How do we balance the interests of personal freedom, public well-being, healthcare, and the economy? Is substance abuse a social issue, or a medical one? As governments, health services, and the World Health Organisation grapple with these issues, the wisdom and experience of history can help map the way forward. Culture Drugs for All. The Professionals Doctors and Pharmacists.
Fear Dens and Degeneration. Economics and Technology The Role of Industry. Mass Culture and Subculture. But wine drinking did not expand, even with the growth of wealth in the nineteenth century and the increased size of the middle classes. James Nicholls, in his history of alcohol, has shown how imbibing different substances, wine or beer, became identified with different styles of party politics in the late seventeenth century.
The rise of gin just a few years later added spirit drinking to this combustible political mix. By the early seventeenth century tobacco had become a global crop. In England, tobacco was a mass consumption commodity by around and possibly before that; enough tobacco was available for 25 per cent of the adult population to have at least one pipeful a day.
Chewing tobacco, a custom observed in the Americas, was however, less congenial to European tastes. Opium, the product of the opium poppy, has been known in medicine for around 6, years, and was possibly the first drug used by early man. It had an early and honoured place in Greek, Roman, and Arabic medicine. In England, the drug had been used early on, chiefly for its narcotic properties. In the middle of the fourteenth century, John Arderne used salves and elixirs containing opium to procure sleep and even as a form of anaesthetic during operations.
Hashish was called esrat in Turkey, kif in Morocco, and madjun when it was made into a sweetmeat with butter, honey, nutmeg, and cloves. It had been known to the Chinese several thousand years before Christ and the Greeks and Romans had used it for both medical and social purposes. Cannabis was also known in Northern Europe before the nineteenth century. But unlike tobacco, its use as plant product did not translate into Europe.
Many descriptions were enthusiastic about the sustaining properties of the leaf. Abraham Cowley, an English physician and poet, celebrated the virtues of coca in his Book of Plants Endowed with leaves of wondrous nourishment, whose juice sucked in, and lo the stomach taken long hunger and long labour can sustain. From which our faint and weary bodies find more succour, more they cheer the dropping mind, than can your Bacchus and your Ceres joined. The exchange of diseases brought smallpox and measles into the New World, syphilis into the old, with consequences for both.
The scale of their production and consumption and their integration into culture made them impervious to prohibition. Courtwright also draws attention to substances which did not make the transition to globalization despite having attractive psychoactive effects and sanctioned cultural usage. One of his examples is khat, which has of course, recently begun to buck the trend. Khat is now flown into Heathrow airport every day to satisfy the tastes of the Somali population in London— although it has still not made the transition to widespread popular demand in the culture as a whole.
When the Somali-born British Olympic runner Mo Farah gained his gold medal in the London Olympics in the summer of , his brother, a farmer in Somaliland, delightedly told journalists that he would buy khat for his neighbours to celebrate. The book will discuss the current indeterminate status of the drug in Chapter This book starts with most of these substances comfortably translated into Western societies cannabis and coca were the exceptions in the nineteenth century.
Why did they then take different paths? Some analysts have tried to formulate reasons why societies respond differently to different social issues. Some had more stringent control on tobacco than they did for guns.
Nathanson identified three factors: Nathanson was not looking at longer-term trends but more at the recent past of her topics. But her approach, moving away from a topic or substance- specific approach, makes a good start. In the nineteenth century, the cultures of alcohol consumption, opiate use, and tobacco smoking were not that different and were widely embedded in social custom in the UK and also elsewhere. But over the next century and a half, they went their different ways. Why did they take these divergent paths?
The argument is that economic and technical change associated with industrial societies interacted with the social movements characteristic of the time. Industrial interests were important. At the same time the professionalization of medicine and pharmacy, and the introduction of systems of medical discipline and control, led in some countries to increased state control, or at least the aspiration for such control.
Public health also came into the equation. Public health concerns were part professionalization and part social concern so not totally altruistic. Fear was also a potent force. If the substance was associated with a feared or despised minority or section of the population, it was easier to take stringent action against it. Finally, the international and global scene has been a powerful agent and location of different control strategies. Such factors operated either to detach a substance from mainstream culture or to embed it more firmly in the period up to and including the First World War.
