Chapter 23

The opium-eater either dies in collapse through nervous exhaustion (with the blood-poisoning and delirium above-mentioned), sometimes after an overdose, but oftener seeming to occur spontaneously, or in the midst of physical or mental agony as great and irrelievable as men suffer in hopeful abandonment of the drug, and with a colliquative diarrhea, by which--in a continual fiery, acrid discharge--the system relieves itself during a final fortnight of the effete matters which have been accumulating for years.

Either of these ends is terrible enough. Let us draw a curtain over their details.

Opium is a corrosion and paralysis of all the noblest forms of life. The man who voluntarily addicts himself to it would commit in cutting his throat a suicide only swifter and less ignoble. The habit is gaining fearful ground among our professional men, the operatives in our mills, our weary sewing-wormen, our fagged clerks, our disappointed wives, our former liquor-drunkards, our very day-laborers, who a generation ago took gin. All our classes from the highest to the lowest are yearly increasing their consumption of the drug. The terrible demands especially in this country made on modern brains by our feverish competitive life, constitute hourly temptations to some form of the sweet, deadly sedative. Many a professional man of my acquaintance who twenty years ago was content with his _tri-diurnal_ "whisky," ten years ago, drop by drop, began taking stronger "laudanum cock-tails," until he became what he is now--an habitual opium-eater. I have tried to show what he will be. If this article shall deter any from an imitation of his example or excite an interest in the question--"_What he shall do to be saved?_"--I am content.

NOTE.--The patient whose sorrowful case suggested this article died just as the magazine was issued. His unassisted struggle had been too long protracted after abandonment of the drug was evidently hopeless, and his resumption of opium came too late to permit of his rallying from his exhaustion.

OUTLINES OF THE OPIUM-CURE.

No. 1 Livingston Place, Stuyvesant Square, April 25, 1868.

MY DEAR SIR:--In accordance with your request, I sketch the brief outline of my plan for the treatment of opium-eaters, premising that it pretends much less to novelty than to such value as belongs to generalizations made from large experience by sincere interest and careful study in the light of science and common sense.

That experience having shown me how impracticable in the large majority of cases is any cure of a long-established opium habit while the patient continues his daily avocations and remains at home, [Footnote: In my article upon opium-eating, entitled, "What Shall They Do to be Saved?" published in _Harper's Magazine_ for the month of August, 1867, and hereto prefixed, I have referred to this impracticability in fuller detail. It arises from the fact that in his own house a man can not isolate himself from the hourly hearing of matters for which he feels responsible, yet to which he can give no adequate attention without his accustomed stimulus; that his best friends are apt to upbraid him for a weakness which is not crime but disease, and that the control of him by those whom he has habitually directed, however well-judged, seems always an harassment.] I shall simplify my sketch by supposing that one great object of my life is already attained, and that an institution for the treatment of the disease is already in successful operation. Starting at this fictitious _datum_, I shall carry from his arrival under our care until his discharge a healthy, happy, and useful member of society, a gentleman whom for convenience we will name Mr. Edgerton.

Our institution is called not an "Asylum," nor a "Retreat," nor by any of those names which savor of restraint and espionage--not even a "Home," as spelled with a capital H--but simply by the name of the spot upon which it is erected--to wit, "Lord's Island."

It is erected on an island because in the more serious cases a certain degree of watchfulness will always be necessary. On the main-land this watchfulness must be exercised by attendants with the aid of fences, bolts, and bars. On an island the patient whose case has gone beyond self-control will be under the Divine Vigilance, with more or less miles of deep water as the barrier between him and the poison by which he is imperilled. For this reason, and because whatever good is accomplished on it for a class which beyond all other sufferers claim heavenly mercy will be directly of the Lord himself, our island is called "Lord's Island." Here our patient will feel none of the irksome tutelage which in an asylum meets him at every step--thrusting itself before his eyes beyond any power of repulsion, and challenging him to efforts for its evasion which are noxious whether they succeed or not; defeating the purpose of his salvation when they do, irritating him when they do not, and keeping his mind in a state of perpetual morbid concentration upon his exceptional condition among mankind in either case. Here he has all the liberty which is enjoyed by the doctors and nurses--save that he can not get at the medicine-chest.

Mr. Edgerton arrives at Lord's Island at 2 P.M. of a summer's day, having crossed by our half-hourly sail-boat, row-boat, or tug, from the railroad station on the main-land. If he is very much debilitated, either by his disease or fatigue, he has full opportunity to rest and refresh himself before a word is spoken to him professionally. If a friend accompanies him, he is invited to remain until Mr. Edgerton feels himself thoroughly at home in his new quarters.

