"NARC0^^ x % BY ♦ J. B MATTISON^ M.D., Medical Director, Brooklyn Home for Habitues. Member American Medical Association; American Association for the Cure of Inebriety; New York Academy of Medicine; New York Medico-Legal Society Brooklyn Neurological Society; Kings County Medical Society. Read before the Brooklyn Neurological Society, December 14, 1892. Reprint from Weekly Medical Review; February u, 1893. The Etiology of Narcotic Inebriety. By J. B. Mattison, M.D., Brooklyn, N. Y. Twenty-two years study and experience, compassing the history or treatment of hundreds of cases, has em- phasized a belief which candor compels me to express, that, in nearly all cases of narcotic inebriety among the better class, in this country, the primal and principal factor in causation is the doctor. There is a consensus of opinion from those best in- formed-by contact with such cases-to the same effect. It is, too, a well-founded fact that in these same cases painful, wakeful conditions have stood very largely in genetic relation to the morbid narcotic need. Granting these two facts, it goes without saying that the force and extent of professional responsibility is both active and passive, direct and indirect. Opium, chloral and cocaine are the main types of this inebrial disease, and the first is by far the most fre- quent. Of this, morphinism is most common, and as regards effects, the subdermic form most disastrous. The active, direct responsibility of medical men in the rise of morphine inebriety is in giving this drug so often when it is not really required. Little doubt, dur- ing the last two decades, of its carelessly needless use, and as little question that this has favored its insidious advances. Akin to this is the too prevalent practice of giving 2 morphia when other anodynes, though perchance less speedy, would secure the same result. Still more force- ful, as to direct responsibility, is the pernicious practice of advising patients to self-subcutaneous medication. But the main measure thereof is in the patient being dismissed without full thought as to ultimate result of the opiate giving, and failure to warn against the harm of continued using; and to insist upon-giving to this earnest, personal attention-entire narcotic quitting when the need for its taking is ended. For details, see papers by the writer, "The Responsibility of the Pro- fession in the Production of Opium Inebriety," and "The Genesis of Opium Addiction." / Chloral and cocaine inebriety-happily decreased and decreasing-owe their rise and progress to the same incautious prescribing and continuing. Added thereto, in the case of cocaine, has been, I have little doubt, the mistaken pernicious opinion of Hammond and Bosworth as to its non-toxic, non-inebrial power. Vide my papers, "Chloral Inebriety," "Chloralism," and "Cocaine Inebriety." While insisting on the part played by the physician in the genesis of narcotic inebriety, I do not overlook the peculiar neurotic status, both ancestral and acquired, of these cases, nor the facility with which this specially nervous temperament favors the use of one or another drug as a stimulant in depressed conditions or a calmant in the reverse. Nor do I forget that some have their rise in vicious desire, morbid curiosity, or other out- come of damaged morale. All these hold second place in causation. If these premises be correct, the weightiest deduction is 'this-narcotic inebriety is a preventable disease. That I believe a fact, of large and far reaching import- ance, and the pivotal point of all precept and practice along this line. Two forms of narcotic inebriety are on the wane- 3 due to wider recognition and appreciation of their cause and the dangers of continuance and to the advent of less harmful hypnotios. Erlenrneyer thinks morphinism will grow worse from year to year. I am less pessimistic than he. I am hopeful and sanguine of its steady decline. But this hope will be realized only when two results are reached. First, a lessened medical use of morphine. This must be secured by teaching and example. Those whose province it is to instruct in medical lore, both in and out the schools, must rise to the need of the situation and urge the wisdom of preventive care. This is of paramount importance, if my belief be true, that the younger men are making most morphinists. With a wish for speedy effect, and larger repute, they are too apt, when called to a case of pain or insomnia, to use that modern mischief-maker-the hypodermic syringe- without proper thought as to risk incurred. Their fathers have gained wisdom by experience-sometimes most unhappy-and as a result, we believe the use of morphia-especially hypodermatic use-is steadily de- creasing among the senior members of the profession. With the non-opiate resources of modern medicine to bring ease and sleep-never so helpful as now-we feel bound to say that, in most cases these first should be availed of, and the more riskful remedy held as a der- nier ressort. Vide six papers by the writer, "Non- Opiate Anodynes and Soporifics." And in the should-be fewer cases where an opiate is deemed demanded we have in codeine that which gives largely the good of morphine with much less risk of en- tailing harm. See the writer's papers, "The Preven- tion of Morphinism; Codeine and Narceine vice Mor- phine," and "Codeine in the Treatment of the Morphine Disease." We have no wish to banish opium. We are not in- veighing against the use of morphine. But the over- 4 use, the needless, careless use, especially hypodermical- ly, we decry. The risk of inebriety from this method is larger than any other. Unless urgently required, it should not be preferred. And to counsel its self-using -save under conditions peculiar, or beyond control, is more than culpable-it is a crime. Second. A lessened general use of morphine. Re- strictive legislation that will restrict. Making it a felony for retail druggists to sell morphine, chloral or cocaine, or to refill a prescription containing either drug, except on order of a physician. To neglect these potent measures for protection is damage to public and discredit to profession. The prevention,, of disease ranks higher than its cure, and in the whole realm of prophylactic medicine there are few finer fields for good work than this. Brooklyn Av.