Part 10

Among all the signal inventions, discoveries, and improvements of the age, social and material, scientific and mechanical, few, perhaps, are fraught with graver possibilities for good and evil than the great achievement of recent medicine—the development, if it should not more properly be called the discovery, of anæsthetics. Steam has revolutionized mechanics; the locomotive, the steam-hammer, and the power-loom, the creation of the railway and the factory system, have essentially modified social as well as material civilization; and it is possible at least that electric lights and motors, telegraphs and telephones, may produce yet greater consequences. This last century has been signalized by greater mechanical achievements than the whole historic period since the discovery of iron. But in obvious, immediate influence on human happiness, it is quite conceivable that the discovery of chloroform, ether, and other anæsthetics—the diffusion of chloral, opium, and other narcotics, putting them within the reach of every individual, at the command of men and women, almost of children, independently of medical advice or sanction—may be, for a time at least, more important than those inventions which have changed the fundamental conditions of industry, or those which may yet change them once more. It is difficult for the rising generation to realize that state of medicine, and especially of surgery, which old men can well remember; when every operation, from the extraction of a bad tooth to the removal of a limb, must be performed upon patients in full possession of their senses. In those days the horror with which men and women, uninfluenced by scientific enthusiasm, now regard the alleged tortures of vivisection was hardly possible. Thousands of human beings had yearly to undergo—every man, woman, and child might have to undergo—agonies quite as terrible as any that the most ardent advocate of the rights of animals, the most vivid imagination excited by fear for dearly loved dumb companions, ascribes to the vivisector’s knife. It may well be doubted whether the highest brutes are capable of suffering any pain comparable with that of hardy soldiers or seamen—much less with that of sensitive, nervous men, and delicate women—when the surgeon’s blade cut through living, often inflamed tissues, generally rendered infinitely more sensitive by previous disease or injury, while the brain was fully, intensely conscious; every nerve quivering with even exaggerated sensibility. The brutes, at any rate, are spared the long agony of anticipation, and at least half the tortures of memory. They may fear for a few minutes; our fathers and mothers lay in terror for hours and days, nay, persons of vivid imagination must have suffered acutely through half a lifetime, in the expectation that, soon or late, their only choice might lie between excruciating temporary torture and a death of lingering hopeless anguish. No gift of God, perhaps, has been so precious, no effort of human intellect has done more to lessen human suffering and fear, to take from life much of its darkest evil and horror, than anæsthesia as developed during the last fifty years. True that in the case of severe operations it is as yet beyond the power of medicine to give complete relief. If spared the torture of the operation, the patient has yet to endure the cruel smart that the knife leaves behind. But the relief of previous terror, of the awful, unspeakable, and, to those who never felt it, almost inconceivable agony endured while the flesh was carved, and the bone sawn, have disappeared from the sick room and the hospital.

Narcotics should be carefully distinguished from anæsthetics. Their use is different, not in degree only, but in character and purpose. Their legitimate object is two-fold: primarily, in a limited number of cases, to relieve or mitigate pain temporarily or permanently incurable; but secondarily and principally to cure what to a large and constantly increasing class in every civilized country is among the severest trials attendant on sickness, over-work, or nervous excitement—that loss of sleep which is a terrible affliction in itself, and aggravates, much more than inexperience would suppose, every form of suffering with which it is connected. Nature mercifully intended that prolonged intolerable pain should of itself bring the relief of sleep or swooning; and primitive races like the Red Indian, living in the open air, with dull imagination and insensible nerves, still find such relief. The victims of Mohawk and Huron tortures have been known, during a brief intermission of agony, to sleep at the stake till fire was used to awaken them. But among the many drawbacks of civilized life must be counted the tendency of artificial conditions to defeat some of Nature’s most merciful provisions. The nerves of civilized men are too sensitive, the brains developed by hereditary culture and constant exercise are too restless, to obtain from sleep that relief in pain, especially prolonged pain, that nature apparently intended. Many of us, even in sleep, are keenly sensitive to suffering, at least to chronic as distinguished from acute pain, to dull protracted pangs like those of rheumatism, ear-ache, or tooth-ache. A little sharper pain, and sleep becomes impossible. The sufferer is not only deprived of the respite that slumber should afford, but insomnia itself enhances his sensibility, besides adding a new and terrible torment of its own. Artificial prevention of sleep was notoriously among the most cruel and the most certainly mortal of mediæval or barbaric tortures. The sensations of one who has not slept for several nights, beginning with a restless, unnatural, constantly increasing consciousness of the brain, its existence and its action, passing by degrees into an acute, unendurably distressing irritation of that organ—generally unconscious or insensible, probably because its habitual sensibility would be intolerable—are indescribable, unimaginable by those who have not felt them; and seem to be proportionate to the activity of the intellect, the susceptibility of nerve and vitality of temperament—the capacity for pain and pleasure. In a word, the finer the physical and nervous character, the more terrible the torment of sleeplessness. A little more and the patient is confronted with one of the most frightful forms of pain and terror, the consciousness of incipient insanity. But long before reaching this stage, sleeplessness exaggerates pain and weakens the power of endurance, quickens the sensibility of the nerves, enfeebles the will, exacerbates the temper, produces a physical and nervous irritability which to an observer unacquainted with the cause seems irrational, unaccountable, extravagant, even frantic, but which afflicts the patient incomparably more than those, however near and however sensitive, on whom it is vented. Drugs, then, which enable the physician in most cases to check insomnia at an early stage—to secure, for example, in a case of chronic pain, six or seven hours of complete repose out of the twenty-four, to arrest a mischief which leads by the shortest and most painful route directly to insanity—are simply invaluable.

