CHAPTER XIII.. Conclusions.

CONCLUSIONS.

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 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

Practitioner, Vol. VI, p. 149.

“The Opium Habit;” reprint from the Chicago Medical Review, October and November 5th, 1880.

“The Hypodermic Injection of Morphia. Its History, Advantages and Dangers.” N. Y., 1880.

“Morbid Craving for Morphia,” London, 1878.

Levenstein, op. cit., p. 69.

“Opium and the Opium Habit.” Philadelphia, 1871, p. 117.

The Personal Experiences of an Ex-opium Habituè.—N. Y. Medical Record, p. 399, Vol. XIII.

Practitioner, 1871.

American Journal of Insanity, July, 1872.

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.

“Hypodermic Medication,” p. 96. Philadelphia, 1879.

“Some Observations on the Deep Injection of Morphia.” Cincinnati Lancet and Clinic, August 10th, 1878.

Chicago Medical Journal and Examiner, Aug. 1877.

Chicago Med. Journal and Examiner, April, 1879.

Boston Medical and Surgical Journal, October 30th, 1879.

“Medico-Chirurgical Society Trans.,” vol. L.

“Materia Medica and Therapeutics,” Phila., 1877, p. 205.

“Medico-Chirurgical Transactions,” vol. L.

N. Y. Medical Record, Aug. 15th, 1874.

Medical Times and Gazette, Sept. 23d, 1865.

British Medical Journal, May, 1879.

British Medical Journal, April 12th, 1879.

Philadelphia Med. and Surg. Reporter, Oct. 18th, 1879.

Med. Times and Gazette, Jan. 4th, 1868, p. 8.

Medical Times and Gazette, Jan. 11th, 1868, p. 53.

“The Hypodermic Method,” Philadelphia, 1879, p. 32.

Edin. Med. Journal, Dec. 1876. Practitioner, 1877, p. 132.

Practitioner, July, 1871, p. 25.

Medical Times and Gazette, June 14th, 1865, p. 42.

Italics mine.

E. P. Wilson, “St. George’s Hospital Reports,” 1869.

“Thèse de Paris,” N. Y. Med. Journal, Sept. 1877.

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.

“The Intravenous Injection of Ammonia,” N. Y. Medical Record, June, 1879.

“Medico-Chirurg. Transactions,” vol. L., p. 570.

New York Medical Gazette, Jan. 10th, 1880.

“The Hypodermic Injection of Morphia; its History, Advantages and Dangers,” N. Y., 1880.

Medical Press and Circular, Nov. 29th, 1876.

In my chapter on “The Morphia Habit,” I shall show that much larger amounts have been used, and for long periods.

“Morbid Craving for Morphia.” London, 1880.

(N. Y. Med. Record), Southern Med. Record, Sept. 20th, 1879.

(Atlanta Medical Journal) Physicians’ Monitor, 1878.

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.

“The Hypodermic Method,” etc., p. 90.

N. Y. Medical Record, 1876, p. 436.

By letter.

April 14th, 1877.

Lancet, Dec. 18, 1875.

Letter.

Philadelphia Medical and Surgical Reporter, Nov. 9, 1878.

Ibid.

Ibid.

American Journal of Insanity, 1878, p. 367.

New York Medical Record, 1872, p. 106.

Wiener Med. Wochenschrift, Feb. 28, 1874.

The Clinic, March 2, 1872.

Philadelphia Med. and Surg. Reporter, Jan. 16, 1875.

Druggists’ Circular and Gazette, Nov., 1879

Edinburgh Medical Journal, Sept. 1877, p. 211.

Dr. A. P. Hayne, Med. Supt. Inebriate Asylum, San Francisco, Cal.

London Lancet, Aug. 2d, 1873.

Letter to the Author.

Lancet, Dec., 1875.

Lancet, March 11, 1876.

Letters to the Author.

Letter to the Author.

Quoted by Mattison, “Chloral Inebriety,” a paper read before the King’s Co. Medical Society, April 15th, 1879.

Mattison, op. cit.

Op. cit., p. 5.

