Chapter 26

Another most important means of alleviation is the galvanic bath. House's patent is an excellent apparatus for the purpose; convenient in shape and size, comfortable, not easily deranged, affording a variety of simple and combined currents, adjustable so as to pass the current either through the whole body or along almost any nervous tract where it is especially wanted for the relief of local suffering like that of the opium sciatica, and manageable by any intelligent child who has ever watched attentively while it was getting put into operation. Many a sufferer who seems quite a discouraging subject under the dry method of administering galvanism responds to it at once transmitted through a bath, and in any case this is a no less beneficial than delightful way of using it. The skin is so much better a conductor when wet, and the distribution by water so uniform, that in most cases it may be pronounced the best way. The Turkish bath I have seen used with excellent result during the earlier days of suffering. It will seem almost incredible to any one who has taken a Turkish bath for other purposes, and knows the tax which it seemed to inflict upon his nervous system for the first few minutes after entering the heated chamber and till profuse perspiration came to his relief, when I say that I have seen a man brought to the bath in that almost dying state of prostration some pages back described as belonging to the acute attack of opiomania, at once subjected to the temperature of 130° F., and in ten minutes after to thirty degrees higher, not only without rapidly sinking into fatal collapse, but with a result of almost immediate and steady improvement. To my own great surprise his pulse began getting fuller, slower, steadier, and in every way more normal from the moment that the attendant laid him down upon his slab. When he came in he was obliged to be carried in the arms of his friends like an infant; his pulse one minute was 140, the next 40-60, or entirely imperceptible, and when fastest alarmingly thready; his countenance was corpse-like, he breathed nine or ten times a minute, and his general prostration so utter that he could scarcely speak even in a whisper. He stayed in the bath an hour and a quarter, in a streaming perspiration for the last forty minutes, and much of the time sleeping sweetly. He came out walking easily without assistance, and in the cool anteroom fell asleep again upon the lounge, not to wake for an hour longer. This one bath entirely broke up the attack. He kept on improving, and with the aid of beef-tea was well enough to go to business in a week. The value of the bath in treating Mr. Edgerton at present will he greatest when he suffers most severely from acute neuralgic pains in the legs and back, especially if the efficiency of the hot full-baths and vapors seem temporarily suspended through frequent use. His own feelings are the best criterion of its worth at any given time. It operates very differently on different people and in different conditions of the system. To some persons it is less debilitating than the use of hot water, and others, myself among the number, find it so excessively disagreeable from the apoplectic sensation it produces in their heads, and the difficulty of breathing which they suffer from it, that nothing but a discovery that it was the only means in their particular case of relieving sufferings like those of opium would induce them to enter it. Many persons profess to like it as well as the Russian (which, singularly enough, in no case have I ever known to produce the disagreeable feeling in head or lungs), and it certainly ranks with the foremost alleviatives of the opium suffering--the agonizing rythmical neuralgia of which I have spoken usually becoming magically lulled within two minutes from the time of entering the first heated chamber, and ceasing altogether as soon as the perspiration becomes thoroughly established. At Lord's Island our Turkish bath-room will immediately adjoin our Russian, and the temperature being supported by pipes from the same boiler which furnishes vapor to the other, will be no heavy addition to our expense in the way of apparatus. I don't know whether it is necessary to tell any body that the Turkish bath is merely an exposure of the naked body (with a wet turban around the head) to a dry heat varying from 110º F. to a temperature hot enough, to cook an egg hard--followed by ablutions and shampooings somewhat similar to those of the Russian bath.

As it is our aim to _cure_ the opium-eater by bringing to bear upon his most complicated of all difficulties every means which has proved effectual in the treatment of any one of its particulars, however caused in other instances, we ask no questions of any appliance regarding its nativity, but take from the empiric whatever he has stumbled on of value as freely as the worthiest discoveries of the philosopher from him. There have been various attempts to erect into a _pathy_ every one of the applications we have already mentioned, and I shall close this brief outline of our therapeutic apparatus at Lord's Island with one more valuable method of relief and cure whose enthusiastic discoverers (or rather adapters) have outraged etymology worse than the regular practice by trying to build on their one good thing an entire system under the title of "Motorpathy." [Footnote: I see that some scholar has lately got hold of them and forced them to respect philological canons by kicking the mongrel out of their dictionary and calling themselves _Kinesipathists_, instead of the other Graeco-Latin barbarism.] The "_Movement Cure_" contains some very good ideas, which, like many of the Hydropathists', ought to be taken up by Science, in whose hands and their proper place they can do fine service.

