brought himself temporarily into a critical place by the fatigues and
anxieties of harassing business, by exceptional overwork which kept
him at his desk or in his shop until inordinately late hours; even,
let me say, by going for entire nights without sleep and neglecting
his regular meals day after day for a period of several weeks;
performing and enduring all this by the support of extra doses of
opium. Perhaps, finding the stimulus to which he has become accustomed
too slow in its operation, he has violated his usual custom of
abstinence from alcoholic drinks and reinforced his opium with more or
less frequent potations of whisky. This is no fancy sketch, Our
overtasked commercial men frequently go on what might with propriety
be called "a business spree," in which for a month at a time, whether
using stimulants or not, they plunge into as mad a vortex with as
thorough a recklessness as those of the periodical inebriate; finding
out in the long run that the fascinations of speculation, and the
spring and fall trade, bring as dire destruction to soul and body as
those of the bowl and the laudanum vial. During times of great
financial pressure or under the screws of preparation for some great
professional effort, the moderate opium-eater finds that he must
inevitably increase his dose. When he adds liquor to it (and this
addition to an old opium-eater is often as necessary as liquor alone
would have been before he used opium at all) he is indeed burning his
candle at both ends. Mr. Edgerton reached the commencement of his
period of extra exertion with as sound a constitution--in as
comfortable condition of general health--as is enjoyed by any man
habituated to opium for four or five years; and such cases are
frequently found among men who appear to enjoy life pretty well,
attend to their business with as much regularity as ever, and show no
trace of the ravages wrought by their insidious foe to any but the
expert student. After six weeks of exciting labor and solicitude,
during which his sleep and his rations were always delayed till
exhaustion overpowered him, and then cut down below half the normal
standard, he wakes one morning from a slumber heavy as death into a
state of the most awful vigilance his mind can conceive of. He even
doubts for some moments whether he shall ever sleep again, and in the
agony of that strange, wild suspicion, a cold sweat breaks out over
him from head to foot. Waking from the most utter unconsciousness
possible to a wide-awake state like having the top of one's skull
suddenly lifted off by some surgeon Asmodeus, and the noonday sun
poured into every cranny of his brain, he suffers a shock compared
with which any galvanic battery, not fatal, gives but a gentle
tap. The suddenness of the transition--no gentle fading out of
half-remembered dreams, no slow lifting of lids, no pleasant
uncertainty of time and place gradually replacing itself by dawning
outlines of familiar chair and window frame and cornice--the leap from
absolute nonentity into a glaring, staring world--for a moment almost
unsettles Mr. Edgerton's reason. Then the fear for his sanity passes
and a strange horror of approaching death takes its room. His pulse at
the instant of waking throbs like a trip-hammer; an instant more and
it intermits. Then it begins again at the old pace. He snatches up his
watch from the bureau with a trembling hand and counts--the beat is
130 a minute. Again it stops; again it begins; but now little by
little growing faster and threadier until it runs so swiftly yet so
thinly as to feel under his finger like some continuous strand of
gossamer drawn through the artery. His feet and hands grow deadly
cold. He seems to feel his blood trickling feebly back to his heart
from every portion of his body. He catches a hurried look at the
glass--he sees a dreadful spectre with bistre rings around the
eyelids, an ashen face, leaden lips, and great, mournful, hollow,
desolate eyes. Then his pulse stops altogether; his lungs cease their
involuntary action; and with a sense of inconceivable terror
paralyzing the very effort he now feels it vital to make, he puts them
under voluntary control and makes each separate inspiration by an
effort as conscious as working a bellows. I doubt not that many men
have died just at this place through absolute lack of will to continue
such effort. Then the metaphorical paralysis of fear is seconded by
the simulation of a literal one, extending through the limbs of one
side or both; the sufferer reels, feeling one foot fail him--tries to
revolve one arm like a windmill, that he may restore his circulation,
and that arm for some instants hangs powerless. Presently, with one
tremendous concentration of will, his brain shouts down an order to
the rebellious member--it stirs with sullen reluctance--it moves an
inch--and then it breaks from the prison of its waking nightmare.
