Among all the signal inventions, discoveries, and improvements of the
age, social and material, scientific and mechanical, few, perhaps,
are fraught with graver possibilities for good and evil than the
great achievement of recent medicine—the development, if it should
not more properly be called the discovery, of anæsthetics. Steam has
revolutionized mechanics; the locomotive, the steam-hammer, and the
power-loom, the creation of the railway and the factory system, have
essentially modified social as well as material civilization; and it
is possible at least that electric lights and motors, telegraphs and
telephones, may produce yet greater consequences. This last century
has been signalized by greater mechanical achievements than the
whole historic period since the discovery of iron. But in obvious,
immediate influence on human happiness, it is quite conceivable that
the discovery of chloroform, ether, and other anæsthetics—the diffusion
of chloral, opium, and other narcotics, putting them within the reach
of every individual, at the command of men and women, almost of
children, independently of medical advice or sanction—may be, for a
time at least, more important than those inventions which have changed
the fundamental conditions of industry, or those which may yet change
them once more. It is difficult for the rising generation to realize
that state of medicine, and especially of surgery, which old men can
well remember; when every operation, from the extraction of a bad
tooth to the removal of a limb, must be performed upon patients in
full possession of their senses. In those days the horror with which
men and women, uninfluenced by scientific enthusiasm, now regard the
alleged tortures of vivisection was hardly possible. Thousands of
human beings had yearly to undergo—every man, woman, and child might
have to undergo—agonies quite as terrible as any that the most ardent
advocate of the rights of animals, the most vivid imagination excited
by fear for dearly loved dumb companions, ascribes to the vivisector’s
knife. It may well be doubted whether the highest brutes are capable
of suffering any pain comparable with that of hardy soldiers or
seamen—much less with that of sensitive, nervous men, and delicate
women—when the surgeon’s blade cut through living, often inflamed
tissues, generally rendered infinitely more sensitive by previous
disease or injury, while the brain was fully, intensely conscious;
every nerve quivering with even exaggerated sensibility. The brutes, at
any rate, are spared the long agony of anticipation, and at least half
the tortures of memory. They may fear for a few minutes; our fathers
and mothers lay in terror for hours and days, nay, persons of vivid
imagination must have suffered acutely through half a lifetime, in the
expectation that, soon or late, their only choice might lie between
excruciating temporary torture and a death of lingering hopeless
anguish. No gift of God, perhaps, has been so precious, no effort of
human intellect has done more to lessen human suffering and fear, to
take from life much of its darkest evil and horror, than anæsthesia
as developed during the last fifty years. True that in the case of
severe operations it is as yet beyond the power of medicine to give
complete relief. If spared the torture of the operation, the patient
has yet to endure the cruel smart that the knife leaves behind. But the
relief of previous terror, of the awful, unspeakable, and, to those who
never felt it, almost inconceivable agony endured while the flesh was
carved, and the bone sawn, have disappeared from the sick room and the
hospital.
Narcotics should be carefully distinguished from anæsthetics. Their
use is different, not in degree only, but in character and purpose.
Their legitimate object is two-fold: primarily, in a limited number
of cases, to relieve or mitigate pain temporarily or permanently
incurable; but secondarily and principally to cure what to a large
and constantly increasing class in every civilized country is among
the severest trials attendant on sickness, over-work, or nervous
excitement—that loss of sleep which is a terrible affliction in itself,
and aggravates, much more than inexperience would suppose, every form
of suffering with which it is connected. Nature mercifully intended
that prolonged intolerable pain should of itself bring the relief of
sleep or swooning; and primitive races like the Red Indian, living in
the open air, with dull imagination and insensible nerves, still find
such relief. The victims of Mohawk and Huron tortures have been known,
during a brief intermission of agony, to sleep at the stake till fire
was used to awaken them. But among the many drawbacks of civilized
life must be counted the tendency of artificial conditions to defeat
some of Nature’s most merciful provisions. The nerves of civilized
men are too sensitive, the brains developed by hereditary culture and
constant exercise are too restless, to obtain from sleep that relief
in pain, especially prolonged pain, that nature apparently intended.
Many of us, even in sleep, are keenly sensitive to suffering, at least
to chronic as distinguished from acute pain, to dull protracted pangs
like those of rheumatism, ear-ache, or tooth-ache. A little sharper
pain, and sleep becomes impossible. The sufferer is not only deprived
of the respite that slumber should afford, but insomnia itself enhances
his sensibility, besides adding a new and terrible torment of its own.
Artificial prevention of sleep was notoriously among the most cruel
and the most certainly mortal of mediæval or barbaric tortures. The
sensations of one who has not slept for several nights, beginning with
a restless, unnatural, constantly increasing consciousness of the
brain, its existence and its action, passing by degrees into an acute,
unendurably distressing irritation of that organ—generally unconscious
or insensible, probably because its habitual sensibility would be
intolerable—are indescribable, unimaginable by those who have not felt
them; and seem to be proportionate to the activity of the intellect,
the susceptibility of nerve and vitality of temperament—the capacity
for pain and pleasure. In a word, the finer the physical and nervous
character, the more terrible the torment of sleeplessness. A little
more and the patient is confronted with one of the most frightful
forms of pain and terror, the consciousness of incipient insanity. But
long before reaching this stage, sleeplessness exaggerates pain and
weakens the power of endurance, quickens the sensibility of the nerves,
enfeebles the will, exacerbates the temper, produces a physical and
nervous irritability which to an observer unacquainted with the cause
seems irrational, unaccountable, extravagant, even frantic, but which
afflicts the patient incomparably more than those, however near and
however sensitive, on whom it is vented. Drugs, then, which enable the
physician in most cases to check insomnia at an early stage—to secure,
for example, in a case of chronic pain, six or seven hours of complete
repose out of the twenty-four, to arrest a mischief which leads by
the shortest and most painful route directly to insanity—are simply
invaluable.
