Popular Science Monthly/Volume 15/September 1879/Chloral and Other Narcotics II
|CHLORAL AND OTHER NARCOTICS.|
By Dr. BENJAMIN W. RICHARDSON, F. R. S.
IT may be interesting at this point to particularize the character of the influence exercised on life by certain of the agents we have now under consideration. With the action of alcohol and tobacco we are all so familiar it is not necessary to repeat what is known of them as members of the toxical family of luxury. Let me rather devote a few pages to the consideration of two or three of the less commonly used agents, with the dangers of which the public mind is not so strongly impressed, and with the facts of which it is not so conversant. I will take three of these as the most important at the present time—namely, chloral hydrate, opium, and absinthe.
The serious truth that chloral hydrate after its introduction into medicine was soon made use of as a toxical luxury has already been adverted to. At the meeting of the British Association for the Advancement of Science, held in Edinburgh in the year 1871, I drew earnest attention to this subject. I said—and the words were published in the report of that year (page 147)—"There is another subject of public interest connected with the employment of chloral hydrate. I refer to the increasing habitual use of it as a narcotic. As there are alcoholic intemperants and opium-eaters, so now there are those who, beginning to take chloral hydrate to relieve pain or to procure sleep, get into the fixed habit of taking it several times daily and in full doses. I would state from this public place as earnestly and as forcibly as I can that this growing practice is alike injurious to the mental, the moral, and the purely physical life, and that the confirmed habit of taking chloral hydrate leads to inevitable and confirmed disease. Under it the digestion gets impaired; natural tendency to sleep and natural sleep is impaired; the blood is changed in quality, its plastic properties and its capacity for oxidation being reduced; the secretions are depraved, and, the nervous system losing its regulating, controlling power, the muscles become unsteady, the heart irregular and intermittent, and the mind excited, uncertain, and unstable. To crown the mischief, in not a few cases already the habitual dose has been the last, involuntary or rather unintentional suicide closing the scene. I press these facts on public attention not one moment too soon, and I add to them the further facts that hydrate of chloral is purely and absolutely a medicine, and that, whenever its administration is not guided by medical science and experience, it ceases to be a boon, and becomes a curse to mankind."
This was stated within two years after the substance chloral hydrate came into medical use. If at that time the mind of the public had been as ripe as it is now for the acceptance of the truth, or if I could then have reached the ear of the public more plainly, much evil might have been nipped in the bud. As it was, the warning had little effect, except to expose me to adverse criticism as an alarmist, and the evil has gone on with increasing rapidity and mischief. There is at the present time a considerable community addicted to the habitual use of chloral hydrate on one pretense or another, and a learned medical society has recently framed a series of written questions on the subject, which questions it has felt it expedient to address to members of the profession of medicine generally for their replies.
The persons who become habituated to chloral hydrate are of two or three classes as a rule. Some have originally taken the narcotic to relieve pain, using it in the earliest application of it for a true medicinal and legitimate object, probably under medical direction. Finding that it gave relief and repose, they have continued the use of it, and at last have got so abnormally under its influence that they can not get to sleep if they fail to resort to it. A second class of persons who take to chloral are alcoholic inebriates who have arrived at that stage of alcoholism when sleep is always disturbed, and often nearly impossible. These persons at first wake many times in the night with coldness of the lower limbs, cold sweatings, startings, 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. It is a kind of rest, and is no doubt better than no rest at all; but it leads to the unhealthy states that we are now conversant with, and it rather promotes than destroys the craving for alcohol. 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 the 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. They are over-susceptible of what is said of them, and of their work, however good the work may be. They are too elated when praised, and too depressed when not praised, or dispraised. They fail to play character-parts on the stage of this world, and as they lie down to rest they take all their cares and anxieties into bed with them, in the liveliest state of perturbation. Unable in this condition to sleep, and not knowing a more natural remedy, they resort to the use of such an instrument as chloral hydrate. They begin with a moderate dose; increase the dose as occasion seems to demand, and at last, in what they consider a safe and moderate system of employing it, they depend on the narcotic for their falsified repose.
