and ignored proprietary preparations. Nevertheless, it is clear that in the second half of the nineteenth century--a period in which major new drugs were introduced, including morphine, cocaine, and heroin--the move towards a monopoly of distribution conferred a formidable power on the medical profession, which treated but also created new forms of addiction. Moreover, in the absence of formal clinical trials for new drugs, it was not uncommon for doctors to practice on themselves and supply a new drug to fellow practitioners and even to friends and relations. The results were unpredictable as is evident in the strange case of Sigmund Freud's 'cocaine episode'.
Cocaine Uber Alles: A Freudian Slip
No doubt the quotations that introduce this essay are familiar, but when juxtaposed, they illuminate an important connection between addiction, impaired medical vision, and Gothic writings at the fin de siecle. The source of the first quotation at the head of this essay is a letter from Sigmund Freud to his fiancee Martha in June 1884. Freud was writing at a time when he openly admitted to taking cocaine, a new 'magical substance' as he describes it to Martha in the same correspondence. (14) Within a matter of weeks, Freud published his first paper on cocaine, 'Uber Coca', in which he declared that the drug was a non-addictive cure for morphine addiction and was, besides, a universal panacea for a very wide range of medical conditions, including depression and psychosis. Among other benefits, Freud found that cocaine induced a sense of euphoria and endowed its users with mental dexterity, extraordinary physical strength, and enhanced sexual appetite.
There are strong similarities between Freud's letter to Martha and the Gothic-erotic style of Dracula, with particular reference to the scene where Jonathan describes his seduction by the female vampires: 'I felt in my heart a wicked, burning desire that they would kiss me with those red lips ... I lay quiet, looking out under my eyelashes in an agony of delightful anticipation' (Stoker, 53). Both Freud and Stoker present a predator-prey relationship between the female or feminised victim and the superhuman or supernatural lovers who possess extraordinary strength and a vitality that can be transferred with a dangerously passionate kiss. Freud was so enchanted with cocaine that he sent regular doses to Martha 'to make her big and strong and to give her cheeks a red colour' (Byck, 7). In the letter quoted in the introduction to this essay he describes his planned amorous assault on his fiancee in Gothic and cannibalistic terms. His beloved is a Romantic 'princess', helpless and weak due to lack of nourishment. He is a 'big wild man who has cocaine in his body' and if the object of his affections resists he warns that he will infuse her with his own life force. His threat--'I will kiss you quite red and feed you till you are plump'--has a distinct resonance with the scenes in Dracula where the heroic men repeatedly infuse the nascent vampire Lucy with their blood. Their transfusions restore the colour to her pallid lips and cheeks, only to feed Dracula, who drains her body, rendering it a mere conduit between man and vampire.
In 'Uber Coca', Freud extols the virtues of this new drug in a style that is unusual in contemporary medical writing. Coca is, he writes, 'a drug, which through its stimulant properties, can supply the place of food, make the coward brave, the silent eloquent, free the victims of alcohol and opium habit from their bondage' (Freud, 70). The juxtaposition of opposites--'coward' and 'brave', 'silent' and 'eloquent', 'freedom', and 'bondage'--is a literary rather than scientifically objective device and Freud goes on to describe the 'violent sexual excitement' cocaine can induce ('Freud, 73). It is evident from 'Uber Coca' that while Freud was aware of the dangers of iatrogenic addiction, he was convinced that cocaine was a non-addictive cure for morphine addicts and also alcoholics:
Coca in the treatment of morphine and alcohol addiction. In America the important discovery has recently been made that coca preparations possess the power to suppress the craving for morphine in habitual addicts, and also to reduce to negligible proportions the serious symptoms of collapse, which appear while the patient is being weaned away from the morphine habit [...] the treatment of morphine addiction with coca does not, therefore, result merely in the exchange of one kind of addiction for another--it does not turn the morphine addict into a coquero [a cocaine addict]; the use of coca is only temporary. (Freud, 70-1)
Freud recommended cocaine to Fleischl-Marxow, his physician friend, who had become addicted to morphine following an operation. According to E. M. Thornton in The Freudian Fallacy, having accepted Freud's advice and, indeed, his supplies, Fleischl-Marxow developed a second iatrogenic addiction. He rapidly increased his cocaine dose to one gram per day (Freud's stated dose was one-twentieth of a gram) and also resorted to the use of morphine. (15) His death some years later was at least partly the result of a toxic excess of morphine and cocaine, although Freud subsequently denied his role in his friend's secondary iatrogenic addiction (Freud, 51).
