Book Review

Consuming Habits: Drugs in history and anthropology

N Engl J Med 1996; 334:1068April 18, 1996

Article

Consuming Habits: Drugs in history and anthropology
Edited by Jordan Goodman, Paul E. Lovejoy, and Andrew Sherratt. 244 pp. New York, Routledge, 1995. $49.95. ISBN: 0-415-09039-3

At a time when the “war on drugs” is still a losing battle, powerful lobbies and legislative forces resist the classification of nicotine-delivery systems (cigarettes) as drugs, and melatonin can escape the scrutiny of the Food and Drug Administration by being billed as a food additive, it behooves physicians to learn as much as they can about psychoactive substances.

This book consists of 10 chapters, each by a different author. Six of the authors are historians, and four are anthropologist-historians. Five of the 10 chapters are based on papers presented at a conference organized by the Past and Present Society in London in July 1991, under the title “Peculiar Substances: The History of Stimulants and Narcotics.” Stimulants and narcotics are defined as “a group of substances which are generally considered to be neither food nor medicine but have in common the fact that they are psychoactive in the sense that they alter, to a greater or lesser extent, the state of consciousness of the user.” These substances include tobacco, coffee, tea, sugar, hemp, betel nut, kola, chocolate, opium, heroin, and cocaine.

A 17th-century appraisal of tobacco made claims even more extravagant than present-day cigarette advertisements:

. . . believed to heal wounds, assuage pain such as toothache; overcome extremes of weather; warm the body, brain, and stomach; purge humidities and superfluous moisture; counter rheumatic and respiratory problems . . . open pores, passages, and bowels; induce sleep; calm passions; energize and restore strength; preserve general health and lengthen life.

From the 17th century on, tobacco was a primary source of tax revenue, especially in Great Britain and France, and was also an important medium of exchange in the slave trade.

We learn from the chapter on kola nuts that in 1886 the druggist John S. Pemberton of Atlanta invented Coca-Cola, which originally combined extracts from coca and kola and was advertised as a “brain tonic.” Kola, according to a medical treatise in Arabic, was at least as wondrous as tobacco:

Among its medicinal properties, kola provided relief from hunger, fatigue, and thirst, but it was also a cure for various aches and pains, including toothache and sore gums. It relived sore throats, could ease headaches, overcome nausea and relieve fevers. It was thought to prevent the loss of hair, counteract greying, improve eye-sight, and strengthen the knees. Its prescription for sexual disorders has already been noted.

The book's final chapter is an interesting history of the use of cocaine in the United States. As with tobacco and kola, exaggerated claims were made for the benefits of cocaine, and its risks were minimized: “Articles in medical journals recommended cocaine as an all-purpose stimulant, a cure for depression, a specific for hay fever and asthma, and other conditions. Especially encouraging were reports that the new drug was useful in treating alcoholism and opiate addiction.”

There are many interesting facts in this book. However, one of the jacket blurbs, presumably an endorsement, hints at its basic problem: “I read this collection with interest. . . . the articles are wide ranging.” The book is a collection of widely differing papers that, despite the presumably unifying theme of psychoactive substances, have little in common. I find it quite a stretch to equate (or even relate) heroin, opium, and cocaine with coffee, tea, and chocolate.

Although the book discusses these substances from a historical and anthropologic perspective, I was disappointed to find that it lacks even a single reference to the neuropharmacology of these substances and does not mention the fascinating work on opiate and other receptors in the mammalian brain. Yet some of the chapters have as many as 12 pages of footnotes, and there is a selected bibliography at the end of the book, “intended to assist in moving these disciplines in the direction of meaningful research.”

Julius Kritzman, M.D.
New England Medical Center, Boston, MA 02111