PREPARATIONS EMPLOYED. MANNER OF USING.
The following are the various preparations used by opium and morphia
takers—
_Crude Opium._—Variable in strength.
_Tincture of Opium, Laudanum._—1 grain of opium to every 25
drops, or 1 grain of opium to every 13 measured drops, _minims_.
_Tincture of opium, Camphorated_ (Paregoric).—1 grain to the
ounce, or 480 drops.
_McMunn’s Elixir._—Same strength as laudanum.
_Dover’s Powder._—1 grain of opium and 1 grain of ipecac to
every 10 grains of the powder.
_Sulphate of Morphia. Acetate of Morphia._—Salts of opium, 1
grain of either being equal to about 6 grains of opium.
Laudanum was De Quincey’s favorite. He avers that he has taken as high
as 8000 drops in the course of twenty-four hours. Coleridge is credited
with having taken more. A patient, a lady, whom I saw in consultation with
Dr. Brennan, of this city, took a half pint every morning. Without it she
was totally unfit to converse or to be seen. Many of the old fashioned
habituès use the gum opium, but few, paregoric, and a less number still,
Dover’s powder. In order to get a sufficient amount of opium for the
average user, from Dover’s powder, the ipecac, which is present in equal
amount, would produce nausea, and offer a further bar to its employment.
Pulverized opium and extract of opium have been used in the form of
suppositories. This was the case with one of my patients, a gentleman
suffering from chronic inflammation of the bladder; after a time he
abandoned the opium, using in its stead morphia, in gradually increasing
doses.
I have already given Dr. Earle’s table as to the relative frequency with
which the different preparations are used. I here append his table of
quantities. Of this and the preparation sold, druggists from whom he
obtained his statistics would be able to judge with a reasonable degree of
accuracy.
QUANTITY.
_Morphia_—
21 persons use from 1 to 3 grains each day.
17 ” ” 3 to 6 ” ”
12 ” ” 6 to 10 ” ”
10 ” ” 10 to 15 ” ”
12 ” ” 15 to 20 ” ”
7 ” ½ a drachm ”
6 ” 1 drachm ”
20 ” 1 bottle per week.
5 ” 2 ” ”
1 ” 11 bottles each month.
_Tr. Opium_—
15 persons use 1 drachm each day.
4 ” 3 ” ”
7 ” 4 ” ”
12 ” 1 ounce ”
4 ” 2 ” ”
1 ” 3 ” ”
1 ” 4 ” ”
_Gum Opium_—
3 persons use 10 grains each day.
5 ” 20 ” ”
9 ” ½ drachm ”
12 ” 1 ” ”
4 ” 2 ” ”
2 ” 3 ” ”
1 ” 4 ” ”
Morphia is used either by the mouth, rectum or hypodermically. I know of
a curious case, to be detailed more fully at a subsequent time, where the
patient, a young lady, took morphine first subcutaneously, then by the
rectum, and finally by the mouth.
I am of the opinion that morphia, when continuously used, works more harm
when taken by the mouth than when taken subcutaneously. Moreover, that the
habit is more difficult to break, and relapses more prone to occur, in the
former than in the latter class of cases. Opium or morphine by the mouth,
after a time, exercises a directly paralyzing and anæsthetic effect upon
the mucous membrane of the alimentary canal, and gives rise to hepatic
derangement and sometimes serious disease. The subcutaneous injection of
morphia undoubtedly exercises a baneful effect upon the same surfaces and
organs, but not so directly as when taken by the mouth.
Among the Eastern nations opium is used chiefly by smoking. As this is
rarely seen in this country, save among people from those countries,
it does not especially concern us. Moreover, a full account of these
practices may be found in books of travel and other treatises upon that
special branch of the subject.
To Dr. Alexander Wood, of Edinburgh, belongs the credit of first
discovering and practically applying the hypodermic syringe to the
treatment of painful affections, more especially neuralgias. Drs. Isaac E.
Taylor and Washington, of this city, claim to have used it in this country
in 1839, while Wood’s discovery was made in 1843, and his first article
appeared in 1855. Wood’s instrument was first brought to this country in
1856, by Prof. Fordyce Barker, of this city. Then comparatively unknown,
it is now in the possession of almost every physician in the world. In
my work upon the hypodermic use of morphia[3] I made, in the preface, the
following statement, the belief in which has since been strengthened:
“There is no proceeding in medicine that has become so rapidly popular;
no method of allaying pain so prompt in its action and permanent in
its effect; no plan of medication that has been so carelessly used and
thoroughly abused; and no therapeutic discovery that has been so great a
blessing and so great a curse to mankind, as the hypodermic injection of
morphia.”