Summoning his entire array of vital forces, our patient leaps, and
smites his breast, kicks, whirls his arms, and little by little feels
his heart tick again. By the time a feeble and sickly but regular
pulse is re-established he has gone through enough agony to punish the
worst enemy, my dear Sir, that you or I ever had. The vague,
overpowering fear of death which during such an attack afflicts even
the man who by grace or nature is at all other times most exempt from
it is one of this period's most terrible symptoms. This passes with
the return of breath and circulation.
But the clammy sweat continues--pouring from every point of the
surface--saturating the garments next the skin as if they had been
dipped in a tub of water. Presently our patient begins to suffer an
intolerable thirst, and runs to the ice-pitcher to quench it. In
vain. He can not retain a mouthful. The instant it is swallowed it
seems to strike a trap and is rejected with one jerk. He seeks the
sedative which up to this hour has allayed his worst gastric
irritations. Now, if never before, opium in every form produces
nausea. Laudanum instantly follows the example of the water, and even
a dry dose of morphia, swallowed with no moisture but saliva, casts
itself back after agonizing retchings. To liquor his rebellious
stomach proves yet more intolerant--food is almost as irritating as
liquor. In a horror he discovers that even pounded ice will not stay
down--and he is parching like Dives. His anguish becomes nearly
suicidal as the fact stares him in the face that he has come to the
place where he can not take opium any more--though to be without it is
hell--that food, drink, medicine, are all denied him.
A merciful, death-like apathy ensues. He lies down, and with his brain
full of delirious visions, appalling, grotesque, meaningless,
beautiful, torturing by turns, still manages to catch an occasional
minute of unconsciousness. He hears his name called--tries to rise and
answer--but his voice faints in his throat and he falls back upon his
bed. Friends enter his bed-chamber--in an agony of alarm rouse
him--lift him to his feet--but he has not the strength of an infant,
and he falls again. In this condition he may continue for a day or
two, then sink into absolute coma, and die of nervous exhaustion, or
his constitution may rally as the effects of the last overdose pass
off, and the man, after a fortnight's utter prostration, come
gradually back to such a state of tolerable health and comfort as he
enjoyed before he overtaxed himself.
Mr. Edgerton is brought to Lord's Island in the condition I have
described, living near enough to be transported on mattresses in
carriage and boat. A few hurried questions put to his friends reveal
that although his condition is alarming it is by no means necessarily
fatal; being one of those in which the habit is of such comparatively
short standing, and the constitution still so vigorous, that even at
home he might come up again by natural reactions.
He is immediately undressed and put to bed, with hot bricks and
blankets at the extremities, and the galvanic battery is judiciously
administered by placing both feet in contact with a copper plate
constituting the negative electrode, while the operator grasps the
positive in one hand, and having wetted the fingers of the other,
follows the spine downward, exerting gentle pressure with them as he
goes. "Judiciously," I say, because there is a vast deal of
injudicious use of the battery. In many cases, for instance, a
powerful and spasmodic current is used to the absolute injury of the
patient, where the greatest benefit might be secured by an even one so
light as scarcely to be perceptible. But I can only mention the
battery. Its application is by itself a science, and demands a
book. The practitioner who treats opium patients needs that science as
much as any one interested in whatsoever branch of nervous
therapeutics. The battery in the hands of a scientific man is one of
our most powerful adjuncts throughout every stage of treatment, both
of opium-eating and its sequelae. Paralysis following the habit, and
persistent long after its abandonment, I have cured by it when all
other means failed. Here, however, we have only room to indicate the
weapons in our armory.
