Morphinism.

Synonyms.—Opium Inebriety; Morphine Habit.

Definition.—A chronic intoxication due to the habitual use of opium, or some of its alkoloids, especially morphin.

Etiology.—The most common cause, in our own country, is the frequent use of morphia as a pain reliever, or to overcome insomnia. Physicians are many times responsible for creating the habit, by the frequent and persistent use of morphia to overcome pain.

Women are more frequently the victims than men. Physicians and druggists make up the greater number of male patients, Mattison reporting seventy per cent to be medical men.

In China, India, Persia, and Turkey, opium-growing countries, the opium habit is as common as alcoholism in Europe and America.

Pathology.—There are no characteristic tissue changes in opium inebriates, other than that due to indigestion and malnutrition. In time the patient becomes anemic, the skin dry, sallow, and inelastic, the heart and blood-vessels show the effects of poor nutrition, and the tissues generally present a starved appearance.

Symptoms.—Several months may elapse before the symptoms are sufficiently marked as to be noticeable. Susceptibility to the drug rapidly decreases, so either larger doses or the same size doses, must be taken at more frequent intervals. Gradually the patient takes on a peculiar anemic or gray color; the skin is dry, harsh, and inelastic; the muscles are shrunken; the eye is listless; the patient complains of languor, is listless, or when not under the influence of the drug is restless, irritable, and is troubled with insomnia. Not only physical weakness results, but, what is still more deplorable, there is moral degeneration. The patient forms the habit of lying, and practices deception on all occasions.

The patient complains of frequent pain in the cardiac region, and palpitation, difficult breathing, and cramping of various muscles are common symptoms. Shortly after taking the drug, an intolerable itching frequently occurs. Males are usually sexually impotent, while females are prone to abort.

When the drug is used hypodermically, the arm or leg shows many scars from the needle, and the blue cicatrices of former abscesses.

Diagnosis.—The diagnosis, where possible, is made from the history of the case, and where this is impossible to get, owing to the lying habits of the victim, the above symptoms must be carefully noted, and a close watch placed upon the patient.

Prognosis.—The prognosis is unfavorable in confirmed cases, when treated by the general practitioner. Where the patient can be isolated and attended constantly by a firm companion, or placed in a retreat for opium inebriates, the prognosis is more hopeful.

Treatment.—The diet should be generous, easily digested, and nourishing; the patient should be much in the open air, with regular exercise; the mind should be occupied by congenial work, and, above all, a rapid withdrawal of the drug. Not total abstinence from the first day of treatment, but a gradual reduction each day, until by the end of a week, a total withdrawal should be effected. Nux vomica, hydrastis, and strychnia will serve a good purpose as a tonic to brace the patient. Passiflora in teaspoonful doses, sulfonal, and trional may be useful in securing sleep. Gelsemium, baths, and massage will afford relief to the various aches and pains complained of by the patient.

Above all, the patient is to be attended by a companion, who is never to relax his vigilance for one moment, in order that the patient may be saved from surreptitiously securing the destroying drug.

The moral nature of the patient is to be strengthened and encouraged by engaging in plans to help those who may be even more unfortunate than himself. Due care must be taken to prevent the patient from taking any substitute, such as choral, cocaine, hyoscyamus, the bromids, and like remedies.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.