ON THE USE

OF

SMOKING OPIUM ;
Thesis

Presented and supported at the Faculty of Medicine of Paris, on November

23, 1829, to obtain the degree of Doctor of Medicine;

By PAUL-ÉMILE BOTTA, born in Turin.

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Oh just, subtle and mighty opium! That to the hearts

of poor and rich alikke, for the wounds that will never
heal, bringest an assuaging balm.

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IN PARIS ,
FROM THE PRINTING OFFICE OF DIDOT LE JEUNE
Printer of the Faculty of Medicine, rue des Maçons-Sorbonne, n° 13.

---

1829

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 TO MY FATHER.

To Mr.

Ducrotay de Blainville.

Tribute of respect and recognition.

P.-É. BOTTA

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----------------------------------------------------------------

ON THE USE

OF

SMOKING OPIUM

---------------

Subjected by his nature, not only to the physical pains common to all living
beings, but also to moral pains resulting from the gift of intelligence which
has been granted to him, man has striven, in all times, to find the means to
escape his real existence, and to go into an imaginary world to seek artificial
happiness and the satisfaction of his insatiable desires. It is as a result of the
need he often feels to escape, at least momentarily, from the evils
inseparable from his position in the world; It was to achieve self-
forgetfulness that he sought the use of various intoxicating substances,
although reason and experience agreed to make him feel both the shame and
the dangers.

Among the substances thus used, opium is, after wine, the one which is most
generally used. The Turks, the Arabs, the Persians, and in general all oriental
peoples use it in a more or less immoderate manner, which is necessary in
some way by the absolute prohibition that their religion has pronounced on
all intoxicating liquors. Everyone knows how the Turks and Persians use it;
they swallow it in pills, often even chew it, despite its unpleasant taste,
either alone or mixed with various aromatics which disguise its bitterness a
little and perhaps impart other properties to it. Taken in this way, opium
causes a sort of intoxication, delicious reveries, a momentary excitement, as
a result of which those who use it fall into an apathy proportionate to the
exaggerated activity which has just tired the nervous system, until a new
3
dose comes to further excite the organs for which this stimulus has become
necessary. By gradually increasing the doses, the Orientals manage to take
almost incredible quantities of opium with impunity; and they become so
accustomed to its use that, if we are to believe the stories of some
travelers, the sudden and forced deprivation of this substance can become
fatal for them.

But men who make such an abuse of opium do not take long to feel the
effects of their pernicious habit; the continual repetition of these unnatural
excitations ends up wearing down their sensitivity in some way; strength is
lost, appetite diminishes, digestion deteriorates; disgust, sadness, a stupid
incapacity to act overwhelm these unfortunate people in the moments when
they are not under the influence of their favorite substance. After a few
years, stagnation, sometimes madness, and always premature decrepitude
put an end to their miserable existence. These are the well-known effects of
the habit of using opium in considerable, often repeated doses. But there is
another way of using it, very common in India and China, and certainly less
pernicious: the Malays, the Chinese, and in general all the peoples of India,
instead of swallowing opium, smoke it almost like tobacco (1). Finding myself
in Canton a few months ago, out of curiosity I learned to use it in this way,
and I continued to use it to alleviate the troubles of a long navigation. Having
thus been able to appreciate for myself the effects of this way of
administering opium; I thought that, although very little known and not at all
used in our countries, it could nevertheless be used with advantage in
certain circumstances; This is why I decided to make it the subject of my
inaugural thesis. I will first discuss the effects of opium smoking, and then
review the cases in which I think its use might be useful. But before entering
into the matter, it is necessary to describe the preparation that opium is
subjected to in order to use it for this purpose, this preparation having to
modify its principles and its way of acting: it mainly consists of subjecting it
to half-roasting. Here's how a Chinese man from Canton taught me to
prepare it.

We take a given quantity of opium, which we dissolve in approximately its

weight in water; we boil it continuously in an earthenware or copper pan until
it dries out completely and reduces to a dust, which we always stir over the
fire, so as to roast it a little while avoiding to carbonize it completely; we
then add a new quantity of water to re-dissolve the opium, then we pass it,
either through a cloth or through fog paper, taking care to wash the residue
several times, to extract all the soluble parts; then we evaporate the
colatures obtained until the consistency of a slightly soft extract (roughly
like molasses) (2).

