(Editor’s Note) I’m sure that to most of us living today, life in 1870 does seem simpler from the perspective of 2018, but that’s only if you are looking at the external environment in which people lived back then. The internal realities of life 150 years ago were exactly the same as they are today. Some of the external causes of the pain and suffering experienced by so many today have changed, but only superficially. Poverty hasn’t changed; exploitation hasn’t changed; homelessness hasn’t changed; hopelessness hasn’t changed; war and cruelty haven’t changed; class and racial hatred haven’t changed; and for the most part most people still don’t give a shit what happens to other people as long as they get theirs.
Although they pretend they do – and that hasn’t changed either.
So with that Jeremiad out of the way, here is Dr. Calkins Chapter Fourteen in which he concludes that nobody really understands anything about why some people – many people, in fact – choose to use substances that make them feel better for a little while and then go on to over-use and become trapped by those substances. He suspects that it has something to do with the basic human condition, as do I.
(From) “Opium And The Opium Appetite”
by Alonzo Calkins, MD (1870)
Chapter XIV: Causes And Occasions
“His alias poteram et plures subnectere causas.” – Juvenal.
“Give you a reason for compulsion!
If reasons were as plenty as blackberries,
I would not give you a reason for compulsion.” – Henry IV
The Causes may be distinguished in a twofold classification, – the physical and the moral.
Under the former division range neurotic and arthritic maladies, such as hold the body in a close gripe, e.g. rheumatism, dysenteric drains, haemorrhoidal tumors, cancerous growths, a retarded convalescence following acute disease, hysteria. Occasional incitants are, paucity of food coupled with the overworking of body or mind either, the familiar use of some nursery cordial, a vicarious interchange with alcoholics.
Dr. Christison had a lady-patient, then twenty-five years of age, using daily at the time of morphine (to which she had been habituated in childhood by a nurse) 15 grains. Contrary to all presumption, there was not any sensible deterioration of the natural vigor.
Dr. Palmer has traced the habit, as established in three youths, to precisely the same sort of early habituation.
A case (not an unusual one) originating in uterine disease with a cystic complication, is communicated by Dr. G. W. Hanna, of Monroe county, New York. Mrs. B., a widow of thirty-four years and a mother (a woman of superior gifts and fine presence still, though opium has made its inroads), began with laudanum as a palliator of pain simply, and in this way got confirmed in her habits. This course has gone on now six years, and the quantity at present used is, according to her own statement, half an ounce on some days, on others twice as much; and indeed it is safe to say the latter amount is within the mark; for whereas she formerly procured her supply in the neighborhood, now she sends to a city ten miles off, and no doubt to create a false impression that should operate as a blind among her neighbors. Having been repeatedly admonished by the doctor that it was “sink or swim” with her, she has made repeated attempts at reform, but ineffectually. Lately she had held out for three days, having had none of her drug in the house for so long; but the prospect is unpropitious, and the more as another stimulus has been superadded. The care of a young family, now devolved upon herself alone, doubtless co-operates in aggravation of the primary cause.
In the life social, where not dress and etiquette alone, but religion besides, acknowledges fealty to fashion, diseases too assume putative shapes in correspondence with some prevailing idea, a “vox omnibus una” nominally, be the real type what it may. At one period all maladies merge into dyspepsia; liver complaint dominates, or neuralgia. Two cases, whose locale was the goodly city of Gotham, are here presented to a discerning public partly for their intrinsic value, partly for their extrinsic significance in bringing forth to the light home of the arcana of science.
First is Miss R., a spinster of thirty-five years, who was being treated for some rheumatic symptom which had found opportune shelter under the more fashionable name. This patient, in homoeopathic hands at the time, was using daily three packets of a something, one of which made her one day strangely stupid. The new physician, Dr. L., took a powder to Adamson of the College of Pharmacy for analyzation. The product was one and one-fourth grains of morphine, showing that the said subject was taking three grains and three-quarters of the alkaloid daily – quite other than infinitesimal doses, plainly. A timely change intercepted a course that would ere long have been fastened beyond change.
The fellow to this case was Mr. B., a gentleman of middle age, whose complaint, a sub-inflammatory affection of the hip – neuralgia again, or the old friend in a new face. This patient was being put through the granule discipline by those distinguished scientists of the Hahnemannic school, Messieurs les Docteurs F. and P.
