Updated: Aug 29
Editor’s Note: Today’s post comes from contributing editor Jordan Mylet. Mylet is a doctoral candidate in history at the University of California, San Diego.
When Bill Wilson had the “spiritual awakening” at the upscale Charles B. Towns Hospital in New York City that would inspire the founding and program of Alcoholics Anonymous, he probably didn’t know the strange, at times sinister, history of the treatment that made his transcendent experience possible.
What he received was the Towns Hospital’s version of the belladonna treatment, which had emerged as a cutting-edge addiction treatment in 1900 and became the dominant method in public and private hospitals by the 1920s. Per its name, the treatment was derived from alkaloids of the belladonna and henbane plants in the nightshade family, which had been used for millennia as poison, cosmetic enhancement, and hallucinogen. They were known to be potent, psychoactive, and potentially fatal. As the belladonna treatment (or “hyoscine cure”) spread in American medical practice, physicians and medical researchers engaged in an unwieldy process of trial and error to control the volatile qualities of the drug mixture. In practice, this meant that poor addicts and alcoholics during the first decades of the twentieth century encountered a far more dangerous version of the belladonna treatment. The course of the hyoscine cure reveals the long history of the United States’ two-tiered addiction treatment (and healthcare) system, and the at times wildly experimental character of medicine and pharmacology in the early twentieth century, the same era in which the nation’s narcotics control laws were developed.
The belladonna treatment for addiction came out of the nineteenth-century revolution in pharmaceutical and medical knowledge. Medical researchers in Western Europe created the drugs that would become both the stuff of, and the supposed cure for, addiction in the twentieth century. In the 1830s, German pharmaceutical researchers—using a process developed by their colleagues to create morphine from opium in 1805—worked successfully to isolate compounds from nightshade plants that could treat specific mental and physical ailments. By the 1890s, asylums in Western Europe and the United States used the Merck company’s nightshade alkaloid, called hyoscine (or scopolamine), to treat cases of chronic mania and, increasingly, chronic alcoholism. In 1901, two physicians, Dr. M.K. Lott from Texas and Dr. George E. Petty from Tennessee, published papers extolling the benefits of “the hyoscine treatment” for morphine addiction. According to a 1938 U.S. Public Health Service report, it was Dr. Petty who was responsible for the belladonna treatment “com[ing] into almost universal use in this country.” Under Petty’s method, the patient was gradually weaned from morphine over a period of 36 hours while simultaneously giving them “cathartics” to purge the body by vomiting and defecating. After the morphine dosing ended, Petty administered frequent doses of hyoscine and purgative drugs for another 36 to 48 hours to induce delirium and continue to clean out their system.
The logic undergirding his withdrawal treatment stemmed from nineteenth-century advances in immunology and curative drugs. In 1891, medical researchers discovered a cure for diphtheria based on the healthy body’s capacity to create antitoxins designed to combat specific bacterial toxins. To physicians like Petty—and later Dr. Alexander Lambert, Theodore Roosevelt’s personal physician and the other founder of the Towns-Lambert cure that Bill Wilson underwent—it made sense that “toxins” like alcohol and morphine must be banished from the body by “antitoxins” like hyoscine, which generated in patients the opposite effects of their chosen narcotic drugs. One of Dr. Lambert’s acolytes described the method as “a really rational treatment for the drug addict,” since it serves to “unpoison the system,” mainly by evacuating the bowels of the patient. Both Petty and Lambert emphasized the importance of purgation; Lambert even mentions “abundant bilious stools” as evidence of a successful treatment. Though addiction researchers by the late 1930s would deem the theory “illogical,” belladonna’s proponents reasoned that if morphine constipated its users, an effective antitoxin would purge the body—and, more controversially, if narcotics induced euphoria, then a cure might necessitate a degree of suffering.
Advertisement in The Boston Medical and Surgical Journal, 1910
The degree to which addicts and alcoholics experienced such suffering while under the belladonna treatment depended on where they received treatment—which depended mostly on their socioeconomic status. No doubt influenced by the Petty method popularized years earlier, Charles Towns, a layman, and Dr. Alexander Lambert declared addiction and alcoholism “curable” in 1909, to much acclaim in the popular and medical press. The Towns Hospital administered the two men’s particular recipe of belladonna and other drugs to mostly wealthy clients, who spent $250 to $300 per day for treatment. (The hospital’s public ward, which charged $70 per day, was closed in the 1920s.) The mixture of belladonna and purgative drugs, administered over a period of days, was accompanied by meal service to patients’ private rooms, a rooftop garden for relaxation and leisure, and personalized care by nurses and physicians.
