Search

Opium in Medical Practice

The
`orthodox‘ medical use of opium was of relatively minor importance at
this time. Doctors and pharmacists, until mid-century at least, lacked
the organizational structures and professional standing even to begin
to define opium use as solely a medical matter. It is easy, reading the
expanding numbers of medical journals produced in this period (the
Lancet, beginning in 1823, being among the first and most notable), to
forget that they catered for a body of men very different from the
later unified profession which exerted social, intellectual and
political influence. `Properly educated practitioners‘ were mostly
lacking before mid-century. The extraordinary diversity of medical
practice in the early nineteenth century, the social `marginality‘ of
local medical practitioners, with medical practice often still very
much a trading occupation of indeterminate status, made it impossible
at this stage for doctors to establish any form of unitary control over
a coherent body of knowledge and practice.1
Opium’s uses within
medicine were nevertheless legion. The opium preparations on sale and
stocked by chemists‘ shops were numerous enough; but a glance at the
opium section of any textbook of materia medica of the period is enough
to show that an even greater variety of preparations was available for
the practitioner to use if he chose. Standardization was almost
completely absent. One of the public health issues used in debates over
legislative restriction of opium was the drug’s widespread adulteration
(to be discussed in Chapter 8). Even the opium preparations of the
textbooks themselves could differ in their formulae. There was no
agreement, before the 1858 Medical Act established the British
Pharmacopoeia, on what were standard preparations. There were separate
Pharmacopoeias in London, Edinburgh and Dublin; and all had different
laudanum formulae. Nevertheless the fourteen opium preparations (as
well as some preparations of poppy capsules and of morphine) listed in
that first national British Pharmacopoeia were witness to the drug’s
popularity. They were all still there in the 1880s (with, of course, a
vastly expanded morphine list); and Squire’s semi-official Companion to
the Pharmacopoeia had twenty-one opium preparations in medical use.2
When John Murray commented of opium, in his System of Materia Medica
and Pharmacy in 1832, that `As a palliative and anodyne, it is indeed
the most valuable article of the materia medica, and its place could
scarcely be supplied by any other‘, he was no more than echoing the
almost unanimous opinion of his medical contemporaries.3
Opium was
by no means a newcomer to medical practice in the nineteenth century.
It had been in limited medical use almost since it was first imported.
Dr Turner, the apothecary in Bishop-gate Street, London, was selling a
compound called Laudanu in 160i. It was said to be `good for
alleviating pain‘, and `will temporarily put a min n a sweate trans‘.4
It was from beginnings such as this that opium had, by the eighteenth
century, become an accepted part of medical practice. The prevailing
monistic system of pathology used `heroic‘ methods such as blistering,
bleeding and purging. Opium was also used in tension pathology, which
involved the use of remedies to increase (stimulate) the tone, or
lessen it by relieving tensions. The burgeoning of English texts which
dealt specifically with the use of the drug – George Young’s Treatise
on Opium for example, Alston’s `Dissertation on opium‘ or Dr Samuel
Crumpe’s Inquiry into the Nature and Properties of Opium (1793) – was
testimony to its increased importance in English medicine.5
There
was greater documentation of medical use of opium in the nineteenth
century, simply because many of the standard medical journals were
established at this time. Debates over methods of treatment raged more
fiercely too, as part of the process of establishment and
differentiation of a separate medical profession, and opium came to the
fore. The old heroic therapies involved in humoral pathology, whereby
an imbalance in body fluids was removed by physical means, gave place
to a greater emphasis on drug treatment and a more localized notion of
pathology. There were attempts to identify previously unclassified
diseases, to evolve a more scientific mode of treatment. The use of
opiates spanned both the old system and the new – and indeed the break
between them was never so sharp.
Despite opium’s importance to
medical practice of all varieties, there was still a great deal of
disagreement, even in the nineteenth century, over the actual effect of
the drug and how it really worked. The debate on whether it was
stimulant or sedative had been very much part of eighteenth-century
medicine; and there were still echoes of the controversy in the
nineteenth. Opium had been assigned by those physicians declaring
allegiance to the Galenic School to the `cold‘ group of drugs because
of its soporific and sense-deadening effects. But rival physicians saw
it as a `hot‘ drug, as a stimulant rather than sedative in its action.
