H. H. Kane

“ I have emphasized the fact that the continued use of chloral is not so liable to end in the formation of a habit, as is the prolonged use of morphia or opium; not that physicians may exercise less care and discrimination in its employment, for the danger is sufficiently great, but simply to refute the statements of some men who are gone wild upon the subject of habituation and inebriety, and who suggest measures for reform, and plans for restraint and treatment, as impracticable and impossible as their statements are whimsical and truthless. ”

“ That which at first gave them pleasure has now become the veriest tyrant, enforcing long hours of pain and anguish, gloom and despondency. They do not continue its use because it gives them pleasure, but simply because it is the only thing that, in increasing doses, can save them from the torment it has itself imposed; because without it they are sunk into a living hell. The mind is incapable of healthy action, the temper is decidedly aggravated, the person taking offence at and scolding furiously about things that in health, or while under the influence of opium, would excite no comment. ”

“ Rapidity as well as intensity of thought is a noticeable phenomenon. De Lucca, after swallowing a dose of the paste, saw, as in a flitting panorama, the various events of his entire life, all proceeding in orderly succession, though he was powerless in the attempt to arrest and detain a single one of them for a more deliberate contemplation. ”

“ Friends are neglected, the books that were once interesting are no longer so, amusements pall upon the taste, family ties, once so pleasant, are become burdensome, and life a dreary space, marked only by the hour at which the drug is to be taken. ”

“ The hours of freedom from the tyrant become shorter and shorter, sleep refuses to come, grave doubts fill the mind, the temper is no longer even and pleasant, but irritable [50] and capricious, pains show themselves in various parts of the body, the nights are long hours of torment, conversation becomes a burden, suspicion shows itself, a desire to be alone is overpowering, better feelings are blunted, benevolence is replaced by selfishness, mental stimulation and exhilarance by torpor. ”

“ The mind wanders; delirium supervenes; diarrhœa and vomiting set in, and sometimes collapse, and a more pitiable object can nowhere be found.
It is at this time that the sufferer, tortured beyond all [21] power of endurance, would sell body, soul, anything, to obtain that drug which, while it gives no fresh pleasure, removes these ill effects, as if by magic.
A dose is taken. A pleasant sense of warmth pervades the body; the mind clears, the hands become steady, the gait natural, the pains vanish, the nausea and diarrhœa cease, and existence becomes again bearable. ”

“ I have already spoken of the two ways in which the opium or morphia habit is formed. A patient of a nervous temperament, suffering from some painful or spasmodic disease, is attended by a physician, who administers one of these drugs, by the mouth, rectum, or subcutaneously. The relief to suffering is magical, and persists so long as the effect of the drug lasts. With a return of the pain comes the natural desire to have it relieved, and as the narcotics just spoken of have been found especially efficacious the patient desires its repetition. ”

“ It may well be questioned whether the world has been the gainer or the loser by the discovery of subcutaneous medication. For every remote village has its slave, and not unfrequently several, to the hypodermic syringe, and in the larger cities, men in business and in the professions, women condemned to a life of constant invalidism, and ladies immersed in the gayeties of social life, are alike bound to a habit which they loathe, but whose bonds they are powerless to break. ”

“ Some ruse, some strategy, some deception is sure to be practiced, either by the patient, the friends, the relatives or the nurse. Very often the relatives, not understanding the meaning of certain symptoms, distressed beyond measure by the pitiful pleadings of the sufferer, will interpose and at once put an end to treatment, thus unwittingly and with well meaning doing the patient an injury of the gravest kind. ”

“ This is undoubtedly due to the fact that women more often than men are afflicted with diseases of a nervous character, in which narcotic remedies are used sometimes for a long period, and also to the fact that in some instances it is used by them in place of alcoholic stimulants, its effects being less noticeable and degrading, although none the less intoxicating.
Both males and females are usually of the higher orders, in point of intellect and culture. In some cases business failure or family trouble has been the incentive for a resort to the use of the drug. ”

“ As time advances, however, the duration of these periods is found to become shorter, and it is necessary, in order to obtain the same pleasant result, to increase the amount of the drug. It has, also, to be taken oftener. Sleep, when it comes, is less profound, the dreams not so pleasant. Should the patient pass the accustomed time for the drug, the loss is at once felt and the first symptoms of rebellion show themselves. A further and larger dose is taken, to quiet the rebellious demon that rules them, and again comes the pleasure, though not so satisfying as at first. ”

