The opium habit and alcoholism

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Chapter I. Peculiarities Of The Opium Habit

The power exerted over the human system by opium habitually used, is difficult to describe. No words can adequately express the horrible sufferings endured by the confirmed opium eater. The habit holds the system in shackles as of steel. The subtle influence of the drug is felt in every fibre of the nervous system, creating decided changes in the endangmm and neurilemma. The patient finds it impossible to abstain from the poison beyond a fixed time. If an attempt is made to decrease or discontinue its use, complications result which are terrible to endure ; a spasm of the nerves' periphery follows, with complete relaxation of the system. The brain is progressively injured and rendered ansemic for the want of nutrition ; yet the ability to suffer is not diminished.

The dipsomaniac's brain, by continual congestion, is dulled, and his sensibilities are deadened by the liquor, a result which mitigates his sufferings to a certain extent. The opium eater has no such relief. The opium habit is a disease of the nervous system, and is not subject to control by the will. In examining the phenomena of the disease, we cannot reconcile them with the idea that it is a mere habit, indulged with a desire to stimulate, and in satisfaction of a depraved appetite. This supposition will not stand the test of careful investigation, as the facts to be presented demonstrate. Women of culture and natural refinement pawn their jewels or sell the feathers from their beds, to secure the requisite amount of opium. The drunkard, when under the influence of liquor, will go to great extremes and commit desperate acts to obtain rum ; but the victim of opium is not actively stimulated, when he barters his honor for the drug. He knows, however, that the time is near at hand when the drug must be taken to sustain the nervous system and ward off prostration which would entail with unerring certainty the agony of a thousand deaths. A mere appetite would not drive him to such extremities.

When the habit is forming, and before any pathological changes have taken place from the continued use of opium, the effects are exceedingly pleasant and fascinating, and the opium eater may be tempted to repeat the dose for the purpose of renewing those effects. No imperative demand for more is made by the system, but the victim is enjoying the full exhilarating action of the drug. When the habit is formed, its delights are lost. The time has now passed in which to quit the practice, and the opium eater henceforth derives only misery from a habit which he cannot control. The drug exercises almost a demoniac influence in misleading its victims, inspiring them with conflicting fears, and leading them on to unnecessary excesses by its deceptive eff.ects. While the habit is foi-ming, and before indulgence becomes a necessity to the system, the effect of opium is peculiarly soothing and tranquillizing, the stimulation reaching a certain point and remaining stationary for many hours.

The stimulation of the intellectual powers is extraordinary, producing a harmonious blending of the conceptions.

The effects of liquor or wine, as compared with those of opium, are coarse and brutalizing. Alcoholic intoxication does not induce the state of waking dreams, inspired by opium, which carries the mind gently through fairyland, exaggerating all that is sublime in the opium eater's nature, allaying pain and drowning trouble in a sense of the beautiful. In these earlier stages of opium eating the imagination is stimulated to wonderful activity. Sights rare and pleasing pass kaleidoscopically through the mind, each bringing with it some new delight of the senses. As sleep approaches, a state of perfect rest ensues; and for hours preceding reaction, a serai-unconscious state is enjoyed, which surpasses all other sensations in its voluptuous delights. By the first decided effects of the drug, the nerves' periphery is played upon; all that is beautiful presents itself to the imagination.

This is but for a time, however. With the coming of reaction, the victim is racked with spasms, his nerves enduring the extremity of agony. A transfer to the rack or the stake would be a welcome change. During the first entrancing effects of the indulgence, the sense of time is lost in the delights of the imagination, and the pleasures of a month are experienced in an hour. In like manner, when the period of suffering comes, this effect is present, and the sufferer imagines that hours have been passed in this exquisite hell of torment, when in reality only a few minutes have elapsed.

The drug misleads its victims, regarding their own ability to maintain mastery over it. Each individual is confident that in his case there is no danger of forming a habit. There is no shadow cast before, as a warning of the coming misery. Pains are soothed; life seems to possess new charms; the victims are reluctant to believe that the action of the poison will ever be otherwise than pleasant, or to doubt their own ability to stop its use at will.