It may seem a paradox, it is a truism, to say that in their value
lies their peril. Because they have such power for good, because the
suffering they relieve is in its lighter forms so common, because
neuralgia and sleeplessness are ailments as familiar to the present
generation as gout, rheumatism, catarrh to our grandfathers, therefore
the medicines which immediately relieve sleeplessness and neuralgic
pain are among the most dangerous possessions, the most subtle
temptations, of civilized and especially of intellectual life. Every
one of these drugs has, besides its immediate and beneficial effect,
other and injurious tendencies. The relief which it gives is purchased
at a certain price; and in every instance the relief is lessened
or rendered uncertain, the mischievous influence is enhanced and
aggravated by repetition; till, when the use has become habitual, it
has become pure abuse, when the drug has become a necessity of life
it has lost the greater part if not the whole of its value, and serves
only to satisfy the need which itself alone has created. Contrary
to popular tradition, we believe that of popular narcotics opium is
on the whole, if the most seductive, the least injurious; chloral,
which at first passed for being almost harmless, is probably the most
noxious of all, having both chemical and vital effects which approach
if they do not amount to blood-poisoning. It is said (we do not
affirm with what truth) that the subsequent administration of half a
teaspoonful of a common alkali operates as an antidote to some of these
specific effects. The bromide of potash, another favorite, especially
with women, is less, perhaps, a narcotic proper than a sedative. It
is said not to produce sleep directly, like chloral or opium, by
stupefaction, but at least in small doses simply to allay the nervous
irritability which is often the sole cause of sleeplessness. But in
larger quantities and in its ultimate effects it is scarcely less to
be dreaded than chloral. It has been recommended as a potent, indeed
a specific and the only specific, remedy for sea-sickness. But the
state to which, as its advocate allows, the patient must be reduced, a
state of complete nervous subjection to the power of the drug, seems
worse than the disease, save in its most cruel and dangerous forms.
Such points, however, may be left to the chemist, the physician, or
the physiologist; our purpose is rather to indicate briefly the social
aspects of the subject, the social causes, conditions, and consequences
of that narcotism which is, if not yet a prevalent, certainly a
rapidly-spreading habit.
The desire or craving for stimulants in the most general sense of the
word—for drugs acting upon the nerves whether as excitant or sedative
agents—is an almost if not absolutely universal human appetite; so
general, so early developed, that we might almost call it an instinct.
Alcohol, of course, is the most popular, under ordinary circumstances
the most seductive, and by far the most widely diffused of all
stimulant substances. From the Euphrates to the Straits of Dover, the
vine has been from the earliest ages second only to corn in popular
estimation; wine, next to bread, the most prized and most universal
article of human food. The connection between _Ceres_ and _Bacchus_
is found in almost every language as in the social life of every
nation, from the warlike Assyrian monarchy, the stable hierocratic
despotism of Egypt, to the modern French Republic and German Empire.
Corn itself has furnished stimulant second in popularity to wine alone;
the spirit which delighted the fiercer, sterner races of Northern
Europe—Swede, Norwegian, and Dane, St. Olaf, and Harold Hardrada,
as their descendants of to-day; and the ale of our own Saxon and
Scandinavian ancestry, which neither spirit, cider, nor Spanish wine
has superseded among ourselves. The vine, again, seems to have been
native to America; but the civilized or semi-civilized races of the
southern and central part of the Western Continent had other more
popular and more peculiar stimulants, also for the most part alcoholic.
The palm, again, has furnished to African and Asiatic tribes a spirit
not less potent or less noxious, not less popular and probably not
less primitive, than whiskey or beer. But where alcohol has been
unknown, among races to whose habits and temperament it was alien, or
in climates where so powerful an excitant produced effects too palpably
alarming to be tolerated by rulers or law-givers royal or priestly,
other and milder stimulants or sedatives are found in equally universal
use. Till the white man introduced among them his own destructive
beverages, till the “fire-water” spread demoralization and disease,
tobacco was the favorite indulgence of the Red Indian of North America,
and very probably of that mighty race which preceded them and seems to
have disappeared before they came upon the scene—the Mound-builders,
whose gigantic works bear testimony to the existence of an agriculture
scarcely less advanced or less prolific, a despotism probably not less
absolute than that of Egypt. Coffee has for ages been almost equally
dear to the Arabs; tea has been to China all that wine is and was to
Europe, probably from a still earlier period, and has taken hold on
the Northern, as coffee and tobacco upon the Southern, branches of
the Tartar race. Opium, or drugs resembling opium in character, have
been found as well suited to the temper, as delightful to the taste,
of the quieter and more passive Oriental races as wine to the Aryan
and Semitic nations. The Malays, the Vikings of the East Indies, found
in _bhang_ a drug the most exciting and maddening in its effects of
any known to civilized or uncivilized man; a substitute for opium or
haschisch bearing much the same relation to those sedatives as brandy
or whiskey to the light wines of Southern Europe.
The craving, then, is not artificial but natural; is not, as
teetotalers fancy, for alcohol alone or primarily, but for some form
of nervous excitement or sedative _specially_ suited to climate or
race. Tea, coffee, and tobacco, opium, haschisch and bhang, _mata_ and
_tembe_, are probably as old as wine, older than beer, and take just
as strong a hold upon the national taste. The desire testifies to a
felt and almost universal want; and the attempt to put down a habit
proved by universal and immemorial practice to answer to a need, real
and absolute—or if artificial easily created and permanent, if not
ineradicable, beyond any other artificial craving or habit—seems doomed
to failure; the desire not being for this or that stimulant, for wine
or alcohol, but for some agent that gives a special satisfaction to the
nerves, some stimulant, sedative or astringent. The discouragement of
one form of indulgence, especially if that discouragement be artificial
or forcible, not moral and voluntary, can hardly have any other result
than to drive the votaries of alcohol, for example, upon opium, or
those of opium upon some form of alcohol. Tea, coffee, and tobacco have
done infinitely more than teetotal and temperance preaching of every
kind to diminish the European consumption of wine, beer, and spirits.