“ If possible, the patient must be kept in motion and applications of cold water be made to the face and spine. If the patient falls the limbs must be raised, and all methods used to keep the heart acting, for if you can bridge over ten or twelve minutes the patient is safe. To prevent being ‘struck,’ as he calls it, one patient of mine carries a cord, which he throws over the arm, and if an unfavorable symptom occurs, he uses it as a tourniquet, and in a moment the result is apparent in the extravasation of the blood and the morphia from the wounded vessel. ”

“ Another symptom dependent on disordered nutrition of the skin is the rapid or slow falling of the hair that occurs in some patients. However much hair restorers and scalp tonics may be used in these cases, the hair, once having commenced to fall, will continue to do so until the general health improves. When the drug has been stopped a free falling out of the hair occurs, followed by a new and luxuriant growth. Indeed, sweeping out and rebuilding seems to be the rule in every tissue. Change in color of the hair has been noted in some cases. ”

“ There seems to be a morbid craving for something, exactly what is not known, until the narcotic is tried, when this morbid appetite is satisfied and fixed, and becomes the typical “morbid craving for morphia.” It will be dipsomania, morphia-mania, chloral-mania, hasheesh-mania, according as the one or other drug is presented to the patient in the condition of craving. Some persons are undoubtedly born with, and some acquire, this craving for some narcotic or stimulant. ”

“ These cases, and the effect on myself, taught me, when injecting a patient for the first time, never to give more than the sixth of a grain—wait a quarter of an hour longer, and then give the remainder of the dose, after ascertaining how the first injection was taking effect. Women, I have found, are generally bad subjects for subcutaneous treatment; for they get frightened and nervous—in fact, one woman told me that though the morphia taken by the skin did her more good than by the mouth, yet she preferred the latter, for the instrument frightened her. ”

“ These persons at first wake many times in the night, with coldness of the lower limbs, cold sweatings, startlings, and restless dreamings. In a little time they become nervous about submitting themselves to sleep, and before long habituate themselves to watchfulness and restlessness, until a confirmed insomnia is the result. Worn out with sleeplessness, and failing to find any relief that is satisfactory or safe, in their false friend, alcohol, they turn to chloral, and in it find for a season the oblivion which they desire, and which they call rest. ”

“ There was a marked increase of the urinary secretion. There were no after effects, such as nausea, headache, or constipation of the bowels.
“The sense of prolongation of time which I experienced was to me very remarkable, but is not uncommon in these [218] cases. It is evidently due to the immense rapidity of the succession of ideas. The mind, without doubt, measures time by the duration of its own processes, and when an infinitude of ideas arise before it in the time usually occupied by a few, time becomes infinitely prolonged to the mind. It is a lifetime in the minute. ”

“ Finding pain, “nervousness” and hysteria constantly claiming his attention, and that nothing relieves them so well as opium, or its alkaloid morphia, which is six times the parent strength, the physician resorts to their use more and more freely, expecting as soon as the more distressing symptoms pass away to pursue another and more permanent plan of treatment. The patient, however, having once experienced relief, insists upon the further use of the drug, sometimes feigns illness, in order to procure it, finally obtains some herself, and in guilty secrecy drifts rapidly into the habit. ”

“ In almost every instance the accompanying ill effects will be found to be due more to the abuse of morphine than to the disease itself. Indeed, its continuance may place the patient in a condition that will preclude the possibility of recovery.
Patients with one foot apparently in the grave, when deprived of their morphine, take a decided turn for the better, and regain fair, if not perfect health. A fatal ending sometimes follows the waiting and attempting to build up the health before commencing the treatment of the habit. ”

“ Reading the histories of those cases where a cure was effected some years ago, one’s mind is divided between admiration of the great heroism displayed by the unfortunates, and pity for the agony which they were allowed to endure. ”

“ It will be seen, from the foregoing cases, that while there is no doubt that in certain individuals a morbid craving for chloral may be established by the prolonged use of the drug, it is very different, as a habit, from that produced by opium or morphine. As an offset to this stands the fact that, in those cases where a habit is formed, it causes a more complete and rapid ruin of mind and body than either opium or morphine.
Persons addicted to the habitual use of this drug are usually of the educated class, as is the case with opium. ”

