Usually as early as the third day after its abandonment (unless the constituion has become so impaired by long habituation that there will probably be no vital reaction) opium begins to show its dissolutions from the tissue by a profuse and increasingly acrid bilious diarrhea, which must not be checked if diagnosis has revealed sufficient constitutional vigor to justify any attempt at abandonment of the drug. Hemorrhoids may result; they must be topically treated; mild astringents may be used when the tendency seems getting out of eventual control; bland foods must be given as often as the usually fastidious appetite will tolerate them; the only tonic must be beef-tea—diffusible stimulus invariably increasing the agony, whether in the form of ale, wine, or spirits. Short of threatened collapse, the bowels must not be retarded. There is nothing in the faintest degree resembling a substitute for opium, but from time to time various alleviatives, which can not be discussed in an untechnical article, may be administered with benefit. The spontaneous termination of the diarrhea will indicate that the effete matters we must remove have been mainly eliminated, and that we may shortly look for a marked mitigation of the pain, followed by conditions of great debility but increasingly favorable to the process of reconstruction. That process, yet more than the alleviate, demands a book rather than an article.
I have intentionally deferred any description of the agony of the opium struggle, as a sensation, until I returned from depicting general symptoms, to relate the particular case which is my text. The sufferings of the patient, from whom I have just returned, are so comprehensive as almost to be exhaustively typical.
When simple nervous excitement had for two days alternated with the already mentioned intervals of delirious slumber, a dull, aching sensation began manifesting itself between his shoulders and in the region of the loins. Appetite for food had been failing since the first denial of that for opium. The most intense gastric irritability now appeared in the form of an aggravation of the tympanic tightness, corrosive acid ructations, heart-burn, water-brash, and a peculiar sensation, as painful as it is indescribable, of self-consciousness in the whole upper part of the digestive canal. The best idea of this last symptom may be found by supposing all the nerves of involuntary motion which supply that tract with vitality, suddenly to be gifted with the exquisite sensitiveness to their own processes which is produced by its correlative object in some organ of special sense—the whole organism assimilating itself to a retina or a finger-tip. Sleep now disappeared. This initiated an entire month during which the patient had not one moment of even partial unconciousness.
In less than a week from the beginning the symptoms indicated a most obstinate chronic gastritis. There was a perpetual sense of corrosion at the pit of the stomach very like that which characterizes the fatal operation of arsenic. There was less action of the liver than usually indicates a salvable case, and no irritation of the lowest intestines. Pari passu with the gastritic suffering, the neuralgic pain spread down the extremities from an apparent centre between the kidneys, through the trunk, from another line near the left margin of the liver, and through the whole medullary substance of the brain itself. Although I was so unfortunate as not to be beside him during this stage, I can still infallibly draw on my whole experience for information regarding the intensity of this pain. Tic-douloureux most nearly resembles it in character. Like that agonizing affection, it has periods of exacerbation; unlike it, it has no intervals of continuous repose. Like tic-douloureux, its sensation is a curiously fluctuating one, as if pain had been fluidized and poured in trickling streams through the tubules of nerve tissue which are affected by it; but, unlike that, it affects every tubule in the human body—not a single diseased locality. Charles Reade chaffs the doctors very wittily in "Hard Cash" on their penchant for the word "hyperaesthesia," but nothing else exactly defines that exaggeration of nervous sensibility which I have invariably seen in opium-eaters. Some of them were hurt by an abrupt slight touch, and cried out at the jar of a heavy footstep like a patient with acute rheumatism. Some developed sensitiveness with the progress of expurgating the poison, until their very hair and nails felt sore, and the whole surface of the skin suffered from cold air or water like the lips of a wound. After all, utterly unable to convey an idea of the kind of suffering, I must content myself by repeating, of its extent, that no prolonged pain of any kind known to science can equal it. The totality of the experience is only conceivable by adding this physical torture to a mental anguish which even the Oriental pencil of De Quincey has but feebly painted; an anguish which slays the will, yet leaves the soul conscious of its murder; which utterly blots out hope, and either paralyzes the reasoning faculties which might suggest encouragements, or deadens the emotional nature to them as thoroughly as if they were not perceived; an anguish, which sometimes includes just, but always a vast amount of unjust self-reproach, winch brings every failure and inconsistency, every misfortune or sin of a man's life as clearly before his face as on the day he was first mortified or degraded by it—before his face, not in one terrible dream, which is once for all over with sunrise, but as haunting ghosts, made out by the feverish eyes of the soul down to the minutest detail of ghastliness, and never leaving the side of the rack on which he lies for a moment of dark or day-light, till sleep, at the end of a month, first drops out of heaven on his agony.
A third element in the suffering must briefly be mentioned. It results directly from the others. It is that exhaustion of nervous power which invariably ensues on protracted pain of mind or body. It proceeds beyond reaction to collapse in a hopeless case; it stops this side of that in a salvable one.
