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The Opium Habit by Horace B. Day

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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?

"How much has he taken in the aggregate?" is practically not an
equivalent of the first question. I have found an absolutely incurable
opium-eater who had never used more than ten grains of morphia _per
diem;_ but he had been taking it habitually for a dozen years. In
another case the patient had for six months repeated before each meal
the ten-grain dose which served the other all day; but he was a man
whose pluck under pain equalled that of a woman's, and after a
fortnight's anguish of such horror that one could scarcely witness it
without being moved to tears, came out into perfect freedom. The
former patient, although he had never in any one day experienced such
powerful effects from opium as the latter, had used the drug so long
that every part of his system had reconstructed itself to meet the
abnormal conditions, and must go through a second process of
reconstruction, without any anodyne to mask the pain resulting from
its decomposition, before it could again tolerate existence of the
normal kind. If opium were not an anodyne the terrible structural
changes which it works would cause no surprise; it would be _felt_
eating out its victim's life like so much nitric acid. During the
early part of the opium-eater's career these structural changes go on
with a rapidity which partly accounts for the vast disengagements of
nervous force, the exhilaration, the endurance of effort, which
characterize this stage, later to be substituted by utter nervous
apathy. By the time the substitution occurs something has taken place
throughout the physical structure which may be rudely likened to the
final equilibrium of a neutral salt after the effervescence between an
acid and an alkali. So to speak, the tissues have now combined with
their full equivalent of all the poisonous alkaloids in opium. Further
use of it produces no new disengagements of nervous force; the victim
may double, quadruple his dose, but he might as well expect further
ebullition by adding more aqua-fortis to a satisfied nitrate as to
develop with opium exhilarating currents in a tissue whose combination
with that drug have already reached their chemical limit. [Footnote: I
say "chemical" because so much it is possible to know experimentally;
and the very interesting examination of such higher forces as
constantly seem to intrude in any nervous disturbance would here
involve the discussion of a theoretical "vital principle"--something
apart from and between the soul and physical activities--which
scientific men are universally abandoning.]

The opium-eater now only continues his habit to preserve the terrible
static condition to which it has reduced him, and to prevent that yet
more terrible dynamic condition into which he comes with every
disturbance of equilibrium; a condition of energetic and agonizing
dissolutions which must last until every fibre of wrongly-changed
tissue is burned up and healthily replaced. Though I have called the
early reactions of opium rapid, they are necessarily much less so than
those produced by a simple chemical agent. No drug approaches it in
the possession of _cumulative_ characteristics; its dependence on
the time element must therefore be always carefully considered in
treating a case. This fact leads us to understand the other element in
the question, how long the torments of the opium-fighter must
continue. Having ascertained the chronology of his case, we must say,
"Given this period of subjection, has the patient enough
constitutional vigor left to endure the period of reconstruction which
must correspond to it?" [Footnote: Not correspond day by day. At that
rate a reforming opium-eater (I use the principle in the
_physical_ sense, for very few opium-eaters are more to blame
than any other sick persons) must pay a "shent per shent" which no
constitution could survive. The correspondence is simply

I am naturally sanguine, and began my study of opium-eaters with the
belief that none of them were hopeless. Experience has taught me that
there is a point beyond which any constitution--especially one so
abnormally sensitive as the opium-eater's--can not endure keen
physical suffering without death from spinal exhaustion. I once heard
the eminent Dr. Stevens say that he made it a rule never to attempt a
surgical operation if it must consume more than an hour. Similarly, I
have come to the conclusion never to amputate a man from his
opium-self if the agony must last longer than three months.
Uneasiness, corresponding to the irritations of dressing a stump--may
continue a year longer; a few victims of the habit outlive a certain
opium-prurience, which has also its analogue in the occasional
titillation of a healed wound--these are comparatively tolerable; but,
if we expect to save a patient's life, we must not protract an agony
which so absolutely interferes with normal sleep as that of the
opium-eater's for longer than three months in the case of any
constitution I have thus far encountered.

Usually as early as the third day after its abandonment (unless the
constituion has become so impaired by long habituation that there will
probably be no vital reaction) opium begins to show its dissolutions
from the tissue by a profuse and increasingly acrid bilious diarrhea,
which must not be checked if diagnosis has revealed sufficient
constitutional vigor to justify any attempt at abandonment of the
drug. Hemorrhoids may result; they must be topically treated; mild
astringents may be used when the tendency seems getting out of
eventual control; bland foods must be given as often as the usually
fastidious appetite will tolerate them; the only tonic must be
beef-tea--diffusible stimulus invariably increasing the agony, whether
in the form of ale, wine, or spirits. Short of threatened collapse,
the bowels must not be retarded. There is nothing in the faintest
degree resembling a substitute for opium, but from time to time
various alleviatives, which can not be discussed in an untechnical
article, may be administered with benefit. The spontaneous termination
of the diarrhea will indicate that the effete matters we must remove
have been mainly eliminated, and that we may shortly look for a marked
mitigation of the pain, followed by conditions of great debility but
increasingly favorable to the process of reconstruction. That
process, yet more than the alleviate, demands a book rather than an

I have intentionally deferred any description of the agony of the
opium struggle, as a _sensation_, until I returned from depicting
general symptoms, to relate the particular case which is my text. The
sufferings of the patient, from whom I have just returned, are so
comprehensive as almost to be exhaustively typical.

