Tag Archives: Opium as medicine
Anecdotes & Evidence: Extreme Dosage Of Opium
(Editor’s note) With this post I am resuming the chapter-by-chapter posting of the remarkable book “Opium And The Opium Appetite” by Alonzo Calkins, MD. This long and challenging book, published in 1870, allows us to hold a mirror up to our current “Opioid Crisis” and see it for what it really is – not a crisis of our times, but an ongoing theme in American life.
In this chapter Dr. Calkins discusses the many cases that he experienced personally, and that he gathered from other physicians and elsewhere, regarding extreme cases of Opium/Morphine consumption. Extremes of consumption were not always tied to addiction, as he points out, and the stories in this chapter ought to make us think twice about the “one dose and you’re hooked” meme that is so popular with those who make a living from ensuring that there is always a plentiful supply of souls in dire need of “rehabilitation” and “recovery”.
Many people born since the 1990’s don’t understand the history of the “Opioid Crisis” because they were not yet born when previous “crises” were being manufactured and sold to the public by breathless media acting as the propaganda mouthpiece of the State. Consider, to take one of the worst examples of social disinformation, the “Crack Epidemic” of the 1980’s that sent tens of thousands of mostly young Black men to prison, creating an entire generation of fatherless Black children and fueling the next act in America’s “drug wars”.
While the “fake news” epithet may seem to be quite contemporary, the fact is that much of the “news” has always been fake, and never so much as when drugs are the topic. For all of his faults, Dr. Alonzo Calkins wrote what he saw and what he believed, and left us a record of what was true 150 years ago and remains true today – we don’t have an Opioid Crisis; we have a permanent crisis of the American soul.
“Opium And The Opium Appetite” by Alonzo Calkins, MD
Chapter XVI: The Posology (Dosage) Of Opium
“Exempla – quorum me turba fatigat.” — Ovid
“Let me have a drachm of poison. Sweet draught! Sweet, quotha? O fool! that now as luscious as locusts, shall shortly be in thy mouth as bitter as coloquintida!” — Romeo and Juliet
By those who have studied the “Ars nihili credendi” many of the statements recorded in this chapter will be transferred to the column of the incredibilia; but there is ample authentication behind nevertheless. Van Swieten refers to a dose of 16 grains as something extraordinary; Garcias (Morewood) knew a woman in Turkey, of good intelligence and of a conversational turn, who informed him her daily consumption was 10 drachms (!). Hufeland mentions a 30-gramme dose, one ounce less half a drachm. As a measure of effect, however, it should be understood the apothecary’s scales are but a very insufficient criterion.
Extremes
Initial doses vary from a fraction of a grain upward; but amateurs start more boldly, as in the instance of a Chicago youth, who began upon 3 grains of morphine, and ran his course proportionably fast. Surgeon Smith names 5 grains of the chandoo for the neophyte; 290 grains he has known in the case of the veteran. Libermann, in the Chronique Medicale, has given a tabulated summary of a thousand smokers, of whom he kept a record while he was in China engaged in the imperial service, as here classified:
Of the thousand, 646 vary between 1 and 8 grammes, 250 between 10 and 20, and the remaining 104 range from 30 to 100 grammes. (The higher extreme seems scarcely credible, and perhaps the text should read grains.)
The Theriakis of Eupatoria not unfrequently go to 100 grains; the Hamals (porters) of Constantinople not seldom use an entire ounce.
The “big doses” are restricted by no lines of longitude. Dr. Hawkins was informed by a druggist of an eastern county in England concerning a farmer there, who one day came into the shop, asking for an ounce and a half of laudanum. This having been swallowed was after a brief time followed by a second draught, and again by a third, and several ounces besides were purchased for taking home. This “operator” was plainly of the new-school progressives.
But in bold practice New York City and the rest may safely challenge Birmingham, or Paris, or Canton. A woman of Atlanta (a buyer for a considerable time, and if she ain’t gone she lives there still) sends her daughter with the two-ounce vial for laudanum three times a day regularly (Redwine). The cause thereunto moving had been a proclivity to “spiritual liquor.” Wayne gives an instance of 6 ounces; Eimer of the same quantity daily repeated.