Men and even women never have been and never will be content with water
or milk, or even with the unfermented juices of fruits; to say nothing
of the extreme difficulty of preserving unfermented juices in those
warmer climates to which they are best adapted.
It seems, however, that the natural craving, especially among women,
or men not subject to the fiercer excitements of war, hunting, and
open air life in general, is not for the stronger but for the milder
stimulants. Ale was the favorite beverage of England, light wine of
Southern Europe, till the Saracen invasion, the crusades, and finally
the extension of commerce, familiarised the Western Aryans with the
non-intoxicant stimulants of the East, and the discovery of America
introduced tobacco. But the use of tea and coffee is not less, we might
say, is more distinctly artificial than that of beer or wine. The taste
for tobacco, as its confinement in so many countries and to so great an
extent to one sex proves, is the most artificial of all.
It is plain, both from the climates and the character of the races
among whom the sedative drugs or slightly-stimulant beverages have
first and most widely taken root, that the preference for sedatives or
gentle excitants is not accidental, but to a large extent dependent
upon the temperament and habits of races or nations. Alcohol suits
the higher, more energetic, active, militant races; and the fiercer
and more militant the temper or habits, the stronger the intoxicant
employed. It is not improbable that the first and strongest incitement
to the use of alcohol, as of bhang, was the desire for that which a
very unfair and ungenerous national taunt describes as Dutch courage.
No race, probably, except their nearest kinsmen of England, was ever
less dependent on the artificial boldness produced by stimulants than
the stubborn soldiers and seamen of Holland. The beer-loving Teutons
have never been, like the wine-drinkers of France, Italy, and Spain,
a military, or even, like the Scandinavians, a thoroughly martial
race. They will fight: none, Scandinavians, Soudanese, and Turks
perhaps excepted, fight better or more stubbornly. It may well be that
the adventurous, enterprising spirit of Englishmen and Scotchmen,
displayed at sea rather than on land, and in semi-pacific quite as
much as in warlike enterprise, is derived in large measure from the
strong Scandinavian element in our national blood. The tea-drinking
Chinamen, the Oriental lovers of haschisch and opium, have mostly been
industrious rather than energetic, agricultural or pastoral rather
than predatory. The coffee-drinking Arabs were not, till the days of
Mahomet, a specially warlike race. Bandits or guerillas they were
perforce; like every people which inhabits a country whose mountains
or deserts afford a safe refuge to robbers but promise no reward to
peaceful industry. No race, no class living in the open air, save in
the warmer climates, no people given to energetic muscular labor or
devoted to war, would be prompt to abandon alcohol in any of its forms
for its milder Oriental equivalents. Tea and coffee were introduced
at a time when manufactures and in-door-life were gaining ground in
Western Europe and found favor first, as is still the case, with the
indoor-living sex. It is still among indoor workers that they are most
in vogue. But if, as seems likely, alcohol was first adopted by the
warriors of savage or semi-savage races as an inspiring or hardening
force, it early lost this character with the introduction of strict
military discipline on the one hand or of chivalry on the other.
Neither the trained soldier of the phalanx and the legion, nor the
knight with whom reckless but also intelligent courage was a point of
honor, could find any help in intoxication, partial or total; nay, he
soon found that while the first excitement of alcohol was fatal to
discipline, its subsequent effects were almost as injurious to the
persevering, steadfast kind of courage in which he put his pride.
Wine or brandy, then, came to be the indulgence of peace and triumph,
not of war; wassail followed on victory, sobriety was necessary till
the victory was won. But still it has always been on the sterner,
fiercer, more energetic races that alcohol, and especially the stronger
forms of alcohol, retained their hold. It is to the passive, quiet,
reflective temperaments—national or individual, peculiar to classes or
to crafts—that tea or coffee, opium or haschisch, substances that calm
rather than excite the nerves, have always proved strongly and often
dangerously attractive.
Now it may be urged with plausibility, and perhaps with truth, that
civilization and intellectual culture, the exchange of out-door for
in-door life, the influences that have rendered intelligence and
dexterity of more practical value than corporeal strength, tend in some
sense and in some measure to Orientalize the most advanced European
races. We are not, perhaps, less daring or less enterprising than
our fathers; but there is a large and ever increasing class to which
strenuous physical exertion is neither habitual nor agreeable. We are
unquestionably becoming sedentary; we work much more with our brains,
much less with our muscles, than heretofore. With this change has come
a decided change of feeling and tastes. We shrink from the fierce
excitement, the violent moral stimulants that delighted ruder and
less sensitive races and generations. The gladiatorial shows of Rome,
the savage sports and public punishments of the Middle Ages, would be
simply revolting to the great majority of almost every European nation
of to-day; not primarily because as thoughtful Christians we deem them
wicked, but because, instinctively, as sensitive men and women in whom
imagination and sympathy are strong, we shudder at them as brutal.
Prize-fights, bear-baiting, bull-fights have become too rough, too
coarse, but above all too exciting; the hideous tragedies of old have
ceased to suit the taste at least of our cultivated classes. In one
word, our nerves are far too sensitive to crave for strong and violent
excitement, moral or physical; it is painful rather than pleasurable.
The sobriety of the educated classes is due much less to moral than
to social causes. It is not that strong wines and spirits are so much
more injurious to us than to our grandsires, nor that we have learned
in fifty years to think intoxication sinful; rather we have come to
despise it, and to dislike its means, because we have ceased to feel or
understand the craving for such violent stimulation, because not merely
the reaction but the excitement itself gives more pain than pleasure.