Perhaps the most noted of all the exponents of the stimulant view was
Dr John Brown of Edinburgh, who in his Elements of Medicine laid down
what became known as the Brunonian system of medicine and whose
influence on Beddoes and the Bristol circle has been described in the
preceding chapter. Brown, like them, saw both opium and alcohol as
stimulants, increasing the tone of the nervous and vascular systems .6
Opium
has always been classified in the twentieth century both legally and in
popular parlance as a soporific, narcotic drug. Its imaginative
literary effects are regarded as something peculiar to a small circle
of creative writers. `Stimulant‘ usage of this type has been seen as
abnormal and definitely non-medical. Yet, as discussion of the
Brunonian system and‘ tension pathology indicates, medical practice
once took a very different position. Although terms were never closely
defined, the drug’s claims to what was called a `stimulant‘ effect were
urged by medical writers well into the nineteenth century. An element
of euphoria was recognized as being among the effects of opium. Samuel
Crumpe strongly disagreed with the compromise position that the drug
had both stimulant and sedative properties. If this was the case, he
pointed out, one principle would neutralize the other and the drug
would turn out inert. In his view, a stimulant would be productive `of
most considerable anodyne effects, which conjunctly possesses the
greatest degree of stimulant power, the most ready diffusibility, and
which is, at the same time, the most suddenly exhausted. The whole of
these properties are accordingly discoverable in opium, to a
considerable degree‘.7
In the following century, the drug’s
stimulant effects, although still a matter of lively interest, were to
a much greater degree isolated from medical practice. Many writers in
the newly established medical journals, in the textbooks of materia
medica, reserved the drug’s stimulant properties for exceptional,
non-medical circumstances, seeing its narcotic effects as the true
medical ones. Professor Robert Christison of Edinburgh, the greatest
authority on poisons in the 1820s and 1830s, maintained that continuous
excitement could be sustained by taking repeated doses. But this, as he
pointed out, was rarely done in medical practice. The effect of a full
`medicinal‘ dose of three grains of solid opium, or a drachm of
tincture, was to produce a general transient excitement and fullness of
pulse, with torpor and sleep a short time after. A book by Michael Ward
on the opiate friction, or the external application of the drug, also
stressed its sedative properties.“ Most medical men appear to have
agreed that the drug’s narcotic properties were indeed paramount, even
if there was a short period of primary stimulation. Some even disputed
that the stimulant effect existed. F. E. Anstie in his Stimulants and
Narcotics (1864) thought opium produced `nothing resembling mental
excitement‘.9 By the end of the century `stimulant‘ use of opium had
been excluded from orthodox medicine.
The question was also bound up
with that of how the drug really worked on the body, whether by the
medium of the blood, or by `nervous communication‘. F. Robinson, a
Hammersmith surgeon, gave as his opinion in 1846 that opium would be
capable of producing quicker and more‘ deadly effects on `a person 0f
thin spare habit and highly nervous temperament than on a large robust
individual of lymphatic sanguineous temperament‘.10 There were echoes
of the earlier medical emphasis on a humoral pathology, and perhaps the
most sensible conclusion was that the effect very much depended on the
person and the setting. The use of opium to aid public speaking was a
particular example of conflicting tendencies and the differing effects
the drug could have. It was also a notable example of the `social‘ use
of this drug which prevailed at the time. Opium was a `pick-me-up‘ and
a `calmer of nerves‘. Wilberforce was known to take opium before his
speeches in the Commons, and Gladstone, too, took laudanum in a cup of
coffee with the same aim. The practice was not unknown in medical
circles, and could have some unforeseen effects. A doctor elected President
of the Hunterian Society in Edinburgh, through anxiety, took a larger
dose of opium than usual before a crucial speech, and promptly fell
fast asleep. When another member of the society also took a dose, it
induced exactly the opposite effect. He was laughed out of the room,
calling and crying out incoherently. The last of the trio, `a crack man
of the „Medical“ and one of its possible presidents‘, went to, make a
speech on the evening prior to the election. He appeared to others
present to be in a state of profound reflection. Time passed; the other
speakers finished, and the meeting was declared over. The aspirant to
office awakened from his opium stupor to find his chance of the
presidency gone.“ Such. were the wayward and conflicting effects of
opium. It could be `stimulant‘ or `sedative‘ depending on dosage and
tolerance, and also on the consumer himself and his own expectations.