According to prescription, this patient was taking powders varying, for different days. from six to nine, one of which, having been submitted to examination as was done in the preceding case, yielded one grain and a half nearly of morphine proper, the addendum being saccharum lactis. This “running the machine” had gone on for five weeks, when Drs. P. and L. were invited to assume the charge.
Opium is frequently used against chronic maladies, either as a palliative proper or vicariously of other medicines of more questionable efficacy, and the more especially for the purpose of procuring sleep under nervous agitation. An instance in illustration was Mrs. W. (the late), a lady of a New England city, who, having been married soon after attaining her majority to a “fast man,” thereby became an invalid for the remnant of her life, that is unto her 37th year. The physical contamination, the “fons et origo mali,” innocently contracted on her part (the real nature of which she was never perhaps made fully cognizant of), was one of those whose tendency is to grow with advancing time rather than to die out with a definite lapse of time. Constipation early established was ever a grievous annoyance, even with the moderate alleviation afforded by purgatives and the syringe. Extreme nervousness, with paroxysms of hysteria, had expression in the most wild and incongruent extravagances; and as for sleep, that was irregular of course and never refreshing. The face presented an oedematous fulness and a putty-like hue, and this with the eye fitfully glaring in its strange wildness, told of the internal commotion more forcibly than tongue could give utterance to. The symptoms and habits of this patient were family known to Dr. S., of whom she had made her purchases for ten years continuously. Here is the report of articles prepared regularly for her use the last two years of her life:
Of Magendie’s solution 4 ounces, of laudanum 4 ounces, of morphine 24 grains combined in pill-form with 36 of guaiacum, “much altogether for every 2 days, the equivalent in a single day of 52 grains of morphine.”
Another case, having its origin in a physical is from Dr. Pitcher. Mrs. R., 35 years of age at the present date, was married at 20. To this point fair health, barring a slight menstrual irregularity, had been enjoyed without any notable variation, but from this time, or soon after, a severe vaginismus had become established. To mitigate this symptom the husband (an apothecary) had supplied her freely with morphine, and so by-and-by the habit became perpetuated. Impregnation had at no time occurred.
The woman was not seen again for the space of four years, but after this interval she was perceived to be in a changed condition. The primal irritation had passed away, but a constitutional obstruction was found to have succeeded, and besides a growing taste for alcoholic liquors had been freely indulged. There had been, notwithstanding, no pretermission of the opium. The two stimuli have been continued, going on in friendly companionship for eight years now. The immediate effects of the conjunction were an impaired appetite for food, and a waning of the moral sense. In evidence of the latter change was the fact, that an intense jealousy had taken possession of her imagination. The mental pathologic condition was of that kind which Brierre de Boismont denominates a folie raisonnanle. Her propensities, as evidenced in her habitual conduct, appeared more and more in contrast with her ordinary discourse as time went on, for her conversational gifts as once displayed were of a very superior order.
The present condition is this. The whiskey having been suspended she takes food with a relish; and, besides being unhampered by a multiplicity of household cares, she goes abroad much in the open air. Her consumption of morphine for a month together amounts to 12 drachms, with scarcely a variation for such period.
The case suggests several inquiries. Was the cause a remote rather than a proximate cause, a hereditary proclivity that is, or was there an exciting cause only, the peculiar condition that had ensued upon the new relation? Or, was it the maternal example that had operated as the main force? Or, rather, may not all the supposed conditions have coalesced in joint operation? “Felix qui pohiit rerum cognoscere causns.”
A very efficient, but as is to be hoped, a very occasional cause at the most is the solitary vice, but which was, as confessed, a cooperating influence in one of the instances included in our enumeration. A pretext for the procuring of laudanum in particular, not unfamiliar to the apothecary, is the pretended need of a liniment. Jones of B. had for several years a regular visitor, who required 6 to 8 ounces weekly on account of “neuralgia in the knee.” The liquid was regularly applied, no doubt, but to the epithelial lining of the oesophagus rather, and not to the cutaneous surface. This is orthodox practice, going upon the principle of metastasis or sympathetic transference. An ingenious excuse is oftentimes as good a passport as any.