But alas! very few ever will that it shall be stopped; they continue the indulgence with one more dose, repeated until the fetters gall them. It is then too late; the die is cast, and they recognize the hideous truth that a fixed habit has been formed.

The physiological action of opium is marked and

general, presenting, however, but few local manifestations that indicate the profound effect the drug is havino- on the system. The secretions are diminished, and the r

PECULIARITIES OF THE OPIUM ShM 1 ^ r 5

activity of the absorbents lessened; constipation is produced through the want of a lubricating material, normally supplied by a secretion from the alimentary tract; the canal is also wanting in tone sufficient to excite peristaltic action. The secretion of urine is diminished, although frequent libations of water are taken during the first stages of the poisoning, owing to the action of opium upon the blood. The opium superinduces a thickened state of the fibrin, and brings about an accumulation of effete matter, which renders functional action through the medulla-oblongata slow and laborious, andcreates a demand for water by drying the mucous coats of the mouth until the constituent parts of the blood are made normal again by the free consumption of water. The bladder is unable to discharge its contents, owing to a contracted state of the urethra in its visceral passage, and not because of a paralysis of its muscular walls, as many- writers persist in declaring. These muscles are brought into active play, the effort being complete and forcible, as is shown by the fact that oblique inguinal hernia is caused by the effort. With all the force brought to bear upon the bladder, the stream is small. The mucous coats of the rectum are dry and hot, making defecation difficult and painful, and often producing hemorrhoids. The ability or desire to accomplish the sexual act has been completely destroyed in ninety-eight per cent, of all cases observed by us. After the habit has been formed, and the system has adapted itself to its effects, the physiological conditions, referred

6 THE OPIUM HABIT AiND ALCOHOLISM.

to above, are greatly modified; but the functions do not assume a normal state during the continuance of the indulgence.

The victim of opium is bound to a drug from which he derives no benefits, but which slowly deprives him of health and happiness, finally to end in idiocy or premature death. Whatever the victim's condition or surroundings may be, the opium must be taken at certain times with inexorable regularity. The liquor or tobacco user can, for a time, go without the use of these agents, and no regular hours are necessary. During sickness, and more especially during the eruptive fevers, he does not desire tobacco or liquor. The opium eater has no such reprieves ; his dose must be taken, and, in painful complications affecting the stomach, a large increase is demanded to sustain the system.

If, in forming the habit, two doses are taken each day, the victim is obliged to maintain that number. It is the Unceasing, everlasting slavery of regularity that humiliates opium eaters by a sense of their own weakness. We will note a case, showing the force of the habit and the fatal results that followed its sudden discontinuance. A married lady, twenty-two years of age, residing in a small village in Kentucky, formed the habit in consequence of a painful uterine disease. Her husband, not appreciating the necessity of the drug for his wife, commanded its immediate discontinuance. She attempted to reason with him, but to no purpose ; he would accept no explanation, but reiterated his command. The wife knew how impossible it would be to obey, and succeeded in deceiving her husband for some time. On discovering her supposed determination to indulge in the use of opium for its stimulating effects, and her duplicity in deceiving him, his anger was excessive. He notified the druggists with threats, not to sell opium to his wife, or to any one else for her ; and did not consider the matter of sufficient importance to make it necessary that he should inform her of what he had done. She usually obtained the drug as she needed it, keeping no supply on hand. During the day, the young wife, heavy with child, seemed to have a presentiment of the terrible fate in store for her. She said to a companion : " I have an awful fear that my husband will do something desperate ; if he stops my morphine I shall surely die." She discovered what course he had taken to make her stop by the druggist's refusal to sell her opium. It was now time for her evening dose, and relaxation, induced by undue excitement and worry, began to show itself. Knowing her husband's character, she was confident that an attempt to get the drug in town would be useless. She therefore ordered a black boy to mount a fleet horse and go to a village five miles distant to obtain it. During his absence she was seen by the neighbors to stand statute like, holding to the gate, looking intently in the direction the boy had taken. On his return she rushed wildly out, and eagerly listening to what he said, she turned, uttering a loud shriek, and fell down insensible. The neighbors carried her into the house and burriedly sent for a physician, who found that two lives had been sacrificed to the opium, for the woman was dead. Her husband had notified the distant druggist, and the boy could not obtain the opium. The woman's system being relax' ■' for the want of its usual support, and the circulation rapid, so sudden a revulsion of feeling, while the patient was in a delicate state, and in no condition to receive and sustain a shock, produced without doubt valvular insufficiency, or an extravasation of blood into the brain substance.