This is a complex process, so, to make the points clearer, I will take this analysis forward through a series of case studies on each issue, sometimes focusing on one substance and sometimes on another, depending on which is most significant. This is not a comprehensive history; the UK is the main focus with other cross-national comparisons, with Europe brought into the picture alongside the ever-dominant US story.
The text will show how the substances moved down separate paths. Then it will turn to show how they have been reconceptualized since the Second World War. The matrix of factors which drew them apart in the early twentieth century seems to be operating to draw them closer together. Drugs for All Thomas De Quincey first took opium in Plagued as he was with rheumatic pains in his head and face, a college friend recommended it.
It was a Sunday afternoon, wet and cheerless: The druggist, unconscious minister of celestial pleasures! I took it—and in an hour, oh! What an apocalypse of the world within me! That my pains had vanished, was now a trifle in my eyes: Here was a panacea … for all human woes: That De Quincey could go to a druggist and buy the drug over the counter tells us something significant. For this anecdote opens the door to a world of drug taking not connected to the expansion of consciousness, to literary or artistic usage, but rather to opium as part of everyday life, the type of product which anyone could buy.
This chapter looks at cultural acceptability. In this discussion, the focus is initially on opium, because its cultural acceptability is more unusual when looked at from the vantage of the present. There is some reference to the parallel situations of alcohol and tobacco. England is the case study and opium use there was completely unrestricted before when the first Pharmacy Act became law.
The London drug wholesaling markets had their cases of opium alongside other imported drugs and spices. Opium was imported from Turkey through normal channels of commerce as one more item of trade. The London based drug wholesaling houses had extensive lists of opium products, which predated the nineteenth century.
There were opium pills, lozenges, powder of opium, opiate confection, opiate plaster, opium enema, and liniment. There was the famous tincture of opium, opium dissolved in alcohol , known as laudanum and the camphorated tincture or paregoric. The dried capsules of the poppy were used, as were poppy fomentation, syrup of white poppies, and extract of poppy. There were local preparations such as Kendal Black Drop, known only because Coleridge used and wrote about it.
Kemp and Son at Horncastle offered nine opium preparations in There were special quotations for twenty-eight pound and fifty-six pound lots of Turkish opium. There were even short-lived attempts to grow opium commercially in England—but the weather and the shortage of labour defeated these. What was this extensive variety of opium-based preparations being used for? Medicine of course was one area. Medical practice relied extensively on opium at the time. For it was essentially a palliative.
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There were few specific cures for diseases in the first half of the nineteenth century, germ theory lay in the future, and many diseases remained to be medically defined. Opium provided pain relief and an intermission which might aid recovery. For cholera its use remained virtually unchallenged. Its best remedy is opium, given judiciously, but fearlessly.
He was well at bedtime … at one a. He was ordered—Wine of opium, ten minims; sulphuric ether, half a drachm; cinnamon water, six drachms. Of this mixture one third was given every half hour, carefully watching, to prevent narcotism. He took all three doses of opium, the vomiting and purging ceased, he retained lime water and milk in his stomach, some reaction occurred, in a few hours he fell asleep, and awoke in the evening, well but weak. Dr John Connolly, one of the leading figures in the movement to establish different responses to insane people, recognized that it could act differently on different people.
With some patients laudanum acts with certainty, and like a charm; others derive comfort for long periods from the acetate of morphia; to some the liquor opii sedatives is alone tolerable. Whatever sedative is employed, the dose should be large. Less than a grain of the acetate of morphia is productive of no good effect whatever; and laudanum requires to be given in doses of a drachm, or at least of forty or fifty drops. I am speaking of acute cases, for in those of longer continuance, use often makes much larger doses necessary. Thomas Jones, a coachman who drank extensively, was admitted to Kings College hospital in London in , reported as seeing devils running about.
His treatment was a diet of porter, beef tea, and brandy, with laudanum every three hours. Opium was available through small general stores as well as the druggists mentioned by De Quincey. Corner stores were the mainstay of working-class districts and the shops were often kept by people little better off than the populations of the areas they served. In factory areas, the wives of factory workers would keep shops to help supplement the family income.
