A very important circumstance to attend to in respect to the dose of opium required to prove fatal is the influence of constitutional circumstances in rendering this drug unusually energetic. In some persons this peculiar anomaly exists always, even during a state of health. Thus, I am acquainted with a gentleman on whom seven drops of laudanum act with great certainty as a hypnotic. In such a one doses, which are safely taken by many, might prove dangerous.
It is more usual, however, to meet with this anomaly in the course of some diseases. These have not yet been satisfactorily indicated. I have several times, however, met with unusually energetic action from medicinal doses in elderly persons affected with severe habitual catarrh; and in one instance death occurred after a dose of twenty-five drops in the advanced stage of acute catarrh supervening on its chronic form, the symptoms being those of poisoning with opium, succeeding apparently a state of comfortable sleep.—A case seemingly of the same nature, where the dose was fifteen drops of Battley’s Sedative Liquor, occurred at Islington in 1841. An elderly lady, in delicate health, and affected severely with asthma, which for ten days prevented her from sleeping, got from a neighbouring druggist a draught of Battley’s solution, syrup, and camphor-mixture. Next morning she was found insensible and livid in the face, with cold extremities and contracted pupils; and she died about twelve hours after taking the draught. There was no sign of natural disease in the dead body to account for death. The druggist was absurdly blamed for giving such a dose to a frail old lady; for the dose was not more than would be generally given in such circumstances. This case was communicated to me by the druggist in question.—Another of the like kind has been communicated to me by Mr. Garstang of Clitheroe. An elderly female, long subject to severe cough, having enjoyed a comfortable night’s rest after a dose of a preparation containing half a grain of opium, took in the morning the equivalent of two grains and a half, or three grains at the utmost, and fell asleep soon after. In no long time, her husband, alarmed because he could not rouse her, sent for Mr. Garstang, who found her husband labouring under all the symptoms of poisoning with opium; and, notwithstanding active treatment, she died six hours after the second dose. Her husband took half a grain with her the evening before, but experienced no effect from it at all. Not the slightest ground could exist in this case for suspecting either foul play or pharmaceutic error.—As a farther illustration, the following incident deserves notice, which occurred last year in London, and was communicated to me by Dr. G. Johnson, a former pupil. A little girl, five years and a half old, affected with violent cough, got a mixture containing opium, which was repeated six, thirteen, and twenty-six hours afterwards. She slept soundly after each dose, and awoke readily after the first three; but after the fourth she had more stupor and much uneasiness; in which state, but with at least one interval of sensibility, she died in nine hours more, or thirty-five hours after the first dose. According to the prescriber’s intention, the child ought to have taken only two minims of laudanum in all; but, according to a rough analysis by Mr. Alfred Taylor, each dose contained an eighth of a grain of opium, or a trifle more. In either view it is impossible that doses so small, and so distant, could produce these effects in ordinary circumstances.
Such cases are important in several respects, but especially because they naturally give rise to suspicions of an over-dose of opium having been incautiously given, and thus to misrepresentations injurious to the druggist or medical attendant. In the last case a Coroner’s Jury brought in the preposterous verdict, that death was caused by “too much opium ordered without due instructions.”
It is scarcely necessary to add, that the dose required to prove fatal is very much altered by habit. Those who have been accustomed to eat opium are obliged gradually to increase the dose, otherwise its usual effects are not produced. Some extraordinary, but I believe correct information on this subject, is contained in the confessions of an English opium-eater. The author took at one time 8000 drops daily, or about nine ounces of laudanum.
An important topic relative to the effects of opium on man is its operation on the body when used continuously in the manner practised by opium-eaters. This subject was brought forcibly under my notice in 1831, in consequence of a remarkable civil trial, in which I was concerned as a medical witness,—that of Sir W. Forbes and company against the Edinburgh Life Assurance Company. The late Earl of Mar effected insurances on his life to a large amount while addicted to the vice of opium-eating; which was not made known at the time to the insurance company. He died two years afterwards of jaundice and dropsy. The company refused payment, on the ground that his lordship had concealed from them a habit which tends to shorten life; and Sir W. Forbes and company, who held the policy of insurance as security for money lent to the earl, raised an action to recover payment.