Philadelphia Medical and Surgical Reporter, Nov. 9, 1878.

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.

London Lancet, Aug. 9, 1873.

Quoted by Mattison, op. cit., p. 5.

American Practitioner, 1875.

Quoted by Labbée, Archiv. Gen. de Med., 1870, p. 330.

Berlin Klin. Wochen., July 3, 1876, p. 389.

Archiv. Gen. de Med., 1870. T. 2, p. 330.

Compte Rendu, Aug. 3, 1874.

American Journal of the Med. Sciences, Oct., 1877.

Virginia Medical Monthly, May, 1880.

Letter to the Author.

Letter to the Author.

June, 1871.

Practitioner, 1873.

Kane; “Chloral Hydrate in the Treatment of the Insomnia of Insanity and Delirium Tremens.” N. Y. Medical Record, Jan. 8 and 15, 1881.

Quoted by Mattison. Op. cit.

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.

Allgemeine Zeitschrift f. Psychiatrie, Bd. 28, Heft. 1.

Kane, “Chloral in Obstetric Practice.” American Journal of Obstetrics, March, 1881.

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.

Practitioner, 1873.

“Antagonism of Therapeutic Agents,” p. 54.

Op. cit.

Lancet, 1871.

Quoted by Mattison. Op. cit.

Allgemeine Zeitschrift f. Psychiatrie, Bd. 28, Heft. 1.

Quoted by Labbée, Bull. Gen. de Therap., 1869. T. 2, p. 758.

Quoted by Mattison. Op. cit.

Lancet, May 24, 1873.

British Medical Journal, Sept. 2, 1876.

Kane; “Deaths from Chloral Hydrate.” N. Y. Medical Record, Dec., 1880.

Calkins; “The Opium Habit,” Phila., 1871.

Op. cit. p. 323.

Materia Medica and Therapeutics, Phila., 1877, p. 226.

Kane; “Deaths from Chloral.” N. Y. Medical Record, Dec. 25, 1880, Jan. 1, 1881.

INDEX.

Abortion from excessive use of morphia, 43.

Abscess from hypodermic injection of morphia, 71.

Absorption of morphia, rapidity of, 83.

Accidents from subcutaneous use of morphia, 71.

Ady, Dr. A., case by, 152.

After-treatment of opium and morphia habits, 140.

Ages of opium and morphia takers, 25. of chloral takers, 150.

Akland, Dr. Fr., on chloral habit, 151.

Albuminuria from continued use of opiates, 46. in chloral takers, 182.

Alcoholic stimulants used by opium takers, 38. in treatment of morphia-mania, 139.

Allbutt, Dr. T. Clifford, observations of, 54.

Alopecia, in morphia takers, 40.

Amaurosis from continued use of opiates, 47. in chloral takers, 197.

Amidon, Dr. R. W., experiments of, 99.

Andrews, Dr. Judson B., case by, 54.

Anstie, Dr., case by, 175, 178.

Aphasia from prolonged use of chloral, 171.

Arton, Dr. J. H., case by, 180.

Ascites from excessive use of morphia, 35, 36.

Atkinson, Dr. A., case by, 76.

Barker, Dr. Fordyce, 29.

Barkitt, Dr. F. W., case by, 102.

Bartholow, Prof. Roberts, observations of, 90. case by, 72.

Baths in treatment of morphia takers, 130.

Beaumetz-Dujardin, case by, 71.

Belladonna in treatment of morphia takers, 136.

Bidlack, Dr., case by, 152.

Bigelow, Dr. H. C., case by, 184, 198.

Bile, effects of continued use of opiates on, 37.

Blalock, Dr. W. C., hydrocyanic acid in treatment of opium habit, 137.

Blood, effects of chloral on, 186.

“Bloating” in morphia takers, 39.

Bond, Dr. Thos., case by, 170.

Bouchut, chloral diabetes, 182.

Braine, Dr. F. W., case by, 88.

Bradley, Dr. Edward, cases by, 184, 199.

Brandeis, Dr. R. C., case by, 180.

