Morphine

“ 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. ”

“ The condition may even go on to a fatal result should morphine be continuously withheld, but injection of even a small quantity of morphine causes these symptoms to cease abruptly. The sudden withdrawal of morphine should therefore never be practised with takers of large quantities of the drug, but gradually diminishing doses given by the physician should be substituted. For the successful treatment of morphinism, complete isolation of the patient is necessary in a place where he is supervised so that he can obtain no morphine. ”

“ Morphine is intrinsically far worse than opium itself, for opium has certain properties which partly counteract the effect of the morphine [Pg 216] that it contains. But morphine is not only the active principle, but the actively evil principle, of the drug.
The user of morphine always retains his faculties. He is usually capable of intelligent conversation. Unlike the alcoholic’s brain, his is not inflamed. It is impossible for the physician intelligently to discuss his symptoms with an alcoholic; with a victim of drugs, on the other hand, he can thresh out every detail of the case. ”

“ In morphine, on the higher animals at least, the narcotic action is very marked, the tetanizing action slightly so; while in thebaine there is little narcotic effect, but a tetanizing action like that of strychnine. Morphine exercises its effects chiefly upon the cerebrum and the medulla oblongata in man. It has in addition a markedly depressing action upon the respiratory centre, it lessens all the secretions except the sweat, and diminishes bowel peristalsis and the size of the pupil. Men are much more affected by it than birds, rabbits, dogs and most other animals. ”

“ Morphine is the greatest anodyne we possess, and no drug yet discovered equals it in pain-relieving power. The most frequent mode of administration is the hypodermic method, on account of the extreme rapidity with which it is absorbed. In pain due to violent sciatica relief and even permanent cure has been obtained by the injection of morphine directly into the muscle of the affected part, and in the treatment of renal and hepatic colic morphine given subcutaneously will relieve the acute pain consequent on the passage of biliary and urinary calculi. ”

“ For these disorders it is truly specific. It is one of the most valuable means for overcoming the bad effects of the morphine habit. In most cases in which the habitue has not used more than four grains daily the opiate may be abruptly discontinued, and even substituted, without any serious results. If a larger quantity than this amount has been taken for some time, it is better to gradually reduce the daily dose of morphine, in the usual manner, simply prescribing the [Pg 37] Avena in addition. ”

“ All this might be true and the man might be innocent. But, selecting from this array of suspicious facts, the one which indicates morphine as the drug employed, and then add to it the fact that expert chemists actually find morphine in the tissues of the body, and you see, gentlemen, that at once this single bit of direct evidence gives substantial form to the whole. ”

“ One can but remark, that luxury, which tends to introduce itself everywhere, has already invaded the domain of morphine. The little syringe of Pravas, which permits of the injection of the poison under the skin, and the consequent avoidance of the bitter taste and the nausea which would be occasioned by eating morphine, has received ingenious and artistic modifications. ”

“ Thebäine does not cause sleep, and in animals produces convulsions like those caused by strychnine, while morphine in the same dose produces deep comatose sleep. Another curious thing about these opium alkaloids is, that they do not act alike on man and animals, as has been demonstrated by Claude Bernard. Man is specially sensitive to the action of morphine, while thebäine is almost without effect upon his nervous system: animals, on the other hand, feel the effects of morphine only when it is given in large doses, while thebäine is for them a violent poison. ”

“ Physiological Action.—From experiments on animals, the essential action of morphine on the nervous and arterial systems has in some measure been examined. There is no very considerable action on the heart. The beats are first accelerated, then diminished in frequency; but very large doses introduced directly into the circulation at once diminish the pulsations, and no acceleration is noticed. The slowing may go on to heart-paralysis. The slowing is central in its origin, for on the vagi being cut, morphine always quickens. ”

“ The legitimate use of morphine by physicians has done more than almost anything else, with the possible exception of cocaine, to relieve suffering, and there is consequently a considerable trade in the drug. ”

“ Some physicians, by carelessly prescribing morphine for neuralgia, migraine, dysmenorrhoea, or any pain, make their patients slaves of this drug.
The degenerative effects of morphine are not so great nor so rapid as those of alcohol. It does not shorten life so much as alcohol does, nor are the children of a person addicted to the use of the drug so liable to idiocy and imbecility. The mind is enfeebled—slowly in some cases, rapidly in others. The patient will resort to almost any means to obtain the {116} drug, if he is deprived of it. ”

“ In three days I have been enabled, by their use, to reduce the amount of morphine from twelve grains to half a grain, in the twenty-four hours, the patient being up and about. Whether the effect will hold, and whether these drugs can be easily abandoned, remains to be seen. It is in drugs of this class that we must look for a substitute for opium and its alkaloid. With other treatment we merely combat the symptoms that arise. ”

“ Your opium-eater does not reduce himself to a state of coma. He usually keeps well within the limits of the tolerance that has been established. The conclusion that emerges is, I think, that the drug was administered by some other person; and the most likely person seems to be Mr. Weiss."
"Isn't morphine a very unusual poison?"
"Very; and most inconvenient except in a single, fatal dose, by reason of the rapidity with which tolerance of the drug is established. But we must not forget that slow morphine poisoning might be eminently suitable in certain cases. ”

