worse consciousness. Though the most untechnical man, he must already
know the disorder which has taken place in his moral nature and his
will. For a knowledge of his physical condition he must resort to his
medical man, and what, when the case is ten years old, must a
practitioner tell the patient in any average case?
"Sir, the chances are entirely against you, and the possession of a
powerfully enduring constitution, if you have it, forms a decided
offset in your favor."
He then makes a thorough examination of him by ear, touch,
conversation. If enough constitution responds to the call, he advises
an immediate entrance upon the hard road of abnegation.
If the practitioner finds the case hopeless he must tell the patient
so, in something like these words:
"You have either suffered a disorganization of irreproducible
membranes, or you have deposited so much improper material in your
tissue that your life is not consistent with the protracted pain of
removing it.
"One by one you have paralyzed all the excretory functions of the
body. Opium, aiming at all those functions for their death, first
attacked the kidneys, and with your experimental doses you experienced
a slight access of _dysouria_. As you went on, the same action,
progressively paralytic to organic life, involved the liver.
Flatulence, distress at the epigastrium, irregularity of bowels,
indicated a spasmodic performance of the liver's work which showed it
to be under high nervous excitement. Your mouth became dry through a
cessation of the salivary discharge. Your lachrymal duct was parched,
and your eye grew to have an _arid_ look in addition to the dullness
produced by opiate contraction of the pupil.
"All this time you continued to absorb an agent which directly acts
for what by a paradox may be called fatal conservation of the
tissues. Whether through its complexly combined nitrogen, carbon, or
both, the drug has interposed itself between your very personal
substance and those oxidations by which alone its life can be
maintained. It has slowed the fires of your whole system. It has not
only interposed but in part it has substituted itself; so that along
with much effete matter of the body stored away there always exists a
certain undecomposed quantity of the agent which sustains this morbid
conservation. [Footnote: I frequently use what hydropaths call "a
pack" to relieve opium distress, and with great benefit. After an hour
and a half of perspiration, the patient being taken out of his
swaddlings, I have found in the water which was used to wash out his
sheet enough opium to have intoxicated a fresh subject. This patient
had not used opium for a fortnight.]
"When this combination became established, you began losing your
appetite because no substitution of fresh matter was required by your
body for tissue wrongly conserved. The progressive derangement of
your liver manifested itself in increased sallowness of face and
cornea; the organ was working on an inadequate vital supply because
the organic nervous system was becoming paralyzed; the veins were not
strained of that which is the bowels' proper purgative and the blood's
dire poison. You had sealed up all but a single excretory passage--the
pores of the skin. Perhaps when you had opium first given you you were
told that its intent was the promotion of perspiration but did not
know the _rationale._ The only way in which opium promotes
perspiration is by shutting up all the other excretory processes of
the body, and throwing the entire labor of that function upon the
pores. (When the skin gives out the opium-eater is shut up like an
entirely choked chimney, and often dies in delirium of blood-
poisoning.)
"For a while--the first six years, perhaps--your skin sustained the
work which should have been shared by the other organs--not in natural
sweat, but violent perspiration, which showed the excess of its
action. Then your palms became gradually hornier--your whole body
yellower--at the same time that your muscular system grew tremulous
through progressively failing nervous supply.
"About this time you may have had some temporary gastric disturbance,
accompanied with indescribable distress, loathing at food, and
nausea. This indicated that the mucous lining of the stomach had been
partially removed by the corrosions of the drug, or that nervous power
had suddenly come to a stand-still, which demanded an increase of
stimulus.
"Since that time you have been taking your daily dose only to preserve
the _status in quo_. The condition both of your nervous system
and your stomach indicate that you must always take some anodyne to
avoid torture, and _your_ only anodyne is opium.
"The rest of your life must be spent in keeping comfortable, not in
being happy."
Opium-eaters enjoy a strange immunity from other disease. They are not
liable to be attacked by miasma in malarious countries; epidemics or
contagions where they exist. They almost always survive to die of
their opium itself. And an opium death is usually in one of these two
manners:
The opium-eater either dies in collapse through nervous exhaustion
(with the blood-poisoning and delirium above-mentioned), sometimes
after an overdose, but oftener seeming to occur spontaneously, or in
the midst of physical or mental agony as great and irrelievable as men
suffer in hopeful abandonment of the drug, and with a colliquative
diarrhea, by which--in a continual fiery, acrid discharge--the system
relieves itself during a final fortnight of the effete matters which
have been accumulating for years.
Either of these ends is terrible enough. Let us draw a curtain over
their details.
