The Opium Habit

by Horace B. Day

Likewise I suppose there are very few people who could patiently regard the fact that one of the very purest and bravest souls I ever knew had become so demoralized by the perseverance of disease and suffering as to deal like a lawyer with his best friends, and shuffle to the very edge of falsehood, when his nature clamored for opium. I was particular to tell him whenever I detected any evasion (an occasion on which his shame and remorse were terrible to witness) that I, personally, had none the less respect for him. I knew he was dominated, and in no sense more responsible for breaking his resolution than he would have been had he vowed to hold his finger in the gas-blaze until it burned off. In this latter case the mere translation of chemical decomposition into pain, and round the automatic nerve-arc into involuntary motion, would have drawn his finger out of the blaze, as it did in the cases of Mutius Scaevola and Cranmer, if they ever attempted the feat credited them by tradition. In his case the abandonment of opium brought on an agony which took his actions entirely out of voluntary control, eclipsing the higher ideals and heroisms of his imagination at once, and reducing him to that automatic condition in which the nervous system issues and enforces only those edicts which are counselled by pure animal self-preservation. Whatever may have been the patient's responsibility in beginning the use of narcotics or stimulants (and I usually find, in the case of opium-eaters, that its degree has been very small indeed, therapeutic use often fixing the habit forever before a patient has convalesced far enough even to know what he is taking) habituation invariably tends to reduce the man to the automatic plane, in which the will returns wholly to the tutelage of sensation and emotion, as it was in infancy; while all the Intellectual, save Memory, and the most noble and imperishable among the Moral faculties may survive this disorganization for years, standing erect above the remainder of a personality defrauded of its completion to show what a great and beautiful house might have been built on such strong and shapely pillars. Inebriates have been repeatedly known to risk imminent death if they could not reach their liquor in any other way. The grasp with which liquor holds a man when it turns on him, even after he has abused it for a lifetime, compared with the ascendency possessed by opium over the unfortunate habituated to it for but a single year, is as the clutch of an angry woman to the embrace of Victor Hugo's Pieuvre. A patient whom, after habitual use of opium for ten years, I met when he had spent eight years more in reducing his daily dose to half a grain of morphia, with a view to its eventual complete abandonment, once spoke to me in these words:

"God seems to help a man in getting out of every difficulty but opium. There you have to claw your way out over red-hot coals on your hands and knees, and drag yourself by main strength through the burning dungeon-bars."

This statement does not exaggerate the feeling of many another opium-eater whom I have known.

Now, such a man is a proper subject, not for reproof, but for medical treatment. The problem of his case need embarrass nobody. It is as purely physical as one of small-pox. When this truth is as widely understood among the laity as it is known by physicians, some progress may be made in staying the frightful ravages of opium among the present generation. Now, indeed, it is a difficult thing to prevent relatives from exacerbating the disorder and the pain of a patient, who, from their uninformed stand-point, seems as sane and responsible as themselves, by reproaches at which they would shudder, as at any other cruelty, could they be brought to realize that their friend is suffering under a disease of the very machinery of volition; and no more to be judged harshly for his acts than a wound for suppurating or the bowels for continuing the peristaltic motion.

Finding—as in common with all physicians I have found so many times before—that no control of the case could be obtained while the patient stayed at home, and deeply renewing my often-experienced regret that the science and Christian charity of this country have perfected no scheme by which either inebriates or opium-eaters may be properly treated in a special institution of their own, I was at length reluctantly compelled to send my friend to an ordinary water-cure at some distance from town.

The cause of my reluctance was not the prospect of a too liberal use of water, for by arrangement with the heads of the establishment I was able to control that as I chose; moreover, an employment of the hot-bath in what would ordinarily be excess is absolutely necessary as a sedative throughout the first week of the struggle. I have had several patients whom during this period I plunged into water at 110° Fahrenheit as often as fifteen times in a single day—each bath lasting as long as the patient experienced relief. In some cases this Elysium coming after the rack has been the only period for a month in which the sufferer had any thing resembling a doze. My reluctance arose from the necessity of sending a patient in such an advanced stage of the opium disease so far away from me that I must rely on reports written by people without my eyes, for keeping personally au courant with the case; that I must consult and prescribe by letter, subject to the execution of my plans by men, who, though excellent and careful, were ignorant of my theories of treatment, and had never made this particular disease a specialty. I accordingly sent Mr. A. away to the water-cure, all friendless and alone to fight the final battle of his life against tougher odds than he had ever before encountered. At no time in my life have I realized with greater bitterness the helplessness of a practitioner who has no institution of his own to take such cases to than when I shook his poor, dry, sallow hand and bade him good-bye at the station.

