Opium: Reality’s Dark Dream by Thomas Dormandy explores the entire history of the world’s most fascinating drug. Dormandy reveals opium’s power to relieve suffering, inspire great art and promote medical advances, but also to destroy individuals, families and even nations. Here the author provides a brief introduction to opium, outlining some of the extraordinary transformations the drug has undergone, and the effects it has had on countries throughout the world.
Author article by Thomas Dormandy
Opium bores are probably as pestilential as wine bores; and I think that over the past few years I have been a particularly virulent specimen. But I am unrepentant. Sir William Osler, Regius Professor of Medicine in the University of Oxford a hundred years ago called the drug God’s own medicine. His famous surgical colleague, William Stewart Halsted, regarded it as a diabolical curse. Differences of opinion about a medication are common; but such extremes could apply only to one. And the opinions were – and are – both right. No other substance has relieved so much suffering. None has destroyed so many lives.
Despite being hard to produce, opium is also one of the oldest drugs known to man. To discover its approximate coeval, alcoholic fermentation, only needed a heap of rotting fruit, a few hours of sunshine, and an experimentally inclined cave-man or cave-woman. To cultivate the white poppy, to scarify its pod in the right way at the right time, to collect the seepage in the correct manner and then to pass it through a complicated process of drying and purification was always a backbreaking task requiring patience and expertise. And yet credible evidence suggests that the discovery was made during the so-called Neolithic Revolution at least 10,000 years ago, during the transition from a hunting-gathering-nomadic lifestyle to an agricultural, animal-breeding, and socially organised existence. The poppy fields around Thebes, today’s Luxor, in Egypt were famous and a source of immense wealth to the pharaohs; and once discovered, the drug never disappeared. During the darkest Middle Ages when no opium was grown and consumed in Western Europe, it was the therapeutic stand-by of the great Islamic and Jewish physicians. It trickled back with the Crusades and under the name “laudanum” it became famous again in Europe by the mid 18th century.
That fame too was unique. Laudanum inspired poets, musicians, writers, politicians – and it destroyed many. It served as the Countess’s suicide potion in Hogarth’s Marriage a la Mode and it precipitated the wars in India which laid the foundations of the Raj Clive, the best of the British generals, became an addict. And when the Industrial Revolution brought a devastating upsurge of tuberculosis that spread through Europe and across the Atlantic, nothing but opium eased the suffering of the likes of Keats, Shelley, Novalis, Schiller, Thoreau, the Duke of Reichstadt, the real and first stage Lady of the Camelias, Chopin, Chekhov and countless others more or less famous but equally stricken. But opium was always more than a pain-killer. Its introduction to China by European, mainly British merchants, became a debilitating national addiction. The two opium wars motivated by pure greed were fought to allow the free entry of the drug into Celestial Kingdom and at home laid the foundation of many Victorian fortunes.
In the meantime two technical innovations transformed the opium scene. First, a young German pharmacist, Wilhelm Serturner, with no academic qualifications but with fanatical determination realised the dream of centuries and isolated the active principle in opium, the alkaloid morphine. But the discovery was tinged with disappointment. It had always been hoped that the pure substance would be without the undesirable side-effects of the parent drug, especially its addictiveness. The opposite proved to be true. Second, a surgeon in Lyon in France named Pravaz devised the subcutaneous syringe and hollow needle. A devout Christian, he used his invention – he possessed only one made of silver and platinum which he carried in a special compartment of the lining of his top hat – to inject the varicose veins of working-class women in factories with a coagulating fluid. A friend, a fashionable physician in Paris, saw the device’s potential and began to inject morphine into aristocratic and even imperial buttocks. It made his fortune; but in many languages it was “pravaz” which became a synonym of morphine injections.
The wars of the mid century – the Crimean, the American Civil War and the wars of the Resorgimento in Italy – became show cases of the drug’s incomparable value as a reliever of suffering but also of its stranglehold on those who became addicted. Not all of the latter became notorious. Florence Nightingale used morphine in Scutari not only on her patients but also on herself: “I could not have got through the day without this wonderful little pick-me-up”. The Iron Chancellor, Otto von Bismarck never ventured into the Chamber without fortifying himself with a hefty dose. Robert Browning used “morphine” as an endearment when writing to his Elizabeth.
In 1896 the discovery of the diacetylated form of morphine, better known as heroin, repeated the morphine saga. For at least ten years it was marketed as a harmless but extraordinarily effective cough mixture – the latter claim was true – and even as a cure from the morphine and opium habit. Encouraged by the manufacturers charitable organisations sent large quantities to missionaries in China to treat the opium addiction of their flock. There the drug became known as “Jesus Opium”.
Throughout the 20th century, including the two world wars, the cold war and the Vietnam War, opium, morphine and heroin continued to play a central though often hidden role. It is still one of the root causes of the conflict in Afghanistan though it is now recognised that to eradicate a crop on which the livelihood of a large proportion of the population depends and winning hearts and minds will never be easy. And every year the drug is conquering new lands and its use is increasing. In the West the debate about how best to deal with it continues: decriminilise or zero tolerance or something in-between?
The book which I am offering does not pretend to be exhaustive; but nor has it a hidden agenda. The use of heroin in palliative care remains one of the blessed advances of the 20th century. The destruction of millions of young people and their families one of its grimmest legacies. And what of the future?
Thomas Dormandy, MD, is consultant chemical pathologist and retired professor of chemical pathology at the Whittington Hospital, University of London, and Brunel University, London. He is the author of the prize-winning book The White Death: A History of Tuberculosis (1998) and The Worst of Evils: The Fight Against Pain, published by Yale in 2006.
Opium: Reality’s Dark Dream is available now from Yale University Press.