An Essay on the Effects of Opium. Considered as a Poison

TO THE

President and Fellows

OF THE

Royal College of Physicians

Gentlemen,

I Was induced to write this Essay, from a Desire of throwing a Light upon a Subject, hitherto but triflingly, and, at best, obscurely treated. As I had no beaten Path to direct me, many perhaps are the Errors that may be traced through every Page.

I do not boast an Ability to enforce my Sentiments with that energic and expressive Beauty of Style some are so happy to possess. I am no Author, and can therefore only rely on your Candour, in Behalf of a simple Recital of such Facts as I have experienced.

When I consider the Novelty of the Subject, and the Rareness of Patients poisoned with Opium, I am inclined to flatter myself, you will not discourage, but be rather inclined to cherish under your Wings, every Effort (however weak) that tends to elucidate so extensive a Branch of Science, as Physic. I beg the Honour of subscribing myself,

Gentlemen,

Your most obedient,

Humble Servant,

St. Margaret's Church-Yard, Westminster, January 5, 1762.

PREFATORY DISCOURSE

Among People who are unacquainted with the Nature of Opium, it is a received Opinion, – That as it will, when taken in proper Doses, lull Pain, and procure Rest; so, in large Quantities, that it will terminate a Life of Cares, by an easy and quiet Death; but it is not so: this argument is directly contrary to the Nature of our Existence, the animal Oeconomy being so formed, as not to bear a total Solution, without some Agonies. Thus, when this Drug is received into the Stomach, in Quality of a Poison, easy Rest is denied, the Senses, roused by their threatened Solution, force the animal Powers into immediate Conflict with the noxious Body, which produces Convulsions, and other dreadful Symptoms, the Forerunners of Death. – The Drug is besides of so strong a Nature, that, though taken only into the Stomach, it can change the Colour of the Skin, and even of the Linen wore next it; a Body also, many Hours after Death, will smell so strongly of it, as to determine whether it was the Instrument of Destruction used.

I might have encreased the Bulk of this Essay, by expatiating on the Effects of Opium upon the arterial Fluid; I could inform you, that the Power of it is diffused by the Stimulus of the recurrent Nerves, to their Origin in the Cerebellum, whence, by Consent of Parts, the whole System partakes of the Affect, and the contaminated Fluid is propelled by them, through the Heart into the Arteries, and communicated to the most distant Parts of the Body; also that the Skin is formed by very minute Fibres of the Nerves, interwoven with arterial Fibres and Veins, forming numerous Compages of secerning Vessels, &c. &c. but these are Subjects best suiting the medicinal Powers of Opium, which being derogatory from my Design, are purposely avoided, and, but that these Pages are for the Perusal of more than the Circle of Physical Gentlemen, the Cases alone would have been inserted, without even giving the natural History of the Drug; for this same Reason, the Prescriptions are set down in English, and the whole Essay disrobed of technical Expressions, as far as the Subject will allow.

It will be thought, perhaps, that I have made too free with Dr. Jones, who is the only English Author that has wrote professedly on this Subject; but many of his Sentiments being directly opposite to mine, I was under a Necessity of bringing them into an immediate Point of View. It is therefore hoped, no Person will be so unfriendly, as to impute to me a Malevolence of Disposition, which is a Character I would always diligently avoid.

THE

EFFECTS

OF

OPIUM,

Opium is a Drug brought to us from the Eastern Countries (the Use of it was first known to the Greeks who gave it the Name of Ὀπὸς, Succus, which was collected from the Papaver Hortense, Semine Albo of Caspar Bauhine) where the Plant, from which it is produced, grows in great Plenty, both wild and cultivated, and is the same with that of the white Poppy in England, the Heads of which are very large, and possess a sleeping Power, many Degrees beyond any other Part of it; the Seeds contained in these Heads are very numerous, and partake of this Quality in so small a Proportion, as to be scarce discernible, and rather help, from the soft Oil they contain, to correct the bad Effects of the acrid Juice of the Mother-Plant; they are therefore separated from the Heads, and used in Emulsions, being esteemed both cooling and emollient.

Distinctions were formerly made of the Goodness of this Drug, according to the Places where it was gathered; that of Thebes being the most famous; but, as it is now, and has been for some Time past, an Article of general Traffic, not only in the Places where it grows, but throughout all Europe, those Distinctions of Country, are necessarily laid aside, and the only Difference now consists in its Purity, or Adulteration by the original Manufacturers or Venders.