The extract thus obtained usually weighs between a third and a half of the
raw opium used; but this varies greatly according to the quality of this
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substance, which, as we know, always contains more or less foreign matter,
such as debris of leaves and stems. To preserve it, it is enclosed in small
boxes of horn or ivory, which the Chinese recommend keeping under water.

This extract retains all the bitterness of opium, but no longer has at all this
virulent and nauseating odor which characterizes it when it is raw; its smell
is, on the contrary, sweet and suave. I made some tests to compare its
action to that of raw opium, and. although they are too small in number for
us to be able to draw any very positive implication from them, it seemed to
me that a grain of extract was equivalent in its potency to two grains of raw
opium; it also seemed to me that the latter produced more agitation and
narcotism. It is certain that every time I have taken it, the roasted opium
extract has produced less heat in my stomach and, above all, less headache
than raw opium.

During preparation, many vapors of a strong and narcotic odor are released,
which, when inhaled, cause, as I have had occasion to observe on myself,
nausea, dizziness and narcotism which can last one or two days; so I think it
is prudent to carry out this preparation either in the open air or in a well-
ventilated laboratory. Despite all my care, I have rarely succeeded in
preparing opium in such a way as to give it all the characteristics of that
which I smoked in China; but I am convinced that this is due to the nature of
the one I used. Most of the opium used in France comes from the Levant,
and differs significantly in its properties from that of Bengal. The Chinese,
contrary to what Scheel's memoir says, prefer Indian opium to that of
Turkey, and always pay more for it. The reason they give is that Turkish
opium is too strong, and that its use causes headaches, dizziness and
sometimes madness. They only use it to mix it with that of India, which alone
would not have enough force for those who, through long use, are already
jaded about the effects of this substance. However, I have sometimes
succeeded in preparing an extract quite similar to that of the Chinese, so
that I could thereby ensure that they did not add any foreign substance to
impart to it properties other than those which it are natural (3).

It is this extract of opium that the Chinese smoke, although I have never
seen them mix it with tobacco, as some authors say. The pipe which is used
for this purpose is quite different from that which is used for smoking
tobacco; it consists, as shown in the figure, of a pipe formed from a portion
of bamboo between two joints. One end is open, the other is naturally closed
by the joint. Near this is a lateral opening furnished with a copper or silver
mount, to which a kind of pipe in the shape of a ball or hollow urn is adapted,
and pierced at its top with a very small hole. To smoke with this instrument,
you must have a small lamp with a very fine wick in order to produce a small
flame, and use soft oil, so as not to feel the taste while smoking. I also used
the flame of a candle to advantage, but the candle imparts an unpleasant
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flavor to the opium. We take a drop of opium extract at the end of a long
iron needle, we dry this drop above the flame of the lamp, taking care to
always roll the needle between the fingers so that the drop, half liquid, does
not fall. You should also not bring the opium too close to the flame; without
this precaution it catches fire and becomes charred, and the smoke
becomes pungent and irritating to the throat and chest. When the opium is
sufficiently dry, it is applied while melted to the place in the pipe where the
small opening is located, then it is brought close to the flame of the lamp,
and it is sucked strongly through the other end of the bamboo pipe. The
flame passes through the opium, burns it, and the smoke comes into the
mouth. For it to produce its full effect, it must be swallowed in part, kept for
as long as possible, and returned through the nose. This smoke has none of
the acridness of tobacco; its flavor, when the extract is well made, is quite
similar to that of hazelnuts. Its smell is suave and very sweet, but a little
unpleasant when you are not used to it; moreover, it leaves neither bad
taste nor unpleasant odor in the mouth; nor does it communicate to the
apartments this tenacious and remarkable odor in places where tobacco is
smoked. Also all the tobacco smokers to whom I have introduced opium have
found it much more pleasant, independently of the effect it subsequently
produces. It should be noted that the Chinese always smoke opium lying
down, or on a bed, either on a sofa, in a dark place, and as far as possible
from noise and movement: this is in some way necessary to completely
enjoy the sensations it provides.

