Read before the Society of Medical Jurisprudence and State Medicine, June 14, 1888.
“All men are liars,” said the writer of ancient days, and the revised version of modern times is, “All men—who take opium—are liars.”
The writer—whose initial acquaintance with this question dates back nearly two decades, and whose professional experience for several years has been exclusively devoted to a large and enlarging clientele of this class—has long held this opinion to be a mistaken one. Years ago he wrote—“Clinical Notes on Opium Addiction,” read before the Kings Co. Med. Soc., 16th January, 1883—“Nor do we share in the opinion, largely held, that no reliance is to be placed on the word of opium habitués. That the habitual use of opium, in many cases, does exert a baneful influence on the moral nature we are well aware, but we also know that in the ranks of these unfortunates are those who would scorn to deceive, and whose statements are as worthy of credence as those upon whom has not fallen this blight.” Increasing attention to this topic has only confirmed that belief, and the recent statement—unwarranted and untrue—of a medical writer and teacher, that “no morphia habitué can be depended on to tell the truth,” with the courteous invitation of your honored President to present you a paper, has prompted me to offer some thoughts on this subject—the result of observation, reflection and applied common sense.
Putting the query—why do men take opium?—the answer to-day is that made nearly twenty years ago by Dr. Joseph Parrish, Pres. Amer. Assoc. for the cure of Inebriates—“men take it for a physical necessity.” In an experience covering the history and treatment of hundreds of cases, I have noted only two exceptions.
Let it be distinctly understood that my remarks apply only to the better class of habitués, who have become such by force of conditions beyond control. With those who, viciously indulgent and lacking alike in principle and purpose, take opium from mere sensual desire, we have nothing to do.
This physical necessity, the great genetic factor in an opiate using, it need scarcely be said, has its rise in painful disorder of body or mind. For this opium in some form is given, which, when the legitimate need for its action is ended, entails a demand for continued taking that will not be denied.
The larger share of responsibility then rests on the medical man who prescribes—very properly it may be—this valued drug, though the main measure of his responsibility depends not on the initial using, but upon the case being dismissed without full thought as to the ultimate result of the opiate taking, and with a neglect to warn the patient against the danger of continued using, and insisting upon—giving to this his personal attention—the entire narcotic disusing when the proper need for its taking is ended. Vide “The Genesis of Opium Addiction,” Detroit Lancet, 1884, and “The Responsibility of the Profession in the Production of Opium Inebriety,” Med. and Surg. Reporter, 1878.
Granting this correct, on what principle of equity or right can one be held accountable, and so culpable, for his use of the drug when, unaware of its ensnaring power, and, confiding in the counsel of his medical adviser he avails himself of the relief it affords?
Another and most important auxiliary factor obtains in these cases—one of which the laity knows little or nothing, and the profession appreciates less than it should—and that is the power opium possesses to create a necessity of its own. Of this, I venture to assert that no one, other than the subject of a painful personal experience, or of large observation, can form a fully adequate idea. The writer has been studying opium and opium habitués for more than sixteen years, with an annual experience, of late, as regards number of cases, that is probably unequalled in this country, and yet he stands more and more in awe of this peculiar power with every case that comes under his care.
Granting a painful physical necessity, and the daily or semi-daily use of opium—especially morphia, subcutaneously—for a few weeks or months, and there are few, if any, who can withstand the ensnaring, enslaving power of this drug. Men stronger of brain and brawn than we have gone down before it. I have known a superbly athletic specimen of physical manhood, able to resist the wintry rigor of a polar expedition, succumb to the power of morphia in less than a month. I have seen a man so generously endowed that he survived the horrors of Salisbury when the death rate averaged eighty per cent., go down before the same resistless power in four weeks. It was my pleasure to see this gentleman recover, and take the lecture platform to tell of his bondage and escape, and this is what he said: