A careful study of the facts presented in the foregoing chapters teach us several lessons well worth considering, and suggest certain cautions and reforms that are greatly needed.
From the abundant evidence upon this point I think we must conclude that the abuse or habitual use of narcotics is steadily upon the increase, especially the subcutaneous use of morphine; that these drugs are, in the majority of instances, first taken to relieve pain, and not for simple gratification of a morbid appetite; and that the drug used and the manner of using it is in consonance with the prevalent medical practice of the time in which the habituè lives.
There are two classes especially blamable for this—the physicians and the druggists. In the early history of the use of the hypodermic syringe the danger of contracting the habit through its frequent use was not recognized, and the physician was not then to blame. At the present time, however, knowing fully the dangers incident to its use, the physician is criminally careless in placing the instrument in the hands of the patient or her friends for their use. If he does not appreciate the full extent of the danger, he is culpably ignorant, and certainly deserving of punishment.
The deaths, and dangerous accidents, and the spread of the continued use of narcotics, is due, to a great extent, to the druggists, who, in many cases, sell the drug without a physician’s prescription, and without any reasonable excuse on the part of the patient, in direct violation of the law. Chloral is sold to men just recovering from a spree; prescriptions containing large amounts of these drugs are renewed for patients for whom they were not originally given; the druggist himself often prescribes a mixture of chloral, morphine and bromide of potassium, for repentant drunkards, or for patients suffering from insomnia.
When spoken to about this matter, they coolly excuse their practices with the remark that “if we don’t do it, some other druggist will; and why should we lose the money.” The laws relating to the sale of poisons are loose and inefficient, the practice rotten, and the statute really a dead letter. Dangerous and even fatal consequences[105] are not, then, so much to be wondered at.
Another matter in this connection needs attention, viz: the lying pretensions of a few charlatans, notably in the West, who, by specious advertisements and deceitful lies, induce the victims to these habits to buy their medicines, or come under their care for treatment. Their so-called specifics are simply preparations of opium or morphine, and their treatment is based upon the plan of substituting one form of the drug for another.
These sharpers are utterly without conscience, and do not scruple to prey upon and undermine the health of their victims, in order to gain a few dollars. It is about time that the people found out that honest, honorable and trustworthy physicians, who have only the good of the patient at heart, do not advertise. It is a shameful fact that the religious press tolerates the advertisements of these charlatans in their columns. As a rule, the vilest advertisements are to be found in these newspapers. Owing to the moral weight supposed to be carried by these sheets, owing to their large circulation among the people, who look upon every word therein contained as truth, these announcements and endorsements do the people an infinite amount of harm. Can it be that the financial “backers” of these papers overrule the scruples of the religious editor? If so, while a good investment financially, it must be a very poor one morally.
I have emphasized the fact that the continued use of chloral is not so liable to end in the formation of a habit, as is the prolonged use of morphia or opium; not that physicians may exercise less care and discrimination in its employment, for the danger is sufficiently great, but simply to refute the statements of some men who are gone wild upon the subject of habituation and inebriety, and who suggest measures for reform, and plans for restraint and treatment, as impracticable and impossible as their statements are whimsical and truthless.
Finally, be it distinctly understood, that many of the symptoms enumerated as occurring in both the morphine and chloral habituès, but especially the latter, are only found where the drug has been used in large amount, or for a long time. Every symptom will, moreover, be modified somewhat by the systemic peculiarities of each patient.
The “mixed” habits, so called, where patients are using two or more narcotics at one time, have not been discussed separately, as they possess no distinctive characters, and the physician who understands the prominent points of each will have no trouble in detecting and treating these cases.
FOOTNOTES
[1] Practitioner, Vol. VI, p. 149.
[2] “The Opium Habit;” reprint from the Chicago Medical Review, October and November 5th, 1880.
[3] “The Hypodermic Injection of Morphia. Its History, Advantages and Dangers.” N. Y., 1880.
[4] “Morbid Craving for Morphia,” London, 1878.
[5] Levenstein, op. cit., p. 69.
[6] “Opium and the Opium Habit.” Philadelphia, 1871, p. 117.
