Editor’s Note: Given the current propaganda-driven panic over opioid addiction in the US, it is worth stepping back a hundred years or so to see what American physicians thought of opium addiction in the late 1800’s. At the time America was in the grip of an addiction epidemic that puts today’s mini-epidemics to shame, so the experiences of both doctors and addicts living through those terrible times are highly relevant today.
As readers of this blog may know I have recently been serializing chapters of a book by Dr. Alonzo Calkins, an American doctor who worked and wrote in the late 1800s. The value of Dr. Calkins has to be extracted by careful reading – there are layers of moralizing that must be penetrated before the experienced and street-smart physician speaks clearly. However, his observations on opium, opium use in medicine, opium use in society, and opium addiction are always informed and worth considering as we face the latest chapter in the old, old story of addiction in America.
In this chapter Dr. Calkins discusses his experience in specific treatments he has used and seen used for opium addiction, and here he discusses many of the medical/herbal/alternative practices and medications used by physicians of his age to treat opium addiction – which by that time in the history of drugs in America also included widespread Morphine & Heroin addiction.
His endorsement of caffeine enemas as an effective treatment for use in opium withdrawal is about as cutting-edge as a doctor could get for his time. The only problem with using caffeine to treat opium addiction, he complains, is that it is so expensive. (That was 1889 when coffee was expensive. In 2018 maybe Starbucks is missing out on a whole new level of customer service.)
As usual in these instances, I am left to wonder whether Coca Leaf tea enemas might also be as effective as we already know Coffee and Cannabis enemas are in treating a wide range of conditions and diseases.
So please enjoy browsing this chapter from Dr. Calkins, and do try to overlook the moralizing tone that makes him sometimes seem quaint & outdated – his information is really quite good and worth browsing.
Note: You might also enjoy browsing the unusual coffee links in my post on greenhouse Coca Leaf cultivation.
Chapter XX: General Therapeutics And Moral Hygiene
“Discite igitur potus medicos curamque salubrem.” – Pliny.
“The skill of the physician shall lift up thine head: give place to him; let him not go from thee, for thou hast need of him.” – Esdras
Under the twinges of an arthritic malady or the agitations from a febrile fire no prudent man would long lie hesitating and debating upon the expediency of having the physician in council; how much more imperative and urgent is the exigency where body and mind both are alike involved and imperilled.
Upon the introductory discipline no less than upon the progressive conduct of the individual case, success if feasible must eventually turn. In the maturing of reformatory plans discouragements will be encountered at the threshold, with the mental disquietude of the patient superadded to an impaired physique now feebly resistive against evil, and the despondency consequent upon abortive efforts already essayed.
Medication furthermore, to operate efficiently, must possess that plastic quality of adaptiveness to mental idiosyncrasy equally as to physical temperament.
At the very outset the materics morbi, the “old leaven,” must be purged out effectually and finally. The fortress must be taken by assault and the enemy be driven from his stronghold, or the campaign is a failure. This is the “una salus victis,” the essential condition of permanent security preparative to a warfare accomplished. Segregation of the patient under wholesome restraint away from the influences of uncurbed temptation should be urged as a prerequisite. The vague hope of procuring occasional though irregular supplies through connivance on the part of some ill-judging friend or through a too lenient laxity of restraint, (and none stronger can be exercised under domestic influence alone), is sufficient of itself to keep awake an appetite, that through severer discipline might in time decline into dormancy. The lion though tamed must be confined to his cage, for with the very first sniff of blood those velvety paws may sprout all at once into barbs and tenterhooks.
To revive the natural appetite for food and for the general recuperation the materia medica affords various helpful resources. Quinine, Iron, Vegetable tonics and the Mineral acids, Nux vomica, the Bromides, Gelscmine, Lobelia, all have been put to service, and favorably. Pliny brings to notice a species of plant in these words: “Bibitur Artemisia ex vino adversus opium.”
Iron, as in the form of ferruginous salts or chalybeate waters, which has had so positive success in controlling the morbid thirst for alcoholics, is certainly to be commended as worthy of more careful trial in this association.
A contributor to the British Medical Journal speaks of Phosphoric acid with Lupulinc in combination as being powerfully efficient towards assuaging the cravings.
In the East the Betel has a reputation as an alexipharmic. Captain Wilkes of the Exploring Expedition, then on a visit to the Sultan of Sooloo witnessed an experiment made upon a young prince of the court, who was successfully revived out of an opium stupor, and mainly through the use of this plant.
Certain familiar beverages bear in this association an accredited reputation, foremost among which are coffee and wine. Coffee, almost unrivalled in celebrity and esteem among the common table drinks, is accounted in Turkey a very efficacious neutralizer of the narcotism from tobacco, and in Europe and the U. S. it holds a prominent place in the estimation of the toxicologists as an antidote to opium.
There is reported lately by Dr. Senneker the case of a child poisoned by an overdose of morphine which had advanced to the stage of coma, when caffeine (the alkaloid), two grains, injected hypodermically operated to the patient’s complete restoration. This agent caffeine commends itself to the attention of physicians (although the high price precludes an indiscriminate use), as what may upon careful trial be found to possess if not a countervailing force to the full extent at least a partially counteractive influence.
