[From The Journal of Inebriety for April, 1892.] 
SOME NEW STUDIES OF THE OPIUM 
DISEASE.* 
By T. D. Crothers, M.D., Hartford, Conn., 
Superintendent Walnut Lodge Hospital. 
As a preface, I wish to express my emphatic dissent 
against the common use of the word habit, in describing the 
opium disease. The popular meaning conveyed by this term 
is some state or condition voluntarily acquired and retained, 
with the certainty of being thrown off at any time at the will 
of the patient. This view assumes a knowledge of the 
physiology and psychology of the brain and its functions 
that is not yet attained. Hence the use of the word is in- 
correct, wrong, and contradicted by the facts in the clinical 
history of each case. It also conveys a false impression of 
the nature and origin of such cases, and is a word to which 
different meanings will always be given. No other word is 
more misleading and confusing, when applied to opium, 
alcohol, and other border-land neuroses. 
Beyond all question, the toxic use of opium and its 
alkaloids is rapidly increasing. Only about fifty per cent, of 
* Read before the Philadelphia County Medical Society Jan. 27, 1892. Some New Studies of the Opium Disease. 
2 
opium and morphine manufactured is required by the legiti- 
mate demands of medicine and pharmacy. The enormous 
balance is consumed in some unknown way. Comparative 
estimates make the number of opium cases in this country 
over a hundred thousand. Whether this is correct or not, it 
is evident that the number is very great and largely con- 
cealed, and many of them are very hopeless and difficult to 
treat. The natural history of such cases indicates a steady, 
progressive degeneration on to death. Recovery is rarely 
spontaneous, and without the aid of applied science. Up to 
the present time all clinical studies have been confined to the 
symptoms and treatment, starting from some indefinite point 
after the opium addiction begins. The old superstition of a 
moral origin, and of some willful, wicked impulse, is accepted 
as the first original cause. Writers and even specialists sel- 
dom go back into the early etiology, or inquire what con- 
ditions or forces led to the first use of opium. The object of 
this paper is to trace some recent facts which throw new 
light on this unknown stage of etiology. 
From a careful clinical study and grouping of the history 
of a number of opium cases, it is evident that a large propor- 
tion have a distinct neurotic diathesis ; or, more literally, have 
inherited from their parents some condition of brain and 
nerve defect which favors and predisposes to the develop- 
ment of neurotic diseases. A more careful study of these 
records shows that in some cases an opium diathesis is pres- 
ent, or a special inherited tendency to use opium. Here are 
two conditions which influence and favor this disease. It is 
a well-known fact that a large proportion of all nerve and 
brain diseases appears in children of neurotic and defective 
parents. Such children have received some special tendency 
and predisposition favoring the growth of nerve diseases,, 
springing into activity from the slightest causes. 
The latency or activity of this diathesis will depend on 
certain conditions of life and surroundings, which in many 
cases can be traced. In some instances the diseases of 
parents reappear in the children, in others in allied diseases,. Some New Studies of the Opium Disease. 
3 
and not infrequently these defects pass over and reappear in 
the third generation. Often such defects are dormant, and 
only break out from the application of some peculiar exciting 
cause. Thus, a hysteric mother and paranoiac father were 
followed by three children. One was an alcoholic, the 
second was a wild, impulsive, temperance reformer, the 
third was a sad, depressed, melancholic man. In the third 
generation opium and alcoholic inebriety, insanity, pauperism, 
also feebleness of mind and body appeared. These varied 
forms of nerve diseases all had a neurotic diathesis as a 
basis, and the different phases were the direct result of dif- 
ferent exciting causes. These facts are numerous and well- 
attested, and so uniform in their operation that it is entirely 
within the realm of possibility to predict, from a knowledge 
of the diseases of the parent and the environment of the 
child, that certain forms of degeneration and disease will ap- 
pear with almost astronomical precision. This term neurotic 
diathesis covers a vast, unknown field of causes, which ex- 
tend back many generations. The evolution of brain and 
nerve defects can often be traced through the realms of 
environment, nutrition, growth, and development. Medical 
text-books and teachings which fail to recognize this give 
very narrow conceptions and strange exaggerations of the 
influence and force of many insignificant and secondary 
factors in the production of disease. The opium-taker has 
often this neurotic element in his history. It may be traced 
back to his ancestors, or it may be associated with brain or 
nerve injuries, cell-starvation, faulty nutrition, auto-intoxica- 
tions, brain strains, or excessive drains of nerve force. A 
train of predisposing causes may have been gathering for an 
indefinite time back. Then comes the match which kindles 
or fires the train of gathering forces. This same train of ex- 
citing causes may not explode, became the germ soil is absent. 
