Chapter 6

Let me repeat, that the main thing for the patient at this point of his trial is not to forego the advantage he has already attained--"not to go back." If he can only hold his own he has so far triumphed, and it is only a question of time when the triumph shall be made complete. _When_ this shall be effected _he_ must decide. The rapidity of his further progress must be determined by what he himself is conscious he has the strength, physical and moral, to endure. With some natures any very sudden descent is impossible; with others, whatever is done must be done continuously and rapidly or is not done at all. The one temperament can not stand up against the assaults of a fierce attack, the other loses courage except when the fight is at the hottest. For the former ample time must be given or he surrenders; the latter will succumb if any interval is allowed for repose. It is, therefore, difficult to suggest from this point downward any rule which shall apply equally to temperaments essentially unlike. I think, however, that the suggestion to divide the daily allowance, whether the descent be a slow or a rapid one, into numerous small parts to be taken at equal intervals of time, will be found to facilitate the success of the attempt in the case of both. The chief value of such subdivision probably consists in its throwing the aggregate influence of the day's opium nearer the hour of bed-time, when it is most needed, than to an earlier hour, when its soporific power is less felt. In addition to this, the importance to the excited and irritated patient of being able to look forward during the long-protracted hours to frequent, even if slight, alleviations of his pain, should not be left out of the account. In general it may be said that whenever the patient feels that he can safely, that is, without danger of failing in his resolution, adventure upon a further diminution of the quantity, an additional amount, smaller or greater according to circumstances, should be deducted till the point is reached where the suffering becomes unendurable; then after a delay of few or many days, as may be needed to make him somewhat habituated to the diminished allowance, a still further reduction should be made, and so on for such time as the peculiarities of different constitutions and circumstances may make necessary, till the quantity daily required has become so small, say a grain or two, that by still more minute subdivisions, and by dropping one of them daily, the final victory is achieved.

I have not ventured to say in how short a time confirmed habits of opium-eating may be abandoned. In my own case it was thirty-nine days, but with my present experience I should greatly prefer to extend the time to at least sixty days; and this chiefly with reference to the violent effects upon the constitution produced by the suddenness of the change of habit. Some constitutions may possibly require less time and some probably, more. While I regard the abandonment of the first three-quarters of the accustomed allowance as being a much easier task than the last quarter, and one which can be accomplished with comparative impunity in a brief period, I would allow at least twice the time for the experiment of dispensing with the last quarter; unless, indeed, I should be apprehensive that my resolution might break down through the absence of the excitement which is unquestionably afforded by the feeling that you are engaged in a deadly but doubtful conflict. So far, also, as can be inferred from cases subsequently narrated in this volume, the probability of success would seem to be enhanced by devoting a longer time to the trial. It can not, however, be too often repeated, that however slow or however rapid the pace may be, the rule to be rigidly observed is this: Never to increase the minimum dose that has once been attained. This is the only rule of safety, and by adhering to it, persons in infirm health, or with weakened powers of resolution, will ultimately succeed in their efforts.

I subjoin my own record of the quantity of opium daily consumed, for the possible encouragement of such opium-eaters as may be disposed to make trial of their own resources in the endurance of bodily and mental distress.

Saturday, Nov. 25....80 grains, = 2000 drops of laudanum. Sunday, " 26....60 " 1500 " " Monday, " 27....50 " 1250 " " Tuesday, " 28....40 " 1000 " " Wednesday, " 29....30 " 750 " " Thursday, " 30....25 " 625 " " Friday, Dec. 1....20 " 500 " " --- ----- Average of 1st week....44 " 1089 " "

Saturday, Dec. 2.....19 grains, = 475 drops of laudanum. Sunday, " 3.....18 " 450 " " Monday, " 4.....17 " 425 " " Tuesday, " 5.....16 " 400 " " Wednesday, " 6.....15 " 375 " " Thursday, " 7.....15 " 375 " " Friday, " 8.....15 " 375 " " ---- ---- Average of 2d week.....16.43" 411 " "

Saturday, Dec. 9.....14 grains, = 350 drops of laudanum. Sunday, " 10.....13 " 325 " " Monday, " 11.....13 " 325 " " Tuesday, " 12.....12 " 300 " " Wednesday, " 13.....12 " 300 " " Thursday, " 14.....11 " 275 " " Friday, " 15.....10 " 250 " " ---- ---- Average of 3d week.....12.14" 304 " "