While understanding the nature and power of the drug, from experience, the opium eater is ignorant of its remote or obscure effects. Its action inspires in its victims a profound fear of fatal results, if they do not continue to take a certain amount. They give the drug credit for greater powers than it possesses. They dare not reduce the quantity taken, through fear of great suffering or death, when in reality no such results would follow, except in rare instances, when the patient is laboring under great fear, or has an organic disease of the heart; and exceptions are useless as precedents. Victims rarely attempt a self-cure, by reducing their dose; for on the first approach of relaxing pain, they resort at once to the poison without stopping to do battle against their mortal enemy. "When the system has adapted itself to the drug, and requires a certain amount of it to support and maintain the abnormal condition created by its use, the natural tendency is to increase the dose. Could opium caters control the desire for this increase, no great or rapid changes would take place; but a large majority surrender to this supposed demand, and soon come to consume prodigious quantities of the drug. Disagreeable sinking sensations, with anorexia and lassitude, and hot and cold flashes, are prominent symptoms that influence them to increase the dose. When the increase is made, it is like ascending a ladder and casting away the rounds; the victims seldom return to their former basis. The larger the dose consumed, the more the system seems to demand, as the drug multiplies complications. The patients suffer intensely, under its debilitating effect; a sleepy habitude ensues, accompanied by a nauseating fulness, difficult to describe. A larger dose is taken in a desperate effort to allay disagreeable sensations, and this process is continued until the system can tolerate no more without exciting alarming symptoms of narcotism, yet the victims suffer apparently for more, when in reality the suffering is the legitimate result of excessive doses. If they would reduce the amount taken to one-half, relief would follow at once, and their sufferings would be comparatively light to bear.

The ability of the system to tolerate large doses, and their effect, differs greatly with different persons. We have cured patients, who, for years, had consumed one drachm of morphia per day; others, taking fifteen grains during the same length of time, would suffer as acutely as the first. One of our patients, a lawyer by profession, was obliged to have an amanuensis to take important notes in court, as he could not possibly keep awake for any length of time, consuming daily, as he did, fifteen grains of morphia hypodermically administered.

The finer sensibilities are generally suppressed. Patients act and appear odd, are prone to exaggerations and unreasonable statements. They generally have some Utopian scheme in hand, engrossing their attention, of the success of which they are sanguine. They are weak and anaemic, with a jaundiced, thickened complexion and sunken eyes. In seventy-nine per cent, of the cases coming under our observation, progressive loss of flesh followed the habitual use of opium, owing to an inability upon the part of the absorbents to take up nutritive principles. While the liquor drinker's normal tissues are absorbed and displaced by a hypernutrition of abnormal deposits in the fibrous and areolar tissues, the opium eater's adipose tissue is consumed and not replaced. There appears, however, to be an inherent principle of limitation, with respect to the amount of tissue thus consumed; as the process stops when the surplus is absorbed, leaving the system only sufficient to sustain itself.

