7

`A Peculiar Sopor'

Opium Poisoning and the Longevity Debate

Reconstruction of patterns of opium use must always be tentative, yet it is clear from the preceding chapters that the availability of the drug in the first half of the century was rarely seen as a 'problem'. From the 1830s, however,-the beginnings of a change were discernible, at least in official and professional attitudes. A climate of opinion began to emerge in which opium use was no longer regarded as an everyday part of life for all sections of society. Instead, the drug's easy availability and the effects of this began to cause concern. Among the first indications was the attention paid to--opium by those involved in the mid-century public health movement, and it is with the place of opium in the general spectrum of public health at that time that the following two chapters will deal. Later chapters will show how, as the century wore on, more restrictive attitudes and practices appeared, with the classification of opium users as deviant from the norms of established society and opium itself as a problem drug.
This is a central issue. How could a drug which was openly available, was quite calmly accepted in many areas and was of proven utility come to be seen in such a different way? Was opium set within a problem framework because of the dangers of its use? Was the drug itself, with its inherently dangerous properties, the motive factor - or were other interests and strategies at work? The mechanics of establishing a problem where none had previously been thought to exist are clearly illustrated in the case of opium. It is tempting simply to see the development of a problem of opium use and resultant controls as an illustration of reform at its most benign. Indeed it is possible to present the public health and increased general concern about opium in a way which emphasizes health dangers and the response of the medical and pharmaceutical professions. But this is, at best, a one-dimensional outlook. What went to define a `problem' were fundamental changes in social structure. The class tensions of an industrializing society had their impact as the scare about working-class opium use described in Chapter 9 makes clear. The emergence of a clearly defined medical profession was to be one of the key issues, too, in changed perceptions of opium use (this is dealt with in Chapters 10-t3). As medical organization consolidated (and medical discoveries and remedies__ proliferated), doctors became more closely involved in the use of opium. Their own position altered. From being one among many prescribers of the drug, with nothing approaching unitary control, they began to re-define opium use as solely a medical matter, within a problem framework. Opium eating, under this medical imprint, became a disease, a habit warranting medical intervention. Doctors became the custodians of a problem which they had helped define. But it is important to see the role of the profession in this sense not simply as one of conspiratorial plotting, out to grab control of the drug for self-interested ends. The position was more complex than this. The attitudes of the profession (so far as it can ever be classified under such a unitary term) arose themselves out of the structural changes which were producing such middle-class groups; doctors, in their perception of opium _ use, as of other conditions, were reflecting and expressing the outlook of that section of middle-class society of which they formed an increasingly important part. This point will be discussed further in Chapter 13 dealing with medical disease theories of opium use.


Opium overdoses

This is not to deny that unrestricted opium did present problems. The dangers from a public health point of view were significant and the reformers involved in the sanitary movement did much to publicize opium as a `dangerous drug', in particular because of the high rate of accidental opium overdoses. But these fatalities were themselves a function of a society where alternative and regular health care was mostly lacking. Indeed, given the social and cultural context of, opium use already described, the level of mortality related to frequency of use was probably not high. However, the campaign for reform did not see it in this light, and open availability and the level of poisonings became a minor, if significant, part of the mid-century public health movement. Case histories in the medical journals, the evidence of the famous inquiries into social conditions in the 1840s and 1860s and those into the sale of poisons and pharmaceutical organization in the 1850s and 1860s established opium as a public health problem.
The theme of professional control was implicit in the public health campaign; for self-regulation among pharmacists, and doctors in particular, was important in bringing about increased involvement in social issues of this type. Public health was never an autonomous entity; and the move to end or reduce opium poisoning was also part of the professional movement of the 1850s and 1860s, which will be described more fully in Chapter 10. The concern about opium deaths was in another sense a form of professional selfdefinition and a validation of a doctor's expert status. Opium was -a-concern, albeit a quite minor one, for the leading public health campaigners. Edwin Chadwick mentioned the drug's use to the inquiry into drunkenness in 1834 and again in his own famous Report on the Sanitary Condition of the Labouring Population (1842).1 Dr Southwood Smith, Chadwick's collaborator, considered the abuse resulting from open availability in his report on the industrial districts for the Commission inquiring into large towns in the early 1840s.2 But mostly it was the medical contingent who brought opium to the fore. The marginal position of doctors at this period was often expressed in active support for social issues. The profession had not yet established its status to the extent that it could subside into conservatism. The public health movement was a cause which attracted many medical men; and the case of opium offered special medical scope. It was particularly through the reports made to Sir John Simon as Medical Officer to the Privy Council in the 1860s that the issue of opium overdosing was highlighted. The reports of Dr Edward Greenhow and Dr Henry Julian Hunter on infant mortality were among the first consistent medical investigations of adult as well as infant mortality from opiates .3 The reports of Dr Alfred Taylor, Professor of Medical jurisprudence at Guy's, on the dispensing 0f poisons, and his evidence to parliamentary select committees on the sale of poisons in 1857 and 1865 further demonstrated the force of professional involvement.'
Notable in the opium campaign was an embryo alliance between the professional sections agitating for reform and the as yet small sector of administration in government. The type of co-operation which was to characterize narcotic policy when it was established in the 1920s and which continues to operate today was already at mid century in the process of formation. For professional arguments on opium poisoning were supported by a clear emphasis on statistics, and the Registrar General's office, established in 1837, as one of the first central government agencies, provided the `scientific' basis on which the medical and public health case was based. There were earlier localized collections of figures on opium deaths. The returns made to coroners of deaths from opium poisoning in 1838 and 1839 were the most obvious example. But the main_ thrust of the public health campaign came with the national Registrar General's reports. Opium statistics were used as public health propaganda. The support which they gave to the medical case (Dr Hunter, for instance, used local infant mortality rates in his report of 1864) was a first step towards an eventual alliance between medicine and the state.'
The agitation against opium began a drug-centred approach which, with modification, has continued to the present day. Concentration on simple statistical results without an awareness of social context or economic reality produced a situation which justified the restriction of open sale of the drug. Opium, as elsewhere, was the scapegoat for broader defects in the society of the time. With these reservations in mind, there is nevertheless no doubt that in absolute terms the number of opium overdoses revealed in the statistics was high. The earlier statistical discussions of opium mortality were generally inadequate. Professor Taylor, for instance, reported that of twenty-seven cases of poisoning admitted to Guy's over three years, five were due to opium. Other investigations were as piecemeal.6 But the Registrar General's series on violent deaths which began in the 1860s presented a fuller picture, despite the undoubted drawbacks of early data of this type? (Table 3, P. 275).
Significant absolute figures were revealed for opiate deaths. There were eighty deaths in 1863 and ninety-five in 1864 from laudanum and syrup of poppies alone. There were also deaths from opium, morphia and Godfrey's Cordial. In 1863, 126 deaths out of a total of 403 poisoning fatalities were ascribed to opium. Its nearest competitors that year were prussic acid, cyanide of potassium and salts of lead; these accounted for only thirty-four deaths apiece. Around one third of all poisoning deaths in the decade were the result of the use of opiates. In relative terms such statistics were less alarming. The actual opium death rate was high but, as has already been mentioned in Chapter 3, had remained apparently static over a twenty-year period. Open availability had led neither to a dramatic rise in home consumption of opium, as import data show, nor to a rapid upturn in mortality rates.
For the public health case, however, the absolute figures were the point. The high level of accidental opium fatalities was, from this point of view, a particular illustration of the dangers of ready availability. In 1863, 106 out of 126 opium deaths were accidental, 1 so out of 138 in 1867.8 Cases where a public figure was involved attracted particular publicity. The Earl of Westmorland, given a phial of laudanum by mistake by his servant in 1834, was saved only by prompt action with the stomach pumps The Bishop of Armagh was less fortunate, and his death in 1822, again from an overdose of laudanum given in mistake for other medicine, caused concern. The death of Augustus Stafford, M.P., in 1857, was also alleged, despite troubles with gallstones and a weak heart, to have been due to his injudicious use of laudanum.10
But mostly accidental overdoses were a simple fact of everyday life. Opium poisoning was a commonplace matter, not always worth medical attention. Like a stomach upset or a cold, it could be dealt with at home. Most `home doctors' included instructions for dealing with a poisoning case. Buchan's Domestic Medicine (1803) gave full instructions for blistering plasters on the arms and legs, stimulating medicines, the use of `strong vomits' and the drinking of warm water with oil to bring up the poison." Many were familiar with what Professor Christison called the `peculiar sopor' caused by an opium overdose. The person had an expression of `deep and perfect repose'. He could always be roused, even though with difficulty, but as soon as the exciting cause was removed, this lethargy returned and death often followed.
