November 3. The pains have abated. Patient has slept for four hours.
November 4. Menstrual discharge still continues. While it is said formerly to have lasted only for a few hours, it has now lasted for forty-eight hours. Toward midday the patient left her bed and remained on the couch for several hours.
November 5. Slept from 11 P.M. till 2.30 A.M. Patient felt oppressed in the night; there was difficult breathing, and she could not remain in bed.
Patient leaves the Institution on November 15th, all bodily functions having become regular. She has up to the present time had no relapse.
In favor of this plan of treatment Levenstein urges the following: “Confidence in the medical adviser is strengthened in consequence of the short duration of the severe symptoms, and the improvement already experienced after a few days; the patients take courage, look forward to their complete recovery, and submit with patience and resignation to the few days of suffering.” And again: “The human organization, as we know from our surgery, midwifery, etc., will, in general, submit more easily to sudden and energetic treatment, even when acting powerfully, than to a milder influence. The gradual deprivation requiring a long time, excites the physical and moral powers to a greater extent, because every dose, smaller than the previous days’ quantity, will produce new symptoms of reaction. The constant mental anxiety in which these patients live, while expecting a smaller dose on the following day, makes them fretful and irritable; their intention of submitting till the end of the cure, and their energy, begin to decline, and they try to evade the treatment. They set up intrigues against the officials and nurses; they simulate morbid appearances, in order to excite the pity of their relations and friends; they lose confidence in themselves and in their doctor, whose full and absolute authority is indispensable for the successful treatment of abstinence.”
This is certainly true of those cases where the treatment is by very gradual reduction, not at all so of those where it lasts but from four to seven days; ten at the most. The latter plan combines all the advantages of Levenstein’s method, and escapes the danger and misery of his, and that of the long protracted course.
In many instances persons addicted to this habit gradually reduce the quantity they have been using to a certain point, beyond which they seem unable to go. Thus, a physician who came under my care reduced his dose from three grains to one-twelfth of a grain in the twenty-four hours, and maintained it at this point for a long time. Finally, however, he returned to the use of the full amount. He employed the subcutaneous method. The majority of patients express their willingness to be rid of the habit, and do endeavor, up to a certain point, to assist themselves, but at this period will power, naturally weakened, gives way, and good resolves are thrown to the wind. It is at this time that every facility for full control of the patient is necessary, for without it the sufferer will invariably stop treatment, claiming that the suffering is beyond his strength, bemoan his sad fate and return to the old habit with renewed force, exclaiming, with Coleridge’s son—
“O woeful impotence of weak resolve.”
The treatment of these cases at the homes of the habituès is rarely successful. Some ruse, some strategy, some deception is sure to be practiced, either by the patient, the friends, the relatives or the nurse. Very often the relatives, not understanding the meaning of certain symptoms, distressed beyond measure by the pitiful pleadings of the sufferer, will interpose and at once put an end to treatment, thus unwittingly and with well meaning doing the patient an injury of the gravest kind. For, the treatment, persisted in almost to the point of cure and then abandoned, so thoroughly disheartens the person that it takes a long time for him to make up his mind to try it again.
Those who are the most likely to behave in a manner such as to cause their friends to interfere, from fear of death or insanity resulting, are hysterical females. Absolute committal to a public or private institution, where the nurses can be absolutely relied upon, and where obedience to the physician’s orders are rigidly enforced, is the only rational plan for treating these cases. Then, too, conveniences for baths of different kinds and temperatures, and varied electrical appliances, not found in patient’s houses, are necessary; more necessary than drugs.