Paregoric and McMunn come in for their share in the awarding of honors. Besides the quart-measure are pint cases in plenty by Shedden, Lee, S. Smith, and others. McMunn also talks loud. Dr. Lente knows a woman at Cold Spring, who buys for the week three dozens of bottles. A gentleman who was making a purchase on Union Square one day, declared of himself that he used up, one day with another, 12 bottles. Dr. L. had seen and prescribed for a youth (as he then was), who, having become habituated to strong drink provided by injudicious friends for a lingering diarrhoea of his, had found in this elixir a present quietive for symptoms threatening delirium tremens. On a certain day he was known positively to have taken six bottles. This case, however, is thrown into shade altogether by a record at Binghamton, that of a lawyer, a detenu at the Asylum there half a dozen years since, whose totality was by his own record 3200 bottles, and for a certain day one and two-thirds dozens, the equivalent of a pint of laudanum within one ounce.
Morphine demands a separate section. MacGillivray’s patient has been noted already (chap. xii.). Dr. Gill of London had on his hands one time a professor of vegetarianism (50 years old actually, but, judged by his attenuated limbs and parchment skin 20 years ahead of that mark), whose stated supply was 55 grains. The allowance having been cut down flesh was substituted for porridge and cabbage, and in no long space Mr. Witherskin was able to make a much-improved show in the outer man. A third drachm case is from Redwine, that of “a brother fallen from his high estate,” who had pioneered upon whiskey. A fourth case is of a German woman lately in the hands of Naumann, who by a gradual progression through several years had finally reached one drachm precisely, at which mark she stood a considerable time. This person cured herself by pursuing, at the suggestion of Mr. N. (a very intelligent druggist), the gradative course. The weekly diminutions were made by grain and two-grain reductions in alternation.
A fifth case is communicated by Mr. Leys of Brooklyn, and the detail is a precise transcript of the record. A woman, thirty-five years old at the time of her death, wife and mother both, had been a regular purchaser for the six years precedent to her demise, though a consumer for several years earlier. Of medium embonpoint and with a fair countenance, she would scarcely have attracted casual attention otherwise than by the half-averted but lustrous eye. In regard to constipation hers was an exceptional case, nor was the final sickness (which was of the acute type) obviously traceable to her morbid habit. The dose for the first month of the six years was 16 grains (in the form of Magendie’s solution), which quantity had doubled by six months and quadrupled by the time a year had run. This 16 grains per month had grown by the end of the fourth year to 16 grains per day, and in another year to 20 grains. For the first half of the sixth year the progress was from 20 up to 30 grains; during the final six months one drachm was the measure, regularly called for as the morning came.
Number six is Mr. B., a prominent druggist in the metropolis, age 49, the subject of a severe chronic diarrhoea for half a dozen years. Morphine, which, like Choroebus penetrating the Grecian phalanx now within Ilion’s towers after assuming the helmet of the slain Androgeos, a pretended friend while an enemy in disguise, was early employed for its supposed curative efficacy (and indeed always to the present mitigation of symptoms, for “without it his bowels would run away from him”), but the benefit derived has ever been of ephemeral continuance only. No notable emaciation is observable as yet, nor has the general health become materially impaired. Magendie’s solution (16 grains to the ounce) is the form, and this is taken, an ounce for the time, in very precise measure, to the extent perhaps of four times that in the day, or again a pint may last the week through. He has been known to have his ounce four times in the day, and an additional one at his private office, i.e. 80 grains of the salt. In the general way, morphine to the amount of 15 grains is no uncommon dose; 30 to 36 grains is with rare exceptions the limit.
Gravity of action may be as disproportioned to quantity as is the case of alcoholics. An instance of idiosyncrasy referable to this section is given by Dr. Barnes. The occasion was an existing diarrhoea. With the approbation of a doctor opium had been used daily for three weeks, by the end of which time, “although the flux was subdued the opium was not subdued.” The medicine acted strangely, kindling Then up a fire in the stomach as it seemed, so that for another three weeks nothing swallowed would lie, rice water excepted, and all the vital powers seemed to be flagging. A year having proceeded in this manner, a change to the right-about was resolved on. Agonies and horrors followed upon the breaking up, to abate only by littles, but success was secured at last. For a time from the first, but for a brief period only, a sort of ideal tranquility, a visionary happiness followed each dose, but the subsequent experience was the reverse of all this. The recollection of the sufferings had survived as vividly twenty-five years after as if they had been of yesterday. The dose (the gum was used) had at no time exceeded four grains.
