Historical Medicine

A Minor De Quincey

LOUIS J. BRAGMAN, M.D.

Syracuse, N. Y.

Medical Journal and Record
Vol. CXXI -- January to June, 1925

INTRODUCTION

In 1837, sixteen years after the master essayist, De Quincey, had produced the Confessions of an English Opium Eater , Fitz Hugh Ludlow was born in Poughkeepsie, N. Y. Upon graduation from the Union College at Schenectady at nineteen, he immediately entered into the sphere of letters. The Hasheesh Eater, subtitled Passages from the Life of a Pythagorean, written while he was a student and published in 1857 in Putnam's magazine, promptly earned for him a wide recognition.

During the following years he held various literary positions, among them that of editor of Vanity Fair from 1858 to 1860, correspondent for two successive years with the New York World, the Evening Post and the Commercial Advertiser, and, for a time, dramatic, musical and art critic for the Home Journal. He also wrote steadily for Harper's Monthly, chiefly short stories, and was one of the leading contributors to the Northern Lights, a Boston periodical. "What Shall They Do To Be Saved?" appeared in Harper's Monthly in 1867 and "The Opium Habit" in 1868. Two years later he died in Geneva, Switzerland, a victim of the self-same habit he so strenuously inveighed against.

The writings of Ludlow show him to have possessed a keen sense of humor, a remarkable insight into character, and a very refined feeling and taste. But apart from the fact that on at least three occasions he not merely touched upon but delved deeply into the vagaries and vicissitudes of the habit forming drugs, opium and hasheesh, little is known of his associations with the drugs themselves or how they affected his life and career. The following summary of his impassioned indictment against the treacherous poppy seed may perhaps shed some light on this matter.

"WHAT SHALL THEY DO TO BE SAVED?"

"God seems to help a man in getting out of every difficulty but opium. There you have to CLAW your way out over redhot coals on your hands and knees and drag yourself by main strength through the burning dungeon bars."

In this intense and vivid discourse are presented, in a masterful fashion, "a few considerations regarding the action of opium on the human system while living, and the peculiar methods by which the drug encompasses its death." The author assumes the rôle of a physician, pretending that he is treating a friend who is an extreme addict. As he sketches the rapid stages in the downfall of the pitiful victim, he makes forceful and elucidating comments on the various features of the pernicious habit.

One is inclined, however, to the suspicion that Ludlow has here recorded his own personal adventures with the drug that he calls vindictively "a corrosion and paralysis of all the noblest forms of life." The impassioned tone and pathetic strain that resound throughout, the vigorous and indisputably realistic descriptions that bespeak first hand knowledge, capped with the fact above mentionetl that he died at thirty-three of the opium habit, afford ample ground for such an assumption. For it is not an uncommon occurrence for men of letters (and Ludlow was a capable and natural writer) to discuss the results of their intimate tamperings with the imagination stirring but disaster wreaking drug.

"There are certain men," he begins, "to whom opium is as fire to tow." His friend was the case in point. His first contact with the drug was a cursory one early in life. But it was not until he became afflicted with an attack of inflammation of the cornea that his indulgence began to any intensity. A doctor whom he had consulted eight years previously had prescribed, in addition to a local application to the eye, internal doses of "M'Munn's elixir" to quell the excruciating pain. This remedy was a prevailing quack preparation, allied chemically to tincture of laudanum.

When he emerged from the dark room at the end of a month and his bandages were removed, he had consumed twenty ounces of the elixir. He then began taking it at short intervals, totaling fifty drops daily, but within a month this was of necessity increased to an ounce a day. When the eye was completely healed he stopped the use of the anodyne -- but not for long. For "he had not forgotten the sweet dissolving views at midnight, the great achievements at noonday, the heavenly sense of selfreliance which dare go anywhere, say anything, attempt anything in the world. He had not forgotten the nonchalance under slight, the serenity in pain, the apathy to sorrow, which for one month set him calm as Buddha in the temple splendors of his darkened room. He had not forgotten that the only perfect peace he had ever experienced was there, and he remembered that peace as something which seemed to blend all the assuaged passion and confirmed dignity of old age with that energy of high emprise which thrills the nerves of manhood."

And so at the age of forty he found himself an habitué of eight years' standing. Whenever the world went wrong with him he resorted to M'Munn's. It soon became imperative that he increase the dose to keep his appetite satisfied. Yet even then the elixir finally proved inefficient, so he changed to laudanum, "which contains the full native vigor of the drug unmodified." But this, as well as gum opium, opium pills and opium powder, which he likewise tasted, nauseated him, and he was thus ultimately "driven to that form of exhibition which sooner or later naturally strikes every opium eater as the most portable, energetic, and instantaneous -- morphine or one of its salts."