Its mode of action remained a matter for investigation. But medical
discussions increasingly emphasized its sedative, not its stimulant
effects.
This uncertainty over its action did not prevent the
widespread use of the drug for every variety of complaint. It was
indeed a palliative. There were few specific cures for conditions in
the first half of the century and many diseases were still to be
medically defined. Opium, if not the cure-all which its most strenuous
advocates saw it as, at least provided a relief from pain and a period
of intermission which might aid recovery. It would almost be easier to
list those areas where it was never employed than to attempt to deal
with every therapeutic possibility. Jonathan Pereira noted in his
textbook of materia medica in 1839 that it was used, in general, `to
mitigate pain, to allay spasm, to promote sleep, to reduce nervous
restlessness, to produce perspiration, and to check profuse mucous
discharge from the bronchial tubes and gastro-intestinal canal‘. 12 Its
popular uses give some idea of the range of minor complaints in which
it was invaluable. It performed basically the same function in major
illnesses, too. In gout, sciatica and neuralgia it was `a most
efficient palliative‘; and the pain of cancer, or gangrene, and the
effects of ulceration were also dealt with by opium. Its use to `allay
spasm‘ was extensive. Cases of hydrophobia were commonly narcotized
with opium, even if the results were never that successful. As in cases
of tetanus, it brought often a temporary amelioration which served to
confirm the belief in its powers. It was often recommended for cases of
intestinal obstruction; and its utility for ague and malarial
conditions has already been demonstrated by the case of the Fens.13
It
was a recognized standby for bronchial affections. There were no
specific cures for tuberculosis, pneumonia or bronchitis and opium
helped to alleviate symptoms, subduing coughing, expectoration and pain
even if it could not touch the root cause. Discharges of all sorts,
too, were dealt with by the drug. Its use in haemorrhage was well-known
-‚of all the wonderful influences … exerted by opium, that by which
it sustains the powers of life when sinking from haemorrhage, and
arrests the flow of blood, is the most extraordinary,‘ commented a
medical journal in 1846.14 In diarrhoea, it was the major remedy,
sometimes combined with camphor, sometimes with nitric acid or calomel.
Its use in dysentery was common, although it was argued that the
constipation it produced could mask other, more serious symptoms. And,
of course, for cholera its use remained virtual. challenged. Despite
the existence of a rudimentary knowledge of saline intravenous
injections, owing much to the work of O’Shaughnessy, the young doctor
who also brought cannabis into English medical practice, there appears
to have been as much reliance upon opium in the last major cholera
epidemic in England, in 1866, as there had been in those of 1831-z and
1849-53.15
In some areas opium was rediscovered. Diabetes was a case
in point. Earlier medical texts had noted the drug’s utility in the
condition; but the method then slipped from notice. Dr Anstie, in fact,
was strongly against its use. But in 1869, cases published by Dr F. W.
Pavy of Guy’s Hospital demonstrated that opium and its alkaloids,
morphine and codeine, had the ability to check the elimination of sugar
in the urine. The codeine and opium treatment he advocated was not
uncritically accepted but it soon became standard. It was still in use
in King’s College Hospital in the 1890s. William Osler, author of the
standard medical text of the period, commented that `opium alone stands
the test of experience as a remedy capable of limiting the progress of
the
disease‘.16
Opium also had a long history in the treatment of
`female complaints‘. Its efficacy as a palliative came into its own in
the treatment of dysmenorrhoea or menstrual pain, and in childbirth
perhaps most notably. It was a useful anodyne for puerperal fever. It
was occasionally given during labour, in particular to compose a
patient during a lengthy delivery; and it was also used to dull
‚after-pains‘, although this practice caused some controversy.“ It was
used for the `nervous disorders‘ which were thought to be specifically
sex-linked. Indeed, it was the medical administration, and consequent
self-administration, of hypodermic morphine to `hysterical women‘ later
in the nineteenth century which was said to have originated the problem
of hypodermic morphine abuse. The female bias of morphine use is,
however, as doubtful as the idea of female fragility and ill-health
which informed most discussions. It may well be, too, that, despite
many assertions to the contrary, female consumers of the drug were no
more numerous than males. Certainly the male death rate from opium
overdoses was
higher.18
One of the major medical areas where
opium was used – in the treatment of insanity – provided a striking
illustration of the changing focus of medical attention and the altered
perception of the drug itself. Opium, at the beginning of the century,
was seen as a welcome alternative to existing treatments. But by the
end of the century, its use was increasingly viewed both as a cause of
mental illness and as a form of insanity in itself. The `disease‘ of
opium addiction as then formulated owed much to the diaease view of
insanity, a condition with which opium had long been associated as a
means of treatment.