“ In short, the man who takes to chloral after alcohol enlists two cravings for a single craving, and is double shotted in the worst sense.
“A third class of men who become habituated to the use of chloral are men of extremely nervous and excitable temperament, who by nature, and often by labors in which they are occupied, become bad sleepers. A little thing in the course of their daily routine oppresses them. What to other men is passing annoyance, thrown off with the next step, is to these men a worry and anxiety of hours. ”

“ 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. ”

“ Business is neglected or but imperfectly performed; family ties are sundered; hope, ambition, happiness, self-respect are meaningless words; the one thing that fills the mind is the gratification of this passion, which they loathe, but from which they cannot break. ”

“ Persons who may be classed under the head of “nervous temperament” are daily on the increase.
Diseases are to-day as different from diseases of a century ago as is their treatment. While the average individual now does more mental work in an hour than did our ancestors in six hours, we are not one-sixth as well able to bear the intellectual strain as they were. ”

“ As the gastric catarrh increases, nausea and finally vomiting ensue, still further debilitating the patient. Derangements of the stomach, liver and bowels are much more common among those who use the drug by the mouth. I have, however, seen patients who, while using morphia hypodermically, have suffered intensely with jaundice, catarrh of the stomach, nausea and vomiting. When these disorders do arise in the course of the subcutaneous use of morphia they are prone to be very acute in character. ”

“ I have known persons (and have one under treatment at this time) who are habituated to the use of narcotics, and who, to avoid being enslaved by either one, alternate between morphia, chloral, whiskey, and the bromides, with the result of rest and composure from each in its turn. They are not opium or chloral habituès, nor inebriates from alcohol, but they are habituated to artificial narcotism.
“In the case now under treatment, the chloral dose does not exceed fifteen grains at bedtime, and the morphia dose does not exceed half a grain, nor the whiskey dose more than a fluid ounce. ”

“ Experiments on a healthy man, aged thirty-two. One-sixth of a grain of acetate of morphia was employed:—
I have found that some drugs, notably jaborandi, when used hypodermically, manifest their peculiar symptoms in so short a time as one minute, no vein of any size being punctured. It is to be supposed that one drug is absorbed from the subcutaneous cellular tissue with about the same rapidity as another, but that each drug manifests its presence in the circulation with a difference in point of time, according to its peculiar action, or to some idiosyncrasy of the patient. ”

“ The insomnia is usually relieved by exercise better than by drugs, although I have often found bromide of potassium and hyoscyamus of service. On no account use chloral hydrate, or give stimulants at bedtime. Exercise is by far the best remedy. Walking, running, making garden, etc., sufficient to tire the patient out thoroughly, is an almost certain sleep producer, appetizer and hastener of tissue metamorphosis. The cold pack or a hot bath at bedtime often proves of service. ”

“ Those who are the most likely to behave in a manner such as to cause their friends to interfere, from fear of death or insanity resulting, are hysterical females. Absolute committal to a public or private institution, where the nurses can be absolutely relied upon, and where obedience to the physician’s orders are rigidly enforced, is the only rational plan for treating these cases. Then, too, conveniences for baths of different kinds and temperatures, and varied electrical appliances, not found in patient’s houses, are necessary; more necessary than drugs. ”

“ The violent delirium tremens spoken of by Levenstein I have never seen, save in one case, which I treated according to his method. When delirium occurs at all, it is usually of a low, muttering, harmless kind. For its treatment and that of the severe nervous irritability and restlessness sometimes seen, the hot bath, followed by the cold douche, is an excellent remedy. If the patient is strong I let him remain in it for twenty minutes; if weak, from five to fifteen minutes. ”

“ So common now are the instances of its habitual use, and so enslaving is the habit when indulged in by this mode, that a lover of his kind must regard the future of society with no little apprehension. ”

“ The brunt of its action seems to be exerted on the heart, and the key to proper treatment is thereby afforded. To whatever cause due, the effect is essentially the same, the difference being only one of degree. That syncope and vaso-motor disturbances are ever due to the injection of air into a vein with the solution, I very much doubt. In the first place the morphia itself is quite sufficient to produce the symptoms, and in the second place not more than a bubble of air is ever left, by carelessness, in a syringe, and this is not sufficient to produce these symptoms. ”