Opium in all forms is given daily, and yet only a comparatively 
small number of cases become addicted to its use. Why 
should an increasing number of persons take opium continu- 
ously for the transient relief it gives ? Why should the 4 
Some New Studies of the Opium Disease. 
effects of this drug become so pleasing as to demand its in- 
creased use, irrespective of all consequences ? The only ex- 
planation is the presence of a neurotic diathesis, either in- 
herited or acquired. The existence of a special opium 
diathesis has been doubted with supercilious contempt by 
many writers. Any clinical study will show the error of 
such doubt. The notes of a few cases which have recently 
come under observation are illustrations by no means un- 
common, and indicate the concealed factors of disease in 
many instances. 
In case i the mother was a secret morphine-taker, the 
father was a hypochondriac and melancholy clergyman. 
Two children followed, who were highly educated and 
healthy. One, a boy, became a physician, and at thirty 
suddenly began to use morphine, and soon became a chronic 
case. The other, a girl, was well up to her marriage, at 
twenty-four, when she began to use opium, for no apparent 
reason. 
Case 2, reported by the late Dr. Parrish. Both parents 
used opium for sleep and neuralgia, and died, leaving three 
children under five years of age. They were brought up in 
temperate families, and had no knowledge of the opium ad- 
diction of their parents. One, at twenty, continued the use 
of morphine after it had been given for some intestinal 
trouble. The second child suffered from dysmenorrhoea and 
began to take morphine for this trouble, and became a mor- 
phine maniac. The third child was a druggist, who at 
thirty was a confirmed opium-taker. 
Case 3. Both parents were neurotic, and probably opium- 
takers. Both died, leaving an infant child, which was ex- 
cessively irritable and peevish. By accident, morphine was 
used as a remedy, and from thenceforth the child would 
become delirious unless morphine was given daily. All 
efforts to break up its use failed, and for five years increasing 
doses were used constantly until the child's death. 
In case 4, five children of unknown parentage were all 
opium-takers ; all lived in different conditions and had dif- Some New Studies of the Opium Disease. 
5 
ferent occupations. Two began the use of opium from some 
bowel trouble. Two have been under treatment, and re- 
lapsed (?). 
The relief which this drug brings on all occasions, and its 
impulsive use, are unmistakable indications of a distinct 
opium diathesis. I believe a careful clinical study will 
reveal many such instances. 
There is a large class of opium cases in which a complex 
diathesis exists - particularly following inebriety and various 
forms of brain exhaustion. Often alcoholics will use 
opium irregularly and transmit to their descendants a dia- 
thesis which very commonly favors the use of this drug. 
Thus the alcohol diathesis frequently becomes the opium 
craze, with but slight exposure. Both of these disorders are 
rapidly interchangeable. The children of opium-takers may 
turn to alcohol for relief, and vice versa. It is clear that the 
moderate use of alcohol produces a degree of degeneration 
that frequently appears in the next generation as predispos- 
ing causes to the opium or allied diseases. Clinical study of 
cases brings ample confirmation of this. The children of 
both alcohol and opium inebriates display many forms of 
brain degeneration. The paranoiacs, criminals, prostitutes, 
paupers, and the army of defects, all build up a diathesis and 
favoring soil for the opium craze. Descendants from such 
parents will always be markedly defective. They are noted 
by brain and nerve instability, hyperaesthesis, and tendency 
to exhaustion ; also extreme pain from every degree of 
functional disturbance, with low powers of restoration, in- 
ability to bear pain, and suffering from mental changeability, 
impulsiveness, and drug credulity, etc. 
