Opium

by Martin Booth

  Meanwhile, in southern Europe, the use of opium declined as the Roman Empire collapsed and was absent for much of the Dark Ages, only to reappear with the return of the Crusaders who regained the knowledge from the Arabs whom they fought.

  For the Christian knights, opium, often confused with other drugs, took on the mantle of myth. The returning warriors told fantastical stories of the raptures and powers of magical herbs and potions, recounting such tales as the Old Man of the Mountains in Persia who fortified his zealous troops with hashish to whip them into a fervour of fighting spirit, the stamina of the Tartar couriers and their horses who banished exhaustion with opium and Turkish soldiers who steeled themselves with it before the battle.

  With the gradual fading of Arab influence, the trade in opium was taken up by the next great trading people – the Venetians. Venice was the centre of European trade and, once again, with goods came knowledge. Opium was imported from the Middle East with spices but it was not a major item of merchandise although, when Columbus sailed to discover the New World, it was one of the commodities he was briefed to bring, back. His instructions were not unique: Cabot, Magellan and Vasco da Gama were all requested to find opium in addition to other commodities. Thanks to da Gama, the Portuguese displaced the Venetians and, having navigated a route round southern Africa, included opium in their cargoes, purchasing it on the Indian subcontinent where poppies were now widely grown, the Mogul emperors encouraging this cultivation for its significant revenue.

  Although it was occasionally taken for recreational purposes, opium was regarded primarily as a medicine in Europe where, by the sixteenth century, its use was established. It is not hard to imagine what kind of an impact it must have had upon the emerging medical sciences. Here was a naturally occurring substance which, with a modicum of preparation, could eradicate pain. The potential benefits were enormous, considerable medical reputations being based upon this ‘new’ wonder drug.

  One such celebrity was Philippus Aureolus Theophrastus Bombastus von Hohenheim (c. 1490–1541), who called himself Paracelsus. He studied and taught medicine at the University of Basle and was tutored in alchemy by the Bishop of Würzburg, alchemy and medicine being akin to each other at the time. An idea of his approach to medicine may be gathered from his writings:

  In my time, there were no doctors who could cure a toothache, never mind severe diseases … I sought widely the certain and experienced knowledge of the art [of medicine]. I did not seek it from only learned doctors: I also enquired of shearers, barbers, wise men and women, exorcisers, alchemists, monks, the noblemen and the humble people … They all tried to teach me what they did not know. For all their wealth and pomp, they are vainglorious chatterers and there is no more in them than in a worm-riddled coffin. So I looked for a different approach.

  Paracelsus’s different approach was somewhat radical. He tossed Avicenna’s Canon of Medicine on to a midsummer night’s celebratory bonfire, denounced other doctors as quacks and cut a dashing figure. He travelled everywhere with a copious supply of ointments, potions and elixirs, precious stones (said to have magical properties), surgical instruments and astrological as well as astronomical charts. He wore a double-handed sword he had obtained from the East and slept with it: it is rumoured the pommel was hollow and contained the Elixir of Life. He prepared all his own medicines and was, when not attacking his professional peers, a lively character according to a contemporary, Oporinus:

  In curing [intestinal] ulcers he did miracles where others had given up. He never forbade his patients food or drink. On the contrary, he frequently stayed all night in their company, drinking and eating with them. He said he cured them when their stomachs were full. He had pills which he called laudanum which looked like pieces of mouse shit but used them only in cases of extreme illness. He boasted he could, with these pills, wake up the dead and certainly he proved this to be true for patients who appeared dead suddenly arose.

  According to the legend which has sprung up around him, Paracelsus called opium ‘the stone of immortality’. He wrote, ‘I possess a secret remedy which I call laudanum and which is superior to all other heroic remedies.’ He used the word arcanum to describe his secret and certainly there was hinted to be a strong degree of the arcane about his opium prescription. It was regarded as being endowed with magical powers which no one questioned scientifically. By chance, the actual ingredients are known: the recipe was 25 per cent opium mixed with henbane, crushed pearls and coral, mummy (a tar-like Arabic drug), bezoar stone (a concretion from a cow’s intestine), amber, musk, certain oils, the ‘bone from the heart of a stag’ and, finally, ‘unicorn’. Presumably, this last was either powdered rhinoceros horn, the ground-down bones or ‘horn’ of a narwhal or crushed sea-shells. The mix of superstition and alchemy with medical knowledge is obvious.