The case of Fanny Wilkinson in the shop at Guisborough mentioned in Chapter 3 could be multiplied many times over. There were also habitual users who misjudged the limits of their acquired tolerance. One such was Mary Ann Beale of Bow, an opium eater for twenty years, who died in 1869 after purchasing four scruples of opium from a local chemist.12 There were cases where occasional users took a little too much, or where those who had drunk too heavily overdosed with laudanum in an attempt to sober up.13 Availability, the variation in strength of preparations and the tradition of popular use of the drug combined to make such incidents common. In a society where a `sup of laudanum' did duty as a means of support, self-medication and substitute for medical care, their everyday occurrence was not surprising.
Opium was also a well-known means of suicide. The drug was said by Professor Christison to be favoured by the timid wouldbe suicide because of the gentleness of its operation 14 (Table 3, p. 275). Other methods were more popular - I, 234 people cut their own throats and 2,570 hanged themselves, compared to a mere 115 opiate suicides, between 1863 and 1867. Opiates, however, were the most popular poisons for self-destruction throughout the century, and the rate may well have been in reality higher. Opium was not decisively displaced from top of the list of preferred suicide poisons until the 1890s, when carbolic acid replaced it in popularity. Prussic and oxalic acid, vermin killer, hydrochloric acid and strychnine were its main rivals in the 1 860s. Arsenic was already being controlled by the Arsenic Act of 1851 and was less of a contender.
The drug was used by the famous for this purpose. Rossetti's wife, Elizabeth Siddal, accustomed to take up to one hundred laudanum drops at a time for the pain of tuberculosis and a spinal deformity, killed herself with an overdose. Rossetti himself later attempted suicide with a bottle of laudanum. Saved by inhalations of ammonia and strong coffee, he suffered for some time with partial paralysis as a result." His action found its parallels repeatedly throughout society. 16 Young girls were presented in case histories as particularly prone to opiate suicide attempts. The owner of a lodging house in Edinburgh found one of her servants in the kitchen `in a complete state of insensibility, with her eyes open...'. She had taken laudanum after a disappointment in love. Such occurrences were disposed of in a matter-of-fact way. When a nursery maid at a house in Covent Garden took half an ounce of laudanum in 1826 `in a fit of jealousy', she was pronounced fit to resume her duties after prompt action with the stomach pump."
The histories were to a certain extent misleading, for the official statistics showed that the typical opium suicide was more likely to be male than female. The male suicide rate from opium always far exceeded the female; the disparity between the two in fact grew greater as the century progressed. The female suicide rate from opium was usually about half the male rate - 0.7 per million living female contrasted to 1.4 per million male in 1865, for instance.',,
Even suicides could have their lighter side. Samuel Hillier, paymaster general in the Ninth Lancers, revealed in his farewell note of 186o the problems that committing suicide with opium could bring. Wrote Hillier, `I really believe I am poison-proof. About ten days ago I took half an ounce of laudanum, enough to poison a horse. It had no effect on me. After that I took eight grains of opium, again no effect, except a slight drowsiness. Then four grains of morphia; no effect. I then took five grains of liquor opii sedativus, with the same result.' Hillier, convinced that he was poison-proof, finally shot himself.19 Yet the question was taken seriously enough by those urging greater restrictions on availability. John Hamill, police magistrate at Worship Street, urged such moves before the Select Committee on the Sale of Poisons in 1857, not because of accidental overdosing, but because of the drug's ready availability to would-be suicides .20 He, like others, believed that legislation would affect the level of opiate suicides and suicide attempts, a belief which the post-1868 mortality rates prove to have been to a large extent unfounded.