These characteristics are prominent, and mark a neurosis 
that quickly merges into the opium disease. Yet a minority 
of these cases show a sensitiveness in the effects of opium 
that prevents them from using it. I have seen a neurotic 
patient become dangerously narcotized by the use of half a 
grain of solid opium. Some of the alcoholics and other 
narcomaniacs have exhibited an incompatibility to opium that 6 
Some New Studies of the Opium Disease. 
is often startling. The emesis and prostration, and the 
brain-stimulation which approaches and becomes hyperaemia 
from one or more doses, are familiar to all. This intolerance 
precludes the use of the drug, and is recognized with alarm 
by the patient. On the other hand, when the effects are 
rapid and marked, relieving pain or restoring the disturbance 
of the functions with no other than a pleasing sense of rest 
and cure, a dangerous diathesis should be suspected. While 
the physician recognizes the constitutional incompatibility 
in one case, he ought not to overlook the abnormal attractive- 
ness of the drug in the other. The dose of morphine which 
gives the first complete rest, or calms the delirious excite- 
ment, or relieves the neuralgic pain or the digestive disturb- 
ance, soon calls for its repetition, and many physicians will 
unconsciously sanction and advise its use. Thus, far more 
fatal conditions are cultivated and roused into activity. In 
all neurotic cases, the use of opium in any form when given 
should be concealed and watched with care. If a special 
predilection for this drug appears, equal care and skill should 
be exercised to divert and change it. Opium should only be 
used from a knowledge of the nature and character of the 
case. I have seen the most disastrous results from the reck- 
less use of morphine with the needle. Recently a man to whom 
morphine was intolerant was cut and stunned by a falling plank 
in the street. The surgeon gave him a hypodermic of mor- 
phine and ordered him to the hospital. He died in a short 
time from opium neurosis. Police surgeons often make this 
mistake, giving morphine that from some unknown reason 
becomes fatal. 
There is another class of opium-takers in which abnormal 
nutrition seems to be the most active factor in the causation. 
The neurotic or opium diathesis is not apparently present, 
and opium-taking dates from some nutrient disturbance. 
Such cases are very commonly sufferers from dyspepsia, de- 
rangement of the liver and bowels. They have a deranged 
appetite, headaches, cramps, thirst, and fever at times, with 
nausea. They are anaemic and hyperaesthetic, and complain Some New Studies of the Opium Disease. 
7 
of varied pains and neuralgias. These cases are evidently 
ill-nourished, and, in all probability, suffer from imperfect 
digestion, assimilation, and elimination of food products and 
waste material. Poisonous compounds and auto-intoxica- 
tions form sources of serious trouble. The brain suffers 
from fatigue and pain, the cells are imperfectly nourished, 
and congestions, complex neuralgias, nerve irritation and in- 
stability follow. For this condition*opium is almost a specific 
paralyzant. These cases are found among the over-fed, and 
those who neglect common hygienic rules of living. Cases of 
over-fed are usually epicures, gormands, and persons living 
sedentary lives, and eating at all times and places. Dys- 
pepsia and derangement of the bowels and kidneys make 
them drug-takers ; then follows opium in some form. De- 
fective elimination and auto-intoxications are always present. 
The under-fed are usually misers or persons very poor and 
very neglectful of themselves, or paranoiacs who have some 
food delusion. They are practically suffering from cell and 
tissue starvation and nutrient debility. The same dyspep- 
sia and bowel derangements follow. Then follows drug- 
taking or special foods, and soon opium is discovered and 
adopted as a remedy. The same poisonous waste products 
appear from deranged assimilation ; also, elimination and the 
nerve centers are deranged by these new and dangerous 
chemical compounds. The class of persons who, from simple 
neglect, become diseased, are often the very poor and ignor- 
ant, or some division of the great army of border-liners, who 
live both mentally and physically on the very frontiers of 
sanity and insanity. Such persons clearly suffer from many 
and various forms of auto-intoxications, and this is proven in- 
ductively by the result of eliminative treatment. In all of 
these cases of nutrient neglect, many favoring conditions en- 
courage the use of opium. These cases are numerous and 
comprise a large part of the invalids, hypochondriacs, and 
chronic drug-takers who are seen in our offices and at the 
dispensaries. They are all practically suffering from faulty 
assimilations, and faulty eliminations and the irritation of re- 8 
Some New Studies of the Opium Disease. 
tained poisonous compounds. Opium is a remedy of positive 
force in covering up the protests of the defective cells and 
irritable nerves. Often these cases are concealed and are 
partly the result of previous disorder, and partially acquired 
from the effects of opium. 