Such shops were plentiful and the vendors were often ill educated. Opium-based recipes for astringent balls, gout remedies, and corn plasters mingled with others for ink, cleaning grates, and making preserves. Street markets also sold opium preparations. According to Samuel Flood, a surgeon in industrial Leeds in the s, Saturday night purchases of pills and potions were a regular habit alongside buying meat and vegetables. An untrained medical adviser to poor families would prescribe mixtures containing laudanum for diarrhoea and dysentery, widespread complaints because of poor sanitation and living conditions.
These opium preparations were developments of self-dosing before industrialization. Poppy-head tea had long been a regular remedy used by families in the country before they moved to the new industrial towns and cities. It was a remedy for fractious babies and also for adults. Laudanum was later the most popular form of opiate. Everyone would have it at home—it was the aspirin or paracetamol of its day. Twenty to twenty-five drops could be had for a penny. Working-class lives became very separate from those of the middle and upper classes, and few at that level realized the extent of use.
It only emerged when special enquiries were made. One such was from a committee enquiring into the sale of poisons in the s. Edward Hodgson, a pharmacist in the northern town of Stockton-on-Tees, decided to make a record of whom he served with opium in one summer month in Two hundred and ninety-two customers bought opium from him during that time. Hodgson was one of six qualified chemists in the area, so that presupposes that at least sixty people each day were buying opiates from these outlets excluding others lower down the retail scale.
This was the pattern outside industrial areas as well. Between June and December , he sold pennyworths of laudanum, two-pennyworth of paregoric to Mrs Coulam on 6 September, a mixed order of laudanum, acid drops on 10 July, with five pence left owing for opium by Stephen Webster; the entries show the acceptability of opiates as everyday purchases. In one rural area, opium use was particularly noticeable. This was the low lying marshy Fenland area covering parts of Lincolnshire, Cambridgeshire, Huntingdon, and Norfolk. The area was remote and attempts at drainage uncompleted, and the Fens were subject to frequent flooding.
It had been known for some decades that these conditions led to a noticeably higher use of opium in the area. One analysis published in commented that more opium was sold in Cambridgeshire, Lincolnshire, and Manchester than in other parts of the country. Poppy-head tea was common, as in other country areas. In the nineteenth century, more commercial opium prepations were used. Greater awareness of the custom and investigation of it took place through the numerous social surveys and public health investigations of the time.
The high death rate in rural Lincolnshire drew particular attention to it in the s and Dr Henry Julian Hunter was sent there to investigate on behalf of the Chief Medical Officer of the day, Sir John Simon, who was medical officer to the Privy Council. He wrote A man in South Lincolnshire complained that his wife had spent a hundred pounds in opium since he married. A man may be seen occasionally asleep in a field leaning on his hoe. He starts when approached and works vigorously for a while. A man who is setting about a hard job takes his pill as a preliminary, and many never take their beer without dropping a piece of opium into it.
To meet the popular taste, but to the extreme inconvenience of strangers, narcotic agents are put into the beer by the brewers or sellers. In the s, Dr Rayleigh Vicars, who practised in Boston in Lincon-shire, was perplexed by the symptoms displayed by one of his patients. One of her friends soon set him right.
Fifteen who came to the dispensary had an average age of seventy-six years, although all were taking over a quarter of an ounce of the drug each week.
Our changing attitudes to alcohol, tobacco, and drugs
Opium taking reached its peak in the Isle of Ely. It was a well-known centre of opium distribution and the surrounding towns and villages, March, Doddington, Chatteris, and Whittlesey also had high opium consumption. In , Thomas Stiles, a druggist who was then in his nineties, remembered the quantities he had dealt in.
Opium was to be bought in the county town of Cambridge on market day. The majority of the population and local shopkeepers clearly accepted its use as quite normal, even well into the s and s. In Boston, Dr Rayleigh Vicars struggled against community support for the habit in order to try to bring a medical imprint to the situation. He gave me a pill box and took up the penny, and so the purchase was completed without my having uttered a syllable.
You offer money, and get opium as a matter of course. This may show how familiar the custom is. These showed that the highest proportion of opium poisoning deaths occurred among young children, especially babies less than a year old. Between and , babies under one had died, and fifty six children aged between one and four. Three hundred and forty children and adults over five had died. On average during those years, Evidence was collected from the industrial towns and cities and the availability of mortality figures through the newly established s General Register Office, showed the high rates of infant mortality in some of those towns.
