The Pathological Action Of Opium

Editorial Note: Dr. Calkins’ Chapter is concerned with a brief review of the processes by which Opium use moves from a blissful to a pathological state. It is worth noting that, in spite of all the current panic about the “Opioid Epidemic” in America, non-prescription Opioid medications are readily available over-the-counter in well over 100 countries around the world, which begs the question: Is the “Opioid Epidemic” a pathological phenomenon, or is America a pathological society? If Opioid pills are openly and legally available just like aspirin in most of the world, why isn’t there a global Opioid Epidemic?

One of the main reasons why I believe that Dr. Calkin’s book is so important today is that while it traces the historical development of Opium addiction worldwide, without saying so directly it is clear that Opium addiction has historically taken a tighter grip of western societies, and in particular on American society, than it has elsewhere in the world.

One might argue that China, for example, is an exception because at the height of its Opium addiction tens of millions of Chinese were severely addicted. However, if tempted to make that argument one would have to account for the fact that before the British and American drug-pushers arrived on the scene Opium use in China was mainly, though not exclusively, an indulgence of the privileged classes, and these people made sure that the Opium they smoked was of the highest quality and thus far less addicting. And, after the Brits and Americans were kicked out Chinese society began to steady itself, and soon became a society where Opium was used, not abused by most Chinese people except those who were most oppressed by life at the bottom of the social and economic ladder. The same argument, and counter-argument, can be made for societies like Persia, India and Turkey.

I believe it is worth asking ourselves – is there something Karmic about American society that drives people at all levels of this society into brutal addiction to all kinds of substances, rather than to a temperate use of these same substances for life-enhancing purposes? Is it beyond imagining that the millions of native people that we slaughtered in order to take their lands, have gathered together in spirit to make our conquest and murder an invisible cancer that is eating away the American soul? Has America ever been the society that we have always proclaimed ourselves to be? Was there ever freedom, justice and liberty for all?  We should make no mistake – ultimately, we will be judged by history, and whatever the judgement it will not be swayed by all our slogans, hymns and propaganda. We will be judged by our deeds.

Dr. Calkins, writing as he did from the perspective of 1870, saw so much of what America has become already in the America of his day. It does make you wonder – what if anything has changed for the better since 1870?

Chapter VII: The Pathological Action Of Opium

(from) Opium And The Opium Appetite”, by Alonzo Calkins, MD (1870)

“Corpore languor inest, vexant insomnia, vixque Ossa tegit macies, nee juvat ora cibus.” Ovid.

“They are drunken, but not with wine; they stagger, but not with strong-drink.” – Isaiah.

 “Ogni fnedagliaha suorovescio” – the picture has its reverse as well as its obverse face.

Leaving the subordinate features to special occasion while we direct our attention to the salient points rather as they jut out upon the pathway, we shall soon perceive we have indeed a Via Dolorosa to traverse, with only here and there a gleam of sunshine to relieve the abiding gloom.

The morbific leaven, subtle and intangible in its primary evolution, acquires as it pervades the system a cumulative force, in this respect transcending arsenic, mercury, lead, indeed every substance whatever of known zymotic energy. The reaction, whether evolved obscurely or outbursting as with a shock, maturing it may be in three weeks, or perchance not under three years, will culminate in a crisis some time, as inevitable as it is portentous.

The organs that primarily and mainly feel the recoil are the brain with the spinal cord, and the great centre of alimentation, the stomach. Tardieu found in his autopsies sometimes a congestion of the cerebral channels, or else the condition of pulmonary apoplexy, or again both symptoms in conjunction. The peculiar excitement which the brain experiences, though approximating in some points to inebriation from alcohol, sustains towards delirium tremens only an analogical relation (Hobson). In the long course nervous tension becomes obtunded and relaxed, from non-oxygenation of the blood the heart is overloaded and the pulmonary vessels get sluggish, whence come palpitations and dyspnoea, with oppressive anhelations, so as almost to preclude exercise even the most moderate.

Erethism of the fauces – a sense of searing it may be (Trousseau) – occurs in progress, deprivation of appetite, the precursor of confirmed dyspepsia, ensues, and in the end every organ almost has become involved and every function perverted. An evidence not uncommon of a vitiated appetite is a partiality to saccharine substances.

Another organ with complex sympathies, the liver, is a common sufferer, being sometimes stimulated to an excessive reaction, but oftener relapsing into an established torpor. A case of mark is contributed by H. F. Quackenbos, M.D., of New York.

