Nineteenth Century High: The Other Opiate Epidemic

In the United States, opiates kill more people than car accidents.  The recent campaign to eradicate a renewed opiate epidemic has emphasized this astonishing fact again and again until I can’t stop thinking about it.  And believe me, there’s nothing about driving a car that I take casually.

The Obama Administration’s regular pronouncements about opiate abuse conjure the opiate epidemic of the nineteenth century.   While both the pain reduction and addictive properties of opium have been known since ancient times, unfettered and often destructive consumption of opiates during the nineteenth century was what drove regulation during the twentieth.

The nineteenth century presented a perfect storm for use of opium and its derivatives, including laudanum, a popular concoction of opium, wine, and spices.    Between 1839 and 1852, British imports of opium rose from 41,000 pounds to 114,000 pounds. In 1840, the United States imported 24,000 pounds of opium, a total that rose to about 135,000 in 1867 and that surpassed 500,000 pounds in the 1890’s.  On one side of the scale were lots of disease, lots of opium, and lots of opportunities to buy opium.  On the other side of the scale were limited medical knowledge, few therapeutic alternatives, little regulation, and absence of stigma.

From a medical standpoint, the germ theory was far in the future.  The pharmacopeia was limited but diseases, including cholera, dysentery, and tuberculosis, were plentiful.  Opiates stopped coughing, halted diarrhea, and provided pain relief even if they did not cure the underlying disorder.  Doctors prescribed them for virtually every ailment from hysteria to hemorrhoids, viewing them either as cures or analgesics.  Medicine had only recently abandoned bleeding, cupping, and purging as routine treatments so opiates were at least on some levels an improvement.  Developments in medical science only intensified matters.  Morphine, the principal component of opium, was isolated in 1805. It began being manufactured for commercial use by Merck in 1827.  Fittingly, when the hypodermic needle in its modern form was introduced in 1853, an invention credited to Dr. Alexander Wood, it was designed specifically to inject opiates. The belief within the profession was that subcutaneous injection would avoid addiction; one only became an opium eater by ingesting the drug by mouth.

Opiates were ubiquitous in the nineteenth century. According to one writer, in Britain, opium preparations “were freely on sale to anyone who wanted to buy them, in any sort of shop.”  Berridge, Virginia. “Victorian Opium Eating: Responses to Opiate Use in Nineteenth-century England,”Victorian Studies 21.4 (1978): 437–461.   “[O]pium was an unremarkable part of daily life.” Robert Morrison, “De Quincey’s Addiction,” Romanticism 17.3 (2011): 270-277.  People who could not afford doctors  self-medicated inexpensively by picking up opium preparations at the grocer or druggist.  In fact, many people often unwittingly purchased opiates when they bought patent medicines.  Patent medicines were unpatented preparations whose ingredients were kept secret but were advertised to be veritable panaceas. Mothers  purchased patent medicines to dose teething babies or to use as “babysitters” to keep infants and toddlers  asleep while parents were at work. In the United States, recreational use of opium and morphine was prevalent among middle and upper class women.  Drinking alcohol was considered unladylike, and indulgence in drugs relieved boredom.  Meanwhile, in the other half of the world, in 1839 and again in 1856, Britain, deaf to China’s concern about a growing addiction problem, was waging two Opium Wars. Waving the banner of free trade, Britain wanted to protect its ability to sell opium produced in India to balance British purchases of Chinese tea, silk, and porcelain.  (Not only did millions of Chinese become addicts in the name of free trade, but when the United States decided that it wanted to crackdown on both opiates and Chinese immigration, propaganda seized upon Chinese opium dens as one of the tropes justifying discriminatory treatment).