In the case of our American kinsmen climate has very much to do
with the matter. A dry, keen, exhilarating air as well as an
intense nervous sensibility renders powerful alcoholic stimulants
unnecessary, over-exciting, unpleasant as well as injurious. Partly
from temperament, a temperament which in itself must be largely the
result of climate, partly from the direct influence of their drier,
keener atmosphere, American women feel no need of alcohol; American men
who do indulge in it, rather as a relief from brain excitement than as
an excitant itself, suffer far more than we do from the indulgence.
The number of drunkards or hard-drinkers in the older States is, we
believe, very much smaller than in England, even at the present day.
But the proportion of lunatics made by drink seems to be much larger.
In America alone teetotalism has been the serious object of social and
legislative coercion. The Maine Liquor Law failed; but it is enforced
in garrisons and colleges, while in many States social feeling and
sectarian discipline forbid wine and spirits to women and clergymen,
and habitual indulgence therein, however moderate, is hardly compatible
with a high reputation for religious principle or strict morality.
But this case, like that of the early Mahometans, is the case of a
people whose climate is unsuited to alcohol; whose very atmosphere is a
stimulant.
In a word, the craving of to-day, moral and physical, especially among
the cultivated classes, among the brain-workers, among those of the
softer sex and of the _fruges consumere nati_, who are almost entirely
relieved from physical labor, is for mild prolonged stimulation, and
for stimulation which does not produce a strong reaction; or else
for sedatives which will allay the sleepless excitement produced by
over-work, or yet oftener, perhaps, by reckless pursuit of pleasure.
It seems, then, not unnatural or improbable that, as tea and coffee
have so largely taken the place of beer or light wine as beverages, so
narcotics should take the place of stronger alcoholic stimulants. That
this has been the case in certain quarters is well known to physicians,
and to most of those who have that experience of life in virtue of
which it is said, “every man of forty must be a physician or a fool.”
Nay, it is difficult to read the newspapers and remain ignorant or
doubtful of the fact. We read weekly of men and women poisoned by an
over-dose of some favorite sedative, burnt to death, or otherwise
fatally injured while insensible from self-administered ether or
chloroform. For one fatal case that finds its way into the newspapers
there are, of course, twenty fatal in a different sense—fatal, not
to life, but to life’s use and happiness—that are never known beyond
the family circle, into which they have introduced unspeakable and
often almost unlimited sorrow and evil; unlimited, for no one can be
sure, few can reasonably hope, that the mischief will be confined to
the individual victim of a dangerous craving. That the children of
drunkards are often pre-disposed to insanity is notorious; that the
children of habitual opium-eaters or narcotists inherit an unmistakable
taint, whether in a diseased brain, in diseased cravings, or simply in
a will too weak to resist temptation of any kind, is less notorious but
equally certain. Of these secondary victims of chloral or opium there
are not as yet many; but many fathers and mothers—fathers, perhaps,
who for the sake of wives and children have overtaxed their brains
till nothing but either the rest which circumstances and family claims
forbid, or drugs, will give them the sleep necessary to the continuance
of their work; mothers, too commonly, who begin by neglecting their
children in the pursuit of pleasure, to end by poisoning their
unborn offspring in the struggle to escape the consequences of
that pursuit—are preparing untold misery and mischief for a future
generation. Happily, narcotism is not the temptation of the young or
energetic. It is later in life, when the effect of years of brain
excitement of whatever nature begins to tell, and generally after the
period in which the greater number of children are born, that men and
women give way to this peculiar temptation of the present age.
The immediate danger to themselves is sufficiently alarming, if only
it were ever realized in time. The narcotist keeps chloroform or
chloral always at hand, forgetful or ignorant that one sure effect of
the first dose is to produce a semi-stupor more dangerous than actual
somnolence. In that semi-stupor the patient is aware, or fancies
that the dose has failed. The pain that has induced a lady to hold a
chloroformed handkerchief under her nostrils returns while her will
and her judgment are half paralysed. She takes the bottle from the
table beside her bed, intending to pour an additional supply on the
handkerchief. The unsteady hand perhaps spills a quantity on the sheet,
perhaps sinks with the unstoppered bottle under her nostrils; and in a
few moments she has inhaled enough utterly to stupefy if not to kill.
The vapor, moreover, is inflammable; perhaps it catches the candle
by her side; and she is burnt to death while powerless to move. The
sleepless brain-worker also feels that his usual dose of chloral has
failed to bring sleep; he is not aware how completely it has stupefied
the brain, to which it has not given rest. His judgment is gone, so is
his steadiness of hand; and, whether intentionally or not, at any rate
unconsciously, so far as reasoning and judgment are concerned, he pours
out a second and too often a fatal dose. Any one who knows how great is
the stupefying power of these drugs, how often they produce a sort of
moral coma without paralysing the lower functions of animal or even of
mental life, would, one might suppose, at least take care to be in bed
before the drug takes effect, and if possible to put it out of reach
till next morning. But experience shows how seldom even this obvious
and essential precaution is taken.
The cases that end in a death terrible to the family, but probably
involving little or no suffering to the victim himself, are by no
means the worst. A life poisoned, paralysed, rendered worthless for
all the uses of intellectual, rational, we might almost say of human
existence, is worse for the sufferer himself and for all around him
than a quick and painless death; and for one such death there must
be twenty if not a hundred instances of this worst death in life. In
nine cases out of ten, probably, the narcotist has been entangled
almost insensibly, but incurably, without intention and almost without
consciousness of danger. With alcohol this could hardly be the case. No
woman, at any rate, could reach the point at which secret indulgence
in wine or spirits became a habit and a necessity without warnings,
evidences of excess palpable to herself if not to others, that should
have terrified and shamed her into self-control, while self-control was
yet possible. The hold that opium and other narcotics acquire is at
once swifter, more gradual, less revolting and incomparably stronger
than that of alcohol. The first indulgence is in some sense legitimate;
is almost enforced, either by acute pain or by chronic insomnia. The
latter is perhaps the more dangerous. The pain, if it last for weeks,
forces recourse to the doctor before the habit has become incurable.
