THE OPIUM
QUESTION.
By Surgeon-Captain Patbick
F.R.C.S.E., Lecturer
on
D.P. H.
Hehib, m.d., f.r.se., (CAMB.),
Medicine and Pathology, Medical School.
Hyderabad
I have been twenty years in India during which time I have filled a number of offices, and have had many opportunities of seeing opium used under almost every conceivable circumstance.
It
not
until
coming brought
to
Hyderabad, howinto intimate daily opium-eater in his home. Those who are familiar with the inner life of Hyderabad know that the busy medical practitioner of these parts has exceptional opportunities of acquiring a good knowledge of every phase of the opium habit. It is as a private practitioner that most of one's experience has been gained, and a very large share of the opinions expressed in this memorandum are based 011 the results of direct personal observation on private patients. As regards the local causes of the opium-habit, was
ever, that I was contact with the
?tradition, tion, race,
custom, example, age, &c., all
sex,
parts.
disease,
occupa-
play important
In Hyderabad, the assignable reasons beginning the consumption of opium and
for the may be embraced under
classes of opium-eaters, the following five main headings :? (1) Those who consume it entirely for the and the peacepleasurable sensations it induces, ful calm and exhilaration it imparts. Those who take it for its aphrodisiac pro-
(2) perties. (3)
as
a
Those who take it
protection against
as a
physical stimulant,
cold and climatic influ-
ences.
Those who have not altogether acquired the habit, but take it (a) for the relief of pain or bodily ailment, or (b) because of its effects during abnormal exertion; (c) those who take it to enhance the pleasure of living after a certain it under the belief acre; those who consume (d) and that it prolongs life; (e) those who take it
(4)
general prophylactic against disease. (5) Infants and children to whom it is administered to ward off disease, or to keep them quiet. Children are given it as a prophylactic against malarial affections, pulmonary or bowel complaints, or to keep them quiet; in the former as a
way it is of great value in these parts. From general observations I would express the opinion that, taking the chief classes of the 28
INDIAN MEDICAL GAZETTE.
170
community separately,
eaters in
Hyderabad
the
Amongst Mahomedans Do.
Hindoos
Do.
Pariahs, an
follows
...
...
and
of
opium-
:?
12 per cent. 7 ?
other
castes
Giving
proportions
are as
average of
...
...
5 8
?
,,
in all classes
collectively.
corresponds with the experience of I made my most practitioners in Hyderabad. observations on 100 of each class, with the above This ratio
The observations were of course inresults. sufficient to be statistically reliable or scientifically accurate and trustworthy, but in the absence of any other data, these figures provide us with a rough estimate of the proportion of opium-eaters in these parts. From the foregoing statement it may be inferred that the habit is widespread amongst all classes ; it is likewise so amongst both sexes and There is only one epoch of human at all ages. life in which the Hyderabad population do not use it?from the age of about 2 or 3 years to With this exception all ages, that of 18 or 20. from the youngest infant to the centeuariau, use
opium habitually.
It is in the effects of opium that we have the powerful incentive to the continuance of The consumer fiuds that it inthe opium-habit. creases his powers of endurauce, that he can perform greater feats of physical strength without feeling fatigue than he could do previously. Amongst Mahomedans there are more opiumeating women than men, aud especially is this so amongst the better classes. If necessary one could adduce a long array of figures in proof of In this connection it may the statement made. suffice to give the experience, of one day's work in some local zenanas, and I take that of to-day (the 7th February 1894) to illustrate and support the assertion. I visited 4 zenanas. In the first there were 14 women; 5 were ladies and 9 maid-servants. Four of the former and 6. of the latter ate opium in daily quantities varying from 2 to 10 grains. In the second there were 2 ladies and 5 maid-servants. One of the former and 3 of the latter ate opium, in doses varying from 3 to 13 grains. In the third there were 3 ladies and 7 maid-servants; of the former 1, and of the latter 3, ate opium, in quantities from 3 to 9 grains a day. In the last there were 7 ladies and 15 servant-women; of the former 5, and of the latter 7, indulged in the drug in quantities varying from 3 to 12 most
grains only.
