Fatal attraction: a brief history of morphine
Few of us could imagine living in a world
without easy access to instant pain relief,
whether to soothe a headache or ease
the pain of a sore toe. We expect to
feel no pain during an operation, and
afterwards we are supplied with pain
medication as a matter of course. Today,
safe medication can help us manage
acute as well as chronic pain.
The desire to live free from pain is universal among all living
entities, and humans have tried to find ways to alleviate pain
since the dawn of civilisation. Although many plants were used
for their analgesic properties in the course of history, sleep-inducing
poppies
(papaver somniferum) were domesticated and
cultivated as early as 5000 BCE, thus likely making opium the
first drug humans discovered. The ‘plant of joy’ had already been
used medically for millennia even before the alkaloid morphine
was isolated from raw opium in 1804. There is plenty of evidence
that physicians in ancient Egypt and Rome regularly used it to
relieve pain as well as calm nerves. Emperor and philosopher
Marcus Aurelius himself relied on an opium-based electuary
compounded with honey to sleep on most nights [1].
By the time apothecary’s assistant Friedrich Wilhelm Sertürner
(Figure 1) set out to isolate opium’s sleep-inducing factor in
1804, opium had seemingly been tried and tested. Sertürner
accomplished his goal and named the substance ‘morphium’
after the Greek god of dreams and sleep, Morpheus. Morphine,
hailed as ten times more potent than opium, was first produced
commercially in 1821 in a parlour behind a pharmacist’s shop in
Farringdon Street. Fifteen years later morphine officially entered
the
London Pharmacopoeia.
Figure 1. Friedrich Wilhelm Sertürner, German pharmacist and pioneer of alkaloid chemistry
Although morphine was quickly accepted, the development of
hypodermic syringes made it one of the most popular drugs of
the 19th Century. Designed simultaneously but independently by
physician Alexander Wood in Britain and surgeon Charles Pravez
in France in 1853, the hypodermic syringe allowed for morphine
to be administered by injection rather than orally (Figure 2).
Wood reasoned that if the drug was injected rather than eaten,
it would not create an appetite – a behaviour that he had already
observed in patients treated with opioids.
Physicians everywhere rejoiced. From the 1860s onwards,
morphine was given to anyone and for anything; it appeared that
the ailment that could not be remedied by hypodermic morphine
did not exist. It relieved reliably the pain of those suffering from
temporary or chronic illnesses, and calmed those in need of
sleep. In 1868, Francis Anstie, founding editor of the periodical
The Practitioner, confidently declared that ‘of danger there is
absolutely none’
[2].
However, critical voices emerged even during the initial wave
of enthusiasm. Felix von Niemeyer, though conceding that
‘the
introduction of hypodermic injections was a great event, and ...
an immense advance in treatment [for neuralgia],’
warned that he
clearly observed it creating addiction in his patients, who began
‘to feel an absolute need of the injections’ [3]. The following
decade saw more and more practitioners come forward with their
own observations. Physician Clifford Allbutt, who had effusively
and publicly praised hypodermic morphine only a few months
before, now reported its injurious effects on his patients:
‘They
seem as far from cure as they ever were, they all find relief in the
incessant use of the syringe, and they all declare that without the
syringe life would be insupportable’
[4].
It became evident that hypodermic morphine was not the
magical panacea that the medical world had hoped and believed
it to be. Yes, it did bring peace and comfort to patients, but at a
cost. The ‘disease’ of morphine addiction that was threatening
society was spreading. For the first time, the question of
culpability arose.
In his important book Morbid Craving for Morphia (Die
Morphiumsucht)
of 1877, German physician Eduard Levinstein
firmly stated that ‘the originators and propagators of this disease’
were the medical men who freely prescribed hypodermic
morphine for any ailment, especially if they supplied patients
with morphine and syringes and left them to their own devices.