When simple nervous excitement had for two days alternated with the
already mentioned intervals of delirious slumber, a dull, aching
sensation began manifesting itself between his shoulders and in the
region of the loins. Appetite for food had been failing since the
first denial of that for opium. The most intense gastric irritability
now appeared in the form of an aggravation of the tympanic tightness,
corrosive acid ructations, heart-burn, water-brash, and a peculiar
sensation, as painful as it is indescribable, of _self-consciousness_
in the whole upper part of the digestive canal. The best idea of this
last symptom may be found by supposing all the nerves of involuntary
motion which supply that tract with vitality, suddenly to be gifted
with the exquisite sensitiveness to their own processes which is
produced by its correlative object in some organ of special sense--the
whole organism assimilating itself to a retina or a finger-tip. Sleep
now disappeared. This initiated an entire month during which the
patient had not one moment of even partial unconciousness.

In less than a week from the beginning the symptoms indicated a most
obstinate chronic gastritis. There was a perpetual sense of corrosion
at the pit of the stomach very like that which characterizes the fatal
operation of arsenic. There was less action of the liver than usually
indicates a salvable case, and no irritation of the lowest
intestines. _Pari passu_ with the gastritic suffering, the neuralgic
pain spread down the extremities from an apparent centre between the
kidneys, through the trunk, from another line near the left margin of
the liver, and through the whole medullary substance of the brain
itself. Although I was so unfortunate as not to be beside him during
this stage, I can still infallibly draw on my whole experience for
information regarding the intensity of this pain. _Tic-douloureux_
most nearly resembles it in character. Like that agonizing affection,
it has periods of exacerbation; unlike it, it has no intervals of
continuous repose. Like _tic-douloureux_, its sensation is a curiously
fluctuating one, as if pain had been _fluidized_ and poured in
trickling streams through the tubules of nerve tissue which are
affected by it; but, unlike that, it affects every tubule in the human
body--not a single diseased locality. Charles Reade chaffs the doctors
very wittily in "Hard Cash" on their _penchant_ for the word
"_hyperaesthesia,"_ but nothing else exactly defines that exaggeration
of nervous sensibility which I have invariably seen in opium-eaters.
Some of them were hurt by an abrupt slight touch, and cried out at the
jar of a heavy footstep like a patient with acute rheumatism. Some
developed sensitiveness with the progress of expurgating the poison,
until their very hair and nails felt sore, and the whole surface of
the skin suffered from cold air or water like the lips of a
wound. After all, utterly unable to convey an idea of the _kind_ of
suffering, I must content myself by repeating, of its extent, that no
prolonged pain of any kind known to science can equal it. The totality
of the experience is only conceivable by adding this physical torture
to a mental anguish which even the Oriental pencil of De Quincey has
but feebly painted; an anguish which slays the will, yet leaves the
soul conscious of its murder; which utterly blots out hope, and either
paralyzes the reasoning faculties which might suggest encouragements,
or deadens the emotional nature to them as thoroughly as if they were
not perceived; an anguish, which sometimes includes just, but always a
vast amount of _unjust_ self-reproach, winch brings every failure and
inconsistency, every misfortune or sin of a man's life as clearly
before his face as on the day he was first mortified or degraded by
it--before his face, not in one terrible dream, which is once for all
over with sunrise, but as haunting ghosts, made out by the feverish
eyes of the soul down to the minutest detail of ghastliness, and never
leaving the side of the rack on which he lies for a moment of dark or
day-light, till sleep, at the end of a month, first drops out of
heaven on his agony.

A third element in the suffering must briefly be mentioned. It
results directly from the others. It is that exhaustion of nervous
power which invariably ensues on protracted pain of mind or body. It
proceeds beyond reaction to collapse in a hopeless case; it stops this
side of that in a salvable one.

On reaching his room I found my friend bolstered upright in bed, with
a small two-legged crutch at hand to prop his head on when he became
weary of the perpendicular position. This had been his attitude for
fifty days. Whether from its impeding his circulation, the
distribution of his nervous currents, or both, the prostrate posture
invariably brought on cessation of the heart--and the sense of
intolerable strangling. His note told me he was dying of heart
disease, but, as I expected, I found that malady merely simulated by
nervous symptoms, and the trouble purely functional. His food was
arrow-root or sago, and beef-tea. Of the vegetable preparation he took
perhaps half a dozen table-spoonfuls daily; of the animal variable
quantities, averaging half a pint per diem. This, though small, was
far from the minimum of nutriment upon which life has been supported
through the most critical periods. Indeed, I have known three patients
tided over stages of disease otherwise desperately typhoid by
_beef-tea baths_, in which the proportion of _ozmazone_ was
just perceptible, and the sole absorbing agency was a faint activity
left in the pores of the skin. But these patients had suffered no
absolute disorganization. The practitioner had to encounter a swift
specific poison, not to make over tissues abnormally misconstructed by
its long insidious action. On examination I discovered facts which I
had often feared, but never before absolutely recognized, in my
friend's case. The stomach itself, in its most irreproducible tissue,
had undergone a partial but permanent disorganization. The substance
of the organ itself had been altered in a way for which science knows
no remedy.

