“Furthermore, we exclude from the treatment all patients weak or exhausted through bodily or mental affliction. It is all the same whether the prostration is caused by night duty, distress, illness, childbed, want of proper food, flooding, etc.; only those conditions of weakness following upon the poisoning with morphia constitute no counter-indication, as they disappear in consequence of the deprivation. Only such individuals, therefore, are suited for the treatment who have continued the injections while in perfect health, the former morbid appearances for which they at first administered them having disappeared.”
From these statements I must heartily dissent. No organic disease, no affection of the general system, save those that are sure to prove fatal, as cancer and the like, justify continuance in this habit. In almost every instance the accompanying ill effects will be found to be due more to the abuse of morphine than to the disease itself. Indeed, its continuance may place the patient in a condition that will preclude the possibility of recovery.
Patients with one foot apparently in the grave, when deprived of their morphine, take a decided turn for the better, and regain fair, if not perfect health. A fatal ending sometimes follows the waiting and attempting to build up the health before commencing the treatment of the habit.
As to the advisability of treating debilitated and exsanguinated patients by the method of sudden deprivation, I fully agree with him, for the trial is as much as a robust and healthy individual can bear. By substitution and gradual deprivation, however, it can be accomplished safely and satisfactorily.
The danger of a return to this habit decreases with each year, each month, each day of abstinence. It is greater in neurasthenic patients and those who have taken large amounts, or who have not received proper after treatment.
Under no circumstances should these people be given opiates in any form or for any complaint, save when life can be saved in no other way, for a relapse is almost certain to occur if this is done. Witness the case of the literary gentleman already referred to. A single dose may undo the work of years.
In conclusion, I feel that I am warranted in again insisting upon the growing evil of indiscriminate and careless use of the hypodermic syringe. The following, from my work upon the hypodermic use of morphia, well expresses my feelings in this matter.
“Some of my correspondents, men of ability and in large practice, express themselves as very skeptical of the truth of the statement that the morphia habit has ever been formed by the use of the drug hypodermically. Testimony from all parts of the civilized world settles this matter beyond question. Bartholow, from whose excellent little work I have so often quoted, says:[44]
“‘The introduction of the hypodermic syringe has placed in the hands of man a means of intoxication more seductive than any which has heretofore contributed to his craving for narcotic stimulation. So common now are the instances of its habitual use, and so enslaving is the habit when indulged in by this mode, that a lover of his kind must regard the future of society with no little apprehension. It may well be questioned whether the world has been the gainer or the loser by the discovery of subcutaneous medication. For every remote village has its slave, and not unfrequently several, to the hypodermic syringe, and in the larger cities, men in business and in the professions, women condemned to a life of constant invalidism, and ladies immersed in the gayeties of social life, are alike bound to a habit which they loathe, but whose bonds they are powerless to break. Lamentable examples are daily encountered, of men and women, regardful only of the morphia intoxication, and indifferent to all the duties and obligations of life, reduced to a state of mental and moral weakness most pitiful to behold.
“‘Usually the habit is formed in consequence of the legitimate use of the hypodermic syringe in the treatment of disease. Employed in chronic painful maladies for a long period, it is discovered, when an attempt is made to discontinue the injections, that the patient cannot or will not bear the disagreeable, even painful, sensations which now occur. More frequently, when the injections are to be used for a long time, the patient is unwisely intrusted with the instrument, and taught all the mysteries of the solutions and the mode of administration.’