Introduction
In the Arms of Morpheus
Sleep had a thousand sons, and of that number He made the choice of waking Morpheus. -- Ovid, Metamorphoses
How fitting it is that Morpheus, the god of dreams, should inspire the naming of morphine, one of the most powerful sleep-inducing, dream-making drugs ever known. Ovid immortalized Morpheus as somnolence personified in Metamorphoses, and from then on he was used as a metaphor for repose. The only son of Somnos, the god of sleep, Morpheus was able to take the shape of a man, thus tying into the Greek word morphi, meaning having form. The image of a being who steals over us to close our eyes and bring us rest has had a number of incarna tions, including Somnos, Hypnos, Brother of Death and even good-natured Mr. Sandman.
Morphine is opium's principal alkaloid, or active ingredient, and is present in all opium, regardless of where it has been grown or how it has been processed. Opium, the dried sap of the poppy Papaver somniferum, consists of over two dozen alkaloids; of these, only morphine and codeine have medicinal significance. Without morphine, and to a lesser extent codeine, opium's effectiveness would be nearly nonexistent, as would its addictiveness; few substances on this earth provoke dependency as thoroughly as morphine.
Opium in its raw state is dark brown, bitter tasting and gummy. It can be eaten, mixed in flavored beverages or made into tinctures, syrups, pills or plasters. Or it can be processed for smoking. Morphine in its isolated form is a white crystallized salt that can be dissolved or melted for use in medicines that are swallowed or injected.
Whereas opium has been recognized for its medicinal attributes for at least 2500 years, morphine was not isolated and identified until the first decade of the 1800s. Before that time, making and prescribing opium medicines took some guesswork because the morphine content in opium varies so much -- from 3 to 17 per cent. Although the substitution of pure morphine for opium produced medicines that were more powerful and reliable, opium continued to be an important ingredient throughout the nineteenth century.
Opium -- and thus morphine -- was the key component in an astounding number of medicines, both reputable and quack. One of the most popular of these was laudanum, or tincture of opium, a potent mixture of wine, opium, saffron and cinnamon. The medicine of choice of nineteenth-century writers, artists and ordinary folk, not only was laudanum legitimate, it had an allure all of its own. But there were hundreds of cure-alls that were unmitigated shams. These were the infamous patent medicines, which, contrary to their name, were rarely patented, had little or even negative medicinal value and were made from anything with a therapeutically bad taste or a scientific or exotic name. Opium surfaced in countless elixirs created between 1700 and 1906, because it gave the semblance of a cure. And, as a plus for manufacturers, it left customers with a yen for more.
All opium medicines, whether they are made from opium or refined morphine, are used against pain, coughing or diarrhea. It is now known that morphine, and thus opium, inhibits pain and produces calm by attaching itself to receptors on certain nerve cells in the brain. These receptors already produce similar but natural narcoticlike substances known as endorphins, sort of homemade pain relievers. So the body, accustomed to its own, albeit not as effective, form of painkiller, recognizes and welcomes the morphine molecules. Once established in the brain, morphine controls pain, coughing, vomiting, euphoria and states of wakefulness. It also works separately on the gut, freezing the muscles in the intestines and thereby controlling bowel movements. Altogether morphine can provoke flushing, sweating, constipation, itchiness, nausea, sleepiness, restlessness, anxiety and shortness of breath.
A quantity of opium sufficient to dull the agony of a toothache will usually produce little more than a mild numbness followed by a deeper than usual sleep along with a slight costiveness in a person who has no need of pain relief. A larger dose may produce nausea or an overwhelming sleepiness or inexplicable restlessness. Those unaccustomed to taking morphine have a higher risk of overdosing than those who take it habitually. The more one is accustomed to taking morphine, the larger the quantity required just to feel normal. An overdose, in any of morphine's forms, including raw opium, can result in death.
Accidental overdoses are rarer than morphine's other side effects, which are universal and almost immediate. To some, the most distressing is the speed with which constipation sets in, followed by even more distressing rapid relief when the drug is stopped. And although opium usually induces sleep, that sleep is often disturbed, the restlessness carrying over into the waking hours. In some, morphine causes insomnia. As well, the appetite tends to fall off, and though the drive for sex at first increases, this is temporary; interest and ability soon plummet. These conditions disappear once the opium is cleared from the body.
A fascinating question, for which there seems to be no set answer, is how long does it take to become addicted to opium? Most observers agree that it depends on the frequency and strength of the doses, the way it is administered, the severity of the ailment for which it has been prescribed and the ease with which the individual develops dependencies. An addiction to laudanum, which came in varying strengths, takes longer to develop than an addiction to morphine injections. Opium in the former instance is diluted in three ways: it is raw opium, which has an average morphine content of 10 per cent; it is added to another ingredient, wine; and once swallowed, it is mixed with gastric juices. With morphine injections, 100 per cent morphine is introduced into the body and travels directly to the brain without any dilution along the way.
Morphine puts the patient at ease while -- it is hoped -- a cure is underway, but if the malady has not been dealt with by the time the patient stops taking the drug, the symptoms return. In the meantime, the patient has been experiencing a sense of wellbeing but needs increasing amounts of morphine to maintain that euphoria; in other words, the patient develops a tolerance to the drug. When attempts are made to stop using it, the intense craving for the drug that develops brings its own physical suffering. Whether it's called morphinism, morphinomanie or morphiumsucht, it's the same thing, an addiction, or an insatiable desire for morphine. Fortunately, today, since other, nonaddictive drugs are available, morphine is limited to short-term use and to palliative care, and dependence on it through medical application is rare.
Never confuse the opium-smoker with the opium-eater. Quite different phenomena. -- Jean Cocteau
My previous book Opium: A Portrait of the Heavenly Demon considered popular attitudes towards opium smoking up to 1930, before and just after narcotic possession became illegal throughout the West. This book examines attitudes towards medical preparations of opium during the same time period. Although medicinal opium was used and abused around the world, my emphasis is on Europe and North America.
The seemingly indiscriminate use of medicinal opium in the past is a complex subject, at times incomprehensible to our current sensibilities. Why did all of those doctors prescribe such addictive medicines? Why did all of those mothers drug their children? It's easy to take a critical point of view, but we'd be on rocky ground if we were to censure this behavior. Before the twentieth century, those who were ill had little choice but to turn to a substance such as opium. At least three conditions paved the way for this situation. First, opium was a vital means of coping with cholera, dysentery and tuberculosis, diseases borne of horrific living condit