Opium is a corrosion and paralysis of all the noblest forms of
life. The man who voluntarily addicts himself to it would commit in
cutting his throat a suicide only swifter and less ignoble. The habit
is gaining fearful ground among our professional men, the operatives
in our mills, our weary sewing-wormen, our fagged clerks, our
disappointed wives, our former liquor-drunkards, our very
day-laborers, who a generation ago took gin. All our classes from the
highest to the lowest are yearly increasing their consumption of the
drug. The terrible demands especially in this country made on modern
brains by our feverish competitive life, constitute hourly temptations
to some form of the sweet, deadly sedative. Many a professional man of
my acquaintance who twenty years ago was content with his
_tri-diurnal_ "whisky," ten years ago, drop by drop, began taking
stronger "laudanum cock-tails," until he became what he is now--an
habitual opium-eater. I have tried to show what he will be. If this
article shall deter any from an imitation of his example or excite an
interest in the question--"_What he shall do to be saved?_"--I am
content.
NOTE.--The patient whose sorrowful case suggested this article died
just as the magazine was issued. His unassisted struggle had been too
long protracted after abandonment of the drug was evidently hopeless,
and his resumption of opium came too late to permit of his rallying
from his exhaustion.
OUTLINES OF THE OPIUM-CURE.
No. 1 Livingston Place,
Stuyvesant Square,
April 25, 1868.
MY DEAR SIR:--In accordance with your request, I sketch the brief
outline of my plan for the treatment of opium-eaters, premising that
it pretends much less to novelty than to such value as belongs to
generalizations made from large experience by sincere interest and
careful study in the light of science and common sense.
That experience having shown me how impracticable in the large
majority of cases is any cure of a long-established opium habit while
the patient continues his daily avocations and remains at home,
[Footnote: In my article upon opium-eating, entitled, "What Shall They
Do to be Saved?" published in _Harper's Magazine_ for the month
of August, 1867, and hereto prefixed, I have referred to this
impracticability in fuller detail. It arises from the fact that in his
own house a man can not isolate himself from the hourly hearing of
matters for which he feels responsible, yet to which he can give no
adequate attention without his accustomed stimulus; that his best
friends are apt to upbraid him for a weakness which is not crime but
disease, and that the control of him by those whom he has habitually
directed, however well-judged, seems always an harassment.] I shall
simplify my sketch by supposing that one great object of my life is
already attained, and that an institution for the treatment of the
disease is already in successful operation. Starting at this
fictitious _datum_, I shall carry from his arrival under our care
until his discharge a healthy, happy, and useful member of society, a
gentleman whom for convenience we will name Mr. Edgerton.
Our institution is called not an "Asylum," nor a "Retreat," nor by any
of those names which savor of restraint and espionage--not even a
"Home," as spelled with a capital H--but simply by the name of the
spot upon which it is erected--to wit, "Lord's Island."
It is erected on an island because in the more serious cases a certain
degree of watchfulness will always be necessary. On the main-land this
watchfulness must be exercised by attendants with the aid of fences,
bolts, and bars. On an island the patient whose case has gone beyond
self-control will be under the Divine Vigilance, with more or less
miles of deep water as the barrier between him and the poison by which
he is imperilled. For this reason, and because whatever good is
accomplished on it for a class which beyond all other sufferers claim
heavenly mercy will be directly of the Lord himself, our island is
called "Lord's Island." Here our patient will feel none of the irksome
tutelage which in an asylum meets him at every step--thrusting itself
before his eyes beyond any power of repulsion, and challenging him to
efforts for its evasion which are noxious whether they succeed or not;
defeating the purpose of his salvation when they do, irritating him
when they do not, and keeping his mind in a state of perpetual morbid
concentration upon his exceptional condition among mankind in either
case. Here he has all the liberty which is enjoyed by the doctors and
nurses--save that he can not get at the medicine-chest.
Mr. Edgerton arrives at Lord's Island at 2 P.M. of a summer's day,
having crossed by our half-hourly sail-boat, row-boat, or tug, from
the railroad station on the main-land. If he is very much
debilitated, either by his disease or fatigue, he has full opportunity
to rest and refresh himself before a word is spoken to him
professionally. If a friend accompanies him, he is invited to remain
until Mr. Edgerton feels himself thoroughly at home in his new
quarters.
