It is best for the patient, if an adult, or the parents of the patient, if he is a minor, to sign a paper, submitting him fully to the entire control of the physician for ten days. On leaving home his trunk and clothing should be thoroughly searched, and any form of opium or morphine should be removed. On entering the institution in question, the person is allowed from twenty-four to forty-eight hours’ rest, to recover from the effects of the journey, to become acquainted with his surroundings, and to allow the physician in charge to judge fully the amount of morphine taken, and the condition of the different organs. The urine should be carefully analyzed and the result saved for future reference. The windows in the rooms are to be firmly secured, and no extra furniture, sharp instruments, or projections from which hanging could be possible, are to be allowed. Low, iron bedsteads are to be preferred, and the room heated by furnace or steam pipes, well protected.
On commencing the treatment, the patient is required to give up all money or valuables he may have about him, for which he is given a receipt. He is then undressed by a nurse, wrapped in a blanket, and taken to the bath-room, where he is given a bath. While this is being done, another nurse, under the supervision of the physician, searches everything the patient has brought with him, including the clothes just removed, and takes away any morphine or opium that may have been secreted, as, also, scissors, knife, needles, etc. The search must be very thorough, as I have known patients to sew packets of morphine into the lining and waistbands of their clothing. The patient is then brought back to his room, the nurse fully instructed, and the treatment by rapid reduction commenced.
The physician himself administers the drug, whether by the mouth or by the skin. I usually reduce the quantity used in twenty-four hours one-third, sometimes one-half, the first day. The following case will illustrate the plan pursued:—
Miss B. (sent to me by Drs. Claggett and Walls, of Baltimore), single, aged twenty-seven, born in Virginia. Tall, thin, emaciated. Weight about ninety-eight pounds. Complexion reddish. Dark-brown hair, grayish-blue eyes. Height five feet seven and one-half inches. Extremely nervous temperament. Pupils irregular and contracted. Entered my house for treatment October 16, 1880. Had been taking morphia subcutaneously for eighteen months. It was first given her by a physician, to relieve the intense pain of an attack of pelvic cellulitis. At the end of the treatment, being still a sufferer, she procured a syringe, and continued the injections herself, gradually increasing the dose until the daily amount reached six grains. Sometimes it would be less than this. She was accustomed to take three injections in the twenty-four hours; one in the early morning, one about midday, and one late in the afternoon. She ceased to menstruate three months after she commenced to use the drug, and had not menstruated up to the time of admission. No history of alcoholic excesses in ancestors. Has one sister who is extremely nervous, and a brother just recovering from paralysis of one side of the face.
Her face is dotted with pustules, as also the chest. Body and limbs marked by cicatrices of old and recent punctures. Appetite fair, bowels constipated. Somewhat lethargic and stupid in mind, but, withal, very nervous. Is despondent, and cries easily, but is very anxious to abandon the habit. There is some vaginismus and spasm of the sphincter of the bladder.
October 15, 1880. Seen by Dr. T. Addis Emmet, who pronounced her to be free from all uterine and ovarian disease, beyond the remains of an old pelvic cellulitis, by which the uterus was drawn somewhat to one side. He recommended the injection of large quantities of hot water.
October 16. Was given four grains of morphia, subcutaneously, in two doses, one at 7 A.M., the other at 3 P.M. Is feeling very much depressed and homesick.
October 17. Passed a fair night. Very nervous in the morning. Given one hundred grains of the bromide of potassium. Fluid extract of coca (Parke, Davis & Co.), in half-ounce doses, at 9 and 11 A.M., 2, 4 and 9 P.M.; also one-half grain pills of cannabis indica, at 8 and 10 A.M., 3, 5, 7 and 10 P.M. Given two grains of morphia at 7 A.M., and one grain at 2 P.M. More quiet; using beef tea (the juice of steak squeezed into boiling water and seasoned), sherry and bottled beer. Some pain over left ovary. Ice cream and milk for supper. 8 P.M., Pulse 100. Less nervous; more talkative and pleasant; expressed a desire for oysters. Pain over left ovarian region somewhat relieved by poultices. Bowels have not moved for two days.
Urine.—Specific gravity 1.018; reaction acid; color pale amber; odor normal; sediment slight; microscopically nothing; chemically nothing save an excess of phosphates.