The functions of the organs are performed under a constant protest. The internal organs of secretion are contracted, the external are relaxed and moist, often bathed in a cold, clammy perspiration ; the pupils of the eyes are contracted, owing to a stimulation of the oculomotor centres. The blunted state of the gastric functions renders the assimilative processes torpid ; the brain suffers for the want of nutrition and reflexes its influence by generating a limited supply of force to the nerves' periphery, inducing undue susceptibility to the action of cold and inability to sustain the shock of a cold bath. Loss of memory and dull perceptions invariably follow as legitimate effects of the drug ; dates, names, and past events become confused. The lips have a deathlike whiteness, while dark circles appear under the eyss. Pruitis of the nose and lips is often a troublesome symptom. A remarkable effect of the drug is seen in its power to arrest diseases of a certain character, keeping them in a quiescent state, not by curative action, but by suspending their activity. This is exemplified in cancers of the breast or uterus, large and continued doses of opium arresting their growth, and, if they are discharging, drying their secretions. This condition lasts while the system is kept fully under the influence of the drug, but the disease resumes its activity with redoubled energy when the opium is withdrawn. Hemorrhage, in phthisis, and the progressive waste of lung tissue are controlled. But the full effects are procured at the expense of forming a habit. If the pains in rheumatism, neuralgia, or sciatica, are controlled by opium, they will return for a time on its withdrawal.

Renewed activity of all the functions follows a complete cure of the opium habit. The glands pour out their secretions. An excessive degree of vitality rapidly follows. The normal weight is soon reached and increased. Seminal emissions occur as a complication. Old gentlemen of seventy will suffer from that cause, their sexual vigor being as great as at any previous period of their lives, and continuing for a greater length of time than would be expected under the circumstances. It appears strange and unreasonable, and is not consistent with well-known laws of cause and effect, yet it has been proved under our observation to be a fact, that after restoration, no complications present themselves, indicative of permanent lesions, resulting from the habit. The functions are vigorous and active, seeming to have a new lease of life. The finer sensibilities return with full force ; desires and ambitions are awakened. If any lasting or obscure complications are superinduced by the habit, which develop in after years, and shorten life or undermine health, predisposing their subject to fall easily into disease, no such results have, as yet, indicated their presence by any premonitory signs, however slight. We wish to be fully understood as referring to patients who have been fully and radically cured.

During the first and second years of the habit, the system is not apt to desire or crave other stimulants than the opium. But finally the system becomes so prostrated and weak, that the opium is increased ; the fainting attacks become frequent, with palpitation of the heart, and vertigo ; the subjects of the habit feel compelled to resort to a diffusable acoholic stimulant with which to support the system and counteract distressing symptoms. Liquor is taken under a delusive idea of selfdefense. Opium eaters in this way allay, temporarily, symptoms of weakness and vertigo, commuting, however, a fatal error, by adding fuel to a flame that is consuming them, as liquor and opium combined induce fatty degeneration of the kidneys, which proves fatal within a few years. The opium depresses but leaves the system with a good foundation to build upon after stopping its use. The liquor counteracts and antagonizes the effects of opium, making an increase necessary to compensate for the deficiency. In their desperate efforts to sustain the system with opium, on the one hand, and to allay dangerous symptoms of narcotism by liquor, on the other, victims of the habit greatly increase the*amount taken of both stimulants, creating deplorable complications. Their mental capabilities fail rapidly ; they become hypochondriac, and slowly descend to the lowest depths of degradation.

The alcohol consumed by them does not act as the hydro-carbons usually do, repairing their impoverished tissue ■ it subjects them instead to its dilapidating influence, without bestowing upon them any compensating effects. Fortunately, only a small proportion of opium eaters allow the desire for drink to engulf them. By controlling the tendency to increase their dose, they enjoy comparative immunity from distressing symptoms, which require alcohol to make them bearable.

One of our patients, a gentleman of character and ability, succeeded in confining his dose by a daily allowance, to seven grains of morphia, making no increase for nineteen years. He forcibly described his trying position, by declaring it to be by a continual hand to hand battle with the monster, that he was enabled to ward off the fatal inclination to increase the dose. His mind and liner sensibilities were apparently unimpaired, a fact which makes his case a remarkable one, as it requires will-power and stamina to maintain such a course.