After becoming fully rested, Mr. Edgerton is invited to state his
case. The head physician must be particular to assure him that every
word he utters will be regarded as in the solemnest professional
confidence. Mr. Edgerton is made to feel that no syllable of his
disclosures will ever be repeated, under any circumstances, even to
the most intimate of his friends or the most nearly related of his
family. This conviction upon his part is in the highest degree
essential. Opium makes the best memory treacherous, and, sad as it may
be to confess it, the most truthful nature, in matters relating to the
habit at least, untrustworthy. Often, I am satisfied, the opium-eater,
during periods of protracted effort or great excitement, takes doses
of the drug which he does not recollect an hour afterward, and may,
practically without knowing it, overrun his supposed weekly dose
twenty-five per cent. I often meet persons addicted to the habit who,
I have every reason to believe, honestly think they are using twelve
grains of morphia daily, yet are found on close watching to take
eighteen or twenty. Again, the opium-eater who by nature would scorn a
lie as profoundly as the boy Washington, is sometimes so thoroughly
changed by his habit that the truth seems a matter of the most
trifling consequence to him, and his assertion upon any subject
whatever becomes quite valueless. Occasionally this arises from an
entire _bouleversement_ of the veracious sense--similar to
certain perversions of the insane mind, and then other faculties of
his nature are liable to share in the alteration. If the man was
previously to the highest degree merciful and sympathizing, he may
become stolid to human suffering as any infant who laughs at its
mother's funeral, not from wickedness of disposition but absence of
the faculty which appreciates woe, and I doubt not that this change
goes far to explain the ghastly unfeelingness of many a Turkish and
Chinese despot whose ingeniously cruel tortures we shudder to read of
scarcely more than the placidity with which he sees them inflicted. If
he was originally so sensitive to the boundaries between Meum and Tuum
that the least invasion of another's property hurt him more than any
loss of his own, this delicate sense may become blunted until he
commits larceny as shamelessly as a goat would browse through a
gardener's pickets, or a child of two years old help himself to a
neighbor's sugar-plums. This, too, quite innocently, and with the
excuse of as true a Kleptomania as was ever established in the records
of medical jurisprudence. I knew a man who had denied himself all but
the bare necessaries of life to discharge debts into which another's
fraud had plunged him, and whose sense of honor was so keen that when
afflicted with chronic dyspepsia the morbid conscientiousness which is
not an unusual mental symptom of that malady took the form of hunting
up the owner of every pin he picked up from the floor, nor could he
shake off a sense of criminality till he had found somebody who had
lost one and restored it to him--yet on being prescribed opium for his
complaint, his nature, under its operation, suffered such an entire
inversion that the libraries, and on several occasions even the
pocket-books of his friends were not safe from him, his larcenies
comprising some of the most valuable volumes on the shelf and sums
varying between two and twenty dollars in the porte-monnaie. "The
Book-Hunter" writing of De Quincey, as you will recollect, under the
_sobriquet_ of "Papaverius," describes the perfectly child-like
absence of all proprietary distinctions which prevailed in that
wonderful man's mind during his later years as regarded the books of
his acquaintance, and the innocent way in which he abstracted any
volume which he wanted or tore out and carried away with him the
particular leaves he wished for reference.
In many cases where the moral sense has suffered no such general
_bouleversement_, the tendency which opium superinduces to look
at every thing from the most sanguine point of view--the vague,
dreamy habit of thought and the inability to deal with hard facts or
fixed quantities--make it necessary to take an opium-eater's
assertions upon any subject with a certain degree of allowance--to
translate them, as it were, into the accurate expressions of literal
life; but even where this necessity docs not exist, in cases sometimes
though rarely met with, where opium has been long used without tinging
any of life's common facts with uncertainty, an opium-eater can
scarcely even be relied on for the exact truth concerning his own
habit. He may be trusted without hesitation upon every other subject,
but on this he almost always speaks evasively, and though about any
thing else he would cut his hand off rather than say the thing that is
not, will sometimes tell a downright falsehood. In most cases he has
been led to this course by witnessing the agony or suffering the
reproach with which the knowledge of his habit is received by his
friends. He lies either in mercy to them or because the pangs which
their rebuke inflicts would become still more intolerable if they knew
the extent of his error.
It is therefore always proper that the opium-eater should find in his
physician a confidant who will not violate his secret even to parent
or wife. The closer the relation and the dearer the love, the greater
will be the likelihood that the optum-eater has shrunk from revealing
the full extent of his burden to the friend in question, and the
greater will be the temptation to deceive the doctor unless the
patient be made to feel that his revelation is as sacred as the
secrets of the bridal-chamber.
I solicit from the friend who accompanied Mr. Edgerton the thoroughest
statement which he can give me of the case, _ab extra_. Such a
statement is of great value--for the inroads which the habit has made
upon the system are often visible to an outsider only. Furthermore, a
friend may give me many circumstances connected with the inception of
the case: family predispositions and inherited tendencies; causes
contributing to the formation of the habit, such as domestic or
business misfortune, prior bad habits of other kinds, illnesses
suffered, and a variety of other agencies concerning which the patient
might hesitate or forget to speak for himself. Then I make
Mr. Edgerton the proffer of that inviolable confidence which I have
mentioned, and having won his perfect faith in me, obtain the very
fullest history of his case which can be elicited by searching, but
most kindly and sympathizing cross-examination. The two statements I
collate and enter for my future guidance in a private record.