Freud initially took cocaine in liquid form but progressed to the 'formidable nasal route', which he claimed was to treat his 'nasal reflux neurosis', a vague medical term for a local sensitivity or pain in the nasal passages (Freud, 10). Shortly after the publication of Freud's first cocaine paper, however, the medical fraternity began to recognise the danger of addiction associated with this new drug and to note its concerns. After his initial and precipitant enthusiasm for cocaine, Freud's own findings concurred with his critics. He discovered, to his dismay, that while the drug could have a beneficial effect on some psychotic patients, if sufficient quantities were taken over a prolonged period, it would induce the very psychoses it was intended to cure, with potentially fatal results. Such cases led the physician Albrecht Erlenmeyer to accuse Freud, in Gothic language, of 'unleashing' an evil drug on the world--the 'third scourge of humanity' after alcohol and morphine (Byck, 11). In 1888, the Journal of Mental Science endorsed Erlenmeyer's view and warned that 'the cultured classes, and doctors in particular, are amongst the chief victims'. (16)
Modern critics, including E. M. Thornton, Robert Byck, and Richard Webster, have argued persuasively that Freud's personal use of cocaine had a significant impact on his scientific objectivity. (17) Even Ernest Jones, Freud's biographer and great admirer, notes that 'On Cocaine' incorporates:
a remarkable combination of objectivity with a personal warmth as if he were in love with the content itself. He used expressions uncommon in a scientific paper, such as 'the most gorgeous excitement' [...] and administering an 'offering' of it rather than a 'dose'. (Byck, 8)
Such expressions indicate a very personal relationship with the drug that is far from scientific and objective. Fortunately, Freud was able to put his 'cocaine episode' behind him. Indeed, his last cocaine paper published in 1887, 'Craving for and fear of cocaine', indicated a revised opinion. The fictional Dr Jekyll was less fortunate and, like Fleischl-Marxow, pursued his addiction to its ultimate, fatal end.
Dr Jekyll: A Study in Addiction, Repression, and Degeneration
While Freud's cocaine papers and correspondence with Martha bear strong similarities to the Gothic mode, the style and form of Stevenson's Strange Case draw closely on the contemporary medical case history format. As Oscar Wilde famously wrote, 'the transformation of Dr Jekyll reads dangerously like an experiment out of the Lancet'. (18) Stevenson's use of the medical case history format provides a plausible framework within which he is able to engage with fin-de-siecle theories of addiction, repressed masculinity, and degeneration. Hyde is the manifestation of Jekyll's 'vice-disease', the compound term coined by the Edinburgh alienist Thomas Clouston to describe a form of mental illness that was largely predetermined by character. (19)
Nordau's description above, which describes the degeneracy and dwarfishness of descendants of addicts, is apt in the context of Strange Case, in which Jekyll metaphorically fathers Hyde, his dwarfish, violent offspring. Jekyll 'had more than a father's interest; Hyde had more than a son's indifference', he confesses (Stevenson, 89). In this reading, Stevenson's novella--which anticipates Freud's theory of the uncanny--is a provocative critique of the professional middleclass doctor, whose natural vitality is deliberately suppressed only to emerge as uncontrollable appetite in the monstrous form of a 'son'. Jekyll's psychosis is of a profoundly morbid nature. He experiences 'morbid cravings', a term used by Eduard Levinstein to describe addictive tendencies in the mid-1870s, and he shares in the pleasures of Hyde 'with a greedy gusto', thus indicating the duality of the repressed male who yields to an uncontrollable appetite. (20)
In Jekyll's 'Full Statement of the Case', Stevenson positions the doctor as a scientifically objective, professional, middle-class male who remains alert to his own degenerative impulses. He notes, for example, with regard to his theory about man's divided nature:
I hesitated long before I put this theory to the test of practice. I knew full well that I risked death; for any drug that so potently controlled and shook the fortress of identity, might by the least scruple of an overdose or at the least inopportunity in the moment of exhibition, utterly blot out that immaterial tabernacle which I looked to it to change. (Stevenson, 83)
Like Freud, however, Jekyll's scientific objectivity is impaired by the personal and emotional nature of self-experimentation, while his unnamed compound shares characteristics in common with cocaine. The compound acts as a stimulant and confers a youthful vigour and heightened sense of confidence on the user. Jekyll describes how he feels 'younger, lighter, happier in body' and he delights in the sense of physical pleasure and psychological freedom. His attempts to wean himself off the drug, only 'to suffer smartingly in the fires of abstinence', are unsuccessful (Stevenson, 83, 89). He likens his return to his addiction in terms of alcoholism and his final observation is Gothic in nature: 'My devil had been long caged, he came out roaring' (Stevenson, 90).
