The Philadelphia Times from Philadelphia, Pennsylvania • Page 11

THE PHILADELPHIA TLMES. DECEMBER 3. 1899. 19 SUXDAY MOTtNING. RTLING CHARGE AGAINST AMERICAN PHYSICIAN THE WAY THE SECRET USER OF MORPHINE AND COCAINE INJECTS THE DRUG BY MEANS OF A HYPODERMIC SYRINGE IHere arc Enswers to it XEbis is the Inbtctment cannot stop without calling attention to the I fact that morphinism is increasing among physicians.

I The reports from private asylums and public hospitals I shoiv that within five years medical men form a con-l siderable part of their inmates. Specialists of nervous I diseases sustain the same fact." Dr. T. D. Crothers.

"Morphine is used among physicians, as Dr. Crothers says, but probably by not more than one per cent It is probably due to two causes the extreme stress under which physicians often labor and the familiarity with drugs which suggest a remedy for the overwrought condition. I doubt if the use of the drug among physicians is greater than in other professions and think there is more excuse for a physician than there is for any other habitue" Dr. Charles M. Seltzer.

Dr. T. D. Crothers Is a physician of repute In Connecticut. He is identified with (in asylum for the cure of habitual users of the morphine, cocaine and similar drugs near Hartford.

He is in position to have an intimate knowledge of the subject on which he writes. That a dignified and learned journal of the well-known standing of the Medical Record which is rend by medical men all over the country, thinks his views sufficiently weighty to he presented to hi fellow practitioners within its columns Is self-evident proof that they are at least worthy the attention of medical men throughout the United States. And in an Important question- of this kind that certainly calls for governmental action they should be of interest to every citizen of the United States. MORPHINISM AMONG PHYSICIANS. T.

D. CItOTHERS. I WAS APPOINTED chairman of a committee to collect ana siueiy sia- I tistics of the prevalence of alcohol and fact that nil other physicians are on the same scale or a lower one than his. "I do not credit any part of the article. If the statistics are correct they must certainly have been made from the very lowest class of men who call themselves puyst-clans.

Dr. McCoy, 1338 Walnut Street- "Medical men are as a rule the most competent and the most trustworthy of any profession. Their morals are generally of a high standard, nnd it Is their business to know what Is harmful and what la not. Necessarily they are more careful than most persons to avoid anything pernicious to themselves, and consequently I believe that their bad habits nre fewer than almost any class of men. "I do not credit the article, nor do I believe that the percentage of medical men with such habits Is Increasing.

Opium, nior. phiue and all other similar drugs wholly unfit a man for all delicate work. He must give up the one or the other or he will eventually sink to the depth of the ordinary drug fiend and lose not only his practice but his friecds." Dr. T. Hetoson Bradford, 123 South Eighteenth Street.

"Physicians nre uo more addicted to druj? habits than other men are. In fact, the percentage would seem to be smaller, because a man may succeed in business, but never In medicine, when he slave to any habit which brooks his nerves or im-steadies his baud." Dr. L. Webster Fox, 1304 Walnut Street "The article dees an Injustice to all reputable physicians nnd causes their patients to look upon them with suspicion. Of course, every profession has its unfortunate men, as does every trade, hut physicians are not as a class any more unfortunate in being addicted to habits than other men nre.

The statistics which the author of the article uwc to show how prevalent habits are among physicians and how rapidly they are Increasing are made up from examinations In a small part of one State. Surely the medical men of ihe world cannot be condemned because a few of that profession lu one State of one country ore condemned by a man who has charge of several patients lu a 'habit Dr J. S. Cohen, 1431 Walnut Street. I have been informed correctly the man who wrote the article In the Medical Keeord is an attending physician at a habit No man has any business in such a place unless his will is thoroughly tried and wonderfully strong.