In the inventory of proximate causes, a very liberal share is set down to the credit of the Faculty; if not beyond their deserts yet in the very face of their disclaimers. Too indiscriminately perhaps have they been pronounced in juridical parlance accessories before as well as after the fact. Some there are who prescribe opiates as a convenience under a pressing exigency, or as a cover to ignorance and to gain time in awaiting a more distinct evolution of symptoms, callous to the conviction that they may be “sowing dragon’s teeth meanwhile that shall by-and-by leap forth in their retributive power as armed men” (Van Deusen). Who can wonder that the sufferers, worn down as they get to be in body and abject as they become in spirit from perpetuated disease, are so eager in their extremity to surrender themselves into the hands of Opium’s unconscionable charlatans, seeing that even “Satan can transform himself into an angel of light?”
A case in point is from Moreton. The patient, a woman of thirty-five, in the full enjoyment of robust health before, became, through toiling incident to the care of children with domestic infelicities super-added, a subject for the doctor’s attention. Laudanum was prescribed as the cure-all, and by the end of five years about it turned out the end-all; for by this time the subject was utterly broken down past recovery.
The leading moral incitements, none the less various than the physical, and in potential force often surpassing them, are, perplexities in business, the reverses of fickle fortune, tedium vitce as from conjugal disagreement, “The chilling heaviness of heart From loss of love, the treachery of friends, Or death of those we dote on,” self-abandonment to a career of sensualism or crime, are as urgent as any. In every instance there is some pretended necessity put forward, when the real and sole reason – the “causarum prima exordia” – may be the passion for the stimulus itself and nothing else (Day).
Among the occasional causes should be specified what Forbes Winslow has denominated a “ psychological romance,” those “Fine Confessions, That make the reader envy the transgressions,” as saith the poet of Newstead concerning St. Augustine. When rhapsody shall have assumed the garb of earnest truth and romance shall have taken the impress of history, then may it be expected of De Quincey’s Confessions, draped as they are in a prismatic gaudiness of attire, that they shall work upon the unsuspecting reader as cautionary dissuasives (as they do not) rather than as provoking appetizers (as they do).
There is yet to be reported the very first exceptional case. That these “confessions to the fact” have directly encouraged tentative trials upon the same line of experiment is now very certainly known from independent counter-confessions.
The Rev. Walter Colton, late a chaplain in the U. S. Navy, having read out of curiosity De Quincey’s narrative at a time when he happened to be on the Mediterranean station, was tempted to make a trial of opium in his own person. The dose was inordinately large, and the effect appears to have been in proportion. “Soon lost to the realities of the outside world (so runs the narrative) for two days and two nights continuously, I awoke at length confused in mind and exhausted in body, having been recalled to my proper self, but only through the assiduous and untiring attentions and soothings of my bosom-friend. Let no one like me venture encounter with the dreamy ecstasies, the agonizing terrors of the opium dream; it is like scaling the battlements of heaven, only to make a desperate plunge into the fiery pit below.”
Blair, the omnivorous bookworm, “who while yet a youth lived upon ale, opium, brandy, and books,” was led to experiment upon himself in the same way and from the same persuasion (Knickerbocker, 1842). An attempt at abandonment, made after a time and in evident earnest, had brought him down from 80 grains to 17 grains; but here he stuck fast; for though his constipation had relaxed, and comfortable sleep to the extent of two hours and more had returned, nevertheless the ravenous gnawing in the stomach reviving compelled him to work up to his maximum again. Discouragements besides, growing out of irregular occupation and pecuniary embarrassments, appear to have disheartened him altogether, and we hear of him last being about to leave the country for his London home again. Many an Ephraimite is thus “joined to his idols.”
To the misuse of the pen, chargeable against De Quincey, must be superadded the weightier responsibility of domestic example. A sister of his, living under the same roof, followed in his wake, and so perseveringly as to have become in the course of a few years as spell-bound under the enchantment as he himself was (Sinclair). Five similar instances of daughters following the pernicious course of the mothers have come under the direct cognizance of the writer. Such in its plenitude is the power of example, that imperious dictator of all that’s good or bad in human nature.”
“Velocius et citius nos Corrumpunt exempla domestica.” — Juvenal.