one process in the Russian bath, is another means of relief constantly
in use while the patient is going through his terrible struggle. Our
attendants upon Lord's Island are picked men. We do not proceed on the
principle in such favor among most of our public institutions,
asylums, water-cures, and the like, of procuring the very cheapest
servants we can get, and thinking it an economical triumph to chuckle
over if [Footnote: This is all that the "canny" business men who
compose the managing boards of some of the first asylums in this
country permit the heads of the institutions to offer those who must
for twenty-three hours of the twenty-four be responsible for the
moral, and physical well-being of a class of patients (the insane) who
require, above all others, wisdom, tact, benevolence, courage,
fidelity, and the highest virtues and capacities in those who attend
them.] we can manage our patients with the aid of subordinates at
twenty dollars a month. We know that in the long run it will
pre-eminently _pay_ to engage the best people, and we pay the wages
which such deserve--wages such as will ensure their quality. Our
attendants are selected from the strongest, healthiest, best-tempered,
most cheerful-minded, kindest-hearted, most industrious and faithful
men and women we can find--people not afraid of work and indefatigable
in it--people who understand that no office they can perform for the
sick is degrading or menial, and who will not object, when the patient
needs it, to lift him like a haby and rub him vigorously with their
hands for an hour at a time. This rubbing our patient often finds the
most heavenly relief, not only right after a bath, but at any hour of
the day or night. There is, therefore, no hour of either during which
Mr. Edgerton can not procure this means of relief from some servant
upon duty. Applied to the back and legs especially, it is a sovereign
soother for both the opium-eater's acute pain and that malaise which
is only less terrible. In very severe cases it may be necessary to rub
the patient for many consecutive hours, and in such cases It may be
necessary either to assign an attendant to the patient's sole care,
or, better yet, to have several attendants relieve each other in the
manual labor. If the patient could afford and desired it, I should
approve of his having his own private servant during the worst of the
struggle to perform this labor for him, with the distinct
understanding, however, that he was to be private only in the sense of
devoting himself to this patient solely, and to receive all his orders
from the head of the institution. The expense of such an arrangement
would be trifling compared with the amount and intensity of agony
which it would save, and in a case of no longer standing than
Mr. Edgerton's need last only through the first fortnight or so after
abandoning the drug.
Another most important means of alleviation is the galvanic
bath. House's patent is an excellent apparatus for the purpose;
convenient in shape and size, comfortable, not easily deranged,
affording a variety of simple and combined currents, adjustable so as
to pass the current either through the whole body or along almost any
nervous tract where it is especially wanted for the relief of local
suffering like that of the opium sciatica, and manageable by any
intelligent child who has ever watched attentively while it was
getting put into operation. Many a sufferer who seems quite a
discouraging subject under the dry method of administering galvanism
responds to it at once transmitted through a bath, and in any case
this is a no less beneficial than delightful way of using it. The skin
is so much better a conductor when wet, and the distribution by water
so uniform, that in most cases it may be pronounced the best way. The
Turkish bath I have seen used with excellent result during the earlier
days of suffering. It will seem almost incredible to any one who has
taken a Turkish bath for other purposes, and knows the tax which it
seemed to inflict upon his nervous system for the first few minutes
after entering the heated chamber and till profuse perspiration came
to his relief, when I say that I have seen a man brought to the bath
in that almost dying state of prostration some pages back described as
belonging to the acute attack of opiomania, at once subjected to the
temperature of 130° F., and in ten minutes after to thirty degrees
higher, not only without rapidly sinking into fatal collapse, but with
a result of almost immediate and steady improvement. To my own great
surprise his pulse began getting fuller, slower, steadier, and in
every way more normal from the moment that the attendant laid him down
upon his slab. When he came in he was obliged to be carried in the
arms of his friends like an infant; his pulse one minute was 140, the
next 40-60, or entirely imperceptible, and when fastest alarmingly
thready; his countenance was corpse-like, he breathed nine or ten
times a minute, and his general prostration so utter that he could
scarcely speak even in a whisper. He stayed in the bath an hour and a