In consequence of inquiries made on this occasion, I became for the first time aware of the frequency of the vice of opium-eating among both the lower orders and the upper ranks of society; and at the same time satisfied myself, that the habit is often easily concealed from the most intimate friends,—that physicians even in extensive practice seldom become acquainted with such cases,—that the effects of the habit on the constitution are not always what either professional persons or the unprofessional would expect,—and generally that practitioners and toxicologists possess little or no precise information on the matter. In what is about to be offered on the subject, some facts will be stated which appear to me interesting, and may induce others to contribute their knowledge towards filling up so important a blank in medico-legal toxicology.
The general impression is, that the practice of opium-eating injures the health and shortens life. But the scientific physician in modern times has seen so many proofs of the inaccuracy of popular impressions relative to the operation of various agents on health and longevity,[[1747]] that he will not allow himself to be hastily carried along in the present instance by vague popular belief. The general conviction of the tendency of opium-eating to shorten life has obviously been derived in part from the injurious effects which opium used medicinally has on the nervous system and functions of the alimentary canal,—and partly on the reports of travellers in Turkey and Persia, who have enjoyed opportunities of watching the life and habits of opium-eaters on a great scale. The statements of travellers, however, are so vague that they cannot be turned to use with any confidence in a scientific inquiry. Chardin, one of the earliest (1671) and best of modern travellers in Turkey, merely says the opium-eater becomes rheumatic at fifty, and “never reaches an extreme old age;”[[1748]] and his successors have seldom been more precise,—no one having given information as to the diseases which it tends to engender. By far the greater number of authorities, however, agree in representing the practice to be hurtful. Mr. Madden, a recent and professional authority, even alleges that it is very rare for an opium-eater at Constantinople to outlive his thirtieth year, if he began the practice early. On the other hand, a few late observers deny altogether the accuracy of these statements. To this number belongs Dr. Burnes of the Bombay army; whose opinion is worthy of notice, because he had ample opportunities of observation during his residence in Cutch and at the Court of Sinde for several years prior to 1831. From what he there witnessed, Dr. Burnes is inclined to think “it will be found in general that the natives do not suffer much from the use of opium,”—that “this powerful narcotic does not seem to destroy the powers of the body, nor to enervate the mind to the degree that might be imagined.”[[1749]] Dr. Macpherson of the Madras army, who had occasion to observe the effects of the parallel practice of opium-smoking in China, coincides in opinion with Dr. Burnes. He says, “were we to be led away by the popular opinion that the habitual use of opium injures the health and shortens life, we should expect to find the Chinese a shrivelled, emaciated, idiotic race. On the contrary, although the habit of smoking opium is universal among rich and poor, we find them to be a powerful, muscular, and athletic people, and the lower orders more intelligent and far superior in mental acquirements to those of corresponding rank in our own country.”[[1750]]
The familiar effects of the medicinal use of opium in disordering the nervous system and the digestive functions constitute a better reason, than the loose statements of eastern travellers, for the popular impression of the danger of its habitual and long-continued use. Yet this consideration ought not to be allowed too much weight; because the functions of the nervous system and of digestion may be deranged by other causes, for example by hysteria, without necessarily and materially shortening life. It is desirable therefore to appeal if possible to precise facts.