Each drop of opium extract lasts only as long as one aspiration, and the
same operation must be repeated a greater or lesser number of times to
obtain the desired effect. The amount of opium one can smoke varies
greatly, depending on individual susceptibility and habit. So the first time I
smoked, two pipes (that is to say two grains of extract smoked in two
inhalations, each drop weighing approximately one grain) produced a marked
effect on me; and I saw another person smoke a dozen draws for the first
time without feeling any appreciable effect. Now, through continued use for
a long time, I have managed to smoke up to twenty grains of opium extract
in an evening without experiencing any inconvenience. The Chinese rarely
smoke more, but they do it again several times during the day, either before
or after meals, and without having any other rule than their desire. In
general, I thought I noticed that people who are addicted to tobacco are less
likely than others to be impressed by opium; and this is understandable,
tobacco smoke also having narcotic properties which can through habit dull
the nervous sensitivity of individuals.

Let us now come to the effects produced by opium smoke, they are primary
or consequential; that is to say, some immediately follow the moments we
spend smoking, and are renewed every time we smoke, to disappear after a
few hours; the others are due to this long-continued use, and still persist.
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Primitive effects. To fully feel the effects of opium, it is necessary to be
sufficiently accustomed to it in order to be able to take a somewhat
considerable dose with impunity; because the first time one smokes, one or
two pipes are enough for some people to cause nausea and even vomiting
which prevents them from appreciating the other effects of the smoke; but
little by little we increase the number without the stomach suffering. When
we have smoked a few grains of opium, the first noticeable effect is a
languor, a particular weakness which seems to spread throughout the
muscular system, and which makes rest necessary and exercise painful. This
effect is almost sudden, and increases in a remarkable way with each
aspiration, so that after each one one seems to feel the weakness spreading
to the extremities. The eyelid levator muscles being relaxed, cause them to
half cover the globe of the eye; which gives the face a particular
appearance. The hands, trembling slightly, have difficulty gripping objects
tightly. The legs only support the body with difficulty; which makes the
stepping somewhat shaky, but only in the first moment; This state is never
accompanied by dizziness. At this time, my pulse generally drops from
seventy to sixty beats, becomes a little irregular, but does not increase in
strength or fullness; the beating of the heart is not felt with more violence
than usual; breathing becomes a little panting, and speech is brief and
broken; the pupil is neither contracted nor dilated, and retains its ordinary
mobility.

Soon manifest symptoms of cerebral excitement become apparent; the

blood goes to the head, but never, at least with me, to the point of
producing headache or even discomfort. The intellectual faculties are
exalted without losing any of their ordinary clarity, and, despite the
effervescence of the imagination, judgment and reason retain all their
integrity. This is, in my opinion, a trait which totally differentiates the type
of intoxication produced by opium from that produced by wine. I saw, in the
ship on which I was, a person, after having smoked considerable doses of
opium, make astronomical observations which require great clarity of vision,
and end with the same success as before the long and complicated
calculations which follow. A quiet gaiety and gentle affections, quite opposed
to the noisy effervescence which animates drinkers, replace the disgust and
boredom which, a few moments previously, could overwhelm the opium
smoker. The causes of sorrow seem light, and hope brightens the future.
This moral pleasure is increased by the singular feeling of physical well-being
produced by opium smoke. It is a very particular state almost impossible to
describe, and which does not resemble anything that can be produced by
other intoxicating substances, all of which disturb more or less the functions
of the mind and body, while opium only seems to excite them and give them
new life. The epigastrium, especially if you have swallowed the smoke, is the
seat of pleasant sensations which from there spread throughout the body.
The pains that we previously felt give way to a perfect calm which, somehow
7
allowing us to forget our bodily envelope, leaves the mind completely free to
develop at its ease. A little heat is felt on the skin, which thereby resists the
feeling of cold more easily; we experience more or less severe itching on the
face and in various parts of the body, but particularly on the sides of the
nose and the scrotum. It is, moreover, a sign which seems to be
characteristic of the use of opium, whatever way it is taken. I have
experienced it every time I have taken this substance, either in nature, in
smoke, or in liquid form, like laudanum.