Hundred of attendants at Insane asylums lose their minds every year. The same thing is true in 'habit In associating constantly with persons addicted to hiibils, no matter of what kind they are, a person will unconsciously feel the "amp desires and the chances are that he will try to satisfy them. In the course of time the habit will (trow and he will become as untruthful, untrustworthy and as pessimistic as the others. As I said before, if he is a physician he will endeavor to impress the public with the If OTF SOME FACTS AS TO PHILADELPHIA In so-called drug stores in New York's Tenderloin the chief business, the year around, is the sale of morphine and other drugs to the more than 10,000 unfortunate women, slaves of the habit 00000000000000000000000000000000000000 000000000000000000000000000000000000000 Inquiry among the leading drug on hps in this city develops the fact that the quantity of cocaine sold in the past year in Philadelphia was In excess of six thousand ounces nnd that less than two hundred ounces was used in the ordinary channels of medical practice. In other words, the medical use of the drug was less than four per cent, of the whole amount sold.

Cocaine Is largely used externally In surgery and to pome extent used Internally In medicine. The ordinary dose given by hypodermic injection Is from one-tenth to pne-twentleth of a grain. In an ounce there are 437la grains, so that nn ounce ropreseutsfron.4,375 to 8,750 doses. Hlx thousand ounces would mean anywhere from twenty-four to forty-eight million hypodermic doses. OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO 00000000000000000000000000000000000300 0 to break up the drink storm or lessen Its effects.

They begin at Intervals to use morphine and continue It steadily. Another class suffer from some neuralgic affection or spasmodic pain, for which morphine gives Instant relief, and use It afterward as a specific remedy. A class quite as numerous find In morphine a supposed stimulant when exhausted, hut In reality a narcotic which covers up the protests of nature. They continue Its use until it is difficult to stop. Insomnia, strains and drains and all the complex symptoms of exhaustion and poisoning find most fascinating relief in using morphine by the needle.

Morphinism Is clearly built up from a foundation of neurasthenia, anaemia, hyper-aemla and from hereditary nerve defects; also from drug taking and Intoxicants, nutrient derangements and the complex Injuries to the uerve centres. To this are lidded the various disturbances which come from Irregularities of life and living and from the nerve shocks of failures, successes and emotions; strains. Following these states are both physical and psychical pains, brain and nerve perturbations, muscular and organic weariness, with depressions. For these the needle Is a panacea. There Is a painful fascination In the rapid, complete change and transition which follow the needle.

To the psychopath, Inherited or acquired, this is a revelation, lind no other form of administering morphine can be compared with it. This actually develops a needle mania, and nearly all morphinists are hypodermatic maniacs. The withdrawal of the morphine is unnoticed as long as the needle Is used. In a certain case a physi-ilan nsed the needle with water, supposing It to be morphine, for two years after the withdrawal of the drug, under the direction of his partner. It Is the common experience to keep up the use of the needle for Its mental effect long after the morphine ts abandoned.

Even then It Is difficult to break up the mania for this form of drug using. It has been stated, with some basis of fact, that the constant administration of drugs by the needle, and particularly morphine. Is a prominent symptom of a niorphlnomaulae physician. The observation is often made that' some of the most enthusiastic defenders of the use of morphine by the needle were confirmed users of the drug. Two therapeutists and authors who praised this form of medication died from the excessive use of the drug.

Thus the needle deluslonlst Is often his own" doctor and patient. This Is true of other drugs. In which the physician's personal experience Is reflected in his enthusiastic use of the same drug upon his patients. The medical morphinist may succeed in concealing his use of morphine for a variable time, but Its effects on his thoughts and conduct cannot be long covered. He will early begin to show carelessness In eon-duet, neglect of duty, loss of personal respect, and emotional changes.

Along with this appear a childish egotism and a disposition to criticize and to expose the weakness of others. A recent Incident of this nature was the sudden slanderous disposition manifested by a quiet physician, who was previously reticent as to the faults of others. For two years he created a good deal of bad feeling by his foolish criticisms and falsehoods. He was arrested for slnu-der. and his morphinism was discovered.