quarter, in a streaming perspiration for the last forty minutes, and
much of the time sleeping sweetly. He came out walking easily without
assistance, and in the cool anteroom fell asleep again upon the
lounge, not to wake for an hour longer. This one bath entirely broke
up the attack. He kept on improving, and with the aid of beef-tea was
well enough to go to business in a week. The value of the bath in
treating Mr. Edgerton at present will he greatest when he suffers most
severely from acute neuralgic pains in the legs and back, especially
if the efficiency of the hot full-baths and vapors seem temporarily
suspended through frequent use. His own feelings are the best
criterion of its worth at any given time. It operates very differently
on different people and in different conditions of the system. To some
persons it is less debilitating than the use of hot water, and others,
myself among the number, find it so excessively disagreeable from the
apoplectic sensation it produces in their heads, and the difficulty of
breathing which they suffer from it, that nothing but a discovery that
it was the only means in their particular case of relieving sufferings
like those of opium would induce them to enter it. Many persons
profess to like it as well as the Russian (which, singularly enough,
in no case have I ever known to produce the disagreeable feeling in
head or lungs), and it certainly ranks with the foremost alleviatives
of the opium suffering--the agonizing rythmical neuralgia of which I
have spoken usually becoming magically lulled within two minutes from
the time of entering the first heated chamber, and ceasing altogether
as soon as the perspiration becomes thoroughly established. At Lord's
Island our Turkish bath-room will immediately adjoin our Russian, and
the temperature being supported by pipes from the same boiler which
furnishes vapor to the other, will be no heavy addition to our expense
in the way of apparatus. I don't know whether it is necessary to tell
any body that the Turkish bath is merely an exposure of the naked body
(with a wet turban around the head) to a dry heat varying from 110º
F. to a temperature hot enough, to cook an egg hard--followed by
ablutions and shampooings somewhat similar to those of the Russian
bath.
As it is our aim to _cure_ the opium-eater by bringing to bear
upon his most complicated of all difficulties every means which has
proved effectual in the treatment of any one of its particulars,
however caused in other instances, we ask no questions of any
appliance regarding its nativity, but take from the empiric whatever
he has stumbled on of value as freely as the worthiest discoveries of
the philosopher from him. There have been various attempts to erect
into a _pathy_ every one of the applications we have already
mentioned, and I shall close this brief outline of our therapeutic
apparatus at Lord's Island with one more valuable method of relief and
cure whose enthusiastic discoverers (or rather adapters) have outraged
etymology worse than the regular practice by trying to build on their
one good thing an entire system under the title of "Motorpathy."
[Footnote: I see that some scholar has lately got hold of them and
forced them to respect philological canons by kicking the mongrel out
of their dictionary and calling themselves _Kinesipathists_,
instead of the other Graeco-Latin barbarism.] The "_Movement
Cure_" contains some very good ideas, which, like many of the
Hydropathists', ought to be taken up by Science, in whose hands and
their proper place they can do fine service.
As we have found in the case of shampooing, a great deal of the
suffering of any part can be taken out by giving it something else to
do. A portion of the good done by rubbing an aching leg is no doubt
accomplished by setting the nerve at work upon the sensations of
pressure and of heat and so diverting it from that of pain, but
another portion is probably due to the fact of motions producing
changes, in the nature of mechanical and chemical decompositions, in
the substance of the tissue; thus by a well known physiological law
summoning a concentration of the nervous forces to the particular
part. Nature is thus accelerated in her action there, and as that
action is always toward cure (so long as life and hope exist), the
nerves of the part are reinforced to act sanely. To be weak is to be
miserable--to be strong is to be free from pain--thus the nerve's
returning vigor eliminates its suffering. The fresh blood that is
pumped into the part by motion brings about another set of
ameliorating changes of more especial importance where the pain is
caused by a local lesion instead of rather being sympathetic with the
whole systematic debility. Whatever be our theory, the tenet that
motion relieves pain, as a tenet, is as old as the "_back-
straightening_" process used in some shires by the British
turnip-hoers who on coming to the end of their rows lie down and let
the rest of the women in the field walk over their toil-bent spine and
cramped dorsal muscles, while as a fact it is as old as pain itself.