Among these classes of men the use of chloral hydrate is on the increase. The use is essentially a bad business at the best, and while I do not wish in the least to exaggerate the danger springing from it—while, indeed, I am willing to state that I have never been able to trace out a series of fatal organic changes of a structural character from such use—I have certainly seen a great deal of temporary disturbance and enfeeblement from it, without any corresponding advantage that might be set forth as an exchange of some good for, some harm. The conclusion I have been forced to arrive at is in brief to this effect: that if chloral hydrate can not be kept for use within its legitimate sphere as a medicine, to be prescribed by the physician according to his judgment, and by him as rarely as is possible, it were better for mankind not to have it at any price.
I expressed an opinion in 1876 that the use of opium, as a toxical agent to which persons habituate themselves, is dying out in this country. I see no reason to modify that view now. I am quite sure that among the better classes the practice of taking opium is less common than it was formerly, and I believe that chloral hydrate has more than usurped its place. The idea, gathered from one or two local practices, which, like a fashion, come and go, that opium-eating is on the increase among the poorer members of society, is, I believe, equally fallacious. I can discover no warranty for any such a general and sweeping assumption. As to the assertion that those who are by their pledge removed from the use of alcoholic drinks, who are professed abstainers, are more addicted to opium-eating than alcoholic drinkers, the idea is too absurd, and can only have been suggested for the sake of the mischief that might follow a promulgation of the notion that, because one devil is cast out of a man, another must enter that is worse than the first. The facts really tell all the other way. The facts in the main are that those men and women who from principle abstain from one form of intoxicant most resolutely abjure all forms; and that those who indulge in one form are more apt than the rest to indulge in more than one. In the course of my career I have met with some persons of English society who have indulged in the use of opium; but I have never met one such who did not also take wine or some other kind of alcoholic drink. Putting the matter in another way, I can solemnly say that in the whole of my intercourse with the abstaining community—and few men indeed have been thrown more into contact with that community—I have never met with an instance that afforded so much as a suspicion of the practice of indulging in narcotism from opium, or any other similar drug. I have never yet met with an abstainer who was even habituated to the use of chloral hydrate. A few abstainers smoke tobacco, but, as the habit seriously taxes their physical health, most of them in due time forego even the luxury of the weed so soon as they discover its injuriousness.
The actual opium-eaters of modern society, who form a natural part of the nation as English people, are extremely limited in number, so limited that the mortality returns give no clew to them as a class suffering from the indulgence. I know not either of any physician or pathologist who has made a study of the organic changes induced in the bodies of natives of these islands who have died from the effects of opium. Still there are a few who indulge; and I fear that among the children of the poor, the infant children, the use of narcotics containing opium is an abused, much-abused system. The adults who indulge are, according to my experience, of three classes: There are some who in the course of disease attended with long-continued acute pain, like neuralgia pain, have found relief from opium, and who having so become habituated to its use keep up the habit sometimes because they feel that they can not sleep without the drug, and sometimes because they have learned to experience a real luxury from its use. There is a limited section that has learned the practice of swallowing or of smoking opium from some Eastern association, and is professed in the practice in a certain moderate degree. Lastly, there are a few doubtless among the poorest of the community, who in some particular localities learn to partake of the narcotic, often not being aware of its true nature, and obtaining it under some fanciful name which has no direct reference to the narcotic itself.
To the few who in these classes may be called opium-eaters might be added a small number of alcoholic inebriates who partake of an opiate occasionally with their spirituous potations.
To whichever class they who habitually resort to opium may belong, they pay dearly for their temporary pleasure. They are a miserable set in mind as in body. They are preserved, as it were, in misery; they do not suffer acute diseases from their enemy, as the alcoholics do, by which their lives are abruptly cut short, but they continue depressed in mind, feeble and emaciated in body, and incapable of any long-continued effort. De Quincey, in language somewhat figurative and poetical, has described the class with a force, and on the whole a correctness, which may be accepted as a faithful record.
I can not report even so favorably on the use of absinthe as I have reported above on the use of opium. There can not, I fear, be a doubt that in large and closely packed towns and cities the consumption of absinthe is on the increase. In London it is decidedly on the increase. It is not possible to find a street in some parts of the metropolis in which the word "absinthe" does not meet the eye in the windows of houses devoted to the sale of other intoxicating and lethal drinks. Much of this advertisement of an unusually dangerous poison is made from ignorance of its nature as much as from cupidity. The suggestion for offering absinthe is that it is an agreeable bitter, that it gives an appetite, and that it gives tone to weak digestions. It is proffered much in the same manner as gin and bitters, and as in some private houses sherry and bitters are proffered. If you ask a seller of absinthe what he vends it for, he tells you, "As a tonic to help digestion."