On reaching his room I found my friend bolstered upright in bed, with a small two-legged crutch at hand to prop his head on when he became weary of the perpendicular position. This had been his attitude for fifty days. Whether from its impeding his circulation, the distribution of his nervous currents, or both, the prostrate posture invariably brought on cessation of the heart—and the sense of intolerable strangling. His note told me he was dying of heart disease, but, as I expected, I found that malady merely simulated by nervous symptoms, and the trouble purely functional. His food was arrow-root or sago, and beef-tea. Of the vegetable preparation he took perhaps half a dozen table-spoonfuls daily; of the animal variable quantities, averaging half a pint per diem. This, though small, was far from the minimum of nutriment upon which life has been supported through the most critical periods. Indeed, I have known three patients tided over stages of disease otherwise desperately typhoid by beef-tea baths, in which the proportion of ozmazone was just perceptible, and the sole absorbing agency was a faint activity left in the pores of the skin. But these patients had suffered no absolute disorganization. The practitioner had to encounter a swift specific poison, not to make over tissues abnormally misconstructed by its long insidious action. On examination I discovered facts which I had often feared, but never before absolutely recognized, in my friend's case. The stomach itself, in its most irreproducible tissue, had undergone a partial but permanent disorganization. The substance of the organ itself had been altered in a way for which science knows no remedy.
Hereafter, then, it can only be rechanged by that ultimate decomposition which men call death. Over the opium-eater's coffin at least, thank God! a wife and a sister can stop weeping and say, "He's free."
I called to my friend's bedside a consultation of three physicians and the most nearly related survivor of his family. I laid the case before them; assisted them to a full prognosis; and invited their views. I spent two nights with my friend. I have said that during the first month of trial he had not a moment of even partial unconsciousness. Since that time there had been perhaps ten occasions a day, when for a period from one minute in length to five, his poor, pain-wrinkled forehead sank on his crutch, his eyes fell shut, and to outsiders he seemed asleep. But that which appeared sleep was internally to him only one stupendous succession of horrors which confusedly succeeded each other for apparent eternities of being, and ended with some nameless catastrophe of woe or wickedness, in a waking more fearful than the state volcanically ruptured by it. During the nights I sat by him these occasional relaxations, as I learned, reached their maximum length, my familiar presence acting as a sedative, but from each of them he woke bathed in perspiration from sole to crown; shivering under alternate flushes of chill and fever; mentally confused to a degree which for half an hour rendered every object in the room unnatural and terrible to him; with a nervous jerk, which threw him quite out of bed, although in his waking state two men were requisite to move him; and with a cry of agony as loud as any under amputation.
The result of our consultation was a unanimous agreement not to press the case further. Physicians have no business to consider the speculative question, whether death without opium is preferable to life with it. They are called to keep people on the earth. We were convinced that to deprive the patient longer of opium would be to kill him. This we had no right to do without his consent. He did not consent, and I gave him five grains of morphia [Footnote: To the younger men of the profession rather than to the public generally I need here to say that this dose is not as excessive as it would naturally appear to be in the case of a man who had used no form of opium for ninety days. When you have to resume the drug, go cautiously. But you will generally find the amount of it required to produce the sedative effects in any case which returns to opium, after abandonment of a long habitation, startlingly large, and slow in its effects.] between 8 and 12 o'clock on the morning of the day I had to return here. He was obliged to eat a few mouthfuls of sago before the alkaloid could act upon his nervous system. I need only point out the significance of this indication. The shallower-lying nervous fibres of the stomach had become definitely paralyzed, and such digestion as could be perfected under these circumstances was the only method of getting the stimulant in contact with any excitable nerve-substance. In other words, mere absorbent and assimulative tissue was all of him which for the purpose of receiving opium partially survived disorganization of the superficial nerves. Of that surviving tissue, one mucous patch was irredeemably gone. (This particular fact was the one which cessation from opium more distinctly unmasked.) At noon he had become tolerably comfortable; before I left (7 P.M.) he had enjoyed a single half-hour of something like normal slumber.
He will have to take opium all his life. Further struggle is suicide. Death will probably occur at any rate not from an attack of what we usually consider disease, but from the disintegrating effects on tissue of the habit itself. So, whatever he may do, his organs march to death. He will have to continue the habit which kills him only because abandoning it kills him sooner; for self-murder has dropped out of the purview of the moral faculties and become a mere animal question of time. The only way left him to preserve his intellectual faculties intact is to keep his future daily dose at the tolerable minimum. Henceforth all his dreams of entire liberty must be relegated to the world to come. He may be valuable as a monitor, but in the executive uses of this mighty modern world henceforth he can never share. Could the immortal soul find itself in a more inextricable, a more grisly complication?