nbcatlover @ Fri Nov 09, 2007 4:59 pm wrote:A patient fighting severe pain may receive 2-4 mg. of morphine every 2 hours. A person without severe physical pain who received 8 or 16 mg. of morphine in a single dose would be "snowed." Lizzie would have been heavily sedated, probably unable to determine what was real from what was a dream or hallucination.
So, do I have this right? If 1 grain = 64.799 mg. then Lizzie's 1/8 of a grain would be approximately 8.1 mg. which could result in considerable mental confusion?
Well, if I'm understanding the math and such correctly diana, it would appear that considerable mental confusion would be the very least that dosage would cause. Interestingly, didn't Bowen testify under oath that he doubled that dosage?
This is what Mr. Adams got out of him at the trial, Page 327:
Bowen had testified regarding his prescription of 1/8th grain sulfate of morphine. Adams followed up:
Q. The next day you changed that?
A. I did not change the medicine, but doubled the dose.
Q. That was on Saturday?
A. On Saturday.
Q. Did you continue the dose on Sunday?
A. Yes, sir.
Q. Did you continue it Monday?
A. Yes, sir.
Q. And on Tuesday?
A. Yes, sir.
-----------
Now...if we have the measurements correct, based on this testimony - well, I'd say "Zonked off her keister" would be charitable, if indeed she was conscious at all. Yaknow?
Even accepting the differences medically (in practice and thought) why in the world would Bowen have zapped her like that??!!! It's literally scary.
I staid the night for shelter at a farm behind the mountains, with a mother and son - two "old-believers." They did all the talking...
- Robert Frost
Today, we generally use morphine IV--going into a vein. It can be given in pill form and 30 mg. in pill form today would be an acceptable initial dose for someone in severe pain. Today we have controlled release medication so I'm not sure how morphine in the 1890s compares with today. Many of the drugs then were in loose powder form and drunk with water. People who use morphine continually develop a tolerance to its pain relief requiring higher doses for pain relief. Today people would be given Ativan or similar to calm them after a shock like a murder, rather than morphine.
Morphine can cause confusion, sedation. dizziness, hallucinations, a floating feeling, strange dreams, etc. as part of its effect on the central nervous system. If Lizzie was in physical pain from her period or as some have speculated, from an abortion, morphine might have been needed. Because of her involvement in the temperance movement, I guess it would have been unacceptable for Dr. Bowen to give her a shot of whiskey.
In 1805, the German pharmacist Friedrich W. Serturner isolated and described the principal alkaloid and powerful active ingredient in opium. He named it morphium after Morpheus, the Greek god of dreams. We know it today as morphine. This event was soon followed by the discovery of other alkaloids of opium: codeine in 1832 and papaverine in 1848. By the 1850s these pure alkaloids, rather than the earlier crude opium preparations, were being commonly prescribed for the relief of pain, cough, and diarrhea. This period also saw the invention and introduction of the hypodermic syringe.
By the late eighteenth century opium was being heavily used in China as a recreational drug. The Imperial court had banned its use and importation but large quantities were still being smuggled into China. In 1839 the Qing Emperor ordered his minister Lin Zexu to address the opium problem. Lin petitioned Queen Victoria for help but was ignored. In reaction, the emperor confiscated 20,000 barrels of opium and detained some foreign traders. The British retaliated by attacking the port city of Canton. Thus the First Opium War began. The Chinese were defeated and the Treaty of Nanjing was signed in 1842. The British required that the opium trade be allowed to continue, that the Chinese pay a large settlement, and that the Chinese cede Hongkong to the British Empire. The Second Opium War began and ended in 1856 over western demands that opium markets be expanded. The Chinese were again defeated and opium importation to China was legalized.