On Lord's Island, therefore, we have a room fitted up with apparatus
intended to give passive exercise to every part of the body which the
pain of abandoning opium is especially likely to attack.
Mr. Edgerton is suffering extremely, about the close of the third day
after his last 1/2 grain dose of morphia, from the agonizing rythmical
neuralgia of which I have spoken, throbbing from the loins to the
feet; and although with good effect we have given him galvanism,
shampooing, baths of several kinds, and a number of internal remedies,
still, wishing to keep each of these appliances fresh in its potency,
we make a change this time to the "movement-room." He is stripped to
his shirt, dressing-gown, and drawers, and laid on his back along a
comfortable stuffed-leather settee, running quite through whose bottom
are a number of holes about four by three and a half inches. These
holes are occupied by loose-fitting pistons which play vertically up
through the cushion--lying level with it when at rest, and when in
motion projecting about two inches above it at the height of their
stroke. Motion is secured to them by crank connection with a light
shaft running beneath the settee, revolved by a band-wheel, which in
its turn connects by a belt with the small engine outside the
building, by which all the drudgery of the house is performed.
Mr. Edgerton is adjusted over the holes so that, in coming up, the
pistons, which are covered with stuffed leather pads, strike him
alternately on each side of the spine, from about the region of the
kidneys to just beneath the shoulder-blade. The shifting of a lever
throws the machine into gear, and for the next five minutes, or as
long as he experiences relief, the artificial fists pummel and knead
him at any rate of speed desired, according to the adjustment of a
brake. This process over, if he still feels pain in the lower
extremities, his foot is buckled upon an iron sole which oscillates in
any direction according to its method of connection with the power,
from side to side, so as to twist the leg about forty-five degrees
each way, up and down, to imitate the trotting of the foot, or with a
motion which combines several. A variety of other apparatus gives play
to other muscles; but I have said enough to show the idea of its
_modus operandi_. The passive exercise thus afforded is an admirable
substitute for that active kind which in his first few days of
deprivation the intensity of his agony often incapacitates him from
taking. I have seen men at this period almost bent double from mere
pain, and hobbling when they attempted to walk like subjects of
inflammatory rheumatism. Their debility also is often so great as to
prevent exercise, especially when the characteristic diarrhea has been
for some days in operation, though different people differ
astonishingly in this respect. I knew one case where an opium-eater of
three years' habituation to the drug endured in its abandonment every
conceivable distress without suffering from debility at all, as may be
inferred from the fact that as his only way of making life tolerable
he took a walk of twelve miles every morning while going through his
trial. The majority, however, suffer not only pain but prostration of
the most distressing character--a combination as terrible as can be
conceived, since the former will not let the victim remain in one
position for a single minute, and the latter takes away all his own
control of his motion, so that he seems a mere helpless, buffeted mass
of agony--an involuntary devil-possessed, devil-driven body,
consciousness at its keenest, will at its deepest imbecility--almost
fainting with fatigue, unable to limp across the room on legs which
seem dislocated in every joint and broken in a thousand places, yet
unable to stop tossing from side to side, and writhing like a trodden
worm all night, all day, perhaps for weeks.
"Oh!" I have heard the patient say, "would to God this made me
_tired!_ healthily tired, so that I could fall into a minute's
doze!"
The apparatus I have just been describing meets this want. Sometimes
while the leather and iron fists are pegging away and pummelling him
at their hardest, he falls asleep on the machine! It has done for him
all that he had not the strength to do for himself--tired him
healthily.
