Part 11

It seems, then, not unnatural or improbable that, as tea and coffee have so largely taken the place of beer or light wine as beverages, so narcotics should take the place of stronger alcoholic stimulants. That this has been the case in certain quarters is well known to physicians, and to most of those who have that experience of life in virtue of which it is said, “every man of forty must be a physician or a fool.” Nay, it is difficult to read the newspapers and remain ignorant or doubtful of the fact. We read weekly of men and women poisoned by an over-dose of some favorite sedative, burnt to death, or otherwise fatally injured while insensible from self-administered ether or chloroform. For one fatal case that finds its way into the newspapers there are, of course, twenty fatal in a different sense—fatal, not to life, but to life’s use and happiness—that are never known beyond the family circle, into which they have introduced unspeakable and often almost unlimited sorrow and evil; unlimited, for no one can be sure, few can reasonably hope, that the mischief will be confined to the individual victim of a dangerous craving. That the children of drunkards are often pre-disposed to insanity is notorious; that the children of habitual opium-eaters or narcotists inherit an unmistakable taint, whether in a diseased brain, in diseased cravings, or simply in a will too weak to resist temptation of any kind, is less notorious but equally certain. Of these secondary victims of chloral or opium there are not as yet many; but many fathers and mothers—fathers, perhaps, who for the sake of wives and children have overtaxed their brains till nothing but either the rest which circumstances and family claims forbid, or drugs, will give them the sleep necessary to the continuance of their work; mothers, too commonly, who begin by neglecting their children in the pursuit of pleasure, to end by poisoning their unborn offspring in the struggle to escape the consequences of that pursuit—are preparing untold misery and mischief for a future generation. Happily, narcotism is not the temptation of the young or energetic. It is later in life, when the effect of years of brain excitement of whatever nature begins to tell, and generally after the period in which the greater number of children are born, that men and women give way to this peculiar temptation of the present age.

The immediate danger to themselves is sufficiently alarming, if only it were ever realized in time. The narcotist keeps chloroform or chloral always at hand, forgetful or ignorant that one sure effect of the first dose is to produce a semi-stupor more dangerous than actual somnolence. In that semi-stupor the patient is aware, or fancies that the dose has failed. The pain that has induced a lady to hold a chloroformed handkerchief under her nostrils returns while her will and her judgment are half paralysed. She takes the bottle from the table beside her bed, intending to pour an additional supply on the handkerchief. The unsteady hand perhaps spills a quantity on the sheet, perhaps sinks with the unstoppered bottle under her nostrils; and in a few moments she has inhaled enough utterly to stupefy if not to kill. The vapor, moreover, is inflammable; perhaps it catches the candle by her side; and she is burnt to death while powerless to move. The sleepless brain-worker also feels that his usual dose of chloral has failed to bring sleep; he is not aware how completely it has stupefied the brain, to which it has not given rest. His judgment is gone, so is his steadiness of hand; and, whether intentionally or not, at any rate unconsciously, so far as reasoning and judgment are concerned, he pours out a second and too often a fatal dose. Any one who knows how great is the stupefying power of these drugs, how often they produce a sort of moral coma without paralysing the lower functions of animal or even of mental life, would, one might suppose, at least take care to be in bed before the drug takes effect, and if possible to put it out of reach till next morning. But experience shows how seldom even this obvious and essential precaution is taken.