Next to this class of nutrient sufferers who become 
opium-takers are those who have some entailment of disease 
or injury. In their history it will appear that some stage of 
invalidism was present, dating from brain, nerve, or bodily 
injury. Fevers, heat, or sunstrokes, brain shocks from any 
source which are followed by unconsciousness, or marked 
mental perturbations, with exhaustion, and also a profound 
lowering of all the vital forces. These and other events 
have left damaged functional and organic activities, manifest 
in various neuralgias and physical disturbances. 
The use of opium conceals and covers up this trouble. 
Many veterans of the late war have become opium maniacs 
for the relief of their pains and sufferings, and this is often con- 
cealed where it might possibly peril the procuring of a pension. 
The pension bureau should recognize the use of opium as a 
natural sequence and entailment following the disease and 
injury in the service. In Prussia both alcohol and opium ine- 
briety are treated as diseases when occurring in the army or 
civil service. The suffering and hardships growing out of 
the war has been the exciting cause of a great many opium 
cases. Many persons who have no special nerve diathesis 
in their history, after some severe illness, injury, or mental 
strain exhibit a degree of nerve instability and feebleness 
that is significant of serious organic change. Such persons 
manifest perversions of taste, with delusions of foods and 
medicines, and are on the border-lines of narcomania, ready 
to use any food or drugs which will bring even transient 
relief. The use of opium is always perilous. Why all these 
and similar cases do not become opium-takers is owing to 
the absence of some diathesis inherited or acquired. 
We can see some of the many complex causes favoring 
brain and nerve strain, with rapid exhaustion and degener- Some New Studies of the Opium Disease. 
9 
ation, and the interchangeability of nerve diseases, in which 
the use of opium is only another form of the same disease. 
But we cannot yet trace the early causes and cell conditions 
which develop the opium craze. This morbid impulse, like 
the delirious thirst for water on a desert-plain, completely 
dominates all reason and so-called will-power, and every con- 
sideration of life and surroundings. It is more than an 
accident, more than a failure to reason and act wisely ; it is 
a disease, an organized march of dissolution. The demand 
for opium is only a symptom ; the removal of opium is not 
the cure. Some central brain degeneration has begun and 
is going on. Narcomania, a morbid thirst for any solids or 
fluids that will produce neuroses, is the general name, and 
opium mania is only one member of this family. 
In this study the fact is emphasized that the opium 
disease appears most frequently in persons who have a 
neurotic and opium diathesis, also in persons who are suffer- 
ing from nutrient disturbances, and those who are invalids or 
have the entailment of previous disease and injury ; also that 
certain diseases and symptoms seem to furnish favoring soils 
for its growth and development. While these are but faint 
outlines of many unknown facts, they are urged as starting 
points from which to base other and more accurate studies. 
The medical treatm^irt from this point of view is very sug- 
gestive. Obviously the removal of the opium is not the cure. 
The various methods of removal detailed with great exact- 
ness, as if they would apply to each case, are unfortunate 
reflections of the failure of the writers, and are based on the 
assumption that all cases are the same, and the removal of 
opium is the great essential in the treatment. Basing the 
treatment on the clinical study of the case, it will be evident 
that where an opium diathesis exists, the withdrawal of 
opium should be very gradual. The treatment and surround- 
ings should be arranged with great care and exactness. 
Such persons should live in an institution for years or be un- 
der constant medical care. The danger of relapse and the 
future of such cases will depend entirely on the conditions of Some New Studies of the Opizim Disease. 
10 
life and surroundings. Rapid reduction and heroic treat- 
ment is seldom permanent, even with the consent of the 
patient. Specifics, faith cures, or any measures that promise 
speedy cure, are failures from the beginning. The road 
back to approximate health is straight, and narrow, and only 
along lines of applied science. Where the history of a 
neurotic diathesis is present, the withdrawal of the opium 
should be equally slow. 
