sooner or later visit the opium-eater. His digestion seemed unimpaired
so long as he took his morphia regularly; he was sallow and somewhat
haggard, but thus far no distressing biliary symptoms had manifested
themselves; his sleep was always dreamy, and he woke at short
intervals during the night, but invariably slept again at once, and
had so adjusted himself to the habit as to show no signs of suffering
from wakefulness; his hand was steady; his muscular system easily
exhausted, but by no means what one would call feeble. As he himself
told me, he had come to the conclusion to emancipate himself because
opium eating was a horrible mental bondage. The physical power of the
drug over him he not only realized when attempting its abondonment.
Its spiritual thraldom was his hourly misery. He was connected by
blood and marriage with several of the best families in the
land. Money had not been stinted in his education, and his
capabilities were as great as his advantages. He was one of the
bravest, fairest, most generous natures I ever came in contact with;
was versatile as a Yankee Crichton; had ridden his own horse in a
trotting match and beaten Bill Woodruff; had carried his own little
30-ton schooner from the Chesapeake to the Golden Gate through the
Straits of Magellan; had swum with the Navigators' Islanders, shot
buffalo, hunted chamois, and lunched on mangosteens at Penang. Through
all his wanderings the loftiest sense of what was heroic in human
nature and divine in its purified form, the monitions of a most tender
conscience, and the echoes of that Puritan education which above all
other schemes of training makes human responsibility terrible, had
gone with him like his tissue. He saw the good and great things within
reach of a fulfilled manhood, and of a sudden waked up to feel that
they could on earth never be his. He was naturally very truthful, and,
although the invariable tendency of opium-eaters is to extirpate this
quality, could not flatter himself. Other minds around him responded
to a sudden call as his own did not. Every day the need of energy took
him more by surprise.
The image-graving and project-building characteristic of opium, which
comes on with a sense of genial radiation from the epigastrium about a
quarter of an hour after the dose, had not yet so entirely disappeared
from its effect on him, as it always does at a later stage of the
indulgence. But instead of being an instigation to the delightful
reveries which ensued on his earlier doses, this peculiarity was now
an executioner's knout in the hands of Remorse. He was daily and
nightly haunted by plans and pictures whose feverish unreal beauty he
remembered having seen through a hundred times. Those Fata Morgana
plans, should he again waste on them the effort of construction? The
result had been a chaos of aimless, ineffectual days. Those pictures,
why were they brought again to mock him? Were they not horrible
impossibilities? Were they not, through the paralysis of his executive
faculties, mere startling likenesses of Disappointment? In his opium
dreams he had seen his own ships on the sea; commerce bustling in his
warehouse; money overflowing in his bank; babies crowing on his knee;
a wife nestling at his breast; a basso voice of tremendous natural
power and depth scientifically cultivated to its utmost power of
pleasing artists or friends; a country estate on the Hudson, or at
Newport, with emerald lawns sloping down to the amber river or the
leek-green sea; the political and social influence of a great
landholder. How pleasurably he had once perceived all these possible
joys and powers! How undeludedly he now saw their impossible
execution!
So, coming to me, he told me that his object in trying to leave off
opium was to escape from these horrible ghosts of a life's unfulfilled
promise. Only when he tried to abandon opium did he realize the
physical hold the drug had on him. Its spiritual thraldom was his
hourly misery.
For three months I tried to treat him in his own house, here in the
city. A practitioner of any experience need not be told with what
success. I could reduce him to a dose of half a grain of sulphate of
morphia a day, keep him there one week, and making a morning call at
the expiration of that time discover that some nocturnal nervous
paroxysm had necessitated either a return to five grains or a use of
brandy (which, though no drinker, he tried to substitute) sufficient
to demand a much larger dose of opium in its reaction. He had lost
most of his near connections, and not for one hour could any hired
attendant have withstood his appeal, or that marvellous ingenuity by
which, without appeal, the opium-eater obtains the drug which, to him,
is like oxygen to the normal man.
This ingenuity manifests itself in subterfuges of a complicated
construction and artistic plausibility which might have puzzled
Richelieu; but it is really nothing to wonder at when we recollect the
law of nature by which any extreme agony, so long as it continues
remediable, sharpens and concentrates all a man's faculties upon the
one single object of procuring the remedy. If my house is on fire, I
run to the hydrant by a mere automatic operation of my nerves. If my
leg is caught in the bight of a paying-out hawser, my whole brain
focuses at once on that single thought, "_an axe."_ If I am
enduring the agony which opium alone can cause and cure, every faculty
of my mind is called to the aid of the tortured body which wants
it. When a man has used opium for a long time the condition of brain
supervening on his deprivation of the drug for a period of twenty-four
hours is such as very frequently to render him suicidal. Cottle tells
us how Coleridge one day took a walk along Bristol wharves, and sent
his attendent down the pier to inquire the name of a vessel, while he
slipped into a druggist's on the quay and bought a quart of laudanum;
but in no fibre of his nature could Cottle conceive the awful sense of
a force despotizing it over his will, a degradation descending on his
manhood, which Coleridge felt as he concentrated on that one single
cry of his animal nature and the laudanum which it spoke for, all the
faculties of construction and insight which had created the "Ancient
Mariner" and the "Aids to Reflection."