But in the early 1800s, treatment with opium and
other drugs appeared to be a means of progress away from earlier
methods_ of restraint. Straitjackets and mechanical means of restraint
were replaced by more subtle therapeutic means of control, opium among
them. John Ferriar at Manchester, one of the earliest opponents of the
`old regime‘, advocated it as a valuable replacement for `beatings and
terror‘. 119 Dr John Connolly, physician to the asylum at Hanwell – and
one of the leading figures in the new attitude towards the insane –
stressed that different preparations could vary in their effects, and
also according to individual idiosyncrasy.
With some patients
laudanum acts with certainty, and like a charm; others derive comfort
for long periods from the acetate of morphia; to some the liquor opii
sedativus is alone tolerable. Whatever sedative is employed, the dose
should be large. Less than a grain of the acetate of morphia is
productive of no good effect whatever; and laudanum requires to be
given in doses of a drachm, or at least of forty or fifty drops. I am
speaking of acute cases, for in those of longer continuance, use often
makes much larger doses necessary …20

There were those who
were suspicious 0f the large claims made for it. W. Smith, at one time
resident surgeon at the Lincoln Lunatic Asylum, in 1849 criticized an
article by Forbes Winslow in the Psychological journal advocating the
sedative treatment. To Smith, the use of narcotics was `merely an old
enemy under a new guise‘, and the drugs, while useful in certain
defined areas, were not general specifics .21 Opium, other authorities
agreed, could aggravate as well as subdue the symptoms of mania and
many were cautious about its use. Haslam, for instance, in his
Observations on Madness and Melancholy saw opium as a drug that could
excite the patient even further, instead of producing the necessary
sedative effect.
Practical experience of the `stimulant‘ properties
of the drug on an already over-stimulated mind brought stricter limits
on the advocacy of its use. The uses to which opium could be put in
insanity were more clearly established and circumscribed in the 1860s
and 1870s. Opium was also a casualty 0f increased specialization in
treatment. The elaboration of disease concepts, the _delineation 0f
particular forms and varieties of mental illness, encouraged
diversification in methods 0f dealing with them. Significantly it was
Henry Maudsley, whose name was synonymous with new departures in mental
illness, who was much associated with the limitation of opium’s use. In
a series of articles on the subject beginning in the late 1860s, he
noted the generally unsatisfactory definition 0f insanity and the
consequent vagueness in the drug treatment. N0 one quite knew how, why
and where opium was having its effect. In a piece in the Practitioner
in 1869, he recommended that the drug be used only in the early stages
of the illness. The sleeplessness, depression and `strange feelings of
alarm‘ which, according to him, often preceded `regular insanity‘ could
be relieved by opium. It was especially valuable in melancholia, or
depression, but not in mania .22
In the succeeding years, Maudsley’s
advice appears to have won increasing support, in particular from
medical men receptive to the new departures. Dr Thomas Clouston,
Superintendent of the Cumberland Asylum at Carlisle, won a gold medal
from the Medical Society of London in 1870 for his demonstration that
cannabis indica and bromide of potassium, used in conjunction, were
more effective than opium in the treatment of `maniacal excitement‘.