  Unfortunately, despite the Renaissance and rediscovery of the classical world, few seem to have heeded the warning words of Diagoras of Melos and Erasistratus, not to mention Hippocrates. Like Avicenna and many others before him, Paracelsus was himself habituated: his sword pommel probably contained his personal stash.

  The widespread use of opium produced a comparatively large population of addicts from the Middle Ages onwards although most were from the upper classes who could afford medical treatment: it is recorded that some addicts took as much as 40 grams a day, but this would have been mixed with wine or as a tincture of opium, not neat. On the other hand, the peasantry were kept blissfully ignorant of opium’s enslavement by way of their poverty.

  Paracelsus’s success and reputation did much to advance opium usage. His disciples were many and covered much of Europe. In 1600, Platerus of Basle widely promoted the use of opium whilst Sylvius de la Boe, the famous Dutch physician, stated he was unable to practise medicine without it. A Belgian doctor called von Helmont prescribed so much opium he was nicknamed ‘Dr Opiatus’. He was also addicted.

  Although not exactly dissenters, there were a few cautioning voices at least outlining the potential dangers of opium. In 1546, the French naturalist Pierre Belon visited Asia Minor and Egypt, drawing attention to the abuse of opium amongst Turks. He wrote:

  There is not a Turk who would not purchase opium with his last coin; he carries the drug on him in war and in peace. They eat opium because they think they will thus become more courageous and have less fear of the dangers of war. At the time of war, such large quantities are purchased it is difficult to find any left.

  On one occasion, he observed an opium-eater take 2 grams in a single dose. When Belon subsequently presented him with another 4 grams, he ate them without any sign of adverse reaction. Such a level of tolerance is easily believable when compared to contemporary statistics: in the late 1500s, it was known some Egyptians took 12 grams of opium per day, or 4.38 kilograms per annum. The scale of the opium trade was also recorded by Belon. Travelling along a caravan route, the naturalist reported seeing fifty camels loaded exclusively with opium en route for Europe.

  He was not alone is recognising the drawbacks of opium. At about the same time, Prospero Alpino noted how it made Egyptians lose their energy and their functions, numbed them and made them so fickle their word in business could not be trusted. A Portuguese doctor, Acosta, wrote upon returning from a voyage to the Far East in 1655: ‘Though opium is condemned by reason, it is used so extensively that it is the most general and familiar remedy of degraded débauchés.’

  Acosta also recorded the condemnation of Arabic, Persian, Turkish, Indian, Malay, Chinese and Malabar doctors, who all decried the drug for its risk of habituation.

  Gradually, the more subtle medical possibilities of opium were being realised. Garcias ab Horto, the Portuguese botanist, visiting the Portuguese colony of Goa on the west coast of India, noted opium suppressed what he termed disagreeable physical and mental impressions, adding that those under the influence ‘spoke wisely about all sorts of things. Such is the power of habit.’

  In England, as across much of north-western E
urope, opium had been medicinally employed mainly for its narcotic properties. John Arderne, in the mid fourteenth century, used salves and potions containing opium (such medicines sometimes known as dwale) to procure sleep and also applied it externally as a crude anaesthetic during surgery. ‘He schal,’ Arderne records, ‘slepe so that he schal fele no kuttyng.’ In Bulwarke of Defence against all Sickness Soarenesse and Woundes, published in 1579, Bullein recommended opium obtained from the white poppy which ‘hath all the vertues’ and from the black poppy ‘which is cold and is used in sleeping medicines: but it causeth deepe deadly sleapes.’

  Arderne was not the first to realise the anaesthetic potential of opium. In the thirteenth century, two medical monks by the name of Hugo of Lucca and Theoderic of Cervia experimented with opium to combat pain during surgery. They invented what was termed a spongia somnifera. As the name implies, this was a sponge soaked with opium and other substances which was held over the patient’s nose, much as a chloroform mask was six centuries later. The sponge could be remoistened throughout the operation, but the evaporation could not be controlled and the effects were very much a hit-and-miss process. If the dose was large enough to kill the pain, it might also have killed the patient and possibly affected the surgeon. As opium has a depressing effect on the heart muscles and respiration, the use of the sponge could promote heart failure. In time, the monks realised it was better to use opium after surgery to reduce pain, rather than as a simplistic anaesthetic.