The caprices of single doses taken for a special occasion are even more variant and strange than the operations under continued use. Of minimum doses of fatality there have been noted (as already mentioned) 3 grains of the gum (Grisolle), a grain of morphia, and half an ounce of laudanum, and there have been even less than these. Maximum doses of tolerance are the very antipodes of such. Recovery has followed upon the ingestion of 30 and 60 grains of the gum, and once after 20 drachms had been swallowed. Instances of like result are recorded of morphia in doses of 30, 55, 60, and even 75 grains, and after laudanum, as in two cases, where 5 ounces had been taken, and in a third where the quantity was 6 ounces.
The records of practice in disease are yet more astounding. Doses fearlessly used at this day for various forms of organic derangement would only a half-century since have staggered the boldest. For instance, Pinel allowed a woman at La Charite, far gone with cancer uteri, 120 grains of solid opium for the twenty-four hours, and greatly to the alleviation of symptoms. M. Marc, in the Gazette de Paris, gives a similar case. His patient on one of the days took 62 grains of morphine. Monges and La Roche of Philadelphia had such a patient, whose allowance her last three months was 3 pints of laudanum for a day and a night, with some pure opium extra. For a urethral malformation a woman under Zaviani consumed in the progress of thirty-four years 200 pounds of the solid and above. On some days 200 grains was her mark. Dr. Knight of New Haven once had a patient with uterine cancer, who used daily and for a very considerable time, and without prejudice also, a drachm of morphine at least, and from that even up to 3 drachms. Bellevue Hospital records make a show ahead even of these. In a case of puerperal peritonitis occurring in 1862, Dr. Clark administered in the course of seven days various preparations, equivalent altogether to 200 ounces of opium proper, and on one of the days 472 grains, an ounce to within a fraction.
Medium doses.
Rev. G. Smith, an English missionary, made a tour of observation one day around Amoy, having Lim-pai, a reformed opium eater, for cicerone, with the following results. Upon questioning ten persons as met indiscriminately and at random, he found their average to be 1 mace or 60 grains. The general average he ascertained to be 3 candareens (= 17% grains) of the chandoo (Allen). The mean for Aleppo Russell puts at 3 drachms; a high figure certainly, even for the maw of a Turk. Dr. Garrod, however, knew of a Turkish gentleman, a mere youth, who used one drachm in the morning and the same repeated at night, besides the laudanum he took in the intervals, an ounce or more.
At the Pauper-house, Singapore, Dr. Little ascertained that of fifteen persons, smokers for periods varying from 3 to 20 and averaging 11 years, the medium dose was 32 grains. At the Mount Hope Asylum 2 to 4 ounces of laudanum is nothing uncommon (Dr. Stokes). Specific quantities are a drachm of the gum, 1 to 2 drachms of the salt, and a pint of the tincture, so much per week (Moore, Skey). The dose varies much with the pecuniary ability. A purchaser at Giles’s (such is a specimen-case) would get from time to time an ounce of laudanum only, it might be, and again twice or thrice that. Equability and moderation in dose is what is oftentimes but very capriciously respected. A gentleman called one day at Tarrant’s for a scruple of morphine; this, having dropped into a tumbler of water, he swallowed forthwith, with the intent, as was for the moment suspected, of poisoning himself. All anxiety was soon removed, however, by the stranger’s explanation that “such was his way.”
Gradual Advances.
“The small quantity of Opium,” observes Dr. Little, “soon loses its effect, and to produce the requisite excitement the little pea must be doubled and again increased, until, as I have known, the original has got multiplied a hundredfold.”
A married woman turned of 50, who began upon two ounces of laudanum for a week, has now, after a considerable term, attained to the pint-mark (Leys). A spinster of 55 was several years in getting as high as 6 ounces per week. Dr. Palmer reports two cases where the weekly consumption was 2 drachms of morphine, and four others in which the quantity was half that Among his opium-cases was Mrs. O’G., addicted to the drug about forty years, .who by very slow advances had reached at last two drachms for the week, with the addition of a little whiskey taken as a priming. Another instance was Mrs. T., 50 years old at her death, who had been a consumer for nigh upon half of this term. She even in her latter years had not exceeded a drachm for the week to the very last year, but here the quantity was doubled. An extra interest attaches to this last case, in connection with the question of degeneracy. Of the two children born subsequently to the confirmation of the habit, the elder, a son always feeble and sickly, died at fifteen; the daughter, contrarily to what might be expected, now eleven years old, has a robust and thriving aspect. The patient died a year ago of pneumonia.