If Mr. Edgerton's digestive apparatus is still as intolerant as at the
commencement of the attack which hurried him to Lord's Island, we may
hope for a marked mitigation of this symptom, in the use of the
battery by passing a mild current transversely through him in the
region of the solar plexus. As soon as it is possible for his stomach
to retain any thing we administer a bolus of _capsicum_,
compounded of five grains of the powder with any simple addition like
mucilage and and liquorice to make it a coherent mass. The remaining
nausea and irritability will in great likelihood be speedily relieved
as by magic, and with these will disappear some of the most
distressing cerebral symptoms--the horror and frenzy or comatose
apathy among them. In few cases will a patient reach the Island in
time for the advantageous use of _belladonna_. That is a direct
antidote--exerting its function in antagonism to the earlier toxical
effects of the opium. In cases where a single overdose has worked the
difficulty and produced the coma which Mr. Edgerton's now resembles,
it may be given to an old _habitué_ of the drug with as good
advantage as to a person whose overdose is his first experience of
opium. It is of especial value where the absorbents have carried the
excess beyond the reach of an emetic, any time, indeed, within fifteen
or twenty hours after the overdose, when sulphate of zinc and the
stomach-pump have failed to bring the poison. If our patient on the
Island has taken his overdose so recently, and it seems still worth
while to act by antidote, we shall be obliged to get over the
difficulty presented by his stomach's lack of retention by
administering our belladonna in the form of _atropin_ in solution
as a hypodermic injection. The many eminent researches of late made in
this interesting method of administering remedies, and the
practitioner's own judgment, must guide him as to the proportions of
his dose--whether one-fortieth grain, one-twentieth, or larger. Of
this operation, with opium-eaters, I have seen several most successful
instances.
In all probability, however, there will be a better field in such
cases as Mr. Edgerton's for the use of nux vomlca than of
belladonna. Where the prostration is so great as to call for the most
immediate action to avoid a syncope from which there shall be no
rallying, it will be unwise to await the soothing action of the
battery, capsicum, or any other means preparatory to giving nux
votnica by the mouth. _Strychnia_ in solution (it is needless to
say with what caution) must be administered like the atropin,
subcutaneously, or else nux vomica tincture in the form of the
ordinary enema in about the same dose as it would be given by the
mouth. The former method in wise hands is the better, both as the
speedier, and, considering the opiate torpidity of the intestines, by
far the more certain. In cases where the stomach tolerates fluid, as
our ability to await the action of the battery and capsicum have now
enabled us to find Mr. Edgerton's, we may give from fifteen to twenty
drops of the ordinary pharmaceutical tincture of nux vomica in a
table-spoonful of water.
In the course of ten minutes we find a decided improvement in the
pulse of the patient; he experiences great relief from his feelings of
apprehension and distress about the epigastrium; and the most powerful
tonic known to science begins dispatching its irresistible behests to
every fibre of the organic life. That painful as well as agitating
_subsultus_--that involuntary twitching and cramp in the muscles
of the limbs and abdomen which often characterizes this form of the
opium malady, by degrees gets lulled as under a charm, and it may not
even be necessary to repeat the dose in two and a half hours to remove
it so entirely that the patient gets ten or fifteen minutes of
refreshing sleep.
The earliest symptoms of this species of attack sometimes indicate
such prostration as make any bath of the ordinary kind unsafe; yet
rare indeed are the cases (not one in a hundred I should say) where
there is any danger of further depressing the nervous system (of
course the great thing to guard against) by putting a patient like
Mr. Edgerton into a _Russian bath_. I need not enlarge upon the
value of this most admirable appliance--all the most enlightened men
of the medical profession know it and esteem it as it deserves, though
its use in rheumatic affections and cutaneous diseases has hitherto
received more study than in the class of maladies where its employment
is perhaps the most beneficial of all--the nervous. Pre-eminently
valuable is it in the treatment of delirium tremens and in every stage
of the opiomania.
As your book is for the purpose of the public rather than professional
men, I may perhaps properly say a few words about this bath by way of
description. We have one, as a matter of course, at Lord's Island.
A room forty-five feet long and twenty broad, with a vaulted ceiling
twenty feet high at the crown, is provided along each of its two
longer sides with a series of marble slabs rising in three tiers from
eighteen inches above the floor to a couple of feet below the
ceiling. The idea may be gained more accurately by supposing three
steps of a giant staircase mounting from an aisle three feet wide
through the middle of the room, back and upward to the parallel
cornice. The level surface of each of these steps is sufficiently wide
to accommodate a man stretched on his back, and the upright portion of
each step is an iron grating. Under the series of steps on both sides
runs a system of sinuous iron pipes pierced with minute holes, and
connected by stop-cocks with a boiler out of sight.
