[Illustration: LAOCOÖN.]
“Ille simul manibus tendit divellere nodos,
Clamores simul horrendos ad sidera tollit.”
_Virgil, Æneid, Lib. 11._
The knotted coils he strains to tear apart,
Filling the air and heaven with horrid cries.
DRUGS THAT ENSLAVE.
THE
OPIUM, MORPHINE,
CHLORAL AND HASHISCH HABITS.
BY H. H. KANE, M. D.,
NEW YORK CITY.
“They are drunken, but not with wine; they stagger,
but not with strong drink.”—ISAIAH.
“What warre so cruelle, and what siege so sore,
To bring the sowle into captivitie,
As that fierce appetite doth fain supplie!”
PHILADELPHIA:
PRESLEY BLAKISTON,
1012 WALNUT STREET.
1881.
Entered, according to Act of Congress, in the year 1881, by
PRESLEY BLAKISTON,
In the office of the Librarian of Congress, at Washington, D. C.
Press of WM. F. FELL & CO.,
1220-1224 Sausom Street.
_To_
Dr. Alexander J. C. Skene,
Professor of the Medical and Surgical Diseases of Women and the
Diseases of Children, in the
LONG ISLAND COLLEGE HOSPITAL, BROOKLYN, N. Y.,
THIS LITTLE WORK IS DEDICATED,
as a mark of the high esteem,
both as regards his scientific attainments, untiring energy,
and the largeness of his heart, in which he is held by
his old pupil and sincere admirer,
THE AUTHOR.
PREFACE.
The idea of writing this little work was first suggested to me by the
numerous letters received from physicians at home and abroad, asking for
information on various points connected with the symptomatology, prognosis
and treatment of the various “habits.” While manifesting an earnest desire
to become acquainted with the main features of the conditions in question,
many presented a lamentable ignorance of the simple facts relating to them.
These facts I have endeavored to present in as comprehensive, yet concise,
a form as possible. But little space has been devoted to the study of the
hashisch habit, owing to its rarity in this country.
The statements as to the dangers and peculiarities of these conditions,
aside from what I have myself observed, are based upon the literature
of the subject, and the letters of nearly a thousand correspondents in
various parts of the world, to whom I take this occasion for returning my
hearty thanks.
_191 West Tenth Street, New York City._
“After my death I earnestly entreat that a full and unqualified
narrative of my wretchedness, and of its guilty cause, may be
made public, that at least some little good may be effected by
the direful example.”—COLERIDGE.
A curse that is daily spreading, that is daily rejoicing in an increased
number of victims, that entangles in its hideous meshes such great men
as Coleridge, De Quincey, William Blair, Robert Hall, John Randolph, and
William Wilberforce, besides thousands of others whose vice is unknown,
should demand of us a searching and scientific examination.
As an illustration of the enormous increase of the use of opium and
morphia in the United States, the following statistics have a painful
interest, and it must be remembered that this is no exceptional case.
In one of our large cities, containing, twenty-five years ago, a
population of 57,000, the sales of opium and morphia reached 350 pounds
and 375 ounces, respectively, or about 43 grains of opium and 3 grains
of morphia yearly for each individual, if the consumption was averaged.
The population is now 91,000, and 3500 pounds of opium and 5500 ounces
of morphia are sold annually. While the population has increased 59
per cent., the sale of opium has increased 900 per cent., and morphia
1100, or an average of 206 grains of opium and 24 grains of morphia to
every inhabitant. But there are additional sales of from 400,000 to
500,000 pills of morphia, which would give us 170 ounces more of the
drug. One-fourth of the opium sold is consumed in its natural state, and
three-fourths are made into opiates, the principal one being laudanum.
The following is official from the New York Custom House:—
Imports of opium into the United States for ten fiscal years, ending June
30th:—
1871, 315,121 lbs. $1,926,915
1872, 416,864 ” 2,107,341
1873, 319,134 ” 1,978,502
1874, 395,909 ” 2,540,228
1875, 132,541 ” 939,553
1876, 388,311 ” 1,805,906
1877, 349,223 ” 1,788,347
1878, 430,950 ” 1,874,815
1879, 405,957 ” 1,809,696
1880, 533,451 ” 2,786,606
Facts like these must, we think, arouse attention. They show a fearful
drift. There is a worse form of intemperance than that which comes from
bad liquor, although the choice would seem to be between the devil and the
deep sea:
“And in the lowest depth, a lower deep,
Still threatening to devour us, opens wide.”
CONTENTS.
PAGE
CHAPTER I.
The Opium and Morphine Habits. Formation; General Symptoms 17-26
CHAPTER II.