A lady of Ontario county with whom the writer has conferred, Mrs. S., age 60 or above, mother now of several grown-up children, became an invalid ere she had completed her maiden life; whereupon, with the concurrence of a physician, she sought relief in morphine. From the beginning through the entire period the advances have been very gradual to a drachm for three weeks (the present limit), or if for any special exigency this amount has been at all exceeded, she has ever been careful to recover the lost ground, returning again to the fixed standard. No other medicine has been found upon trial to answer her needs by way of substitution. Those common sufferings, such as constipation, agrypnia and ugly dreams, have not been among her experiences, nor is there during the day any marked exhilaration, or indeed any very definitely-pronounced characteristic, with the exception of the peculiar skin-hue and a somewhat toddling gait. A discontinuance was not advised.
Periodic augmentations in a ratio constantly increasing are according to the normal course; but then there are stages also of what may be called a “satisfied craving,” lasting for months or even years. Formiggini had a patient with a facial neuralgia that had come of caries of the maxilla, who used one gramme of morphine daily. This kept her system at the saturation point; but this precise quantity the lady must have, no less, no more; any excess she could not (or would not) tolerate, and if put on reduced allowance she became desperate (Revue de Paris).
The Lancet, 1832, contains a case not dissimilar. In this instance hysteria was the objective malady. A woman, now of the respectable age of 50, used for her measure 20 grains of the gum, so much precisely, day after day. (These hysterial cases require a good deal of humoring, particularly when spinsters are concerned who have arrived at a “certain age,” that age of all ages the most uncertain.) Dr. S. S. sends the case of a woman twenty-five years old and married, who made a beginning upon laudanum in her 20th year. Lately she has kept herself strictly to 4 ounces for the twenty-four hours; but “this much she will have at all events, even if she must beg for it or steal for it.”
Jones had for a reputed customer an elderly lady of the Hudson River border somewhere along, who purchased her supply of him for several years, sending a granddaughter (her deputy in the transaction) once a month for the pint of laudanum. Like the rest she ceased by-and-by to make report representatively or otherwise. “They come and go,” as Dr. Guion says.
A woman of mature age, an attendant at Eimer’s for fifteen years continuously there was, whose weekly purchase was what would make an average of half a drachm for a day. There was also a teacher attached to one of the public schools in Brooklyn, who was so careful of her ways, that she was at the pains of crossing East River about every four days, to get as many ounces of laudanum from a doctor at the West End (Mr. L.). Her general aspect all this time gave no indication of any progressing deterioration, nor was there so much as constipation complained of. This person all at once ceased to reappear; whether it was that she had opened a new account with another doctor, or whether she had gone to settle an old account with death, did not transpire.
Moderation in quantity and steadiness of dose are oftener observable perhaps in case of congenital infirmity or traumatic lesion; for instance, when spinal irritation or an ununited fracture is the coexisting evil.
Inconsiderable advances upon the existing dose are seldom hazardous, where a large stride might prove critical. An inquest at Bradford, England, brought out the following facts: a woman with chronic asthma (one of those maladies that contraindicate opium absolutely) had taken a dose considerably exceeding the usual one, causing her death only a few hours after. A second case to be adduced comes from Binghamton. A patient there was, who, having strayed off to town one evening, felt disposed to have a fresh sip of an old friend; and so, having purchased two ounces of laudanum he swallowed the whole at once, a quantity he had never ventured on before. Dr. Day reached him, but not immediately, nor until the comatose stage had set in. The battery with other appropriate helps was put to expeditious use, but to no purpose, for death had his victim the very same night.