It is a natural Supposition, and indeed the Turkish Histories sufficiently demonstrate, that the original Use of Opium, or Extract from the Poppy, was first introduced to dissipate Anxieties, Pains, and Perturbations of the Mind, which appears not unlike the Use of intoxicating Drinks, so much requested in Europe. Labours of Mind and Body in every Person's Life, being somewhat considerable, a temporary Relief becomes indispensably necessary; and though Opium is not in common Use in England, such similar Advantages we instance of Tobacco, with which alone the Soldier can perform his March, and the Sailor his Service, through the rudest Storm, in a Night-watch upon Deck.

In Europe, we are not only fond of intoxicating Liquors, but add to their sleeping Qualities by the Use of Tobacco; Smoaking and Snuff-taking are fashionable, and Chewing not uncommon; all which Methods have, until familiarized to the Party, very disagreeable Effects, the Plant containing a corrosive Oil or Sulphur, with a volatile Salt, which makes it partake the Quality of Opium, though in a distant Degree; the Chinese, indeed, exceed us, they having a Narcotic Weed, which they smoak, a Species of the Poppy.

To treat upon the Effects of Opium, and the various Shapes wherein it may be advantageously used for many Diseases, would frustrate my present Design; therefore I shall confine myself to that Property, which makes it considered as a Poison; and by the Analysis of the various Powers it contains, destroy, or in a great Measure prevent, the fatal Consequences which often attend the immoderate and imprudent Use of this Drug.

The great Doctor Mead, in his Tract upon Poisons, gives an Example of such a Power being in Opium, by pouring it, dissolved in warm Water, into a Dog. Had that able Genius, adequate to the Task, pursued his Experiments with that Spirit wherewith he abounded, it would have yet added to the Obligation the World owes him; but over the Means necessary to be used to counteract this Poison, and the Effects of it upon human Bodies, he has drawn a Veil, and informs us, that the Cure is to be compleated by acid Medicines, and lixivial Salts: Far be it from me to comment upon the Principles of this Doctrine; he was too just not to be sensible of what he wrote; perhaps he thought the Subject of too delicate a Nature to be made common, and as many People might then indiscriminately use it, it would take from that necessary Fear and Caution, which should prevent their experiencing the extensive Power of this Drug; for there are many Properties in it, if universally known, that would habituate the Use, and make it more in Request with us than the Turks themselves, the Result of which Knowledge must prove a general Misfortune.

From the Ease it affords to the Pains of Mind and Body, Opium obtained the Name of Laudanum, derived from the Latin Laudabilis, or Laudatum; yet, though it has this Property of easing Anxieties and Torments of the most excruciating Diseases, the constant Use of it should be rejected, as it will impair the Memory, destroy the Appetite, bring on a Stupor, and by Relaxation, weaken the whole Frame. That it impairs the Nerves, is manifest, for applied to the Ear, to ease Pain, it may cause Deafness; to the Nostrils, to stop an Hæmorrhage, Loss of Smelling; and however applied, whether internally or externally, (unless very sparingly) it will benumb the Part most immediately in Contact with it. When we consider the nervous Coats of the Stomach, and the Action of Opium upon them by constant Use, the Effects may easily be judged; and if a Person so habituated, is prudent enough to throw aside the Use of it, before he is betrayed into some fatal Disease, the Appetite is to be restored by nervous Stimulants, Bracers, and Cold-bathing. Doctor Jones advises gradual Decrease of the Opiate, and to use, instead of it, generous Wine in Moderation.

The Production of Opium is from the Fruits or Seed-vessels of the Poppy-Plants, commonly called the Heads; they are gathered while green, which (the Seeds being taken out) are bruised and pressed. The Juice thus collected from them is dried to a Substance, which being wrapped in Leaves, is formed into Balls or Lumps, generally under a Pound Weight, and in that Form transported to all the Markets of Europe.

Though it is a received Opinion, that Opium, with us, and other Countries where not manufactured, has not near the Strength of that used by the People where it grows; yet in Turkey they can venture to take it in larger Quantities; and hence it is manifest, that the Effects would be more pernicious amongst them, if they did not use it in a most pure State; and though Habit might conduce to the Constitution bearing it in much larger Doses, than we in England dare give it, yet certainly the constant Use of it, unless when of a most fine Texture of Parts, must sooner prove hurtful, than the immoderate and constant Drinking of Wines, and Spirits; and by this Means, the Lives of the major Part of the Eastern Countries, where it is so much requested, would drop in the Flower of their Youth, and whole Nations, in the Space of a Century, be depopulated.