Brown-Sequard on chloral paralysis, 178.

Bromides in the treatment of opium takers, 136.

Bryce, Dr. C. A., case by, 205.

Bunting, Dr. James, case by, 170.

Cable, Dr. W. W., case by, 91.

Calkins, Dr. Alonzo, observations of, 44, 210.

Calvet, observations of, 96.

Cannabis Indica in treatment of opium habit, 137. continued use of, 206.

Capsicum in treatment of opium habit, 136.

Casts in urine of morphia takers, 46.

Change from opium to alcohol, etc., 38.

Chills, nervous, in chloral takers, 177.

Chloral hydrate, continued use of, 149. in treatment of opium habit, 137.

Circulation, effects of chloral on, 186. in morphia takers, 48.

Civil condition of chloral takers, 150.

Civilization as a modifier of the nervous system, 17.

Claggett & Walls, Drs., case sent by, 118.

Clark, Dr. Alonzo, case by, 93.

Clinical Society of London, report of, 149.

Coca in treatment of opium habit, 136.

Coleridge, amount of opium used by, 27.

Color of skin in morphia takers, 38.

Compton, Dr. W. M., observations of, 155.

Constipation in opium takers, 37.

Corona, injection of drugs into veins, 90.

Cram, Dr. C. W., observations of, 155.

Craving for stimulants and narcotics, 33, 207.

Crothers, Dr. T. D., case by, 173.

Cullen, Dr. C. R., observations of, 194.

Dabbs, Dr. G. H. R., case by, 186.

Dangers, of chloral habit, 202.

Davis, Dr. G. W., case by, 171.

Deaths from chloral, 202.

Delmont, Dr. F., case by, 194.

Delirium in abandoning chloral, 200.

Dessau, Dr. S. Henry, case by, 204.

De Quincey, confessions of, 22, 33. preparation and amount used by, 27.

Diabetes from morphia taking, 41, 46, 47. chloral taking, 182.

Diet in the treatment of morphia abstinence, 138.

Digestive apparatus, effect of opiates on, 34. chloral on, 180.

Diplopia from excessive use of morphia, 47.

Diseases of the present day, peculiarities of, 17.

Doane, Dr. H. H., case by, 172, 185.

Douche, cold, uses of, 131.

Dover’s powder, 27.

Dreams, 19, 20.

Drunkards, use of chloral by, 163.

Dyspepsia in opium takers, 34, 142.

Dyspnœa in chloral takers, 195.

Earle, Dr. C. Warrington, observations of, 24.

Electricity in treatment of opium takers, 132.

Elliot, Dr. Geo. F., case by, 200.

Eruptions in morphia takers, 37, 38.

Erysipelas from subcutaneous injection of morphine, 74.

Eyes, effect of prolonged use of opiates on, 47. chloral on, 197, 201.

Fæces, in morphia-mania, 36, 37.

Feltz & Ritter on chloral diabetes, 182.

Folsom, Dr. Norton, case by, 113.

Formation of opium and morphine habits, 18, 31, 32.

Fowler, Dr. Geo. R., observations of, 84.

Francis, Dr. Sam’l W., case by, 84.

Fry, Dr. Frank H., case by, 172.

Gastric juice, effect of opiates on secretion of, 34. catarrh in opium takers, 35.

Georges & Bernard-Claude, experiments of, 92.

Graham, Dr. Arthur, case by, 78.

Griswold, Dr. Gaspar, experiments of, 97.

Habit, opium, how formed, 18.

Hemorrhoids in morphia habituès, 37.

Hemorrhage from mucous surfaces in chloral takers, 182, 201.

Hair, falling of in opium takers, 40.

Ham, Dr. O. F., case by, 185.

Harrington, Dr. H. L., case by, 80.

Hashisch habit, 206.

Hayne, Dr. A. P., observations of, 171.

Haywood, Dr. Burke, case by, 198.

Heartburn in morphia takers, 37.

Herpes zoster in morphia takers, 40.

Holbrook, Dr. M. L., cases by, 153.

Houtz, Dr. J. A., observations of, 87.