Jekyll's record of the events that lead to his violent death represent a startling conflation of the medical and Gothic styles of writing. Ultimately, the mystery at the heart of Strange Case is revealed by a once respectable doctor whose mind is unhinged by a dangerous drug experiment. Jekyll's awareness of the dangers of his experiment and his rapid degeneration suggest a subversive mind that fears but nevertheless delights in unhealthy primitive urges.
Mayhem and Madness in Seward's Asylum
The theme of self-medication emerges again in Dracula where Stoker explores the ambivalent position of Seward in the context of the doctor's mismanagement of Renfield's bizarre food addiction, which forms part of the lunatic's compulsive attachment to Dracula. Under Seward's care his patient suffers a violent death, a fatality that Seward fails to prevent due to his stubborn refusal to accept facts that do not correspond to his knowledge and experience, despite the constant urging of his mentor Van Helsing. Through Seward's diaries, Stoker indicates that the doctor's professional judgment is clouded by his depression and self-medication. The portrait is of a man struggling to maintain a detached, disciplined approach to his work but who increasingly gives way to confusion, uncertainty, and the fear of insanity.
We know from his diary that Seward is in the habit of taking the sedative and hypnotic drug chloral, 'the modern Morpheus--[C.sub.2]H[Cl.sub.3]O.[H.sub.2]O' (Stoker, 134), and that he considers resorting to the drug to assuage the depression following his thwarted love for Lucy and his confinement to 'the grim sternness of my own cold stone building, with its wealth of breathing misery, and my own desolate heart to endure it all' (Stoker, 134, 153). This sense of repression, which is given physical shape in the form of the asylum, reflects his grim state of mind and sense of failure at a personal and professional level. Like Freud and Jekyll, he is aware of the inherent dangers of self-medication and decides not to take chloral because it will dishonour Lucy's memory (Stoker, 134). Seward's depression or hypochondria (male hysteria) following Lucy's rejection of his marriage proposal is palpable, as is evident in his diary entry:
Ebb tide in appetite today. Cannot eat, cannot rest, so diary instead. Since my rebuff of yesterday I have a sort of empty feeling; nothing in the world seems of sufficient importance to be worth the doing. (Stoker, 82)
To divert himself he decides to embark on a detailed clinical study of Renfield whom he later refers to as his 'pet lunatic' (Stoker, 300). But the same diary entry suggests that he is knowingly unprofessional in his approach:
I questioned him [Renfield] more fully than I had ever done, with a view to making myself master of the facts of his hallucination. In my manner of doing it there was, I now see, something of cruelty. I seemed to wish to keep him to the point of madness--a thing which I avoid with the patients as I would the mouth of hell. (Stoker, 83)
'I seemed to wish to keep him to the point of madness' suggests that Seward does not fully understand his own motives and, as if to reassert his rationality, he goes on to question his use of the phrase 'the mouth of hell'. Here we glimpse the doctor's medical language merging with the Gothic mode before he reverts to standard case history format:
R. M. Renfield, aetat. 59.--Sanguine temperament; great physical strength; morbidly excitable; periods of gloom ending in some fixed idea which I cannot make out. I presume that the sanguine temperament itself and the disturbing influence end in a mentally-accomplished finish; a possibly dangerous man ... (Stoker, 83)
Renfield's obsession is with everlasting life. He devours live insects and birds--the latter causing him to vomit feathers and bones - and asks for a kitten, as he seeks to work his way up the food chain (Stoker, 94, 95). Like Hyde, Renfield can appear quite sane--he speaks like a gentleman and demonstrates his middle-class education, for example by quoting Latin and discussing elemental philosophy (Stoker, 300). His eating disorder, therefore, represents an aberration from middle-class male rationality and normalcy, while his delight in and celebration of his addiction is a hallmark of the subversive.