There is no more terrible mistake than this statement. Absinthe as it is made in France, whence it is imported, is a mixture of essence of wormwood (absinthium), sweet-flag, anise-seed, angelica-root, and alcohol. It is colored green with the leaves or the juice of smallage, spinach, or nettles. It is commonly adulterated. M. Derheims found it adulterated with sulphate of copper, blue vitriol, which substance is added in order to give the required greenish color or tint, as well as to afford a slight causticity, which to depraved tastes is considered the right thing to taste and swallow. M. Stanislas Martin stated that he found chloride of antimony, commonly called butter of antimony, as another adulteration used also to give the color. Chevalier doubts this latter adulteration, but the adulteration with the sulphate of copper is not disputed. The proportion of essence of wormwood to the alcohol is five drachms of the essence to one hundred quarts of alcohol. The action of absinthe on those who become habituated to its use is most deleterious. The bitterness increases the craving or desire, and the confirmed habitué is soon unable to take food until he is duly primed for it by the deadly provocative. On the nervous system the influence of the absinthium essence is different from the action of the alcohol. The absinthium acts rather after the manner of nicotine; but it is slower in taking effect than the alcohol which accompanies it into the organism. There is therefore felt by the drinker first the exciting relaxing influence of the alcohol, and afterward the constringing suppressing influence of the secondary and more slowly acting poison. The sufferer, for he must be so called, is left cold, tremulous, unsteady of movement, and nauseated. If his dose be large, these phenomena are exaggerated, and the voluntary muscles, bereft of the control of the will, are thrown into epileptiform convulsions, attended with unconsciousness and with an oblivion to all surrounding objects which I have known to last for six or seven hours. In the worst examples of poisoning from absinthe the person becomes a confirmed epileptic.
In addition to these general indications of evil there are certain local indications not less severe, not less dangerous. The effect which the absinthe exerts in a direct way on the stomach would alone be sufficiently pernicious. It controls for mischief the natural power of the stomach to secrete healthy digestive fluid. It interferes with the solvent power of that fluid itself, so that taken in what, is considered to be a moderate quantity, one or two wineglassfuls in the course of the day, it soon establishes in the victim subjected to it a permanent dyspepsia. The appetite is so perverted that all desire for food is quenched until the desire is feebly whipped up by another draught of the destroyer. In a word, a more consummate devil of destruction could not be concocted by the finest skill of science devoted to the worst of purposes than is concocted in this destructive agent, absinthe. It is doubly lethal, and ought to be put down peremptorily in all places where it is sold. Our magistrates have full power to deal with this poison, if they had the discretion and the courage to use their power. They could prohibit the license to all who sell the poison. Beyond this, there is another power that ought to come into play. Absinthe should be under the control of the Sale of Poisons Act, and no person ought to be able to get it in any form at all without signing a book and going through all the necessary formality for the purchase of a poison. To move the country to a due regard for its own interests as well as for the interests of the ignorant and deluded toxico-maniacs who indulge in absinthe, is the duty of all honest and truthful men.
It is my business in the remaining part of this communication to deal with a question which springs out of the practice of using lethal agents, and with which the minds of the thinking community are sorely exercised. The question I refer to is—Whether the use of these agents springs from a natural desire on the part of man, and of animals lower than man, for such agents; or whether it springs from a perversion or unnatural provocation acquired and transmitted in hereditary line, a toxico-mania, in plain and decisive language.
In respect to the idea that these agents are demanded by living animals as necessities of their transitory existence and residence on this earth, it must be obvious that the argument, as so stated, is based on the desire which has been impressed on the mind of the reasoners by the agents themselves. It is quite certain that men, and all the lower animals, can live without the supposed aid afforded by these substances, and that when they are not known life goes on smoothly and happily enough in their absence. They therefore are only pleaded for when they have made themselves felt, which looks strangely like an artificial pleading for an artificial as apart from a natural thing. Children do not plead for them; men who have been educated without them do not plead for them; animals do not beg for them; none ask for them until by education they have learned to use them. At first all rebel at them, and only after a fiery trial, during which they get over repugnance, acquire a liking to them, after which the liking may run into desire, and desire into infatuation.
