Douglas Small, Cream and Cocaine: Hallucination, Obsession, and Sexuality in Victorian Cocaine Addiction

This post accompanies Douglas Small’s Journal of Victorian article ‘Masters of Healing: Cocaine and the Ideal of the Victorian Medical Man’ which can be downloaded here.

Painless Surgery

Cocaine occupied something of a contradictory position in the late-Victorian cultural imagination. Albert Niemann had isolated the cocaine alkaloid from raw coca leaves as early as 1860, but it was not until 1884 that cocaine truly entered the popular consciousness. In September of that year, a Viennese Ophthalmologist (and friend of Sigmund Freud’s) named Carl Koller revealed that a solution of the drug would, if introduced into the eye, deaden the nerves’ sensitivity to pain. In cocaine, Koller had discovered the world’s first practical local anaesthetic.

The news had an electrifying effect on both the medical community and the lay public. Cocaine apparently promised a way to easily eliminate pain without the dangers and inconveniences that were widely thought to attend older anaesthetics, such as ether and chloroform. From 1884 until the early years of the twentieth century, cocaine was widely feted as a ‘marvellous’ medical innovation, and as a tangible sign of the new heights that fin-de-siècle therapeutic technology had attained.


Dr Thomas Neill Cream

This sense of cocaine’s epochal significance, though, was also accompanied by frequent reports detailing the ‘grotesque’ and ‘special’[i]details of cocaine abuse. In this period cocaine had a highly varied set of connotations, signifying both the innovative dynamism of modern medicine, as well as modern dissipation and immorality. Beyond its stimulant function, cocaine was known to act as an aphrodisiac. Indeed, one possible side-effect of intravenous cocaine injection (at least in men) is spontaneous ejaculation.[ii]For Victorian commentators then, cocaine habituation raised not only the spectre of addiction, but also suggested a particularly disturbing form of unrestrained, predatory sexuality. The most vivid example of this can be seen in the reporting of the crimes of the serial killer Dr Thomas Neill Cream.

Dr Thomas Neil Cream
Dr Thomas Neil Cream

Born in Glasgow in 1850, Cream’s family had emigrated to Quebec when he was four. He received his initial medical training in Montreal, and for most of his life he drifted between Canada, America, England, and Scotland, before returning to London for the last time in October 1891. He was hanged at Newgate thirteen months later for the murders of four women, having given them strychnine capsules that he claimed were medicines. Shortly after his trial a casual (and anonymous) acquaintance of Cream’s was convinced to describe his experiences to the press. He claimed that:


His principle characteristic was his never-ending talk about women, upon whom his entire thoughts seemed to run, and I confess his language about them was far from tolerable or agreeable; and he carried a number of pornographic photographs which he once forced upon my notice […] I have constantly seen him swallow some three or four pills which he stated were composed of strychnine, morphia and cocaine which he did not disguise had aphrodisiac properties. Indeed, he was exceedingly vicious, and seemed to live only for the gratification of his passions.[iii]


The Poisoning of Girls: The Lambeth Mystery
The Poisoning of Girls: The Lambeth Mystery


The interviewee followed up these Mr-Hyde-like descriptions of Cream’s personality with the suggestion that, ‘it is just possible that he became so inured to these poisons that he had them made up in larger quantities than an ordinary person could take and live, and that he gave the capsules to the women to produce the same effect as that for which he took them himself, and not with any direct attempt to kill them.’[iv] The details revealed at Cream’s trial confirm that he had deliberately intended to murder his victims[v] but anonymous informant’s speculation is significant nonetheless. The suggestion that Cream might have accidentally poisoned his victims by giving them aphrodisiacs implicitly transforms his uncontrolled appetites – both his sexual hunger and his craving for drugs – into a means of murder. Cream’s rapacious desires lead him to consume his victims, just as he consumes pornographic photographs and cocaine.


The Execution of Dr Neill Cream
The Execution of Dr Neill Cream

Cocaine Bugs

If cocaine could destroy sexual restraint, it could also seemingly destroy sanity itself. One effect of protracted cocaine toxicosis is a condition referred to in modern medical literature as ‘Delusional Parasitosis’ (and colloquially known as ‘coke bugs’). This condition is a tactile hallucination of an itching, tickling, or crawling sensation, accompanied by the delusional convinced that insects or some other irritant are embedded in the sufferer’s skin. Victims of delusional parasitosis often become obsessed with trying to pick or scratch out the imaginary parasites.[vi]

Victorian accounts of cocaine addiction frequently emphasise these hallucinatory and obsessive symptoms. One account that was printed in several papers in 1889 described three patients: ‘One patient was always scraping his tongue and thought that he was extracting from it little black worms; another made his skin raw in the endeavour to draw out cholera microbes; and a third, a physician, is perpetually looking for cocaine crystals under his skin.’[vii]Another addict was ‘compelled to walk round and round in circles [and] to endeavour to pick up needles where he knew none to be found.’[viii]A doctor whose habit had reached as high as fifty grains of cocaine a day was reported to have experienced a variety of paranoid hallucinations: ‘He imagined some body, some enemy, was continually pursuing him, trying to kidnap him. He frequently thought he saw a dark lantern flashed at him. He would sometimes hear noises and imagine that enemies were pursuing him in the night.’[ix]

As an interesting aside, the Oxford English Dictionary describes the image of something ‘being or getting under a person’s skin’ as a figure for obsession and restless preoccupation. To get under a person’s skin is ‘to annoy or irritate someone intensely; (also) to fill someone’s mind in a compelling or persistent way.’ (OED) The first use of the phrase dates from 1896, only a few years after the hallucinatory symptoms of cocaine addiction began to be reported in the British popular press. These articles connect cocaine habituation with the notion of a mental and physical parasitism. The addicts’ obsessive appetite for drugs is seemingly transformed into a wider fixation on the products of their own minds, and as their flesh is invaded by imaginary contaminants, their thoughts are swarmed by their fantasies, fears, and incoherent desires. As delusions seemed to burrow beneath their skins, the image of obsession was provided with a disturbingly literal progenitor in the sufferings of the first cocaine addicts.


[i]‘A New Intoxicant,’ Dundee Courier and Argus, 11266 (16 August 1889), 4; and ‘What the Modern Use of Poisons Lead To,’ Blackburn Standard and Weekly Express, 2784 (22 June 1889), 2.

[ii]Mark S Gold, Cocaine (New York: Plenum Medical Book Co, 1993), 83-84.

[iii]‘The Condemned Prisoner in Newgate,’ Leeds Mercury, 17021 (25 October 1892), 3.


[v]See Angus McLaren, Prescription for Murder: The Victorian Serial Killings of Dr Thomas Neill Cream (Chicago: University of Chicago Press, 1995), 13-21 and 49-60.

[vi]See Amber Elliot, Tashfeen Mahmood, and Roger D. Smalligan, ‘Cocaine Bugs: A Case Report of Cocaine-Induced Delusions of Parasitosis,’ The American Journal on Addictions, 21 (2012), 180-1.

[vii]See ‘A New form of Intoxication,’ Trewman’s Exeter Flying Post, 6870 (25 May 1889), 8; ‘What the Modern Use of Poisons Leads To,’ Blackburn Standard and Weekly Express, 2784 (22 June, 1889), 2; and ‘A New Intoxicant,’ Dundee Courier and Argus, 11266 (16 August 1889), 4.

[viii]‘A Victim to Cocaine,’ Western Mail, 6078 (7 November 1888), 7.

[ix]‘More About Cocaine,’ Hampshire Telegraph and Sussex Chronicle, 5635 (15 June 1889), 11.

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