The cases that end in a death terrible to the family, but probably involving little or no suffering to the victim himself, are by no means the worst. A life poisoned, paralysed, rendered worthless for all the uses of intellectual, rational, we might almost say of human existence, is worse for the sufferer himself and for all around him than a quick and painless death; and for one such death there must be twenty if not a hundred instances of this worst death in life. In nine cases out of ten, probably, the narcotist has been entangled almost insensibly, but incurably, without intention and almost without consciousness of danger. With alcohol this could hardly be the case. No woman, at any rate, could reach the point at which secret indulgence in wine or spirits became a habit and a necessity without warnings, evidences of excess palpable to herself if not to others, that should have terrified and shamed her into self-control, while self-control was yet possible. The hold that opium and other narcotics acquire is at once swifter, more gradual, less revolting and incomparably stronger than that of alcohol. The first indulgence is in some sense legitimate; is almost enforced, either by acute pain or by chronic insomnia. The latter is perhaps the more dangerous. The pain, if it last for weeks, forces recourse to the doctor before the habit has become incurable. Sleeplessness is a more persistent, and to most people a much less alarming thing; and it is moreover one with which the doctors can seldom deal save through the very agents of mischief. Neuralgia, relieved for a time by chloroform or morphia, may be cured by quinine; sleeplessness admits of hardly any cure but such complete change of life as is rarely possible, at least to its working victims. And the narcotist habit once formed, neither pain nor sleeplessness is all that its renunciation would involve. The drunkard, it must be remembered, gets drunk, as a rule, but occasionally. Save in the last stages of dipsomania, he can do, if not without drink, yet without intoxicating quantities of drink, for days together. The narcotist who attempts to go for a whole day without his accustomed dose, suffers in twenty-four hours far more cruelly than the drunkard deprived of alcohol in as many days. The effect upon the stomach and other organs, upon the nerves as well as on the brain, is one of indescribable, unspeakable discomfort amounting to torture; a disorder of the digestive system more trying than sea-sickness, a disorganization of the nerves which after some hours of unspeakable misery culminates in convulsive twitchings, in mental and physical distress, simply indescribable to those who have not felt it. Where attempts have been made forcibly and suddenly to withhold the accustomed sedative, they have not unfrequently ended within a few days in madness or death. In other cases the victim has sought and obtained relief by efforts and through hardships which, in his or her best days, would have seemed impossible or unendurable. One woman thus restrained escaped in a _déshabille_ from her bed-room on a winter night of Arctic severity; ran for miles through the snow, and was fortunate enough to find a chemist who knew something of the fearful effect of such privation, and had the sense and courage to give in adequate quantity the poison that had now become the first necessary of life. In a word, narcotics, one and all, are, to those who have once fallen under their power, tyrants whose hold can hardly ever be shaken off, which punish rebellion with the rack, and with all those devices of torture which mediæval and ecclesiastical cruelty found even more terrible than the rack itself; while the most absolute submission is rewarded with sufferings only less unendurable than the punishment of revolt. De Quincey’s dreams under the influence of opium were to the tortures of resistance what the highest circle of purgatory may be to the lowest pit of the Inferno. But any reader who knows what nightmare is would think such tortures of the imagination, so vividly realized by a consciousness apparently intensified rather than impaired by slumber, a sufficient penalty for almost any human sin.

Chloral, bromide of potash, chloroform, henbane, and their various combinations and substitutes are, however, by their very natures medicines and no more. They are taken in the first instance as such; at worst as medicinal equivalents for a quantity of alcohol which women are afraid to take or unable to obtain, much more commonly as medicines originally useful, mischievous only because the system has been accustomed to depend on and cannot dispense with them. Their effects at best are negatively, not actively, pleasurable. They relieve pain or insomnia, or the craving which they themselves have created; but their victims would, if they could, gladly be released from their tyranny. Their character, moreover, is if not immediately yet very rapidly perceptible. Very few can have used them for six months without becoming more or less alarmed by the consequences. The minority, for whom they are mere substitutes for alcohol, resort to them only when the system has already been poisoned, the habits incurably vitiated. With opium the case is different. In those which may be called its native countries, it is not a medicine but a stimulant or sedative, used for the most part in much greater moderation but in the same manner as wine or spirits among ourselves; as an indulgence pleasurable and innocent, if not actually desirable in itself. It suits the climates and temperaments to which the heating, exciting influence of alcohol is wholly unsuitable. It is, moreover, incompatible with the free use of the latter, a thing which may be said in some sense of most narcotics. Taken up by persons not yet addicted to intemperance, chloral and similar drugs operate to discourage the use, or at least the free use, of wine or spirits by intensifying their effect to a serious and generally an unpleasant degree. But it does not appear that they act, like opium, to indispose the system for alcohol. To the opium-eater, as a rule, the exciting stimulus of alcohol, counteracting the quiet, dreamy influence of his favorite drug, is decidedly obnoxious; the action of chloral much more resembles that of the more stupefying and powerful spirits. A drunkard desirous to abandon his favorite vice, and reckless or incredulous of the possibility that the remedy may be worse than the disease, would probably find in opium the most powerful and effectual assistance and support to which he could have recourse. It has moreover a strong tendency to diminish the appetite for food, so much so that both in the East and in Europe severe privation tends to encourage and diffuse its use.