The ancient Accounts of the Manner of gathering Opium, was, according to Diascorides, by the milky Juice being collected from Time to Time, that distilled from the wounded Head of the Poppy; thus gathered, it is entirely pure, and being taken, gives no disagreeable Sensation to the Stomach. This Extract being almost wholly volatile, immediately enters into Action, and discharges itself by Perspiration, opening the Pores, and refreshing the Spirits, without any attendant Injury; and daily Experience will convince every one who will put it to the Tryal, that the purer the Opium, in the greater Quantity it may be taken, unattended with the Nausea, Vertigo, and Tremor, which are so often the Consequences of it with us, though used in small Doses. Tournefort, Page 292, Materiæ Medicæ, informs us, that Opium, or Laudanum, does not only pass off freely by Perspiration, but cures those Distempers arising from Obstructions of the Organs of Respiration in hot Countries, without any Inconvenience whatever, which cannot be said of it, in such Cases, in England, though assisted with volatile and cordial Medicines. This seems a palpable Contradiction to the Opinion of Doctor Jones, who says, that Opium may be taken in much larger Doses, in Cold, than in hot Climates.

It is a natural Supposition, that when a Country produces a Commodity, in a Manner peculiar to herself, the Manufacturers will embrace the most ready Means of collecting it. The first Consideration generally is, how to make the greatest Emolument with the least Labour; if the Opium, which is brought into Europe, were to be taken from the Head of each Poppy, by Incision, as is supposed by some Authors, the Produce would not be sufficient to supply the Markets; for as the daily Collection of Opium, from one Head, could not exceed one Grain in Weight, and many might fail even of that the Labour, Time, and Hands requisite to gather one Pound only, must necessarily make that Article, five, if not ten Times the Price it now bears. Though it is not improbable, that Opium, being a pure body, and wholly volatile, may be gathered by Incision, Yet it is not natural to suppose, that the Quantity of Opium, so nicely produced can answer, in any moderate Proportion, what may be made by gathering the Heads, while green, grinding them, and expressing the Juice, which may be easily inspissated. Vide Plin. Secund. Lib. 20. Cap. 18.

Some Authors apprehend, that common Opium is not made alone from the Head, but from the impressed Juice of the whole Plant; and indurated by the Sun's Heat, See Mathiolus, Scaliger, &c. But, if the Authority of Pliny is not thought sufficient, Geoffroy further refutes this Opinion; clearly proving, by extracting the Juice of the Leaves and Stem of the Poppy-Plant, that on the most strict Analysis, it is many Degrees inferior in Strength to the Properties of common Opium. This is also confirmed by the Examination of the Fæces, or impure Parts, remaining from the Solution of our Opium, they having no Similitude to the woody Fibres belonging to the Plant, which might pass with the Juice, by the Force of the Press, but to the light spongy Particles from the Apex or Head, with some little Grit.

We have several Instances of the fæculent Parts of inspissated Vegetable Juices increasing the Violence of their Operation; such are the Aloes of the Shops, Scammony, and grosser Juice of the wild Cucumber, called Elaterium. The Fæculæ of Opium, in the State wherein we receive it, will clog the more fine Parts, and prevent their ready Passage through the Pores of the Skin; and as the Time of its Duration in the Body, by such Means, is greatly increased, the Effects must necessarily remain longer, and the deleterious Quality have more Power over the human System. Wedelius says, id certissimum habemus nunquam ab Opio ulla timenda esse incommoda si bene sit depuratum. Lib. 1. Sect. 2. Cap. 3.