The remedies I have mentioned are capable of indefinite
combinations. The head of an institution like Lord's Island will want
them all, although any one given case may not require all of them. In
the hands of a thoroughly scientific, skillful man, they form an
armory of means with which such an amount of good can be done as
beggars our imagination. Combined with the most faithful attention to
the patient's diet--the establishment of healthful nutrition, so that
as fast as those abnormal matters which have been clogging the system
get cleared away by Nature's relentless processes of decomposition,
fresh material may be soundly built up into the system to replace the
strength which the fatal stimulant feigned--combined with vigilant,
tender, patient nursing--the means described are probably, in many
cases, adequate of themselves to restore any opium-eater who is
salvable at all. Still, brief as this sketch is, and so far from
making any pretensions to be an exhaustive treatise for the guidance
of the profession, I should fail of presenting even a fair outline of
the treatment which an unusually wide experience with opium-eaters has
convinced me to be the true one, did I not add to the above a few
words regarding the medicinal agents which are of value during the
month of peculiar trial through which Mr. Edgerton is now passing.
It is scarcely necessary to premise that no such thing as a
succedaneum for opium is comprehended in the list of these agents. Any
drug which would so nearly accomplish for the opium-eater what opium
accomplishes that he would not miss the latter, must be nowise
preferable to opium itself. Such a drug must be able to prevent the
decompositions which cause the suffering; to continue that
semi-paralysis of the organic functions in which opium's greatest
fascination exists, a paralysis leaving the cerebral man free to
exhaust all the vitality of the system in pleasant feelings, lofty
imaginings, and aerial dreams, without a protest from the gauglionic
man who lies a mere stupefied beggar without any share in the funds of
the partnership wherewith to carry on the business of the stomach and
bowels and heart, the kidneys and lungs and liver. It must be a drug
that can prevent the re-awakening ol the nutritive and excretory
processes--for it is these whose waking, seeing how late in the day
it is, clamoring at the confusion in which they find affairs and at
the immense quantity of behind-hand work suddenly thrown on them,
together with that re-sharpening of long-dulled sensation by which the
clamor comes into consciousness loud as the world must be to a totally
deaf man suddenly presented with his hearing, which constitute the
series of phenomena which we call pain. No! there is no such thing as
a substitute for opium, save--more opium or death. And I do not know
that I need say "_or_."
Still, there are many alleviatives by which the suffering may be
rendered more endurable--by which now and then our patient may be
helped to catch a few moments of that heavenly unconsciousness which
makes the nervous system stronger to fight the battle out to its
blessed end--by which processes of Nature may be slowed when they get
too fiery-forceful for human courage to endure, or accelerated when
the pull seems likely to be such a long one as to kill or drive mad
through sheer exhaustion. I have spoken of bromide of potassium. This
in connection with the pack may in many cases wisely be continued
throughout the whole progress of the case, and often hastens the
restoration of general nervous equilibrium by many days, removing to a
very pereptible degree that _hyperaesthesia_, that exaggerated
sensation of all the natural processes normally unconscious, which
continues to rob the sufferer of sleep long after acute pain is
lulled. The greatest variety of opinions prevails upon the subject of
cannabis and scutellaria. The principal objection to the cannabis lies
in two facts. First, it is very difficult to obtain any two
consecutive specimens of the same strength, even from the same
manufacturer. Second, in its gum state it is exceedingly slow of
digestion, and unlike opium not seeming to affect the system at all by
direct absorption through the walls of the stomach, it is very slow in
its action; the dose you give at 4 P.M. may not manifest itself till 9
or even midnight, and even then may still move so sluggishly that you
get from it only a prolonged, dull, unpleasant effect instead of a
rapid, favorable, and well-defined one. If it is given in the form of
a fluid extract or tincture, its operation can be more definitely
measured and counted on, but the amount of alcohol required to
dissolve it is sufficient often to complicate its effects very
prejudicially, while in any case the immense proportion of inert
rubbish, gum, green extractive, woody fibre, and earthy residuum is so
great as to be a severe tax on the digestive apparatus--often
seriously to derange the stomach of the well man who uses it, and much
more the exquisitely sensitive organ of the opium-eater, I might add a
third objection-the fact that its effects vary so wonderfully in
