In 1877, Edward Levinstein, M.D. and director of the Maison de Santé in Schonberg-Berlin wrote Morbid Craving for Morphia or, in German, Die Morphiumsucht. Levinstein disclaimed any attempt to trace the history of morphine or its medical importance; his main interest was to examine the process of morphine addiction and, if possible, how to cure it.
Title page of "Morbid Craving for Morphia."
Levinstein starts his work with a brief disquisition on the subject of morphine addiction. Interestingly, he claims that the addiction “selects its victims from among the higher and more educated classes of society…” (5). With a broader perspective on the history of addiction in the 19th century, Levinstein’s claim is particularly interesting in light of addiction trends in the United Kingdom where laudanum was widely available and widely prescribed for many of the same conditions Levinstein discusses. The perception of opiate addiction as something indulged in for artistic reasons by the literati — including figures such as Thomas de Quincy and Samuel Taylor Coleridge, both well-known English writers — kept addiction a popular topic during the 19th century — and probably helped to make addiction seem fashionable, even enjoyable. Contemporary commentators bemoaned this trend much as present-day ones do the fashion models who made heroin chic appear attractive.
Levinstein also points out — as did many commenters on opiate addiction across Europe — the readiness of physicians to prescribe opiates, including morphine, for a wide variety of conditions, from post-surgical pain to mild insomnia. He suggests that doctor-supervised use of morphine is less likely to lead to addiction and overuse than when the patient is left to his or her own devices when it comes to use of the drug.
He divides the symptomatology of morphine addiction in two halves: the symptoms of morphine “poisoning” and those of withdrawal from morphine use (10). Within these categories, Levinstein offers many case studies with the implication that these are from his files and observations.
The case studies follow patients undergoing what we would think of today as “drug rehab” with daily notes tracking their physical health and progress and any outstanding symptoms of withdrawal, disease, or distress. Some of these patients have committed themselves to medical care or have been brought by their families or other physicians. The causes of addiction vary: many patients had suffered severe injuries or diseases for which morphia was originally prescribed as a painkiller. Some had become addicted immediately; others needed a relapse or a second or even third painful event to bring on dependency. Levinstein also discusses experiments performed on animals to induce addiction and then bring on withdrawal.
Levenstein’s short work is a fascinating tour through the 19th century view of addiction and its consequences.
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