There are several Plants which have a sleeping Property, though not in so great a Degree as the inspissated Juice of the Poppy, yet more poisonous, because they are not endued with that volatile Power to carry themselves off. Thus we find the Juice of Hemlock, Mandrake, Nightshade, and several others of this Class, loaded with an acrid Salt, which, when inwardly taken, will corrode, vellicate, and cause an immediate Inflammation in the Primæ Viæ, to which the Nerves consent by a general Convulsion; and if any of these venene Powers remain long enough in the Body, to insinuate themselves into the Circulation, the debilitated Blood will become stagnant in, or lacerate, the capillary Vessels. Examples of these have been seen in Indians, who have taken Poison, which, though not of immediate Power to destroy Life, has manifested itself in Ulcers over the whole Body; and what is related of the Poison of the Seps Hæmorrhous, or Hæmorrhoid Serpent, is very extraordinary, that it will make the Blood flow out from several Parts of the Body; which can only be accounted for by an extream Fluidity of the Blood, and a consequent Velocity in Circulation, increased to such a Degree, as to lacerate the capillary Vessels, and thereby force them to part with their Contents.

From the various and violent Effects I have observed to arise from the Use of different Parcels of Opium, I am inclined to think, that the Juice of some Narcotic Plant is frequently added to that of the Poppy, in order to increase the Quantity of the Drug; and Bellonius observes, that Traders in Opium have so far adulterated it, that four Ounces of the pure Drug have sometimes been multiplied to a Pound. I myself have observed, in the Use of two different Opiums upon one Subject, that the one had a mild and proper Effect, and the other, through its Churlishness of Operation in the first Passages and Symptoms, on the following Day, had the Appearance of Poison, though in an inferior Degree. Such may always be suspected of Adulteration with the acrid Juice of some other Plant, and when a Purging ensues the taking of Opium, it most probably arises from a Mixture with the milky Juice of Spurge; there being nothing in the Principles or Effects of the pure Drug, to excite Purgation. This I apprehend to be the Reason why solid Opium sometimes purges, and the Tincture very seldom, the Menstruum used, dissolving only the finer Powers.

To judge of pure Opium in the Lump, is a great Nicety, and what the Buyer ought to be very careful of, that it may answer his Intention of easing, and not injuring his Patient, if he designs using it inwardly; for this Intent, some Authors have given Instructions; but how few are they, who are assiduous to know the different Degrees of Strength each different Lump may contain! It is thought enough, if it has the Appearance of Opium, and the stronger it is in Smell and Taste (provided it is not drossy) they think it will go furthest, and consequently is best.

This Drug is to be chosen by Colour, Smell and Taste; the best Sort is of a Reddish-Brown; that which is deepened to Blackness, being fit only for external Use, as we may expect it to be mixed with some other narcotic Extract. To the Smell it should be pungent, almost to Volatility, without Fœtidness. When it proves very powerfully acrimonious to the Tongue (which the Opium we use, too often does) the inward Use of it should be rejected. The Right Sort is very bitter, and as such will be pungent to the Tongue, but will not leave a Soreness behind, in the Manner of corrosive Bodies; it should not be chosen heavy, lest it should be mixt with Sand, to increase the Weight; nor very dry, as some of its finer Powers might be then lost; and when cut in thin Slices, it may, by holding it to the Light, be easily discovered, if drossy.

Burning it, in order to try the Purity, is recommended by some Authors; the best, emitting a clear Flame; to which let me add, that being a resinous Body, it may, if pure, be moulded by Heat into any Form, and answers the Characteristic observed of it by Pliny, Lib. 20. Cap. 18. Sed maxime mirum, Æstivo sole deprehendi. Syncerum enim sudat, & se diluit, donec succo recenti simile fiat.

All authors agree, that Opium is very volatile, which Volatility must be the Cause of its immediate action on the Stomach; this is likewise manifest, by the following simple Experiment:

"Take a Portion of Opium, either sliced or grated, place it before the Fire, near enough to dry without scorching; after remaining some time, you will find the Strength of it considerably abated."

This Process was directed by the Ancients, to deprive it of its supposed poisonous Quality, but that is left behind in the grosser Body. The effects of it, thus managed, would not be so sudden, though used in large Doses, yet would prove, for Reasons given in a former Page, more severe and permanent; by this Means, the fixt Salts and Fæculæ remain, and the volatile Spirit, which occasions the soft refreshing Sleep, is in a great Measure, evaporated.

