Drugs that enslave

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.

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:—

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.