different people--but the physician can soon get over that by making
his patient's constitution in the course of a few experiments with the
drug the subject of his careful study. Both its lack of uniformity and
its difficulty of exhibition may be nullified by using the active
principle. It has been one of the _opprobria medicinæ_ that in a
drug known to possess such wonderful properties so little advance has
been made toward the isolation of the alkaloid or resinoid on which it
depends for its potency. I have for years been endeavoring to interest
some of our great manufacturing pharmaceutists in the attainment of a
form--condensed, uniform, and portable--which should stand to cannabis
in the same relation which morphia bears to opium. I believe that, in
collaboration with my friend Dr. Frank A. Schlitz (a young German
chemist of remarkable ability and with a brilliant professional career
before him), I have at last attained this desideratum. I have no room
or right here to dwell upon this interesting discovery further than to
say that we have obtained a substance we suppose to bear the analogy
desired and to deserve the title of _Cannabin_. If further
examination shall establish our result, we have in the form of
grayish-white acicular crystals a substance which stands to cannabis
in nearly the same proportional relation of potency as niorphia to
opium, and this most powerful remedy can be given as easily and
certainly as any in the pharmacopoeia. If we are successful we shall
ere long present it to the medical profession. With all the objections
that prejudice cannabis now, I have still witnessed repeated proofs of
its great value in lulling pain and procuring sleep, when all other
means had failed with the reforming opium-eater, in doses of from one
drachm to five of fluid extract or tincture (in some rare cases even
larger), administered twice a day. Like opium it is only secondarily a
soporific, and to produce this effect it should be given three or four
hours before the intended bed-time. Then the earliest effect will be a
cerebral stimulus, sufficient to divert the mind from the body's
sufferings during day-light, and the reaction will come on in time to
produce slumber of a more peaceful and refreshing character--more
nearly like normal sleep in a strong, energetic constitution fatigued
by healthy exertion, than that invoked by any drug I know of.
It may sometimes be necessary, when the pain has become so maddening
and been so protracted, to save the brain from the delirium of
exhaustion (or even as I have known to happen, _death_) by
procuring sleep for half an hour at any cost save that of a
return. The most interesting patient and noble man whose sufferings
compose the text and prompted the writing of my _Harper's
Magazine_ article, died just as it was going to press through the
exhaustion of a brain that had no true sleep for months. To avoid such
a termination, sleep must be had at any cost, and even the danger
attending chloroform or ether must be risked, though I need not point
out the necessity of pre-eminent wisdom, and the constant personal
presence and watchfulness of symptoms, in the physician during the
time that the anaesthetic is inhaled. Of ether as much as three or
four ounces may be inhaled during a single evening without much
danger, if the precaution of alternating the inspirations from a
saturated handkerchief with those of pure atmospheric air be carefully
attended to. Chloroform is much more risky, and almost always tends
to derange the stomach for several days after its use, still its
action is certain in some cases where ether fails even to obscure
sensation, and must be resorted to. A single ounce per evening,
inhaled with rather longer intervals between whiffs, need not be a
perilous dose, and in my experience has often conferred magical
relief. Nitrous oxide is too transient to be of much use, but to the
extent of twenty or thirty gallons may be used with pleasant effect
and about five minutes of alleviation.
Very different from these powerful agents is the humble,
much-neglected _scutellaria_. It has been repeatedly pronounced
inert, but is beyond all question a minor sedative of charmingly
soothing properties, giving sleep, as I have sometimes witnessed, out
of the very midst of intolerable rythmical neuralgic suffering--in one
case the first sleep the patient had enjoyed since leaving off
opium. It may be given with impunity in much larger doses, but on
those constitutions with which it has any effect at all a
table-spoonful is usually efficacious about ten minutes after its
exhibition in the form of fluid extract. Lupulin, valerian,
valerianate of zinc, and hyoscyamus (or with a much less tendency to
derange the stomach, _hyoscyamin_ in 1/10 grain doses) all have
their value in the less violent cases or toward the close of the
struggle. Capsicum, in the five grain doses earlier mentioned, may
often be relied on to counteract the tendency to frightful dreams
arising from the exquisitely irritable state of the stomach in which
the opium-habit leaves its victims.