The Opium Habit: A Statistical and Clinical Lecture

By Charles W. Earle

Chicago Medical Review, Vol. 2 (1880), 442-46.

Inquiries were made at fifty drug stores. The three divisions of the city were visited, and localities inhabited by the different classes and nationalities were thoroughly canvassed. I was greatly surprised to find that druggists on the West Side were patronized to a greater extent (excepting a few on Clark street) than in any other part of the city. Foreign druggists (German and Scandinavian), seem to exhibit more conscientious scruples in regard to the trade than our own nationality. I learned from some of these gentlemen that in Denmark, and, if I mistake not, in Norway and Sweden, the trade is absolutely forbidden. Fifty druggists have 235 customers, or an average of nearly five to each store. SEX Among the 235 habitual opium-eaters, 169 were found to be females, a proportion of about 3 to 1. Of the 169 females, about one-third belong to that class known as prostitutes. Deducting these, we still have among those taking the different kinds of opiates, 2 females to 1 male. In one family I found the mother at the age of 65 taking one drachm of gum opium each day, and her daughter, at the age of 30, consuming two drachms of the tincture. One lady, aged 50, has taken it since she was 13 years of age. Suffering from some painful sickness during her youth, she was given, by a physician, a box of powders, on which was written "Morphia. " She had the prescription repeated, and gradually found herself in the power of the seductive drug, from which, in all probability, she will never be freed.

I am acquainted with an aged couple living on Harrison street, aged respectively 70 and 75, who take a drachm of morphia each every week, when by any means whatever they can procure it. The husband has suffered from fracture, and the wife with neuralgia and rheumatism.

NATIONALITY

• Entire number of cases 235
• American 160
• German 7
• Irish 17
• Scotch 10
• Colored 12
• English 6
• Scandinavian 5
• Unknown 18

It will be noticed that it is among our own people that we find the largest number yielding easily, and in considerable numbers, to the influence of this drug. The Germans and the Irish find relief from their troubles in the anestheic effect of beer and whisky, while the American takes a not less effective agent, but one whose effects for the time do not incapacitate the victim for business. And, in addition, I suppose it is true that it is more particularly among Americans, and the foreign class who come to be Americanized, that we find those neurasthenic people who bear pain badly, and demand relief from some source. I have always found it difficult to dissuade a certain class of ladies from taking more anodynes than I thought proper. They constantly demand to be relieved from pain.

AGE (APPROXIMATE)

Males- From 20 to 30 years 5

From 30 to 40 years 19

From 40 to 50 years 11

From 50 to 60 years 7

From 60 to 70 years 1

From 70 to 80 years 1

Unknown age 22

Total 66

Females

From 10 to 20 years 2

From 20 to 30 years 18

From 30 to 40 years 39

From 40 to 50 years 22

From 50 to 60 years 14

From 60 to 70 years 4

One-third entire number prostitutes, probably from 15 to 50 56

Unknown age 14

Total 169

It is, as will be seen, a vice of middle life, the larger number, by far, being from 30 to 40 years of age. One woman, an octoroon, commenced using it when 13 years of age. Away from her friends, she became downhearted and homesick, when an elderly lady, herself a morphia-eater, offered the young girl a powder, with the remark that it would cheer her up and cause her to forget her sorrows. This was repeated for several days, the morphia habit was established, which has clung to the woman to this day. She now takes thirteen grains of morphia in the morning and five grains in the evening, and has taken as high as sixty grains per day. It is reported to me, although I cannot be held responsible for the statement, that a young woman, now 2 5 years of age, and following the occupation of prostitute, commenced to take morpbia when only 5 years of age. While I cannot vouch for the truth of the above remark, I know, from my own observation, that many young children, even infants, become accustomed to and feel the stimulating effects of opiates. Not only this, but they experience the terrible depression, and have the symptoms which I always notice in an adult after the withdrawal. An infant at two weeks of age was given its first dose of soothing syrup. It took two bottles during the first month, six bottles during the second and third months, and four bottles each month during the remaining four months of its life. It died during its seventh month. During the last three months it was constantly nervous, it gradually became pale and slightly yellow, yet increased in flesh. Upon the rapid withdrawal of its morphia, which I assume to be the anodyne ingredient in its soothing syrup, it was taken with terrible diarrhoea, incessant vomiting, apparent unbearable muscular pains, prostration, and death. While a bronchitis with which the little suff erer was attacked, may have had something to do with its death, it has always seemed to me that many of its symptoms were due to the withdrawal of its customary soothing syrup. Of course the entire history of this case was not given to me until after the death of the child. With all the facts in my possession I should have stimulated the child in every way possible, and gradually reduced the soothing syrup.

