Remembering that Chinaman's face, I can not wonder at the popular notion regarding the abandonment of opium. Men say it is a mental pain; because spiritual woe is the expression of the sufferer's countenance. And so it is, but this woe is underlain by the keenest brute suffering. Let me sketch the opium-eater's experience on the rugged road upward.
Let us suppose him a resolute man, who means to be free, and with that intent has reduced to a hundred drops the daily dose which for several years had amounted to an ounce of laudanum. I am not supposing an extreme case. An ounce of laudanum is a small per diem for any man who has taken his regular rations of the drug for a twelvemonth. In the majority of cases I have found an old habitué's daily portion to exceed three, or the equivalent of that dose in crude opium or morphia; making seventy-two grains of the gum or twelve of its most essential alkaloid. In one most interesting case I found a man who having begun on the first of January with one half a grain of sulphate of morphia for disease, at the end of March was, to all appearance, as hopeless an opium-eater as ever lived, taking thirty-two grains of the salt per day in the form of Magendie's Solution. This, however, was an unusual case. According to my experience the average opium-eater reaches twelve grains of morphia in ten years, and may live after that to treble the amount: the worst case I ever knew attaining a dose of ninety grains, or one and a half of the drachm vials ordinarily sold. I am happy, in passing, to add that for more than two years both the extreme cases just mentioned have been entirely cured.
If the opium-eater has been in the habit of dividing his daily dose he begins to feel some uneasiness within an hour after his first deprivation, but it amounts to nothing more than an indefinite restlessness. In any case his first well-marked opium torments occur early after he has been without the drug for twenty-four hours.
At the expiration of that time he begins to feel a peculiar corded and tympanic tightness about the epigastrium. A feverish condition of the brain, which sometimes amounts to absolute phantasia, now ensues, marked off into periods of increasing excitement by a heavy sleep, which, after each interval, grows fuller of tremendous dreams, and breaks up with a more intensely irritable waking. I have held a man's hand while he lay dreaming about the thirty-sixth hour of his struggle. His eyes were closed for less than a minute by the watch, but he awoke in a horrible agony of fear from what seemed to have been a year-long siege of some colossal and demoniac Vicksburg.
After the opium-eater has been for forty-eight hours without his solace this heavy sleep entirely disappears. While it stays it never lasts over half an hour at a time, and is so broken by the crash of stupendous visions as not to amount to proper slumber. During its period of continuance the opium-eater woos its approaches with an agony which shows his instinct of the coming weeks of sleeplessness. It never rests him in any valid sense. It is a congestive decomposition rather than any normal reconstruction of the brain. He wakes out of it each time with a heart more palpitating; in a perspiration more profuse; with a greater uncertainty of sense and will; with a more confused memory; in an intenser agony of body and horror of hopelessness. Every nerve in the entire frame now suddenly awakes with such a spasm of revivification that no parallel agony to that of the opium-eater at this stage can be adduced, unless it be that of the drowned person resuscitated by artificial means. Nor does this parallel fully represent the suffering, for the man resuscitated from drowning re-oxydizes all his surplus carbon in a few minutes of intense torture, while the anguish which burns away that carbon and other matter, properly effete, stored away in the tissues by opium, must last for hours, days, and weeks. Who is sufficient for this long, long pull?
From the hour this pain begins to manifest itself it continues (in any average case of a year's previous habituation to the drug) for at least a week without one second's lull or exhaustion. A man may catch himself dozing between spasms of tic-douloureux or toothache; he never doubts whether he is awake one instant in the first week after dropping his opium. One patient whom I found years ago at a water-cure followed the watchman all night on crutches through his tour of inspection around the establishment. Other people, after walking a long time, shift from chair to chair in their rooms, talking to any body who may happen to be present in a low-voiced suicidal manner, which inexperience finds absolutely blood-freezing. Later such rock to and fro, moaning with agony, for hours at a time, but saying nothing. Still others go to their beds at once, and lie writhing there until the struggle is entirely decided. I have learned that this last class is generally the most hopeful.
