“A study of the opinions and cases that I have collected and presented in the preceding chapters furnishes abundant food for thought; the more so, as nearly every physician in the world is using a hypodermic syringe with more or less frequency. Many are unquestionably using this instrument too often; are using it in cases where the same, or other remedies, by the mouth, would be equally efficacious, and certainly safer. Far be it from me to condemn the use of an instrument the employment of which has brought both temporary and permanent relief, sometimes cure, to thousands suffering the most intense agony. Its value in cases especially suited to it cannot be over-estimated; its use in cases unsuited to it, or where other means would answer as well, cannot be too strongly and heartily condemned. Death, syncope, alarming narcotism, and, perhaps, more important than all, that living death—the morphia habit—bids us choose our cases well, and continue its use for only so long a time as is absolutely necessary.
“It would seem, from a study of the cases related under the latter head, and from many of the interesting letters for which I cannot find space, and, therefore, give at second-hand, that so long as the drug is used carefully, and with discrimination, by the physician, the morphia habit is little apt to result, and that it may be broken off when once formed, although the amount of morphia used is large. But, nevertheless, even when these results are attained, persons, especially those of the neurasthenic type, will often procure a hypodermic syringe surreptitiously, and continue, commence or re-commence the practice anew. For this the physician is certainly not to blame, but the fact still stands, and the question arises whether relief by other means, though less prompt and less permanent, would not have been more preferable to the deplorable mental, moral and physical condition that almost uniformly obtains when the habit is once established.
“When Wood first gave his idea to the world, and when that idea was practically developed and extended in point of applicability by Hunter and others, it was thought to be glory enough to have found a weapon sufficiently powerful to cope with severe and obstinate neuralgia and diseases that would not yield to other treatment. To-day, as seen from its journal literature, the subcutaneous method of giving morphine has become almost universal, and it is employed for complaints of the most trivial character. Aside from the immediate and remote danger of thus needlessly extending this practice, there is another reason why this instrument should not be so commonly employed—there is apt to be slurring of diagnosis and a blind treatment of the most prominent symptom. This is especially the case with the younger members of the profession. Having relieved the pain, they fail to study the minor symptoms, to look at patient’s family and personal history, to be observing of skin, and tongue, and pulse. It may be urged that the patient often recovers without any other treatment. True! But many do not, and the lack of study of every point in the successful cases bears its fruit of slovenly diagnosis and unscientific treatment in many succeeding cases.
“Finally, let it be distinctly understood that I consider the hypodermic use of morphia a very decided therapeutic advance, and of incalculable benefit in allaying pain and curing disease in cases where other modes of treatment utterly fail. In calling attention to the dangers sometimes attending the use of the drug in this way, I do it not from a one-sided view of the question, not with a desire to condemn it, simply to point out what may occur, endeavor to show how best to avoid it, and, if possible, restrict its use to those cases in which it is proper.”
The physician should never entrust a syringe or the solution to patients or their friends. He should use it himself.
THE CHLORAL HABIT.
CHAPTER VIII.
THE CONTINUED USE OF CHLORAL HYDRATE.
But little attention has been paid in this country to the habitual use of chloral. German and English literature is more abundant, but at best vague and unsatisfactory, and the professional mind does not seem to be at all settled upon the subject as to whether such a thing as a chloral habit does or does not exist.
A committee was appointed by the Clinical Society of London, a short time ago, to investigate this matter. The result was a failure, owing to the fact that the medical gentlemen who received circulars asking for information upon various points failed to answer in sufficient numbers or with sufficient explicitness to make the results valuable. There were but seventy replies from the thousand circulars sent out.