In lieu of the costly alkaloid a strong infusion made from the berry slightly browned only, and taken, a wine-glass for the time and several times repeated in the course of the day (and night perhaps), is commended with a very assured confidence. An alternative mode of using the same is by introducing with an instrument per rectum – a practice favored by Rambosson.
Wine has been adverted to in the preceding chapter. The controlling power of wine is certified to by the very general testimony of the Turks, and in particular by a gentleman of Aden, who assured Dr. Aliston that wine regularly used as a substitute for opium will take away the taste in a month to a certainty. For occasions apple wine or other pure wine might help in propping up an attenuated frame, or in case of an extremely depressed innervation rum punch would be a good pro-tempore restorative. “Ancops remedium potiusquam nullum.”
As food “strong meat” is required, and such is beef, venison, oysters, eggs, rich milk too, if agreeable, maize-bread (panne as it is called along the Wabash) for its laxative property as well, and there should be a liberal use of condiments and fruit sauces, the tomato before all.
To obviate so far as may be practicable that sorely-besetting symptom constipation, the rectum syringe should ever have a place in the furniture of the wardrobe. Functional derangement from the continued use there is none whatever; the comfort ensuing upon the practice is to the experimenter scarcely appreciable. Capt. L., after employing such instrument for more than ten years and regularly too, expressed one time his obligations to the writer for the suggestion to him so advantageous in the avoidance of many a drastic pill. The occasional diarrhoea, which will recur, must be treated specially and for the occasion.
A restorative of great cooperative power, appropriate besides to any and every condition of the invalid from opium, is the warm bath. The fluid may be indifferently heated water as in the simple warm bath, steam vapor as in the Russian bath, or an atmosphere of hot air as in the Turkish bath. The shower or the douche, if bearable, should regularly follow. The magnates of Rome in the days of imperial luxury (like their imitators of today in Constantinople and Isfahan) well appreciated in their practice the salubrious influence of the daily ablution. The estimation in which the bath was held as long ago as eighteen hundred years is apparent in the following distich: “Balnea, Vina, Venus, corrumpunt corpora nostra; Corpora et roborant, balnea, vina, venus.”
Finally, among the physical resources and helps come into consideration exercise and occupation. Not slothful inaction, the dolce-far-niente or blessed-be-nothing impassivity of existence is required, (for mind as well as body to keep its balance must have employment), but only abstraction from severe labor and oppressive study. Not the “Socraticis sapientia libris” nor exercises upon the calculus will meet the existing want; commend rather ball playing and quoits, the saddle interchanging with the democrat wagon, railcar exercise to help on digestion and to provoke lagging sleep, cheerful company, festive scenes and rural pastimes – such are the agencies and agents that will help to disenthral the opium-bound prisoner, far transcending the metamorphoses wrought by any fabled Asmodeus.
But inasmuch as “the life is more than meat,” we must have a care in making provision for the man physical to regard with no blinking eye the moral aspects and needs. We have to deal with subjects whose will if not absolutely dormant is held under the control of a superior and an extraneous force as well. This fact is tersely expressed in the language of Dr. John Reid: “The idea that nervous complaints are subject to the control of the will-power is a fallacy.”
What avail then dialectic formularies a-la-Sorbonne, or indeed only plain homilies of the hortatory cast addressed to the “moral sense,” when that sense if not already dead and buried is at least benumbed into a fatal torpidity? Remonstrance though backed by reason rarely suffice to make any effectual stand against the cravings of an impetuous bodily appetite: “Reproaches come too late – They search, but cure not.”
Or if the penitent soul shivering in its agony is yet alive to a sense of its deep degradation and galling bondage, not “The February face, So full of frost, and storm, and cloudiness,” but the “verba et voces” it is, the compassionating look, the magnetizing pressure of the hand, the lute-like tone of sympathetic recognition only that can moderate the present pang and revive the hopeful glow once more. Get a point d’appui from which to make your approaches, bring out the keynote to which the strained heart chords shall respond in harmonious echo, and the battle is half won. Or suppose the attack does not succeed in front then try a flank movement; if the attempt fails today renew the trial tomorrow.
A habit so overmastering as that of opium eating can be treated with no parleying, no compounding, no temporizing. Vigilance on the part of friends can never with safety be relaxed while yet the evil abides, however favorable in seeming the disposition of the patient. “Di buona volente sta pierro l’inferno” – good resolutions resting upon naked promises are scarcely more stable than the idle wind.
Two false impressions (fantasies they might be termed) are apt to possess the patient’s mind; the idea that a half-cure is better than nothing, and this other, that the use of “confections after the art of the apothecary” can obviate total abstinence. As to half-cures there are none; “Vulnus in antiquum redit male firma cicatrix.” Then again the inexorable law, “Touch not,” can make no accommodation with imprudence and wrong out of complaisance towards human infirmity. The conditions are rigid and the trial as by a furnace ordeal, but the triumphs if secured will transcend all the mere succors of art.