As we have found in the case of shampooing, a great deal of the suffering of any part can be taken out by giving it something else to do. A portion of the good done by rubbing an aching leg is no doubt accomplished by setting the nerve at work upon the sensations of pressure and of heat and so diverting it from that of pain, but another portion is probably due to the fact of motions producing changes, in the nature of mechanical and chemical decompositions, in the substance of the tissue; thus by a well known physiological law summoning a concentration of the nervous forces to the particular part. Nature is thus accelerated in her action there, and as that action is always toward cure (so long as life and hope exist), the nerves of the part are reinforced to act sanely. To be weak is to be miserable--to be strong is to be free from pain--thus the nerve's returning vigor eliminates its suffering. The fresh blood that is pumped into the part by motion brings about another set of ameliorating changes of more especial importance where the pain is caused by a local lesion instead of rather being sympathetic with the whole systematic debility. Whatever be our theory, the tenet that motion relieves pain, as a tenet, is as old as the "_back- straightening_" process used in some shires by the British turnip-hoers who on coming to the end of their rows lie down and let the rest of the women in the field walk over their toil-bent spine and cramped dorsal muscles, while as a fact it is as old as pain itself.

On Lord's Island, therefore, we have a room fitted up with apparatus intended to give passive exercise to every part of the body which the pain of abandoning opium is especially likely to attack.

Mr. Edgerton is suffering extremely, about the close of the third day after his last 1/2 grain dose of morphia, from the agonizing rythmical neuralgia of which I have spoken, throbbing from the loins to the feet; and although with good effect we have given him galvanism, shampooing, baths of several kinds, and a number of internal remedies, still, wishing to keep each of these appliances fresh in its potency, we make a change this time to the "movement-room." He is stripped to his shirt, dressing-gown, and drawers, and laid on his back along a comfortable stuffed-leather settee, running quite through whose bottom are a number of holes about four by three and a half inches. These holes are occupied by loose-fitting pistons which play vertically up through the cushion--lying level with it when at rest, and when in motion projecting about two inches above it at the height of their stroke. Motion is secured to them by crank connection with a light shaft running beneath the settee, revolved by a band-wheel, which in its turn connects by a belt with the small engine outside the building, by which all the drudgery of the house is performed. Mr. Edgerton is adjusted over the holes so that, in coming up, the pistons, which are covered with stuffed leather pads, strike him alternately on each side of the spine, from about the region of the kidneys to just beneath the shoulder-blade. The shifting of a lever throws the machine into gear, and for the next five minutes, or as long as he experiences relief, the artificial fists pummel and knead him at any rate of speed desired, according to the adjustment of a brake. This process over, if he still feels pain in the lower extremities, his foot is buckled upon an iron sole which oscillates in any direction according to its method of connection with the power, from side to side, so as to twist the leg about forty-five degrees each way, up and down, to imitate the trotting of the foot, or with a motion which combines several. A variety of other apparatus gives play to other muscles; but I have said enough to show the idea of its _modus operandi_. The passive exercise thus afforded is an admirable substitute for that active kind which in his first few days of deprivation the intensity of his agony often incapacitates him from taking. I have seen men at this period almost bent double from mere pain, and hobbling when they attempted to walk like subjects of inflammatory rheumatism. Their debility also is often so great as to prevent exercise, especially when the characteristic diarrhea has been for some days in operation, though different people differ astonishingly in this respect. I knew one case where an opium-eater of three years' habituation to the drug endured in its abandonment every conceivable distress without suffering from debility at all, as may be inferred from the fact that as his only way of making life tolerable he took a walk of twelve miles every morning while going through his trial. The majority, however, suffer not only pain but prostration of the most distressing character--a combination as terrible as can be conceived, since the former will not let the victim remain in one position for a single minute, and the latter takes away all his own control of his motion, so that he seems a mere helpless, buffeted mass of agony--an involuntary devil-possessed, devil-driven body, consciousness at its keenest, will at its deepest imbecility--almost fainting with fatigue, unable to limp across the room on legs which seem dislocated in every joint and broken in a thousand places, yet unable to stop tossing from side to side, and writhing like a trodden worm all night, all day, perhaps for weeks.