The danger of forming the habit from the use of the drug in this way is
undoubted. Correspondents, physicians from all parts of this country,
England and France, assert this and detail cases. Levenstein[4] gives many
instances in Germany, and Dr. Loose, of Bremen, sends me the report of an
able paper read by him before a medical society, wherein he cites cases,
deplores the rapid spread of the practice, and advises special legislation
upon the subject. He remarks for that country what Dr. J. B. Mattison,
myself and others have noted in the United States, _i. e._, that many of
the victims are members of the medical profession, in good standing. One
hundred and thirty-one physicians report to me one hundred and eighty-four
cases of the morphia habit, in all of which it was contracted by the use
of the hypodermic syringe.
The largest amount taken in the twenty-four hours by this method is
reported to me by Dr. W. F. McAllister, of the Quarantine Office, San
Francisco, California: “A physician, resident in this city, contracted
dysentery in Shanghai, China, in the summer of 1873. Morphia was used
hypodermically, and he drifted into the habit of using the drug in this
way himself; the habit resulting in his death in 1878. I was called to see
him professionally in 1875. He was at that time residing in Hong Kong,
China. He was consuming each day _seventy-two grains_ of the sulphate of
morphia in three doses: twenty-four grains to the dose. This he continued
to do until the day of his death.”
[Illustration: FIG. 1.—Hypodermic Syringe. Glass cylinder with metal
casing. Indexed on glass.
FIG. 2.—Plain Glass Syringe, with needle. Index on stem.
FIG. 3.—Plain Metal Syringe, graduated on stem.
FIG. 4.—Plain Metallic Syringe, graduated on stem, with a cap for securely
closing needle end of barrel, and a device by which needle can be carried
in hollow stem. This is an excellent instrument. All those here shown
were made by Codman & Shurtleff, of Boston, and are durable, accurate and
easily cleaned.]
Prof. T. Gaillard Thomas, of this city, relates to me two fatal cases,
in young persons, death being due to extreme exhaustion, dependent
on imperfect nutrition and a gradual depression of the nervous and
circulatory systems.
In consequence of the skepticism evinced by some physicians as to the
danger of contracting the habit in this way, I feel myself called upon to
urge upon them the utmost care in the use of this instrument, especially
in the case of neurasthenic patients. I have had so many deplorable
cases of this kind brought to my notice, either as patients or through
correspondence, that I cannot help but feel that this matter is one of
great importance, and worthy of more attention and care than is usually
given it.
I have already spoken of the two ways in which the opium or morphia
habit is formed. A patient of a nervous temperament, suffering from some
painful or spasmodic disease, is attended by a physician, who administers
one of these drugs, by the mouth, rectum, or subcutaneously. The relief
to suffering is magical, and persists so long as the effect of the drug
lasts. With a return of the pain comes the natural desire to have it
relieved, and as the narcotics just spoken of have been found especially
efficacious the patient desires its repetition. This may go on for weeks
and months, until the disease, of which the pain was but a symptom, is
cured, or it may never be cured. At any rate, the patient awakes to the
knowledge that he must have his narcotic. Life without it is unbearable,
and instead of putting forth an extreme effort of the will, as is done
by some, and then and there abandoning its use, the majority allow
themselves to drift into this habit of daily intoxication with opium.
The majority of habituès first use the drug for the relief of pain, and
then find themselves unable to break loose from it. Some seem to be so
constituted that a single or a few doses of drugs of this nature light up
in them an irresistible desire to continue their use. There seems to be
a morbid craving for _something_, exactly what is not known, until the
narcotic is tried, when this morbid appetite is satisfied and fixed, and
becomes the typical “morbid craving for morphia.” It will be dipsomania,
morphia-mania, chloral-mania, hasheesh-mania, according as the one or
other drug is presented to the patient in the condition of craving. Some
persons are undoubtedly born with, and some acquire, this craving for some
narcotic or stimulant.
A person knowing this fact can readily see how like putting a match to
gunpowder it is to give these people opium or morphine in any form, and
how inevitably the reading such a book as that of De Quincey’s would
create a longing and open the way to a road that has a certain ending in
a life’s bondage. Such as these are to be pitied, and deserve the kindest
treatment and the most judicious care. They are like a person who has
lost a limb, or is suffering from a cancer. In the one instance they lack
a certain something that should be there, and which is necessary to the
free, full and proper enjoyment of life; in the other case—the acquired
tendency or craving—they have a pernicious addition to the system that
threatens them with death.
Pity, then, rather than blame, at the same time using every legitimate
means to break up both the habit and the tendency.