Miss P., a lady of easy condition in life, who died eventually at the early age of 26, began the use of opium ten years before that event, and for the mitigation of suffering caused by morbid obstruction. The routine life of this person was singular in various respects. At sunrise, when people generally are getting up for the day, she went to bed; about sunset she had her breakfast, and her dinner at midnight. Laudanum was the preparation in use, of which she took altogether for the day three wine glasses, the first at 9 o’clock, which acted always as a sedative against the shivery agitations of the morning, the second preceded the breakfast her first meal for the day, and the third was had about 11 p.m., when she was ready for the salon. In the daytime she would lounge about, wearing away the hours in a sort of half-stupor, answering a question with a labored grunt, as if comprehending only one-half and indifferent to the rest, and impatient like as one aroused from a recent doze; but when the deep hours of the night had arrived the transformation in her entire appearance was as if she had just come from some Armida’s bower, when she shone out upon the admiring throng as with a meteor-blaze.

A necroscopic examination revealed the organ more immediately associated with her decline, the liver, now of a purplish-brown hue, enormously hypertrophied (the biggest liver the doctor had ever seen), and so extremely indurated, that on accidentally falling from the hand to the floor it sounded more like a stone. This lady’s death was accelerated by thoracic inflammation, the cause of which was exposure after going from a cotillon party.

As a sequela to hepatic disorder a persistent vis inertia of the various organs is ere long established, and an unresponsiveness to purgatives, and verging to a habitual constipation. This sealing-up of the alvine channels may hold for a fortnight; or, if the wonted allowance has been intermitted (commonly by three days – Day), there is an alternating change, a relaxing of the intestinal constriction, a colliquative diarrhoea by a vicarious effort sets in, and stercoraceous bile loaded with scybalous concretions has free expulsion. An occasional concomitant, debilitating in the extreme whenever it occurs, is a free seminal drain (Macgowan).

Change in the entire contour becomes painfully apparent. Instead of the “complexionally pleasant” softness of hue such as arsenic is said to impart to the cheeks of the Styrian damsels, there is a bronzed complexion and a rigidity of skin like as of parchment, and a tendency to rigors also, unrelieved, unless occasionally, and by an intense sudation setting in. The eye kindles to flash in a momentary glint only, then shrinks again into its characteristic gaze upon vacancy, and the once sonorous ring of the voice has passed into a husky squeak.

An incidental (not uncommon) symptom is a general hyperesthesia, and this being fairly established, the nervous susceptivity may become so acute that not so much as an articulated sound, not the jar from a footstep, shall be endurable. Indeed, the physical torment present seems at times as if an aggregation of all conceivable tortures in their totality. Not the fiery thrills from tic douloureux, not the lancinating pains of cancer can hold comparison, for they, with their exacerbations, have their alternating relaxations; the pangs from opium hold one as with the grip of a vise. Twinges as from electric sparks shoot along the nerve-fibrils, or again flame-flashes radiate from circumference to centre and from spine to surface again. Under such combination of physical pressure body and mind with it succumb inevitably.

Privation

If for an extended period (as among the impoverished classes in China) the wonted supply is no longer, or only very irregularly procurable, glandular degenerescence, rickets, a hydropic tendency or albuminuria will likely ensue (Hill, Oxley). Such privation, indeed, in the view of some observers, as Pidduck and Little, may jeopardize the very life.

A confirmatory instance is from Chardin. A young Persian having a journey to make through a waste and scantily-populated territory, and where supplies of any sort were not to be counted on, had proceeded only half-way when his provisional stock of opium had become exhausted. There was but one alternative, to wheel horse about and put back with all speed for home again; but in the effort he sunk in a fatal collapse. Of this narrative it is safe to say at a venture, “Se non e vero, e bene trovato.”

The culmination of suffering there is yet to be named – the agrypnia or insomnia that must be endured. In place of the “heavy honey-dew of slumber,” come “Slumbers that are not sleep, But a continuance of enduring thought;” when the lone sufferer, with brain distraught and eyeballs as if glazed, must endure and endure hour upon hour, unremittedly agitated and hopelessly bereft of repose, until forced in the exhaustion of his agony to exclaim with Sigismunda, “Oh, for that quiet sleep which knows no waking!”

Sleep, if indeed procurable, is never equable and refreshing, but rather agitative and disquieting; meanwhile comes “The Dream, That mystical usurper of the mind, The spectres which no exorcism can bind.”

The satirist Scarron, quondam-husband of De Maintenon, who for years had been habituated to an evening dose of laudanum, declares in an auto-epitaph written by anticipation, that his first night in the grave was his first night of sleep.

At one period in his life so perseveringly tormented was De Quincey with a diablerie of night-spectres, that he declared despairingly he would “never, never sleep again;” and indeed for years, even after a long intermission, he could get but three hours at most, and then only past midnight.

