These facts tend on the whole rather to show, that the practice of eating opium is not so injurious, and an opium eater’s life not so uninsurable, as is commonly thought; and that an insured person, who did not make known this habit, could scarcely be considered guilty of concealment to the effect of voiding his insurance. But I am far from thinking,—as several represent who have quoted this work,—that what has now been stated can with justice be held to establish such important inferences; for there is an obvious reason, why in an inquiry of this kind those instances chiefly should come under notice where the constitution has escaped injury, cases fatal in early life being more apt to be lost sight of, or more likely to be concealed.
Meanwhile, insurance companies and insurance physicians ought to be aware, that not a few persons in the upper ranks of life are confirmed opium-eaters without even their intimate friends knowing it. And the reason is, that at the time the opium-eater is visible to his friends, namely, during the period of excitement, there is frequently nothing in his behaviour or appearance to attract particular attention. From the information I have received, it appears that the British opium-eater is by no means subject to the extraordinary excitement of mind and body described by travellers as the effect of opium-eating in Turkey and Persia; but that the common effect merely is to remove torpor and sluggishness, and make him in the eyes of his friends an active and conversible man. The prevailing notions of the nature of the excitement from eating opium are therefore very much exaggerated. Another singular circumstance I have ascertained is, that constipation is by no means a general effect of the continued use of opium. In some of the cases mentioned above no laxatives have been required; and in others a gentle laxative once a week is sufficient.
In the civil suit regarding Lord Mar’s insurances, the insurance company was at first found not entitled to refuse payment,—not, however, on the ground that the habit of opium-eating is harmless to longevity,—but chiefly on a technical ground, implying that they did not make inquiry into his habits with the care usually observed by insurance companies, and were therefore to be understood as accepting the life at a venture. A new trial was granted by the court on the ground of the judge’s charge having been not according to evidence; but on this occasion the parties compromised the case.[[1752]]
The previous remarks on the symptoms of poisoning with opium in man have been confined to its effects when swallowed. But it was mentioned under the head of its mode of action, that this poison has been known to act with energy upon animals through every channel by which it can be introduced into the system. It is natural to expect that the same will be the case with man also.
The only other modes in which poisoning with opium is reported to have been produced in man, besides administration by the mouth, have been by injections into the anus, by application to the skin deprived of its cuticle, perhaps even also to the unbroken skin, and by its introduction into the external opening of the ear.
In the Journal de Chimie Médicale, an instance is shortly noticed of a lady who was poisoned by the administration of too strong an anodyne injection prepared by herself from fresh poppy-heads. She recovered.[[1753]]
It is generally believed in France that opium acts more energetically through the medium of the rectum, than through the stomach. Orfila in particular has endeavoured to establish this proposition by experiments on animals, and quotations from cases recorded by some authors of its action upon man.[[1754]] But neither the experiments nor the quotations appear to me satisfactory; and the rule they go to support is completely at variance with the practice pursued in the medicinal administration of the drug in Britain. It is the custom to give at least twice as much in an enema as in a draught. I have given by injection, without producing more than the usual somnolency, one drachm and even two drachms by measure of laudanum, a dose which, were Orfila’s statement correct, would prove fatal.
As to the action of opium through the skin when deprived of its cuticle, I am not acquainted with any fatal case of the kind, but have no doubt that such may happen. One of my friends very nearly lost his life in the way alluded to. He had applied an opium-poultice to the scrotum to allay the violent irritation caused by a blister, and fell into a state of profound sopor, which was luckily interrupted by a visitor, so that the cause was discovered before it was too late. An instance of the same kind has also been published by M. Pelletan. A child two months old very nearly perished, in consequence of a cerate containing fifteen drops of laudanum having been kept for twenty-four hours on a slight excoriation produced by a fold of the skin. When the cause of illness was discovered, the child had been for some hours almost completely insensible, with a slow, obscure pulse, and occasional convulsions.[[1755]]
But perhaps opium may in some circumstances act even through the unbroken skin. It has certainly been often applied in this way to relieve local pain without avail. Yet on the other hand its effect is at times unequivocal; and the following incidents seem to show, that it may even prove fatal, both when the skin is healthy, and in certain diseased states of the integuments. A young dramatic writer in Paris was directed by his father, a physician, to apply over the stomach a poultice moistened with a few drops of laudanum. The patient, in order to relieve his pain more quickly, poured the whole contents of the bottle over the poultice, and soon fell into a deep sleep. Prompt assistance was obtained, but proved of no avail, and death is said to have ensued with great rapidity.[[1756]] A soldier affected with erysipelas of the leg, had a linseed poultice applied, which his surgeon ordered to be sprinkled with 15 drops of laudanum. Next morning the patient was found in a state of deep sopor, accompanied with convulsive twitches of the muscles of the face and limbs; and in no long time he expired. His soporose state turned the surgeon’s attention to the poultice, which he found coloured yellow and smelling strongly of opium; and on removing it he discovered that it was completely soaked with laudanum, which the attendant had carelessly poured on it to the extent of an ounce. The patient died notwithstanding all the remedies which his state called for; and the viscera were found quite healthy; but in many places the blood is said to have had a strong odour of opium.[[1757]]
In an instance reported by M. Tournon of Bordeaux, death is supposed to have arisen from the introduction of opium into the external opening of the ear, as a remedy for ear-ache. It is possible that fatal poisoning may thus be induced by laudanum too freely and frequently renewed: but it seems very unlikely that death was owing to opium in the instance in question, since it was used in the solid form, and in the quantity of four grains; so that the dose was small, and absorption must have been very slow. The account merely states that the patient fell asleep, but his sleep was that of death.[[1758]]