(Connolly had earlier also pushed the claims of cannabis.) Half a
drachm of the bromide and of cannabis tincture was given continuously
to his patients over eight months. Clouston found the mixture
particularly effective in menopausal women -‚I think here we have a
palliative of great value and importance.’23
The work of Dr Anstie,
too, encouraged a dislike of `strong narcotics‘, and the appearance of
new drugs, in particular the bromides and chloral, hastened the move
away from opium. Chloral was being prescribed increasingly in general
practice from the 1860s for sleeplessness in cases where an opiate
draught or a `composing mixture‘ would once have been given. The first
chloral addicts, Dante Gabriel Rossetti among them, were becoming
known. Its use was advocated in insanity, too. Anstie supported the
drug’s use in the newly founded Journal of Mental Science. Bucknill and
Tuke’s standard work, Psychological Medicine, was said in 1874 to be in
need of revision so far as the position of opium was concerned. Chloral
and bromide of potassium, it was thought, `enable us … to dispense
with opium and its preparations, or to reserve them for those cases of
melancholia in which they are so
eminently useful‘.24
Opiates,
however, continued to be used in the treatment of the mentally ill at
the end of the century, even if advocacy was less eager or
all-embracing than half a century before. Allbutt had reported on his
introduction of electric treatment in the West Riding Lunatic Asylum
reports in 1872. Digitalis, calabar bean and hyoscyamus also had their
devotees. But opium was not completely abandoned, and its use in
everyday circumstances in asylums and hospitals could have been more
extensive than the academic texts indicate. John Cumming Mackenzie,
assistant Medical Officer at the Northumberland County Asylum, still
considered, as late as 1891, that opium was the major hypnotic in the
treatment of the insane -‚experience but widens the field of its
application while other hypnotics pass away‘.25
In another area of
insanity, delirium tremens, the continuing link between opium and
alcohol was again demonstrated. Opium and alcohol had often been
counterposed in eighteenth-century medicine, even if Dr John Brown had
classified both as stimulants. As already mentioned in Chapter 3, the
drug was popularly used as a means of sobering up. The connection
between the two reemerges at many stages in nineteenth-century society
– in the working-class opium-eating `scare‘, for instance, or in the
concept of `inebriety‘ and the formulation of disease theories of
addiction (see Chapters 9 and 13). In the treatment of D.T.s the
connection entered medical practice. Jonathan Pereira himself had known
an alcoholic doctor who for many years took a large dose of laudanum if
he was called out to see a patient while drunk. On one occasion,
however, `being more than ordinarily inebriated‘, he swallowed too much
and died of apoplexy. 26 Such treatment was rather irregular in those
circumstances, but was certainly standard medical practice in the first
half of the century. Opium was the ’sheet-anchor‘ of the condition. It
was in use in hospital practice in 1850; Thomas Jones, an intemperate
`gentleman’s coachman‘ admitted to King’s College Hospital and reported
as seeing devils running about, was sustained on a diet of porter, beef
tea and brandy, with laudanum every three hours.27
Its use in D.T.s
was, though, the subject of increasing criticism from about this time.
Isolated voices were raised against its efficacy and new treatments
were suggested. Tartar emetic was found useful, and a supporting diet
`of an unstimulating nature‘ recommended. An onslaught by Professor
Laycock, Lecturer on Medical Psychology at Edinburgh University, in
1858, marked the beginning of serious debate. Laycock questioned the
total medical reliance on the use of narcotics. He himself had treated
twentyeight cases without opium or stimulants and all had recovered
rapidly. Recommending that the patient be kept warm and on a suitable
diet, he urged the abandonment of opium -‚while many have recovered
without opium, and some in spite of it, none can be said to have died
for the want of it‘. George Johnson, Professor of Medicine at King’s
College, in a series of lectures on delirium tremens, supported
Laycock’s views. Large doses of opium were, in his opinion, to be
avoided, although the drug could be given in small quantities and often
worked best when combined, surprisingly enough, with alcohol.28 It was
a remedy with as many possibilities for evil as for good. Anstie,
always opposed to the free use of opiates, supported this line of
reasoning. `The idea that patients in delirium tremens require to be
narcotized into a state of repose, may now be said to be abandoned by
those best qualified to speak on the subject,‘ he wrote in 1866.29 The
drug nevertheless remained in limited use in particular varieties of
the conditions. Few were prepared to recommend its use in large
quantities indiscriminately. Dr Latham, however, told the Cambridge
Medical Society in 1882 that patients in moderate health could be given
opium without risk – I or I grain injections of morphia were best until
the delirious person fell asleep. But for those in broken health, opium
should only be given with great caution.30
Opium indeed continued as
one of the most valuable drugs in medical practice well into the 1860s
and 1870s. It was not simply recommended in the official texts, but
actually used in everyday practice. How much opium was in fact
prescribed and dispensed must remain in doubt. Between the mid 1840s
and 1860s, for instance, around i4-2o per cent of prescriptions
dispensed by one Islington pharmacist were based on opium (234 out of
1,677 prescriptions in 1845). George Daniel, a chemist in the Holloway
Road, dispensed a similar proportion; I6 per cent of his prescriptions
in 1866 and 18 per cent in 1876 used opium.31 Hospital case notes, too,
for King’s College Hospital, for instance, and the General Lying-In
Hospital in London, show that opium was indeed regularly used for the
conditions for which the textbooks recommended it. Most dispensing of
prescriptions still took place in the doctor’s surgery, and practice
records have rarely survived. The amount of opiates generally dispensed
must remain conjectural. Yet there can be little doubt of the
established medical popularity of the drug in the first half of the
century, nor of the way in which the range of complaints commonly
self-treated with opium found their parallels in established medical
practice.