Its peculiar danger, however, lies in the nature of the pleasure, and the remoteness of the pain and mischief which attend its use. Its effect on different constitutions and at different periods of life is exceedingly different. As De Quincey remarks, it is not essentially and primarily narcotic. It does not necessarily, immediately, or always produce sleep. Some fortunate temperaments reject it in all forms whatever. With these it produces immediate or speedy nausea, and consequent repugnance. But its most universal effect is the diffusion of comfort, quiet, calm, conscious repose, a general sensation of physical and mental ease throughout the system; not followed necessarily or generally by acute reaction, or even by depression. De Quincey’s earlier experience accords with that of most of those to whom opium is in some sense suited, to whom alone it is likely to become a dangerous temptation. Used once in a fortnight, or even once a week, it gives several hours of placid enjoyment, and if taken with some mild aperient and followed next morning by a cup of strong coffee, it generally gives a quiet night’s rest, entailing no further penalty than a certain not unpleasant lassitude on the morrow. A working-man, for instance, might take it every Saturday night for twenty years without other effect than a decided aversion to the public-house on Sunday, if he could but resist the temptation to take it oftener. Again, till it loses its power by constant use it is in many cases the surest and pleasantest of all anæsthetics; it relieves all neuralgic pains, tooth-ache and ear-ache for example, and puts, especially in combination with brandy, a quick and sure if by no means a wholesome check on the milder forms of diarrhœa.

In this connection one danger peculiar to itself deserves especial notice. Other narcotics are seldom given or sold save under their own names; and if administered in combination, in quack medicine or unexplained prescriptions, their effect betrays itself. Opium forms the basis of innumerable remedies and very effective remedies, sold under titles altogether reassuring and misleading. Nearly all soothing-syrups and powders for example—“mother’s blessings” and infant’s curses—are really opiates. These are known or suspected by most well-informed people. What is less generally known is that nine in ten of the popular remedies for catarrh, bronchitis, cough, cold and asthma are also opiates. So powerful indeed is the effect of opium upon the lining membrane of the lungs and air passages, so difficult is it to find an effective substitute, that the efficacy, at least the certain and rapid efficacy, of any specific remedy for cold whose exact nature is not known affords strong ground for suspecting the presence of opium. Many chemists are culpably, almost criminally, reckless; and not a few culpably ignorant in this matter. An experienced man bought from a fashionable West-end shop a box of cough lozenges, pleasant to the taste and relieving a severe cough with wonderful rapidity. Familiar with the influence of opium on the stomach and spirits, he was sure before he had sucked half-a-dozen of the lozenges that he had taken a dose powerful enough to affect his accustomed system, and strong enough to poison a child, and do serious harm to a sensitive adult. Yet the lozenges were sold without warning or indication of their character; few people would have taken any special precaution to keep them out of the way of children, and the box, falling into the hands of a heedless or disobedient child, might have poisoned a whole nursery.

Another personal experience may serve to dispel the popular delusion that opium is necessarily or generally a stupefying agent. A mismanaged minor operation exposed two sensitive nerves, producing an intolerable hyperæsthesia and a nervous terror which rendered surgical relief for the time impossible, and endurance utterly beyond human power. For a fortnight or more the patient was never free from agony save when the nerves of sensation were practically paralysed by opium. During that fortnight he took up for the first time, and thoroughly mastered, as a college examination shortly afterwards proved, Mill’s _Principles of Political Economy_, a work not merely taxing to the uttermost the natural faculties of nineteen, but demanding beyond any other steady persistent coherence and lucidity of thought. The patient affirmed that never had his mind been clearer, his power of concentration greater, his receptive faculties more perfect or his memory more tenacious. That the drug had in no wise impaired the intellectual, however it might have quelled the muscular or nervous energies, seems obvious. Yet at that time the patient was ignorant of the two antidotes above mentioned; and neither coffee nor aperient medicine qualified or mitigated the influence of the opiates; an influence strong enough to quell for some twenty-two hours out of the twenty-four an acute and terrible nervous torture.

After the use of a fortnight or a month—especially when used legitimately to relieve pain and not to procure pleasure—the entire abandonment of opium may be easily accomplished in the course of two or three days. The pain or the disease it is used to overcome carries off, so to speak, or diverts in great measure the injurious influence of the drug; as a person suffering from diarrhœa, snakebite, or other cause of intense lowering of physical and nervous power, may take with impunity a dose of brandy which in health would certainly intoxicate him. But after six months’ or a year’s daily use or abuse, only the strongest and sternest resolution can overcome or shake off the tyranny of opium, and then only at a price of suffering and misery, of physical and mental torture such as only those who have known it can conceive.