One or two hours after one has stopped smoking opium, these various
sensations become more obtuse; the apparatus of the senses seems to enter
into a half-sleep, during which pleasant daydreams pass through the mind a
thousand incoherent pictures: I have, however, never experienced true
visions; that is to say, being still awake after having smoked, I have never
seen fantastic beings pass before my open eyes; nor have I learned that it
was ever produced by the smoke of opium, although these visions frequently
follow the practice of swallowing this substance, as a remarkable example
can be seen in the confessions of an eater of opium. (Confessions of an
English opium eater.) At this time, the mouth is dry, one feels thirst; and if
one has taken a little excess of opium, or if one has smoked too soon after
eating, one experiences nausea, sometimes even vomiting which, like all
those produced by opium, happen without pain, and almost without effort. If
you swallow smoke, you experience borborygmi, but never colic or stomach
pain. No venereal excitement is felt, and opium seems to calm rather than
ignite these desires. There is some difficulty in urinating, which seems to be
caused by weak contractions of the bladder; but the urine neither increases
nor decreases appreciably. Their quality does not change either; they can be
clear or loaded, depending on circumstances entirely independent of the use
of opium. Soon a deep sleep, rarely interrupted by dreams, follows all these
phenomena. During its duration, it is rare for sweating to be greatly
increased; However, this sometimes happens; but then there are some
incidental circumstances involved, such as the ingestion of hot watery
drinks, or a bed that is too soft and blankets that are too heavy.

The next day, when you wake up, your mouth is dry and a little sore; but the
bad taste disappears by moving forward. The language offers nothing
special; sometimes the appetite is felt later than usual; there is never
constipation or drowsiness during the day following smoking.

Let us now come to the consequential effects which result from the use of
opium smoking. If I judged by my personal experience, after continued use
for almost a year, I would consider it to have no harmful effect on the
animal economy. Indeed, although attentive to observing myself, to stop the
moment I notice any alteration in my health, I have not yet experienced
anything that I can attribute to this habit. However, I am far from believing
8
that it is completely safe to smoke opium. Used in this way, it certainly
produces the same effects as when eaten, but only after a longer time. All
the Chinese whom I questioned in this regard always told me that those who
indulged in this pleasure in an immoderate manner eventually became pale,
thin, puny, and that very often impotence was the result of this disastrous
custom; but it must be observed that those among them who suffer from it
make a real abuse of it; because they have barely left the state of well-being
that this pastime causes them when they start smoking again to immerse
themselves in it again; so that, like opium eaters, they become incapable of
acting when they are not stimulated by their usual stimulant. I therefore
consider it certain that the immoderate use of smoking opium brings with it
the same inconveniences as that of eating it, but after a longer time; which
is due to the much milder way this substance acts when smoked.

To prove that opium when smoked acts in a gentler manner and with less
disturbance than when it is ingested, one only has to compare the action of
the two modes of administration (and I have been able to make this
comparison on myself), we will see on both sides approximately the same
symptoms, with less violence only in the method that I propose. In this there
are no hallucinations, no dizziness or convulsions; there is not this delirium
that all the travelers and all the authors who have written on opium agree to
say is the result of each dose that opium eaters swallow; the only moral
effect produced is a gentle and calm cheerfulness, and the exaltation of the
intellectual faculties. The circulation disorder is not very marked; but what is
most striking is the little alteration of digestive functions. No colic, stomach
pain or loss of appetite; no constipation, a symptom so constant after the
ordinary use of opium. With the exception of that of the mucous membranes
which decreases notably, the secretions are little altered; the urine changes
neither in its quality nor in its quantity, while the ingestion of opium usually
makes it rare and cloudy. Because the effects of smoked opium are less
intense, the period of depression which follows them is less marked: there is
neither drowsiness, nor lack of activity, nor incapacity to act, unless smoking
excessive doses.