References

1.
For the position of the medical profession in the first half of the
nineteenth century, see, for example, N. and J. Parry, The Rise of the
Medical Profession. A Study of Collective Social Mobility (London,
Croom Helm, 1976), pp. 109-31 ; I. Inkster, `Marginal men: aspects of
the social role of the medical community in Sheffield, 1790-1850′, pp.
128-63 in J. Woodward and D. Richards, eds., Health Care and Popular
Medicine in Nineteenth Century England. Essays in the Social History of
Medicine (London, Croom Helm, 1977); and M. J. Peterson, The Medical
Profession in Mid- Victorian London (Berkeley, University of California
Press, 1978).
2. For an example of an early pharmacopoeia, see Royal
College of Physicians, London, Pharmacopoeia (London, G. Woodfall, 3rd
edn 1815). British Pharmacopoeia (London, Spottiswoode, 1858), and a
later edition of 1885, also list standard opium preparations in medical
use. See also P. Squire, A Companion to the Latest Edition of the
British Pharmacopoeia (London, J. and A. Churchill, 14th edn, 1886).
3. J. Murray, A System of Materia Medica and Pharmacy (Edinburgh, Adam Black, 6th edn 1832), P. 94.
4. Notes and Queries, 2nd set. 3 (1857), P. 445.
5.
‚G. Young, A Treatise on Opium Founded on Practical Observations
.(London, A. Mular, 1753); C. Alston, `A dissertation on opium‘, op.
cit., pp. 110-76; S. Crumpe, An Inquiry into the Nature and Properties
of Opium (London, G. G. and J. Robinson, 1793).
6. J. Brown, The
Elements of Medicine (London, J. Johnson, 1795); the influence of
Brown’s ideas on Beddoes and the literary and scientific circles at
Bristol is described in A. Hayter, op. Cit., pp. 27-8; and M. Lefebure,
op. cit., pp. 61-2.
7. S. Crumpe, op. cit., pp. 19o-91.
8. R.
Christison, A Treatise on Poisons (Edinburgh, Adam Black, 2nd edn
1832), p. 617; M. Ward, Facts Establishing the Efficacy of the Opiate
Friction (London, C. Wheeler, 1809), p. 55.
9. F. E. Anstie, op.
cit., p. 79; T. C. Allbutt, `Opium poisoning and other intoxications‘,
pp. 874-920 in his System of Medicine (London, Macmillan, 1897), vol. 2.
10.
F. Robinson, `On the utility of a knowledge of the temperaments in
connexion with the diagnosis and treatment of disease‘, Lancet, I
(1846), p. 360.
11. `The action of opium‘, Medical Times and Gazette, 12 (x845), pp. 1656.
12. J. Pereira, op. cit., vol. 2, p. 1301.
13.
Any medical journal of the period can give a multitude of examples of
the reliance placed on opium. For the use of opium in the conditions
mentioned here, see, for example, G. B. Wood, A Treatise on
Therapeutics (Philadelphia and London, J. B. Lippincott and H.
Bailliere, 1856), PP. 739-44, 745, 748, 750-58 etc. Also the articles
on gout, rheumatism, convulsions, neuralgia, obstruction of the bowels,
etc. in J. Russell Reynolds, ed., A System of Medicine (London,
Macmillan, 1866-79), vols. n-5.
14. `Review of Dr Griffin’s Medical and Physiological Problems‘, British and Foreign Medical Review, 21 (1846), pp. 105-7.
15.