When opium and liquor are combined, and their quan tity is gradually increased, enormous amounts can be consumed. A lady in our practice took each week four drachms of morphia with one gallon Tr. Valerian. A lady patient, married, thirty-five years old, consumed every month two ounces of morphia with five gallons of whisky this quantity being allowed by her husband. She was not satisfied, however, and would pawn jewels, clothing and furniture in order to get more, so that it is impossible to determine the exact amount taken. The husband said " that he was in constant communication with pawn-brokers, having spent thousands of dollars in redeeming articles." The patient was a lady of rare attainments, belonging to a good family, having enjoyed all the advantages that wealth and a fine social position can give ; she lormed a taste for wine at her father's board, and the opium nabit during subsequent illness. Eany impressions left her in a position to fall easily into excesses.

Chapter II

To enable the physician fully to understand and appreciate the essential characteristics of the disease, as presented under a multiplicity of forms and circumstances, and to assure a perfect success, we give the record of individual cases, then history, indications, and treatment, with results attained. We also make suggestions as to changes and improvements, found by experience to be necessary.

The first great cause or incentive to take the drug, is pain in its varied forms. We have had presented for treatment cases differing in every essential particular, possessing little in common with each other. As the exciting causes are many, so the indications and complications, and temperamental idiosyncrasies play an important part, and materially assist or prove obstacles to the physician's work of treatment.

Ten patients take the same amount of opium. Its effects and power to control are dissimilar. Each one has his particular method and time for taking the drug that exerts its influence over the system. They consume different compounds of the drug. One uses Magendie's solution of morphia, hypodermically. Others

take morphia by the stomach, or rectum, or by snuffing it up the nostrils. Others use gum opium, laudanum, paregoric, clovers powders, McMunn's elixir of opium, soothing syrup, cough syrups and patent anodynes. Morphia enjoys the greatest popularity, as it is concentrated, leaving fewer bad after-effects. The hypodermic method is resorted to by many persons, and its results are more distressing than are those produced when the drug is taken by the stomach. As the habit advances they are obliged to resort to the use of the syringe from three to five times a day, filling the arms and hips with perfusions that excite hyperesthesia of the cutaneous surface, and inflicting great pain by the operation. The arms become one mass of cicatrixs, resulting from abcesses and perforations, that leave indurated lumps under the cuticle, resembling to the touch a No. 2 shot. Finally, it becomes difficult to find a place large enough, between the nodules, to admit a needle ; the hips are used and soon present the same condition. The parts receiving a limited supply of nutrition, abcesses become indolent, and are slow to heal, often exciting atrophy of the muscles to follow.

If the patient is taking any of the compounds of opium, the physician should find by a mathematical calculation the equivalent of his dose in morphia and take the latter as a basis. Of gum opium it requires seven grains to make one grain of morphia. One fluid ounce of laudanum is equal to four grains of morphia. Dovers powder contains one grain of gum opium to ten grains of the powder. We have found that three grains of morphia

PECULIARITIES OF THE OPIUM HABIT.

would sustain a patient in the habit of consuming one bottle of McMunn's elixir of opium per day. Paregoric contains one and one-half grains of gum opium to the fluid ounce.

If the patient is addicted to any patent anodynes, cough or soothing syrups, the physician should find, by cautious experiments with minute doses of morphia, what amount the dose would represent in morphia. The painful disease for which the drug was first taken, should be carefully considered, as the opium exerts a peculiar power to suppress and hold in abeyance certain diseases. Their liability to return must be considered with reference to the result which their return would have upon treatment. Again, the suppressed disease may come to need treatment, and it must be asked in advance what success is reasonably to be expected in such an event.

Uterine and ovarian complications cause more ladies to fall into the habit, than all other diseases combined, and are also a prolific cause of trouble and vexation during treatment. The uterus being liberally supplied with nerves, vessels and glands, relaxation, for the want of opium, causes great pain, reflexing a decided action upon the general system. Women with child abort at once, and the miscarriage is followed by a uterine hemorrhage, frightful to contemplate, which requires promptness and decision on the part of the physician to ward off a fatal termination. The utero-placental vessels have opened wide their flood-gates, being atonic, and relaxed for the want of their accustomed support derived from the opium. The menstrual functions, when no pregnancy exists, are suppressed for months, indicating the profound effect exerted over the uterine plexus, by the habitual use of opium. When a cure is effected, the flow is profuse, accompanied with bearing down and expulsive pains; leucorrhcea is invariably present, whether the patient has suffered similar symptoms before, or not.