Husted, Dr. N. C., case by, 198.

Hutchinson, Dr. Wm. F., case by, 132.

Hydrocyanic acid in treatment of morphia taking, 137.

Hypodermic injection of morphia, 24, 30, 145.

Hysteria, how modified by opiates, 54.

Impaction of fæces, 37.

Impotence from prolonged use of opiates, 45.

Incoherence of morphia takers, 53.

Ingalls, Dr. E. F., case by, 79.

Inglis, Dr. T., case by, 159.

Injection of morphine into a vein, 75.

Insanity from continued use of chloral, 168. opiates, 52.

Insomnia, best remedy for, 140.

Intellectual grade of opium takers, 25.

Jaundice from continued use of opiates, 35, 37, 38.

Jewell, Prof. J. S., observations of, 84.

Jones, Dr. N. Jasper, case by, 163. Dr. E., case by, 76.

Kane, Dr. H. H., experiments of, 95, 98.

Keyes’ solution of morphia, 72.

Keyser, case by, 198.

Kidneys, effect of prolonged use of opiates on, 39, 46.

Kiernan, Dr. J. G., observations of, 192.

Kilpatrick, Dr. A. R., case by, 204.

King, Dr. Willis P., case by, 168.

Kinsman, Dr. D. N., case by, 169.

Kirn, Dr. Ludwig, observations of, 187, 195.

Labbée, chloral diabetes, 182.

Lactucarium, 138.

Lee, Dr. Benj., case by, 175.

Leucorrhœa in opium takers, 43, 141.

Levenstein, observations and experiments of, 30, 42, 45, 47, 62, 106, 107, 182.

Lewis, Dr. Morris J., observations of, 183. Dr. R. F., case by, 203.

Ligature in subcutaneous medication, 100.

Lobelia, 137.

Locomotion in opium takers, 48.

Loose, Dr., observations of, 30.

Lupulin, 138.

Lusk, Prof. W. T., observations of, 94.

Lying propensities of opium takers, 52, 53.

Lyman, Prof. H. M., case by, 154.

MacDonald, Dr. Carlos F., on the chloral habit, 152.

Malaria, symptoms of, in opium takers, 62.

Mattison, Dr. J. B., observations of, 30, 136, 175, 178, 179.

Marsh, Dr. Madison, observations of, 155.

Maudsley on chloral in insanity, 171.

McAllister, Dr. W. F., case by, 30.

Medico-Chirurgical Society’s cases and experiments, 83, 98.

Meldon, Dr. Austin, case by, 103.

Memory, effect of continued use of chloral on, 170. hashisch on, 211.

Menstruation in morphia takers, 41, 142. chloral takers, 185.

Miller, F. H., case by, 84. J. A., case by, 184.

Mind, effect of prolonged use of opiates on, 49. chloral on, 165. hashisch on, 211.

Morgan, Dr. Herbert M., observations of, 201.

Morphia habit, the, 17. subcutaneous use of, 24, 30, 145.

M’Rae, Dr. A. E., case by, 193.

Murphy, Dr. W. Kirkpatrick, cases by, 165, 178.

Muscæ volantes, 47.

Muscular system, effect of continued use of opiates on, 48. effect of continued use of chloral on, 194.

Neal, Dr. W. A., case by, 77.

Nervous element, growth of, 17, 18. system, condition of, in opium takers, 53. system, condition, of, in chloral takers, 174.

Neuralgia from prolonged use of opiates, 53, 142. chloral, 174, 175.

Neurasthenic patients, danger of using narcotics and stimulants with, 31, 32.

Nordlin, Dr. J. H., observations of, 151. case by, 185.

Nose, reddening of, in opium takers, 39.

Nussbaum, Prof., case by, 84.

“Observer,” case by, 85.

Œsophagus, paralysis of, 180.

Opium habit, the, 17. smoking, 29. preparations of, 27.

Pack, the cold, 131.

Paralysis from continued use of chloral, 177.

Park, Dr. Roswell, case by, 170.

Parker, Prof. Willard, case by, 94.