The criminal use of opiates was never a public health issue to the same degree and was dealt with separately. How far opium was ever widely used either as a poisoning agent or to drug unwilling victims is uncertain. Perhaps the best known instance of its use to aid robbery came from Mark Moore, an `investigator of intemperance' who, in 1834, reported how East End prostitutes would add laudanum to sailors' beer. Rendered insensible, they were easy prey -'They are then robbed of every penny they possess, and very often of their new clothes...'. How far such stories were attempts at self-justification by sailors who had made fools of themselves is arguable. Certainly similar tales of `drugging' circulating in London in the First World War were found, on investigation, to be groundless .E1 Professor Christison described several cases where thieves had planned `To deaden the sense of taste by strong spirits, and then to ply the person with porter or ale drugged with laudanum, or the black drop, which possesses
less odour.'22
At Greystoke in Cumberland in 1827, the drug was used in a rather bizarre community murder. Mary Kirkbride, a woman of weak intellect who came of a family notorious for its illegitimate children and which had `Brought the Township to a great deal of Trouble', was deliberately poisoned by some local women, among them the wife of the overseer of the poor. `They gave her a whole Noggin of Laudanum ... in a Large Table Spoon with Loaf Sugar to Deceive her.' Mary died after lingering for a fortnight; many in the town knew of what had happened, but few were willing to talk about it. 23 How far such practices were ever more than exceptional is difficult to assess. Opiates were known to be used in euthanasia for adults in the Fens, and for children elsewhere, too.
Whether or not the criminal use of opium was widespread must remain in doubt; but the practice was obviously given credence at the time. Laudanum was mentioned in the Offences Against the Person Act of 1861 in order to counter its supposed abuse. The 1851 Act for the Better Prevention of Offences, in increasing penalties for those who used `stupefying things' to commit crime, had specifically mentioned chloroform and laudanum. The 1861 Act, too, established a range of penalties, including transportation and imprisonment, for those administering, or attempting to administer, `Any chloroform, laudanum, or other stupefying or overpowering Drug. ..'.24 What effect the Act had on the criminal use of opiates is impossible to estimate, since opium used simply to stun and stupefy did not enter the Registrar General's calculations. But the absence of any comment on the practice suggests that it was no longer of such importance, if, indeed, it ever had been. There were always isolated cases of murder by opium.25 Murder with morphia remained reasonably popular as a fictional device; but the criminal use of the drug to stupefy, to aid the commission of crime, had died away.26
The public health discussions on opium poisoning marked the beginnings of sustained medical intervention in the question of opium. In the narrower sense opium poisoning also became a medical question. Although opium overdoses were often dealt ._.with in a `self-help' way, the professional was becoming more closely involved in the treatment of the condition. Opium poisoning became a medical matter. This was hardly surprising, given the number 0f overdoses : doctors thought 0f a `narcotic poison' before all else if they were called to an unconscious patient. It was also a function 0f development within the profession. There was the advent of toxicology as a new medical specialism, in particular by way 0f the Edinburgh Medical School, many 0f whose graduates had studied in Paris under Orfila and Magendie, the pioneers in this subject. Professor Robert Christison's Treatise on Poisons (1829), with its origin in his work in Edinburgh, was the forerunner of many inquiries into the action of drugs.
Like the public health campaign, the debates on opium poisoning and its management by the profession marked the evolution of opium as a problem drug. The medical analysis 0f opium poisoning and its treatment was in many ways the model for later elaboration of disease theories 0f opium addiction. The intense debates on treatment had obvious parallels with the discussions of addiction and its treatment at the end of the century. Direct physical means were used at first in conjunction with agents to remove the poison. Emetics were employed; and the stomach pump was coming into use in English practice in the 1820s. In 1823, a Mr Jukes reported that with it he had managed to evacuate laudanum from the stomachs of `several dogs, three. persons, and himself ...'.?' What was also later termed `bullying' the patient was enthusiastically undertaken. Dr John Crampton of Dublin, in 1824, treated a female patient who had swallowed two ounces of laudanum by giving her emetics, shaving her head, exposing her to cold air, as well as dousing her with cold water. The whole process culminated in prolonged exercise in `some open vehicle'.28 One can sympathize with Sir Clifford Allbutt's later opinion that such methods were `as useless as barbarous'.