The egotism grows, and becomes a verltnble delusion that bis condition Is concealed and unknown to others. In some cases Intense aversion exists to acknowledging the fact of using morphine, and keen pleasure In concealing and denying its use. This low regnrd for the truth Is an rthlcai defect common to nearly all cases of morphinism. It usually Is childish and apparent, but often extremely subtle and cunning. In most cases It applies to all the relations of life: In others It Is partial, and confined to the morphine addiction.

It shows the damage to the sensory and reasoning centres as well as the effect on the higher pliychlcal brain. The defect also grows, and the danger of his condition Is minimized, while his ability to stop nnd to treat himself Increases In his own opinion. Credulity alternated with distrust follow enoh other, and at one time a good physician will accept and use secret drugs, and do many unreasoning things. Later, he will doubt every thing, and be suspicious of every condition of his surroundings and his relations to them. This erratic conduct will be seen In his Indorsement of new and strange theories.

His former politics and religious vlewa will change, und he will show distrust, and deceive his nearest friends. He will make strange acquaintances, write eccentric papers for the Joumnla, or read them to the local society. A study of papers In medical Journals will show the writing of concealed morpblnomantncs and cocaine takers. The one will be startling. Inconsistent and assertive; the other will be a continuous, monotonous flow of words, pointing In every direction, and never ending.

A voluminous medical writer under my care for morphinism has never written a line since his recovery, before he wrote from one to two A. opium inebriety. During this interval of nine years a large number of statistical observations and data have been gathered. From these facts I present a preliminary report confined exclusively to the study of morphinism among physicians. I shall give conclusions rather than tables and general facts rather than exhaustive studies.

These data enme almost exclusively from physicians 'who were requested to ascertain Sjie. number of medical men of their acquaintance and vicinity who used alcohol and opium, also to give a percentage of the whole number. ah tuts way a history of 3.244 physicians residing in the Eastern, Middle and some of tlie cities of the Western States was obtained, of whom twenty-one per cent, were found using spirits or opium to excess. Six per cent, of this number used morphine or opium persistently. Ten per cent, were using opium or other drugs secretly outside of this number.

Over twenty per including this number, used spirits In so-called moderation. In another study of one hundred and seventy physicians seven per cent, used opium or morphine and six per cent, were secret drug takers. From the personal observation of a number of city physicians who have a large acquaintance wirh medical men, from eight to ten per cent, were found to be either secret or open drug and morphine habitues. These figures appear to be approximately correct and show that from six to ten per cent, in this country are opium Inebriates. This is considered a conservative statement, considering the foot that drug takers, and physicians in particular, are secretive nii'l conceal their use of drugs, especially when it Implies weakness and reflects on their social standing.

There are many reasons for the support of the statement of Dr. Klaln that large percentage of physicians suffer and die from drug treatment of themselves. They begin to ne spirits, opium and other drugs for functional and transient disturbances, and later contract serious organic disease, the early drug taking having been a eontribut-lug A physician who In middle life is excessively neurotic and neurasthenic, or who Is rheumatic, lias organic heart disease or neuritis, or chronic gastritis, is often suffering from the results of excessive spirit or drug taking In early life. The early user of morphine, chloral, cocnine and other drugs of this class, who after a time stops all use of them, suffers later from varied and complex neuroses. In the same way the spirit drinker finds In later life serious organic diseases springing up without any apparent cause.

In reality thev are traceable to the poisonous effects of drug taking early In life, although a period of abstinence n.ny have Intervened. Such cases are not uncommon nnd-occur in persons by whom this drug taking Is concealed to a large extent. There Is no donht a great deal of Invalidism, diseases and failures among medical men that are due directly or Indirectly to secret drug Inking. Morphinism among physicians Is usually associated with the use of Ihe drug by the needle. Opium In the tincture and gum Is nlso used, but loss prominently.

The effects are the same, only varying in Intensity and rapidity. The opium users are often alcoholic Inebriates switched on to a parallel road. After a period of so-called moderate or excessive use of beer, wine or strong spirits, either secretly or openly, they turn to the tincture or powdered opium. Froiri this time their career is one of progressive organic degeneration. The tendency is toward Imbecility, and although they may be active for years, a low form of Invalidism follows and acute, fatal lniHnniinntlons are always Impending.