The period during which this pain is to continue depends upon two elements. 1st. How long has the patient habitually taken opium? 2d. How much constitutional strength remains to throw it off?
"How much has he taken in the aggregate?" is practically not an equivalent of the first question. I have found an absolutely incurable opium-eater who had never used more than ten grains of morphia per diem; but he had been taking it habitually for a dozen years. In another case the patient had for six months repeated before each meal the ten-grain dose which served the other all day; but he was a man whose pluck under pain equalled that of a woman's, and after a fortnight's anguish of such horror that one could scarcely witness it without being moved to tears, came out into perfect freedom. The former patient, although he had never in any one day experienced such powerful effects from opium as the latter, had used the drug so long that every part of his system had reconstructed itself to meet the abnormal conditions, and must go through a second process of reconstruction, without any anodyne to mask the pain resulting from its decomposition, before it could again tolerate existence of the normal kind. If opium were not an anodyne the terrible structural changes which it works would cause no surprise; it would be felt eating out its victim's life like so much nitric acid. During the early part of the opium-eater's career these structural changes go on with a rapidity which partly accounts for the vast disengagements of nervous force, the exhilaration, the endurance of effort, which characterize this stage, later to be substituted by utter nervous apathy. By the time the substitution occurs something has taken place throughout the physical structure which may be rudely likened to the final equilibrium of a neutral salt after the effervescence between an acid and an alkali. So to speak, the tissues have now combined with their full equivalent of all the poisonous alkaloids in opium. Further use of it produces no new disengagements of nervous force; the victim may double, quadruple his dose, but he might as well expect further ebullition by adding more aqua-fortis to a satisfied nitrate as to develop with opium exhilarating currents in a tissue whose combination with that drug have already reached their chemical limit. [Footnote: I say "chemical" because so much it is possible to know experimentally; and the very interesting examination of such higher forces as constantly seem to intrude in any nervous disturbance would here involve the discussion of a theoretical "vital principle"—something apart from and between the soul and physical activities—which scientific men are universally abandoning.]
The opium-eater now only continues his habit to preserve the terrible static condition to which it has reduced him, and to prevent that yet more terrible dynamic condition into which he comes with every disturbance of equilibrium; a condition of energetic and agonizing dissolutions which must last until every fibre of wrongly-changed tissue is burned up and healthily replaced. Though I have called the early reactions of opium rapid, they are necessarily much less so than those produced by a simple chemical agent. No drug approaches it in the possession of cumulative characteristics; its dependence on the time element must therefore be always carefully considered in treating a case. This fact leads us to understand the other element in the question, how long the torments of the opium-fighter must continue. Having ascertained the chronology of his case, we must say, "Given this period of subjection, has the patient enough constitutional vigor left to endure the period of reconstruction which must correspond to it?" [Footnote: Not correspond day by day. At that rate a reforming opium-eater (I use the principle in the physical sense, for very few opium-eaters are more to blame than any other sick persons) must pay a "shent per shent" which no constitution could survive. The correspondence is simply proportional.]
I am naturally sanguine, and began my study of opium-eaters with the belief that none of them were hopeless. Experience has taught me that there is a point beyond which any constitution—especially one so abnormally sensitive as the opium-eater's—can not endure keen physical suffering without death from spinal exhaustion. I once heard the eminent Dr. Stevens say that he made it a rule never to attempt a surgical operation if it must consume more than an hour. Similarly, I have come to the conclusion never to amputate a man from his opium-self if the agony must last longer than three months. Uneasiness, corresponding to the irritations of dressing a stump—may continue a year longer; a few victims of the habit outlive a certain opium-prurience, which has also its analogue in the occasional titillation of a healed wound—these are comparatively tolerable; but, if we expect to save a patient's life, we must not protract an agony which so absolutely interferes with normal sleep as that of the opium-eater's for longer than three months in the case of any constitution I have thus far encountered.