In the United States during the 19th century, opium preparations and 'patent medicines' containing opium extract such as paregoric (camphorated tincture of opium) and laudanum (deodorized opium tincture) became widely available and quite popular. In the 1860s morphine was used extensively pre- and post-operatively as a painkiller for wounded soldiers during the Civil War. Civil War physicians frequently dispensed opiates. In 1866 the Secretary of War stated that during the war the Union Army was issued 10 million opium pills, over 2,840,000 ounces of other opiate preparations (such as laudanum or paregoric), and almost 30,000 ounces of morphine sulphate. The inevitable result was opium addiction, called the 'army disease' or the 'soldier's disease.' These opium and morphine addiction problems prompted a scientific search for potent but nonaddictive painkillers. In the 1870s, chemists synthesized a supposedly non-addictive, substitute for morphine by acetylating morphine. In 1898 the Bayer pharmaceutical company of Germany was the first to make available this new drug, 3,6-diacetylmorphine, in large quantities under the trademarked brand name Heroin. 3,6-diacetylmorphine is two to three times more potent than morphine. Most of the increase is due to its increased lipid solubility, which provides enhanced and rapid central nervous system penetration.
There's also a section on prussic acid! Did you know that small amounts of prussic acid might stop vomitting, especially vomitting associated with pregnancy? Oh, brother!
Yooper @ Mon Nov 05, 2007 9:17 am wrote:I was able to find a recommended adult dosage for sulphate of morphine, 10-30 milligrams. Based upon FairhavenGuy's conversion of 1 grain=64.79 milligrams, we have 1/8 grain=8.1 milligrams, and 1/4 grain=16.2 milligrams. I'm sure the 10-30 milligrams would be based in part upon body mass, so I imagine Dr. Bowen's dosages were within reason. The 1/8 grain dose seems a bit light.
The 10-30 milligram dose range was specified for every four hours. Conversions from grain and milligram (measurements of mass) to milliliter and cc (volume measurements) are not possible without knowing the concentration. I don't know what difference there might be between sulfate of morphine in 1892 and the present, but the molecular structure of the substance would not change.
Would a person who was pre-sensitized to opiates require a higher dose than a person who had no previous exposure? Sulfate of morphine dosages are also a function of body mass, 0.15-0.30 milligrams per kilogram. One kilogram is roughly equal to 2.2 pounds, so the recommended dose is 6.8-13.6 milligrams per 100 lbs of body mass. Lizzie's initial dose of 8.1 milligrams would be the minimum dose for a 119 pound person. Doubling the dose to 16.2 milligrams becomes the maximum dose for a 119 pound person, hence, the question of pre-sensitivity.
It's not only the weight; it's the route. Dosing pills is one standard, receiving medication in the bloodstream via hypodermic needle is more potent and more dangerous in higher doses. I am not clear how Lizzie received the morphine.
And yes, if a person is used to taking morphine, it takes a higher dose over time to gain the same effect.
So I guess the issues are the amount of the drug, the route (oral vs. IV) the drug was given, the level of pain Lizzie was in (pain, right now, of unknown origin), and past history of opiate drug use. Also the amount of other drugs (bromo-caffeine?) and any interactions between the drugs.
Does it seem like something major is going on with Lizzie beyond shock and grief? This seems like more than Midol-level pain.
After I had my leg operated on, I was given morphine pills for pain. Boy, now I know I have an additive personally! I was given a 5mg pill and I was sooo light headed!
Suicide is painless It brings on many changes and I will take my leave when I please.
I don't recall anything in the testimony which might support an IV application of the drug. Would Lizzie have injected it herself, or would a doctor have done that? Dr. Bowen's testimony describing a dose of 1/8, later 1/4 grain is a description of mass rather than a description of concentration in a solution. Was the drug administered as a sedative or were there better choices available as sedatives at the time? The current Merck manual lists a veterinary use for gastric problems.
Do we have any idea of Lizzie's size? The 119 pound calculation is based solely upon the dose given, it may or may not be correct as a representation of Lizzie's weight. While I find it hard to imagine her weighing substantially less than 119 pounds, the more she weighed, the further she was from a maximum dose at 1/4 grain. If 119 pounds is at least a fair ballpark figure, we still see an increase from a relative minimum to a relative maximum amount of morphine. The rate of increase may have the greatest significance.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
From augusta's previous post containing Dr. Bowen's testimony, the bromo-caffeine was prescribed for headache and nervous excitement, and morphine was substituted on Friday night in a 1/8 grain dose. The very next day the dosage was increased to 1/4 grain. Dr. Bowen was unaware of Lizzie having used morphine previous to that time, he had not prescribed it.