Mrs. M. of W. New York, a woman now sixty years old, who has used morphine (5 grains for the day) now less than two years, even thus early sleeps but irregularly, occupying herself for the most part with noisy soliloquy for the edification of her family in the night-hours, and diversifying the day with visits to the office of an electro-galvanic praestigiator in the neighborhood.

The Erotic Force Of Opium.

Does this agent, upon repeated use, operate as an aphrodisiac, or as an anaphrodisiac, or is it simply neutral? The question has been variously mooted. In Eastern Asia the positive belief obtains, as appears from Cleyer: “Ad venexem enim ciere integrae nationes usum norunt, et in hunc se adhibent.”

A corresponding idea is entertained among the ladies of Turkey, as we learn from a note of Jahn: “Feminae Turcicae opio viros incitare in contubernium solent.” If the orgasm – favored, as the Chinese suppose, by the admixture of saffron – is really enhanced in the early use, a premature exhaustion may be expected in the sequel. According to Dr. Macgowan an abiding impotentia is the finale, and Brodie and Astley Cooper have expressed similar convictions. De Pouqueville and De Tort also ascertained concerning the theriakis of the Levant, that they are habitually tormented with a satyriasis as abortive as it is insatiable. Several of Dr. Palmer’s cases also appear to indicate a growing indifference to the peculiar marital relation and a prospective dissolution of the bonds.

A case, as untoward in progress as it was gloomy in the end, will illustrate some points in pathogenesis. The particulars, derived upon direct personal inquiry, are communicated by a familiar friend (that was) of the patient.

Dr. C, of the Genesee Valley, whose death at the age of 47 occurred two years since, had been an opium eater eleven years. Diphtheria (for this seems to be the proper name) appearing at an early period, had seriously impaired a constitution originally frail, leaving behind a nervous adynamia and a gastric derangement that had degenerated into’ a settled dyspepsia. To combat the existing gastralgia, and at the instance of a brother-doctor, morphine was put on trial, and thereafter continued for the rest of his life, though the relief anticipated never came. The patient grew melancholic and morose as time wore on, insisting he must die soon, and that the doctors were but ignoramuses, comprehending nothing of his maladies. For the last few years the average professedly consumed was over one drachm for the week, besides the very considerable leeway-reserve always to be calculated on in such cases. Constipation, early confirmed, became a permanent and most annoying symptom, over which purgatives exerted but a qualified efficacy, and which the syringe only scantily relieved. Insomnia was the rule, and sleep, such as it was, brought no refreshing. The eye wore the peculiar dazy glitter, a basilisk-lustre almost, such as the person describing had never seen the like of, or would willingly see again. The fauces became aphthous, a brownish sordes loaded the rugose tongue, and incessant twinges in the stomach kept the man in a sort of perpetual motion. As the months passed the patient got more and more intractable. At times he would be around, with vial in pocket, so as to have his stimulus at free command, and whoever does this will renew his dose without stint, bongre malgre; or if for prudential reasons put upon strict allowance, feeble and impotent as he was he would work himself into a frenzy, begging for his morphine with moans and sobs; or again, assuming the minatory attitude, he would denounce his friends for their barbarities with reproaches and imprecations. On a certain day (nor was this, as appears, a solitary instance) he must have swallowed what, upon estimate (and as was his admission to a professional friend), an entire drachm of morphine.

This child in sensitiveness, this monomaniac in wayward capriciousness, became in his last months so thoroughly restive under any and every restraint devised, that an allowance of whiskey was judged expedient. The drink was given in measured quantity at first, and in alternation with his morphine, but afterward conjointly with it, and finally was supplied ad libitum. The “vulnus in venis” had penetrated too deeply even for the plastic hand of a Machaon to reach. “Vraiment Thomme ne meurt pas, il se tue.”

A case from Dr. C. H. Wood illustrates the impetuosity of this morbid appetite, and the consequent inveteracy of the habit. C. a cordwainer, age 35, having suffered dysenteric attacks repeatedly (but not from intemperate living), had after various discouragements sought relief in morphine. The dose, very inconsiderable at first, and but gradually advancing, had got to be a stationary one, a drachm for the week, but now and then just twice that. The malady declined so as to occasion little trouble, but not so the urgency for the remedy. Trials at a change repeatedly undertaken were as often baffled. The patient, sustained by his adventitious support, was happy as a lord, and equal to a full day’s work at any time; but so surely as the supply was intermitted for any cause, such was the precordial distress he must take to his bed and have the doctor’s help right off. The skin had finally taken a deep icteric hue, as though it had been dyed in saffron. These victims of habit come and go, appearing and disappearing again, chacun a son tour.