It may seem a paradox, it is a truism, to say that in their value lies their peril. Because they have such power for good, because the suffering they relieve is in its lighter forms so common, because neuralgia and sleeplessness are ailments as familiar to the present generation as gout, rheumatism, catarrh to our grandfathers, therefore the medicines which immediately relieve sleeplessness and neuralgic pain are among the most dangerous possessions, the most subtle temptations, of civilized and especially of intellectual life. Every one of these drugs has, besides its immediate and beneficial effect, other and injurious tendencies. The relief which it gives is purchased at a certain price; and in every instance the relief is lessened or rendered uncertain, the mischievous influence is enhanced and aggravated by repetition; till, when the use has become habitual, it has become pure abuse, when the drug has become a necessity of life it has lost the greater part if not the whole of its value, and serves only to satisfy the need which itself alone has created. Contrary to popular tradition, we believe that of popular narcotics opium is on the whole, if the most seductive, the least injurious; chloral, which at first passed for being almost harmless, is probably the most noxious of all, having both chemical and vital effects which approach if they do not amount to blood-poisoning. It is said (we do not affirm with what truth) that the subsequent administration of half a teaspoonful of a common alkali operates as an antidote to some of these specific effects. The bromide of potash, another favorite, especially with women, is less, perhaps, a narcotic proper than a sedative. It is said not to produce sleep directly, like chloral or opium, by stupefaction, but at least in small doses simply to allay the nervous irritability which is often the sole cause of sleeplessness. But in larger quantities and in its ultimate effects it is scarcely less to be dreaded than chloral. It has been recommended as a potent, indeed a specific and the only specific, remedy for sea-sickness. But the state to which, as its advocate allows, the patient must be reduced, a state of complete nervous subjection to the power of the drug, seems worse than the disease, save in its most cruel and dangerous forms. Such points, however, may be left to the chemist, the physician, or the physiologist; our purpose is rather to indicate briefly the social aspects of the subject, the social causes, conditions, and consequences of that narcotism which is, if not yet a prevalent, certainly a rapidly-spreading habit.

The desire or craving for stimulants in the most general sense of the word—for drugs acting upon the nerves whether as excitant or sedative agents—is an almost if not absolutely universal human appetite; so general, so early developed, that we might almost call it an instinct. Alcohol, of course, is the most popular, under ordinary circumstances the most seductive, and by far the most widely diffused of all stimulant substances. From the Euphrates to the Straits of Dover, the vine has been from the earliest ages second only to corn in popular estimation; wine, next to bread, the most prized and most universal article of human food. The connection between _Ceres_ and _Bacchus_ is found in almost every language as in the social life of every nation, from the warlike Assyrian monarchy, the stable hierocratic despotism of Egypt, to the modern French Republic and German Empire. Corn itself has furnished stimulant second in popularity to wine alone; the spirit which delighted the fiercer, sterner races of Northern Europe—Swede, Norwegian, and Dane, St. Olaf, and Harold Hardrada, as their descendants of to-day; and the ale of our own Saxon and Scandinavian ancestry, which neither spirit, cider, nor Spanish wine has superseded among ourselves. The vine, again, seems to have been native to America; but the civilized or semi-civilized races of the southern and central part of the Western Continent had other more popular and more peculiar stimulants, also for the most part alcoholic. The palm, again, has furnished to African and Asiatic tribes a spirit not less potent or less noxious, not less popular and probably not less primitive, than whiskey or beer. But where alcohol has been unknown, among races to whose habits and temperament it was alien, or in climates where so powerful an excitant produced effects too palpably alarming to be tolerated by rulers or law-givers royal or priestly, other and milder stimulants or sedatives are found in equally universal use. Till the white man introduced among them his own destructive beverages, till the “fire-water” spread demoralization and disease, tobacco was the favorite indulgence of the Red Indian of North America, and very probably of that mighty race which preceded them and seems to have disappeared before they came upon the scene—the Mound-builders, whose gigantic works bear testimony to the existence of an agriculture scarcely less advanced or less prolific, a despotism probably not less absolute than that of Egypt. Coffee has for ages been almost equally dear to the Arabs; tea has been to China all that wine is and was to Europe, probably from a still earlier period, and has taken hold on the Northern, as coffee and tobacco upon the Southern, branches of the Tartar race. Opium, or drugs resembling opium in character, have been found as well suited to the temper, as delightful to the taste, of the quieter and more passive Oriental races as wine to the Aryan and Semitic nations. The Malays, the Vikings of the East Indies, found in _bhang_ a drug the most exciting and maddening in its effects of any known to civilized or uncivilized man; a substitute for opium or haschisch bearing much the same relation to those sedatives as brandy or whiskey to the light wines of Southern Europe.