Hereafter, then, it can only be rechanged by that ultimate
decomposition which men call death. Over the opium-eater's coffin at
least, thank God! a wife and a sister can stop weeping and say, "He's

I called to my friend's bedside a consultation of three physicians and
the most nearly related survivor of his family. I laid the case
before them; assisted them to a full _prognosis_; and invited
their views. I spent two nights with my friend. I have said that
during the first month of trial he had not a moment of even partial
unconsciousness. Since that time there had been perhaps ten occasions
a day, when for a period from one minute in length to five, his poor,
pain-wrinkled forehead sank on his crutch, his eyes fell shut, and to
outsiders he seemed asleep. But that which appeared sleep was
internally to him only one stupendous succession of horrors which
confusedly succeeded each other for apparent eternities of being, and
ended with some nameless catastrophe of woe or wickedness, in a waking
more fearful than the state volcanically ruptured by it. During the
nights I sat by him these occasional relaxations, as I learned,
reached their maximum length, my familiar presence acting as a
sedative, but from each of them he woke bathed in perspiration from
sole to crown; shivering under alternate flushes of chill and fever;
mentally confused to a degree which for half an hour rendered every
object in the room unnatural and terrible to him; with a nervous jerk,
which threw him quite out of bed, although in his waking state two men
were requisite to move him; and with a cry of agony as loud as any
under amputation.

The result of our consultation was a unanimous agreement not to press
the case further. Physicians have no business to consider the
speculative question, whether death without opium is preferable to
life with it. They are called to keep people on the earth. We were
convinced that to deprive the patient longer of opium would be to kill
him. This we had no right to do without his consent. He did not
consent, and I gave him five grains of morphia [Footnote: To the
younger men of the profession rather than to the public generally I
need here to say that this dose is not as excessive as it would
naturally appear to be in the case of a man who had used no form of
opium for ninety days. When you have to resume the drug, go
cautiously. But you will generally find the amount of it required to
produce the sedative effects in any case which returns to opium, after
abandonment of a long habitation, _startlingly large_, and
_slow in its effects_.] between 8 and 12 o'clock on the morning
of the day I had to return here. He was obliged to eat a few mouthfuls
of sago before the alkaloid could act upon his nervous system. I need
only point out the significance of this indication. The shallower-lying
nervous fibres of the stomach had become definitely paralyzed, and
such _digestion_ as could be perfected under these circumstances
was the only method of getting the stimulant in contact with any
excitable nerve-substance. In other words, mere absorbent and
assimulative tissue was all of him which for the purpose of receiving
opium partially survived disorganization of the superficial nerves. Of
that surviving tissue, one mucous patch was irredeemably gone. (This
particular fact was the one which cessation from opium more distinctly
unmasked.) At noon he had become tolerably comfortable; before I left
(7 P.M.) he had enjoyed a single half-hour of something like normal

He will have to take opium all his life. Further struggle is
suicide. Death will probably occur at any rate not from an attack of
what we usually consider disease, but from the disintegrating effects
on tissue of the habit itself. So, whatever he may do, his organs
march to death. He will have to continue the habit which kills him
only because abandoning it kills him sooner; for self-murder has
dropped out of the purview of the moral faculties and become a mere
animal question of time. The only way left him to preserve his
intellectual faculties intact is to keep his future daily dose at the
tolerable minimum. Henceforth all his dreams of entire liberty must be
relegated to the world to come. He may be valuable as a monitor, but
in the executive uses of this mighty modern world henceforth he can
never share. Could the immortal soul find itself in a more
inextricable, a more _grisly_ complication?

In publishing his case I am not violating that Hippocratic vow which
protects the relations of patient and adviser; for, as I dropped my
friend's wasted hand and stepped to the threshold, he repeated a
request he had often made to me, saying:

"It is almost like Dives asking for a messenger to his brethren; but
tell them, tell _all young men,_ what it is, 'that they come not
into this torment.'"

Already perhaps--by the mere statement of the case--I might be
considered to have fulfilled my promise. But since monition often
consists as much in enlightenment as intimidation, let me be pardoned
for briefly presenting a few considerations regarding the action of
opium upon the human system while living, and the peculiar methods by
which the drug encompasses its death.