From the little disturbance that smoked opium causes, and especially from
the little alteration it causes in digestive functions, could we not draw a
therapeutic indication? I believe that, whenever we need to use opium in
such a way as to cause it to produce a slight effect on the economy, but
continued for a long time, and especially when we have to fear that its
ingestion increases an already existing disorder in the digestive system, it
will be advantageous to use it in smoke rather than in nature. It would
therefore not be to combat tetanus or cholera morbus, or to prevent attacks
of pernicious intermittent fevers that I would recommend the use of opium
smoking. In these cases, as in many others, it is necessary to act promptly,
and with energy proportionate to the activity of the evil. For this, it is
9
necessary to give considerable doses of this medicine suddenly, without
paying attention to the disadvantages which follow its use, and which, in
these circumstances, are slight, if we compare them to the advantages
which we hope for.

In general, more will be gained from this way of giving opium in chronic
illnesses than in acute illnesses; and, among the first, those which depend on
or are accompanied by lesions of the nervous system will experience better
effects. Thus smoked opium will be advantageous in certain colic and
stomach pains, which often depend on moral causes, and which the spirit of
system alone can relate to phlegmasia of the intestinal organs, since no
other symptom comes to bear witness to the existence of this inflammation,
and that moreover they respond better to sedatives and narcotics than to
anti-inflammatory drugs. We will have, by the means that I propose, the
advantage of opposing sadness and moral affections, causes of illness, with
an artificial cheerfulness, and of dulling the sensitivity of the gastric organs
without having to fear irritating them by the presence of medications. I am
even convinced that in chronic gastritis, when the period of inflammation
has passed, we would derive good effects from this method, which leaves
opium with its sedative qualities, and removes, at least to a large extent, its
irritating properties; perhaps, at the onset of gastritis, it would be possible to
abort them by combining smoked opium with other means necessitated by
the circumstances.

The great nervous susceptibility which, in hypochondria, seems to result

sympathetically from the suffering of the digestive organs, also seems to me
to be able to be combatted advantageously by the means that I propose. In
this case, as in the previous ones, we would act in a sedative manner on the
nervous system without harming the digestive functions, already so
disturbed in this disease.

In coryza, it would be much more advantageous to smoke opium, and to pass

the smoke through the nasal passages, than to breathe emollient and
narcotic vapors, which have the disadvantage of increasing the swelling of
the pituitary membrane and secretion of mucus.

In gingivitis, buccitis, even in tonsillitis, when they are still in their early
stages or when they have passed into a chronic state, I would advise the use
of opium smoke, which, as we we have seen, hardly produces the influx of
blood to the upper parts, an advantage which it does not have when
administered in any other way.

In diseases of the pulmonary system, opium smoke, which can act directly
on diseased surfaces, must certainly have a marked action. I would
recommend its use especially in nervous affections of these organs, such as
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certain asthmas which do not respond to antiphlogistics, and especially in
angina pectoris, which all the symptoms indicate to be a lesion of the nerves
of the pulmonary plexus and cardiac.

In whooping cough, this means would have the double advantage of acting as
an antispasmodic, and at the same time reducing the secretion of the
mucous membrane of the lungs; because we have seen that one of the
properties of opium is to reduce mucous secretions. This property, combined
with its sedative qualities, must make smoked opium particularly useful in
chronic catarrh, in which it will facilitate perspiration, suspend coughing,
soothe irritation, and reduce the abundance of secreted phlegm, while
providing calm, rest and sleep for the patient. Why not use it in pulmonary
phthisis, a disease in which it could calm irritation, cough and the abundant
flow of phthisis, especially in mucous phthisis, and at least provide patients
with relief in desperate cases , a few moments of well-being.

In neuralgia, diseases so often resistant to the most energetic means,

smoked opium can only be offered as an accessory; However, since it can be
continued for a long time without harming digestive functions, its sedative
action, constantly renewed, would perhaps succeed, in the long run, in
overcoming the stubborn pain, the unique symptoms of these diseases, or at
least reducing them. It is especially a means to try in dental neuralgia.

By the remarkable calm it brings to the muscular system, opium smoke must
act effectively against chorea. Patients affected by chronic rheumatism will
also certainly need calm, sleep and a more or less complete cessation of
their pain.

In gonorrhea, as an accessory remedy, smoked opium will be very useful, not

as being able to have a great influence on the course of this affection, but
to prevent the frequent erections, which are so painful in this disease.
Because of these remarkably anti-aphrodisiac properties, I would use this
means with confidence against this sad disease, which in the female sex
takes the name of nymphomania, and in the male sex that of satyriasis.