Let us suppose an average hopeful case.
I find that my patient is about thirty years of age--of the energetic
yet at the same time delicate and sensitive nervous organization which
is peculiarly susceptible to the effects of opium, from which it draws
the vast majority of its victims, and in which it makes its most
relentless havoc; with a front brain considerably beyond the average
in size and development. My patient's general health, apart from the
inevitable disturbances of the drug, has always been fair, and his
constitufion, under the same limitations, is a vigorous one. His
habit, as in nine cases out of every ten, dates from the medical
prescription of opium for the relief of violent pain or the cure of
obstinate illness. He was not aware of the drug then administered to
him, or at any rate of the peril attending its use, and his malady was
so long protracted that opium had established itself as a necessary
condition of comfortable existence before he realized that it
possessed the slightest hold upon him. When the prescription was
discontinued he suffered so much distress that he voluntarily resumed
it, without consulting his physician, or, if he did consult him,
receiving no further warning as to his danger than that "he had better
leave off as soon as practicable." Or else, on leaving off his use of
opium, the symptoms for which it had originally been administered
returned with more or less severity, and under the idea that they
indicated a relapse instead of being one of the characteristic actions
of the drug itself, he resumed the dose. It gradually lost its power;
little by little he was compelled to increase it; and having begun
with 1/3 grain powders of which he took three per diem, he is now
taking 18 grains of morphia per diem at the end of five years from his
first dose.
If I find him tolerably vigorous on his arrival, as will be the case
when he has come to Lord's Island after calm deliberation and the
conviction not that he _must_, but on all accounts _had better_
abandon the habit, I leave him to recover from the fatigues of his
journey and get acquainted with his surroundings before I begin any
treatment of his case. If, however, as sometimes occurs, he reaches us
in desperate plight, having been so far injured by his habit as to
show unequivocal signs of an opium-poisoning which threatens fatal
results; if, as in several cases known to me, he has summoned all his
remaining vitality to get to a place of refuge, being overtaken either
by that terrible _coma_ which often terminates the case of the
opium-eater in the same fashion that persons new to the narcotic are
killed by an overdose, or by that only less terrible opium-delirium
belonging to the same general class as mania potu--then his case
admits of not a moment's delay. Opium-eaters differ so widely--every
new case furnishing some marked idiosyncrasy which may demand an
entirely different management and list of remedies from those required
by the last one--that for any general scheme of treatment a week's
study of the patient will be necessary. During that week our attitude
will be simply tentative and expectant, and at its close the proper
fidelity and vigilance will have authorized us in making out something
like a permanent schedule for the patient's upward march, though even
then we must be prepared, like skillful generals, to meet new
emergencies, take unforeseen steps, even throw overboard old theories,
at any stage of his progress. In no disease is there such infinite
variety as in that of opio-mania, in none must the interrogation of
nature be more humbly deferent and faithfully attentive; in none do
slight differences of temperament, previous habits, and circumstances
necessitate such wide variation in the remedies to be used. Notice, by
way of illustration, the fact that one opium-eater under my care was
powerfully affected and greatly benefited by the prescription of _one
drachm_ of the fluid extract of _cannabis indica_, while another, in
temperament, history, tendencies, and all but a few apparently
trifling particulars almost identical, not only received no benefit
but actually experienced no perceptible effect whatever from the
absolutely colossal dose of _four fluid ounces_. [Footnote: I am
aware how incredible this statement will seem to those who have never
had any extensive experience of the behavior of this remarkably
variable drug, and get their notion of its action from the absurd
directions on the label of every pound vial I have seen sent forth by
our manufacturing pharmaceutists. "Ten to twenty drops at a dose,"
they say, "cautiously increased." Cannabis should always be used with
caution, but ten or even twenty drops must be inert in all but the
rarest cases, and I have given an ounce per diem with beneficial
effect. But four ounces of the best extract (Hance & Griffith's)
producing literally no effect of any kind on an entirely fresh
subject, is a phenomenon that I must have needed eye-witness to
imagine possible.] I may add that in the latter case, _bromide of
potassium_ was administered with the happiest result--in fact as
nearly approaching in its efficiency the character of a succedaneum as
any remedy I ever used to alleviate the tortures of opium, while in
the former no result attended its administration salutary or
otherwise. The vast diversity of operation exhibited in different
patients by the drug _scutellaria_ is still another illustration of
the careful study of idiosyncrasies requisite for a successful
treatment of the opium disease. But when the case comes into our hands
at a desperate period there are many means of instant alleviation
which may anticipate without interfering with future treatment based
on study.