Again, if these agents were natural for the wants of man and animal, they would not reasonably be expected to be left so far away, as they are left, from the immediate reach and possession of man and animal. To secure them for man and animal they have to be produced; to produce them, requires human ingenuity and skill, knowledge, science, and in some cases, as in the case of alcohol and alcoholic beverages, a very considerable degree of skill and an enormous amount of skilled labor. It is true that two of these substances, absinthium and opium, lie nearer at hand than the others, might be gathered and utilized by men in their savage state, and might be plucked and eaten even by beasts of the field. But the fact really seems to be that these very simples have not come into the possession of man for the service of the human family until by art the educated of the human race have learned the mode of use; while the lower animals, instead of instinctively finding them out and claiming the advantages which come from them, have instinctively avoided them with an instigation of common sense that might happily have been imitated by their superiors in wisdom and intelligence.
Moreover, it has generally turned out that all which is required by man as a necessity for his existence has been in the most signal manner provided for him. He is a water-engine, so water is ready at his command; he is a muscular-engine, so muscle-forming substance is at his instant command; he is a passive skeleton, so the materials for the skeleton are at his ready command; he is a receptive organism through his nervous organization, so everything that is wanted for that system is ready prepared. He requires light to bring him into visible communion with the external world, and ere he existed the sun was ready to give him light and to quicken him with heat and motion. He requires sound, and there is the prepared atmosphere ready to vibrate in obedience to his voice. These were all pre-prepared for the man and his life. Is it possible that something more was wanting that he, in course of ages, had to discover? Suppose, like the lower animals, he had failed to discover, what then had been his fate?
To my mind—and I wish to be as open to conviction on this point as any one can be—I fail to discern a single opening for the use of these lethal agents in the service of mankind save in the most exceptional conditions of disease, and then only under skilled and thoughtful supervision, from hands that know the danger of infusing a false movement and life into so exquisite an organism as a living, breathing, pulsating, impressionable human form.
In the argument that these lethal agents are necessities, instinctively selected and chosen to meet human wants, there is no logical sequence. It is all confusion, assumption, apology for human weakness, exaltation of human weakness, sanction of temporary and doubtful pleasure, compromise with evil, and acceptance of penalties the direst, for advantages the poorest and least satisfactory. But when we turn to the other argument—when we reason that these lethal agents induce a physical and mental aberration which they afterward maintain—when we but whisper the word toxico-mania, as the exposition of their influence, all is clear enough. We leave the purely natural world of life to enter the aberrant world, and all there is as it would be to eyes from which the scales of superstition have fallen. These agents play no part in natural function or construction, but add a part which is obviously an aberration. If into a steady-going locomotive-engine the engineer infused some gallons of brandy, he would do something that would be conspicuous enough, but he would not thereby play a natural part in the working of that engine. He would only add a part which would be an aberration. There might be more rapid pulsation and motion for a brief period truly, but the pressure would be unequal, the working-gear unsteady, and by much repetition of the same act there might be accident, apoplexy, stroke, even in an engine, and there certainly would be a wearing-out which would lead to a limited future. So with the body under these lethal spells; we may add a part, or we may take a part away, but we can not by them maintain the uniform and natural law of life.
These agents create a desire, a craving for themselves, a new automatic expression, a new sense of necessity which did not preëxist, and which never exists until it is acquired. This seems to me the most perfect evidence of aberration. Whoever craves for anything is aberrant, and much craving for one thing is the most certain sign of a mad mind. We all admit this truth when the craving becomes insatiable; but between the smallest persistent craving and the most lamentable insatiate there is nothing more than degree; the fact is the same, and the movement along the line from the moderate toward the insatiate is commonly too easy and continuous. Craving for purely natural things in the midst of them is an unknown phenomenon in healthy men. Craving for unnatural things in the midst of them is well known; but is that healthy? The sane man who wants water asks for it; the sane animal that wants water seeks for it; the aberrant man clutches wine; the aberrant animal, rendered aberrant by the acquired craving, grows furious. No man drinks wine as he drinks water; there is a furor in the drinking of wine which marks a phenomenal disturbance, and which is distinct from the simple act of drinking from necessity, in the act as well as in the object.
