This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
The extremely grateful effects of opium on most prisons, in its first stimulant action, and in the calming influence which follows, has led to an enormous abuse of the drug, which, though less injurious either to the individual or to society than a similar abuse of alcohol, is often very pernicious in its effects on the health of those who give way to it. Like the alcoholic beverages, though employed habitually, provided its use be restrained within certain limits, it does little apparent injury, even through a long course of years, and does not seem, obviously, at least, to shorten life. We are told, on the most reliable authority, that in India and China, in the mode in which it is commonly employed by those of respectable position, who have a character to maintain, its effects are in genera] not such as to produce any seeming unfitness for the ordinary duties of life, or materially to shorten its duration. In our own country, the apothecaries inform us of sales of opium or its preparations to a vast amount, beyond any possible calls for it as a medicine; yet the number of instances are comparatively few, in which its ill effects are brought under the notice of the physician. The vice is indulged secretly, and does not betray itself by any disorder in the acts, or, so far as known, in the health of the individual; and the best British writers make the same statements relative to the abuse of the drug in their country. But the danger is that, as its pleasing effects cease to be felt, at least with the same zest, from the original dose, the temptation is always present to increase the quantity used, and to go on increasing it until it becomes a source of great and undeniable evil.
If the ordinary operation of opium be compared with that of alcohol, the cause will be obvious why life is so much less endangered by the former than the latter. The stimulant influence of opium, either on the part to which it is applied, or generally on the circulation, is very much less than that of alcohol; nor does it equally excite the functions of the lungs, liver, and kidneys. Hence it is much less liable to induce either chronic inflammation of the different organs, or that organic degeneration, which almost necessarily attends the debility consequent upon excessive vascular excitement. Operating mainly on the functions, the disordering influence of opium is witnessed chiefly in the functions.
Occasionally the medical man is consulted in this country by the slaves of opium, and has the opportunity of witnessing the consequences of its excessive abuse. In his own therapeutic observation, he also witnesses frequent disturbance of the functions from its medicinal employment, and necessarily infers that the same disturbances must exist in those who use it as a luxury within the same limits. The greatest sufferings experienced by the opium-eater are those which attend the state of nervous depression, always existing when its direct influence is no longer felt There are excessive restlessness, a universal and indescribable uneasiness, feelings of intolerable distress, especially in the epigastrium and lower extremities, an irksome sense, moreover, of incapacity both for intellectual exertion, and for mental or emotional enjoyment, constituting together a state of exquisite misery, from which the only relief is by renewed recourse to the stimulus, which, if taken in an increasing dose, renders him happy again, and again capable of exertion; and thus he goes on, in an alternation of lessening comfort and increasing misery, to the end. At the same time, there is a gradual depravation of the functions, which impairs the degree of health, though it may not very materially shorten life, unless the indulgence be carried to great excess. The ordinary derangements of the organic functions are impaired appetite and digestion, habitual constipation, and defective action of the liver; those of the animal functions, tremors, wakefulness, weakened memory and intellect, and loss of interest in the usual concerns of life and social relations. The lowest stage of degradation has been attained, when the indulgence ends in a total loss of self-respect, and indifference to the opinions of the community; and everything is sacrificed to the insatiable demands of the vice. Not unfrequently, this habit of excess has been engendered by the supposed necessity of obtaining relief from painful affec-tions, such as cancer, and certain incurable cases of neuralgia; but, though some palliation, this is no satisfactory excuse; for, by proper management, considerable relief of pain can generally be obtained, without an excess sufficient to degrade the mind, or even materially the general health; and it is rather a weak yielding to the seductive pleasures of opium, than any necessity for its anodyne influence, that leads to the lowest depths of the evil.
The effects of the vice of opium-eating, and opium-smoking, among the lower class of the Orientals, have been frequently described, and with such warm colouring that a suspicion is apt to arise of some interference of the imagination in the pictures given; especially as we do not meet their exact counterparts among those, who perhaps equally abandon themselves to the vice among ourselves. It is possible that the fumes of opium inhaled may exercise a more deleterious influence on the health than the drug taken into the stomach; and this may explain the incompatibility of the descriptions of travellers with our own observation. Dr. Oppenheim, one of the most recent and reliable observers, gives the following account of what he has himself witnessed in European and Asiatic Turkey. The opium-eater usually begins with from half a grain to two grains, and gradually increases to two drachms and sometimes more in a day. He is readily recognized by his appearance. "A total attenuation of body, a withered yellow countenance, a lame gait, a bending of the spine frequently to such a degree as to assume a circular form, and glossy deep-sunken eyes, betray him at the first glance. The digestive organs are in the highest degree disturbed, the sufferer eats scarcely anything, and has hardly one evacuation in a week; his mental and bodily powers are destroyed; he is impotent." Finding the stimulant effect of the poison at length almost lost, he conjoins with it the use of corrosive sublimate, gradually increasing the latter till it amounts to ten grains daily. He becomes subject finally to neuralgic pains, to which the opium yields no relief; and, if he has begun the use of the drug early in life, seldom attains the age of forty. (Brit. and For. Med. Rev., iv. 394.) It is unnecessary to state, that the corrosive sublimate has probably quite as much to do with the fatal result as the opium.
It is satisfactory to know that this evil habit may be corrected, without great difficulty, if the patient is in earnest; and, as the disorders induced by it are mainly functional, that a good degree of health may be restored. It will not answer to break off suddenly. No fortitude is sufficient to support the consequent misery, and life might be sacrificed in the effort. Of the particular phenomena which might result I have no experience; for I have met with no case in which the attempt has been made, or at any rate more than momentarily persevered in. Dr. B. H. Coates, however, states that he has seen well characterized cases, in which delirium tremens occurred (N. Am. Med. and Surg. Journ.. iv. 34); and this result might be reasonably anticipated. The proper method of correcting the evil is by gradually withdrawing the cause; a diminution of the dose being made every day, so small as to be quite imperceptible in its effects. Supposing, for example, that a fluidounce of laudanum is taken daily, the abstraction of a minim every day would lead to a cure in somewhat more than a year; and the progress might be much more rapid than this. Time, however, must be allowed for the system gradually to regain the healthy mode of action, which it had gradually lost.