Sleeplessness is a more persistent, and to most people a much less
alarming thing; and it is moreover one with which the doctors can
seldom deal save through the very agents of mischief. Neuralgia,
relieved for a time by chloroform or morphia, may be cured by quinine;
sleeplessness admits of hardly any cure but such complete change of
life as is rarely possible, at least to its working victims. And the
narcotist habit once formed, neither pain nor sleeplessness is all that
its renunciation would involve. The drunkard, it must be remembered,
gets drunk, as a rule, but occasionally. Save in the last stages of
dipsomania, he can do, if not without drink, yet without intoxicating
quantities of drink, for days together. The narcotist who attempts to
go for a whole day without his accustomed dose, suffers in twenty-four
hours far more cruelly than the drunkard deprived of alcohol in as many
days. The effect upon the stomach and other organs, upon the nerves as
well as on the brain, is one of indescribable, unspeakable discomfort
amounting to torture; a disorder of the digestive system more trying
than sea-sickness, a disorganization of the nerves which after some
hours of unspeakable misery culminates in convulsive twitchings, in
mental and physical distress, simply indescribable to those who have
not felt it. Where attempts have been made forcibly and suddenly to
withhold the accustomed sedative, they have not unfrequently ended
within a few days in madness or death. In other cases the victim has
sought and obtained relief by efforts and through hardships which, in
his or her best days, would have seemed impossible or unendurable.
One woman thus restrained escaped in a _déshabille_ from her bed-room
on a winter night of Arctic severity; ran for miles through the snow,
and was fortunate enough to find a chemist who knew something of the
fearful effect of such privation, and had the sense and courage to give
in adequate quantity the poison that had now become the first necessary
of life. In a word, narcotics, one and all, are, to those who have once
fallen under their power, tyrants whose hold can hardly ever be shaken
off, which punish rebellion with the rack, and with all those devices
of torture which mediæval and ecclesiastical cruelty found even more
terrible than the rack itself; while the most absolute submission is
rewarded with sufferings only less unendurable than the punishment of
revolt. De Quincey’s dreams under the influence of opium were to the
tortures of resistance what the highest circle of purgatory may be to
the lowest pit of the Inferno. But any reader who knows what nightmare
is would think such tortures of the imagination, so vividly realized by
a consciousness apparently intensified rather than impaired by slumber,
a sufficient penalty for almost any human sin.
Chloral, bromide of potash, chloroform, henbane, and their various
combinations and substitutes are, however, by their very natures
medicines and no more. They are taken in the first instance as such;
at worst as medicinal equivalents for a quantity of alcohol which
women are afraid to take or unable to obtain, much more commonly as
medicines originally useful, mischievous only because the system has
been accustomed to depend on and cannot dispense with them. Their
effects at best are negatively, not actively, pleasurable. They relieve
pain or insomnia, or the craving which they themselves have created;
but their victims would, if they could, gladly be released from their
tyranny. Their character, moreover, is if not immediately yet very
rapidly perceptible. Very few can have used them for six months without
becoming more or less alarmed by the consequences. The minority,
for whom they are mere substitutes for alcohol, resort to them only
when the system has already been poisoned, the habits incurably
vitiated. With opium the case is different. In those which may be
called its native countries, it is not a medicine but a stimulant or
sedative, used for the most part in much greater moderation but in
the same manner as wine or spirits among ourselves; as an indulgence
pleasurable and innocent, if not actually desirable in itself. It suits
the climates and temperaments to which the heating, exciting influence
of alcohol is wholly unsuitable. It is, moreover, incompatible with
the free use of the latter, a thing which may be said in some sense of
most narcotics. Taken up by persons not yet addicted to intemperance,
chloral and similar drugs operate to discourage the use, or at least
the free use, of wine or spirits by intensifying their effect to a
serious and generally an unpleasant degree. But it does not appear
that they act, like opium, to indispose the system for alcohol. To the
opium-eater, as a rule, the exciting stimulus of alcohol, counteracting
the quiet, dreamy influence of his favorite drug, is decidedly
obnoxious; the action of chloral much more resembles that of the more
stupefying and powerful spirits. A drunkard desirous to abandon his
favorite vice, and reckless or incredulous of the possibility that the
remedy may be worse than the disease, would probably find in opium
the most powerful and effectual assistance and support to which he
could have recourse. It has moreover a strong tendency to diminish
the appetite for food, so much so that both in the East and in Europe
severe privation tends to encourage and diffuse its use.
Its peculiar danger, however, lies in the nature of the pleasure, and
the remoteness of the pain and mischief which attend its use. Its
effect on different constitutions and at different periods of life is
exceedingly different. As De Quincey remarks, it is not essentially
and primarily narcotic. It does not necessarily, immediately, or
always produce sleep. Some fortunate temperaments reject it in all
forms whatever. With these it produces immediate or speedy nausea, and
consequent repugnance. But its most universal effect is the diffusion
of comfort, quiet, calm, conscious repose, a general sensation
of physical and mental ease throughout the system; not followed
necessarily or generally by acute reaction, or even by depression. De
Quincey’s earlier experience accords with that of most of those to whom
opium is in some sense suited, to whom alone it is likely to become a
dangerous temptation. Used once in a fortnight, or even once a week,
it gives several hours of placid enjoyment, and if taken with some
mild aperient and followed next morning by a cup of strong coffee, it
generally gives a quiet night’s rest, entailing no further penalty
than a certain not unpleasant lassitude on the morrow. A working-man,
for instance, might take it every Saturday night for twenty years
without other effect than a decided aversion to the public-house on
Sunday, if he could but resist the temptation to take it oftener.
Again, till it loses its power by constant use it is in many cases the
surest and pleasantest of all anæsthetics; it relieves all neuralgic
pains, tooth-ache and ear-ache for example, and puts, especially in
combination with brandy, a quick and sure if by no means a wholesome
check on the milder forms of diarrhœa.
In this connection one danger peculiar to itself deserves especial
notice. Other narcotics are seldom given or sold save under their
own names; and if administered in combination, in quack medicine or
unexplained prescriptions, their effect betrays itself. Opium forms the
basis of innumerable remedies and very effective remedies, sold under
titles altogether reassuring and misleading. Nearly all soothing-syrups
and powders for example—“mother’s blessings” and infant’s curses—are
really opiates. These are known or suspected by most well-informed
people. What is less generally known is that nine in ten of the popular
remedies for catarrh, bronchitis, cough, cold and asthma are also
opiates. So powerful indeed is the effect of opium upon the lining
membrane of the lungs and air passages, so difficult is it to find
an effective substitute, that the efficacy, at least the certain and
rapid efficacy, of any specific remedy for cold whose exact nature is
not known affords strong ground for suspecting the presence of opium.
Many chemists are culpably, almost criminally, reckless; and not a
few culpably ignorant in this matter. An experienced man bought from
a fashionable West-end shop a box of cough lozenges, pleasant to the
taste and relieving a severe cough with wonderful rapidity. Familiar
with the influence of opium on the stomach and spirits, he was sure
before he had sucked half-a-dozen of the lozenges that he had taken a
dose powerful enough to affect his accustomed system, and strong enough
to poison a child, and do serious harm to a sensitive adult. Yet the
lozenges were sold without warning or indication of their character;
few people would have taken any special precaution to keep them out of
the way of children, and the box, falling into the hands of a heedless
or disobedient child, might have poisoned a whole nursery.
Another personal experience may serve to dispel the popular delusion
that opium is necessarily or generally a stupefying agent. A mismanaged
minor operation exposed two sensitive nerves, producing an intolerable
hyperæsthesia and a nervous terror which rendered surgical relief for
the time impossible, and endurance utterly beyond human power. For a
fortnight or more the patient was never free from agony save when the
nerves of sensation were practically paralysed by opium. During that
fortnight he took up for the first time, and thoroughly mastered, as
a college examination shortly afterwards proved, Mill’s _Principles
of Political Economy_, a work not merely taxing to the uttermost the
natural faculties of nineteen, but demanding beyond any other steady
persistent coherence and lucidity of thought. The patient affirmed that
never had his mind been clearer, his power of concentration greater,
his receptive faculties more perfect or his memory more tenacious.
That the drug had in no wise impaired the intellectual, however it
might have quelled the muscular or nervous energies, seems obvious.
Yet at that time the patient was ignorant of the two antidotes above
mentioned; and neither coffee nor aperient medicine qualified or
mitigated the influence of the opiates; an influence strong enough to
quell for some twenty-two hours out of the twenty-four an acute and
terrible nervous torture.
After the use of a fortnight or a month—especially when used
legitimately to relieve pain and not to procure pleasure—the entire
abandonment of opium may be easily accomplished in the course of two
or three days. The pain or the disease it is used to overcome carries
off, so to speak, or diverts in great measure the injurious influence
of the drug; as a person suffering from diarrhœa, snakebite, or other
cause of intense lowering of physical and nervous power, may take with
impunity a dose of brandy which in health would certainly intoxicate
him. But after six months’ or a year’s daily use or abuse, only the
strongest and sternest resolution can overcome or shake off the tyranny
of opium, and then only at a price of suffering and misery, of physical
and mental torture such as only those who have known it can conceive.
It would be as foolish to depreciate the value as to underrate the
danger of this, the most powerful and in many respects the safest of
anæsthetics. Nothing else can do what opium can to relieve chronic,
persistent, incurable nervous pain, to give sleep when sleeplessness is
produced by suffering. The more potent anæsthetics, like chloroform,
are applicable only to brief intense tortures, whose period can be
foreseen or determined—to produce insensibility during an operation,
or to mitigate the pangs of child-birth. Opium can relieve incurable
chronic pain that would otherwise render life intolerable, and perhaps
drive the sufferer to suicide; and this, if moderation be observed,
and the necessary correctives employed, without impairing, as other
narcotics would, the intellectual faculties. It is, moreover, as
aforesaid, the quickest and surest cure for bronchial affections of
every kind, and might not impossibly, as De Quincey thought, if used in
time and with sufficient decision, prolong a life otherwise doomed, if
it could not actually cure phthisis or consumption after the formation
of tubercle has once begun. But its legitimate use is limited to
three cases. It can relieve temporary neuralgic pain when cure would
be slow, or while awaiting a curative operation. One peculiarity
of neuralgic pain is its tendency to perpetuate itself. The nerves
continue to thrill and throb because worn out by pain. Give them,
through whatever agency, a brief period of rest, and it may well happen
that, the temporary cause removed, the pain will not return. Secondly,
opium is the one anæsthetic agency available to mitigate incurable
and intolerable suffering. Not only can it render endurable a life
that must otherwise be one continuous torture, till torture hastens
death; but it may in many cases render that life serviceable as well as
endurable. De Quincey gives the instance of a surgeon, suffering under
incurable disease of an intolerably painful kind, who owed the power
of steady professional work for more than twenty years to the constant
use of opium in enormous quantities. Finally, when a working life
draws near its natural close, when old age is harassed by the nervous
consequences of protracted over-work or over-strain such as is often
almost inseparable from the anxieties of business—the severe taxation
of the mental powers by professional or literary labor—opium, given
habitually in small quantities and under careful medical direction,
often does what wine effects with less certainty and safety; gives
rest and repose, calms an irritability of nerve and temper more trying
to the patient himself than to those around him, and renders the last
decade of a useful and honorable life much more comfortable, and no wit
less useful or honorable, than it might otherwise have been.
