‘The American Disease’ Turns Forty

Editor’s Note: This spring marks 40 years since the first publication of The American Disease: Origins of Narcotic Control, the groundbreaking book by David F. Musto (1936-2010). In honor of this anniversary, Nancy D. Campbell has organized an online symposium at Points this week on Musto’s book and its impact, featuring leading drug historians. The symposium begins today with a reflection by David T. Courtwright, Presidential Professor of History at the University of North Florida. Courtwright discusses the origins and publishing history of The American Disease, and the role it played in his own career as a drug historian, which has produced such similarly lauded works as Addicts Who Survived: An Oral History of Narcotic Use in America, Dark Paradise: A History of Opiate Addiction in America, and Forces of Habit: Drugs and the Making of the Modern World.

In 1968 Dr. Stanley Yolles, the Director of the National Institute of Mental Health, assigned a young physician named David Musto the task of investigating the history of the narcotic issue. Yolles was particularly interested in the narcotic clinics that briefly flourished in the early 1920s. Musto, then attached to the U.S. Public Health Service, dutifully began reading documents in the National Archives and the Library of Congress. He made two discoveries. The first was that almost no one before him had bothered to use archival sources. The second was that these sources did not line up with either the medical-reformist or police-enforcement versions of the past. “These ‘histories,’” Musto wrote, “appeared to be more in the nature of political party platforms than accurate descriptions of the process of narcotic control in the United States.”

This defect Musto corrected in The American Disease (1973), whose fortieth anniversary falls this year. What his book conveyed was the contingency and complexity of narcotic control. It untangled American drug policy’s serpentine roots, showing how narcotic abuse and addiction, diplomatic maneuvering, muckraking journalism, racial anxieties, pharmaceutical and medical lobbying, and moral entrepreneurship all affected early laws and treaties. Federalism further complicated the story. In the early twentieth century many Americans questioned whether and to what extent the federal government had jurisdiction over drug control. The matter ended up in the Supreme Court, which in 1919 narrowly upheld both the constitutionality of the Harrison Narcotic Act and federal prosecutions of individual physicians who wrote large numbers of prescriptions to maintain addicts’ habits.

Yale University Press ad for the 1973 edition of 'The American Disease'.
Yale University Press ad for the 1973 edition of ‘The American Disease’.

It was the constitutional questions that first led me to the book. In 1975 I was a Rice University graduate student in Harold Hyman’s legal history seminar. I was struggling to understand the ban on addict maintenance, which had only recently and grudgingly retreated before the methadone revolution. My first thought, as I thumbed through The American Disease, was one of disappointment. Someone had already published a big book—with Yale University Press, no less—on my intended subject.

But disappointment turned to gratitude when I discovered how thorough its author had been. The careful narrative was backed by 82 pages of further explication and extended citations in endnotes that often ran to several hundred words. No editor today would tolerate such amiable discursiveness. But I treasured it, and mined the notes for documents and archival leads. If I and other scholars chose to interrogate The American Disease’s sources in different ways, that is simply the nature of historical scholarship and an essential means by which it advances.

Musto himself sought to build upon his pioneering work, twice expanding The American Disease. The 1973 edition dealt principally with the formative policy period of 1906 to 1937. The revised editions, published by Oxford University Press in 1987 and 1999, also described drug use in the long1960s and the ensuing drug wars. The new chapters benefitted from Musto’s personal acquaintance with high-level policy figures like Dr. Peter Bourne. They reiterated one of his favorite themes, that drug history is cyclical, with swings of toleration and repression. Yet they lacked the depth and detail of the prewar narrative. Gone were the discursive endnotes. The terse new ones might have been composed by Detective Joe Friday.

It is hard to know if the minimalism of the added chapters stemmed from source limitations (few archival collections being open for events scarce a decade or two passed), editorial dictates, or declining authorial enthusiasm. Musto, who died in 2010, was a scholar of broad and sometimes diverting interests. John Adams and Sherlock Holmes lay closer to his heart than Hamilton Wright and Harry Anslinger. His drug research began as a serendipitous assignment. Coming upon what amounted to a protracted policy chess match, he had carefully documented the opening moves. Then he contented himself with sketching the middle- and endgames, leaving something less than a full account. I find it significant that all three editions bore the same subtitle, Origins of Narcotic Control. That is what David Musto promised his readers. And that is what he delivered.

David T. Courtwright

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