It is the most complicated drug in the Pharmacopoeia. Though
apparently a simple gummy paste, it possesses a constitution which
analysis reveals to contain no less than 25 elements, each one of them
a compound by itself, and many of them among the most complex
compounds known to modern chemistry. Let me concisely mention these by

First, at least three earthy salts-the sulphates of lime, alumina, and
potassa. Second, two organic and one simpler acid--acetic (absolute
vinegar), meconic (one of the most powerful irritants which can be
applied to the intestines through the bile), and sulphuric. All these
exist uncombined in the gum, and free to work their will on the mucous

A green extractive matter, which comes in all vegetal bodies developed
under sunlight, next deserves a place by itself, because it is one of
the few organic bodies of which no rational analysis has ever been
pretended. Though we can not state the constitution of this
chlorophyl, we know that, except by turning acid in the stomach, it
remains inert on the human system, as one might imagine would happen
if he swallowed a bunch of green grass. _Lignin_, with which it
is always associated, is mere woody fibre, and has no direct physical
action. In no instance has any stomach been found to _digest_ it
save an insect's--some naturalists thinking that certain beetles make
their horny wing-cases of that. I believe one man did think he had
discovered a solvent for it in the gastric juice of the beaver, but
that view is not widely entertained. So far as it exists in opium it
can only act as a foreign substance and a mechanical irritant to the
human bowels. Next come two inert, indigestible, and very similar
gummy bodies, _mucilagin and bassorine_. Sugar, a powerfully
active volatile principle, and a fixed oil (probably allied to
turpentine) are the only other invariable constituents of opium
belonging to the great organic group of the hydro-carbons.

I now come to a group by far the most important of all. Almost
without exception the vegetable poisons belong to what are called the
"nitrogenous alkaloids." Strychnia, brucia, ignatia, calabarin,
woovarin, atropin, digitalin, and many others, including all whose
effect is most tremendous upon the human system, are in this
group. Not without insight did the early discoverers call nitrogen
_azote_, "the foe to life." It so habitually exists in the things
our body finds most deadly that the tests for it are always the first
which occur to a chemist in the presence of any new organic poison.
The nitrogenous alkaloids owe the first part of their name to the fact
of containing this element; the second part to that of their usually
making neutral salts with acids, like an alkaline base. The general
reader may sometimes have asked himself why these alkaloids are
diversely written--as, e.g., sometimes "_morphia,_" and sometimes
"_morphine,_" The chemists who regard them as alkalies write them
in the one way, those who consider them neutrals, in the other. Of
these nitrogenous alkaloids, even the nuts of the tree, which
furnishes the most powerful, _swift_ poison of the world,
contains but three--the above-named strychnia, brucia, and
ignatia--principles shared in common with its pathological congener,
the St. Ignatius bean. Opium may be found to contain _twelve_ of
them; but as one of these (cotarnin) may be a product of distillation,
and the other (pseudo-morphia) seems only an occasional constituent, I
treat them as ten in number--rationally to be arranged under three

First, those whose action is merely acrid--so far as known expending
themselves upon the mucous coats. (_Pseudo-morphia_ when it
occurs belongs to these.) So do _porphyroxin; narcein_; probably
_papaverin_ also; while _meconin_, whose acrid properties in
contact with animal tissue are similar to that of meconic acid, forms
the last of the group.

The second head comprises but a single alkaloid, variously called
paramorphta or thebain. (It may interest amateur chemists to know that
its difference from strycchnia consists only in having two less
equivalents of hydrogen and six of carbon--especially when they know
how closely its physical effects follow its atomic constitution.) A
dose of one grain has produced tetanic spasms. Its chief action
appears to be upon the spinal nerves, and there is reason to suppose
it a poison of the same kind as nux vomica without the concentration
of that agent. How singular it seems to find a poison of this totally
distinct class--bad enough to set up the reputation of any one drug by
itself--in company with the remaining principles whose effect we
usually associate with opium and see clearest in the ruin of its

The remainder, five in number, are the opium alkaloids, which act
generally upon the whole system, but particularly, in their immediate
phenomena, upon the brain. I mention them in the ascending order of
their nervine power; narcotin; codein; opianin; metamorphia, and

The first of these the poppy shares in common with many other narcotic
plants--tobacco the most conspicuous among the number. In its
anti-periodic effects on the human system it has been found similar to
quinia, and it is an undoubted narcotic poison acting on the nerves of
organic life, though, compared with its associates in the drug,
comparatively innocent.

The remaining four act very much like morphia, differing only in the
size of the dose in which they prove efficient. Most perfectly fresh
constitutions feel a grain of morphia powerfully; metamorphia is
soporific in half-grain doses; [Footnote: American Journal of
Pharmacy, September, 1861.] opianin in its physical effects closely
approximates morphia; codein is about one-fifth as powerful; a new
subject may not get sleep short of six grains; its main action is
expended on the sympathetic system. It does not seem to congest the
brain as morphia does; but its action on the biliary system is
probably little less deadly than that of the more powerful narcotic.