Likewise I suppose there are very few people who could patiently
regard the fact that one of the very purest and bravest souls I ever
knew had become so demoralized by the perseverance of disease and
suffering as to deal like a lawyer with his best friends, and shuffle
to the very edge of falsehood, when his nature clamored for opium. I
was particular to tell him whenever I detected any evasion (an
occasion on which his shame and remorse were terrible to witness) that
_I,_ personally, had none the less respect for him. I knew he was
dominated, and in no sense more responsible for breaking his
resolution than he would have been had he vowed to hold his finger in
the gas-blaze until it burned off. In this latter case the mere
translation of chemical decomposition into pain, and round the
automatic nerve-arc into involuntary motion, would have drawn his
finger out of the blaze, as it did in the cases of Mutius Scaevola and
Cranmer, if they ever attempted the feat credited them by tradition.
In his case the abandonment of opium brought on an agony which took
his actions entirely out of voluntary control, eclipsing the higher
ideals and heroisms of his imagination at once, and reducing him to
that automatic condition in which the nervous system issues and
enforces only those edicts which are counselled by pure animal
self-preservation. Whatever may have been the patient's responsibility
in _beginning_ the use of narcotics or stimulants (and I usually
find, in the case of opium-eaters, that its degree has been very small
indeed, therapeutic use often fixing the habit forever before a
patient has convalesced far enough even to know what he is taking)
habituation invariably tends to reduce the man to the _automatic_
plane, in which the will returns wholly to the tutelage of sensation
and emotion, as it was in infancy; while all the Intellectual, save
_Memory,_ and the most noble and imperishable among the Moral
faculties may survive this disorganization for years, standing erect
above the remainder of a personality defrauded of its completion to
show what a great and beautiful house might have been built on such
strong and shapely pillars. Inebriates have been repeatedly known to
risk imminent death if they could not reach their liquor in any other
way. The grasp with which liquor holds a man when it turns on him,
even after he has abused it for a lifetime, compared with the
ascendency possessed by opium over the unfortunate habituated to it
for but a single year, is as the clutch of an angry woman to the
embrace of Victor Hugo's _Pieuvre._ A patient whom, after
habitual use of opium for ten years, I met when he had spent eight
years more in reducing his daily dose to half a grain of morphia, with
a view to its eventual complete abandonment, once spoke to me in these
words:
"God seems to help a man in getting out of every difficulty but
opium. There you have to _claw_ your way out over red-hot coals
on your hands and knees, and drag yourself by main strength through
the burning dungeon-bars."
This statement does not exaggerate the feeling of many another
opium-eater whom I have known.
Now, _such_ a man is a proper subject, not for _reproof_,
but for _medical treatment_. The problem of his case need
embarrass nobody. It is as purely physical as one of small-pox. When
this truth is as widely understood among the laity as it is known by
physicians, some progress may be made in staying the frightful ravages
of opium among the present generation. Now, indeed, it is a difficult
thing to prevent relatives from exacerbating the disorder and the pain
of a patient, who, from their uninformed stand-point, seems as sane
and responsible as themselves, by reproaches at which they would
shudder, as at any other cruelty, could they be brought to realize
that their friend is suffering under a disease of the very machinery
of volition; and no more to be judged harshly for his acts than a
wound for suppurating or the bowels for continuing the peristaltic
motion.
Finding--as in common with all physicians I have found so many times
before--that no control of the case could be obtained while the
patient stayed at home, and deeply renewing my often-experienced
regret that the science and Christian charity of this country have
perfected no scheme by which either inebriates or opium-eaters may be
properly treated in a special institution of their own, I was at
length reluctantly compelled to send my friend to an ordinary
water-cure at some distance from town.
