by Lucy Inglis
Meanwhile, the court enjoyed regular Thursday-night drinking parties in their lavish gardens, where everyone was to have exactly what they wanted in terms of alcohol and drugs. Taking the lead from the Persian court, where wine had been traditional for centuries, the Mughals wished to appear similarly sophisticated, but they also used strong spirits, and descriptions indicate they took their opium dissolved in cups of wine or liquor. One hopes these were not the ‘spirit of mutton, spirit of deer, spirit of goat’ distilled in Surat, as reported by one EIC agent, created by adding a portion of whichever animal ‘spirit’ was desired to the still.8 When, in 1621, Jahangir’s ‘old and trusted servant’, the keeper of the royal intoxicants, died, Jahangir appointed two in his stead, one for wine, the other for opium.9 He was a man of tremendous appetites: at about the same time, he recorded that between his eleventh and his fiftieth birthday, he had hunted almost every day, and that he had seen 28,532 animals ‘killed in my presence’, of which over 17,000 were by his own hand, including birds, mountain goats, sheep and deer, but also eighty-six lions and ten crocodiles.10
Jahangir was also responsible for granting the opium trading rights to the EIC in 1617, as part of a package of trade concessions, and after repeated ambassadorial missions from England. As early as January 1613, the EIC had established a warehouse or factory at Surat on the coast of Gujarat, defending it against the Portuguese, and Sir Thomas Roe arrived in 1615, and spent three years at court drinking and waiting on Jahangir, to secure EIC interests. Roe’s account of his time at the Mughal court was part of a collection of travelogues published in 1625, as Hakluytus Posthumus or Purchas his Pilgrimes, which became a touchstone for readers interested in the wonders of the East. Roe’s descriptions of Jahangir’s daily life are extraordinary, with mentions of 600 elephants and upwards of 10,000 horses all on the move at the same time, and dressed in finery of an almost unimaginable splendour. Roe found himself having to get on his horse just to be out of the crush of people. Jahangir himself wore a plumed turban, decorated on one side with a ruby ‘as big as a Walnutt’, mirrored by a diamond on the other, and at the front ‘an emralld like a hart, much bigger’. And around ‘his neck hee carried a Chain of most excellent pearl, three double; so great I never saw; at his Elbowes, Armlettes set with diamondes’.11 Jahangir’s court jeweller was, intriguingly, a Dutchman. The emperor’s gloves, Roe was pleased to note, were English, but even the description of the dressing ceremony is exhausting and must have been tedious on a daily basis, and there is little wonder that Jahangir was often ‘at Play’ and ‘fell to sleep’. There are frequent mentions of the emperor’s women, and how much time he liked to spend with them. Although the European descriptions of the royal harem are less than romantic, the image of the emperor lounging among his female coterie is a powerful one. In reality, there were strong women in the harem, such as Nur Jahan, who built private palaces for herself along the route of her husband’s processions, and who also had her own trading interests. Mughal women preferred to trade with English merchants rather than the Portuguese, after the Portuguese captured a ship, the Rahimi, belonging to the emperor Akhbar’s mother Maryam Makani, which traded spice, opium and textiles for export. Nur Jahan eventually acquired the title ‘protector of English goods’, indicating the strength of her position with the English, and as such it is unlikely that she did not play a part in the negotiations with Sir Thomas Roe.12
Jahangir died in 1627 in Kashmir, still on tour, but crippled by decades of intoxication. The tales of him and his court that had reached the West, however, were to have an immense legacy. He is the most famous of the opium-eating Mughals, and the descriptions of his court had particular importance for European readers. By contrast, in the Habsburg Empire and the rest of western Europe, opium was still regarded by most as an exotic import. The produce of the different empires was viewed distinctly and people argued over which was the superior article, and how to consume it. In England, where Turkish opium was still generally thought to be the strongest and most easily available, although Egyptian remained the finest, developments were about to take place that altered the consumption of opium in the West forever.
‘Medicine would be a cripple without it.’