The voluntary public health movement brought its influence to bear. The Manchester and Salford Sanitary Association was one such. The Association expressed its anxiety about infant doping as one of the examples of working-class mismanagement of their children. Such stereotypes did not always represent reality and many mothers did not work full-time. Opium was to some extent a palliative for the gastrointestinal complaints which in conditions of poor housing and sanitation caused most infant illness and death.
Nevertheless, it did have some role to play in an imperfect system of infant management. Occasionally, too, beliefs in the positive power of the drug for children creep through the torrents of criticism. In one parliamentary enquiry, we find the testimony of Mary Colton, a twenty-year-old lace runner in Nottingham, who had been advised how to care for her illegitimate child by women in her community. Prescription books with their opiate-based preparations show that opium solutions were widely dispensed for middle-class infants.
They were a cure-all for conditions, some trivial, some serious, for which little other attention was available. The drug was for instance widely used for sleeplessness. These uses paralleled those in orthodox medical practice. Self-medication with opium probably encompassed a broader range of complaints than those dealt with by trained medicine. The connection of opium and drink was one such, although as we saw earlier, opiates did come into use in medicine for the treatment of delirium tremens.
Drugs were in use in the s at the population level, with higher rates in some areas than in others. The advent of registration of births and deaths in the s enabled some idea of overall patterns of use to be gained. Child mortality from opiates was high in some areas. Deaths from opium were high died from narcotic poisoning in and there was a high level of accidental overdose. But whether the figures were rising or not is open to doubt. The rate in of five per million population for narcotic poisoning deaths had risen to six per million by the s—not a steep increase, considering the first figure was probably an underestimate.
Import statistics show that home consumption was rising, although not as swiftly as contemporaries thought. It was a quality issue—the variability of the drug as sold to consumers. The high accidental death rate was due to the lack of standardization of what people bought over the counter. In , of the opium deaths were accidental. The deaths or near misses involving public figures drew attention to the problem. The Earl of Westmoreland was handed a phial of laudanum by his manservant in mistake for another medicine, and was only saved by prompt action with the stomach pump.
Accidental overdoses were a fact of everyday life. But the vendor pressed him to take the whole stock. Fanny Wilkinson, a local servant, sent for powdered rhubarb. Fanny died after taking a teaspoonful of powdered opium; Mr Story had to stand trial for manslaughter. Such cases could be multiplied time and again. Dealing with an opium overdose was commonplace and appeared as a standard section in most books of domestic medicine, self-help medical advice.
He could always be roused, although with difficulty, but as soon as the stimulation was removed, this lethargy would return and death often followed. Christison was also involved in investigating the quality of drugs sold; for a major concern in the first half of the nineteenth century was the adulteration of all sorts of food and drugs.
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He bought laudanum from seventeen different shops, fourteen in Edinburgh and three in a Scottish country town. These gave wildly varying percentages of morphia, one of the active principles of the drug. Further evidence of the lack of quality control was publicized in the Lancet, then a radical campaigning journal under the editorship of Thomas Wakley. Nineteen out of the twenty-three samples of gum opium purchased were found to be impure, with the most common additives being poppy capsules and wheat flour.
But not until later in the century, in the s, did the sale of adulterated drugs become punishable. Habitual use, what we would now call addiction, caused less concern. One can speculate as to why this was so. But this reliance was not always obvious. Supplies were available and it was only if they were suddenly interrupted that the situation became plain.
The surveys and the anthropological accounts of the late twentieth century were far in the future.
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Patterns of use appear haphazardly, and the survey which Christison and a surgeon, G. Mart, carried out in the s, was very unusual for the time. This recorded twenty opium eaters, thirteen women, of whom seven could be called working class, and seven males, two of whom were workers. Their habit was known and acknowledged, so that fact alone made them out of the ordinary. Most addiction went unremarked.
Robert Harvey was at that time an assistant to the house surgeon at Stockport Infirmary. At the end of his career he had become the Inspector General of civil hospitals in Bengal and reflected on his earlier experience while giving evidence to the Royal Commission on Opium in the s. Dr Frances Anstie, the editor of The Practitioner, wrote about the prevalence of opium taking among poor people in London.
