to any one accustomed to dealing only with the prostration of ordinary disease to see to what an extremity the opium-eater will bear to be reduced–what an extent of muscular debility he will even thrive under. If we look at him closely, we will see through all his pallor a healthy texture of skin–in all his languor a _soundness_ of vital operation which stands to his account for more valid strength, than if he could lift all the weights of Dr. Winship. Unless the opium-disease is complicated with some serious organic difficulty it is safe to carry on the process of relaxation as long as it relieves pain until the patient has just enough strength left to lift his eyelids. We have kept him up with the constant, faithful administration of beef-tea–half a tea-cupful, by slow sips, every hour or hour and a half that he was awake during day or night, but never rousing him for any purpose whatever if he showed any inclination to sleep. The nurse who does that when an opium-eater is going through his struggle should be discharged without warning. Sleep for ten minutes any time during this month is worth to nutrition alone more than a week’s feeding.
At the end of the month Mr. Edgerton can sleep with tolerable soundness for half an hour–even an hour at a time, and the sum of all his dozes amount to about four hours out of the twenty-four. He is still nervous, though the painful tigerish restlessness is gone. The pangs of his opium-neuralgia are also gone–or re-appear at long intervals, and much mitigated, to stay but a few minutes. He is in every respect on the upward grade. When his sleep becomes decidedly better, so that most of his night, despite frequent wakings, is consumed in it, he enters on an entirely different stage of his treatment. We stop pulling him down. We begin toning him up.
To the description of this process I need devote but little room. It consists in a gradual cooling of the temperature of his baths–a substitution of the more bracing and invigorating for one after another of the relaxing and soothing forms of treatment. The hot full-bath is discontinued almost entirely, and we replace it by the use of a couple of pailfuls of water at 65-75, doused over the patient; or “the flow,” in which the water spreads through a fan-shaped faucet like a funnel with its sides smashed flat and falls over his shoulders; or the salt sponge–all followed by vigorous towel and hand-rubbing until the skin is in a healthy glow. The pack we still employ, wringing the sheet out of water as near the natural temperature as he can comfortably and at once react from. It is an admirable means of equalizing the circulation of our patient and soothing his remaining nervous irritability. We encourage his being in the open air and sunshine as much as is compatible with the season and the weather, and favor his taking exercise in every unexhausting way possible. His appetite will by this time take care of his nutrition with-out much nursing, but we must listen to its caprices and provide it with every thing it thinks it would like. Our sedative medicines may in all likelihood be safely discontinued, and very little indeed of any kind be given him save tonics. In my experience, and that of all others to whom I have recommended them, the very best and most universally to be relied on at this stage are quinine, nux vomica tincture, and pyro-phosphate of iron, together with last, but most important of all, our invaluable stand-by, beef-tea. This may be made more palatable to the fastidious palate which has become palled by a steady month or two of it, by a few whole cloves and shreds of onion, but most people relish its delicious meaty flavor quite as well when it is simply made by chopping lean rump into pieces the size of dice, covering them with cold water in the proportion of about three pints to two pounds, letting the whole stand a couple of hours to soak in a saucepan, then drawing it forward upon the range, where it will gently simmer for ten minutes, and salting and pouring it out just as it comes up to a brisk boil. If the meat be just slightly browned on both sides (not broiled through, remember) before being chopped, the flavor of the tea is to many tastes still more exquisite. Beef-tea should be on the range, ready for patients in our house who need it, at all hours of the day and night, and all the year round. The whole cookery of our establishment must be of the very best. There is no greater mistake than that existing in most sanitary institutions– stinting in the larder and the kitchen. The best meats, the most skillful, delicate cookery, the freshest of vegetables and fruit, the ability to tempt the capricious palate by all sorts of savory little made dishes–these should always characterize the table of a place where food has to do so much as with us in replacing the fatal supports of the narcotics and stimuli. It will be noticed that neither here nor in my mention of tonics have I referred to alcoholic stimulants. The omission has been intentional. My entire experience has gone to prove that the use of alcohol in any form with opium-eaters undergoing cure is worse than useless, almost invariably redoubling their suffering from loss of opium, and frequently rendering the craving for a return to their curse an incontrollable agony. I therefore leave it entirely out, alike of my pharmacopoia and my bill of fare.
A few final words about the attractions of the Island. Besides the amusements earlier mentioned, I propose that our perfected scheme shall contain every thing necessary to make the social life in-doors a delightful refuge, to all far enough advanced to take pleasure in society, from the dejection and introversion peculiarly characteristic of opium’s revenges. This comprehends a suite of parlors where ladies and gentlemen can meet in the evening on just the same refined and pleasant terms that belong to an elegant home elsewhere; furnished with piano to dance to, play, or sing with; first-class pictures as fast as our own funds, aided by donations and bequests, can procure them for us–but bare wall or handsome paper or fresco rather than any daub to fill a panel; fine engravings in portfolios; cosy open fire-places; unblemished taste in furniture and carpets; in fine, an air of the highest ideal of a private family’s handsomest assembling-room. I propose a billiard-room with a couple of tables–so neatly kept that both ladies and gentlemen can meet there to enjoy the game, a reading-room with the best papers and magazines and a good library, both to be enjoyed by guests of either sex; a smoking and card-room for the gentlemen. I propose to have our engine before mentioned do the work of taking our invalids up and down stairs by a lift, like those in use in some of our best hoteis, so that the highest rooms may be practically as near the baths, the dining and social apartments, and as eligible as any of the lower ones. And if feasible, I suggest that some at least of the rooms be arranged in small suites or pairs, so as to admit of a well daughter, son, sister, parent, wife, or brother coming to stay with any invalid who needs their loving presence and nursing.
I have thus given as clear an outline as I can of my idea what such an institution as we have so often talked over ought to be, and described a method of treatment which has been successful wherever I have had the opportunity even to approach its realization. For its perfect realization an institution especially devoted to the noble work is a _sine qua non_. If the publication of this letter shall call to our aid in its establishment, by awakening to a sense of its necessity, any of our vigorous, public-spirited countrymen, I am sure we may live to see it flourishing on a sound basis and doing an incalculable amount of good which shall make mankind wonder how so many generations ever lived without it since opium began to scourge the world. I shall then, too, be even more indebted to you than I am now for the courtesy which has afforded so large a space in your book to
Your Friend,
FITZ HUGH LUDLOW.