It would be as foolish to depreciate the value as to underrate the danger of this, the most powerful and in many respects the safest of anæsthetics. Nothing else can do what opium can to relieve chronic, persistent, incurable nervous pain, to give sleep when sleeplessness is produced by suffering. The more potent anæsthetics, like chloroform, are applicable only to brief intense tortures, whose period can be foreseen or determined—to produce insensibility during an operation, or to mitigate the pangs of child-birth. Opium can relieve incurable chronic pain that would otherwise render life intolerable, and perhaps drive the sufferer to suicide; and this, if moderation be observed, and the necessary correctives employed, without impairing, as other narcotics would, the intellectual faculties. It is, moreover, as aforesaid, the quickest and surest cure for bronchial affections of every kind, and might not impossibly, as De Quincey thought, if used in time and with sufficient decision, prolong a life otherwise doomed, if it could not actually cure phthisis or consumption after the formation of tubercle has once begun. But its legitimate use is limited to three cases. It can relieve temporary neuralgic pain when cure would be slow, or while awaiting a curative operation. One peculiarity of neuralgic pain is its tendency to perpetuate itself. The nerves continue to thrill and throb because worn out by pain. Give them, through whatever agency, a brief period of rest, and it may well happen that, the temporary cause removed, the pain will not return. Secondly, opium is the one anæsthetic agency available to mitigate incurable and intolerable suffering. Not only can it render endurable a life that must otherwise be one continuous torture, till torture hastens death; but it may in many cases render that life serviceable as well as endurable. De Quincey gives the instance of a surgeon, suffering under incurable disease of an intolerably painful kind, who owed the power of steady professional work for more than twenty years to the constant use of opium in enormous quantities. Finally, when a working life draws near its natural close, when old age is harassed by the nervous consequences of protracted over-work or over-strain such as is often almost inseparable from the anxieties of business—the severe taxation of the mental powers by professional or literary labor—opium, given habitually in small quantities and under careful medical direction, often does what wine effects with less certainty and safety; gives rest and repose, calms an irritability of nerve and temper more trying to the patient himself than to those around him, and renders the last decade of a useful and honorable life much more comfortable, and no wit less useful or honorable, than it might otherwise have been.

But except as a relief in incurable disease, or in that most incurable of all diseases, old age, the continual or prolonged use of opium is always dangerous and nearly always fatal. It impairs the will; not infrequently it exercises a directly, visibly, unmistakably deteriorating influence upon the moral nature. There is nothing strange in this to those who know how an accidental injury to the skull may impair or pervert the moral no less than the intellectual powers. That moral is hardly a less common or less distinctive disease than mental insanity, that the conscience as well as the intellect of the drunkard is distorted and weakened, no physiologist doubts. Opium has a similar power, but exerts it with characteristic slowness of action. The demoralization of the narcotist is not, like that of the drunkard, rapid, violent, and palpable; but gradual, insidious, perceptible only to close observers or near and intimate friends. In nine cases out of ten, moreover, opium ultimately and certainly poisons the whole vital system. The patient loses physical and mental energy, courage, and enterprise; shrinks from exertion of every kind, dreads the labor of a walk, the trouble of writing a letter, dreads still more intensely any effort that calls for moral courage, flinches from a scene, a quarrel, a social or domestic conflict, becomes at last selfish, shameless, weak, useless, miserable to the last degree.

But this, like every other effect of opium, is in some measure uncertain; and hence arises one of its subtlest dangers. De Quincey would seem to have been less susceptible than most men to the worst influences of his favorite drug, seeing what work, excellent in quality as well as considerable in quantity he achieved after he had become a confirmed opium-eater. It took, no doubt, a tenfold greater amount of opium to reduce him to intellectual impotence than would suffice to destroy the minds of nine brain-workers in ten. But his own story clearly reveals how completely the enormous doses to which he had recourse at last overpowered a mind exceptionally energetic, and a temperament exceptionally capable of assimilating, perhaps, rather than resisting the power of opium. Here and there we find a constitution upon which it exerts few or none of its characteristic effects. As a few cannot take it at all, so a few can take it with apparent impunity. With them it will relieve pain and will not paralyse the nerves, will quell excitement without affecting mental energy; nay, while leaving physical activity little more impaired than age and temperament alone might have impaired it. Here and there we may find a confirmed opium-eater capable of taking and enjoying active exercise—a fairly fearless rider, a lover of nature tempted by taste, or it may be by restlessness, to walks beyond his muscular strength; with vivid imagination well under his own control; in whom even the will seems but little weakened, whose dread of pain and flinching from danger are not more marked after twenty years spent under the influence of opium than when they first drove him to its use. Such cases are, of course, wholly exceptional; but their very existence is a danger to others, misleads them into the idea that they may dally with the tempter, may profit by its pleasure-giving and pain-quelling powers without falling under its yoke, or may fall under that yoke and find it a light one. I doubt, however, whether the most fortunate of its victims would encourage the latter idea; whether there be any opium-eater who would not give a limb never to have known what opium can do to spare suffering, to give strength for protracted exertion, if he had never known what slavery to its influence means.