The craving, then, is not artificial but natural; is not, as teetotalers fancy, for alcohol alone or primarily, but for some form of nervous excitement or sedative _specially_ suited to climate or race. Tea, coffee, and tobacco, opium, haschisch and bhang, _mata_ and _tembe_, are probably as old as wine, older than beer, and take just as strong a hold upon the national taste. The desire testifies to a felt and almost universal want; and the attempt to put down a habit proved by universal and immemorial practice to answer to a need, real and absolute—or if artificial easily created and permanent, if not ineradicable, beyond any other artificial craving or habit—seems doomed to failure; the desire not being for this or that stimulant, for wine or alcohol, but for some agent that gives a special satisfaction to the nerves, some stimulant, sedative or astringent. The discouragement of one form of indulgence, especially if that discouragement be artificial or forcible, not moral and voluntary, can hardly have any other result than to drive the votaries of alcohol, for example, upon opium, or those of opium upon some form of alcohol. Tea, coffee, and tobacco have done infinitely more than teetotal and temperance preaching of every kind to diminish the European consumption of wine, beer, and spirits. Men and even women never have been and never will be content with water or milk, or even with the unfermented juices of fruits; to say nothing of the extreme difficulty of preserving unfermented juices in those warmer climates to which they are best adapted.

It seems, however, that the natural craving, especially among women, or men not subject to the fiercer excitements of war, hunting, and open air life in general, is not for the stronger but for the milder stimulants. Ale was the favorite beverage of England, light wine of Southern Europe, till the Saracen invasion, the crusades, and finally the extension of commerce, familiarised the Western Aryans with the non-intoxicant stimulants of the East, and the discovery of America introduced tobacco. But the use of tea and coffee is not less, we might say, is more distinctly artificial than that of beer or wine. The taste for tobacco, as its confinement in so many countries and to so great an extent to one sex proves, is the most artificial of all.