The cause of my reluctance was not the prospect of a too liberal use
of water, for by arrangement with the heads of the establishment I was
able to control that as I chose; moreover, an employment of the
hot-bath in what would ordinarily be excess is absolutely necessary as
a sedative throughout the first week of the struggle. I have had
several patients whom during this period I plunged into water at 110°
Fahrenheit as often as fifteen times in a single day--each bath
lasting as long as the patient experienced relief. In some cases this
Elysium coming after the rack has been the only period for a month in
which the sufferer had any thing resembling a doze. My reluctance
arose from the necessity of sending a patient in such an advanced
stage of the opium disease so far away from me that I must rely on
reports written by people without my eyes, for keeping personally
_au courant_ with the case; that I must consult and prescribe by
letter, subject to the execution of my plans by men, who, though
excellent and careful, were ignorant of my theories of treatment, and
had never made this particular disease a specialty. I accordingly sent
Mr. A. away to the water-cure, all friendless and alone to fight the
final battle of his life against tougher odds than he had ever before
encountered. At no time in my life have I realized with greater
bitterness the helplessness of a practitioner who has no institution
of his own to take such cases to than when I shook his poor, dry,
sallow hand and bade him good-bye at the station.
As I said in the beginning, I am just home from seeing the
result. Mr. A. has fared as special cases always do in places where
there is no special provision for them. To speak plainly, he had been
badly neglected; and that, undoubtedly, without the slightest
intention on the part of the heads of the house to do other than their
duty. Six weeks ago I heard from the first physician that my friend
was entirely free from opium, and, though still suffering, was
steadily on the mend. I had no further news from him till I was called
to his bedside by a note which said he feared he was dying, pencilled
in a hand as tremulously illegible as the confession of Guy Fawkes. I
was with him by the earliest train I could take, after arranging with
a neighbor for my practice, and found him in a condition which led him
to say, as I myself said at the commencement of this article; "Would
to God that every young person could stand for a single hour by this
bedside before Life's Responsibilities have become the sentinels and
Habit the jailer of the Will!"
I had not been intelligently informed respecting the progress of his
case. He had been better at no time when I was told he was so, though
his freedom from opium had been of even longer duration than I was
advised. _For ninety days he had been without opium in any
form_. The scope of so un-technical an article leaves no room to
detail what had been done for him as alleviation. His prostration had
been so great that he could not correspond with me himself until the
moment of his absolute extremity; and only after repeated entreaties
to telegraph to myself and his family had been refused on the ground
that his condition was not critical, he managed to get off the poor
scrawl which brought me to his side.
For the ninety days he had been going without opium he had known
nothing like proper sleep. I desire to be understood with mathematical
literalness. There had been periods when he had been _semi-conscious;_
when the outline of things in his room grew vaguer and for five
minutes he had a dull sensation of not knowing where he was. This
temporary numbness was the only state which in all that time simulated
sleep. From the hour he first refused his craving, and went to the
battle-field of bed, he had endured such agony as I believe no man but
the opium-eater has ever known. I am led to believe that the records
of fatal lesion, mechanical childbirth, cancerous affection, the stake
itself, contain no greater torture than a confirmed opium-eater
experiences in getting free. Popularly this suffering is supposed to
be purely intellectual--but nothing can be wider of the truth.
Its intellectual part is bad enough, but the physical symptoms are
appalling beyond representation. The look on the face of the opium
sufferer is indeed one of such keen mental anguish that outsiders may
well be excused for supposing that is all. I shall never forget till
my dying-day that awful Chinese face which actually made me rein my
horse at the door of the opium _hong_ where it appeared, after a
night's debauch, at six o'clock one morning when I was riding in the
outskirts of a Pacific city. It spoke of such a nameless horror in its
owner's soul that I made the sign for a pipe and proposed, in
"_pigeon English_" to furnish the necessary coin. The Chinaman
sank down on the steps of the _hong_, like a man hearing medicine
proposed to him when he was gangrened from head to foot, and made a
gesture, palms downward, toward the ground, as one who said, "It has
done its last for me--I am paying the matured bills of penalty." The
man had exhausted all that opium could give him; and now, flattery
past, the strong one kept his goods in peace. When the most powerful
alleviative known to medical science has bestowed the last Judas kiss
which is necessary to emasculate its victim, and, sure of the prey,
substitutes stabbing for blandishment, what alleviative, stronger than
the strongest, shall soothe such doom? I may give chloroform. I always
do in the _dénouement_ of bad cases--ether--nitrous oxyd. In
employing the first two agents I secure rest, but I induce death nine
cases out of ten. Nothing is better known to medical men than the
intolerance of the system to chloroform or ether after opium. Nitrous
oxyd I am still experimenting with, but its simple undiffused form is
too powerful an agent to use with a patient who for many days must be
hourly treated for persevering pain. So the opium-eater is left as
entirely without anæsthetic as the usual practice leaves him without
therapeutic means. Both here and abroad opium-eaters have discovered
the fact that, in an inveterate case, where opium fails to act on the
brain through the exhausted tissues of the stomach, bichlorid of
mercury in combination with the dose behaves like a _mordant_ in
the presence of a dye, and, so to speak, _precipitates_ opium
upon the calloused surfaces of the mucous and nervous layers. This
expedient soon exhausts itself in a death from colliquative diarrhea,
produced partly by the final decompositions of tissue which the
poisonously antiseptic property of opium has all along improperly
stored away; partly by the definite corrosions of the new addition to
the dose. But in no case is there any relief to a desperate case of
opium-eating save death.