With time his daily consumption ranged from twelve to twenty grains, one half immediately after rising, the rest just about sundown. Physically at this period his body was in no way impaired, but he came to the conclusion that he "must emancipate himself, because opium eating was a horrible mental bondage."

The pleasures and dubious joys of the addiction were waning. The victim found that "the image graving and project building characteristic of opium, which comes on with a sense of general radiation from the epigastrium about a quarter of an hour after the dose, had not yet so entirely disappeared from its effect on him, as it does at a later stage of the indulgence. But instead of being an instigation to the delightful reveries which ensued on his earlier doses, this peculiarity was now as an executioner's knout in the hands of remorse. He was daily and nightly haunted by plans and pictures whose feverish unreal beauty he remembered having seen through a hundred times. Those Fata Morgana plans, should he again waste on them the efforts of construction? The result had been a chaos of ineffectual days. Those pictures, why were they brought to mock him? Were they not horrible impossibilities? Were they not, through the paralysis of his executive faculties, mere startling likenesses of disappointment? In his opium dreams he had seen his own ships on the sea; commerce bustling in his warehouse; money overflowing in his bank.... How pleasurably he had once perceived all these possible joys and powers! How undeludedly he now saw their improbable execution!"

But alas for good intentions! The physical hold of the drug by this time was too strong -- and "the spiritual thralldom was his hourly misery. Under the hand of the doctor the doses were gradually reduced, until he was taking only one half a grain a day. But nocturnal paroxysms necessitated the restoration of the original amount, for "when a man has used opium for a long time, the condition of the brain supervening on his deprivation of the drug for a period of twenty-four hours is such as very frequently to render him suicidal."

The power of the will and grim determination were handicapped from the start by the strenuous hold of the drug on the mind. It had long passed the stage of "I can" and "I will." And this is what Ludlow says on the matter of the blame: "Whatever may have been the patient's responsibility in beginning the use of narcotics or stimulants (and I usually find, in the case of opium eaters, that its degree has been very small, indeed, therapeutic use often fixing the habit before the patient has convalesced far enough even to know what he is taking), habituation invariably tends to reduce the man to the automatic plane, in which the will returns wholly to the tutelage of sensation and emotion, as it was in infancy; while all the intellectual, save memory, and the most noble and imperishable among the moral faculties may survive this disorganization for years, standing erect above the remainder of a personality defrauded of its completion to show what a great and beautiful house might have been built on such strong and shapely pillars."

The denial of the drug brought on an agony "which took his actions out of voluntary control, eclipsing the higher ideals and heroisms of his imagination at once, and reducing him to that automatic plane in which the nervous system issues and enforces only those edicts which are counseled by pure animal selfpreservation." The only recourse left was to send him to a water cure where absolute deprivation could be maintained. He was accordingly starved of his Nepenthe for ninety days during which time he knew no normal sleep. He fell into a semiconscious state and for the last fifty days sat constantly bolt upright in bed.

At the end of the treatment he was almost prostrate, in intense agony, and mentally confused. The prognosis was very gloomy, so the baneful drug was restored to him, for further struggle meant sure death. The patient's final injunction was heartrending: "It is almost like Dives asking for a messenger to his brethren; but tell them, tell all young men what it is, 'that they come not into this torment.'"

Is there then no hope? Must the note be always pessimistic? Not always, for "over the opium eater's coffin, at least, thank God! a wife and a sister can stop weeping and say, 'He's free.'"

The course on the road upward, Ludlow says further in discussing the attempted cure, is very perilous. "The records of fatal lesion, mechanical childbirth, cancerous afflictions, the stake itself, contain no greater tortures than a confirmed opium eater experiences in getting free." The recovery is to take weeks and months; "who is sufficient for this long, long pull?"

Twenty-four hours after the deprivation, the torments begin. First there is a peculiar "corded and tympanic tightness about the epigastrium then a feverish condition of the brain which sometimes amounts to absolute phantasia." Following this occur periods of increasing excitement marked off by heavy sleep, which after each interval "grows fuller of tremendous dreams, and breaks up with a more intensely irritable waking." In forty-eight hours the heavy sleep disappears. "Every nerve in the entire frame now suddenly awakens with such a spasm of revivification that no parallel agony to that at this stage can be adduced." This horrible state continues for a week with neither lull nor exhaustion.