There was a New York lady, now of middle age, a custom-visitor at Bedford’s for years together, who for the alleviation of an existing intra-pelvic tumor had used morphine a long time, but in very definite and exactly-measured doses always. Her usage was to have the 48 grains (her amount for the day) divided into three-grain packets, so that the times of recurrence should come with the expiration of every hour and a half. One morning it appears, but for some reason not cleared up, she had put four of the divisions together for a single dose, thus having swallowed 12 grains instead of the 4. The stimulative action proper was overwhelmed by the predominant toxic force, and a fatal coma set in.
The rule of progressive cumulation reversed is among the rarest of the rare, and asseverations made to fortify such pretensions must ever be taken cum grano salis, i.e. at a very considerable discount.
There used to present herself very regularly at Goodall’s a young woman with her four-ounce laudanum vial. That she used twice four ounces every day was manifest from a circumstance she did not appear herself to have thought of, the extra label that had been superadded at another shop. There was a merchant who had broken down upon McMunn’s, an irregular visitor at Gates’s, who whenever he called would drink off a vial of the elixir, and take away several of the same sort, for occasional use only as he pretended, when doubtless he did the same thing at other druggeries. A Frenchman, known to Naumann for nineteen years, who all this time and even before had been familiar with laudanum, had a two-thirds ounce vial, which he was very particular to have filled once a day. The double labelling it was that exposed him. Long and freely as this monsieur had been addicted to his stimulus, he showed no distinctive indication of the habit other than in the peculiar sallowness of complexion.
Devices intended for disguising the extent if not the fact of the enslavement are as ingenious and varied as the contrivers are numerous. Two considerations act as prompters to such course; the supposed power of exerting a certain self-control over the paroxysmal excitement, and the apprehension of encountering a frowning public opinion in case the deception is unmasked.
Miss P., a spinster of thirty summers (and who was liable to continue such for as many winters), had purchased of Loines in the course of two years (so the ledger showed) 13 gallons of McMunn’s solution, without enumerating the additional supplies she had certainly procured in the interims from other establishments. This course it appears had been followed up so clandestinely all the while, that outside of her own family not a surmise of the existing habit had found place even among the naturally credulous. Opium eaters, if they cannot obviate suspicion altogether, may by the exercise of a dextrous ingenuity often put this same suspicion on its good behavior. A nibble from the mass, a pinch from the packet or a sip from the vial may create no more wonder, than the brandy flask slyly drawn from the pocket, or the delicate thumbing of the rappee box by the suaviter-faced tourist in the linen overall.
Reductions upon established doses, palpable in quantity if not of permanent continuance too, are to be reckoned among the actualities as well as the possibilities. De Quincey once fell back from his professed maximum of 8000 drops to 1000, and without experiencing any considerable discomfort either. Mr. B. of the Hospital calculated upon personal trials, that for real working service half an ounce of the gum or half a drachm of the alkaloid is as good as twice that. In the occasional use, amidst the daily avocations of business, it is possible to exercise much “prudence and discretion,” what is in accordance with the views of Dr. Pitcher (who appears to have a sharp eye for observation), and also of Dr. Lee. The merchant, for instance, who feels the need of an extra stimulus of some sort, by substituting a pill of opium in place of the half-gill of whiskey, is better able to work himself out of the perplexities of the hour without attracting the notice of some censorious neighbor, who is ever quick in discerning the mote in a brother’s eye though unaware all the time of the beam in his own eye.
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Opium Addiction: The Stress Of Modern Life In 1870
(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.
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Calkins Chapter 13: Utilities And Anomalies Of Opium
(Editor’s note) If you have been following my posts of the preceding 12 chapters of “Opium & The Opium Appetite”, you know that the author holds prohibitionists in pure contempt. He objects to their obnoxious moralizing, but he objects even more because the remedies they have always proposed – moral condemnation, forced confessions, and foul imprisonment – are demonstrably ineffective and invariably do nothing but cause further suffering and harm.
In this chapter we see Alonzo Calkins as a doctor who fully appreciates Opium as a powerful natural medicine, one which had no equal in his day and, truth be told, has no equal today, although finally the world is also finally beginning to re-awaken to the powerful, natural healing virtues of Cannabis and Coca. So-called pharmaceutical science has discovered plenty of ways to take the basic power of Opium and magnify it many times over through chemical manipulation, but if Mother Earth had never given her People the Opium Poppy, doctors would still be stuck with leeches and bleeding to “heal” their patients.