“ Benzyl-morphine Hydrochlorate, Merck.—White powd.—Sol. readily in water; insol. in alcohol, chloroform, and ether.—Substitute for Morphine as a Sedative and Anodyne.—Uses: Coughs, catarrhs, rheumatic and neuralgic pains, etc.; almost wholly free from the by-effects of morphine.—Dose: 1/3—1 grn., in pill or sweetened solut.
Phenacetin.
Para-acetphenetidin.—Wh., tastel., cryst. powd.—Sol. in 1500 parts water, 16 alcohol.—Antipyretic, Antineuralgic, Analgesic.—Dose: Antipyr., 8—10 grn.; analg., 15—24 grn.; children, up to 5 grn. ”

“ In the first place, lessening the dose is of little avail; there is as much suffering in the final deprivation of a customary quarter of a grain as of twenty grains. In the second place, it cannot be ascertained by gradual reduction whether there is any disability which makes morphine necessary, since no intelligent diagnosis can be made so long as a patient is under the influence of the smallest quantity of the drug. ”

“ We have to accept it as a conceivable hypothesis that it may be sleeping sickness because we cannot positively prove that it is not. That is all. But when we come to the hypothesis of morphine poisoning, the case is different. The symptoms agree with those of morphine poisoning in every respect. There is no exception or disagreement whatever. The common sense of the matter is therefore that we adopt morphine poisoning as our working diagnosis; which is what you seem to have done. ”

“ I did so, and there continued two years and a quarter, performing in that time as much literary labor as ever in three times the interval in any prior period of my life. In short, I had three happy, intellectually-vigorous, outpouring years, with bodily health uniformly sound and complete with the exceptions hereafter to be mentioned. And yet, through those years I never used less than a quarter of an ounce of morphine per week, and sometimes more. I attribute my retaining so much health, in spite of the morphine, to the rigorous salubrity of my habits, bodily and mental, in other respects. ”

“ If the pain is very severe morphine should be given by the hypodermic method and inhalations of chloroform given until morphine has had time to act. Local applications are sometimes grateful,—hot poultices or cloths wrung out of hot water may be helpful. Cloths wrung out of steaming hop, wormwood, or smartweed teas, are of benefit sometimes. Change of position often gives relief; when the stone is large an operation may be needed. The patient should drink freely of hot lemonade, soda water, barley water. ”

“ Besides the methyl derivative, however, others are possible, and several have been recently prepared, giving rise to a class of artificial alkaloids known as codeines. Morphine, rapidly distilled over zinc dust, yields phenanthren, trimethyl-amine, pyrrol, pyridine, quinoline, and other bases. The action of strong hydrocholoric acid upon morphine changes it into apomorphine, C17H17NO2, by the withdrawal of a molecule of water. Ferricyanide of potassium and caustic soda solution change morphine into oxidimorphine, C34H36N2O6. When heated with strong potassium hydrate, it yields methylamine. ”

“ It was very like morphine poisoning; and, if it was morphine, it was no common, medicinal dose that had been given. I opened my bag and took out my hypodermic case from which I extracted a little tube of atropine tabloids. Shaking out into my hand a couple of the tiny discs, I drew down the patient's under-lip and slipped the little tablets under his tongue. Then I quickly replaced the tube and dropped the case into my bag; and I had hardly done so when the door opened softly and the housekeeper entered the room.
"How do you find Mr. Graves?" ”

“ A morphine manufacturer has no particular interest in ascertaining the amount of water in the opium he purchases. All he requires to know is the percentage of morphine which the drug contains. It is otherwise with the pharmaceutist, whose preparations have to be made with dried opium. ”

“ PROGNOSIS.
Cure may be assured if proper control of the patient is had. As much depends on proper after treatment of these cases as in that of the morphine habit.
Relapses less often occur in these than in opium habituès.
Finally, then, the prolonged use of chloral is not so likely to form a habit; is not so thoroughly enslaving when formed; is less prone to endanger life in small, more prone to destroy mind and body in large doses, and is easier broken, than the opium and morphine habits. ”

“ Patsy, however, was taught the use of the hypodermic needle, which Maud and Beth quite understood.
"We've a big stock of morphia, in its various forms," said the doctor, "and I expect it to prove of tremendous value in comforting our patients."
"I'm not sure I approve the use of that drug," remarked Uncle John.
"But think of the suffering we can allay by its use," exclaimed Maud. "If ever morphia is justifiable, it is in war, where it can save many a life by conquering unendurable pain. I believe the discovery of morphine was the greatest blessing that humanity has ever enjoyed. ”

“ 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.
The age at which this habit is most common is from thirty to forty, both in males and females. ”

“ Unless the indirect importation of morphine into China from Europe and the United States is stopped, a worse habit and more difficult to cure than any other (except perhaps that of cocaine) may replace that of opium-smoking in China. It is worse even than opium-eating, in proportion as morphine is more active than opium. The sale and use of morphine in India and Burma is now restricted. The quantity of morphine that any one may legally possess, and then only for medicinal purposes, is in India 10 grams, and in Burma five. ”

“ So long, however, as menstruation does occur, there is a possibility of the woman’s becoming pregnant.
In the majority of instances sensation is finally lost, although it is usually increased during the first few months’ use of the drug. A patient of mine, a lady who had used morphine by the mouth for sixteen years, found her virile power during and at the end of that time in no way impaired. If anything, it was increased. Her dose of morphine was ten grains. ”

“ It is really morphine treated with acetic acid which renders it more powerful than morphine alone.”
“How do they take them? What’s the effect?” I asked.
“The person who uses heroin usually powders the tablets and snuffs the powder up the nose,” he answered. “In a short time, perhaps only two or three weeks, one can become a confirmed victim of ‘happy dust.’ And while one is under its influence he is morally, physically and mentally irresponsible.”
Kennedy was putting away the paraphernalia he had used, meanwhile talking about the drug. ”