However, doctors
‘must not be blamed for acting as they did,’
Levinstein continued, ‘as it was done in the hope of affording
relief to their patients, none of them thinking of the attendant
danger’
[5]. This danger was only now being understood. It could,
so he argued, happen to anyone – and it did; every echelon of
society was affected. By 1888, the
British Medical Journal even
claimed that
‘the abuse of morphine has in many cases replaced
the abuse of alcohol, especially in refined society’
[6].
Figure 2. Morphine tabloids for hypodermic use, ca 1940. Anaesthesia Heritage Centre
By this time too, morphine addiction and the figure of the
morphine addict was featuring prominently in literature as well
as visual culture. There was an outburst of morphine-themed
art particularly in Paris, where artists were fascinated with
portraying the female
morphinée. These society women were
said to routinely slip away during a theatre performance to indulge in their secret pastimes using bejewelled syringes and
morphine bottles. Women did not become more easily addicted
to morphine than men; yet, female addicts were often seen
as particularly immoral, devoid of self-control, lying and even
vicious. When Sir Lauder Brunton, however, recounted the case
of a Member of Parliament who self-injected 24 to 32 grains of
morphine daily – often secretly when in session – he stressed that
the MP only started this habit because his daughter was seriously
ill, evoking empathy rather than contempt [1].
What could be done to combat this ‘morally dangerous disease’?
For those already battling with addiction, Levinstein’s advice
was to quit suddenly, as he found that his patients had generally
overcome the withdrawal symptoms in two or three days [5].
Writing a decade later, Oscar Jennings recommended the
opposite approach of gradual reduction, eventually replacing
morphine with other medicines such as sparteine and trinitrine
[7]. Both claimed successes in rehabilitating patients. For a brief
time, it was believed that cocaine could be used to wean people
from morphine.
But how to prevent addiction occurring in the first place? Anstie
still believed morphine to be
‘one of the most valuable inventions
of the country’
, of equal significance as gaslight and the railway.
As such it was too valuable to renounce completely. He simply
recommended keeping the doses small [8]. The
British Medical
Journal
emphasised that morphine should only be used by
professionals, and advised keeping a record of the doses given.
Moreover, morphine should only be given for 14 days.
Nonetheless, morphine addiction remained prevalent. Even in
the early 20th Century there were shops offering ‘buy one get
one half-price’ injections in Germany. In Britain, too, real change
only came with the Dangerous Drugs and Poisons (Amendment)
Act of 1923. A year later, a Committee on Morphine and Heroin
Addiction was set up. It concluded that, though morphine
addiction was still more common than heroin addiction, both had
become rare in Britain, attributed to the difficulty of obtaining
drugs without medical prescriptions.
Morphine was both a blessing and a curse. It undeniably
alleviated the physical and mental pain of many, but possibly
caused as much pain and heartache in the process. Pain
management has come a long way as medical professionals have
striven to develop effective as well as safe pain medication.
Felicia El Kholi
Heritage Assistant, Association of Anaesthetists Anaesthesia
Heritage Centre
Twitter: @Anaes_Heritage, @feliciaelkholi
References
- Davenport-Hines R. The pursuit of oblivion: a global history of
narcotics. New York: WW Norton & Co, 2002.
- Anstie FE. The hypodermic injection of medicines. The Practitioner
1868; 1: 32-41.
- Von Niemeyer F, Humphreys GH, Hackley CE. A text-book of practical
medicine. New York: Appleton, 1869.
- Allbutt C. On the abuse of hypodermic injections of morphia. The
Practitioner 1870; 5: 327-31.
- Levinstein E. Morbid craving for morphia (Die Morphiumsucht).
London: Smith, Elder & Co. 1878.
- Anon. The abuse of morphine. British Medical Journal 1888: 2: 773.
- Jennings O. On the cure of the morphia habit. London: Bailliére,
Tindall & Cox, 1890.
- Anstie FE. On the effect of the prolonged use of morphia by
subcutaneous injection.
The Practitioner 1871; 6: 148-58.