A pronounced and significant phenomenon, we are told, has now supervened. After the third day, "profuse and increasingly acrid bilious diarrhea occurs, which must not be checked if diagnosis has revealed sufficient constitutional vigor. The spontaneous termination of the diarrhea will indicate that the effete matters we must remove have been eliminated." Soon after this there is a mitigation of the pain, followed by great debility.

Subjectively, the agony of the struggle is very pronounced. There is a "dull, aching sensation between the shoulders and in the region of the loins. The most intense gastric irritability appears in the form of an aggravation of the tympanic tightness, corrosive acid eructations, heartburn, water-brash, and a peculiar sensation, as painful as it is indescribable, of selfconsciousness in the whole upper part of the digestive canal." Concomitant with the gastric sufferings, there is a neuralgic pain which spreads down the extremities from a centre between the kidneys, through the trunk, and through the "whole medullary substance of the brain, itself." Comparing the pain with that of tic douloureaux, he says that it has periods of exacerbations like the tic, but none of its continuous repose; like it, it fluctuates, but affects the entire body rather than a single area.

To heap coals on the blazing fire, there is a torturing hyperesthesia. The slightest touch hurts, the least jar aggravates, as it does a martyr to acute rheumatism. The very hair and nails feel sore, and the whole surface of the skin suffers from cold air or water "like the lips of a wound."

If bodily punishment were the entire mete, the treatment might perhaps be endured. Yet "the totality of the experience is only conceivable by adding this physical torture to a mental anguish which even the Oriental pencil of De Quincey has but feebly painted; an anguish which slays the will, yet leaves the soul conscious of its murder; which utterly blots out hope, and either paralyzes the reasoning faculties which might suggest encouragements, or deadens the emotional nature to them as thoroughly as though they were not perceived; an anguish which sometimes includes just, but always a vast amount of unjust selfreproach, which brings every failure and inconsistency, every misfortune or sin of a man's life as clearly before his face as on the day he was first mortified or degraded by it -- before his face, not in one terrible dream, which is once for all over with the sunrise, but as haunting ghosts, made out by the feverish eyes of the soul, down to the minutest details of ghastliness, and never leaving the side of the rack in which he lies for a moment of dark or daylight, 'til sleep, at the end of the month, first drops out heaven on9 his agony."

What shall the doctor do to save them? There are several lines to follow. "When the most powerful alleviative known to medical science has bestowed its last Judas kiss which is necessary to emasculate its victim, and, sure of its prey, substitutes stabbing for blandishment, what alleviative, stronger than the strongest, shall soothe such a doom? I may give chloroform. I always do in the denouernent of bad cases."

That, of course, is the ultrahumane method. The doctor might, our author tells us, speak as follows to the average case of ten years' duration:

"Sir, the chances are entirely against you, and the possession of a powerfully enduring constitution, if you have it, forms a decided offset in your favor."

He then advises immediate entrance upon the road of selfabnegation. If the case is hopeless from the start he may elaborate to this effect:

"You have either suffered a disorganization of irreproducible membranes, or you have deposited so much improper material in your tissues that your life is not consistent with the protracted pain of removing it. One by one, you have paralyzed all the excretory functions of the body. Opium, aiming at all those functions for their death, first attacked the kidneys, and with your experimental doses you experienced a slight excess of dysuria. As you went on, the same action, progressively paralytic to organic life, involved the liver. Flatulence, distress at the epigastrium, irregularity of the bowels, indicated a spasmodic performance of the liver's work which showed it to be under high nervous excitement. Your mouth became dry through a cessation of the salivary discharge. Your lactrymal duct was parched and your eye began to have an arid look in addition to the dullness produced by opiate contraction of the pupil.

"All this time you continued to absorb an agent which directly acts for what, by a parades, may be called fatal conservation of the tissue. Whether through its complexly burned nitrogen, carbon or both... the drug has starved the fires of your whole system... You have sealed up all but a single excretory passage -- the pores of the skin, and when that gives out, your body shall be shut up like an entirely choked chimney.

"The condition both of your nervous system and your stomach indicate that you must always take some anodyne to avoid torture, and your only anodyne is opium. The rest of your life must be spent in keeping comfortable, not in being happy."

A closing plea Ludlow makes anent the insidious drug which "sings to every sense a lulling song from which it may not awake for years, but wakes a slave":

"Would to God that every young person could stand for a single hour by the victim's bedside before Life's responsibilities have become the sentinels and Habit the jailer of the Will."

Buried though they are in the dust and files of nearly seventy years, these words carry today a portentous meaning. "What Shall They Do To Be Saved?" is withal a living, a truthful, and a highly authentic document.