Electrical and galvanic stimulation was another variation. Galvani's original experiments with shocks from an electric machine had taken place in 1786. It was in the 1840s that the method achieved popularity as a treatment for opium poisoning. The belief that muscle movements were due to electricity led to reliance on electrical methods as a suitable form of stimulation. In the mid 1840s, electrical stimulation from galvanic or electromagnetic batteries was in regular use in cases at Middlesex and University College Hospitals. Dr Iliff of Kennington was certain that electrogalvanic elements applied to the various points on the body of a woman , who had tried to kill herself with laudanum while depressed were responsible for her recovery. A few months later she tried again, and the same methods were used.29 Parallels with the later electrical treatment of mental illness were clear. The electric shock treatment of opium poisoning was doubtful in its effects and fell out of favour by the end of the century.
Cruder physical methods of all kinds were being replaced by drug treatment. Drugs appeared to offer a `scientific' means of treating opium overdoses. The attempts to find a drug cure in the last quarter of the century, and the debate between advocates of rival cures, or even of variants of particular cures, were an illustration of the process of medical self-definition and the establishment of a medical area of specialization. The controversy over atropine as an antidote was one example.30 Caffeine, green tea and nitroglycerine had their advocates; and, at the turn of the century, Dr W. O. Moor's The Permanganate Treatment of Opium and Morphine Poisoning evoked interest in the use of potassium permanganate. 31


Opium and longevity

The profession was involved in defining the problem; and was, at the same time, charged with both defining and treating the symptoms. The parallels with the later elaboration of disease theory were clear, and indeed in many textbooks a section on `acute poisoning from opium' often preceded one on `chronic poisoning', a term in use to represent addiction. The medical debates on opium poisoning foreshadowed later medical control of opium eating. Opium eating itself was not a matter of sustained medical interest at this time. As Chapter 13, on the growth of a disease view of addiction, will indicate, medical attention was limited in the early part of the century. But the first substantial medical intervention in opium eating, as distinct from opium poisoning, can also be traced in this period - a result of interest in the question of opium eating and longevity. Discussion centred not on the condition itself, but on its effects on life and health. The longevity debate, like the discussions about opium poisoning, was the forerunner of the disease theory of later-nineteenth-century medical thought. The question of opium eating and life insurance was the starting point, and an insurance case involving the Earl of Mar provided the opening.32 The Earl, who had taken out several insurances on his life, died in 1828 of jaundice and dropsy. Investigations revealed that he was an opium eater of thirty years' standing, taking a tablespoonful each night before going to bed. He had at one stage informed his housekeeper that he was taking forty-nine grains of solid opium and an ounce of laudanum a day. The insurance policies led to a court case, where the insurance company argued that opium eating was a habit affecting health and longevity which should have been revealed; it therefore refused to pay out on the policy.
It was medical inquiries and medical evidence given in the course of two trials in the Scottish courts, in 183o and 1832, which opened up the question. Professor Christison was again a prime mover in the matter. Christison, along with several other Edinburgh physicians consulted at the trial, agreed that opium eating must shorten life. There was nothing about the question in medical records and texts ; his own investigations led him to conclusions different from his original ones. His survey of opium eaters, published in the Edinburgh Medical and Surgical journal in 1832, was the first to consider opium eating a domestic phenomenon. Its value as an indication of the incidence of opium eating at the time is, as already mentioned, limited. But it was a clear indication of a growing medical interest in opium eating and its effects.
Christison's conclusion was that `a certain number of opium eaters may attain a good old age' - one supported by the present judgement that opiates themselves produce no directly damaging or life-shortening effect on the body and that addiction itself is not a physically damaging condition. Opium eaters, to him, often appeared cheerful and active, and it was difficult to tell when they were under the influence of the drug.33 Other contributors disputed the point. G. R. Mart's case histories led to the conclusion that opium eating did shorten life. 34 Some of the contributors to the debate argued from Far Eastern experience. Surgeon-General Little, for instance, who attacked Christison's conclusions in the Monthly Journal of Medical Science in 185o, dealt exclusively with his experience of opium eating and opium smoking in Singapore.35 Such contributions were indicative of the relationship between Far Eastern and British use of opium to be firmly established through the anti-opium movement at the end of the century.
Perhaps the most generally adopted conclusion about the longevity question was given by Jonathan Pereira:

... some doubt has recently begun to be entertained as to the alleged injurious effect of opium eating on the health, and its tendency to shorten life; and it must be confessed that in several known cases which have occurred in this country, no ill-effects have been observable ... we should be ... careful not to assume that because opium in large doses, when taken by the mouth, is a powerful poison, and when smoked to excess is injurious to health, that, therefore, the moderate employment of it is necessarily detrimental .. .36

His remarks were an adequate summing-up of the medical position on opium at this time. Opium as a `powerful poison' was indeed already an issue by mid-century, a problem .established by the public health campaign as warranting professional control. Opium eating itself was as yet of more peripheral importance, even though the discussion on longevity foreshadowed the full-scale medical intervention into the condition at the end of the century.

References

1. P.P. 1834, V I I I : Select Committee ... on Drunkenness, op. cit., q. 325; P.P. 1842, XX V 11: On the Sanitary Condition of the Labouring Population, Local reports for England and Wales (Irish University Press, 1971), v01. 3, p. 212.
2. P.P. 1844, X V I I, First Report of the Commissioners for Inquiring into the State of Large Towns and Populous Districts, qs. 943-5. Other reports
to the Commission, in particular the Rev. J. Clay's piece on Preston and John Ross Coulthart's on Ashton-under-Lyne, also brought up the issue of opium.
3. M. W. Flinn, ed., Introduction to Chadwick's Sanitary Condition of the Labouring Population of Great Britain (Edinburgh University Press, 1965), p. 21, notes the involvement of the profession in social questions. P.P. 1862, XXII: Fourth Report of the Medical Officer of the Privy Council, Appendix 5, `Dr Greenhow's report on the circumstances under which there is an excessive mortality of young children among certain manufacturing populations', p. 659; and P.P. 1864, XX V I I I: Sixth Report of the Medical Officer of the Privy Council, and Appendix 14, `Report by Dr Henry Julian Hunter on the excessive mortality of infants in some rural districts of England', pp. 459-64.
4. P.P. 1864, op. cit., Sixth Report of the Medical Officer of the Privy Council, Appendix 16, `Professor Alfred S. Taylor's report on poisoning and the dispensing, vending and keeping of poisons', pp. 754-5; P.P. 1857, XII: Report ... on the Sale of Poisons ..., op. cit., q. 778 and qs. 852-8; P.P. 1865, XII. Special Report from the Select Committee on the Chemists and Druggists Bill and Chemists and Druggists (No. 2) Bill, q. 63
5. M. W. Flinn, op. cit., p. 31, notes the use of statistics in this way.
6. P.P. 1857, op. cit., q. 791.
7. Annual Reports of the Registrar General, op. cit. (London, H.M.S.O., 1867), pp. 176-9. See B. W. Benson, `The nineteenth century British mortality statistics; towards an assessment of their accuracy', Bulletin of the Society for the Social History of Medicine, 21 (1977), pp. 5-13, for discussion of the limitations of the Registrar General's reports.
8. The accident figures could have been inflated, for it was well known that coroners would do much to avoid the stigma of a suicide verdict. The opium mortality rates are discussed in V. Berridge and N. Rawson, op. Cit., pp. 351-63.
9. The Times, 4 March 1834.
10. J. H. Sprague, `On the most efficacious means of remedying the effects of opium', London Medical Repository, r8 (1822), pp. 125-9; `Decease of Mr Augustus Stafford, M.P.', Pharmaceutical Journal, 17 (1857-8), PP. 339-41
11. W. Buchan, op. cit., p. 445.
12. `Death from opium', Pharmaceutical journal, n.s. 7 (1865-6), p. 37 13. W. Ryan, `Delirium tremens - poisoning by laudanum - erysipelas - recovery', Lancet, 2 (1845), PP. 475-7.