The greater
of the habit in women arises partly from the custom of polygamy amongst Mahomedaus, but the main factor is undoubtedly the wearisomeness of zenana life. When this is the cause they take it in comparatively large quantities, consuming from 8 to 15 grains a day, although the vast majority take less than 10.
?
1894
In the history and origin of the opium-habit in Hyderabad, it is important to mention that the Hyderabad territory was once a great opiumgrowing country,?especially the Telinganah District. In those days there was no restriction upon the sale of opium, and as it was very much cheaper, the use of opium was much more widespread, and altogether greater encouragement was given to the opium-habit. In the year 1880, a change occurred in the method of sale, but the influence of past times on the habits of the people (especially in zenana life, where traditions are, in a certain sense, consecrated and handed down from generation to generation without the least deviation) could not be altogether eradicated in a day. This history connects opium in Hyderabad with many virtues, especially its influence upon the preservation of the health of infants and young children, its protection from colds, its prophylactic influence against malarial diseases, bronchial affections, dysentery and diarrhoea; its ability to prolong life after the age of 40, this effect, indeed, having passed into the proverb assa-e piri (staff of old age); and its capacity to endue the consumer with renewed vigour. The average quantity of opium consumed by all people and classes is about 8 grains a day, half in the morning and half in the evening. O O 1 would take the liberty of stating and emphasize the statement that the foregoing remarks deal with matters of daily observation into which the smallest element of doubt does not enter. In some families it is given to all children from the age of one month up to that of two or three years, as a matter of custom. In others, it is given to certain infants only, after they show signs of a predisposition to intestinal ailments,
general weakness, susceptibility
to
fever,
In all such other infirmity. cases, however, it is given because it is supposed to have the effect of wardiug off disease in one form or other. Amongst the coolies, ryots, pariahs, and labouring classes generally, it is giveu to keep the infants quiet, especially is this so when the mothers are obliged to be out working the greater part of the day. Indeed this is the prototype of what is now so very prevalent in a number of the manufacturing centres in England, such as Manchester, Sheffield, Leeds,
cold,
or
to
some
etc.
If we take into consideration the hundred and dangers to which human life, especially infant life, is exposed in Hyderabad amongst the lower classes, we wonder that so many survive the infant stage ot existence. Living in a mud hut with the common soil as the floor (there being no foundation or basement), which is on the level of the surrounding ground, with no windows and only one door, and that of such dimensions that a man of ordinary size has toone
frequency
[May
May
HEHIR ON THE OPIUM QUESTION.
1894.]
stoop down to get in, the wall is only four or five feet high, and the roof a rotten thatch which leaks in the rains, lets in the heat in the summer, and does not keep out the cold in winter, with one cotton garment as the sole raiment of the suckling ; fed by a mother who is herself in poor health and has all her energies wasted in physical labour; surrounded by material and unwholesome filth, breathing a foul atmosphere charged with the products of the putrefactive decomposition going 011 in a soil charged with animal aud vegetable organic matter?it is indeed how the progeny of this class surstrange
vive infancy. In regard to the methods and periods of consumption there are four classes of opium-eaters in Hyderabad: (1) The confirmed opium-eater who takes his dose regularly every morning and evening. This is by far the most common class. (2) The habitue who takes one large pill at ?