(From) “Opium And The Opium Appetite”
By Alonzo Calkins, MD (1870)
Chapter XIII: Utilities And Anomalies Of Opium
“Quo nihil magis meliusve terris Fata donavere, bonique divi.” – Horace
“Take the goods the gods provide thee.” – Dryden
Like as the prince of Athenian orators, when interrogated upon the essential constituents of eloquence, pronounced action to be the first, the second, and the third cardinal element, so the physician, whom long experience has made sage, on surveying the broad field of the materia medica, would name opium as the “quo magis nil simile aut secundum,” his first, his second, and his third reliance.
Opium has been denominated, and in no extravagance of hyperbole, the grand catholicon for human ills. Laudation here has scarcely been exhausted even in the excess. In the “Opiologia” of Wedelius, opium is the “medicamentum ccelitus demissum,” the heaven-born gift. Tillingius styles it the “ anchora salutis sacra,” – the bower anchor of health. Sydenham says that “medicine without it would go at a limping gait;” and John Hunter, in an exuberance of enthusiasm, exclaims: “Thank God for opium!” Van Swieten in his estimate does not fall behind: “Opium, le plus efficace de tous les medicaments et sans quoi tout de guerir cesserait d’exister, est le remede de quoi le Tout-Puissant a fait present pour le bonheur et la consolation de l’humanite souffrante.”
Opium is indeed the Columbiad of the medical arsenal. Of this most potent agent thus writes Dr. Lee: “In disease, suppose the dose restricted within warrantable bounds, neither headache nor nausea nor discomfort in any form ensues, but a peaceful sleep is brought on, to be succeeded by a feeling of refreshing. Not merely is nervous excitement quieted and physical depression guarded against, but more: when there has been degenerescence of tissue, as from phagedenic ulcerations, opium, while it assuages pain, arrests in notable ways the morbid waste that is going on and re-energizes the languishing functions. The powers of this life-renovator, working out as they do under sinister conditions, appear indeed almost marvellous, far surpassing in their magnitude any force that inheres in alcoholics or quinine, or in all the anaesthetics besides.”
In the hour also that presages cold death’s approach to disjoint the mortal fabric, opium viewed as a euthanasial resource alone is second only to the vital air we breathe.
As an instance of the adventitious support that opium often renders under disease, the case of the late Dr. O. of New York may be adverted to. An invalid half his life and from inherited causes, he was afflicted mainly with a form of neuralgia which seemed disposed to concentrate its force in the knee joints. Pains most acute, of the spasmodic sort, would suddenly invade the parts and without any premonition whatever, and pass off again perhaps as suddenly. The suffering at such times was excruciating, amounting indeed oftentimes to an agony. By-and-by there were evidences of what is denominated locomotor ataxia, which would show itself for instance on his getting into his wagon, when he would be a considerable time exercised in effecting the proper upright balance. There was but one resource that had been found of service to the mitigation of his pains, and that was morphine. This he took very regularly and for a good while, two grains three times for the day. His life, which indeed was by this help rendered tolerable only, was doubtless prolonged at least ten years beyond the limit by natural course. A prominent symptom, and one of great annoyance, was a habitual constipation, which had no other relief for the time than in the use of cathartic pills taken every three to four days.
Life in this instance may be said to have gradually worn down with the progress of the nervous exhaustion, and death surely was rather a boon to be longed for than an evil to be deprecated.
The magical virtues which popular belief has ascribed to the poppy have been embodied in story and commemorated in song. Thus the illustrious Carthaginian queen – “evicta dolore”, overcome with grief and chagrin in the prospect of being deserted and left forlorn by the wily adventurer, to whom, out of the fulness of her confiding heart, she had so generously proffered an asylum and a refuge after his toilsome wanderings, all-despairing now, while dissembling her ultimate purpose, devises this stratagem. As if hoping, when other hope had failed, by availing herself of some magic influence, still to detain the fickle Aineas within her realm and against the declared decrees of fate, she commissions her sister Anna to undertake a journey away to Ocean’s farthest margins, even unto Ethiopia’s bound, there to seek out a Massylian woman, priestess in Apollo’s temple (and the same who had preserved the golden apples in the gardens of the Hesperides, by soporizing the dragon that was lying in wait and watching his chance for them), and there to procure from the sorceress a phannakon that should dissolve her present enchantment, and deliver her desolate spirit from the thraldom in which the perjured Trojan now held her captive.