The physic-Inn who uses opium is nlways somnolent, serene and meditative In manner. Except an increasingly defective memory and degenerating ethical sense and Irregularities of conduct, with a certain llvld-lty of face, there Is little to Indicate his condition. On the other hand, the morphlnnmnnlac shows great extremes of emotion. At times he will be talkative and sensitive to his surroundings: then silent. Indifferent.

Irritable or violent In his Impulses and talk. He will at times be very brilliant, make a clear diagnosis, perforin a dlflb tilt operation and even deliver a lecture with spirit and energy. The same Impaired memory and ethical sense appear, although more concealed. Morphlnoinanla tends toward acute mania a.d suicide, with the same Impending acute Inflammations. A certain number of morphinists have been wine, beer and spirit drinkers and while suffering from the effects of excesses have found quick relief from morphine.

Later they have In part or altogether given up spirits and used morphine. J'crlodlcal drinkers not Infrequently find the (auie relief from morphine and uae It the manufacture of drugs or for other purposes of a similar nature, but it certainly did not go through the usual channels In which It is consumed in the course of physiologic treatment. When you consider the fact that the ordinary dose of cocaine by byperdoruilc Injection, which is the usual method of application, is from a twentieth to a tenth of a grain, and tliut there are some i'i'Vi trains in nn ounce, the meaning of this tremendous excessive use is appreciated. Kach ounce represents anywhere from 4.000 to 8,000 Injections, provided, of course, that It is all used through the hyperdcrmic syringe. Then multiplying this number by the excessive sale of the drucr, wo have over forty-five million hyper-dermic doses used in other than tho legitimate, ways each year.

This 13 certainly an appalling i'uet. In the manufacture of preparations In. tended to be sold to the public promiscuously the use of cocaine cannot be said to be legitimate. The public is supiMised lo use these preparations Indiscriminately and to become hnbitunl users of them through some effect that they have or some seductive taste or lnilucnce. They do not appreciate the fact that this effect Is produced by the use of a narcotic more powerful than morphine, and tbnt lu a smnll way because the dose Is small they are becoming cocaine habitues.

Were all such means of explaining the abnormal use of cocaine investigated it would certainly be found that there are a great number who nre addicted to its misuse knowingly and with the full Intent of satisfying nn nppetlte that is illegitimate and deadly lu Its destructive influences. It would not bo too much to say, according to some students who have Investigated these conditions as thoroughly as Is possible without giving mental aid, that at least one-hulf of the cocaine used is used to satisfy a viscious nppetlte. As for morphine, the figures are not very much less surprising, while chloral and strychnine to a small extent enslave men to a remarkable degree. Whether the physicians are consumers o( these drugs or responsible for their distribution need not be discussed here. It is certainly time that the government took a hand in the matter and passed some restrictions upon its sale that will more effectively confine It to legitimate channels than the present laws do.

In New York the enslaving habit has reached its greatest proportions. Kx-Ku-perlntendent Ityrues estimates that there are fully lo.tsH women alone who nre "dope fiends," by which title all users of drugs are known. There are no less than four drug stores In the old Tenderloin district whose principal Income the year round Is derived from the Immense profits In the sale of morphine and cocaine lu Its various forms. In at least one of these stores it is riouhtful If an ordinary prescription could bp filled. It is a "dope" shop, pure and simple.

In the same district of the city are a few physicians who make an Income writing the prescriptions by means of which the cravings of the morphine victims nre satisfied. The technicalities of the law ae Just barely observed. One prescription In the drug stores mentioned will satisfy the proprietors for every call, week after week, from the customer to whom It la given, AN INVESTIGATION of the eslstnnt conditions in Philadelphia with regard to the sale aud use of cocaine, morphine, chloral, strychnine nnd similar drugs develops the fact that, while Iir f'rothcr's indictment against physicians innv be untrue, it Is nevertheless fact that large quantities of the drugs nre used In excess of the actual legitimate requirements of the medical profession. At least, the amount of the drugs sold Is far in excess of the requirement of Its physiological use The sales are made through so ninny sources that It Is Impossible without an exhaustive Investigation to say exactly by whom It Is used, but a careful examination of the records of the various hospitals in this city develops the fact that where It would naturally be used In vast quantities a comparatively Insignificant amount is yearly consumed. The figures upon the use of morphine are not readily obtainable for the reason that it is very largely bought and sold for speculative purposes, and while large quantities may be at one time sold this same delivery may be sold and K-sold many times before It Is actually used professionally.