It has frequently happened to me to find out, from the chance of a patient being brought under my notice in the wards of a hospital that such a patient was a regular consumer, perhaps, of a drachm of laudanum, from that to two or three drachms per diem, the same doses have been used for years without any variation. His comments on this discovery were realistic.
In such a situation, where the drug was freely available with, in the first half of the century, and even after that, minimal controls, the type of distinction between what was medical and what was non-medical use was more blurred than it became later on. In some areas such as the Fens, where usage was investigated in some detail, there was a recognition that consumers were taking the drug for part medical, part what we would now call recreational use.
The writer Thomas Hood on a visit to Norfolk, was surprised to find out about opium eating in the Fens. Dr Rayleigh Vicars, who had grown accustomed to the unusual habits of his patients, also recognized this to be the case. The lives of middle-class consumers, it should be remembered, were less subject to investigation. The liberal politician and prime minister, William Gladstone, took opium in a cup of coffee before big speeches in the House of Commons, as did William Wilberforce, the reformer of the slave trade.
Opium was simply a part of life for many consumers, neither exclusively medical nor entirely social. This, then, was the overall picture of British drug consumers in the nineteenth century. Drug use was common at all levels of society and was largely unconnected with medical practice before the arrival of the alkaloids of opium such as morphine of which more later. This may not have been a universal model, even in European and North American countries. Non- medical use there was mainly in the form of opium smoking. What happened in the States, so it appears, was a move away from iatrogenic medical addiction and a descent down the social scale, with a greater role for underworld consumers by the end of the nineteenth century.
Such a picture does not correspond at all with the British case and even the type of medically induced addiction seems to have been different, as we will see in Chapter 8. But it is difficult to make comparisons. In the British pattern of use outlined above, the prescription had little importance until the twentieth century, until after the advent of National Health Insurance. The terminology of addiction comes later in the British context; the extent of opium use in the general population via pharmacists seems to have been greater, with access from different sources of supply.
While out in India he first encountered the use of cannabis. But it was used infrequently in medical practice because of its uncertainty of action. This was a useful debating point for cannabis reformers in the s but it appears to have little foundation in fact.
Nevertheless the myth has continued to be circulated. In one area only—the treatment of insanity and of opium eating—did cannabis gain temporary popularity, ironically given its later denigration as a cause rather than a cure for mental illness. But of popular use on the model of opium there was none in the nineteenth century.
Coca, the leaves of the coca plant, had a similar limited role. Cocaine, the alkaloid, was in the process of being isolated. But it was the properties of the coca leaf which initially attracted most attention, with a number of doctors investigating them. In , the American pedestrian, Weston, used the coca leaf in walking trials in London.
His conclusion was that the drug did not help maintain physical endurance. But others, including medical men, were enthusiastic about its potential use. Foremost among them was Sir Robert Christison, the Edinburgh pharmacologist who had been the investigator of opium in the s. Now he became an advocate of the benefits of coca chewing. He was able to walk fifteen miles without fatigue and two ascents of Ben Vorlich in the Highlands were exceptional for a man of his age.
At the bottom, I was neither weary, nor hungry, nor thirsty, and felt as if I could easily walk home four miles. Other medics were keen to promote its use for what might now be considered non- medical purposes. It was a cure for bashfulness, and helped in steadying the aim while out shooting. Later it was used in patent medicines and coca wines; in , there were at least seven firms producing coca wines for the domestic market.
However, here too, certain misconceptions have crept into general discourse, as we will see. There is no doubt that heavy drinking and the consumption of large amounts of alcohol, especially by men, was seen as normal and even beneficial well into the nineteenth century. Hard drinking was notable at all levels of society. Drink was embedded in all aspects of life and the rites of passage, christening, weddings, and funerals, were normally occasions for heavy communal drinking. During times of public celebration, ale and wine would be distributed to the common people.
In the eighteenth century, drink was built into the fabric of social life—it played a part in nearly every public and private ceremony, commercial bargain, and craft ritual. On the following day a young fellow who had become so intoxicated as to be incapable, would be selected as mock mayor for the next year. From to the late nineteenth century there was a large increase in consumption; the consumption of beer, wine, and spirits all peaked around The consumption of tea also grew.