If Lizzie had no previous morphine or opiate habit, it seems like a rather high degree of nervous excitement and/or the headache from hell. While everyone reacts in their own way and Lizzie had lived through the murder of her parents, Emma had experienced the same outcome and Bridget had lived through the same murders. Were they as nervously excited as Lizzie? Lizzie was described as remarkably calm by some immediately after the murders. While this is a value judgment by the observer, she had expressed a choice of an undertaker during this time and had responded to police questioning in a seemingly rational manner, so she wasn't hysterical by any means.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
I also noted that Emma received nothing too, and although everybody is different in the way they react to trauma and shock, I agree Lizzie did not seem overly traumatized when she said to the ladies that she did not need her blouse loosened, she was not about to faint. Unless you actually see someone swallow the meds, and stay with them for a time, there is no way to know if the pills were taken at all, or if they were seen to be taken but hidden or self-induced vomiting may have occured later. An intravenous injection would be the only way to know for sure just how medicated Lizzie was.
I checked the arrest record and thought Lizzie's weight would be there but it's not. Hmmm...
Well, I have usually believed Dr. Bowen left pills and so really anyone could take those. Maybe Emma shared pills with Lizzie. Personally, I don't think Lizzie was that confused in her inquest. It wasn't disallowed at trial due to medication anyway, was it? It was not included because of possible self-incrimination due to an outstanding arrest warrant someone had in their pocket at the time.
I'll have to read that argument again, the details are a bit hazy. I did though find this, which suggests at least that the exclusion was based on firm constitutional grounds - per the Commonwealth's constitution, not just the US constitution as amended 15 December 1791.
Following is Article XII, contained in the Commonwealth's Constitution of 1780:
No subject shall be held to answer for any crimes or no offence until the same if fully and plainly, substantially and formally, described to him; or be compelled to accuse, or furnish evidence against himself; and every subject shall have a right to produce all proofs that may be favorable to him; to meet the witnesses against him face to face, and to be fully heard in his defence by himself, or his counsel at his election. And no subject shall be arrested, imprisoned, despoiled, or deprived of his property, immunities, or privileges, put out of the protection of the law, exiled or deprived of his life, liberty, or estate, but by the judgment of his peers, or the law of the land.
I'd almost bet the root of the exclusion is right there in that paragraph.
I staid the night for shelter at a farm behind the mountains, with a mother and son - two "old-believers." They did all the talking...
- Robert Frost
That's right, Kat, the Inquest testimony was excluded because the authorities had done everything short of serving the warrant. There was a line of questioning in which Adams questioned Dr. Bowen about the effects of "double doses" of morphine. He (Adams) suggests that it might cause confusion or even hallucinations, which also lays the groundwork for the testimony being excluded, and may imply malicious intent on the part of authorities if they were aware of Lizzie being under the influence of morphine at the time.
The question seems to have evolved to one of why Lizzie needed a near maximum(?) dose of morphine to settle her nerves.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
I've noticed a bit of inconsistency in the testimony by Dr. Bowen concerning "double doses" of morphine. The idea of a double dose appears to be at the suggestion of attorney Adams to make a point and Dr. Bowen did not argue it. If Lizzie was given a minimum dose of 1/8 grain and the amount was subsequently increased to 1/4 grain, then the dose was indeed doubled. However, the 1/4 grain dose was not twice the recommended amount for an adult as Adams suggests. It was probably near the maximum amount recommended, but it was still a single dose, not a double dose which would have been 1/2 grain or double the maximum. If it takes a double dose (1/2 grain) to induce mental instability manifesting as confusion or hallucinations, then Lizzie may have been in no danger of such.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
Exactly.
When I proof-read submissions for the magazine, I see "double-dose" sometimes. I think it is the lore now- gone into legend- gone out over the Internet-- and I hope everyone takes note that Dr. Bowen doubled the original dose- but did not say he gave a double-dose.
A recommended dose is never defined by either Dr. Bowen or Adams, although Adams qualified 1/8 grain as a normal dose, then corrected that to a light dose. The exchange is made using only proportionality. It would be more accurate to say that Lizzie was initially given a half dose which was subsequently increased to a full dose. The fact that it had to be doubled to do so is a singular coincidence with morphine dosage in that the recommended maximum is double the recommended minimum.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
I never heard the theory that she was pregnant. With the bucket of sanitary napkins soaking downstairs- and her testimony of having "fleas" that doesn't seem to fit.