The result Is that the sale ai! legitimate con-sumption show a wide dl.arlty that does not In reality exist. In the use of cocaine, however, this Is not true. There Is not any extensive speculation In the drug, and the amount that Is sold every year by the big wholesale bouses In this eitv represents very nearly the actual use of "the commodity. At the same time nn investigation of the legitimate uses of the drug In the usual course of medical practice is astouudingly small, altogether out of proportion aud certainly Indicating a large illegitimate use. What form this use takes no one Is willing to definitely say.

It may be in preparations of patent medicines to a degree. It may be in the indulgence of a vice bv physicians or by other habitues. It may be through a hundred nnd one sources that only an exhaustive investigation, backed by government authority, can possibly determine. The sale of chloral nnd strychnine I not disproportionate ith the strict necessities of the medical profession to nny great degree. I'miuestlonably they are both misused to some extent.bnt not sulliclently to cause any great alarm for more than a very sinnll percentage of those who use them.

The sale of cocnine is astounding, too, bo-ennse of the remarkable Increase of the lust decade. Ten years ago It was comparatively unknown. It then began to spring Into some prominence as a medical remedy nnd Its use grew to surprising figures. But In the last live years, although the actunl use of the drug by physicians In prescriptions and by surgeons, both medical nnd denial, has not increased to any great extent, the sales have been almost trebled. Inquiry anions lnrite ilnn houses In thin city developed the.

fact that the qminttty of cocaine sold In the punt year In Philadelphia, was In excess of six thousand ounces. The use of the drtiK by prescription and for surgical purposes wss less than two hundred ounces. In other words the pel eentnuo of the letel mate use of coaclue In Philadelphia was less than four per cent of the whole amount sold. The rest of the drug used In Philadelphia was not necessarily used by cocaine habitues. It may have been largely used la his own care.

He may succeed In withdrawing the drug, but relapse will be certain, and the failure will leave him worse than before. He should go under the care of some one In whom lie has confidence, where special 'itirrouiulIngH and special means can be used, and where the work of recovery can be made exclusive. Then he should give up all of self-treatment and trust to others without question or doubt. The morphine can be removed In a few days, nnd then the real treatment logins; and this can be carried on In lines familiar to the patient and with his full co-operation. The morphinist will discover the damage done to his system only when the drug is removed and a good adviser may do much to permanently repair It and be a healthy man in the future.

I cannot stop without calling attention to the fact that morphinism is increasing among physicians. The reports from private asylums and public hospitals show that within five years medical men form a considerable part of their Inmates. Specialists of nervoua diseases sustain the same fact. The yonng and the mitldie-aged men nre the most common victims. Often they are from that class of delusional therapeutists who want to prove everything by personal experience, or who have exalted concept! ns of the power of drugs, and believe that researches In that direction will open the road to a physical miltenlum.

I'erhaps morphinism among physicians Is rather a sign of the stress and nervous strain in the world Incident to civilization, or common to the over-crowding and overwork demanded of the successful man. At all events it is one of the most fascinating and serious modern diseases which can come to the professional man. Teachers of therapeutics by their graphic descrip-Hons have nroused a morbid curiosity which has been fatal to the student in after life. 1 have collected a number of instances of this kind, showing that the danger of making morphinists in this way Is not only possible, but Is a reality to an unknown extent. I conclude with a caution which cannot be stated In words too strongly.