The following is a summary of twenty-five cases, the particulars of which I have obtained from various quarters. The general result rather tends to throw doubt over the popular opinion.—1. A lady about thirty, in good health, has taken it largely for twenty years, having been gradually habituated to it from childhood by the villany of her maid, who gave it frequently to keep her quiet. 2. A female who died of consumption at the age of forty-two, had taken about a drachm of solid opium for ten years, but had given up the practice for three years before her death, and led in other respects a licentious life from an early age. 3. A well-known literary author, about sixty years of age, has taken laudanum for thirty-five years, with occasional short intermissions, and sometimes an enormous quantity, but enjoys tolerable bodily health. 4. A lady, after being in the practice of drinking laudanum for at least twenty years, died at the age of fifty,—of what disease I have been unable to learn. 5. A lady about fifty-five, who enjoys good health, has taken opium many years, and at present uses three ounces of laudanum daily. 6. A lady about sixty gave it up after using it constantly for twenty years, during which she enjoyed good health; and subsequently she resumed it. 7. Lord Mar after using laudanum for thirty years, at times to the amount of two or three ounces daily, died at the age of fifty-seven of jaundice and dropsy; but he was a martyr to rheumatism, and besides lived rather freely. 8. A woman, who had been in the practice of taking about two ounces of laudanum daily for very many years, died at the age of sixty or upwards. 9. An eminent literary character, who died about the age of sixty-three, was in the practice of drinking laudanum to excess from the age of fifteen; and his daily allowance was sometimes a quart of a mixture consisting of three parts of laudanum and one of alcohol. 10. A lady, who died lately at the age of seventy-six, took laudanum in the quantity of half an ounce daily for nearly forty years. 11. An old woman died not long ago at Leith at the age of eighty, who had taken about half an ounce of laudanum daily for nearly forty years, and enjoyed tolerable health all the time. 12. Visrajee, a celebrated Cutchee chief, mentioned by Dr. Burnes, had taken opium largely all his life, and was alive when Dr. Burnes drew up his Narrative, at the age of eighty, “paralyzed by years, but his mind unimpaired.”[[1751]]
For the particulars of the remaining cases I am indebted to Dr. Tait, surgeon of police in this city. 13. M. C., a ruddy, healthy-looking woman, sixty years of age, has taken laudanum for twenty-five years to the extent of half an ounce daily in a single dose. 14. M. H., a flabby, dissipated-looking woman of thirty-six, has taken for ten years thirty grains of opium daily in three doses. 15. M. T., a widow, forty-eight years of age, who takes twice daily a dose of one fluidrachm of laudanum, and has done so for fourteen years, cannot observe any permanent injury except diminution of appetite. 16. Mrs. G., aged twenty-four, has taken a single dose of sixty drops regularly at bed-time for five years, and has not suffered in health in any respect, except that she is costive. 17. F. S., a thin, sallow woman of forty-six years of age, has taken a fluidrachm of laudanum three times a day for ten years, cannot take food without it, but is so well as to be able to get up regularly at six in the morning. 18. H. S., a shrivelled old-looking woman, who for thirty-eight years had taken daily towards a drachm of opium in one dose, and who latterly was strong, lively, and of good appetite, died recently at the age of sixty-nine. 19. Mrs. S., who has taken about a scruple of opium for twenty-one years, is a tall, active, old-looking woman of fifty-seven, enjoys good health when she uses the opium, but suffers from an affection like delirium tremens, when she cannot get her usual quantity. 20. M. A., aged thirty-one, has taken half a drachm of opium daily in two doses for ten years, was a thin, drunken, starved-looking prostitute some years ago, but, having reformed her ways, is now “a fine-looking, bouncing woman,” younger in appearance than formerly, and not liable to any suffering either before or after her doses, except that she cannot take food without them. 21. Miss M., who has taken ten grains of opium three times a day for five years, is a healthy, florid young woman of twenty-seven, liable to costiveness, and, when without her opium, to languor and want of appetite, but otherwise free of complaint. 22. Mrs. ——, a plump, hale-looking old lady of seventy, has taken opium for six and twenty years, and for some years to the extent of a drachm daily in two doses. She thinks her health improved by it, and has suffered no inconvenience except merely costiveness, and always aversion to food till she gets her dose. 23. J. B., aged 23, has taken laudanum since she was fourteen, and some time past to the amount of an ounce or ten drachms in three or four doses daily. She has only menstruated twice since first using the laudanum, has bilious vomiting once a month, and looks older than her years, but is otherwise quite healthy, and has two children. 24. Mrs. M’C., a ruddy young-looking woman of forty-two, has taken opium during two years for cough and pain in the stomach, latterly to the extent of ten grains twice a day. She has never menstruated since, but has enjoyed better health, and in particular has a good appetite after her dose, and has got entirely quit of a former tendency to constipation. 25. An army officer’s widow, fifty-five years old, healthy and young-looking, although subject to costiveness and rather defective appetite, has taken laudanum for eleven years, and latterly opium to the extent of fifteen grains morning and evening.