The steps occupy in length twenty-five feet of the room, and its
entire breadth except the narrow aisle between the is occupied by a
tank sunk beneath the floor, sixteen feet square by four and a half
deep, filled with water kept throughout the year at a uniform
temperature of about 70° F., and by the gallery which runs round the
railing of the tank on the floor level. About the sides of the gallery
are arranged hot and cold water-pipes with faucets and hose
connections, the hose being terminated by a spray apparatus similar to
the nose of a watering-pot. Opening off the gallery at the end
furthest from the steps is a small closet fitted up with ascending,
descending, and horizontal shower apparatus, by means of perforated
plates connecting with the water-pipes by faucets set in floor, walls,
and ceiling.
After the battery, the capsicum, and the nux, if Mr. Edgerton can
retain it, we feed him by slow tea-spoonfuls from one-half to a whole
cup of the most concentrated beef-tea--prepared after Lieblg's recipe
or another which I have usually found better relished, and as that,
where food must be administered to fastidious stomachs, is half the
battle, which I prefer. (I will give it hereafter.) Should his stomach
reject it thus administered, it must be given as an enema. Its place
in the plan of all enlightened medical treatment is too lofty to need
my insisting on. We must rely on it at Lord's Island every step of our
way. It will not have been within our patient's system five minutes
before the pulse shows it, nor ten before he feels from head to foot
as if he had taken some powerful and generous stimulant. It is always
wise to give beef-tea, even just before a bath of any kind, and it is
never well to enter the Russian bath on an empty stomach.
Having taken his beef-tea, Mr. Edgerton is carried or propelled in a
wheel-chair by attendants to the Russian bathroom. Having stripped in
an anteroom, upon entering the vaulted chamber he finds himself in an
atmosphere of steam at 120° F., which fills the apartment, even
obscures the skylights, yet to his surprise does not impede his
respiration or produce any unpleasant sense of fullness in the
head. He is now stretched on his back upon one of the lowest slabs,
where the atmosphere is coolest and the vapor least dense; a large wet
sponge is put under his occiput for a pillow, and another sponge in a
pail of cool water placed by his side with which he, or in case of too
extreme debility his attendants, may from time to time bathe and cool
the rest of his head. As soon as he has become accustomed to the heat
and moisture, a sensation of pleasant languor steals over him; all
remains of his nausea and other gastric distress vanish; his nervous
system grows more and more placid; his clammy skin is bedewed by a
profuse and warm natural perspiration. Perhaps, as in cases of extreme
debility and where the nerves have suffered tension from protracted
pain, he even falls into a pleasant sleep. He is allowed to lie
quietly on this lower slab for about fifteen minutes. An attendant
then lathers him from head to foot with a perfumed cake of soap and
gives him a gentle but thorough scrubbing with an oval brush like that
in use among hostlers--finishing the operation by vigorously
shampooing, Oriental fashion, each separate joint of his whole body,
with a result of exquisite relief not exaggerated by Eastern
travellers as applicable to well people and quite beyond expression
when its subject is the poor, long-tortured frame of a sick
opium-eater. The process over, the patient is taken to the gallery and
stood up before the hose apparatus above-mentioned. One hand of the
attendant directs over his body a fine spray of steam and the other
follows it up and down with a spray of cool water (either of which by
combining and graduating appropriate faucets may be made as warm as
you like), producing a fine glow and reaction of the whole
surface. The up, down, and lateral showers are then administered,
after which the patient is sent to plunge into the tank, and if able
to swim, a stroke or two. Emerging, rosy as Aphrodite, and with a
sense of vigor he can hardly believe, he again lies down on the
slab-this time taking the next higher tier, and in about ten minutes
more, mounting, if so disposed, to the highest, where the perspiration
rolls from him in rivulets, and with it as makes him feel like a new
being. Finally, in about an hour from the time he entered the
bath-room he is treated to one last plunge in the tank and carried
back to the anteroom. The thermometer there marks but 70° F., or half
a hundred degrees cooler than the steam from which he has just
emerged; still his blood has been set in such healthful circulation,
and during the last hour he has absorbed such an amount of caloric,
that the change seems a very pleasant one, and his skin has been so
toned that he runs not the slightest risk (even were he the frailest
person with pulmonary disease) of catching cold. Singular as it may
seem, the first case of such a result has yet to be recorded.