SOCIETY RELATIONS

It is very rare to find a poor Bohemian or Swede habitually taking any kind of an opiate. It is equally rare to find a wealthy person, in the full enjoyment of his or her property, taking it. A large number of those who have formerly occupied high social standing and enjoyed wealth, but from different causes have become reduced in circumstances and position, are taking the drug. It is, however, among the middle class that we find the very great majority who are to-day our opium-eaters. There are a few exceptions, but in general I believe my statement is correct.

MARRIED OR SINGLE

The great majority of morphia-takers either are or have been married. Many of both sexes, who have occupied this relation, are now separated, the unreliability and loss of respect, and untruthfulness, which the use of the drug usually produces, being the cause of the unhappy condition between husband and wife.

OCCUPATION

From my notes, made while making these investigations, I take the occupation of 100 occurring at the head of the list:

Males Females

Iron merchant 1 Housewives 45

Newsdealer 1 Society ladies 3

Business men 5 Widow 1

Physicians 2 Sewing woman 1

Laborer 3 Servant 1

Turner 1 Washwoman 2

Druggist 1 Prostitutes 5

Bookkeeper 2 Unknown 9

Capitalist 2 Clerk 1

Contractor 1

Insurance agent 1

Book agent 1

Railroad men 1

Attorney 1

Unknown 9

It will be observed that it is in those occupying middle stations, that we find the largest number taking the drug, although among thirty-three men, two are classed as capitalists. I find also, with much regret, two of our profession, which leads me to remark that a few of the heaviest consumers of morphia are physicians and druggists. Their devotion to the seductive influences of the drug has, however, destroyed their business, and they wander around, in some instances at least, leading an aimless and abandoned life. A large proportion of the females are classed as "housewives," but they must necessarily include many widows or those abandoned by their former husbands. The small number of prostitutes numbered in the list arises from the fact that the locations where these observations were made, were among the best in the city, only a few of this class residing there.

CAUSE ASSIGNED

In many cases it is difficult to ascertain the reason for taking the drug, The customer buys the preparation he desires and immediately takes his departure; and it is usually a delicate question to ask, "What do you take it for?" Dr. Joseph Parish says "that men take it not for social enjoyment, but for a physical necessity." With such an opinion I have no sympathy. When it is a physical necessity for men to steal and lie, and murder, and partake of alcohol to such an extent as to incapacitate themselves for work, and bring ruin on their families, then I will admit the same in regard to opium-eating. Quite a number, however, freely confess the reason for taking the drug. Eight say that it is for its stimulating and happy effect; four formerly were addicted to drink and seek quietude by taking opium; five are unhappily married; thirty-eight have had rheumatism and are now suffering from it to some extent, and an equal number assign neuralgia as the cause of their pains, for which some form of opiate is taken. Those diseases known by the incomprehensible name of "female complaints," are frequently given as the cause for taking an opiate. Previous sickness, and wounds received during the war, painful stumps after amputation, injuries to nerves, etc., etc., loss of property and position in society, are given by a few. But the great majority confess that it was first given during some disease in the course of which pain was a prominent symptom. An opiate was prescribed by the physician, and ever afterward, when suffering pain, the little powder, or laudanum, or gum opium, has become their solace. However much we may desire to avoid this grave responsibility, the truth must be confessed, that the greater number of men and women who are now completely enslaved to the different preparations of opium, received their first dose from members of our profession.

KIND OF NARCOTIC

Morphia was used in 120 cases

Tincture opium 30

cc Paregoric 5

McMurm's elixir 2

Gum opium 50

Dover powders 1

Unknown 27

235

Ladies use morphia in the majority of cases, men, of the lower classes, gum opium, and a few, of both sexes, who have a desire for alcoholic stimulants, in addition to the opiate, use the tincture, and occasionally one is found taking large doses of paregoric. An American lady, aged 50, a widow, buys of one druggist half a gallon every week. One lady takes morphia and chloral; another morphia and Dover powders; a patient, under my care at this time, has nearlydestroyed herself and ruined her friends by taking morphia and chloroform.