Preparations Employed. Manner of Using 27-33
CHAPTER III.
General Symptoms Analyzed and Classified 34-45
CHAPTER IV.
General Symptoms Analyzed and Classified—Concluded 46-70
CHAPTER V.
Accidents Incident to the Subcutaneous Use of Morphia 71-105
CHAPTER VI.
The Treatment of the Opium and Morphia Habits. General
Considerations 106-129
CHAPTER VII.
Agents Used in the Treatment of the Opium and Morphia Habits 130-148
CHAPTER VIII.
The Continued Use of Chloral 149-164
CHAPTER IX.
Effects of Chloral on the Different Systems and Apparatuses 165-179
CHAPTER X.
Effects of Chloral on the Different Systems and
Apparatuses—Concluded 180-199
CHAPTER XI.
Symptoms of Abstinence from Chloral—Treatment 200-205
CHAPTER XII.
The Hashisch Habit 206-218
CHAPTER XIII.
Conclusion 219-221
THE OPIUM AND MORPHINE HABITS.
CHAPTER I.
THEIR PATHOLOGY.
A higher degree of civilization, bringing with it increased mental
development among all classes, increased cares, duties and shocks, seems
to have caused the habitual use of narcotics, once a comparatively rare
vice among Christian nations, to have become alarmingly common.
Increase in mental strain, hot-house development of the passions, lessened
physical labor and increased mental work, have been gradually giving us
bodies in which the nervous element largely preponderates. Persons who
may be classed under the head of “nervous temperament” are daily on the
increase.
Diseases are to-day as different from diseases of a century ago as is
their treatment. While the average individual now does more mental work in
an hour than did our ancestors in six hours, we are not one-sixth as well
able to bear the intellectual strain as they were.
Nine-tenths of us neither eat, sleep, exercise, bathe, or procreate in
a proper way. It is all hurry and turmoil; little rest and much care.
Generation by generation our physical natures are changing, and in the
children of each succeeding generation we see the preponderance of the
nervous element; a gradual evolution of that or those peculiarities most
prominently brought forth by the exigencies of the individual and national
life of a people.
Finding pain, “nervousness” and hysteria constantly claiming his
attention, and that nothing relieves them so well as opium, or its
alkaloid morphia, which is six times the parent strength, the physician
resorts to their use more and more freely, expecting as soon as the more
distressing symptoms pass away to pursue another and more permanent plan
of treatment. The patient, however, having once experienced relief,
insists upon the further use of the drug, sometimes feigns illness, in
order to procure it, finally obtains some herself, and in guilty secrecy
drifts rapidly into the habit.
Some physicians are weak enough to place the means of gratifying this
morbid appetite directly in the hands of the patient. This is more
especially the case since the hypodermic use of the drug has become
common. So magical is the effect of this mode of administration, so rapid
and forcible the action of the drug, that many persons will not rest
content until they possess and are using the instrument. As the affections
for which opium and morphine are most commonly used are chiefly found in
neurasthenic patients, and as these patients are ever ready to indulge
in excesses, in both stimulants and narcotics, it is not surprising that
the number of victims to this slavery is daily on the increase, both in
town and country. Moreover, nervous affections are on the increase: pain
without any very apparent cause, nervousness from the most trivial things.
Neuralgias are more common. Insanity also. Suicide is daily more frequent.
Those not acquainted with the truth in this matter will be surprised to
learn that there are to-day thousands of educated and respectable people
in all countries and among all classes, confirmed habituès; slaves to a
habit that is more exacting than the hardest taskmaster, that they loathe
beyond all else, and yet that binds them in chains that they are wholly
unable to break.
Everything must give way to this vice. Business is neglected or but
imperfectly performed; family ties are sundered; hope, ambition,
happiness, self-respect are meaningless words; the one thing that fills
the mind is the gratification of this passion, which they loathe, but from
which they cannot break.
Thus from day to day, week to week, year to year, they go on; not
living—simply existing. Each day, each hour, each minute binds them more
firmly, until at last they feel their own inability to cope with the demon
that has overpowered them, and abandon themselves, hopelessly, listlessly,
to the vice. Repentance comes too late. The momentary pleasure, the short
period of excitement, the hour of vivacity bears fruit a thousand-fold;
fruit, the bitter taste of which must last them a lifetime. That which at
first gave them pleasure has now become the veriest tyrant, enforcing long
hours of pain and anguish, gloom and despondency. They do not continue its
use _because it gives them pleasure_, but simply because it is the only
thing that, in increasing doses, can save them from the torment it has
itself imposed; because without it they are sunk into a living hell. The
mind is incapable of healthy action, the temper is decidedly aggravated,
the person taking offence at and scolding furiously about things that in
health, or while under the influence of opium, would excite no comment.