Looking at the marvellous complexity of opium we might be led to the
_apriori_ supposition that its versatility of action on the human
system must be equally marvellous. Miserably for the opium-eater,
fortunately for the young person who may be dissuaded from following
in his footsteps, we are left in no doubt of this matter by the
conclusions of experience. In practical action opium affects as large
an area of nervous surface, attacks it with as much intensity, and
changes it in as many ways as its complexity would lead us to
expect. I have pointed out the existence in opium of a convulsive
poison congeneric with brucia. The other chief active alkaloids, five
in number, are those which specially possess the cumulative
property. Poisons of the strychnia and hydro-cyanic acid classes
(including this just mentioned opium alkaloid, thebain) are swifter
agents; but this perilous opium quintette sings to every sense a
lulling song from which it may not awake for years, but wakes a slave.
Every day that a man uses opium these cumulative alkaloids get a
subtler hold on him. Even a physician addicted to the practice has no
conception how their influence piles up.

At length some terrible dawn rouses him out of a bad sleep into a
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-

"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

"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

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

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.


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

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.

Mr. Edgerton, though by no means a man of ruined constitution, has
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 _habitue_ 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

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 hac 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.

In advanced cases, where opium has been used long enough to break down
the will and the sense of moral accountability, I may feel it wise to
ask of the friend who accompanies my patient that he go through the
baggage and clothes of the latter before leaving him, and report to me
that no form of opium is contained in them. But in most cases I prefer
to rely entirely upon the good understanding established between my
patient and myself for my guarantee that no opiate is smuggled into
the institution, and upon my own daily examination of the patient to
determine whether this guarantee is kept inviolate. To an expert
reader of opium cases it will soon become apparent whether in any
given case a patient is taking more than the amount prescribed--and
after total abandonment is resolved upon, the question whether the
patient is taking opium at all may be decided by a tyro.

In the case of Mr. Edgerton, who has voluntarily come to ask our help
on the way upward, I proceed by a system of complete mutual
confidence. I tell him that I am sure he feels even more deeply than
myself the necessity of abandoning the drug. I promise him that he
shall never be pushed beyond the limits of endurance, and ask only
that he will allow any dose he may take to pass through my hands. I
request that if he has brought any form of opium with him he will give
it to me, and we enter into a stipulation that he will come to me for
any opiate or other alleviative which he may desire. I bind myself
never to upbraid or censure him--never to reveal to a living soul any
confidence soever which he may repose in me--and then I ask him to
name me the average dose upon which, before his late acute attack, he
has managed to keep comfortable--rather, I should say, before the
overwork and consequent opiate excess which brought it on. During his
terrible six weeks of high-pressure, he tells me, he reached a per
diem as high as 25, on one occasion even 30 grains; but for a year
previous he had never taken more than the equivalent of 18 grains of
morphia a day. This, then, shall furnish our starting-point.

Whether he has previously adopted the same method or not, I divide
this amount into three or more doses to be taken at regular intervals
during the day.

I say "the equivalent of 18 grains of morphia," because although the
majorify of _habitues_ use that principle of opium as their favorite
form, there are some who after many years' use of the drug still
adhere to crude gum opium or laudanum. The portability and ease of
exhibition which belong to morphia--the fact that it fails to sicken
some persons in whom any other opiate produces violent nausea--its
usual certainty, rapidity, and uniformity of action, and the ability
which it possesses to produce the characteristic effects of the
narcotic after other preparations have become comparatively inert,
make it the most general form in use among opium-eaters of long
standing. Still, bearing in mind the wonderful complexity of opium
(_vide_ "What Shall They Do to be Saved?") and the equally marvellous
diversity in the manner in which it affects different people, we can
not wonder at the fact that some of its victims require for their
desired effect either the crude drug or other preparations containing
its principles entire. Morphia is by far the most important of these
principles, and more nearly than any one stands typical of them
all. Still, it is easy to conceive how certain constitutions may
respond more sympathetically to the complex agent of Nature's
compounding than to any one of its constituents. [Footnote: In some
cases, especially of shorter standing, codeia may be used as the form
of opiate to diminish on. In any case its employment is worth trying,
for it possesses much of the pain-controlling efficiency of opium and
morphia, with less of their congestive action upon the brain.
Practically it may be treated in such an experiment as the equivalent
of opium; not that it at all represents all the drug's operations, but
that where crude opium has been the form in use, codeia may be
substituted grain for grain. Some patiets find it quite valueless as
a substitute, but there is always a chance of its proving adequate.
When tried, the best form is a solution similar to Magendie's, but
replacing one grain of morphia by six of codeia.] We may therefore
find it necessary to carry on our reformatory process upan laudanum or
M'Munn's Elixir, but by far the larger number of cases will do better
by being put instantly upon a regimen of Magendie's Solution of
Morphia. The formula for this preparation is:

Morph. Sulph. . . . . . . . . . . . grs. xvi.
Aqua Destill. . . . . . . . . . . . ounce j
Elix. Vitrioli. . . . . . . . . . . quant. suff.

Mr. Edgerton has used 18 grains of morphia per diem. His equivalent in
Magendie's Solution will be 9 fluid drachms.