In addition to those known and recognized as opium eaters, a large number of ladies are in the habit of using from one-third to one grain of morphia daily. They have done this for years without imparting their secret to their nearest friends. It was commenced to allay some pain, and then continued for its stimulant effect. The lady I referred to as being under treatment for morphia and chloroform, took the first-named drug four years before her husband was aware of it.

MANNER AND TIME OF TAKING

My observations do not agree with certain writers; for instance, Dr. Kane, who has recently written a book on the hypodermic method, in regarding this way of taking morphine as particularly liable to cultivate the habit: "A physician of the present day, without a hypodermic syringe in his pocket, or close at hand, would be looked upon as would have been a physician fifty years ago, did be not own and use a lancet. There is no proceeding in medicine that has become so rapidly popular; no method of allaying pain so prompt in its action and permanent in its effect. No plan of medication that has been so carelessly used and so thoroughly abused; and no therapeutic discovery that has been so great a blessing and so great a curse to mankind, as the hypodermic injection of morphia." In some respects I agree with the author, but in my experience the hypodermic syringe is not resorted to with the frequency that Dr. Kane has stated. But very few of the 235 cases, not more than four or five, upon which I base my article, take the drug in this manner, and only two or three of those who have been placed under my care, used the instrument. The great bulk consumed is by the mouth, and, as regards time and frequency of dose, it varies from two or three times a day to a single large dose once in two or three days. It is a curious fact that some of the oldest opium-eaters take a large dose at intervals of from one to three days, and that an even and happy effect is experienced during all that time.

PHYSICAL EFFECTS

In many cases the deleterious results are very long in making their appearance. Indeed, some take this drug for years and years, and seem to enjoy excellent health, and in no way can they be distinguished from those not addicted to the drug. Only a few days ago I met a gentleman on Carroll avenue who has taken morphine thirteen years, in doses of from two to fifty grains daily. He was well dressed, had a healthy color, and was in every respect as respectable looking as the majority I saw on the street. Some become fleshy, especially when commencing its use, while others emaciate. It makes one logy and sleepy, another vivacious and happy. Sooner or later, however, we find symptoms denoting disordered nutrition and enervation. The opium-eater's countenance, in the greater number of cases, betrays him. It becomes sullen, haggard, and apathetic, and the eye loses its brilliancy. All these objective symptoms are most noticeable when the habituate is deprived for even a short time of his usual opiate. We soon find the appetite impaired, and digestion poor. The bowels are habitually constipated. There is also vesical and sexual torpor. Indeed, every function of the body is performed in a sluggish manner. If, from any cause, the victim is deprived of his accustomed drug, he soon begins to have intolerable cramps in the muscular system, with involuntary twitchings. The patient by this time is usually weak and feeble. A gentleman from the central part of our state, when presented for treatment, was a perfect picture of a marasmic patient.

MENTAL AND MORAL EFFECTS

The man avoids society, and before he is fairly confirmed in his habit is tortured with the thought that he is becoming a victim to a habit that he can now only rid himself of by great will-power and bodily suffering. He cannot make the resolution to stop to-day, but defers it until to-morrow. The memory of the poor man is already becoming poor. He neglects his business; he falls asleep for a few moments as he rides in the car, or as conversation lags for a moment with his associates. Equally marked, and more so, if possible, is the change in the moral sentiment of the individual. He neglects his family. He will obtain his usual proportion of opium by making promises that he knows he is unable to fulfill. He becomes cross and irritable if attempts are made to deprive him of his opiate; and, sooner or later, moral rectitude, every noble impulse, every generous thought, is swallowed up in this terrible fight to possess more and more of the narcotic, to obtain which, in almost every instance, the victim has become an inveterate prevaricator. It is claimed by those having greater experience than myself, that the hypodermic use of morphia does not so rapidly, or in such a complete degree, gain the ascendancy over the physical condition and moral sentiments of the individual.