In all cases where the disease is beyond the resources of the art, there
remains for the doctor nothing else to do than to calm, as much as possible,
the suffering of the patient, this way of administering opium seems to me to
be preferred to all the others, since it offers the same advantages without
having the same disadvantages.

Finally, wouldn't this be a way to administer opium to children with less

danger? We know how carefully this substance must be used at a young age,
because of the ease of cerebral congestion at this time of life, and we have
seen that smoked opium produces this effect with much less violence than
11
when taken in nature.

These are the observations that I believe I must make on the use of opium
smoking. I am convinced that, in many cases, this way of giving this
medicine can be useful, and I hope that experience will confirm what I have
said about it.

END.

Note 1. Determined by the natural desire in youth to know the world, and by
the intention of doing some research in natural history, I took advantage of
an opportunity offered to me to embark as a doctor on a merchant ship
intended for a long voyage. Leaving France in April 1826, we successively
reached Brazil, Chile, Peru, Mexico and California, where we stayed for quite
a long time, and from where we passed to the Sandwich Islands, then later to
China, from where we returned via the Cape of Good Hope. Thus completing
the world tour, we arrived in France in July 1829, after a journey of thirty-
nine months, during which I, as a doctor, had little to do other than admire
how the recent progress in navigation has served to maintain the health of
the crews, in such a way as to make the ancient disasters of Lord Anson and
other navigators of that era almost fabulous. I could truly say that there is
no more scurvy; for, during quite a long voyage, I did not have the
opportunity of seeing a single scorbutic patient, either in the ship in which I
was, or in many others which I visited.

Note 2. In a Memoir by Scheel, read at the Copenhagen Medical Society, and

translated by M. Demangeon, we find described another way of preparing
opium by roasting which differs a little from this one; But basically we see
that it must modify the opium in the same way. In fact, the whole difference
consists in drying the opium directly on the fire by spreading it in the bottom
of the pan, which is then turned over, instead of continuing to shake it and
roast it inside of the vase.

Note 3. The use of opium smoking is fairly recent in China; but, despite very
severe prohibitions, it is expanding every day. Considering this substance as
pernicious for the health of the people, and above all as detrimental to the
fortune of the state, because it causes a large quantity of money to leave
the country, the emperors defended its introduction in a very-rigorous way.
But as always happens, this did not prevent the spread of this habit, and now
seventy to eighty million francs of opium are imported into China annually,
which is only used for smoking, the Chinese using it little or nothing as
medicine. Although forbidden, this trade is carried out in an almost open
manner; the Mandarins, responsible for preventing it, are themselves
interested in tolerating it, because, for them as for all rich people, opium has
become an object of prime necessity.
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 --------------------------------------

HIPPOCRATIS APHORISMI.
(Hippocrates's Aphorisms)

I.

Ars longa, vita brevis, experimentum periculosum, judicium difficile.

(Art is long, life is short, experiment is dangerous, judgment is difficult.)

II.

Ars medica , ab eo quod molestum est liberat , et id, ex quo quis aegrotat,
suferendo, sanitatem reddit : idem et natura per se facere novit.
(The art of medicine frees from that which is troublesome, and restores health from that
from which one is ill and suffers: nature also knows how to do the same by itself.)

III.

Frigida velut nix, glacies, pectori inimica. tusses movent, sanguinis eruptiones
ac calarrhos inducunt.
(Colds as snow, ice, hostile to the chest, cause coughing, eruptions of blood, and
convulsions.)

IV.

A morbo belle comedenti nihil proficere corpus, malum est.

(It is bad for the body to gain nothing from a disease that eats well.)

V.

Mutationes anni temporum maxime pariunt morbos, et in ipsis temporibus

magnae mutationes tum frigoris tum caloris, et caetera pro ratione eodem
modo.
(The changes of the seasons of the year give rise mainly to diseases, and in the seasons
themselves great changes both of cold and of heat, and the rest for the same reason.)

VI.

Naturarum aliae quidem ad aestatem, aliae vero ad hyemem, bene aut malfc
sunt constitutae.
(Some of the natures are indeed conostituted for summer, and others for winter, for better
or worse.)

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