At times Renfield's case history, as recorded by Seward, reads like a comical detective story, with both the lunatic and Van Helsing constantly dropping hints and clues that Seward cannot understand. The revelation of Renfield's food addiction and its implications is made to the reader long before it is evident to Seward who initially finds the lunatic's 'love of animals' a 'redeeming quality', only to be disgusted by the sight of Renfield eating a large blowfly:
He disgusted me much while with him, for when a horrid blow-fly, bloated with some carrion food, buzzed into the room, he caught it, held it exultingly for a few moments between his finger and thumb, and, before I knew what he was going to do, put it in his mouth and ate it. I scolded him for it but he argued quietly that it was very good and very wholesome; that it was life, strong life, and gave life to him. (Stoker, 92-3)
Seward's response to Renfield's bizarre addiction is typical of his era: he invents a new medical disorder. Renfield is, Seward decides, a 'zoophagous (life-eating) maniac'--a new and fictional category in the growing taxonomy of madness at the fin de siecle (Stoker, 95). Roy Porter comments on this fin-de-siecle trend in which psychiatrists created new definitions of insanity yet failed to effect cures:
Psychiatrists had become victims of their own opinions. They had warned that society was riddled with masses of hitherto unknown psychiatric disorders--which they alone could treat. Developing such categories as 'monomania', 'kleptomania', 'dipsomania', and 'moral insanity', they had maintained that much aberrant conduct traditionally labelled vice, sin, and crime were, in truth, mental disorders, that should be treated psychiatrically in the asylum. (21)
The power struggle in the doctor-patient relationship between Seward and Renfield raises important questions about the physician's authority to name and treat a disorder, which he can neither fully understand nor cure. Seward's inability to control Renfield physically--the lunatic escapes three times over a very short period--is symptomatic of his inability to understand and control the lunatic's mind. On the one hand, the reader is presented with a doctor who begins to doubt his sanity, and on the other, with a lunatic who is capable of rational and educated discourse. In the doctor-patient relationship, Renfield represents a distorted mirror image of Seward and illustrates the close proximity of sanity and madness in the middle-class male at the fin de siecle. At times Renfield also displays a genuine affection for his keeper and he begs to be sent away in order to protect Mina. He does not ask for his freedom but to be incarcerated elsewhere (Stoker, 317). Seward refuses, despite Van Helsing's doubts, and as a result, Dracula enters the asylum, kills Renfield, and attacks and infects Mina.
Seward's misjudgement is symptomatic of the shortcomings of the contemporary physician. Van Helsing's recognition of these limitations, as articulated to Seward, illuminates the wider theme of this essay:
You are a clever man, friend John; you reason well, and your wit is bold; but you are too prejudiced. You do not let your eyes see nor your ears hear, and that which is outside your daily life is not of account to you [...] Ah, it is the fault of our science that it wants to explain all; and if it explain not, then it says there is nothing to explain. (Stoker, 246)
The quest at the fin de siecle for an expansion of medical knowledge, Van Helsing warns, is countered by the physician's intellectual limitations. In the medico-Gothic narrative of addiction, the figure of the pioneering doctor is undermined by his lack of vision and he becomes a source of fear and danger to himself, his patients, family, and friends. In the context of the medico-Gothic narrative of addiction, the doctor is implicated as the instigator of iatrogenic addictions, while his flawed treatment of patients reveals the disturbing proximity of sanity and madness in the figure of the doctor. The medico-Gothic mode of writing provided a powerful framework in which writers explored these fraught discourses at a time when the public's appetite for thrilling narratives was matched by society's fear of the potential for addiction and degeneration increasingly associated with the figure of the doctor.
