Morphinomania

Albert Matignon (1860-1937), La morphine, 1905, huile sur toile, 1,09 m x 1,96 m, Château-musée de Nemours.

The public notoriety of the “morphinée" at the end or the 19th century is a testament to the political and professional issues at play as categories were being devised regarding substance abuse.

    Appearing in the pharmacopoeia in the course of the 1820s, morphine became, over the 19th century, one of physicians’ go-to medicine: given its pain relief properties, doctors readily turned to it in the absence actual pharmaceutical drugs. Under such circumstances, when pain relief was at the heart of the matter, resorting to morphine enabled a physician to enhance his professional status in the face of the enduring competition of non-official therapists, be they bone-setters, healers or herbalists. Doctors did not have words enough to praise the “wonderful” morphine, the formidable instrument that legitimated their corporation. In 1868,  Alfred Terson (1838-1925), a Toulouse practitioner and ophthalmologist concluded a paper on the substance’s benefits in these words: “I could not but emphatically recommend to my colleagues the use of sub-cutaneous injections of morphine in the circumstances I have just outlined: their effect is such in some cases that they surprise even the doctor and that the patient admires the powers of our art.” (A. Terson, Des injections sous-cutanées de morphine dans les affections douloureuses des yeux, Le Sud médical, n°20, 1868, p. 387-394)

   Since the use of morphine increased the doctors’ prestige, they used it in many indications that went way beyond mere pain relief. For instance, it was prescribed for gastric troubles, as a forerunner to anti-depressants, in end-of-life care or even in the framework of lung diseases. Alienists frequently turned to it, for healing purposes but also more importantly – and pragmatically – to sedate restless patients, notably hysteric cases. In some services, for instance at the Salpêtrière, it was used daily in heavy dosage.

   Addiction was not as yet considered or known as a phenomenon in se. The act of consuming excessive amounts of psychotropics was deemed a vice, not an illness, mainly affecting, according to the times’ mindset, individuals thought inferior (alcohol) or the colonised peoples (opium or coca). But over the 1880s, alienists must face the facts: their hysteric patients can no longer dispense with morphine. Doctor Dalbanne asserts that “should morphine come to be suspended, nothing short of a revolution would shake” the Salpêtrière. Other cases begin to emerge with patients in home care, who have been taught by their doctors to inject themselves and been given prescriptions to be renewed at their discretion. According to available sources, 87% of the morphine addicts mentioned in medical research between 1876 and 1913 became dependant following a doctor’s prescription.

   Even as the profession achieves an ever-broader acknowledgment of its competence among the populace, morphine addiction comes to shake this freshly acquired trust, for doctors are found responsible for the advent of this new pathology soon to be known as “morphinomania”. One of the defence strategy put forward by the alienists – the chief offenders – consists in setting out “types” of illnesses with descriptions which underscore the patient’s own responsibility in the genesis of their condition. Thus do they create the figure of the Morphinée, a woman of easy virtue, dissolute, discovering in morphine usage a new sinful pleasure. Accordingly, the discourse promptly disseminated in the press and the arts, insinuates that women are, given their fragile and perverse nature, the chief victim of morphinomania. Viz. the portrait drawn by Dr Rodet in 1897: “Society women, artists, fallen women of all classes, all neurotic, all unhinged, that lot sacrifice at the altar of the goddess morphine in countless numbers. They are legion!  Their total in direct proportion with the ever-growing development of the moral unbalance that seems to characterise our closing century. Neither is it about to decline!”

   By pointing the finger at the “deviances” of female morphine addicts, physicians outline a contrario the criteria of “respectable femininity” in terms of maternal role, dedication, modesty, calm. Furthermore, as they assert that the disease is spreading, the alienists angle for the opening of new specific services dedicated to the care of these patients and which they would direct.

   At the end of the 19th century, the responsibility for morphinomania shifted: the patients, would henceforward demonstrate through their weakness, vices and laziness the “predestined” nature of their illness. This exceedingly demeaning representation was extended to mere users as physicians made no difference between consumption and addiction. Meanwhile, what was experienced by its contemporaries as a catastrophic “epidemic” never actually took place. There may have been in France between the late 1870s and the beginning of the First World War at most a few hundreds cases of morphinomania (equally distributed between men and women). The episode would however have a lasting impact on the medical profession and marked the starting point of a morphinophobia or fear of morphine that would result in the collapse of its medical use throughout the 20th century.

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Read the paper in French : Morphinomanie