Thomas Sydenham,
Medical Observations Concerning the History and the Cure of Acute Diseases (1676)
When, in 1603, Shakespeare had his villain Iago speak of the unhappy Othello’s tormented state of mind, he referred to the classic recipe, ‘Not poppy, nor mandragore, Nor all the drowsy syrups of the world, Shall ever medicine thee to that sweet sleep, Which thou ow’dst yesterday.’13 As Othello was written, England was in the grip of another wave of plague, and medicine was the source of much renewed interest as part of the overwhelming wave of Renaissance humanism spreading throughout Europe. Philosopher and statesman Francis Bacon (1561–1626) called for a more empirical approach that would change the human condition for the better. He hoped that the world would profit from a continued age of discovery, and the title page of his masterwork Novum organum scientarium, or The New Instrument of Science, published in 1620, shows a ship passing between the Pillars of Hercules as it exits the Mediterranean for the Atlantic. Although Bacon had nothing new to say on opium in his quasi-medical treatise History of Life and Death, it is remarkable for its sheer humanity and breadth of influence, and he did hope that his work would be for the general good, wishing ‘that through it the higher physicians will somewhat raise their thoughts’.14
In London, physicians were often seen as figures of fun, preferring to work in theory rather than practice, leaving most patients at the mercy of the barber-surgeons, apothecaries, midwives and, often, quacks. These London physicians were generally divided into two camps, that of Galen or Paracelsus. Galen’s tradition was based on herbs and holistic medicine, whereas Paracelsus had of course favoured the alchemical or specific route to treating the patient. The followers of Paracelsus were regarded with disdain by the Galenists in the debates in London’s Royal College of Physicians. For them, Paracelsus carried the brimstone whiff of Faust, but for others, his ideas still resonated.
London was an important intellectual centre in the seventeenth century, particularly for medicine. It was a time of war, both at home and abroad, but an overall rise in living standards meant that education, arts and sciences were becoming a priority as they had in other centres before. People were becoming more self-reliant and beginning to question the dogmas of the past, aided by instruments such as globes, telescopes, microscopes and barometers. A number of extraordinary minds across all fields acted as catalysts for chemical and scientific experimentation, not least the great polymaths such as William Harvey, who discovered how the circulatory system worked, and whose teachings inspired others like Christopher Wren, John Locke and Robert Hooke. A contemporary of these men, Thomas Sydenham was born in 1624, in Dorset, to a military family. His time at Oxford University was cut short by the English Civil Wars (1642–51), and he ultimately only qualified as a doctor at Pembroke College, Cambridge in 1676. He had, however, been granted a licence to practise medicine in London from 1663 onwards. It had been an impressive couple of decades for progress in all fields, and in 1657, Christopher Wren had conducted an experiment of utmost importance for the future of the history of medicine, when he administered the first recorded intravenous injection, to a dog.
Wren was helped in his endeavour by Robert Boyle, an Anglo-Irish chemist of wealthy background, who in 1655–6 took lodgings in Oxford in the apothecaries’ quarter, so that he might easily practise his experiments. His apartments are now covered by University College. Wren, by this time aged twenty-four, was sitting with Boyle and others, discussing how poisons worked, when Wren declared he knew how to move liquid into the blood of a living creature. They obtained a dog and summoned assistants to restrain the dog to a table, and Wren used a lancet, followed by a sharpened goose quill, and an animal bladder to perform the injection, which he wrote about later, saying, ‘I Have Injected Wine and
Ale in a liveing Dog into the Mass of Blood by a Veine, in good Quantities, till I have made him extremely drunk, but soon after he Pisseth it out.’15 He went on to say that he had tested ‘the Effects of Opium, Scammony & other things’ in the same way. The dog injected with a mixture of opium and white wine survived, because he was made to get up and move until the effects had passed, by being whipped around the garden.