They suffer from terrible nightmares. They are constantly on the edge of
imaginary precipices, or falling, falling down dizzy heights. Sleep, if
had at all, is broken, unsatisfactory and fraught with the most frightful
and torturing dreams, into the warp and woof of which are constantly
woven the most horrible sights. Now they are the victims of some terrible
accident, again, they are hurried on by some malignant persecution. They
fancy that they are drowning, that they are being burned at the stake,
inhaling the sickening odor of their own burning flesh, feeling it peel
from their aching bones. Then comes the awakening with a start or scream.
The gradual realization that these things are not real; the cold sweat;
the trembling of the limbs; the sense of utter exhaustion from which they
sink into sleep once more, to live again the agonizing scenes of their
diseased imagination; waking and sleeping and counting the minutes as
days, the hours as years, until morning finally comes.
Nor are the torments of day much less than those of the night. The stomach
rebels; nausea is persistent and distressing; saliva gathers in the
mouth; there is sinking at the pit of the stomach; severe cramps of the
intestines; the lips and throat are dry and parched; the tongue swollen.
A dry, irritating cough sets in. Pains girdle the body and shoot with
agonizing intensity down the limbs and into the face. The muscular system
fails; locomotion is attended with difficulty; the sufferer staggers like
a drunkard; the muscles of the face and eyelids twitch; the hands shake
so that a glass falls from them, and it is impossible to pick up a small
object. The circulation is affected; flushing and chilliness alternate;
the eyes are dry, and feel as though filled with sand. The mind wanders;
delirium supervenes; diarrhœa and vomiting set in, and sometimes collapse,
and a more pitiable object can nowhere be found.
It is at this time that the sufferer, tortured beyond all power of
endurance, would sell body, soul, _anything_, to obtain that drug which,
while it gives no fresh pleasure, removes these ill effects, as if by
magic.
A dose is taken. A pleasant sense of warmth pervades the body; the mind
clears, the hands become steady, the gait natural, the pains vanish, the
nausea and diarrhœa cease, and existence becomes again bearable.
Each dose must be a little larger than the preceding, in order to obtain
the desired effect. In some cases the increase is very slow, but these
are rare exceptions. Rarer still are those instances where no increase is
necessary.
I have here portrayed the suffering of one who has been using the drug for
a considerable time, or for a shorter time in large doses. The chains,
though not at first galling, are nevertheless there, and each succeeding
dose rivets them tighter.
There are certain rare cases where opium seems, instead of doing harm,
to be of positive benefit to the person using it. Dr. Joseph Parrish, a
veteran observer of these cases, wrote me that he had known of several.
One is related by Dr. Golding Bird.[1] A lady, probably hysterical, took
morphia for the relief of paroxysmal pain in the loins. She had been
taking it for several years. For the past two years she had increased the
dose to ten grains, taken three times daily. There were no obvious ill
effects; functions were properly carried on, the appetite was good, and
there was no known organic disease.
The therapeutics of any epoch is strictly in conformity with the most
prominent disease or symptom of the people upon whom the physicians
practice. This is true of whole countries and sections of countries as
well as of times.
Formerly, when it was common for physicians to prescribe opium, it was
this drug that the people ate. As morphine came into fashion, it was
prescribed largely by the profession and the persons forming the habit
at that time, as a rule, ate morphine. Habituès of the opium epoch also
resorted to it, finding it so much more powerful than the crude drug, so
much less bulky, and it did away with the necessity for calling forth
a response to opium from the shattered system by resort to alcoholic
stimulants. At the time in which De Quincey, Coleridge, and Southey lived,
the people and the profession knew little of the opium habit, save among
foreign nations; the habituès were few in number, and, as a consequence,
when De Quincey’s article appeared, it created a most decided impression
on the public mind; an impression not yet effaced, and one which bore with
it an incalculable amount of harm. Men and women who had never heard of
such a thing, stimulated by curiosity, their minds filled with the vivid
pictures of a state of dreamy bliss, a feeling of full content with the
world and all about, tried the experiment, gradually wound themselves in
the silken meshes of the fascinating net, which only too soon proved too
strong to admit of breaking.
There is no question in my mind that, in writing his “Confessions,” De
Quincey left a large debit on the side of truth, and handed down to
succeeding generations a mass of ingenious lies; more pleasantly the
fiction, vaporizing from a laudanum-soaked brain. He must needs seek some
justification for his life of willful misery, for the blasted hopes,
ambitions and prospects of what might have been a noble career, and he
offered the dream life, the fuller development of benevolence, and the
many pleasures so fantastically portrayed, as a justification, in part at
least, for his sin.