The piquant Moliere, ever liberal of his satire in squaring accounts with the doctors, while ridiculing the routine medicaments of his day, has indirectly, perhaps unwittingly, pronounced a laudation upon opium.
That opium imparts to the imagination a wonderful vivacity and to the tongue a most lively volubility, is a fact that in instances has had signal display. There was Jane, Duchess of Gordon, half a century back, the cynosure of the gay throng and the life-spirit of the conversazione, whose life had been of as little account to the outside world as her death was of concern to the magic circle within which she had lived and moved. She drew her peculiar powers of inspiration confessedly from this same energizing fountain.
A New York lady, of scarcely inferior but only of more circumscribed fame, and a rival who might have been by chance association, there was, a patient some twenty years ago of Dr. C. A. Lee. “My friend, Miss H. (thus writes Dr. L.), a lady of brilliant endowments by nature, to which, however, opium gave additional lustre, was accustomed to have her paregoric, a pint, daily. Regularly as the morning came her bottle went to the apothecary’s, and by night the contents were used up. Bright as a star in Andromeda’s girdle, she shone amid the throng from eight o’clock in the evening to midnight and past, often seeing the grey morning ere she retired for bed. Marvellous indeed were her parts and her power of display; but then it took her the entire day to rouse the fires and get up steam.”
A pertinent case belonging to the same family is contributed by Dr. Quackenbos. Mrs. B., who died about ten years since at the age of 65, contracted the habit of stimulating upon opium, using the same according to a doctor’s prescription for hemorrhage incident to the first parturition. A sherry wine glass three times a day was her measure, and in regard to quantity she was always very precise, not having deviated in any degree as was believed for the last fifteen years. Being a lady of fashion with abundant wealth, she divided her time between city and her country house, without occupation either physical or mental, such as was likely to give a favorable diversion to a growing morbid taste. Change for the worse in almost every respect grew upon her as the months advanced. The skin contracted a turbid yellowish hue and had a good deal the feel of parchment. What, however, is an exceptional condition, she had no regular constipation, nor did she in the progress of years get dropsical.
Her daily routine was this. Four o’clock in the morning was her hour for bed and from this on to ten, when she had her first glass or eye-opener. By this time the whole frame would be agitated with most intolerable tremors; but a cup of black coffee (the strongest), taken soon after, helped to steady the nerves very decidedly. The day was worried through as best it might be by one who was without the capacity to enjoy, and with whom the hours went laggingly along. The second glass was upturned at six in the evening, a little precedent to her breakfast, the first meal of the day. The third glass was taken at eleven, and now she was ready for the living room. In the daytime she looked like a woman; now she appeared as of the “fat, fair and forty” age (without the fat). The transformation she had undergone by this was marvellous even to her familiar acquaintances. Her skin (for she was of a sanguineous temperament) now shone again transparent as in youth, her eyes sparkled as with a gem glitter, and the brilliancy of her conversational talents concentrated upon herself the admiring attention of all beholders. Her dinner hour was now twelve, and at this time she had an enjoyable repast. Her death had no connection with the habit, having followed upon an attack of pneumonia.
The transient exaltation of the imaginative faculty under the inspiration of opium has an exemplification in the polished and highly poetic style of Dr. Thomas Brown’s treatise on the “Philosophy of the Human Mind.” In elaborating his chapters the author would sometimes trench upon the deep hours of the night, feeding the intellectual fire meanwhile whenever it flagged with bountiful potations of whiskey that had been “seasoned” from the laudanum vial.
Sir James Mackintosh, a pupil of the doctor’s at the time, hearing the office one morning somewhat abruptly and unexpectedly, happened to overhear a private order (which was intended for the daughter’s ear alone} delivered in the following terms; “ My dear, bring me the moderate stimulus of a hundred drops.”
Distinguished criminal-lawyers (and a conspicuous instance was Erskine of England) have been wont to prepare themselves for a special effort with the same sort of help.
In 1770 (Kerr) a famine pervaded India, and so severe and widespread did the suffering become, that only people of wealth had the means of providing for their wants, and making their condition at all tolerable, in the substitution of opium for other food, procuring it finally at a most extravagant cost.
Cotton Famine Food Riots
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