mid-day. (3) The occasional
who takes it when he feels inclined, a class corresponding with the ordinary cigarette-smoker in the use of his cigarettes. (4) The habitue who takes small quantities several times a day as the effects wear off, a class comparable with our alcoholic " tippler." These people are always more or less under the effects of the drug. We cau emphatically state that opium under uo circumstances produces disease of any kind, and that instead of shortening, it increases the length of life, and that instead of increasing, it decreases the mortality of its consumers. The habit of opium-eating is most seductive? perhaps, after cocaine, the most fascinating drug in its effects, known. Besides this, the habit is acquired after a comparatively few doses of the drug have been indulged in. No matter in what form the drug is administered or for what reason the consumption is begun, the establishment of the habit is very speedily induced ; although certain preparations of opium appear to be more alluring than others in this respect. Thus it is well known that the habit of taking morphine is more rapidly induced than is that in connection with the other preparations of opium. Opium is taken as a stimulant, much as we take beer, etc. It is consumed for its exhilaraconsumer,
whenever he thinks of it,
or
ting properties. Physical degeneracy and moral debasement are conditions foreign to the opium-eater?when seeking examples of these states in the human being, the abuser of alcohol, the corpulent glut-
other classes may be investigated with than the opium-eating class. The opium-habit has now passed through many generations, but it has failed to produce any modification in the physique and physical power, or ton and
more succoss
171
iii the activity of mind and moral tone, of those who have indulged in this harmless agent. Opium alleviates many of the painful ailments due to existence in a tropical climate; it removes that despondency and melancholy which a hot climate is at times prone to initiate, it allays mental anxiety and weariness; it removes physical exhaustion and nervous depression, substituting for these a complete change by introducing pleasurable sensations and an indescribable feeling of contentment, together with renewed physical energies and activity of mind. If a man is in a state of excitement or of mental irritability it tranquillizes him, it he is in his ordinary state of health it tends to bring out the finer feelings of his nature, to call forth his virtues, aud render more obscure his evil
tendencies. With all this, is it to be can
it
possible, we ask, for opium predispondent to crime? In no sense be compared with ganja or alcohol in this
a
respect.
All labourers tell us that the taking of opium enables them to go through a hard day's work It is their stiwithout fatigue or exhaustion. mulant?with it they go through their labour
cheerfully.
far the most powerful stimulant centres of ideation, will, and memory we possess if we except cocaine, but its effects in this respect are much more lasting than those of cocaine. In speaking of mental excitement, we mean that form of stimulation which may be made mental toil, in use of in conducting severe dealing with difficult questions, writing on abstruse subjects, and so 011; and in this respect opium does good without ulterior harm. It does not give rise to the wild delirium and absence of co-ordinate thought produced by cannabis indica, nor does it remove the keen edge of perceptibility in the way that alcohol does. The erroneous idea, taken from the Chinese opium dens, that the opium-eater of Iudia is always sleeping or in a sleepy state, is quite a mistake. He sleeps the usual 6 to 8 hours, according to his natural wants, and 110 more. Indeed to the opium-eater opium is never a narcotic. It keeps him awake, aud if he wishes to sleep he allows the effects to abate considerably, before attempting to do so. The opiumeater is, as a rule, an active energetic being, capable of going through any amount of physical or mental labour, and in a competition, whether it be physical or mental, would defeat A widespread his non-opiifm eating confrere. but erroneous belief has got abroad that the opium-eater is a slave to inactivity, he is pictured as sitting and nodding perpetually, or sleeping whilst working, and so on ; whereas the reverse is the case, all these conditions and statements might apply ichilst he is not under its to
Opium
is
by
the cerebral
172
INDIAN MEDICAL GAZETTE.
[Mat
1894.
influence, but not otherwise; indeed in the distension of the bladder, will cause contraction of the cutaneous vessels, and shivering, in on opium-eater they are altogether absent. We believe that error3 in feeding of every suffering from such poisoning. Opium appears day life, both of the indigenous population and to be useful in such conditions probably by lesEuropeans, do far greater injury than the effects sening the excitability of the general vaso-motor of opium?that for example, the daily consumpThis exalted condition of irritability of centre. tion of large quantities of chillies, of pounds of the general vaso-motor centre is one very comsolid meat, &c., does infinitely more harm than monly met with in Hyderabad and its suburbs, and beiug the determining cause of many of the opium consumed in the ordinary way. Proportionately to the facility with which the cases of ague met with, we may often ward off opium-habit is established, is its relinquishment attacks of ugue by giving sedative doses of opium difficult, and the difficulty increases in direct to lessen those chemical, vital, functional or metaratio to the period it has been indulged in and bolic changes in the protoplasmic constituents of the quantity consumed. ganglionic cells of this special centre, and thereOpium has now been used habitually long by keep the blood at the surface, a condition enough in this country to ascertain whether it incompatible with the manifestations of an attack is capable of acting injuriously or otherwise of ague. I believe it to be a fact that in 60 per cent, of upon the people. It has been taken for many generations and the houses in Hyderabad and its suburbs at the if it had any special tendency to produce a depresent moment, opium, or some preparation of
generacy in the race, this would have shown itself long a
QUESTION.