These were trends which were associated with rising living standards. Within the overall trends, different groups in Great Britain had very different drinking patterns. People in the countryside drank less than those in the towns and cities. Some groups were teetotal. Across the UK, urban dwellers tended to consume more alcohol than their rural counterparts, and areas dominated by trades like mining and dock work also recorded higher levels. Pubs became social centres for the lower classes but their activities were often regarded as problematic.
Trade and political groups were prohibited from licensed premises by Parliament in because of fears generated by the French Revolution. After relaxation of the laws however, trade union activities resumed in pubs. Branches often associated themselves with particular houses in the city. Alcohol, like opium, also had its medical uses and these became the subject of agitations by medical temperance supporters later in the nineteenth century. Smoking too had spread in Europe since its introduction in the sixteenth century.
In England, tobacco had become a mass consumption commodity by the late seventeenth century at least. Enough tobacco was available for at least 25 per cent of the population to have a pipeful once a day. Until the invention of the cigarette for mass production in the second half of the nineteenth century, the clay pipe was a major means whereby tobacco was consumed.
Cigars also spread among middle- class consumers and more widely in Southern European countries. British consumers turned to snuff from the late eighteenth century but not to chewing tobacco. Like opium, tobacco also had its medical uses and Goodman has noted that, like that drug, the boundaries between medical and non-medical recreational usage, are difficult to draw at this time. The pipe returned to the British tobacco scene and by the middle of the century, 60 per cent of British consumption was pipe tobacco.
Pipes too changed during the century as more became manufactured of briar rather than clay. But clay pipe smoking remained common among working-class consumers. The habit was seen as essential for them to perform their everyday work. Publicans gave away pipes free and the association between drinking and smoking was close. By the middle of the century cheaper cigars were more widely available and began to appear more widely in the novels of Dickens, Thackeray, and Trollope.
Devotees collected the props of smoking culture, including clay pipes, briar pipes, pipe cleaners, matches, cigar holders, cigar cases, snuff boxes, and pipe racks. Tobacco, alcohol, and opiates were in common use, although in different ways and for different purposes. But they began to follow very different regulatory and cultural routes by the early twentieth century. Those paths were set at two stages: The next chapters will examine the factors which impacted on changing culture and regulation: All these operated to differentiate the substances from each other.
We will begin by looking at the role of social movements and what would now be called activism: Temperance Joseph Livesey, a Preston weaver, had founded a temperance group within the Sunday school he ran for adults; many young men who attended signed the pledge of moderation in drinking. He felt that the alcohol in wine and beer was the same as that in spirits and equally harmful. So in he took the step which marked the birth of the British temperance movement.
On Thursday, August 23rd , John King was passing my shop in Church Street and I invited him in, and after discussing this question, upon which we both agreed, I asked him if he would sign a pledge of total abstinence, to which he consented. The pledge provided the founding charter of the temperance movement.
That stance was to have significant consequences for society in the nineteenth and early twentieth centuries and also for the position of drinking and its regulation. This chapter begins the consideration, in turn, of factors which have impacted differentially on alcohol, drugs, and tobacco. Each will be illustrated by means of a case study. Social movements, or the more restrictive term, pressure groups, can be major catalysts for policy and also for cultural change.
In present-day society, we are used to the activities of campaigning groups across a range of issues. In the nineteenth century, such activity was a new development in the UK, which is where the case study is located. Movements like the one for the abolition of slavery, or for the abolition of the Corn Laws, represented something different in society. They brought together the organized efforts of men usually so at this stage to try to achieve changes in social attitudes but also in legislation.
It affected culture, but also developed a political dimension, which began to draw upon the extended role of the state in the last decades of the nineteenth century.
Demons: Our changing attitudes to alcohol, tobacco, and drugs
The roots of temperance lay in wider changes in Victorian society. The historian Roy Porter drew attention to the emergence of philanthropic lobbies, fired by Evangelicism, and given over to rescuing drunkards. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Demons Our changing attitudes to alcohol, tobacco, and drugs Virginia Berridge Considers varying attitudes to the use of drugs, tobacco, and alcohol from the 19th century to the present day Looks at how and why various substances have been regulated differently over time in different places Considers recent debates in public health in the light of historical changing attitudes.
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