Boyle, Wren and their friends continued with these experiments when the opportunities presented themselves, and Wren had little doubt that it could work on people, particularly ‘Malefactors’. From 1660 onwards, men such as these were presenting their findings to the new Royal Society in London, which brought together the best minds working in the city at the time. One of those recording what the members of the Royal Society worked upon wrote of Wren’s and Boyle’s work with intravenous injection, ‘Hence arose many new experiments, and chiefly that the transfusing of blood.’16
The restoration of King Charles II to the English throne, the founding of the Royal Society and the intellectual community that formed around the centre of London prompted many rapid developments in a short time, not least the work that Sydenham had busied himself with at the same time as Wren’s and Boyle’s experiments. He had been working with a great range of patients suffering different ailments, and was particularly convinced of the value of observing hospital patients over time. He was living and working in Pall Mall in premises next to an apothecary, Mr Malthus, whose shop was called the Pestle & Mortar. Doctors such as Sydenham were becoming skilled at devising medicines from old remedies as well as the ones that had arrived from the New World, such as ipecac and quinine. As with China, new foods were also arriving in Europe, such as potatoes, rice and corn, which allowed the working populations to grow, although some did come with attendant health diseases, like pellagra in corn. Sydenham promoted the use of opium strongly for many ordinary ailments, believing that ‘Of all the remedies it has pleased almighty God to give man to relieve his suffering, none is so universal and so efficacious as opium.’ Yet, only two years after Sydenham began to practise officially, the twin horrors of the Plague and the Great Fire saw he and his family flee to the country. There, he began to write up his observations, many of which – such as those on gout, which he admitted was largely suffered by ‘bad-living and hard-drinking profligates’, and mental health, for which he advised plenty of exercise such as horse-riding – are now seen as the beginning of the clinical age of medicine.17 For this he is known as the English Hippocrates, but he did not receive much respect from the majority of the medical establishment in his own lifetime. His sensible works on fevers, gout and arthritis went against received wisdom and it seems that although he was never truly poor, he was not among the elite of London’s physicians.
Sydenham, though, was truly most influential in the creation of a new form of opium, which also no doubt helped him with his pioneering works on fevers. As seen from Galen to Paracelsus and the habitual Persian user, pills made of opium had long been in use, and Sydenham experimented with the drug to try and create an improved form. Pills often gave users stomach cramps and sickness, and much depended upon the skill of the druggist in determining the dose. As with dwale and with Wren’s white wine mixture, alcohol was frequently used with opium to mask the bitterness, to help with intoxication and also digestion, and because alcohol was used readily on its own as medicine.
Alcohol also has an effect on opium latex, making it feel more potent to the user, and so no doubt Sydenham had experimented enough to find the use of sherry, a premium fortified wine, beneficial in his recipe, which also included opium, saffron, cinnamon and cloves, which were mixed, macerated for fifteen days, and then filtered.18
Unlike Paracelsus, who kept the key to his Stone of Immortality a secret, in 1667 Sydenham shared his knowledge in the interests of his fellow man. The recipe was an instant success. It had all the positive properties of an ancient theriac, such as saffron, cinnamon and cloves, which made it reassuringly expensive, but then it was soaked in sherry, and it was much easier to take and gentler on the stomach. And as apothecaries and opium supplies both became much more reliable in the latter part of the seventeenth century, the dose was almost standard, and could be dispensed easily over the counter. For the apothecaries such as Mr Malthus, it was relatively easy to make up and not so time-consuming as pills. A rapidly intoxicating, fever-reducing painkiller that also calmed the bowels and the senses: Sydenham’s laudanum recipe was disseminated rapidly through England, France and then on through western Europe.
