Disproving Self-Indulgence: Congenital Addiction in the Early Twentieth Century

On October 10, 1989, police arrived at the Medical University of South Carolina. They handcuffed Lori Griffin, a black girl not yet eighteen, and arrested her for distributing cocaine to a minor. That minor was her newborn child — distribution took place through the placenta. The police came because Lori’s urine had tested positive for cocaine. ¹

Even after the debunking of the “crack baby” myth, states have passed laws that target pregnant women.² Historians have written about these sorts of policies that ostensibly protect fetuses and newborns, but in effect criminalize motherhood.³

Yet the history of the “addicted infant” can be looked at in other ways.⁴ Drug use during pregnancy is often framed as a contemporary scourge. In the early 20th century, opiate-dependent babies did not incite panic to the same degree as they would a century or half-century later. A historical take shows that fears of drug-use are partly shaped by fears of drug users.

Everyday Opiates

Therapeutic opiate use in the nineteenth and early twentieth centuries was widespread. Between the Civil War and World War I, doctors wrote about poisoned infants and their heroic efforts to save them. In 1903 Chicago, a healthy baby, Jeanie C., was “given by mistake one-sixth of a grain of morphine.” Dr. Julia Dyer Merrill arrived at Jeanie’s mother’s house the next day. She gave Jeanie hot baths, cold sprinklings, and rectal injections of coffee and whiskey. Jeanie lived.⁵

Doctors cast wide blame for these poisonings. University of Kentucky Medicine Professor Walter F. Boggess in 1899 identified “midwives [as] largely responsible for introduction of [opiates] to the laity…” and “the druggists [who] continue to sell poisonous substances to anybody who has the price….”⁶

An investigation into opium use at the New York Babies’ Hospital in 1899 reported that infants acquire the habit “through the mother, who does not realize the harm she is doing” or “through the nursery maid or other attendant who neither knows nor cares what the result may be ….”⁷

Many cases of poisoning and addiction were the fault of doctors. Yet stories of non-expert users poisoning children helped doctors make a case for exclusive control of opiate prescription. The first attempt at this was the 1910 Foster Anti-Narcotic bill, though lobbying by pharmacists and drug manufacturers ensured that the bill was never brought to a vote.⁸ A revised version became the Harrison Narcotic Act of 1914, the foundation of American federal drug policy.

Proof in Pregnancy

The idea that opiate addicts are morally inferior people has a century-long history, from eugenicists to the commentators who fretted over the mothers of “crack babies.” In the early tens and twenties though, confidence in science’s ability to overcome intractable challenges inspired alternative explanations of addiction and the addict.

In 1913, New York physician Ernest Bishop proposed a theory of addiction based on trending sciences of the day: bacteriology and immunology. Bishop’s antitoxin theory explained two aspects of addiction that perplexed medical professionals: tolerance (that addicted people need to consume more of a drug for the same effect — and could consume doses lethal to non-addicted people) and withdrawal (physiological symptoms that occur when a drug is taken away for an extended period of time).

According to Bishop, morphine consumption caused bodies to produce an antitoxin that neutralized morphine’s effects. The antitoxin itself was poisonous when not working to remove morphine, hence, withdrawal. And as a person consumed more morphine over time, they produced more antitoxin, which could neutralize more morphine, hence, tolerance.⁹

One of Bishop’s go-to pieces of evidence for this theory was the drug-dependent infant. In his 1920 monograph on addiction disease, Bishop wrote that “prenatal development of addiction-disease exists beyond dispute and certainly cannot be explained upon grounds of conscious appetite or deliberate self-indulgence.”¹⁰

Christian FJ Laase, another prominent New York physician, detailed a case of a newborn exhibiting withdrawal symptoms in 1919, saying that “it seems absurd to explain any of the phenomena displayed … by psychiatric or psychologic approach.” He continued, “Something in the infant’s body caused the physical manifestations it exhibited. This something was manufactured by the body of the infant itself, and not merely supplied to it thru [sic] the umbilical circulation.”¹¹

Because an infant could become addicted through the mother’s blood, and because infants could not make moral judgments, addiction was a physical disease and not simply a psychological defect or weak moral sense.

Science and Sympathy

Babies born dependent on drugs in the early 1900s did not generate much media or medical panic. This was due to low recorded prevalence, the social status of women drug users, and the perceived legitimacy of female addicts.

Charles Terry and Mildred Pellens’s The Opium Problem (1928), a landmark survey of addiction science, records responses to a nationwide survey about “Congenital Narcotic Addiction.” Over 500 of the 570 respondents wrote that they had never seen or heard of the condition.¹²

In the reported cases, the mother’s addiction came from medically prescribed opium or morphine. Doctors did not note much about the condition besides how to wean babies off of opiates. This did not always work. One laconic case report recorded: “bottle baby, weakling from birth … cried incessantly, until morphin [sic] was given. Taken it 58 years.”¹³

Reports from prisons show more anxiety. Perry Lichtenstein, physician for the New York “Tombs” prison, wrote in 1914 about heroin addicts giving birth in custody: “The infant born of addicted parents is an unfortunate victim.” If such children lived, they displayed “an inherited tendency toward taking narcotics.”¹⁴

Another reason for lack of stigma attached to reports of congenital addiction was the prevalence of addiction among elites. From the late nineteenth century to the early twentieth century, most addicts were medically-addicted, middle-class, white women: people who could afford to pay for drugs and the doctors who could give them.