[7] The Personal Experiences of an Ex-opium Habituè.—N. Y. Medical Record, p. 399, Vol. XIII.
[8] Practitioner, 1871.
[9] American Journal of Insanity, July, 1872.
[10] From the subsequent history of the patient, especially while in the asylum, we are led to believe that these attacks of delirium took place at menstrual periods.
[11] “Hypodermic Medication,” p. 96. Philadelphia, 1879.
[12] “Some Observations on the Deep Injection of Morphia.” Cincinnati Lancet and Clinic, August 10th, 1878.
[13] Chicago Medical Journal and Examiner, Aug. 1877.
[14] Chicago Med. Journal and Examiner, April, 1879.
[15] Boston Medical and Surgical Journal, October 30th, 1879.
[16] “Medico-Chirurgical Society Trans.,” vol. L.
[17] “Materia Medica and Therapeutics,” Phila., 1877, p. 205.
[18] “Medico-Chirurgical Transactions,” vol. L.
[19] N. Y. Medical Record, Aug. 15th, 1874.
[20] Medical Times and Gazette, Sept. 23d, 1865.
[21] British Medical Journal, May, 1879.
[22] British Medical Journal, April 12th, 1879.
[23] Philadelphia Med. and Surg. Reporter, Oct. 18th, 1879.
[24] Med. Times and Gazette, Jan. 4th, 1868, p. 8.
[25] Medical Times and Gazette, Jan. 11th, 1868, p. 53.
[26] “The Hypodermic Method,” Philadelphia, 1879, p. 32.
[27] Edin. Med. Journal, Dec. 1876. Practitioner, 1877, p. 132.
[28] Practitioner, July, 1871, p. 25.
[29] Medical Times and Gazette, June 14th, 1865, p. 42.
[30] Italics mine.
[31] E. P. Wilson, “St. George’s Hospital Reports,” 1869.
[32] “Thèse de Paris,” N. Y. Med. Journal, Sept. 1877.
[33] Pepper, N. Y. Medical Record, Nov. 16th, 1878. H. H. Smith, Ibid. Joseph H. Howe, Ibid., Dec. 7th, 1878, and Jan. 4th, 1879. J. S. Prout, Ibid., May 11th, 1878.
[34] “The Intravenous Injection of Ammonia,” N. Y. Medical Record, June, 1879.
[35] “Medico-Chirurg. Transactions,” vol. L., p. 570.
[36] New York Medical Gazette, Jan. 10th, 1880.
[37] “The Hypodermic Injection of Morphia; its History, Advantages and Dangers,” N. Y., 1880.
[38] Medical Press and Circular, Nov. 29th, 1876.
[39] In my chapter on “The Morphia Habit,” I shall show that much larger amounts have been used, and for long periods.
[40] “Morbid Craving for Morphia.” London, 1880.
[41] (N. Y. Med. Record), Southern Med. Record, Sept. 20th, 1879.
[42] (Atlanta Medical Journal) Physicians’ Monitor, 1878.
[43] H. C. Wood; “Materia Medica and Therapeutics,” p. 440. Phila., 1877.
| ℞. | Ferri sulphatis, | gr. xx | |
| Ext. alöes, aq., | ʒj | ||
| Ext. taraxaci, | q. s. | M. |
Ft. pil. No. 60.
Sig.—Two, night and morning.
[44] “The Hypodermic Method,” etc., p. 90.
[45] N. Y. Medical Record, 1876, p. 436.
[46] By letter.
[47] April 14th, 1877.
[48] Lancet, Dec. 18, 1875.
[49] Letter.
[50] Philadelphia Medical and Surgical Reporter, Nov. 9, 1878.
[51] Ibid.
[52] Ibid.
[53] American Journal of Insanity, 1878, p. 367.
[54] New York Medical Record, 1872, p. 106.
[55] Wiener Med. Wochenschrift, Feb. 28, 1874.
[56] The Clinic, March 2, 1872.
[57] Philadelphia Med. and Surg. Reporter, Jan. 16, 1875.
[58] Druggists’ Circular and Gazette, Nov., 1879
[59] Edinburgh Medical Journal, Sept. 1877, p. 211.