From this point onwards, the way the East and West chose to consume opium would never be the same again. The West would always choose the faster route, whereas in the East, the biggest consumers, such as Persians and the Chinese, remained committed to opium pills or smoking. The sociability of smoking was an obvious draw for men in the East, and the pills a convenience they had been accustomed to for generations, particularly in rural areas. For the rising urban population of the West, where druggists were common and supply unrestricted, it was a simple thing to take a half-pint bottle and obtain a dose for the family medicine cupboard; because it was measured in drops, it was easier not to overdose a child. A new age in drug-taking dates from Sydenham’s laudanum recipe, as made up by Mr Malthus. Apothecaries across Europe were achieving a new prominence through the creation of these new medicines, and it is a remarkable coincidence that, less than a year after Sydenham’s publication, in Darmstadt in Germany, Bavarian apothecary Friedrich Jacob Merck bought the Angel druggist shop, starting a pharmaceutical dynasty that is now one of the world’s biggest companies.
Sydenham’s generosity with his skill and time are shown in a case he assisted on almost a decade after he published his laudanum recipe. The physician and philosopher John Locke (1632–1704) was a close contemporary and friend of Sydenham and had a thorough knowledge of medicine, although he ceased to practise as a doctor owing to his increasing political and intellectual commitments. In 1676, he made the first known report in Europe of the distressing and excruciatingly painful disorder trigeminal neuralgia, commonly known as tic douloureux, a disease that would go hand in hand with opiate abuse for the coming century and a half. The Countess of Northumberland was suffering a severe case of neuralgia of the nerves in her mouth and face. Her husband was the ambassador to France, but her French doctors had failed to cure her, despite even removing two of her teeth in a last-ditch attempt. This was also botched. She was left in a state of near-permanent nervous agony. Locke was called in to see if there was anything that might be done, and he wrote to colleagues, including Sydenham, with a detailed report of the condition and requests for advice. Sydenham, whose ideas were not particularly popular amongst the medical establishment, despite his success with laudanum, wrote back with what he would do ‘were she one of those poor people my lott engages me to attend (for I cure not the rich until my being in the ground makes me an Authority)’.19 It is clear from Locke’s letters that he held Sydenham in high regard and valued his advice, which included, naturally, opiates internally and laudanum applied to the affected parts. It is also clear just how much pain the countess was in, and how quickly it was possible to become dependent on the medicine that brought such relief. Most of the other measures Locke and Sydenham discussed for her treatment, with the exception of hyoscyamine, were little more effective for neuralgia than the rosemary water or syrup of violets used to deliver them.
Locke’s account of his treatment of the countess is no more than a foonote in the vast body of work he bequeathed to society, but it is a milestone in the history of opiate use to treat a nervous disorder. Laudanum and various medicines containing it rapidly became the standard treatment for neuralgia, and almost all nervous conditions.
In contrast to Locke, Sydenham may have felt that his influence in his own lifetime was limited, yet ultimately it was enormous. While he may have given away the secret to his laudanum recipe, therefore making it possible for any apothecary to concoct,
he was also pivotal in the birth of proprietary medicines – something that was to become a cornerstone of opiate consumption throughout the eighteenth and nineteenth centuries.
At the house in Pall Mall, Sydenham took a pupil, one Thomas Dover, born in 1660 and educated at both Oxford and Cambridge. Sydenham treated Dover when the latter contracted smallpox, with what was then a modern treatment of confinement to a clear, well-ventilated room, coupled with ‘cooling’, including medicines containing opium to both bring on sweating and to calm the patient. Recovered, Dover married and returned to the country to oversee his sick father’s farm in Warwickshire, hoping to continue as a doctor there. After his father’s death in 1696, he moved to Bristol, where he became a volunteer doctor at the new St Peter’s Hospital for the poor, following in Sydenham’s footsteps. In the twelve years Dover was in Bristol, he built up a lucrative practice, but continued to see poor patients. His work ethic was remarkable, perhaps another trait he acquired from Sydenham, and during one typhus outbreak, recorded seeing twenty-five patients a day, taking breaks to meet with a surgeon and an apothecary in a coffee house to compare notes. This meeting of colleagues during a time of professional stress shows how important this triumvirate were. As with Sydenham and Malthus, the working relationship of a doctor with an apothecary was not only one of professional courtesy, it was a close partnership that required a high level of knowledge and trust on both sides.