By Surgeon-Captain Patbick
F.R.C.S.E., Lecturer
on
D.P. H.
Hehib, m.d., f.r.se., (CAMB.),
Medicine and Pathology, Medical School.
Hyderabad
I have been twenty years in India during which time I have filled a number of offices, and have had many opportunities of seeing opium used under almost every conceivable circumstance.
It
not
until
coming brought
to
Hyderabad, howinto intimate daily opium-eater in his home. Those who are familiar with the inner life of Hyderabad know that the busy medical practitioner of these parts has exceptional opportunities of acquiring a good knowledge of every phase of the opium habit. It is as a private practitioner that most of one's experience has been gained, and a very large share of the opinions expressed in this memorandum are based 011 the results of direct personal observation on private patients. As regards the local causes of the opium-habit, was
ever, that I was contact with the
?tradition, tion, race,
custom, example, age, &c., all
sex,
parts.
disease,
occupa-
play important
In Hyderabad, the assignable reasons beginning the consumption of opium and
for the may be embraced under
classes of opium-eaters, the following five main headings :? (1) Those who consume it entirely for the and the peacepleasurable sensations it induces, ful calm and exhilaration it imparts. Those who take it for its aphrodisiac pro-
(2) perties. (3)
as
a
Those who take it
protection against
as a
physical stimulant,
cold and climatic influ-
ences.
Those who have not altogether acquired the habit, but take it (a) for the relief of pain or bodily ailment, or (b) because of its effects during abnormal exertion; (c) those who take it to enhance the pleasure of living after a certain it under the belief acre; those who consume (d) and that it prolongs life; (e) those who take it
(4)
general prophylactic against disease. (5) Infants and children to whom it is administered to ward off disease, or to keep them quiet. Children are given it as a prophylactic against malarial affections, pulmonary or bowel complaints, or to keep them quiet; in the former as a
way it is of great value in these parts. From general observations I would express the opinion that, taking the chief classes of the 28
INDIAN MEDICAL GAZETTE.
170
community separately,
eaters in
Hyderabad
the
Amongst Mahomedans Do.
Hindoos
Do.
Pariahs, an
follows
...
...
and
of
opium-
:?
12 per cent. 7 ?
other
castes
Giving
proportions
are as
average of
...
...
5 8
?
,,
in all classes
collectively.
corresponds with the experience of I made my most practitioners in Hyderabad. observations on 100 of each class, with the above This ratio
The observations were of course inresults. sufficient to be statistically reliable or scientifically accurate and trustworthy, but in the absence of any other data, these figures provide us with a rough estimate of the proportion of opium-eaters in these parts. From the foregoing statement it may be inferred that the habit is widespread amongst all classes ; it is likewise so amongst both sexes and There is only one epoch of human at all ages. life in which the Hyderabad population do not use it?from the age of about 2 or 3 years to With this exception all ages, that of 18 or 20. from the youngest infant to the centeuariau, use
opium habitually.
It is in the effects of opium that we have the powerful incentive to the continuance of The consumer fiuds that it inthe opium-habit. creases his powers of endurauce, that he can perform greater feats of physical strength without feeling fatigue than he could do previously. Amongst Mahomedans there are more opiumeating women than men, aud especially is this so amongst the better classes. If necessary one could adduce a long array of figures in proof of In this connection it may the statement made. suffice to give the experience, of one day's work in some local zenanas, and I take that of to-day (the 7th February 1894) to illustrate and support the assertion. I visited 4 zenanas. In the first there were 14 women; 5 were ladies and 9 maid-servants. Four of the former and 6. of the latter ate opium in daily quantities varying from 2 to 10 grains. In the second there were 2 ladies and 5 maid-servants. One of the former and 3 of the latter ate opium, in doses varying from 3 to 13 grains. In the third there were 3 ladies and 7 maid-servants; of the former 1, and of the latter 3, ate opium, in quantities from 3 to 9 grains a day. In the last there were 7 ladies and 15 servant-women; of the former 5, and of the latter 7, indulged in the drug in quantities varying from 3 to 12 most
grains only.