14. R. Christison, Treatise, op. cit., p. 600.
15. L. J. Bragman, `The case of Dante Gabriel Rossetti', American Journal of Psychiatry, 92, part 2 (1935-6), pp. II 1I-22; D. I. Macht and N. L. Gessford, `The unfortunate drug experiences of Dante Gabriel Rossetti', Bulletin of the Institute of the History of Medicine, 6 (1938), PP. 34-61.
16. `Poisoning with opium', Lancet, 2 (1828-9), p. 764.
17. W. Howison, `On the medical and moral treatment of young women who have swallowed laudanum in large quantity', Edinburgh Medical and Surgical journal, 18 (1822), pp. 49-62. J. Tweddale, letter, Lancet (1826), p. 245.
18. For further discussion of this, see V. Berridge and N. Rawson, op. cit., PP. 351-63.
19. `Large doses of opium', Pharmaceutical journal, n.s. 2 (186o-61), p. 386; A. Calkins, op. cit., p. 127.
20. P.P. 1857, op. cit., qs. 468-97.
21. P.P. 1834, VIII: Select Committee ... on Drunkenness, op. cit., q. 7; Metropolitan Police papers, Mepol 2/1698 1916, Sir Edward Henry, Metropolitan Commissioner of Police, to Sir Francis Lloyd, General Officer Commanding the London District.
22. R Christison, Treatise, op. cit., p. 601. See also Blackwood's, 8o (1856), op. cit., pp. 629-36; `Abuse of opium in Scotland', London Medical Gazette, 4 (1829), P. 249; `Attempt to poison witnesses on a trial', Pharmaceutical journal, 16 (1857), pp. 293-4; and R. Richardson, `A dissection of the Anatomy Act', Studies in Labour History, 1 (1976), pp. 1-14 for other examples of opium used for criminal purposes.
23. Cumberland Record Office, Lowther Mss. Stray Letters, 1827.
24. An Act for the Better Prevention of Offences, 1851, 14 and 15 Vict. ch. 19; Offences against the Person Act, 1861, 24 and 25 Vict. ch. 100.
25. A. J. Coulthard, `Arthur Devereux: chemist and poisoner', journal of Forensic Medicine, 6 (1959), pp. 178-88, describes the case of a chemist who murdered his wife and children with morphia in 1900.
26. For example, Baroness Orczy's story `The Woman in the Big Hat' (1910) where the fatal morphia is administered in a cup of chocolate. Reprinted in H. Greene, ed., The Rivals of Sherlock Holmes. Early Detective Stories (London, Bodley Head, 1970), p. 270.
27. Medical and Physical journal, 49 (1823), p. 119; see also S. Wray, `Cases illustrating the decided efficacy of cold affusion', London Medical Repository, 18 (1822), pp. 26-9.
28. `Poisoning by opium', Medico-Chirurgical Review, 2 (1825), P. 235.
29. W. T. Iliff, `On a case of poisoning by opium, and its successful treatment by electro-galvanism', Lancet, 1 (1849), PP. 314-15, and 2, PP. 574-5
30. J. Hughes Bennett, `Antagonism between sulphate of atropia and meconate of morphia', British Medical journal, 2 (1874), pp. 518-20, 547-8 and 581-3; J. Harley, `The Gulstonian Lectures, Lecture 3: On the physiological action and thereapeutic use of henbane, alone and in combination with opium, and on the combined operation of opium and belladonna', Medical Times and Gazette, r (11868), p. 376; A. G. Burness, `Strychnine as an antidote to opium poisoning', Medical Press and Circular, r8 (1874), P. 333.
311. Review of Dr Moor's book, British Medical Journal, r (1900), p. 200.
32. Surveyed in V. Berridge, `Opium eating and life insurance', op. cit
33. R. Christison, `On the effects of opium eating on health and longevity', Edinburgh Medical and Surgical Journal, 37 (11832), pp. 123-35; also R. Christison, Lancet, op. cit., pp. 614-17.
34. G. R. Mart, op. cit., pp. 7112-13.
35. R. Little, `On the habitual use of opium', Monthly Journal of Medical Science, to (11850), PP. 524-8.
36. J. Pereira, op. cit., p. 1293.