This is all the more remarkable when we consider that instead of being
immediately wrapped up after his vigorous drying with furzy
bath-towels, he is kept naked for five minutes longer during a further
process of hand-rubbing and shampooing by an attendant. The shampooing
takes place as he lies prostrate on a couch and thus gives his
debility all the advantage of rest and passive exercise at the same
time. Whether we explain it upon the yet unsettled hypotheses of
friction, the suppling which the patient gets in this part of the
process from the hands of a strong, faithful, cheerful-minded and
hale-bodied servant is one of the most valuable means which can be
relied upon for the relief of opium suffering at any stage
whatever. After coming from the anteroom our patient who entered more
dead than alive may feel vigor that he would like to give his
recovered powers play in walking back to his room, but it is best not
to humor him by letting him draw on his first deposit. He should be
tenderly wheeled back as he came--put to bed, and if it does not
revolt his appetite, fed slowly as before another cup of
beef-tea. After that he will probably fall into a refreshing slumber
from which he is on no account to be roused, but suffered to wake
himself. On his waking another cup of beef-tea should be given him,
and no other medicine, unless his pulse becomes alarming and he shows
signs of return to the original sinking condition in which we found
him--when the nux may be repeated.
It is now improbable, after the happy change described has taken place
in him, that he will succumb to the acute attack of opium-poisoning
which led him to us. Alarming as it appears, it is seldom dangerous or
persistent. The patient who has not constitutional strength to rally
at once, goes down rapidly and dies in a few days, while he who
rallies once gets well, _pro hâc vice_, without much medical
treatment save that which was promptly given at the critical moment,
or treatment of any kind but nourishing food, rest, baths, and
vigilant, tender nursing. As soon as the chronic appetite calls for
its habitual dose, and the stomach receives it without revenging its
grudge against the recent excesses, the patient may be considered out
of danger as far as the acute attack is concerned.
Here I will be asked (as I am constantly out of the book), why not
begin the abandonment of the drug as soon as this acute attack is
over? When the terrible and immediate peril has been staved off by
such a mere hair's-breadth, why listen again to "the chronic appetite"
which "calls for its habitual dose?" Surely, now that the patient has
gone for forty-eight hours or more without that dose, would it not be
better never to return to it? Must he begin his former career again
and afterward have all the same ground to go over?
I answer that he will not have the same ground. That which he has just
traversed was the ground separating between an excess and his normal
life--and he is in reality in a worse condition to try the experiment
of instant abandonment than he was before the struggle. It is a very
different thing to cure a man of acute from curing him of chronic
opium-poisoning; and my own large experience, together with that of
all the most experienced, the soundest and most skillful men that I
have ever known as successful practitioners among these cases, points
to the unanimous conclusion that it is not safe, either to mind or
body, to make the abrupt transition required of an old opium-eater who
must give up his drug _in toto_ and at once, especially after
such an acute attack as that just described. He would be very likely
to die of exhaustion, to endure an amount of agony which would
permanently enfeeble his mind, or to commit suicide as his only way of
escape from it, if we cut him short from the equivalent of 15 or 20
grains of sulphate of morphia after having used the drug for five
years. The most terrible case of opium-eating which I ever saw
instantly cu short was one where the patient used 33 grains of morphia
per diem, but he had used it for less than a year, and possessed a
constitution whose physical grit and mental pluck anybody would
pronounce exceptional, though even that did not save him from the
tortures which endangered his reason. I am always in favor of a man's
"breaking off short" if he can. I believe that the majority of people
who have used the drug less than a year can, but the number who are
able to do it after that diminish in geometric ratio with every month
of habituation.
I therefore permit Mr. Edgerton, as soon as his stomach will bear it,
to return to the use of opium.
But before giving him his dose I make the stipulation that from this
moment he shall deal as frankly with me as he does with his own
consciousness--that we shall have no opium secrets apart.