After becoming fully rested, Mr. Edgerton is invited to state his case. The head physician must be particular to assure him that every word he utters will be regarded as in the solemnest professional confidence. Mr. Edgerton is made to feel that no syllable of his disclosures will ever be repeated, under any circumstances, even to the most intimate of his friends or the most nearly related of his family. This conviction upon his part is in the highest degree essential. Opium makes the best memory treacherous, and, sad as it may be to confess it, the most truthful nature, in matters relating to the habit at least, untrustworthy. Often, I am satisfied, the opium-eater, during periods of protracted effort or great excitement, takes doses of the drug which he does not recollect an hour afterward, and may, practically without knowing it, overrun his supposed weekly dose twenty-five per cent. I often meet persons addicted to the habit who, I have every reason to believe, honestly think they are using twelve grains of morphia daily, yet are found on close watching to take eighteen or twenty. Again, the opium-eater who by nature would scorn a lie as profoundly as the boy Washington, is sometimes so thoroughly changed by his habit that the truth seems a matter of the most trifling consequence to him, and his assertion upon any subject whatever becomes quite valueless. Occasionally this arises from an entire _bouleversement_ of the veracious sense--similar to certain perversions of the insane mind, and then other faculties of his nature are liable to share in the alteration. If the man was previously to the highest degree merciful and sympathizing, he may become stolid to human suffering as any infant who laughs at its mother's funeral, not from wickedness of disposition but absence of the faculty which appreciates woe, and I doubt not that this change goes far to explain the ghastly unfeelingness of many a Turkish and Chinese despot whose ingeniously cruel tortures we shudder to read of scarcely more than the placidity with which he sees them inflicted. If he was originally so sensitive to the boundaries between Meum and Tuum that the least invasion of another's property hurt him more than any loss of his own, this delicate sense may become blunted until he commits larceny as shamelessly as a goat would browse through a gardener's pickets, or a child of two years old help himself to a neighbor's sugar-plums. This, too, quite innocently, and with the excuse of as true a Kleptomania as was ever established in the records of medical jurisprudence. I knew a man who had denied himself all but the bare necessaries of life to discharge debts into which another's fraud had plunged him, and whose sense of honor was so keen that when afflicted with chronic dyspepsia the morbid conscientiousness which is not an unusual mental symptom of that malady took the form of hunting up the owner of every pin he picked up from the floor, nor could he shake off a sense of criminality till he had found somebody who had lost one and restored it to him--yet on being prescribed opium for his complaint, his nature, under its operation, suffered such an entire inversion that the libraries, and on several occasions even the pocket-books of his friends were not safe from him, his larcenies comprising some of the most valuable volumes on the shelf and sums varying between two and twenty dollars in the porte-monnaie. "The Book-Hunter" writing of De Quincey, as you will recollect, under the _sobriquet_ of "Papaverius," describes the perfectly child-like absence of all proprietary distinctions which prevailed in that wonderful man's mind during his later years as regarded the books of his acquaintance, and the innocent way in which he abstracted any volume which he wanted or tore out and carried away with him the particular leaves he wished for reference.

In many cases where the moral sense has suffered no such general _bouleversement_, the tendency which opium superinduces to look at every thing from the most sanguine point of view--the vague, dreamy habit of thought and the inability to deal with hard facts or fixed quantities--make it necessary to take an opium-eater's assertions upon any subject with a certain degree of allowance--to translate them, as it were, into the accurate expressions of literal life; but even where this necessity docs not exist, in cases sometimes though rarely met with, where opium has been long used without tinging any of life's common facts with uncertainty, an opium-eater can scarcely even be relied on for the exact truth concerning his own habit. He may be trusted without hesitation upon every other subject, but on this he almost always speaks evasively, and though about any thing else he would cut his hand off rather than say the thing that is not, will sometimes tell a downright falsehood. In most cases he has been led to this course by witnessing the agony or suffering the reproach with which the knowledge of his habit is received by his friends. He lies either in mercy to them or because the pangs which their rebuke inflicts would become still more intolerable if they knew the extent of his error.

It is therefore always proper that the opium-eater should find in his physician a confidant who will not violate his secret even to parent or wife. The closer the relation and the dearer the love, the greater will be the likelihood that the optum-eater has shrunk from revealing the full extent of his burden to the friend in question, and the greater will be the temptation to deceive the doctor unless the patient be made to feel that his revelation is as sacred as the secrets of the bridal-chamber.

I solicit from the friend who accompanied Mr. Edgerton the thoroughest statement which he can give me of the case, _ab extra_. Such a statement is of great value--for the inroads which the habit has made upon the system are often visible to an outsider only. Furthermore, a friend may give me many circumstances connected with the inception of the case: family predispositions and inherited tendencies; causes contributing to the formation of the habit, such as domestic or business misfortune, prior bad habits of other kinds, illnesses suffered, and a variety of other agencies concerning which the patient might hesitate or forget to speak for himself. Then I make Mr. Edgerton the proffer of that inviolable confidence which I have mentioned, and having won his perfect faith in me, obtain the very fullest history of his case which can be elicited by searching, but most kindly and sympathizing cross-examination. The two statements I collate and enter for my future guidance in a private record.

