3 The word morphiomania, used by writers, is contrary to all etymological rule (Zambaco, De la Morphéomania, Paris, 1883).
ETIOLOGY.—A. Predisposing Influences.—Pain holds the chief place among the influences which predispose to the formation of the opium habit. By far the greater number of cases have taken origin either in acute sickness, in which opium administered for the relief of pain has been prolonged into convalescence until the habit has become confirmed, or in chronic sicknesses, in which recurring pain has called for constantly repeated and steadily increasing doses of opiates. In view of the frequency and prominence of pain as a symptom of disease, and the ease and efficiency with which opium and its preparations control it, the remote dangers attending the guarded therapeutic use of these preparations are indeed slight. Were this not so, the number of the victims of the opium habit would be lamentably greater than it is. In a considerable proportion of cases of painful illness the relief afforded by opiates is attended by at least some degree of malaise, nausea, vomiting, and vertigo—symptoms which render the speedy discontinuance of the remedy scarcely less desirable than the control of the pain for which it was administered. Occasionally these symptoms are so distressing as to render opium wholly inadmissible. In other instances each successive dose is attended by an aggravation of the distress. More commonly, especially in acute illnesses, decreasing pain may be controlled by diminishing doses, thus rendering practicable entire discontinuance of the drug before those modifications of the nervous system, and especially before that tolerance for large doses, which constitutes the beginning of the opium habit, are established. For these reasons the use of opiates in acute sickness, if properly regulated, is attended with but little danger. Far different is it, however, in chronic painful illnesses. Here to procure relief by opium is too often to pave the way not only to an aggravation of the existing evils, but also to others which are often of a more serious kind. Opium is at once an anodyne and a stimulant. The temptations to its use are of a most seductive character. To the overworked and underfed mill-operator it is a snare more tempting than alcohol, and less expensive. It allays the pangs of hunger, it increases the power of endurance, it brings forgetfulness and sleep. If there be myalgia or rheumatism or neuralgia, and especially the dispiriting visceral neuralgias so common and so often unrecognized among the poorer classes of workpeople, opium affords temporary relief. The medical man suffering from some painful affection, the worst symptoms of which are relieved by the hypodermic injection of morphine, falls an easy prey to the temptation to continue it—a danger increased by the fact that he is too often obliged to resume his work before convalescence is complete. Indeed, the self-administered daily doses of physicians sometimes reach almost incredible amounts. To women of the higher classes, ennuyée and tormented with neuralgias or the vague pains of hysteria and hypochondriasis, opium brings tranquillity and self-forgetfulness.
Of 100 cases collected by Jouet,4 the habit followed the therapeutic use of morphine in 32 cases of ataxia, 24 of sciatica and other neuralgias, 8 of asthma, 2 of dyspepsia, 4 of hypochondriasis, 2 of madness, 9 of painful tumors, 2 of prostatic inflammation, 7 of nervous conditions (not specified), 1 of peritonitis, 2 of periostitis, 1 of gastro-enteralgia, 4 of pleuritic pains, 1 of contracture, and 1 case of hæmoptysis.
4 Étude sur le Morphinism chemique, Thèse de Paris, 1883.
The responsibility of the physician to his patient becomes apparent when we reflect that with very few exceptions the opium habit is the direct outcome of the use of the drug as a medicine.
The decade of life at which the opium habit is most common is between thirty and forty. But it may be developed at any age. Even infants are not rarely made the subjects of chronic opium narcotism by the use of soothing syrups and other poisonous nostrums.
Sex in itself exerts very little influence as a predisposing cause. Owing to collateral circumstances, the number of women addicted to opium is greater than the number of men. Kane5 states that females more frequently fall victims to these drugs than males, in the proportion of three to one, and attributes this excess to the fact that women more often than men are afflicted with diseases of a nervous character in which narcotic remedies are used for long periods. This observer suggests as an additional explanation the occasional preference on the part of women for opium as a stimulant in place of alcohol, its effects being less noticeable and degrading. On the other hand, Levinstein observed in 110 cases 82 men and 28 women. He does not, however, regard the conclusion that the use is more common among men as warranted by these figures. The habit resulted in these 110 cases from the following causes: In 20 men and 6 women after acute affections; in 46 men and 17 women after chronic affections, these diseases being in each instance accompanied by great pain. One man began to use morphine as an antiaphrodisiac. Either to produce mental excitement simply or to cause forgetfulness of the ordinary cares of daily life, 15 men and 5 women indulged to an uncontrollable extent.
5 Drugs that Enslave, Philadelphia, 1881. I refer with pleasure to the early labors of this observer. His later publications tell their own story.
Occupation has in some respects much to do in favoring the development of the opium habit. Familiarity with the use of drugs exerts a powerful influence. Of Levinstein's 110 cases, 47 occurred in persons belonging to the medical profession or dependent upon it; thus, 32 physicians, 8 wives of physicians, 1 son of a physician, 4 nurses, 1 midwife, and 1 student of medicine.