The greater
of the habit in women arises partly from the custom of polygamy amongst Mahomedaus, but the main factor is undoubtedly the wearisomeness of zenana life. When this is the cause they take it in comparatively large quantities, consuming from 8 to 15 grains a day, although the vast majority take less than 10.
?
1894
In the history and origin of the opium-habit in Hyderabad, it is important to mention that the Hyderabad territory was once a great opiumgrowing country,?especially the Telinganah District. In those days there was no restriction upon the sale of opium, and as it was very much cheaper, the use of opium was much more widespread, and altogether greater encouragement was given to the opium-habit. In the year 1880, a change occurred in the method of sale, but the influence of past times on the habits of the people (especially in zenana life, where traditions are, in a certain sense, consecrated and handed down from generation to generation without the least deviation) could not be altogether eradicated in a day. This history connects opium in Hyderabad with many virtues, especially its influence upon the preservation of the health of infants and young children, its protection from colds, its prophylactic influence against malarial diseases, bronchial affections, dysentery and diarrhoea; its ability to prolong life after the age of 40, this effect, indeed, having passed into the proverb assa-e piri (staff of old age); and its capacity to endue the consumer with renewed vigour. The average quantity of opium consumed by all people and classes is about 8 grains a day, half in the morning and half in the evening. O O 1 would take the liberty of stating and emphasize the statement that the foregoing remarks deal with matters of daily observation into which the smallest element of doubt does not enter. In some families it is given to all children from the age of one month up to that of two or three years, as a matter of custom. In others, it is given to certain infants only, after they show signs of a predisposition to intestinal ailments,
general weakness, susceptibility
to
fever,
In all such other infirmity. cases, however, it is given because it is supposed to have the effect of wardiug off disease in one form or other. Amongst the coolies, ryots, pariahs, and labouring classes generally, it is giveu to keep the infants quiet, especially is this so when the mothers are obliged to be out working the greater part of the day. Indeed this is the prototype of what is now so very prevalent in a number of the manufacturing centres in England, such as Manchester, Sheffield, Leeds,
cold,
or
to
some
etc.
If we take into consideration the hundred and dangers to which human life, especially infant life, is exposed in Hyderabad amongst the lower classes, we wonder that so many survive the infant stage ot existence. Living in a mud hut with the common soil as the floor (there being no foundation or basement), which is on the level of the surrounding ground, with no windows and only one door, and that of such dimensions that a man of ordinary size has toone
frequency
[May
May
HEHIR ON THE OPIUM QUESTION.
1894.]
stoop down to get in, the wall is only four or five feet high, and the roof a rotten thatch which leaks in the rains, lets in the heat in the summer, and does not keep out the cold in winter, with one cotton garment as the sole raiment of the suckling ; fed by a mother who is herself in poor health and has all her energies wasted in physical labour; surrounded by material and unwholesome filth, breathing a foul atmosphere charged with the products of the putrefactive decomposition going 011 in a soil charged with animal aud vegetable organic matter?it is indeed how the progeny of this class surstrange
vive infancy. In regard to the methods and periods of consumption there are four classes of opium-eaters in Hyderabad: (1) The confirmed opium-eater who takes his dose regularly every morning and evening. This is by far the most common class. (2) The habitue who takes one large pill at ?