This amount I divide into three equal doses--one to be administered
after each meal. By administering them after meals I give nutrition
the start of narcotism, prevent the violent action possessed by
stimulants and opiates on the naked stomach, and secure a slower, more
uniform distribution of the effects throughout the day. The position
of the third dcse after the 6 o'clock meal of the day is particularly
counselled by the fact that opium is only secondarily a narcotic, its
sedative effects following as a reaction upon its stimulant, and the
third dose accordingly begins to act soporifically just about
bed-time, when this action is especially required.

I keep a glass for each of my patients, upon which their "high-water
mark" is indicated by a slip of paper gummed on the outside. When
Mr. Edgerton, pursuant to our stipulation, comes to me for his dose, I
drop into the glass before his eyes a shot about the size of a small
pea--then fill the glass with Magendie's Solution up to the mark
indicated. (This shot varies in each case with the rapidity of
diminution I think safe to adopt. In some cases it is a buckshot or a
small pistol bullet.) Every day a new shot goes in--and if he bears
that rate of progress I may even drop one into the glass with each
alternate dose.

Midway between the doses of morphia I give Mr. E. a powder of bromide
of potassium, amounting to 30 or even 40 grains at a time, and an
average of about 100 grains per day. The value of this remedy has been
a matter of much controversy--some practitioners lauding it to the
skies as one of the most powerful agents of control in all disorders
of the nervous system, others pronouncing it entirely inert. Where it
has proved the latter it has probably been given in too small doses or
not persevered in for a sufficient length of time. (The timidity with
which it is often prescribed may be seen in the fact that one of the
principal druggists on Broadway lately warned a person to whom I had
given a prescription for 30 grain doses that he was running a very
dangerous risk in taking such a quantity!) Its operation is so
entirely different from that of the vegetable narcotics that people
looking for their instantaneous sedative effect can not fail to be
disappointed. It is very slowly cumulative in its action, seeming to
act upon the nervous system by a gradual constitutional change rather
thin any special impetus in a given direction. Because that is its
_modus operandi_, I begin to give it thus early; and it is of
peculiar value now, not only as making the daily diminution of the
opium more tolerable, but as preparing the system for the time when
the drug is to be abandoned altogether and the hardest part of the tug

In Mr. Edgerton's case the gradual descent to 1/2 grain per diem, when
we leave off the opium entirely, consumes let us say a period of one
month. It is not to be expected that this period will pass without
considerable discomfort and some absolute suffering, for the nervous
system can not be dealt with artfully enough to hide from it the fact
that it is losing its main support. It is the nature of that system
not even to rest content with the continuation of the same dose. It
grows daily less susceptible to opium and more clamorous of
increase. When the dose does not even remain _in statu quo_ but
suffers steady diminutions however small, the nerves can not fail to
begin revenging themselves. Still, this period may be made very
tolerable by keeping the mind diverted in every pleasant occupation
possible, such as I shall presently refer to as abounding on our
Island. Our physical treatment for the month is especially directed to
the establishment of such healthy nutrition and circulation as shall
provide the nervous system with a liberal capital to for at least the
first ten days or fortnight after the complete abandonment of
opium. The patient's digestion must be carefully attended to, and kept
as vigorous as is consistent with the still continued use of the
drug. Beef-tea, lamb-broth with rice, all the more concentrated forms
of nutriment, are to be given him, in small quantities at a time, as
frequently as his appetite will permit; and if progressive gastric
irritability does not develop itself as the diminution of the narcotic
proceeds, he is to have generous diet of all kinds. We must pay
particular attention to the excretory functions--getting them as
nearly as possible in complete working order for the extra task they
have presently to fulfill when the barriers are entirely withdrawn and
the long pent-up effete matters of the body come rushing forth at
every channel. The bowels must be trained to perfect regularity, and
the skin roused to the greatest activity of which it is capable.
Exercise, carried to the extent of healthy fatigue, but rigorously
kept short of exhaustion, may be secured in our bowling-alley,
gymnasium, and that system of light gymnastics perfected by Dio
Lewis--a system combining amusement with improvement to a remarkable
degree, as being a regular drill in which at certain regular hours all
those patients, both ladies and gentlemen, who are able to leave their
rooms, join under the command of a skillful leader to the sound of
music. This system has an advantage, even for well people, with its
bars, poles, ropes, dumb-bells, etc., inasmuch as it secures the
uniform development, on sound anatomical and physiological principles,
of every muscle in the human body, instead of aiming at the
hypertrophy of an isolated set. I do not mean by this to deny the
value of the old style gymnasium, our Island will possess as good a
one as any athlete could desire. Horseback riding will form another
admirable means of effecting our purpose, especially where the patient
suffers from more than the usual opiate torpidity of the liver. We
shall have room enough if not for an extended ride at least for a mile
track around the Island, and a stud, however unlikely to set John
Hunter looking to his laurels, capable of affording choice between a
trotter and a cantering animal. During the summer there will be ample
opportunity for those who love horticulture to take exercise in the
flower and vegetable garden attached to the institution, and such as
wished might be assigned little plots of ground whose management and
produce should exclusively belong to them. Looking for a moment from
the therapeutics to the economics of the matter, I can see no reason
why the house might not rely largely upon itself for at least its
summer vegetables and its fruit--if the poorer patients were permitted
to pay part of their dues, when they so elected and the exertion was
not too much for them, by taking care of the grounds. Another
admirable means of exercise will be found in rowing. Our Island must
have a good substantial boat-house, containing a good-sized barge for
excursions and several pleasure-boats pulling two or three pair of
sculls each; perhaps, eventually, a pair of racing-boats for such of
our guests as were well enough to manage a club. Bath-houses for the
convenience of those who love a plunge or a swim will be
indispensable--affording facilities for a species of summer exercise
which nothing can replace.

