I YALE MEDICAL LIBRARY HISTORICAL LIBRARY FROM THE BEQUEST TO YALE UNIVERSITY OF RUSSELL H. CHITTENDEN, Ph.B. 1875 LAOCOON [lie siiuul manibus tend it divellere nudos>, Clamorcs simul horrendos ad sidera lollit." Virgil, .-Encid, Lib. ll. The knotted coils he strains tu tear apart, Killing the air and heaven with horrid cries. — Drugs That Enslave. THE OPIUM, MORPHINE, CHLORAL AND HASHISCH HABITS. BY H. H. KANE, M. D., lit NEW YORK CITY. "They are drunken, but not with wine; they stagger, but not with strong drink." Isaiah. '• What warre so cruelle, and what siege so sore, To bring the sowle into captivitie, As that fierce appetite doth fain supplie 1" PHILADELPHIA: PRESLEY BLAKISTON, 1012 WALNUT STREET. l88l. Entered, according to Act of Congress, in the year 18S1, by PRESLEY BLAKISTON, In the office of the Librarian of Congress, at Washington, D. C. ' K 56© Press of WM. F. FELL 4 CO., 1220-1224 Snnsom Street. To it. grtexatttlw g. fit. £fcene, Professor of the Medical and Surgical Diseases of Women and the Diseases of Children, in the Long Island College Hospital, Brooklyn, N. Y., THIS LITTLE WORK IS DEDICATED, as a mark of the high esteem, both as regards his scientific attainments, untiring energy, and the largeness of his heart, in which he is held by his old pupil and sincere admirer, THE AUTHOR. PREFACE. The idea of writing this little work was first suggested to me by the numerous letters received from physicians at home and abroad, asking for information on various points connected with the symptomatology, prognosis and treat- ment of the various "habits." While manifesting an earnest desire to become acquainted with the main features of the conditions in question, many presented a lamentable ignorance of the simple facts relating to them. These facts I have endeavored to present in as compre- hensive, yet concise, a form as possible. But little space has been devoted to the study of the hashisch habit, owing to its rarity in this country. The statements as to the dangers and peculiarities of these conditions, aside from what I have myself observed, are based upon the literature of the subject, and the letters of nearly a thousand correspondents in various parts of the world, to whom I take this occasion for returning my hearty thanks. ipi West Tenth Street, New York City. — — : — "After my death I earnestly entreat that a full and unqualified narrative of my wretchedness, and of its guilty cause, may be made public, that at least some little good may be effected by the direful example." Coleridge. A curse that is daily spreading, that is daily rejoicing in an increased number of victims, that entangles in its hideous meshes such great men as Coleridge, De Quincey, William Blair, Robert Hall, John Randolph, and William Wilberforce, besides thousands of others whose vice is unknown, should demand of us a searching and scientific examination. As an illustration of the enormous increase of the use of opium and morphia in the United States, the following statis- tics have a painful interest, and it must be remembered that this is no exceptional case. In one of our large cities, contain- ing, twenty-five years ago, a population of 57,000, the sales of opium and morphia reached 350 pounds and 375 ounces, respectively, or about 43 grains of opium and 3 grains of mor- phia yearly for each individual, if the consumption was averaged. The population is now 91,000, and 3500 pounds of opium and 5500 ounces of morphia are sold annually. While the population -has increased 59 per cent., the sale of opium has increased 900 per cent., and morphia 1100, or an average of 206 grains of opium and 24 grains of morphia to every in- habitant. But there are additional sales of from 400,000 to 500,000 pills of morphia, which would give us 170 ounces more of the drug. One-fourth of the opium sold is consumed in its natural state, and three-fourths are made into opiates, the principal one being laudanum. The following is official from the New York Custom House : Imports of opium into the United States for ten fiscal years, ending June 30th : 1871, 315,121 lbs. $1,926,915 " 1872, 416,864 2,107,341 " 1873. 3i9>!34 1,978,502 " 1874. 395.909 2,540,228 " 1875. 132.541 939.553 " 1876, 388,311 1,805,906 " 1877. 349.223 1,788,347 " 1878, 430,950 1,874,815 " 1879. 405.957 1,809,696 " 1880. 533.451 2,786,606 Facts like these must, we think, arouse attention. They show a fearful drift. There is a worse form of intemperance than that which comes from bad liquor, although the choice would seem to be between the devil and the deep sea " And in the lowest depth, a lower deep, Still threatening to devour us, opens wide." CONTENTS. CHAPTER I. page The Opium and Morphine Habits. Formation ; General Symptoms 17-26 CHAPTER II. Preparations Employed. Manner of Using 27-33 CHAPTER III. General Symptoms Analyzed and Classified 34-45 CHAPTER IV. General Symptoms Analyzed and Classified— Concluded. 46-70 CHAPTER V. Accidents Incident to the Subcutaneous Use of Mor- phia 71-105 CHAPTER VI-. The Treatment of the Opium and Morphia Habits. General Considerations 106-129 CHAPTER VII. Agents Used in the Treatment of the Opium and Mor- phia Habits 130-148 CHAPTER VIII. The Continued Use of Chloral 149-164 CHAPTER IX. Effects of Chloral on the Different Systems and Appa- ratuses 165-179 7 8 CONTENTS. CHAPTER X. page Effects of Chloral on the Different Systems and Appa- ratuses—Concluded 180-199 CHAPTER XL Symptoms of Abstinence from Chloral—Treatment 200-205 CHAPTER XII. The Hashisch Habit 206-218 CHAPTER XIII. Conclusion 219-221 ; THE OPIUM AND MORPHINE HABITS. CHAPTER I. THEIR PATHOLOGY. A higher degree of civilization, bringing with it in- creased 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 an- cestors 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 17 18 THE OPIUM HABIT. or those nervous element ; a gradual evolution of that peculiarities most prominently brought forth by the exi- gencies 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 perman- ent 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 hypo- dermic 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 ITS PATHOLOGY. 19 educated and respectable people in all countries and among all classes, confirmed habitues ; 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, hope- lessly, listlessly, to the vice.