Many elites saw the demonization of addicts as wrong, but only because it brought shame to respectable people. An article appearing a few pages after Terry’s description of “Drug Addiction in the Newborn” in 1917 in American Medicine, written by “A Prominent Medical Man, Long A Health Official of an American City” illustrates the point:

“One of the great hardships under which every addict suffers is the constant dread lest his affliction become known and he be branded a “morphine fiend,” a term which should be prohibited, or at least never used by an intelligent physician. What this exposure would mean to a man of standing in his community I need not explain.”

In the same issue, another writer, “A prominent member of the New York Bar” wrote: “I have never experienced the slightest pleasurable or sensually enjoyable sensations from the administration of morphine …. It may be true of the degenerate who has become addicted, but it is certainly untrue in my case.” By claiming to experience no pleasure, such users wanted to be seen as merely sick, not deviant.

After The Opium Problem

Early writings about congenital addiction show optimism that the condition would reveal some biological fact of addiction. By the time of The Opium Problem, congenital addiction was just “another interesting phase of tolerance.” It was presented “without speculation as to the mechanism involved and quite regardless of the views as to the nature of tolerance held by the writers.”¹⁵ Bishop was dead by then, as was the hope for a purely physical understanding (and cure) of addiction. The drug-dependent infant was once again medical obscura.

By the 1920s, the demography of addiction had changed. There were fewer middle-class addicts whose habit originated in a doctor’s office. The new faces of addiction were young men who used heroin and had started recreationally, whom doctors and lawmakers found less sympathetic.¹⁶ Maintenance clinics closed due to pressure from drug-enforcement agencies. Doctors in private practice and hospitals, save for those who worked in prisons and expensive sanatoriums, stopped treating addicts.¹⁷

In Creating the American Junkie, Caroline Jean Acker argues that Charles Terry “implicitly conceded the battle” between a medical versus criminal policy towards addicts by insisting that most addicts were respectable and deserved treatment.¹⁸ This meant some addicts did not. The undeserving, defective addict became the norm in cultural imagination.

When the drug-dependent infant emerged again in medical journals, in the late 1940s and early 1950s, it became associated with the image of addicts as doomed. This theme is visible in hyperbolic coverage of crack babies, and more recently, “oxytots” and the rising number of stories about Neonatal Abstinence Syndrome.

The pregnancies of Lori Griffin and the one treated by Christian Laase demonstrate a change in medical response to addiction. It is not one based on scientific or medical advancement. It is instead mediated by race, class, and a more fearful state. While women drug users are today seen as particularly treacherous, one hundred years ago, their addiction might have been considered legitimate. The drug-dependent baby is not a new phenomenon, but the turn towards vicious and criminal responses to it is.

Notes

1. Brief for Petitioners, Ferguson et al. v. City of Charleston, et al.” (October 2000). Return to text.
2. Jason Glenn, “Making Crack Babies: Race Discourse and the Biologization of Behavior,” in Precarious Prescriptions: Contested Histories of Race and Health in North America, ed. Laurie B. Green (University of Minnesota Press, 2014). Return to text.
3. By no means a full list: Janet Golden, Message in a Bottle: The Making of Fetal Alcohol Syndrome; Elizabeth M. Armstrong, Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder; Nancy Campbell and Elizabeth Ettorre, Gendering Addiction: The Politics of Drug Treatment in a Neurochemical World; and Stephen Kandall, Substance and Shadow: Women and Addiction in the United States. Also see the National Advocates for Pregnant Women. Return to text.
4. Contemporary definitions say that addiction involves both physical dependence and psychological craving. Because a baby cannot “understand the connection between pleasure and the presence of the drug or pain and the absence of the drug,” it cannot be considered addicted; see, Courtwright, “A Note on Terminology, (2001). In this post, I use the terms used by the historical actors. Return to text.
5. Julia D. Merrill, “Morphine Poisoning in an Infant One Month Old” The Chicago Clinic (1903). Return to text.
6. Walter F. Boggess, “Enormous Doses of Laudanum Taken By an Infant” Archives of Pediatrics (1899). Return to text.
7. Floyd Crandall, et al. “The Opium Habit in Children” Archives of Pediatrics (1899). Return to text.
8. David Musto, The American Disease (Oxford University Press, 1999): 48. Return to text.
9. Ernest Bishop, “Narcotic addiction—A Systemic Disease Condition” Journal of the American Medical Association, 60.6 (1913): 431-434. Return to text.
10. Ernest Bishop, The Narcotic Drug Problem (MacMillan, 1920): 24. Return to text.
11. Christian FJ Laase, “Narcotic Drug Addiction the New-Born: Report of a Case” American Medicine (1919). Return to text.
12. Charles Terry and Mildred Pellens, The Opium Problem (New York, 1928): 426. Return to text.
13. Terry and Pellens, 425. Return to text.
14. Perry Lichtenstein, “Infant Drug Addicts” New York Medical Journal (October 30, 1915). Return to text.
15. Terry and Pellens (1928): 410. Return to text.
16. David Courtwright, Dark Paradise: A History of Opiate Addiction in America (Cambridge: Harvard University Press, 2001): 144. Return to text.
17. Caroline Jean Acker, Creating the American Junkie: Addiction Research in the Classical Era of Narcotic Control (Johns Hopkins University Press 2005): 52-53. Return to text.
18. Acker, Creating the American Junkie, 54. Return to text.

---

Featured image caption: Ad for “cocaine toothache drops,” from around 1880-1899. (US National Library of Medicine | Public domain)