Saturday, Dec.16..... 9 grains, = 225 drops of laudanum. Sunday, " 17..... 8 " 200 " " Monday, " 18..... 8 " 200 " " Tuesday, " 19..... 7 " 175 " " Wednesday, " 20..... 6 " 150 " " Thursday, " 21..... 5 " 125 " " Friday, " 22..... 4 " 100 " " ---- ---- Average of 4th week.....6.71" 168 " "

Saturday, Dec.23..... 3 grains, = 75 drops of laudanum. Sunday, " 24..... 3 " 75 " " Monday, " 25..... 2 " 50 " " Tuesday, " 26..... 2 " 50 " " Wednesday, " 27..... 2 " 50 " " Thursday, " 28..... 2 " 50 " " Friday, " 29..... 1 " 25 " " ---- ---- Average of 5th week.....2.14" 54 " "

Saturday, Dec.30..... 1 grain, = 25 drops of laudanum. Sunday, " 31..... 1 " 25 " " Monday, Jan. 1..... 1 " 25 " " Tuesday, " 2.....1/2 " 12 " " Wednesday, " 3.....1/4 " 6 " " ---- ---- Average of 6th week....0.75 " 18 " "

The fourth and fifth weeks I found to be immeasurably the most difficult to manage. By the sixth week the system had become somewhat accustomed to the denial of the long-used stimulant. At any rate, though no abatement of the previous wretchedness was apparent, it certainly seemed less difficult to endure it. It is at this stage of the process that I regard the advice and encouragement of a physician as most important. He may not indeed be able to do much in direct alleviation of the pain incident to the abandonment of opium, for I suspect that little reliance can be placed upon the medicines ordinarily recommended. The system has become accustomed to the stimulant to an exorbitant degree; the suffering is consequent upon the effort to accustom the system to get on without it. Other kinds of stimulants, like spirits or wine, will afford a slight relief for a few days, especially if taken in sufficiently large quantities to induce sleep. It is the sedative qualities of the opium that are chiefly missed, for as to excitement the patient has quite as much of it as he can bear. For this reason malt liquors are preferable to distilled spirits--they stupefy more than they excite. But to malt liquors this serious objection exists, they tend powerfully to aggravate all disorders of the liver. This tendency the reforming opium-eater can not afford to overlook, for no one effect of the experiment is more distressing than the marvellous and unhealthy activity given to this organ by the process through which he is passing. The testimony of all opium-eaters on this point is uniform. For months and even years this organ in those who have relinquished the drug remains disordered. When in its worst state, the use of something bitter, the more bitter the better, is exceedingly grateful. The difficulty lies in finding any thing that has a properly bitter taste. Aloes, nux vomica, colocynth, quassia, have a flavor that is much more sweet than bitter. These serious annoyances from the condition of the liver, as well as those arising from the state of the stomach and some of the other organs, may be somewhat mitigated by the skill of an intelligent medical man, who, even if he happens to know little about the habit of opium-eating, should know much as to the proper regimen to be observed in cases where these organs are disordered.

In respect to food it seems impossible to lay down any general rule. De Quincey advises beefsteak, not too much cooked, and stale bread as the chief diet, and doubtless this was the best diet for him. Yet it is not the less true that "what is one man's meat is another man's poison," and food that is absolutely harmless to one may disorder the entire digestion of another. Roast pork, mince pies, and cheese do not, I believe, rank high with the Faculty for ease of digestion, yet I have found them comparatively innoxious, while poultry, milk, oysters, fish, some kinds of vegetables, and even dry toast have caused me serious inconvenience. The appetite of the recovering opium-eater will probably be voracious and not at all discriminating during the earlier stages of his experiment, and will continue unimpaired even when the stomach begins to be fastidious as to what it will receive. Probably no safer rule can be given than to limit the quantity eaten as far as practicable, and to use only such food as in each particular case is found to be most easy of digestion.