The establishment of the craving or desire for these lethal agents in one living body is the frequent origin of the same desire in bodies that are to be. The craving is thus sometimes begotten of a craving, like other hereditary taints which lead to physical and mental errors and diseases, a specific indication of aberration from the natural health into disease, depending on hereditary constitutional tendency, and singularly indicative of original departure from the natural life. A still more striking illustration of the position I am now supporting is afforded in another action of these agents. The tendency of their action is, as a rule, toward premature physical death: the tendency is also toward premature mental death. A sudden excess of indulgence by any one of them, save perhaps arsenic, is all but certain to lead to some form of acute mental derangement or stupor, more or less decisive and prolonged. A gradual excessive indulgence is almost as certain to lead to a confirmed condition of aberration more or less determinate. If we watch carefully the career of a man who is passing through the course of an alcoholic intoxication, and if, after analyzing each phase of that progress, we pass into a lunatic asylum and look at the various phases of insanity exhibited in the persons of the different inmates who are there confined, there is no difficulty in finding represented, through certain of those unfortunates, all the shades of mental aberration which have previously been exhibited by the single person in the course of his rapid career from sanity into insanity and into helpless paralysis. The wonder suggested, by such analysis of natural phenomena, is not that forty per cent, of the insanity of the country should be directly or indirectly produced by one lethal agent alone, but that so low a figure should indicate all the truth.
When, then, we fairly consider the two questions now before us—whether the lethal agents are called for because they are demanded by a law of natural necessity, a law which stands above man, and is dominant over his nature because independent of him; or whether there is no such law whatever, but an error of man himself, by which he institutes for himself a taste for lethal derangement, and, making for himself and his heirs a new constitution, begins thereupon to justify what he has done on the basis of the constitution he has established—when, I repeat, we consider these two questions, we can, I think, come but to one conclusion. We must, if prejudice be not too strong, lean to the view that man makes the constitution he defends, and that it is the lethal agent, speaking as it were through him, on which a defense of all these agents, common or uncommon, rests for its support.
There is one final argument which many set lip who are not content with either of the two views above described. This argument is that, in the natural state of man and beast, the things which "wreathe themselves with ease in Lethe's walk" are not in any sense necessary things. On the contrary, the things are decidedly injurious, and should not be used. At the same time, it is also admitted that the indulgence in lethal agents is, in truth, a mania which begets a mania, and which inflicts all kinds of follies, crimes, and miseries on the race. But, continues the argument, the mania being admitted as such, is rendered justifiable by the circumstance that they who make it and propagate it do not start from the natural condition. They find in the world so much care, so much sorrow, so much misery, and their own path is bestrewed with so many anxieties and difficulties, that they are, in fact, diseased. All society is diseased. Therefore, to meet this vast amount and volume of disease, remedies of a palliative kind are required. Exceptional conditions call for exceptional measures. A man who can not sleep, owing to the cares and anxieties of his life, must take chloral hydrate or opium to obtain sleep. A man who can not finish a certain amount of work against time, by his own natural powers, must whip himself up to the work by means of wine; must force his heart and brain on against time at all risks and sacrifices. A man who has forced himself on against time, and has thereby obtained a momentum which he can not arrest by ordinary means, must calm himself down by tobacco, must literally put the reins on his heart, and pull the heart up sharply and decisively. These remedies, at all risks of learning to crave for them, at all risk of falling the victim to toxico-mania, must be accepted, that the work of the world may go on at full pace.
The argument is specious. If it be a sound argument, it must be the fact that they who, for the sake of the world, are throwing their lives behind them as fast as they can, are doing more work and better work than they who, keeping their lives in their hands, are content to labor without resort to any perilous adventitious assistance. Is it so? Is the man who never touches a lethal weapon—alcohol, opium, tobacco, chloral, hasheesh, absinthe, or arsenic—a worse man, a weaker man, a less industrious man, a less-to-be-trusted man, than he who indulges in those choice weapons ever so moderately, or ever so freely? If he is, then my position is confessedly undermined, and toxico-mania is a blessing, with all its curses.—Contemporary Review.