mid-day. (3) The occasional
who takes it when he feels inclined, a class corresponding with the ordinary cigarette-smoker in the use of his cigarettes. (4) The habitue who takes small quantities several times a day as the effects wear off, a class comparable with our alcoholic " tippler." These people are always more or less under the effects of the drug. We cau emphatically state that opium under uo circumstances produces disease of any kind, and that instead of shortening, it increases the length of life, and that instead of increasing, it decreases the mortality of its consumers. The habit of opium-eating is most seductive? perhaps, after cocaine, the most fascinating drug in its effects, known. Besides this, the habit is acquired after a comparatively few doses of the drug have been indulged in. No matter in what form the drug is administered or for what reason the consumption is begun, the establishment of the habit is very speedily induced ; although certain preparations of opium appear to be more alluring than others in this respect. Thus it is well known that the habit of taking morphine is more rapidly induced than is that in connection with the other preparations of opium. Opium is taken as a stimulant, much as we take beer, etc. It is consumed for its exhilaraconsumer,
whenever he thinks of it,
or
ting properties. Physical degeneracy and moral debasement are conditions foreign to the opium-eater?when seeking examples of these states in the human being, the abuser of alcohol, the corpulent glut-
other classes may be investigated with than the opium-eating class. The opium-habit has now passed through many generations, but it has failed to produce any modification in the physique and physical power, or ton and
more succoss
171
iii the activity of mind and moral tone, of those who have indulged in this harmless agent. Opium alleviates many of the painful ailments due to existence in a tropical climate; it removes that despondency and melancholy which a hot climate is at times prone to initiate, it allays mental anxiety and weariness; it removes physical exhaustion and nervous depression, substituting for these a complete change by introducing pleasurable sensations and an indescribable feeling of contentment, together with renewed physical energies and activity of mind. If a man is in a state of excitement or of mental irritability it tranquillizes him, it he is in his ordinary state of health it tends to bring out the finer feelings of his nature, to call forth his virtues, aud render more obscure his evil
tendencies. With all this, is it to be can
it
possible, we ask, for opium predispondent to crime? In no sense be compared with ganja or alcohol in this
a
respect.
All labourers tell us that the taking of opium enables them to go through a hard day's work It is their stiwithout fatigue or exhaustion. mulant?with it they go through their labour
cheerfully.
far the most powerful stimulant centres of ideation, will, and memory we possess if we except cocaine, but its effects in this respect are much more lasting than those of cocaine. In speaking of mental excitement, we mean that form of stimulation which may be made mental toil, in use of in conducting severe dealing with difficult questions, writing on abstruse subjects, and so 011; and in this respect opium does good without ulterior harm. It does not give rise to the wild delirium and absence of co-ordinate thought produced by cannabis indica, nor does it remove the keen edge of perceptibility in the way that alcohol does. The erroneous idea, taken from the Chinese opium dens, that the opium-eater of Iudia is always sleeping or in a sleepy state, is quite a mistake. He sleeps the usual 6 to 8 hours, according to his natural wants, and 110 more. Indeed to the opium-eater opium is never a narcotic. It keeps him awake, aud if he wishes to sleep he allows the effects to abate considerably, before attempting to do so. The opiumeater is, as a rule, an active energetic being, capable of going through any amount of physical or mental labour, and in a competition, whether it be physical or mental, would defeat A widespread his non-opiifm eating confrere. but erroneous belief has got abroad that the opium-eater is a slave to inactivity, he is pictured as sitting and nodding perpetually, or sleeping whilst working, and so on ; whereas the reverse is the case, all these conditions and statements might apply ichilst he is not under its to
Opium
is
by
the cerebral
172
INDIAN MEDICAL GAZETTE.
[Mat
1894.
influence, but not otherwise; indeed in the distension of the bladder, will cause contraction of the cutaneous vessels, and shivering, in on opium-eater they are altogether absent. We believe that error3 in feeding of every suffering from such poisoning. Opium appears day life, both of the indigenous population and to be useful in such conditions probably by lesEuropeans, do far greater injury than the effects sening the excitability of the general vaso-motor of opium?that for example, the daily consumpThis exalted condition of irritability of centre. tion of large quantities of chillies, of pounds of the general vaso-motor centre is one very comsolid meat, &c., does infinitely more harm than monly met with in Hyderabad and its suburbs, and beiug the determining cause of many of the opium consumed in the ordinary way. Proportionately to the facility with which the cases of ague met with, we may often ward off opium-habit is established, is its relinquishment attacks of ugue by giving sedative doses of opium difficult, and the difficulty increases in direct to lessen those chemical, vital, functional or metaratio to the period it has been indulged in and bolic changes in the protoplasmic constituents of the quantity consumed. ganglionic cells of this special centre, and thereOpium has now been used habitually long by keep the blood at the surface, a condition enough in this country to ascertain whether it incompatible with the manifestations of an attack is capable of acting injuriously or otherwise of ague. I believe it to be a fact that in 60 per cent, of upon the people. It has been taken for many generations and the houses in Hyderabad and its suburbs at the if it had any special tendency to produce a depresent moment, opium, or some preparation of
generacy in the race, this would have shown itself long a