During the first few days after a cure is effected, the secretions are all profuse; the erectile tissue is acutely sensitive, simulating nymphomania. Such results, excited by functional disorders, enable one to form an intelligent conception of the troublesome complications to be anticipated, when a diseased condition of these parts really exists. If a patient has taken opium for a uterine disease, she ignorantly assures the physicians, in many instances, of its supposed cure; basing the assumption on the fact that the symptoms have not been present while the drug has been in use. The physician must not let this declaration mislead him, but should prepare to render prompt, well-directed assistance during the crisis. Many patients feel ashamed of being addicted to the drug, and wishing to retain respect, will tell the physician of some imaginary trouble as the cause of the habit. He should accept their statement and give them his sympathy; passing judgment upon the case, however, according to the indications.

Diseases acting spasmodically, and ataxic symptoms, must be met and treated as if occurring under any other circumstances. There is a period of twelve hours only requiring active interference with aggravated cases of the opium habit, in which there is danger of a return to the drug, through the severity of the patient's sufferings. It is necessary to be on the alert during that time, and to bridge over the critical period, by direct efforts to control spasmodic nervous action.

A serious question arises when young married ladies apply for treatment and declare that they are with child, not having menstruated for five, six or eight months. This condition is natural to the opium habit; yet the patient may be enceinte, and the physician must form a correct opinion. If the woman is with child, an immediate cure is out of the question. Treatment must be postponed until it will not imperil mother or child, as is suggested under the proper head. If there is suppression only, you do not wish to lose time. Question the patient categorically, and find out what her habit has been heretofore; further than this you can rely upon the usual signs in pregnancy; they are not otherwise modified. If not fully convinced, and entertaining reasonable doubts, avail yourself of the judge's right, which is also yours, and reserve your decision. No case is too old for treatment; the patient who has taken the drug for twenty years is as susceptible to treatment (other conditions being favorable) as one who has used it during three years only. The amount consumed does not stand in the way of a radical cure. We call to mind an easily attained victory over the drug, where it had been taken for twenty years, and where, during the last nine years, one drachm of morphia was consumed daily.

By carefully pursuing the methods suggested, noting special features connected with the following cases, a clear conception may be had of the principles involved in the successful treatment of the opium habit.

Chapter III. History And Treatment Of Case No. 1

Mrs. B. L., married, thirty-two years old; general health, previous to forming the habit, good; when treatment was begun she was consuming fifteen grains of morphia per day. The incentives prompting her to the indulgence were worry and suspense concerning the uncertain fate of her husband, who was in the army. A neighbor, and without doubt an opium eater, suggested the use of the drug as a means of drowning trouble. After taking morphia for six months, constitutional weakness and prostration prompted the victim to make a desperate effort to throw off the habit. After suffering the torture of relaxation for fifteen hours, she abandoned the effort, unable to endure the pain, and resigned herself hopelessly to the practice.

The power of opium to stimulate and soothe was lost to her; yet she was obliged to take her usual dose daily. The history of a subsequent attempt, made by the woman's husband, to break the habit, is full of interest to the physician, illustrating as it does the power exercised by the drug over the system. On his return from the army, he learned the facts connected with his wife's habit for the first time and determined to take matters into his own bands and effectually to cure her. Calling a sister to his aid, he unfolded a brilliant plan of procedure. This sister heartily seconded bis resolution, promising her help and co-operation, the more readily because she had been often humiliated by her sister's oddities, which attracted attention and prompted unfavorable comments. The victim of the scheme expostulated, and endeavored to impress upon her husband and sister the impossibility of carrying out their plan; but remonstrance was to no purpose, as her tormentors belonged to that unfortunate class of persons who can learn only from that severe, but ingenious teacher, experience.