Parrish, Dr. Jos., observations of, 21, 153.

Pathology of opium and morphine habits, 17-27.

Pepper, Prof. Wm., intravenous injection of milk, 87.

Pepy’s Journal, extract from, 95.

Personal experiences of an ex-opium habituè, 50.

Perrigo, Dr. James, case by, 171.

Perspiration in opium habituès, 39.

Pflueger’s theory of artificial menopause, 42.

Photophobia from chloral, 197.

Physicians, how to blame, 18.

Pollak, Dr., on chloral habit, 155.

Pollock, Dr. C., case by, 173.

Pregnancy in morphia takers, 43.

Preparations of opium commonly used, 27.

Preservatives for morphia solutions, 74.

Prevalence of the opium habit, 18.

Progeny, effect of continued use of morphine on, 44.

Prognosis in opium habituation, 143. chloral habituation, 202.

Purpura hemorrhagica from excessive use of morphine, 35, 40.

Quantity of opium and morphine used by habituès, 28.

Rapidity of absorption of morphine, 98.

Reiman, Dr., observations of, 151.

Remondino, Dr. P. C., case by, 203.

Respiration, effects of chloral on, 195.

Richardson, Dr. B. W., on the chloral habit, 156.

Roberts, Arthur, case by, 89. Dr. John, observations of, 183.

Schlaugenhausen, Dr., opinions of, 151.

Schüle, observations of, 193, 198.

Seguin, Dr. E. C., case by, 78.

Semen, condition of, in opium habituès, 45.

Sensation modified by prolonged use of opiates, 41, 70.

Sex of opium habituès, 25. chloral takers, 150.

Sexual organs, effects of continued use of opiates on, 41. effects of continued use of chloral on, 184.

Shettle, Dr. R. C., observations of, 194.

Shurtleff, Dr. G. A., observations of, 153.

Skin, effects of continued use of opiates on, 38, 71. chloral on, 187.

Sleep of morphia takers, 49.

Sleightholme, Dr. J. Pennock, case by, 90.

Smith, Prof. A. A., on chloral habit, 152. Dr. Q. C., observations of, 164. Dr. Nathan R., observations of, 192.

Specific gravity of urine in morphia takers, 46. chloral takers, 183.

“Spectator,” case by, 85.

Sterility from continued use of opiates, 42.

Stimulants, 139.

Stools, character of, in opium habituation, 36.

Strangury from prolonged use of opiates, 47.

Stramonium, 137.

Strychnia, 136.

Sudden deprivation, dangers of, 127.

Symptoms of abstinence from morphia, 125. chloral, 200.

Taylor, Dr. Isaac E., 29.

Temper in opium habituès, 49.

Temperament of chloral takers, 162.

Testicles, atrophy of, 45.

Tetanus from subcutaneous injections, 101.

Thomas, Prof. T. Gaillard, cases by, 31.

Thornley, Dr. J. G., use of chloral in insanity, 151.

Treatment of opium and morphine habits, 106. chloral habit, 200.

Tupper, Dr. Aug. M., case by, 80.

Turnbull, observations of, 194.

Upham, Dr. W. R., case by, 177.

Upshur, Dr. J. N., cases by, 184.

Urinary organs, effect of continued use of opiates on, 46. effect of continued use of chloral on, 181.

Vaginismus from continued use of opiates, 43, 62.

Vaso-motor disturbances due to chloral, 177.

Veiled Prophet of Khorassan, 51.

Veins, puncture of, by hypodermic needle, 75.

Vertigo in chloral habituès, 179.

Vesical tenesmus from opium habituation, 62.

Von Mering and Musculus, uro-chloralic acid, 183.

Washington, Dr., 29.

Webb, Dr. J. W. F., cases by, 184, 192.

Wells, Spencer, observations of, 194.

Wenger, Dr. E., case by, 88.

Wilson, Dr. E. T., case by, 78.

Wood, Alexander, 29. Prof. H. C., cases by, 83. on hashisch, 212.

Woodling, Dr. M. E., case by, 75.