The following are the various preparations used by opium and morphia takers—

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 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.”

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.