As I said in the beginning, I am just home from seeing the result. Mr. A. has fared as special cases always do in places where there is no special provision for them. To speak plainly, he had been badly neglected; and that, undoubtedly, without the slightest intention on the part of the heads of the house to do other than their duty. Six weeks ago I heard from the first physician that my friend was entirely free from opium, and, though still suffering, was steadily on the mend. I had no further news from him till I was called to his bedside by a note which said he feared he was dying, pencilled in a hand as tremulously illegible as the confession of Guy Fawkes. I was with him by the earliest train I could take, after arranging with a neighbor for my practice, and found him in a condition which led him to say, as I myself said at the commencement of this article; "Would to God that every young person could stand for a single hour by this bedside before Life's Responsibilities have become the sentinels and Habit the jailer of the Will!"

I had not been intelligently informed respecting the progress of his case. He had been better at no time when I was told he was so, though his freedom from opium had been of even longer duration than I was advised. For ninety days he had been without opium in any form. The scope of so un-technical an article leaves no room to detail what had been done for him as alleviation. His prostration had been so great that he could not correspond with me himself until the moment of his absolute extremity; and only after repeated entreaties to telegraph to myself and his family had been refused on the ground that his condition was not critical, he managed to get off the poor scrawl which brought me to his side.

For the ninety days he had been going without opium he had known nothing like proper sleep. I desire to be understood with mathematical literalness. There had been periods when he had been semi-conscious; when the outline of things in his room grew vaguer and for five minutes he had a dull sensation of not knowing where he was. This temporary numbness was the only state which in all that time simulated sleep. From the hour he first refused his craving, and went to the battle-field of bed, he had endured such agony as I believe no man but the opium-eater has ever known. I am led to believe that the records of fatal lesion, mechanical childbirth, cancerous affection, the stake itself, contain no greater torture than a confirmed opium-eater experiences in getting free. Popularly this suffering is supposed to be purely intellectual—but nothing can be wider of the truth.

Its intellectual part is bad enough, but the physical symptoms are appalling beyond representation. The look on the face of the opium sufferer is indeed one of such keen mental anguish that outsiders may well be excused for supposing that is all. I shall never forget till my dying-day that awful Chinese face which actually made me rein my horse at the door of the opium hong where it appeared, after a night's debauch, at six o'clock one morning when I was riding in the outskirts of a Pacific city. It spoke of such a nameless horror in its owner's soul that I made the sign for a pipe and proposed, in "pigeon English" to furnish the necessary coin. The Chinaman sank down on the steps of the hong, like a man hearing medicine proposed to him when he was gangrened from head to foot, and made a gesture, palms downward, toward the ground, as one who said, "It has done its last for me—I am paying the matured bills of penalty." The man had exhausted all that opium could give him; and now, flattery past, the strong one kept his goods in peace. When the most powerful alleviative known to medical science has bestowed the last Judas kiss which is necessary to emasculate its victim, and, sure of the prey, substitutes stabbing for blandishment, what alleviative, stronger than the strongest, shall soothe such doom? I may give chloroform. I always do in the dénouement of bad cases—ether—nitrous oxyd. In employing the first two agents I secure rest, but I induce death nine cases out of ten. Nothing is better known to medical men than the intolerance of the system to chloroform or ether after opium. Nitrous oxyd I am still experimenting with, but its simple undiffused form is too powerful an agent to use with a patient who for many days must be hourly treated for persevering pain. So the opium-eater is left as entirely without anæsthetic as the usual practice leaves him without therapeutic means. Both here and abroad opium-eaters have discovered the fact that, in an inveterate case, where opium fails to act on the brain through the exhausted tissues of the stomach, bichlorid of mercury in combination with the dose behaves like a mordant in the presence of a dye, and, so to speak, precipitates opium upon the calloused surfaces of the mucous and nervous layers. This expedient soon exhausts itself in a death from colliquative diarrhea, produced partly by the final decompositions of tissue which the poisonously antiseptic property of opium has all along improperly stored away; partly by the definite corrosions of the new addition to the dose. But in no case is there any relief to a desperate case of opium-eating save death.