  Opium was the essential ingredient of the four great mainstays of the medieval apothecary and doctor: mithridatum, theriaca, philonium and diascordium. They were common palliatives and general antidotes to a vast range of medical conditions, but opium was also used specifically in a form called ‘laudanum’, the name deriving from the Latin verb laudare, meaning to praise.

  The name was first coined by Paracelsus when referring to his mouse dropping-like pills, but it was the English physician, Thomas Sydenham, regarded as the founder of clinical medicine, who reapplied it in the 1660s to a tincture of opium mixed with alcohol by which it was thenceforth known.

  Laudanum was a common opium preparation, the bitter taste disguised. Little different from Helen’s nepenthe, it was usually strong red wine or port in which a dosage of opium had been dissolved. The combination of the two ingredients made a powerful and potentially very dangerous mixture. It was the main form in which opium was taken until well into the nineteenth century.

  Sydenham’s zeal for laudanum was considerable and his praise ever forthcoming:

  … here I cannot but break out in praise of the great God, the giver of all good things, who hath granted to the human race, as a comfort in their afflictions, no medicine of the value of opium, either in regard to the number of diseases it can control, or its efficiency in extirpating them … Medicine would be a cripple without it; and whosoever understands it well, will do more with it alone than he could well hope to do from any single medicine.

  He was of the opinion that without opium the art of healing would cease to exist – or certainly would not advance – for, with its aid, a doctor was able to perform near miraculous cures and conduct surgery. Sydenham’s eulogy for opium was so expansive it earned him the sobriquet of ‘Opiophilos’.

  Each doctor tended to have his own recipe. Sydenham’s laudanum was far more scientifically based, doing away with the mumbo-jumbo of Paracelsus’s mixture. It contained 2 ounces of opium, 1 ounce of saffron, and a drachm of cinnamon and of cloves, all dissolved in a pint of Canary wine. Other mixtures of the same period were not so logical and free of superstition or quackery. One, Laudanum Josephi Michaelis, published in The Commonplace Book of an Apothecary of Great Dunmow, included pearls, coral and amber; another, ominously named ‘Lancaster (or Quaker’s or Kendal) Black Drop’ and originally cooked up by a Capuchin monk called Rousseau, contained opium, fermented crab-apple juice, nutmeg, saffron and yeast. Of the consistency of syrup, it was claimed to be three or four times the strength of previous versions of laudanum and it must have pleased his patients for Rousseau became a successful practitioner in Paris under the patronage of Louis XIV. His concoction had a long life: it appeared in the Hamburg Codex of 1845 and in the US Pharmacopoeia of 1851.

  Thomas Dover was the inventor of another opium product, Dover’s Powder, which first appeared in the London Pharmacopoeia of 1788 and was being used up until the Second World War.

  Dover was a fascinating, larger-than-life character. As a young man he had lived in Sydenham’s house in the village of Wyndford Eagle in Dorset, where he contracted smallpox. Sydenham treated and cured him. After studying under Sydenham, he became a privateer and commanded a vessel called the Duke, with which he raided the coast of South America: on 2 February 1709, he rescued Alexander Selkirk (on whom Defoe based Robinson Crusoe) from the Juan Fernández Islands. Dover later returned to England and set up in medical practice: although lacking any formal training other than that acquired with Sydenham, he had doubtless picked up a large amount of knowledge on his travels.

  Dover’s Powder was described by its inventor as a ‘diaphoretic’ (a substance to promote sweating), for which he gave the method of preparation in his Ancient Physician’s Legacy to his Country, a collection of writings from his forty-nine years in the medical profession. The ingredients were 1 ounce each of opium, liquorice and ipecacuanha with 4 ounces each of saltpetre and vitriolated tartar. Dover wrote the dosage was:

  from 40 to 60 or 70 grains in a glass of white wine posset on going to bed. In two or three hours at the furthest the patient will be free from pain, and though not able to put his foot to the ground, ‘tis very much if he cannot walk next day.

  He declared quite bluntly that the powder was strong, adding that ‘some apothecaries have desired their patients to make their wills before they venture upon so large a dose.’