The version given to the treatment’s earlier and poorer recipients was far more severe. In his 1901 paper, Texas physician Dr. Lott acknowledged that patients could become “quite wild,” hallucinating voices and visions, and recommended that patients be supervised constantly in order to prevent self-harm. In 1904, a Mississippi asylum superintendent, Dr. James Buchanan, published his observations of two hyoscine patients—one of whom underwent the treatment against his will—in the American Journal of Insanity. Over the course of a few days, Buchanan’s notes recounted the content of belladonna-induced delirium: “Begged for morphine and cocaine. Has begun to see bugs.” “Delirious and hard to keep on bed.” “Delirious and very nervous, picking at bed-clothes, sees bugs, and is afraid of the hypodermic.” “Vomiting.” “Still buggy.” Buchanan expressed satisfaction with the method despite its side effects because the patients, at the end of treatment, reported no craving for morphine. However, the journal published comments to Buchanan’s article from other physicians who emphasized that hyoscine was “a very dangerous drug” and that they had seen extreme suffering result from its usage. A 1904 editorial in the Journal of Inebriety responded to the “number of communications extolling hyoscine in the treatment of morphinism” with a reminder of its “uncertain and dangerous” results, including the instance of an addicted physician who tried the hyoscine treatment and fell into “acute delirium” for 22 days.
A striking firsthand account of the hyoscine treatment as experienced by an indigent New York City heroin addict comes from Leroy Street’s pseudonymous 1953 memoir I Was A Drug Addict. While recounting the years from 1910 to 1923 that he spent addicted, Street describes the various cures he tried to quit his habit. Around 1915, Street heard from a fellow user that the city was offering treatment at Metropolitan Hospital on Blackwell’s Island, free of charge. He heard from another using friend that people had died under this “Met cure,” but signed up at the city office on the dock anyway. Upon arriving at the island hospital, Street was told it was mandatory to note his religious affiliation. A priest came to read Street his last rites, then Street entered into a ward with six beds, three of which had “figures[s] that moaned and struggled,” their bodies “held down by straps and restraining sheets” and “contorted…into inhuman grimaces of pain, of horror, of fear, of loathing.” When the staff injected him with the hyoscine mixture, Street felt “a stream of liquid fire” spread throughout his arm, then “a swarm of centipedes” crawling across his body. What followed were visions of desperate searches for heroin, arrest by narcotics agents, and unspecified “terrors” from his childhood—until he woke up, three days later, “drenched in perspiration and so weak” he could barely walk after being unstrapped. The hospital kept him for another week—during which Street noticed the disappearance of a couple fellow hyoscine patients from the ward—and then shipped him back to the city. He used heroin after getting off the dock.
It’s hard to know what dosage of hyoscine was administered to Street, but it seems fair to speculate that his “cure” was far more extreme than that experienced by the clients of the Towns hospital and perhaps many other recipients of the belladonna mixture. Yet the popularity of the Towns-Lambert method—and the luxuriousness of its institutional setting—often obscured the fact that hyoscine treatments remained dangerous, particularly for poor addicts and alcoholics. In 1921, the prominent physician Charles Terry testified in the U.S. House that he himself had been responsible for the death of an addicted woman after administering the Towns-Lambert method to her in a Jacksonville clinic. He had raised funds to operate a clinic on the Towns model for indigent addicts, but “was not prepared for the extreme suffering” he observed. In a 1938 report, influential addiction researchers Lawrence Kolb and Clifton Himmelsbach concluded that “unreported deaths” from belladonna treatments must have been “fairly common,” based on their personal experience and a review of the medical literature. They also emphasized that the Towns-Lambert treatment permeated American medical practice—but its careful, more holistic administration did not. In the case of two deaths, Kolb and Himmelsbach attributed them to the hospital’s refusal to provide any morphine to the patients, because the staff “considered [it]…to be more or less sinful and criminal to give morphine to an addict.”
In that same report, Kolb and Himmelsbach declared belladonna treatments “absolutely useless and even harmful to addicts in withdrawal”—while also acknowledging that they have “no theory” about drug addiction or how to treat it. They advocated for a gradual withdrawal process under hospital observation, in lieu of any ambitious promises of cure. When looking back at Leroy Street’s experience, or that of Charles Terry’s patients, their contempt for the belladonna method is understandable. And yet it’s interesting to consider, also, that one of the nodes on the peculiar genealogy of this treatment is Bill Willson’s epiphany, and the spark of a grassroots recovery movement.
I owe the substance of this insight to pathologist Thomas Dormandy in his book Opium: Reality’s Dark Dream (Yale University Press, 2012).