But except as a relief in incurable disease, or in that most incurable
of all diseases, old age, the continual or prolonged use of opium
is always dangerous and nearly always fatal. It impairs the will;
not infrequently it exercises a directly, visibly, unmistakably
deteriorating influence upon the moral nature. There is nothing strange
in this to those who know how an accidental injury to the skull may
impair or pervert the moral no less than the intellectual powers.
That moral is hardly a less common or less distinctive disease than
mental insanity, that the conscience as well as the intellect of the
drunkard is distorted and weakened, no physiologist doubts. Opium has
a similar power, but exerts it with characteristic slowness of action.
The demoralization of the narcotist is not, like that of the drunkard,
rapid, violent, and palpable; but gradual, insidious, perceptible only
to close observers or near and intimate friends. In nine cases out of
ten, moreover, opium ultimately and certainly poisons the whole vital
system. The patient loses physical and mental energy, courage, and
enterprise; shrinks from exertion of every kind, dreads the labor of a
walk, the trouble of writing a letter, dreads still more intensely any
effort that calls for moral courage, flinches from a scene, a quarrel,
a social or domestic conflict, becomes at last selfish, shameless,
weak, useless, miserable to the last degree.
But this, like every other effect of opium, is in some measure
uncertain; and hence arises one of its subtlest dangers. De Quincey
would seem to have been less susceptible than most men to the worst
influences of his favorite drug, seeing what work, excellent in
quality as well as considerable in quantity he achieved after he had
become a confirmed opium-eater. It took, no doubt, a tenfold greater
amount of opium to reduce him to intellectual impotence than would
suffice to destroy the minds of nine brain-workers in ten. But his
own story clearly reveals how completely the enormous doses to which
he had recourse at last overpowered a mind exceptionally energetic,
and a temperament exceptionally capable of assimilating, perhaps,
rather than resisting the power of opium. Here and there we find a
constitution upon which it exerts few or none of its characteristic
effects. As a few cannot take it at all, so a few can take it with
apparent impunity. With them it will relieve pain and will not paralyse
the nerves, will quell excitement without affecting mental energy;
nay, while leaving physical activity little more impaired than age and
temperament alone might have impaired it. Here and there we may find a
confirmed opium-eater capable of taking and enjoying active exercise—a
fairly fearless rider, a lover of nature tempted by taste, or it may
be by restlessness, to walks beyond his muscular strength; with vivid
imagination well under his own control; in whom even the will seems but
little weakened, whose dread of pain and flinching from danger are not
more marked after twenty years spent under the influence of opium than
when they first drove him to its use. Such cases are, of course, wholly
exceptional; but their very existence is a danger to others, misleads
them into the idea that they may dally with the tempter, may profit by
its pleasure-giving and pain-quelling powers without falling under its
yoke, or may fall under that yoke and find it a light one. I doubt,
however, whether the most fortunate of its victims would encourage the
latter idea; whether there be any opium-eater who would not give a
limb never to have known what opium can do to spare suffering, to give
strength for protracted exertion, if he had never known what slavery to
its influence means.
Dread of pain, dislike of excitement and worry, impatience of suffering
and discomfort, of irritation, and sleeplessness, are all strong and
increasingly-marked characteristics of our highly artificial life and
perhaps almost overstrained civilization. Nature knows no influence
that can relieve worry, mitigate pain, charm away restlessness,
discomfort, and even sleeplessness, as opium can. Alcohol is at once
too stupefying and too exciting for the tastes and temperaments that
belong to cultivated natures and highly-developed brains. Beer suits
the sluggish laborer, or the energetic navvy when his work is done,
and his system, like that of a Scandinavian Viking or Scythian warrior
in his hours of repose, craves first exhilaration and then stupid,
thoughtless contentment. Wine suits less active and more passionate
races, to whom excitement is an unmixed pleasure; brandy those who
crave for stronger excitement to stimulate less susceptible nerves. But
the physical stimulants of our fathers and grandfathers, as the moral
excitements of remoter times, are far too violent for our generation.
Champagne has succeeded port and sherry as the favorite wine of those
who can afford it, being the lightest of all; and time was, not so
long ago, when medical men were accused of recommending champagne with
somewhat careless facility to those whose nerves, worn out by unhealthy
pursuit of pleasure, by unnatural hours and unwholesome excitement,
might have been effectually though more gradually restored by a change
which to most of them at least was possible; by life in the country
rather than in London, by the fresh air of the early morning instead
of that of midnight in over-heated gas-lighted rooms and a poisoned
atmosphere. There is a danger lest, as even champagne has proved too
much of a stimulant and too little of a sedative, narcotics should
take its place. The doctors will hardly recommend opium, but their
patients, obliged for one reason or another to forego wine, might be
driven upon it.
As aforesaid, the craving for stimulation or tranquillization of the
brain—in one word, for that whole class of nerve-agents to which tea,
opium, and brandy alike belong—is so universal, has so prevailed in all
ages, races and climates, that it must be considered, if not originally
natural, yet as by this time an ingrained, all but ineradicable,
human appetite. To baffle such an appetite by any coercive means, by
domestic, social or legislative penalties, has ever proved impossible.
Deprive it of its gratification in one form, and it is impelled or
forced to find a substitute; and finds it, as all strong human cravings
have ever found some kind of satisfaction. And here lies one of the
worst, most certain and yet least considered dangers of the legislation
eagerly demanded by a constantly increasing party. Maine liquor laws,
prohibition, local option, every measure that threatens to deprive of
their favorite stimulant those who are not willing or have not the
resolve to abandon it, would probably fail in their primary object.