  Not only physicians and travellers were well acquainted with opium. So, too, were writers. In The Canterbury Tales, writing in The Prologue of the pilgrim who was a doctor, Chaucer lists, amongst others, Aesculapeius, Hippocrates, Dioscorides, Galen, Avicenna and a number of Arabic doctors (such as Rhazes, Hali, Serapion and the Moor, Averroes) who were noted for their opium use. His catalogue is not restricted to Arabs and classical figures: Chaucer also mentions John of Gaddesden, a medical authority educated at Merton College, Oxford, who died in 1361, during Chaucer’s lifetime. In The Pardoner’s Tale, the third rioter plans the death of his comrades by poisoning their bottles of wine with, Chaucer adds, a substance described by Avicenna as sure to bring on a pretty ghastly end whilst the grieving Lady in The Book of the Duchess bemoans that even Galen and Hippocrates could not heal her woe or ease her pain.

  It goes without saying opium did not escape William Shakespeare’s attention. His most famous reference comes in a soliloquy by Iago in Othello:

  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.

  The imagery is not all that poetic. Shakespeare would have known the term ‘drowsy syrup’ for, in fact, it was accepted medical terminology for opium.

  Sir Thomas Browne, who was a seventeenth-century doctor as well as a writer, used opium as an image in his work: ‘The iniquity of oblivion blindly scattereth her poppy, there is no antidote against the opium of time’ and ‘I need no other laudanum than this [his faith in prayer] to make me sleep.’ Robert Burton, the noted scholar and priest who died in 1640, wrote in his famous work, Anatomy of Melancholy, of the problem of those who were insomniacs ‘by reason of their continual cares, fears, sorrows, dry brains [which] is a symptom that much crucifies melancholy men.’ His remedy was laudanum Paracelsi, swallowed with violets, roses, lettuce, mandrake, henbane, nutmegs or willows: the last was an interesting addition for it was known that willow also cured headaches, containing as it does a natural form of aspirin. Alternative cures for melancholia which Burton propose
d included smelling a ball of opium (as he said the Turks did), anointing the forehead upon retiring with an opium–rosewater mixture and applying leeches behind the ears then rubbing opium into their puncture marks.

  Whilst most scholars and writers would have been acquainted with opium, few would have been addicted. By taking it in small, infrequent quantities, they would have avoided the trap. Yet there was one who was famously habituated: he was Thomas Shadwell, the leading Whig supporter, Restoration dramatist and poet.

  His habit was widely known throughout society and he became the butt of jokes as a result of it. Shadwell, who had a long-standing political and literary quarrel with John Dryden, was the subject of the latter’s mock-heroic poem MacFlecknoe, the Prince of Dullness, who ‘never deviates into sense’ and who was given a wreath of poppies. In his Absalom and Achitophel, Dryden directly refers to Shadwell’s habit. Yet, whilst his addiction was ridiculed for the sake of literary enmity, Dryden did not condemn it and a mock epitaph On Shadwell’s death more or less treated his habituation as an acceptable failing. It went:

  Tom writ, his readers still slept o’er his book,

  For Tom took opium, and they opiates took.

  Ironically, Shadwell had the last laugh. After the revolution of 1688, he superseded Dryden as both Poet Laureate and Historiographer Royal. Clearly, his addiction was not regarded as an obstacle to his rising in both royal favour and literary stature. His death was ironic, too: despite his funeral orator stating, to his certain knowledge, that Shadwell had not taken his dose of opium and went to his maker with a clear mind, it seems more than likely he died of an overdose.

  In later years, opium was to claim more famous slaves or acolytes. Clive of India was addicted to it, having taken it as a painkiller for a bowel complaint: he killed himself at the age of forty-nine with an overdose. Robert Hall, the Baptist divine, was addicted, as was Thomas Wedgwood, the father of photography. The Duke of Wellington reported that George IV took laudanum to counteract his alcoholic hangovers. In America, Benjamin Franklin, the politician and one of the authors of the Declaration of Independence, was almost certainly addicted to opium in his declining years, as was John Randolph of Roanoke, Virginia, the arrogant and eccentric politician who fought the emancipation of slaves even though he gave his own their liberty in his will.