It is plain, both from the climates and the character of the races among whom the sedative drugs or slightly-stimulant beverages have first and most widely taken root, that the preference for sedatives or gentle excitants is not accidental, but to a large extent dependent upon the temperament and habits of races or nations. Alcohol suits the higher, more energetic, active, militant races; and the fiercer and more militant the temper or habits, the stronger the intoxicant employed. It is not improbable that the first and strongest incitement to the use of alcohol, as of bhang, was the desire for that which a very unfair and ungenerous national taunt describes as Dutch courage. No race, probably, except their nearest kinsmen of England, was ever less dependent on the artificial boldness produced by stimulants than the stubborn soldiers and seamen of Holland. The beer-loving Teutons have never been, like the wine-drinkers of France, Italy, and Spain, a military, or even, like the Scandinavians, a thoroughly martial race. They will fight: none, Scandinavians, Soudanese, and Turks perhaps excepted, fight better or more stubbornly. It may well be that the adventurous, enterprising spirit of Englishmen and Scotchmen, displayed at sea rather than on land, and in semi-pacific quite as much as in warlike enterprise, is derived in large measure from the strong Scandinavian element in our national blood. The tea-drinking Chinamen, the Oriental lovers of haschisch and opium, have mostly been industrious rather than energetic, agricultural or pastoral rather than predatory. The coffee-drinking Arabs were not, till the days of Mahomet, a specially warlike race. Bandits or guerillas they were perforce; like every people which inhabits a country whose mountains or deserts afford a safe refuge to robbers but promise no reward to peaceful industry. No race, no class living in the open air, save in the warmer climates, no people given to energetic muscular labor or devoted to war, would be prompt to abandon alcohol in any of its forms for its milder Oriental equivalents. Tea and coffee were introduced at a time when manufactures and in-door-life were gaining ground in Western Europe and found favor first, as is still the case, with the indoor-living sex. It is still among indoor workers that they are most in vogue. But if, as seems likely, alcohol was first adopted by the warriors of savage or semi-savage races as an inspiring or hardening force, it early lost this character with the introduction of strict military discipline on the one hand or of chivalry on the other. Neither the trained soldier of the phalanx and the legion, nor the knight with whom reckless but also intelligent courage was a point of honor, could find any help in intoxication, partial or total; nay, he soon found that while the first excitement of alcohol was fatal to discipline, its subsequent effects were almost as injurious to the persevering, steadfast kind of courage in which he put his pride. Wine or brandy, then, came to be the indulgence of peace and triumph, not of war; wassail followed on victory, sobriety was necessary till the victory was won. But still it has always been on the sterner, fiercer, more energetic races that alcohol, and especially the stronger forms of alcohol, retained their hold. It is to the passive, quiet, reflective temperaments—national or individual, peculiar to classes or to crafts—that tea or coffee, opium or haschisch, substances that calm rather than excite the nerves, have always proved strongly and often dangerously attractive.

Now it may be urged with plausibility, and perhaps with truth, that civilization and intellectual culture, the exchange of out-door for in-door life, the influences that have rendered intelligence and dexterity of more practical value than corporeal strength, tend in some sense and in some measure to Orientalize the most advanced European races. We are not, perhaps, less daring or less enterprising than our fathers; but there is a large and ever increasing class to which strenuous physical exertion is neither habitual nor agreeable. We are unquestionably becoming sedentary; we work much more with our brains, much less with our muscles, than heretofore. With this change has come a decided change of feeling and tastes. We shrink from the fierce excitement, the violent moral stimulants that delighted ruder and less sensitive races and generations. The gladiatorial shows of Rome, the savage sports and public punishments of the Middle Ages, would be simply revolting to the great majority of almost every European nation of to-day; not primarily because as thoughtful Christians we deem them wicked, but because, instinctively, as sensitive men and women in whom imagination and sympathy are strong, we shudder at them as brutal. Prize-fights, bear-baiting, bull-fights have become too rough, too coarse, but above all too exciting; the hideous tragedies of old have ceased to suit the taste at least of our cultivated classes. In one word, our nerves are far too sensitive to crave for strong and violent excitement, moral or physical; it is painful rather than pleasurable. The sobriety of the educated classes is due much less to moral than to social causes. It is not that strong wines and spirits are so much more injurious to us than to our grandsires, nor that we have learned in fifty years to think intoxication sinful; rather we have come to despise it, and to dislike its means, because we have ceased to feel or understand the craving for such violent stimulation, because not merely the reaction but the excitement itself gives more pain than pleasure.

In the case of our American kinsmen climate has very much to do with the matter. A dry, keen, exhilarating air as well as an intense nervous sensibility renders powerful alcoholic stimulants unnecessary, over-exciting, unpleasant as well as injurious. Partly from temperament, a temperament which in itself must be largely the result of climate, partly from the direct influence of their drier, keener atmosphere, American women feel no need of alcohol; American men who do indulge in it, rather as a relief from brain excitement than as an excitant itself, suffer far more than we do from the indulgence. The number of drunkards or hard-drinkers in the older States is, we believe, very much smaller than in England, even at the present day. But the proportion of lunatics made by drink seems to be much larger. In America alone teetotalism has been the serious object of social and legislative coercion. The Maine Liquor Law failed; but it is enforced in garrisons and colleges, while in many States social feeling and sectarian discipline forbid wine and spirits to women and clergymen, and habitual indulgence therein, however moderate, is hardly compatible with a high reputation for religious principle or strict morality. But this case, like that of the early Mahometans, is the case of a people whose climate is unsuited to alcohol; whose very atmosphere is a stimulant.

In a word, the craving of to-day, moral and physical, especially among the cultivated classes, among the brain-workers, among those of the softer sex and of the _fruges consumere nati_, who are almost entirely relieved from physical labor, is for mild prolonged stimulation, and for stimulation which does not produce a strong reaction; or else for sedatives which will allay the sleepless excitement produced by over-work, or yet oftener, perhaps, by reckless pursuit of pleasure.