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.”
Fig. 1.—Hypodermic Syringe. Glass cylinder with metal casing. Indexed on glass.