If they succeeded in that, they would, in a majority of instances,
force the drinker, not to be content with water or even with tea, but
to find a subtler substitute of lesser bulk, more easily obtained and
concealed. Opium is the most obvious, and, among sedatives powerful
enough to be substituted for wine or spirits, the least mischievous
resource. And opium, once adopted as a substitute for alcohol, would
take hold with far greater tenacity, and its use would spread with
terrible rapidity, because its evil influence is so subtle, so slowly
perceptible; and because, if used in moderation and with fitting
precautions, its worst effects may not be felt for many years;
because women could use it without detection, and men without alarm
or discredit. This peril is one of which wiser men than Sir Wilfrid
Lawson will not make light, but which too many comparatively rational
advocates of total abstinence seem to have totally overlooked. Without
underrating the frightful evils of intoxication, its baneful influence
upon the individual, upon large classes, and upon the country as a
whole, no one who knows them both can doubt that narcotism is the more
dangerous and more destructive habit. The opiatist will not brawl in
the street, will not beat his wife or maltreat his children; but he is
rendered as a rule, even more rapidly and certainly than the drunkard,
a useless member of society, a worthless citizen, an indifferent
husband, helpless as the bread-winner, impotent as the master and
ruler of a household. And opium, to the same temperaments and to many
others, is quite as seductive as alcohol; far more poisonous, and
incomparably more difficult to shake off when once its tyranny has been
established. To forbid it, as some have proposed to forbid the sale or
manufacture of beer, wine, and spirits, is impossible; to exclude it
from the country is out of the question; its legitimate uses are too
important, and no restrictions whatever can put it out of the reach of
those who desire it. Silks, spirits, tobacco were smuggled as long as
it paid to smuggle them; opium, an article of incomparably less bulk
and incomparably greater value, would bring still larger profit to the
importer; while the customer would not merely be attracted by cheapness
or fashion, but impelled by the most imperious and irresistible of
acquired cravings. Any man could smuggle through any barriers enough to
satisfy his appetite for a year, enough to poison a whole battalion.
That opium can become the favorite indulgence with numerous classes,
and apparently with a whole people, the experience of more than one
Eastern nation clearly shows. As the Oriental tea and coffee have to so
large an extent superseded beer as the daily drink of men as well as
women and children, so opium is calculated under favoring circumstances
to replace wine and spirits as a stimulant. It might well do so even
while the competition was open. Every penalty placed on the use of wine
or brandy is a premium on that of opium.
De Quincey is not the only opium-eater who has given his experience to
the world. It is evident that the practice is spreading in America,
and the records published by its victims are as terrible as the
worst descriptions of the drunkard’s misery or even as the horrors
of _delirium tremens_. It is noteworthy, however, how little any of
these seem to know of other experiences than their own—for instance,
of the numerous forms and methods in which the drug can be and is
administered. Opium—the solidified juice of the poppy—is the natural
product from which laudanum, the spirituous tincture of opium, and
all the various forms of morphia, which may be called the chemical
extract, the essential principle of opium, are obtained. Morphia,
again, is sold by chemists and exhibited by doctors in many forms,
the principal of which are the acetate, the sulphate and the muriate
of morphia—the substance itself combined with acetic, sulphuric, or
hydrochloric acid. Of these last the muriate is, we believe, the
safest, the acetate and in a lesser degree the sulphate having more of
the pleasurable, sedative, seductive influence of opium in proportion
to their pain-quelling power. They act, in some way, more powerfully
upon the spirits while exerting the same anæsthetic influence, and
the injurious effects of each dose are more marked and less easily
counteracted. Laudanum, containing proof spirit as well as morphine,
and through the proof spirit diffusing the narcotic influence more
rapidly and affecting the brain more quickly and decidedly, is perhaps
the worst vehicle through which the essential drug can be taken. Again,
morphine, in its liquid forms can be injected under the skin; as
solid opium it can be smoked or eaten, as morphia it can be swallowed
or injected. Of all modes of administration—speaking, of course, of
the self-administered abuse, not of the strict medical use of the
drug—subcutaneous injection is the worst. It acts the most speedily
and apparently the most pleasurably; it passes off the most rapidly,
and tempts, therefore the most frequent, re-application. Apart,
moreover, from the poisonous influence itself, this mode of application
has injurious effects of its own; produces callosities and sores
of a painful and revolting character. Smoking seems to be the most
stupefying manner in which solid opium can be consumed, the one which
acts most powerfully and injuriously upon the brain. But opium-smoking
is hardly likely to take a strong hold on English or European taste.
A piece of opium no larger than a pea, chopped up and mixed with a
large bowlful of tobacco, produces on the veteran tobacco-smoker a
nauseating effect powerfully recalling that of the first pipe of his
boyhood; while its flavor is incomparably more disagreeable to the
palate accustomed to the best havanas or the worst shag or bird’s-eye
than these were to the unvitiated taste. It is probable that the
Englishman who makes his first acquaintance with opium in this form
will be revolted rather than tempted, unless indeed the pipe be used
to relieve a pain so intolerable that the nauseousness of the remedy
is disregarded. Morphia in all its forms, liquid or solid, has a
thoroughly unpleasant bitterness, but neither the nauseous taste of
the pipe nor the intensely disgusting flavor of laudanum, a flavor so
revolting to the unaccustomed palate that only when largely diluted
by water can it possibly be swallowed. On the whole, the muriate,
dissolved in a quantity of water large enough to render each drop the
equivalent of a drop of laudanum, is probably the safest, and should be
swallowed rather than injected. But rather than swallow even this, a
wise man, unless more confident in his own constancy and self-command
than wise men are wont to be, had better endure any temporary pain
that nature may inflict or any remedial operation that surgery can
offer.—_Contemporary Review._