Unless Opium were a resinous Body, it could not retain its volatile Power, to bear transporting in the Form it does, much less endure to be kept in the Shops with little Loss. The burning of it proves the Truth of this Assertion, and if it were a mucous Gum, or viscous juice, it would not flow by Heat, nor import its Strength to a spirituous, but to an aqueous Menstruum, after the Manner of Gum Arabic. It may be asked here, in Opposition to this, how the Extract from Opium is made, in which Process the Opium, according to the College, is ordered to be dissolved in Water? In Answer to it, I presume, the Water is only an Agent, that prevents the Adustion of the Parts so exposed to intense Heat, which Menstruum, being partly imbibed by the Impurities of the Drug, causes a sufficient Separation, for the resinous Parts to become soft enough to be pressed through a Bolter; by such Management, the fæcæs are entirely separated from the purer Parts, and the Water, though used most cautiously, and in as sparing a Quantity as possible, by the necessary Evaporation, in order to reduce the pure Body to the former Substance, loses more than it gains; and after all, in my Opinion, is not so much to be depended upon, or has so mild an Effect as good Opium; notwithstanding Doctor Jones's Opinion to the to the contrary, and his partial Fondness, in giving the Name Panacea to his Solution in Water.

The College of Physicians have ordered only two Preparations that retain the Name of Opium, wisely considering, that those of the Ancients were so numerous, and so variously combined with other Substances, under the Title of Correctors, that the Bulk in administering them was greatly encreased, and an Inconvenience arose oftentimes to the Patient, who not being able to take the Quantity of the Opiate required, thereby rendered the Effect frequently precarious.

One Preparation, directed by them, is by Solution, as mentioned above, merely to purify it from heterogeneous Particles, and thence called Extractum Thebaicum, or Extract of Opium; the other a Tincture or Re-Solution of that Extract, to be preserved in a fluid State with Wine, in the Proportion of two Ounces to one Pound, with an Addition of Aromatics. This last Preparation, which is in more general Use than the Extract, is commonly known by the Name of Laudanum; though that Epithet was formerly used by Authors for various Preparations of the Drug, with the Appendage of Opiatum, Tartarizatum, &c. to characterise their Differences.

I shall not enlarge upon Opium in a physical Sense, further than is necessary to shew the poisonous Effects of it in over-large Doses, and as such, I confine myself to the Sort within every one's Knowledge, and to be commonly met with in the Shops.

The poisonous Effects of Opium, whether in a solid or fluid State, may be considered in the same Light, as Ebriety from spirituous Liquors; a very small Quantity will overcome a weak Constitution, while a strong one will require much more; nevertheless, a weak Constitution, used to Opium, will bear as much, uninjured, as the strongest, if unaccustomed to the Use of it. In a general Sense, however, even in the most robust, a Dose, exceeding three Grains, may be truly pronounced to be of dangerous and poisonous Consequence; and in some Cases, half that Quantity will prove sufficient. It operates sooner in a liquid, than in a solid Form; in the former, admitting the Doses are too large, in half an Hour, and often in fifteen, or ten Minutes, unless Exercise intervenes; In the latter, in two Hours, sometimes in one, sometimes in half an Hour; the Injury produced by the Liquid, being more sudden and transient, that of the Solid, more slow and lasting.

The Liquid, by a speedy Expansion, is frequently, and almost instantly, rejected by the Stomach, the other not; by which it is easily discoverable, that though the Effects of Opium, in a liquid State, are more immediate, they are sooner counteracted, and more easily overcome; for which Reason, every Vender of Medicines ought to be extreamly cautious to whom he sells this Drug, that it may not be converted to a wrong Use. However it is seldom known that a Person attempts to poison himself with solid Opium, though frequently with the Tincture.

The general Effects of Opium, are as follow, viz. Upon almost immediate taking, the first Symptoms are a Heat and Weight at the Stomach, succeeded by an Extravagance of Spirits, even to violent Laughter, Listlesness of the Limbs, Giddiness, Head-ache, Loss of Memory, dead Look of the Eyes, imperfect Speech, Drowsiness, slow and full Pulse, short and quick Breathing, Nauseas, and an extream florid Complexion. These Symptoms are the common Consequences of Drunkenness, as well as Opium, though not all at the same Time in one and the same Object, the Symptoms varying according to the Strength of the Constitution. The more violent and extream Effects are Itchings of the Skin, Madness, Vertigoes, Vomitings, Hickups, heavy and dead Sleeps, unequal Pulse, Contraction of the Jaw, Convulsions, profuse Sweats, universal Relaxation, Faintings, Coldness of the extreme Parts; and lastly, a cold Breath, a certain Indication of Death.