Literature is a window to history, and period literature reflects routine opium use.  Quick.  What do Byron, Shelly, Coleridge, and Keats  have in common?  Yes, they were all romantic poets, but they were also  all opiate users.  Coleridge even claimed to have written his poem “Kubla Khan” while on an opium trip. Balzac wrote a story called “L’Opium.” Composers Berlioz and Chopin indulged.   Wilkie Collins was said to be a laudanum addict and wrote about laudanum addicts in his novels.  The German poet Henrich Heine was said to be a user and according to a recent biography, so was Karl Marx (which, if true, casts his thought about religion being an opiate of the masses in a different light). Anna Karenina consumed morphine.  Dracula ensnared potential victims with it, but  Dr. Frankenstein used laudanum himself.  Louisa May Allcott, Elizabeth Barrett Browing, Proust, and Sir Walter Scott all partook.  Opiates figure in novels by George Eliot, the Bronte Sisters, and Stendhal.  One of the slave women in Uncle Tom’s Cabin kills her child with opiates. Politicians were not exempt:  near the end of his life, Thomas Jefferson took laudanum regularly, Mary Todd Lincoln was addicted, British prime minister William Gladstone took laudanum with his coffee, and British anti-slavery champion William Wilburforce took opium pills for 45 years.

The poster-boy for opiates was British journalist and essayist Thomas De Quincey.  In 1821 De Quincey described his laudanum addiction in Confessions of An Opium-Eater, an essay whose impact has been hotly debated. De Quincey began ingesting laudanum at age 18, picking up a bottle at a local druggist to treat what he described as rheumatic pains.  For the next eight years, he claims to have controlled the habit, limiting himself to 25 drops of laudanum once a week.  In a section of his Confessions called “Pleasures of Opium,” De Quincey disparages the belief that opium leaves the user intoxicated.  He says that his use produced a heightened intellect, which he described with soaring enthsiasm. He raves, “That my pains had vanished was now a trifle in my eyes: this negative effect was swallowed up in the immensity of those positive effective which had opened before me—in the abyss of divine enjoyment thus suddenly revealed.”  De Quincy exclaims about his discovery that “happiness might now be bought for a penny, and carried in the waistcoat pocket; portable ecstasies might be had corked up in a pint bottle….” He claims not to have experienced let-downs or torpor. However,  in the next section of the Confessions, entitled “Pains of Opium,” DeQuincey describes the escalation of his addiction. Eight years after his first use of laudanum, De Quincey began suffering from a stomach ailment. He started dosing himself with 8,000 drops of laudanum.   The result was a torment of lethargy, in which he was unable to think, write, or handle his family responsibilities. He was tortured by haunting and terrifying dreams.  After years of excess, De Quincey suffered a horrific period of months in which he weaned himself to a more manageable intake but suffered chills, anxiety, and irritability in an only modestly successful withdrawal.

De Quincey’s biographer, Robert Morrison, argues that De Quincy may have made opiates fashionable.  Although DeQuincey claimed that the Confessions were intended to discourage opium use, Morrison maintains that DeQuincey “was the first to commemorate his drug experience in a compelling narrative that was consciously aimed at — and consumed by — a broad commercial audience. Further, in knitting together intellectualism, unconventionality, drugs, and the city, De Quincey mapped in the counter-cultural figure of the bohemian.”  According to Morrison, De Quincey’s “Confessions loosed the recreational genies from the medicine bottle and made opiates for the masses.”  http://blog.oup.com/2013/02/de-quinceys-confessions-english-opium-eater/#sthash.19QpZwfE.dpuf

Whatever  De Quincey’s impact, attitudes about opiates had shifted by the dawn of the twentieth century. Governments began regulating use of opiates. The arrival of safe and effective alternatives in medical treatment, the introduction of public health measures that reduced cholera and dysentery,  the understanding that opiates’ dangers often outweighed their medical benefits, the concern over adulterated patent medicines, and the formation of medical and pharmacist associations anxious to wield a monopoly over the prescription and dispensing of drugs were among the factors that sparked the sea change at least until the most recent epidemic.

For more: Barbara Hodgson, In The Arms Of Morpheus: The Tragic History of Morphine, Laudanum and Patent Medicines (2001).

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