I always thought Bowen tried to keep her medicated because he was worried she would say too much to the authorities. If she could be kept quiet and in her room, with a plausible excuse not to be pressed for details and bothered, she had less of a chance of slipping up and incriminating herself. I don't think she was a very good liar.
Keeping her sedated would have ruined her inquest testimony, I think, and put her in more jeopardy. As for a rumor of pregnancy, that was in the Trickey/McHenry Globe story, wasn't it?
I meant that I thought Bowen kept her quiet when she was at the house by giving her sedatives. Jennings may have even suggested it if he thought she might blab something incriminating in her excitement immediately after the murders.
Well, I can see what you mean. But I have one experience myself with Demerol in the energency room and OMG! I yakked and yakked and flirted with the cute doctor! Whew! I'm glad I don't have a RX for that stuff! It was like taking truth serum, with a twist.
Keeping Lizzie sedated in her room might prevent the authorities from questioning her at all, it would provide an excuse. The morphine was originally prescribed for use at bedtime, maybe that was the intent; to help Lizzie sleep. In any case, Lizzie seemed coherent during the questioning at the Inquest. She might say anything if she was looped enough, so I imagine she would have been advised to lay off the dope before the Inquest.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
Opium and Morphine
By the 1820s morphine was a popular anodyne, or soother. Morphine was also, however, a prime method of Victorian suicide. Morphine was six times as potent as opium. It was commercially available, and it was sold using a standardized measure of strength, allowing for accurate doses. Despite the merits of morphine, the newer drug; opium still remained popular among doctors. Dr. Jonathon Pereira, author of standard-setting works on therapeutics, maintained that opium was still the most important drug because its effects are "immediate, direct, and obvious; and its operation is not attended with pain or discomfort." Opium's chief advantage was the lack of ostensible side effects, at least short term. Many doctors were aware of the addictive properties of opium, but they ignored this fact and declined to inform patients. Many upper and middle class patients purchased morphine from doctors and injected themselves daily with newly developed needles. This 'morphinism' was unbounded by legal or social guidelines, and many morphine addicts were unaware of there addiction. Despite the ramifications of morphine as a leisure drug, it allowed for longer and more effective surgery, and for tremendously more efficient battlefield treatment. (Booth 70)
Of course, there must be differences from the usage in the 1820s and the usage in the 1890s. It was the self-injection of morphine in the 1820s that interested me. It was interesting that morphine was considered a "leisure drug." People tend to think recreational drug use was invented in the '60s hippie era.
There was an interesting documentary on TV about the history of drugs. Amazing that drugs were legal and were even sold in the Sears catalog, along with syringes and needles!!
Cocaine and Heroin were seen as wonderful drugs and people in Victorian times, while seeming prim and proper, enjoyed their drugs. It's amazing to think your great-great-grandmother may have used cocaine and other drugs on a regular basis!! And it was perfectly legal!!
Lizzie could very well have indulged...it was an easy thing to do. As to the murders, I think she knew exactly what she was doing. She kept changing her stories as the need arose...I don't think she really thought through her alibi prior to the murders. She had to fine-tune her story until it seemed right.
It was Lizzie's need to distance herself from the events which presented the dilemma of hearing Abby return. She would have been far better off telling the police she heard SOMETHING while she was in the barn or while in the process of discovering her father's body. At the time of the police interview she wanted to appear completely unaware of the events.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
Why did Lizzie need to tell the story about the note?
Wouldn't she know that was a physical thing in the real world that might be looked for and people would want that to be found?
Why not just tell Andrew that Abbie had gone to get the dinner?
Lizzie needed to be unaware of Abby's death for perhaps an hour and a half, and a note might have put Abby out of the house for an extended time period. A short trip to the grocery store or anywhere else wouldn't have quite done it.
That's a good point, Kat, a note could be corroborated by its physical presence, by a sender, or by a delivery person. Lizzie might have told Andrew anything to explain Abby's absence if she wanted to prevent his searching for her. It might also be argued that Lizzie was planning Andrew's demise if she made up any story at the time she told him about the note.
To do is to be. ~Socrates
To be is to do. ~Kant
Do be do be do. ~Sinatra