Nor does the final confession of the intense pain, the abject misery, the
tottering of the mind, the crumbling of the reasoning and will power, and
the ever attendant and impenetrable gloom of a living hell, serve to fully
counteract the baneful effects of the portrayal of the pleasures of opium.
The reader, confident of his ability to stop short of the ever-shifting
line that divides the happiness from the misery, is in no wise deterred
from trying the danger-fraught experiment. I know of several patients who
began the use of opium simply from reading this most pernicious book.
Upon persons living in temperate and cold climates this drug does not
have any such effect, with reference to the subject matter of dreams, as
upon Orientals. Indolent, over-fed, and by reason of their mode of life,
religious associations and habits of thought, fancifully imaginative, it
is not surprising that they should enjoy, while under the influence of the
drug, grotesque, and to them, pleasant, dreams. Did the opium cause dreams
foreign to the picture daily conjured by their fertile imaginations, it
would indeed be more surprising. That it does not produce such effects on
our plain, work-a-day people is not to be wondered at.
As I have already said, the preparation of the drug used and the manner of
using it in any epoch has been exactly in consonance with the practice of
physicians at that time. Of late years physicians are becoming more and
more addicted to the subcutaneous use of morphine, and as a consequence,
the number of persons who habitually use the drug in this way is daily on
the increase. Eight-tenths of those from whom I hear and of those who come
to me for treatment are using the drug subcutaneously.
Dr. Charles Warrington Earle, of Chicago, in a very able and well written
little pamphlet,[2] is of the opinion that the majority of habituès do
not use the drug in this way. In reply I can only reassert my opinion
just expressed, and must say that the tendency of these patients to
falsify, and their delicacy in disclosing their manner of using the drug
to the druggists from whom they obtain their supply, must be taken into
consideration. Dr. Earle bases his conclusions on 235 cases, the histories
of which have chiefly been obtained from druggists.
Be it understood, however, that I do not maintain that the majority of
opium and morphine takers use the latter drug by the hypodermic syringe. I
simply say that in my experience this manner of using the drug is largely
on the increase among habituès, and will go on increasing from year to
year, in the same manner that morphine is rapidly replacing opium in the
practice of physicians. This is well shown by one of Dr. Earle’s carefully
prepared tables:—
KIND OF NARCOTIC.
Morphia was used in 120 cases.
Tincture of opium was used in 30 ”
Paregoric ” ” 5 ”
McMunn’s elixir ” ” 2 ”
Gum opium ” ” 50 ”
Dover’s powders ” ” 1 ”
Unknown ” ” 27 ”
---
235
The age at which this habit is most common is from thirty to forty, both
in males and females. The following table, which, as Dr. Earle states, is
only approximative, is of interest in this connection:—
_Males_—
From 20 to 30 years 5
From 30 to 40 years 19
From 40 to 50 years 11
From 50 to 60 years 7
From 60 to 70 years 1
From 70 to 80 years 1
Unknown age 22
--
Total 66
_Females_—
From 10 to 20 years 2
From 20 to 30 years 18
From 30 to 40 years 39
From 40 to 50 years 22
From 50 to 60 years 14
From 60 to 70 years 4
One-third entire number prostitutes, probably from 15 to 50 56
Unknown age 14
---
Total 169
Females are more frequent victims than males, in the proportion of three
to one. This is undoubtedly due to the fact that women more often than
men are afflicted with diseases of a nervous character, in which narcotic
remedies are used sometimes for a long period, and also to the fact that
in some instances it is used by them in place of alcoholic stimulants,
its effects being less noticeable and degrading, although none the less
intoxicating.
Both males and females are usually of the higher orders, in point of
intellect and culture. In some cases business failure or family trouble
has been the incentive for a resort to the use of the drug. In some
instances the fact that opium eating had ruined the mental powers of the
victim, or caused him to be careless or negligent of his home relations,
has led to the business failure, or the sundering of family ties. The
majority of patients come from the middle classes, those people who are
continually toiling and worrying in the almost ceaseless endeavor to “keep
up appearances.”
The fact that most opium eaters are married, widow or widower, is probably
explainable on the ground that in the majority of instances, the patients
among whom it is most common are at just the age when marriage has taken
place. In some the habit is contracted before, in others after marriage.
I knew of one example where the wife, a young woman of eighteen,
contracted the habit of using the drug subcutaneously, through the
carelessness of her physician. The husband began then to use it himself,
and to-day the two are separated, the wife partially insane, the husband
a confirmed habituè and also an alcoholic drunkard. One who sees much of
this disease meets with some very sad cases.