In winter and summer the bath must be our principal reliance for
promoting that vigorous action of the excretory system which with
healthy nutrition is our great aim in treating the patient.

Quackery has to so great an extent monopolized the therapeutic use of
water, and so much arrant nonsense has been talked in that pure
element's name, that we are in danger of overlooking its wonderful
value as a curative means. It is one of the most powerful agents at
the command of the practitioner, and should no more he trifled with
than arsenic or opium. Used by a blundering, shallow-pated empiric it
may be worse than useless--may do, as in many cases it has done,
incalculable mischief to a patient. In the hands of a clear-sighted,
experienced, scientific man, who administers it according to
well-known laws of physiology and therapeutics, it is an inestimable
remedy, often capable of accomplishing cures without the assistance of
any other medicine, and, indeed, where all other has failed. Many of
the forms in which it is applied at water-cures well deserve adoption
by the more scientific practitioner. Among these the pack occupies a
front rank. During Mr. Edgerton's month of diminution we use this with
him daily. Its sedative effect, when given about three and a half
P.M., just after the second dose of bromide of potassium, is
exceedingly happy-seeming, as I have heard a patient remark, "to
smooth all the fur down the right way"--removing entirely the
excessive nervous irritability of the opium-craving, and often
affording the patient his only hour of unbroken sleep during the
twenty-four. Its tendency to promote perspiration makes it a most
effective means for restoring the activity of the opium-eater's skin,
and this benefit will be still further increased if it be followed by
sponging down the body with strong brine at a temperature as low as
the patient can healthily react from, concluding the operation with a
vigorous hand-rubbing administered by the attendant until the skin
shines. This same salt sponge is a most invigorating bath to be taken
immediately on rising. Another excellent bath in use at water-cures,
of value both for its tonic and sedative properties, is "_the
dripping sheet_," in which a sheet like that used in the pack, of
strong muslin and ample size, is immersed in a pail of fresh water at
about 70 F., and, without wringing, spread around the standing
patient so as to envelop him from neck to feet, the attendant rubbing
him energetically with hands outside it for several minutes till he is
all aglow. In cases where great oppression is felt at the
epigastrium--that _corded_ sensation so much complained of by
opium-eaters during their earlier period of abandonment, and that
peculiar self-consciousness of the stomach which follows in the track
of awakening organic vitality--the greatest relief may be expected
from "_hot fomentations_," This is the well-known "hot and wet
external application" of the regular practice, and consists of a
many-folded square of flannel wrung out of water as hot as the skin
can bear, and laid over the pit of the stomach, with renewals as often
as the temperature perceptibly falls.

The symptom of cerebral congestion--a chronic sense of fullness in the
head--is often very simply alleviated by placing the patient in "_a
sitz_" or hip-bath, with the water varying from 70 to 90 F,
_Enemata_ will constantly be found of service where the torpidity
of the bowels is extreme. Not only so, but in cases where the liver is
beginning to re-assert itself, and its tremendous overaction sends
down such a supply of bile as to provoke inversion of the pylorus, an
enema may often act sympathetically beyond that portion of the
intestine actually reached by it, and change the direction of the
intestinal movement, so as to convert the deadly nausea excited by the
presence of bile in the stomach into a harmless diarrhea which at once
removes the cause of the suffering. Of the value of foot-baths I need
not speak, and to the hot full-bath I must now make reference as the
most indispensable agent in ameliorating the sufferings of one who has
completely abandoned the drug.

When Mr. Edgerton's dose has reached as low an ebb as 1/2 grain of
morphia he abandons the drug entirely. In my _Harper's Magazine_
article I have fully depicted the sufferings which now ensue--as
fully, at least, as they can be depicted on paper--though that at the
best must he a mere bird's-eye view. During the period of diminution
he has endured considerable uneasiness and distress, but these have
been trifling to compare with the suffering which he must endure for
the first few days and nights, at least, after total abandonment.
Universal experience testifies that although the previous period of
diminution greatly shortens and softens the sufferings to be endured
after giving up opium altogether, the descent from 1/2 grain of morphia
to none at all must involve a few days at least of severe suffering,
which nothing borne during the diminution at all foreshadows.

In my _Harper's_ article I have said:

"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 [Footnote: On some occasions, by repealed
additions from the hot faucet as the temperature of the water in the
bath-tub fell, I have raised the bath as high as 120 F. without
causing any inconvenience to the patient. Most bath-tubs--all in our
own city houses--are too capacious, and too broad for their depth. To
prevent cooling by evaporation the tub should be just the width of a
broad pair of shoulders and about two feet deep.] 110 F. as often as
fifteen times in a single day--each bath lasting as long as the
patient experienced relief."