Debbie Harrison Birkbeck, University of London
(1) Sigmund Freud, Letter to his fiancee Martha Bernays, in Robert Byck, Cocaine Papers: Sigmund Freud (New York, Meridian, 1974), p. 10. All subsequent quotations are taken from this edition and given in parentheses in the body of the text.
(2) Robert Louis Stevenson, The Strange Case of Dr Jekyll and Mr Hyde (Oxford: Oxford University Press, 2006), p. 83. All subsequent quotations are taken from this edition and given as parentheses in the text.
(3) Bram Stoker, Dracula (London: Penguin, 1993), pp. 134 and 353. All subsequent quotations are taken from this edition and given in parentheses in the body of the text.
(4) Eduard Levinstein MD, Die Morphiumsucht nach Eigenen Beobacthungen or Morbid Craving for Morphia: A Monograph Founded on Personal Observations (1876, trans1878, London: Smith, Elder, & Co), p. 6. All subsequent quotations are taken from this edition and given as parentheses in the text.
(5) Virginia Berridge, Opium and the People: Opiate Use and Drug Control Policy in Nineteenth and Early Twentieth Century England (London, New York: Free Association Books, 1999), p. 144.
(6) Ibid., p. 218.
(7) For an excellent account of iatrogenic addiction, see Richard Davenport-Hines, The Pursuit of Oblivion: A Social History of Drugs (London: Phoenix Press, 2001, repr. 2002), Chapter 4, 'Nerves Needles and Victorian Doctors', pp. 67-93.
(8) Max Nordau, Degeneration (Lincoln and London: University of Nebraska Press, 1993), p. 34.
(9) Lawrence Rothfield, Vital Signs: Medical Realism in Nineteenth-Century Fiction (Princeton, New Jersey: Princeton University Press, 1992), p. 149.
(10) Andrew Smith, Victorian Demons: Medicine, Masculinity and the Gothic at the Fin de Siecle (Manchester and New York: Manchester University Press, 2004), p. 7.
(11) Fred Botting, Gothic (London: Routledge, 1996), p. 1.
(12) See M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley, Los Angeles, London: University of California Press, 1978); and Roy Porter, 'Mental illness', in Roy Porter, (ed.), The Cambridge Illustrated History of Medicine (Cambridge: Cambridge University Press, 1996).
(13) Ibid., p. 3.
(14) Ernest Jones, The Life and Works of Sigmund Freud, extract reproduced as 'The Cocaine Episode' in Robert Byck, Cocaine Papers: Sigmund Freud (New York, Meridian, 1974), pp. 10-11. All subsequent quotations are taken from this edition and given in parentheses in the body of the text.
(15) E. M. Thornton, The Freudian Fallacy: Freud and Cocaine (London: Paladin, 1986), pp. 44, 49.
(16) 'The Morphia Habit and its Treatment', Journal of Mental Science, XXXIV (April, 1888), p. 117.
(17) Thornton, The Freudian Fallacy; Byck, Cocaine Papers; and Richard Webster, Why Freud Was Wrong: Sin, Science and Psychoanalysis (1995, repr. London: Harper Collins, 1996).
(18) Oscar Wilde, 'The Decay of Lying', in Hesketh Pearson, (ed), Essays by Oscar Wilde (London: Methuen & Co., 1950), p. 39.
(19) T. S. Clouston, 'Diseased Cravings and Paralysed Control', Edinburgh Medical Journal, XXXV, pt II (March 1890), 806-7.
(20) Levinstein, Morbid Craving, p. 6.
(21) Roy Porter, The Cambridge Illustrated History of Medicine, p. 296.
Address for Correspondence
Debbie Harrison, 6 Palmers Hill, Epping, Essex, CM16 6SG, UK. E-mail: d.harrison@bbk. ac.uk