Let us suppose an average hopeful case.

I find that my patient is about thirty years of age--of the energetic yet at the same time delicate and sensitive nervous organization which is peculiarly susceptible to the effects of opium, from which it draws the vast majority of its victims, and in which it makes its most relentless havoc; with a front brain considerably beyond the average in size and development. My patient's general health, apart from the inevitable disturbances of the drug, has always been fair, and his constitufion, under the same limitations, is a vigorous one. His habit, as in nine cases out of every ten, dates from the medical prescription of opium for the relief of violent pain or the cure of obstinate illness. He was not aware of the drug then administered to him, or at any rate of the peril attending its use, and his malady was so long protracted that opium had established itself as a necessary condition of comfortable existence before he realized that it possessed the slightest hold upon him. When the prescription was discontinued he suffered so much distress that he voluntarily resumed it, without consulting his physician, or, if he did consult him, receiving no further warning as to his danger than that "he had better leave off as soon as practicable." Or else, on leaving off his use of opium, the symptoms for which it had originally been administered returned with more or less severity, and under the idea that they indicated a relapse instead of being one of the characteristic actions of the drug itself, he resumed the dose. It gradually lost its power; little by little he was compelled to increase it; and having begun with 1/3 grain powders of which he took three per diem, he is now taking 18 grains of morphia per diem at the end of five years from his first dose.

If I find him tolerably vigorous on his arrival, as will be the case when he has come to Lord's Island after calm deliberation and the conviction not that he _must_, but on all accounts _had better_ abandon the habit, I leave him to recover from the fatigues of his journey and get acquainted with his surroundings before I begin any treatment of his case. If, however, as sometimes occurs, he reaches us in desperate plight, having been so far injured by his habit as to show unequivocal signs of an opium-poisoning which threatens fatal results; if, as in several cases known to me, he has summoned all his remaining vitality to get to a place of refuge, being overtaken either by that terrible _coma_ which often terminates the case of the opium-eater in the same fashion that persons new to the narcotic are killed by an overdose, or by that only less terrible opium-delirium belonging to the same general class as mania potu--then his case admits of not a moment's delay. Opium-eaters differ so widely--every new case furnishing some marked idiosyncrasy which may demand an entirely different management and list of remedies from those required by the last one--that for any general scheme of treatment a week's study of the patient will be necessary. During that week our attitude will be simply tentative and expectant, and at its close the proper fidelity and vigilance will have authorized us in making out something like a permanent schedule for the patient's upward march, though even then we must be prepared, like skillful generals, to meet new emergencies, take unforeseen steps, even throw overboard old theories, at any stage of his progress. In no disease is there such infinite variety as in that of opio-mania, in none must the interrogation of nature be more humbly deferent and faithfully attentive; in none do slight differences of temperament, previous habits, and circumstances necessitate such wide variation in the remedies to be used. Notice, by way of illustration, the fact that one opium-eater under my care was powerfully affected and greatly benefited by the prescription of _one drachm_ of the fluid extract of _cannabis indica_, while another, in temperament, history, tendencies, and all but a few apparently trifling particulars almost identical, not only received no benefit but actually experienced no perceptible effect whatever from the absolutely colossal dose of _four fluid ounces_. [Footnote: I am aware how incredible this statement will seem to those who have never had any extensive experience of the behavior of this remarkably variable drug, and get their notion of its action from the absurd directions on the label of every pound vial I have seen sent forth by our manufacturing pharmaceutists. "Ten to twenty drops at a dose," they say, "cautiously increased." Cannabis should always be used with caution, but ten or even twenty drops must be inert in all but the rarest cases, and I have given an ounce per diem with beneficial effect. But four ounces of the best extract (Hance & Griffith's) producing literally no effect of any kind on an entirely fresh subject, is a phenomenon that I must have needed eye-witness to imagine possible.] I may add that in the latter case, _bromide of potassium_ was administered with the happiest result--in fact as nearly approaching in its efficiency the character of a succedaneum as any remedy I ever used to alleviate the tortures of opium, while in the former no result attended its administration salutary or otherwise. The vast diversity of operation exhibited in different patients by the drug _scutellaria_ is still another illustration of the careful study of idiosyncrasies requisite for a successful treatment of the opium disease. But when the case comes into our hands at a desperate period there are many means of instant alleviation which may anticipate without interfering with future treatment based on study.

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.