More attention must be paid to the brain and nerve 
nutrition. The removal of opium may be followed by the 
appearance of very serious disorders, such as epilepsy, 
hysteria, complex neuralgias and paranoiac states, alcoholism, 
and various other neuroses. The slow withdrawal of opium 
enables one to discover and anticipate these neurotic 
troubles which have been masked before. In one case, 
suicidal melancholy ; in another, in hyperaemia of the brain, 
with delusions ; in the third, irritation and delirium ; in the 
fourth, hysterical spasms appeared when the opium was re- 
moved. I have seen two cases of general paralysis suddenly 
spring into great activity, after the opium was taken away. 
This condition was not suspected before. Alcoholism is a 
very common sequel after the removal of the opium. 
Cocaine, chloral, and almost every drug that has narcotic 
properties are also very common entailAents. While these 
are extreme cases, they are likely to appear at any time. 
Great care should be exercised in using other narcotics to 
lessen the irritation from the withdrawal of this drug. 
These cases require the same general treatment as neuras- 
thenia and other states of brain exhaustion. They are drug- 
takers and will resort to anything for relief. They are 
secretive, and require more care and more mental remedies, 
with long, exact hygienic surroundings. 
Where the opium addiction has apparently come from 
bad nutrition and faulty elimination, with auto-intoxications, 
the treatment is very hopeful. A long preliminary course of 
baths, mineral waters, and tonics should precede the removal 
of opium. Then the drug may be removed at once, without Some New Studies of the Opium Disease. 
11 
the knowledge of the patient. In proper surroundings with 
frequent baths, little danger of relapse or suffering will fol- 
low. Careful study and treatment of nutrition and digestion 
will restore the case, and relapse seldom occurs except from 
failure or neglect of the surroundings. 
In the last class, where opium is taken and apparently fol- 
lows from the entailment of some injury or disease, or the ex- 
haustion of old age, a preliminary treatment seems to be re- 
quired. Often the opium can be abandoned at once for some 
milder narcotic, and from this, by gradations, discontinued 
entirely. Full knowledge of the diseased states present will 
always suggest the lines of treatment. In some cases the opium 
should not be removed at once ; its diminution and conceal- 
ment is required. In others its rapid removal is essential. 
Many varied and difficult questions will appear in these cases. 
The more accurately the diseased states, predisposing and 
exciting causes, the diathesis, and varied influences which 
have caused opium to be used, are studied, the more accurate 
the treatment. As in many other diseases, the causes may 
be anticipated, also neutralized and prevented. 
Routine treatment, either by slow or rapid reduction of 
the opium, is not always wise. In a certain number of cases 
the withdrawal of opium only unmasks more serious diseases. 
A case of general paresis is now under treatment for the 
opium addiction. Before this opium addiction began the 
patient caused great distress by his delusions and extrava- 
gantly strange conduct. This treatment is wrong. A 
rheumatic woman of seventy is going through the same course 
to be free from opium, which has made life tolerable for ten 
years past. The treatment of opium mania is something 
more than the application of means and remedies for with- 
drawal of the drug with the least suffering. The symptom- 
atology and organic lesions often date back to other causes 
more complex than opium. The treatment must begin by 
their removal. The general or special diathesis must be 
treated ; the nutritive disorders, intoxications, and starvations 
must be recognized and removed. The influence of patho- 12 
Some New Studies of the Opium Disease. 
logical states from previous disease and injury must be ascer- 
tained and treated. The power of environment, climate, oc- 
cupation, and idiosyncrasies are also powerful factors to be 
considered. 
These are the essential facts and conditions which must 
enter into the practical treatment. Among the mali'y im- 
portant problems, that of prevention promises the greatest 
possibilities. A recognition of the neurotic diathesis and 
other predisposing causes would enable the physician to suc- 
cessfully guard its approach. 
The successful stamping out of both this and the alcoholic 
disease will be a reality in the future. 
It is evident that t^opium disease is still an undiscovered 
country, and the few student experts have not yet passed be- 
yond its frontiers. This disease is all about us and may in- 
vade our homes and firesides any time, and hence demands 
recognition and most careful study ; above all, ethical and 
moral levels. Its laws of growth, development, treatment, 
and curability all follow the great highway of evolution and 
dissolution.