Too much prominence can not be given to bodily exercise as intimately connected with the recovery of the patient. Without this it seems to me doubtful whether a person could withstand the extreme irritation of his nervous system. In his worst state he can not sit still; he must be moving. The complication of springs in the famous Kilmansegge leg, is nothing compared with the necesity for motion which is developed in the limbs of the recovering opium-eater. Whatever his health, whatever his spirits, whatever the weather, walk he must. Ten miles before breakfast will be found a moderate allowance for many months after the habit has been subdued. A patient who could afford to give up three months of his time after the opium had been entirely discarded, to the perfect recovery of his health, could probably turn it to no better account than by stretching out on a pedestrian excursion of a thousand miles and back. This would be at the rate of nearly twenty-six miles a day, allowing Sunday as a day of rest. This advice is seriously given for the consideration of those who can command the time for such a thorough process of restoration. Nor should any weight be given to the objection that the body is in too enfeebled a state to make it safe to venture upon such an experiment. Account for it as physiologists may, it is certain that the debilitating effects of leaving off opium much more rapidly pass away from the lower extremities than from the rest of the body. At no time subsequent to my mastery of opium have I found any difficulty in accomplishing the longest walks; on the contrary they have been taken with entire ease and pleasure. Yet to this day, any considerable exercise of the other muscles is attended with extreme debility. In the absence of facilities for walking, gymnastic exercise is not wholly without benefit, and if this exercise is followed by a cold bath, some portion of the insupportable languor will be removed. Walking, however, is the great panacea, nor can it well be taken in excess. So important is this element in the restorative process that it may well be doubted whether without its aid a confirmed opium-eater could be restored to health.

It is useless for any person to think that he can break off even the least inveterate of his habits without effort, or the more obstinate ones without a struggle. Wine, spirits, tobacco, after years of habitual use, require a degree of resolution which is sometimes found to be beyond the resources of the will. Much more does opium, whose hold upon the system is vastly more tenacious than all these combined, call for a resolute determination prepared to meet all the possible consequences that pertain to a complete and perfect mastery of the habit. It should be remembered, however, that the experience here recorded is that resulting from years of large and uninterrupted use of opium. The entire system had necessarily conformed itself to the artificial habit. For years the proper action of the nervous, muscular, digestive, and secretory system had been impeded and forced in an unnatural direction. In time all the vital functions had conformed as far as possible to the necessity imposed upon them. Scarce a function of the body that had not been daily drilled into a highly artificial adaptation to the conditions imposed upon the system by the use of opium. Nature, indeed, for a time rebels and resists the attempt to impose unnatural habitudes upon her action; but there is a limit to her resistance, and she is then found to possess a marvellous power of reconciling the processes of life with the disturbance and disorder of almost the entire human organization. This power of adaptation, while it unquestionably lures on to the continued indulgence of all kinds of bad habits, is, on the other hand, the only hope and assurance the sufferer from such causes can have of ultimate recovery from his danger. If it requires years to establish bad habits in the animal economy, why should we expect that they can be wholly eradicated except by a reversal, in these respects, of the entire current of the life, or without allowing a commensurate time for that perfect restoration of the disordered functions which is expected?

If this view of the case is not encouraging to the veteran consumer of opium, it certainly is not without its suggestive utility to that larger class whose use of opium has been comparatively limited both in time and quantity. Fortunately, much the greater number of opium-eaters take the drug in small quantities or have made use of it for only a limited period. In their case the process of recovery is relatively easy; the functions of their physical organization still act for the most part in a normal way; they have to retrace comparatively few steps and for comparatively a short time. Even to the inveterate consumer of the drug it has been made manifest that he may emancipate himself from his bondage if he will manfully accept the conditions upon which alone he can accomplish it. In the worst conceivable cases it is at least a choice between evils; if he abandons opium, he may count upon much suffering of body, many sleepless nights, a disordered nervous system, and at times great prostration of strength. If he continues the habit, there remains, as long as life lasts, the irresolute will, the bodily languor, the ever-present sense of hopeless, helpless ruin. The opium-eater must take his choice between the two. On the one hand is hope, continually brightening in the future--on the other is the inconceivable wretchedness of one from whom hope has forever fled.

DE QUINCEY'S "CONFESSIONS OF AN ENGLISH OPIUM-EATER."

Under this title an article appeared in the "London Magazine" for December, 1821, which attracted very general attention from its literary merit and the novelty of its revelations. So considerable was the interest excited in these "Confessions" that the article was speedily republished in book form both in London and this country. The reading public outside of the medical profession were thus for the first time made generally acquainted with the tremendous potency of a drug whose fascinations have since become almost as well known to the inhabitants of England and America as to the people of India or China. The general properties of the drug had of course been familiar to intelligent men from the days of Vasco de Gama, but how easily the habit of using it could be acquired, and with what difficulty when acquired it could be left off, were subjects respecting which great obscurity rested on the minds even of medical men. Such parts only of these "Confessions" as have relation to De Quincey's habits as an opium-eater, have been selected for republication; such extracts from his other writings are added as embody his entire experience of opium so far as he has given it to the world.