Remembering that Chinaman's face, I can not wonder at the popular
notion regarding the abandonment of opium. Men say it is a mental
pain; because spiritual woe is the expression of the sufferer's
countenance. And so it is, but this woe is underlain by the keenest
brute suffering. Let me sketch the opium-eater's experience on the
rugged road upward.
Let us suppose him a resolute man, who means to be free, and with that
intent has reduced to a hundred drops the daily dose which for several
years had amounted to an ounce of laudanum. I am not supposing an
extreme case. An ounce of laudanum is a small _per diem_ for any man
who has taken his regular rations of the drug for a twelvemonth. In
the majority of cases I have found an old _habitué's_ daily portion to
exceed three, or the equivalent of that dose in crude opium or
morphia; making seventy-two grains of the gum or twelve of its most
essential alkaloid. In one most interesting case I found a man who
having begun on the first of January with one half a grain of sulphate
of morphia for disease, at the end of March was, to all appearance, as
hopeless an opium-eater as ever lived, taking thirty-two grains of the
salt per day in the form of _Magendie's Solution_. This, however, was
an unusual case. According to my experience the average opium-eater
reaches twelve grains of morphia in ten years, and may live after that
to treble the amount: the worst case I ever knew attaining a dose of
ninety grains, or one and a half of the drachm vials ordinarily
sold. I am happy, in passing, to add that for more than two years both
the extreme cases just mentioned have been entirely cured.
If the opium-eater has been in the habit of dividing his daily dose he
begins to feel some uneasiness within an hour after his first
deprivation, but it amounts to nothing more than an indefinite
restlessness. In any case his first well-marked opium torments occur
early after he has been without the drug for twenty-four hours.
At the expiration of that time he begins to feel a peculiar
_corded_ and _tympanic_ tightness about the epigastrium. A
feverish condition of the brain, which sometimes amounts to absolute
_phantasia_, now ensues, marked off into periods of increasing
excitement by a heavy sleep, which, after each interval, grows fuller
of tremendous dreams, and breaks up with a more intensely irritable
waking. I have held a man's hand while he lay dreaming about the
thirty-sixth hour of his struggle. His eyes were closed for less than
a minute by the watch, but he awoke in a horrible agony of fear from
what seemed to have been a year-long siege of some colossal and
demoniac Vicksburg.
After the opium-eater has been for forty-eight hours without his
solace this heavy sleep entirely disappears. While it stays it never
lasts over half an hour at a time, and is so broken by the crash of
stupendous visions as not to amount to proper slumber. During its
period of continuance the opium-eater woos its approaches with an
agony which shows his instinct of the coming weeks of sleeplessness.
It never _rests_ him in any valid sense. It is a congestive
decomposition rather than any normal reconstruction of the brain. He
wakes out of it each time with a heart more palpitating; in a
perspiration more profuse; with a greater uncertainty of sense and
will; with a more confused memory; in an intenser agony of body and
horror of hopelessness. Every nerve in the entire frame now suddenly
awakes with such a spasm of revivification that no parallel agony to
that of the opium-eater at this stage can be adduced, unless it be
that of the drowned person resuscitated by artificial means. Nor does
this parallel fully represent the suffering, for the man resuscitated
from drowning re-oxydizes all _his_ surplus carbon in a few minutes of
intense torture, while the anguish which burns away that carbon and
other matter, properly effete, stored away in the tissues by opium,
must last for hours, days, and weeks. Who is sufficient for this long,
_long_ pull?
From the hour this pain begins to manifest itself it continues (in any
average case of a year's previous habituation to the drug) for at
least a week without one second's lull or exhaustion. A man may catch
himself dozing between spasms of tic-douloureux or toothache; he never
doubts whether he is awake one instant in the first week after
dropping his opium. One patient whom I found years ago at a water-cure
followed the watchman all night on crutches through his tour of
inspection around the establishment. Other people, after walking a
long time, shift from chair to chair in their rooms, talking to any
body who may happen to be present in a low-voiced suicidal manner,
which inexperience finds absolutely blood-freezing. Later such rock to
and fro, moaning with agony, for hours at a time, but saying
nothing. Still others go to their beds at once, and lie writhing there
until the struggle is entirely decided. I have learned that this last
class is generally the most hopeful.
The period during which this pain is to continue depends upon two
elements. 1st. How long has the patient habitually taken opium?
2d. How much constitutional strength remains to throw it off?