For O’Shaughnessy, see N. Howard-Jones, `Cholera therapy in the
nineteenth century‘, journal of the History of Medicine and Allied
Sciences, 27 (1972), pp. 373-96. For examples of cholera treated with
opium, see British and Foreign Medico-Chirurgical Review, 40 (1867),
pp. 9, 18, 26, 36. `Cholera mixtures‘ based on camphor, turpentine and
laudanum, sometimes with the addition of brandy or `best Irish
whiskey‘, are often to be found in prescription books of this period.
16.
F. W. Pavy, `Report of a case of diabetes mellitus successfully treated
by opium‘, Transactions of the Clinical Society of London, 2 (1869),
pp. 44-56. Pavy’s researches were widely publicized in the leading
medical journals. See also Royal College of Physicians, King’s College
Hospital case notes, `Case of Maurice Ward, labourer with diabetes
mellitus‘, Dr Yeo, vol. 79, and W. Osler, The Principles and Practice
of Medicine (London, Y. J. Pentland, 1892) P. 304.
17. For some
discussion of the use of opium in childbirth, see F. A. B. Bonney, `On
the effect of opiates upon labour and after pains‘, Lancet, 2 (1844),
pp. 71-2; E. Murphy, `Lectures on the mechanism and management of
natural and difficult labours‘, ibid., 2 (1845), P. 29; J. Craig, `On
the use of opium in uterine haemorrhage‘, ibid., 2 (1846), pp. 10-12.
Case notes also provide illustrations of its use: e.g. `Case of Anne
Hoskins‘, 1827, Greater London Record Office, General LyingIn Hospital
case notes (GLI/B19).
18. Ideas of female ill-health are discussed
in L. Duffin, `The conspicious consumptive: woman as an invalid‘, pp.
26-56 in S. Delamont and L. Duffin, eds., The Nineteenth Century Woman:
Her Cultural and Physical World (London, Croom Helm, 1978). The sex
variation of mortality statistics is discussed in V. Berridge and N.
Rawson, `Opiate use and legislative control: a nineteenth century case
study‘, Social Science and Medicine (1979).
19. J. Ferriar, Medical Histories and Reflections (London, Cadell and Davies, 2nd edn 181o), pp. 136-7.
20. J. Connolly, `Clinical lectures on the principal forms of insanity‘, Lancet, 2 (1845), P. 526.
21. W. Smith, `Practical observations on the treatment of insanity‘, Medical Times and Gazette, 20 (1849), pp. 197-9.
22. H. Maudsley, `Opium in the treatment of insanity‘, Practitioner, 2 (1869), pp. 1-8.
23.
T. S. Clouston, `Observations and experiments on the use of opium,
bromide of potassium and cannabis indica in insanity, especially in
regard to the effects of the two latter given together‘, British and
Foreign Medico-Chirurgical Review, 46 (1870), pp. 493-511; 47 (1871),
pp. 20320.
24. F. E. Anstie, `On certain nervous affections of old
persons‘, journal of Mental Science, i6 (1870-71), pp. 31-41;
`Psychological medicine‘, ibid., 20 (1874-5), PP. 224-35.
25. J. C.
Mackenzie, `The circulation of the blood and lymph in the cranium
during sleep and sleeplessness, with observations on hypnotics‘,
Journal of Mental Science, 37 (1891), pp. 18-61. 26. J. Pereira, op.
cit., p. 1304.
27. `Case of Thomas Jones‘, 1850, Dr Todd’s cases, King’s College Hospital case notes.
28.
T. Laycock, `Clinical illustrations of the pathology and treatment of
delirium tremens‘, Edinburgh Medical Journal, 14 (1858-9), pp. 289305;
G. Johnson, `On delirium tremens, its symptoms, pathology and
treatment‘, Lancet, r (1866), pp. 419, 449, 607, 712.
29. F. E. Anstie, `Alcoholism‘, p. 88 in J. Russell Reynolds, op. cit., vol. 2 (1868).
30. `Cambridge Medical Society‘, Lancet, r (1882), p. 65.
31.
These conclusions are based on an analysis of prescription books from
London, Manchester and Yorkshire. Prescription book of an Islington
chemist, Wellcome Library Mss. 3875-3993; Manchester prescription book,
Wellcome Ms. 6471; Prescription book of George Daniel, chemist of
Holloway Road, Wellcome Ms. 2033; Prescription book of William
Armitage, Wellcome Ms. 978.

next

 

 

Schreibe einen Kommentar