* * * * *

I here present you, courteous reader, with the record of a remarkable period of my life. According to my application of it, I trust that it will prove not merely an interesting record, but in a considerable degree useful and instructive. In _that_ hope it is that I have drawn it up, and _that_ must be my apology for breaking through that delicate and honorable reserve which for the most part restrains us from the public exposure of our own errors and infirmities.

Guilt and misery shrink by a natural instinct from public notice: they court privacy and solitude; and, even in the choice of a grave, will sometimes sequester themselves from the general population of the church-yard, as if declining to claim fellowship with the great family of man, and wishing--in the affecting language of Mr. Wordsworth--

'Humbly to express A penitential loneliness.'

It is well, upon the whole, and for the interest of us all that it should be so; nor would I willingly, in my own person, manifest a disregard of such salutary feelings, nor in act or word do any thing to weaken them. But on the one hand, as my self-accusation does not amount to a confession of guilt, so on the other, it is possible that, if it did, the benefit resulting to others from the record of an experience purchased at so heavy a price might compensate, by a vast over-balance, for any violence done to the feelings I have noticed, and justify a breach of the general rule. Infirmity and misery do not, of necessity, imply guilt. They approach or recede from the shades of that dark alliance in proportion to the probable motives and prospects of the offender, and the palliations, known or secret, of the offense; in proportion as the temptations to it were potent from the first, and the resistance to it, in act or in effort, was earnest to the last. For my own part, without breach of truth or modesty, I may affirm that my life has been on the whole the life of a philosopher; from my birth I was made an intellectual creature; and intellectual in the highest sense my pursuits and pleasures have been, even from my school-boy days. If opium-eating be a sensual pleasure, and if I am bound to confess that I have indulged in it to an excess not yet _recorded_ [Footnote: "Not yet _recorded_," I say; for there is one celebrated man of the present day [Coleridge] who, if all be true which is reported of him, has greatly exceeded me in quantity.] of any other man, it is no less true that I have struggled against this fascinating enthrallment with a religious zeal, and have at length accomplished what I never yet heard attributed to any other man--have untwisted, almost to its final links, the accursed chain which fettered me. Such a self-conquest may reasonably be set off in counterbalance to any kind or degree of self-indulgence. Not to insist that, in my case, the self-conquest was unquestionable, the self-indulgence open to doubts of casuistry, according as that name shall be extended to acts aiming at the bare relief of pain, or shall be restricted to such as aim at the excitement of positive pleasure.

Guilt, therefore, I do not acknowledge; and, if I did, it is possible that I might still resolve on the present act of confession, in consideration of the service which I may thereby render to the whole class of opium-eaters. But who are they? Reader, I am sorry to say, a very numerous class indeed. Of this I became convinced some years ago, by computing at that time the number of those in one small class of English society (the class of men distinguished for talent, or of eminent station) who were known to me, directly or indirectly, as opium-eaters; such, for instance, as the eloquent and benevolent -----, the late Dean of -----; Lord -----; Mr. -----, the philosopher; a late under-secretary of state (who described to me the sensation which first drove him to the use of opium in the very same words of the Dean of -----, viz., "that he felt as though rats were gnawing and abrading the coats of his stomach"); Mr. -----; and many others, hardly less known, whom it would be tedious to mention. Now if one class, comparatively so limited, could furnish so many scores of cases (and that within the knowledge of one single inquirer), it was a natural inference that the entire population of England would furnish a proportionable number. The soundness of this inference, however, I doubted, until some facts became known to me which satisfied me that it was not incorrect. I will mention two: 1. Three respectable London druggists, in widely remote quarters of London, from whom I happened lately to be purchasing small quantities of opium, assured me that the number of _amateur_ opium-eaters (as I may term them) was at this time immense; and that the difficulty of distinguishing these persons, to whom habit had rendered opium necessary, from such as were purchasing it with a view to suicide, occasioned them daily trouble and disputes. This evidence respected London only. But, 2, (which will possibly surprise the reader more,) some years ago, on passing through Manchester, I was informed by several cotton manufacturers that their work-people were rapidly getting into the practice of opium-eating; so much so that on a Saturday afternoon the counters of the druggists were strewed with pills of one, two, or three grains, in preparation for the known demand of the evening. The immediate occasion of this practice was the lowness of wages, which at that time would not allow them to indulge in ale or spirits, and wages rising, it may be thought that this practice would cease; but as I do not readily believe that any man, having once tasted the divine luxuries of opium, will afterward descend to the gross and mortal enjoyments of alcohol, I take it for granted

"That those eat now who never ate before; And those who always ate, now eat the more."