Science and experience have thus far revealed no other way of making
tolerable the agonizing pain which Mr. Edgerton now endures. This pain
is quite inconceivable by the ordinary mind. It can not be described,
and the only hint by which an outsider can be let into something like
an inkling of it is the supposition (which I have elsewhere used) that
pain has become _fluidized_, and is throbbing through the
arteries like a column of quicksilver undergoing rhythmical
movement. If the arteries were rigid glass tubes, and the pain
quicksilver indeed, there could not be a more striking impression of
ebb and flow every second against some stout elastic diaphragm whose
percussion seems the pain which is felt. This is especially the case
along the course of the sciatic nerve and all its branches, where the
pulse of pain is so agonizing that the sufferer can not keep his legs
still for an instant. There is occasionally severe pain of this kind
in the arms also, but this is very rare. The suffering which usually
accompanies that of the legs is a maddening frontal headache, and a
dull perpetual ache through the region of the kidneys, described as a
sensation of "breaking in two at the waist;" nausea, burning, and
constriction about the epigastrium, and intense sensitiveness of the
liver--besides general nervous and mental distress which has neither
representative nor parallel.

All these symptoms are instantaneously met and for the time being
counteracted by the hot-bath. When the patient gets tired of it, and
it temporarily loses its efficiency from this cause, great advantage
may be gained by substituting either the Russian bath or the common
box vapor-bath, with an aperture in the top to stick the head out of,
and a close-fitting collar of soft rubber to prevent the escape of the

I must here refer to another means of alleviation, concerning which I
can not bear the witness of personal experience, but which has been
highly recommended to me. Even this brief sketch of treatment would be
imperfect without at least a mention of it, and if it possesses all
the value claimed for it by persons of judgment who have reported it
to me, it will form an indispensable part of our apparatus on Lord's
Island. This is an air-tight iron box of strongly-riveted boiler
plates, with a bottom and top fifteen feet square and sides ten feet
high; thick plate-glass bull's-eyes in each side sufficiently large to
light the interior as clearly as an ordinary room; and a cast-iron
door, six feet in height, shutting with a rubber-lined flange, so that
all its joints are as air-tight as the rest of the box. Inside of the
box, in the centre, stands a table, suitable for reading, writing,
draughts, cards, chess, or games of any similiar kind, with
comfortable chairs arranged around it corresponding in number to the
people who for an hour or two could comfortably occupy the room. In
one side of the box is a circular aperture connecting with an iron
tube, which in its turn is joined to a powerful condensing air-pump
outside, and on the other side is a pressure gauge with its index
inside the box. Sufferers from severe neuralgic pain being admitted,
the air-tight door is shut; they seat themselves, and the condensing
pump is set in motion by an engine until the gauge within indicates a
pressure of any amount desired. I am told that the severest cases of
neuralgia have found instantaneous and thorough relief by the addition
of six or eight atmospheres to the usual pressure of air upon the
surface of the body. There is no reason why the condensation might not
be continued to twenty or more, the increased density causing no
uneasiness to those within the box, the same equilibrium between
internal and outward pressure that exists everywhere in the air being
maintained here. Persons who have made trial of this apparatus speak
of the cessation of their pain as something magical; say they can feel
it leaving them with every stroke of the pump; and although as yet we
may not be able to offer a scientific explanation of the relief
afforded, we can not fail to see its applicability to the case of the
reforming opium-eater. If it does all that is claimed for it, it
probably acts both mechanically and chemically--the pressure, even
though imperceptible from its even distribution, affecting the body
like the shampooing, kneading action of an attendant's hand, and the
vastly increased volume of oxygen which it affords to the lungs and
pores accelerating those processes of vital decomposition by which the
causes of many a pain, but especially that of our patient, are to be

The shampooing just referred to, and previously mentioned as forming
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 110
F. to a temperature hot enough, to cook an egg hard--followed by
ablutions and shampooings somewhat similar to those of the Russian

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

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

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 medicina_ 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.

Our object with Mr. Edgerton during the month of struggle has been to
assist Nature in eliminating the obsolete matters of the system by all
the excretory passages as preparative to the rebuilding of his system
on a healthy plan by new material. During most of the time he has
suffered from a profuse and weakening diarrhea, but this we have not
checked nor retarded, because it was Nature's indispensable condition
precedent to the new man. His perspiration has been profuse, and that
we have assisted for the same reason by every means in our power--all
our baths and rubbings, our galvanism and medicine so far as used,
have favored to the utmost the activity of his skin. Our repeated
hot-baths have greatly relaxed him; he may have come to the end of his
month so weak that he could not walk a quarter of a mile if his life
depended on it. No matter. This, however alarming at first sight, is
good practice. The more rapidly he has become relaxed, the further and
the further we have banished pain, from whose presence a state of
_tension_ is inseparable. We have not injured him. It is astonishing

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