"Oh!" I have heard the patient say, "would to God this made me _tired!_ healthily tired, so that I could fall into a minute's doze!"

The apparatus I have just been describing meets this want. Sometimes while the leather and iron fists are pegging away and pummelling him at their hardest, he falls asleep on the machine! It has done for him all that he had not the strength to do for himself--tired him healthily.

The remedies I have mentioned are capable of indefinite combinations. The head of an institution like Lord's Island will want them all, although any one given case may not require all of them. In the hands of a thoroughly scientific, skillful man, they form an armory of means with which such an amount of good can be done as beggars our imagination. Combined with the most faithful attention to the patient's diet--the establishment of healthful nutrition, so that as fast as those abnormal matters which have been clogging the system get cleared away by Nature's relentless processes of decomposition, fresh material may be soundly built up into the system to replace the strength which the fatal stimulant feigned--combined with vigilant, tender, patient nursing--the means described are probably, in many cases, adequate of themselves to restore any opium-eater who is salvable at all. Still, brief as this sketch is, and so far from making any pretensions to be an exhaustive treatise for the guidance of the profession, I should fail of presenting even a fair outline of the treatment which an unusually wide experience with opium-eaters has convinced me to be the true one, did I not add to the above a few words regarding the medicinal agents which are of value during the month of peculiar trial through which Mr. Edgerton is now passing.

It is scarcely necessary to premise that no such thing as a succedaneum for opium is comprehended in the list of these agents. Any drug which would so nearly accomplish for the opium-eater what opium accomplishes that he would not miss the latter, must be nowise preferable to opium itself. Such a drug must be able to prevent the decompositions which cause the suffering; to continue that semi-paralysis of the organic functions in which opium's greatest fascination exists, a paralysis leaving the cerebral man free to exhaust all the vitality of the system in pleasant feelings, lofty imaginings, and aerial dreams, without a protest from the gauglionic man who lies a mere stupefied beggar without any share in the funds of the partnership wherewith to carry on the business of the stomach and bowels and heart, the kidneys and lungs and liver. It must be a drug that can prevent the re-awakening ol the nutritive and excretory processes--for it is these whose waking, seeing how late in the day it is, clamoring at the confusion in which they find affairs and at the immense quantity of behind-hand work suddenly thrown on them, together with that re-sharpening of long-dulled sensation by which the clamor comes into consciousness loud as the world must be to a totally deaf man suddenly presented with his hearing, which constitute the series of phenomena which we call pain. No! there is no such thing as a substitute for opium, save--more opium or death. And I do not know that I need say "_or_."

