Opium (5 page)

Within a century of the death of Muhammad in
AD
632, the Arab empire expanded rapidly. Doctors and learned men, who had studied the writings of their Greek antecedents, travelled with merchants in the footsteps of the armies, propounding the teachings of Islam and spreading their sciences of mathematics and medicine. They raided, traded and travelled west to Spain, down the coasts of east and west Africa and east through Persia into India: they even reached as far as China, although they did not establish a colony or presence there as they did almost everywhere else. Wherever they went the knowledge of, and trade in, opium went too. It was a perfect merchandise: valuable, concentrated and compact, it did not deteriorate easily. It reached Europe by sea and India either by caravan or dhow, whilst east of India it travelled exclusively by dhow, the Arab sailors being skilled navigators.

For the best part, opium was used only as a medicine. In Arabic Spain and around the Mediterranean, it was an accepted painkiller and specific cure for stomach ailments, but in India it was regarded with almost Galen-like enthusiasm and considered a cure-all as well as a form of recreation. Needless to say, once the efficacy of opium was established in a land conquered either by arms or trade, poppies were soon under local cultivation.

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 Europe, 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.