[60] Dr. A. P. Hayne, Med. Supt. Inebriate Asylum, San Francisco, Cal.
[61] London Lancet, Aug. 2d, 1873.
[62] Letter to the Author.
[63] Lancet, Dec., 1875.
[64] Lancet, March 11, 1876.
[65] Letters to the Author.
[66] Letter to the Author.
[67] Quoted by Mattison, “Chloral Inebriety,” a paper read before the King’s Co. Medical Society, April 15th, 1879.
[68] Mattison, op. cit.
[69] Op. cit., p. 5.
[70] Philadelphia Medical and Surgical Reporter, Nov. 9, 1878.
[71] In a letter just received Dr. Mattison states that Dr. Benj. Lee, of Philadelphia, is the gentleman referred to, but that he (Dr. Mattison) does not remember in what journal he saw the case reported.
[72] London Lancet, Aug. 9, 1873.
[73] Quoted by Mattison, op. cit., p. 5.
[74] American Practitioner, 1875.
[75] Quoted by Labbée, Archiv. Gen. de Med., 1870, p. 330.
[76] Berlin Klin. Wochen., July 3, 1876, p. 389.
[77] Archiv. Gen. de Med., 1870. T. 2, p. 330.
[78] Compte Rendu, Aug. 3, 1874.
[79] American Journal of the Med. Sciences, Oct., 1877.
[80] Virginia Medical Monthly, May, 1880.
[81] Letter to the Author.
[82] Letter to the Author.
[83] June, 1871.
[84] Practitioner, 1873.
[85] Kane; “Chloral Hydrate in the Treatment of the Insomnia of Insanity and Delirium Tremens.” N. Y. Medical Record, Jan. 8 and 15, 1881.
[86] Quoted by Mattison. Op. cit.
[87] Kane; “Some Peculiar Effects of Chloral Hydrate on the Eyes and Skin.” N. Y. Medical Record, 1881.
To those interested in the further study of the action of chloral on the skin, I give the following references:—
Browne, Crichton, Lancet, Vol. 1, p. 440. Curschmann, Deutsches Archiv f. Klin. Med., 1871, p. 139. Brochin, M., Bull. Gen. de Therap., Feb. 15, 1880. Burman, J. Wilkie, Lancet, Mar. 16, 1872. Farquharson, Braithwaite’s Epitome, Mar., 1880. Ingalls, Wm., N. Y. Medical Record, 1871, p. 91. Liebreich, O., Lancet, June 16, 1877. Mayer, La France Medicale, 1876. Martinet, Thèse de Paris, 1879. Neal, Breward, Lancet, Aug. 23, 1873. Smith, Nathan R., N. Y. Medical Record, 1871, p. 299. Kiernan, J. G.; Quoted by Mattison. Op. cit.
[88] Allgemeine Zeitschrift f. Psychiatrie, Bd. 28, Heft. 1.
[89] Kane, “Chloral in Obstetric Practice.” American Journal of Obstetrics, March, 1881.
[90] This is conclusively proved by the experiments of both Labbée and Rajewsky, quoted by H. C. Wood, “Materia Medica and Therapeutics,” Philadelphia, 1877, p. 318, 319.
[91] Practitioner, 1873.
[92] “Antagonism of Therapeutic Agents,” p. 54.
[93] Op. cit.
[94] Lancet, 1871.
[95] Quoted by Mattison. Op. cit.
[96] Allgemeine Zeitschrift f. Psychiatrie, Bd. 28, Heft. 1.
[97] Quoted by Labbée, Bull. Gen. de Therap., 1869. T. 2, p. 758.
[98] Quoted by Mattison. Op. cit.
[99] Lancet, May 24, 1873.
[100] British Medical Journal, Sept. 2, 1876.
[101] Kane; “Deaths from Chloral Hydrate.” N. Y. Medical Record, Dec., 1880.
[102] Calkins; “The Opium Habit,” Phila., 1871.
[103] Op. cit. p. 323.
[104] Materia Medica and Therapeutics, Phila., 1877, p. 226.
[105] Kane; “Deaths from Chloral.” N. Y. Medical Record, Dec. 25, 1880, Jan. 1, 1881.