The therapeutics of any epoch is strictly in conformity with the most prominent disease or symptom of the people upon whom the physicians practice. This is true of whole countries and sections of countries as well as of times.
Formerly, when it was common for physicians to prescribe opium, it was this drug that the people ate. As morphine came into fashion, it was prescribed largely by the profession and the persons forming the habit at that time, as a rule, ate morphine. Habituès of the opium epoch also resorted to it, finding it so much more powerful than the crude drug, so much less bulky, and it did away with the necessity for calling forth a response to opium from the shattered system by resort to alcoholic stimulants. At the time in which De Quincey, Coleridge, and Southey lived, the people and the profession knew little of the opium habit, save among foreign nations; the habituès were few in number, and, as a consequence, when De Quincey’s article appeared, it created a most decided impression on the public mind; an impression not yet effaced, and one which bore with it an incalculable amount of harm. Men and women who had never heard of such a thing, stimulated by curiosity, their minds filled with the vivid pictures of a state of dreamy bliss, a feeling of full content with the world and all about, tried the experiment, gradually wound themselves in the silken meshes of the fascinating net, which only too soon proved too strong to admit of breaking.
There is no question in my mind that, in writing his “Confessions,” De Quincey left a large debit on the side of truth, and handed down to succeeding generations a mass of ingenious lies; more pleasantly the fiction, vaporizing from a laudanum-soaked brain. He must needs seek some justification for his life of willful misery, for the blasted hopes, ambitions and prospects of what might have been a noble career, and he offered the dream life, the fuller development of benevolence, and the many pleasures so fantastically portrayed, as a justification, in part at least, for his sin.
Nor does the final confession of the intense pain, the abject misery, the tottering of the mind, the crumbling of the reasoning and will power, and the ever attendant and impenetrable gloom of a living hell, serve to fully counteract the baneful effects of the portrayal of the pleasures of opium. The reader, confident of his ability to stop short of the ever-shifting line that divides the happiness from the misery, is in no wise deterred from trying the danger-fraught experiment. I know of several patients who began the use of opium simply from reading this most pernicious book.
Upon persons living in temperate and cold climates this drug does not have any such effect, with reference to the subject matter of dreams, as upon Orientals. Indolent, over-fed, and by reason of their mode of life, religious associations and habits of thought, fancifully imaginative, it is not surprising that they should enjoy, while under the influence of the drug, grotesque, and to them, pleasant, dreams. Did the opium cause dreams foreign to the picture daily conjured by their fertile imaginations, it would indeed be more surprising. That it does not produce such effects on our plain, work-a-day people is not to be wondered at.
As I have already said, the preparation of the drug used and the manner of using it in any epoch has been exactly in consonance with the practice of physicians at that time. Of late years physicians are becoming more and more addicted to the subcutaneous use of morphine, and as a consequence, the number of persons who habitually use the drug in this way is daily on the increase. Eight-tenths of those from whom I hear and of those who come to me for treatment are using the drug subcutaneously.
Dr. Charles Warrington Earle, of Chicago, in a very able and well written little pamphlet,[2] is of the opinion that the majority of habituès do not use the drug in this way. In reply I can only reassert my opinion just expressed, and must say that the tendency of these patients to falsify, and their delicacy in disclosing their manner of using the drug to the druggists from whom they obtain their supply, must be taken into consideration. Dr. Earle bases his conclusions on 235 cases, the histories of which have chiefly been obtained from druggists.
Be it understood, however, that I do not maintain that the majority of opium and morphine takers use the latter drug by the hypodermic syringe. I simply say that in my experience this manner of using the drug is largely on the increase among habituès, and will go on increasing from year to year, in the same manner that morphine is rapidly replacing opium in the practice of physicians. This is well shown by one of Dr. Earle’s carefully prepared tables:—
KIND OF NARCOTIC.
| Morphia | was used in | 120 | cases. |
| Tincture of opium | was used in | 30 | ” |
| Paregoric | ” ” | 5 | ” |
| McMunn’s elixir | ” ” | 2 | ” |
| Gum opium | ” ” | 50 | ” |
| Dover’s powders | ” ” | 1 | ” |
| Unknown | ” ” | 27 | ” |
| 235 |