Never use morphine by the needle on yourself and never use It except by the- counsel of a truMcd medical adviser. Never give morphine as a nnrcotic fr psydopathle physician until you are satisfied that It is the best remedy that can be used. If yon are using soon become disappointed or dissatisfied, and secrete morphine for possible emergencies of the future, or go away condemning the asylum and its management for their failures. In this way the deceptive egotism ana secret I veness, with delusional reasoning, make the medical morphinist a most dllllcult patient to treat. The removal of the morphine and the restoration of the functional derangements are practically simple with the full control of the patient and his surroundings.

The treatment nnd after care require far more skill and tax on our therapeutic resources. The abandonment of the needle at the start, nii'l the change to some other form of opium or other narcotic to Icbscii thencuteness of the withdrawal symptoms, then the slow or rapid withdrawal of the drug, are the most practical menus. The hot air bath with massage dally, and more frequently if necessary, is the most valuable. Strychnine, acids and some of the bitier tonics are useful. The brmnldcs-of sodium, cannabis Indies, hyoscyamlne, and the milder sedatives, such as valerian and lupulln, may nil be used to relieve the acutcness of the withdrawal symptoms.

The mental effect of remedies and efforts are often more effective than In any other disturbance, and constitutes very Important means of treatment. The power of suggestion, and faith in certain drugs, will overcome the most distressing symptoms. An unknown drug has often broken up the Insomnia nnd the reflex disturbances. One of the specific opium drugs, which has brought great wealth to the proprietor, contains only lupulln and acid, but is given with great minuteness of direction and sustained by a large book of most extravagant certificates of former cures. A bolserous, emphatic clergyman Impressed a morphinist doctor that he would be lost if he did not give up morphine at once.

He went to bed nnd from the dominance of this Idea overcame all the common symptoms and made a good recovery. A physician under my care on the eve of marriage gave up at one the use of ten grains of morphine daily and had none of the corn-man after-symptoms from some mind effects. The hypersensitlvencss, both mental and physical, requires mental means in the treatment as well as exact -surroundings and exaet care. The medical morphinist Is dangerous to himself and to others and should place himself under treatment at once. It Is folly papers a week, and rend them hefore all the societies in his neighborhood.

Often morphine and opium are the subjects of their writings, and while they may read voluminously on this subject they write strangely and erratically. The proportions are distorted. Insignificant parts of the subject are exaggerated and central truths mini-mixed. Morphinists are also prominent as writers on (Several topics in medicine, and report extraordinary gynaecological cases and many startling conclusions. In their personal Intercourse they are boastful, and have marvelous experiences, and lead all others in business and mental activity.

With these mental changes there Is Increasing abruptness and coarseness of manners and language, and neglect of personal appearance. The untruthfulness merges Into deceit and dishonesty and often senseless stealing. There Is increasing suspicion and distrust. I'hyslcally there is general anaemia, with digestive and neuralgias, both general and local, are prominent. After a time the medicai morphinist will accede to the presmire of friends and try to stop Its use.

Hp may succeed, but soon relapses. Then he will tryagain with the same results. Or he will turn to spirits or other drugs, nnd after a time give them up, only to return to morphine. All sorts of plans nnd specific remedies are tried, but all fall. The gradual reduction, extending over months, ends In dlseus- an') return to larger doses.

All tills experience Increases hit egotism nnd confidence In his ability to escape by his own powers, if he can only have his own way and control the conditions. Klnally, after trying various means and measures, he consents to go to an Institution for legitimate treatment. He Is either skeptical and suspicious, and secretes morphine In his clothes for emergencies; or he Is credulous, and han exaggerated notions that the morphine can be taken away without the slightest discomfort, or even without his knowledge or without his feeling it. 8uch have fixed conviction of mental strength equal or superior to others regarding the use of morphine, particularly from experience enabling them to decide on ihe measures and means for successful treatment. Like many alcohnllHts, they assume superior knowledge of their own cohc and how they should be treated, and constantly review their own symptoms and reason out the means for VucesKfuI treatment.

As the symptoms chniiye the diagnosis and treatment should chtfiige; the result that they morphine abandon It at once or make every to attempt to ao this at home and und ''wwVW ft me earnest moment..