Still, there are many alleviatives by which the suffering may be rendered more endurable--by which now and then our patient may be helped to catch a few moments of that heavenly unconsciousness which makes the nervous system stronger to fight the battle out to its blessed end--by which processes of Nature may be slowed when they get too fiery-forceful for human courage to endure, or accelerated when the pull seems likely to be such a long one as to kill or drive mad through sheer exhaustion. I have spoken of bromide of potassium. This in connection with the pack may in many cases wisely be continued throughout the whole progress of the case, and often hastens the restoration of general nervous equilibrium by many days, removing to a very pereptible degree that _hyperaesthesia_, that exaggerated sensation of all the natural processes normally unconscious, which continues to rob the sufferer of sleep long after acute pain is lulled. The greatest variety of opinions prevails upon the subject of cannabis and scutellaria. The principal objection to the cannabis lies in two facts. First, it is very difficult to obtain any two consecutive specimens of the same strength, even from the same manufacturer. Second, in its gum state it is exceedingly slow of digestion, and unlike opium not seeming to affect the system at all by direct absorption through the walls of the stomach, it is very slow in its action; the dose you give at 4 P.M. may not manifest itself till 9 or even midnight, and even then may still move so sluggishly that you get from it only a prolonged, dull, unpleasant effect instead of a rapid, favorable, and well-defined one. If it is given in the form of a fluid extract or tincture, its operation can be more definitely measured and counted on, but the amount of alcohol required to dissolve it is sufficient often to complicate its effects very prejudicially, while in any case the immense proportion of inert rubbish, gum, green extractive, woody fibre, and earthy residuum is so great as to be a severe tax on the digestive apparatus--often seriously to derange the stomach of the well man who uses it, and much more the exquisitely sensitive organ of the opium-eater, I might add a third objection-the fact that its effects vary so wonderfully in different people--but the physician can soon get over that by making his patient's constitution in the course of a few experiments with the drug the subject of his careful study. Both its lack of uniformity and its difficulty of exhibition may be nullified by using the active principle. It has been one of the _opprobria medicinæ_ that in a drug known to possess such wonderful properties so little advance has been made toward the isolation of the alkaloid or resinoid on which it depends for its potency. I have for years been endeavoring to interest some of our great manufacturing pharmaceutists in the attainment of a form--condensed, uniform, and portable--which should stand to cannabis in the same relation which morphia bears to opium. I believe that, in collaboration with my friend Dr. Frank A. Schlitz (a young German chemist of remarkable ability and with a brilliant professional career before him), I have at last attained this desideratum. I have no room or right here to dwell upon this interesting discovery further than to say that we have obtained a substance we suppose to bear the analogy desired and to deserve the title of _Cannabin_. If further examination shall establish our result, we have in the form of grayish-white acicular crystals a substance which stands to cannabis in nearly the same proportional relation of potency as niorphia to opium, and this most powerful remedy can be given as easily and certainly as any in the pharmacopoeia. If we are successful we shall ere long present it to the medical profession. With all the objections that prejudice cannabis now, I have still witnessed repeated proofs of its great value in lulling pain and procuring sleep, when all other means had failed with the reforming opium-eater, in doses of from one drachm to five of fluid extract or tincture (in some rare cases even larger), administered twice a day. Like opium it is only secondarily a soporific, and to produce this effect it should be given three or four hours before the intended bed-time. Then the earliest effect will be a cerebral stimulus, sufficient to divert the mind from the body's sufferings during day-light, and the reaction will come on in time to produce slumber of a more peaceful and refreshing character--more nearly like normal sleep in a strong, energetic constitution fatigued by healthy exertion, than that invoked by any drug I know of.

It may sometimes be necessary, when the pain has become so maddening and been so protracted, to save the brain from the delirium of exhaustion (or even as I have known to happen, _death_) by procuring sleep for half an hour at any cost save that of a return. The most interesting patient and noble man whose sufferings compose the text and prompted the writing of my _Harper's Magazine_ article, died just as it was going to press through the exhaustion of a brain that had no true sleep for months. To avoid such a termination, sleep must be had at any cost, and even the danger attending chloroform or ether must be risked, though I need not point out the necessity of pre-eminent wisdom, and the constant personal presence and watchfulness of symptoms, in the physician during the time that the anaesthetic is inhaled. Of ether as much as three or four ounces may be inhaled during a single evening without much danger, if the precaution of alternating the inspirations from a saturated handkerchief with those of pure atmospheric air be carefully attended to. Chloroform is much more risky, and almost always tends to derange the stomach for several days after its use, still its action is certain in some cases where ether fails even to obscure sensation, and must be resorted to. A single ounce per evening, inhaled with rather longer intervals between whiffs, need not be a perilous dose, and in my experience has often conferred magical relief. Nitrous oxide is too transient to be of much use, but to the extent of twenty or thirty gallons may be used with pleasant effect and about five minutes of alleviation.

Very different from these powerful agents is the humble, much-neglected _scutellaria_. It has been repeatedly pronounced inert, but is beyond all question a minor sedative of charmingly soothing properties, giving sleep, as I have sometimes witnessed, out of the very midst of intolerable rythmical neuralgic suffering--in one case the first sleep the patient had enjoyed since leaving off opium. It may be given with impunity in much larger doses, but on those constitutions with which it has any effect at all a table-spoonful is usually efficacious about ten minutes after its exhibition in the form of fluid extract. Lupulin, valerian, valerianate of zinc, and hyoscyamus (or with a much less tendency to derange the stomach, _hyoscyamin_ in 1/10 grain doses) all have their value in the less violent cases or toward the close of the struggle. Capsicum, in the five grain doses earlier mentioned, may often be relied on to counteract the tendency to frightful dreams arising from the exquisitely irritable state of the stomach in which the opium-habit leaves its victims.