NOTE.—The patient whose sorrowful case suggested this article died just as the magazine was issued. His unassisted struggle had been too long protracted after abandonment of the drug was evidently hopeless, and his resumption of opium came too late to permit of his rallying from his exhaustion.
OUTLINES OF THE OPIUM-CURE.
No. 1 Livingston Place,
Stuyvesant Square,
April 25, 1868.
MY DEAR SIR:—In accordance with your request, I sketch the brief outline of my plan for the treatment of opium-eaters, premising that it pretends much less to novelty than to such value as belongs to generalizations made from large experience by sincere interest and careful study in the light of science and common sense.
That experience having shown me how impracticable in the large majority of cases is any cure of a long-established opium habit while the patient continues his daily avocations and remains at home, [Footnote: In my article upon opium-eating, entitled, "What Shall They Do to be Saved?" published in Harper's Magazine for the month of August, 1867, and hereto prefixed, I have referred to this impracticability in fuller detail. It arises from the fact that in his own house a man can not isolate himself from the hourly hearing of matters for which he feels responsible, yet to which he can give no adequate attention without his accustomed stimulus; that his best friends are apt to upbraid him for a weakness which is not crime but disease, and that the control of him by those whom he has habitually directed, however well-judged, seems always an harassment.] I shall simplify my sketch by supposing that one great object of my life is already attained, and that an institution for the treatment of the disease is already in successful operation. Starting at this fictitious datum, I shall carry from his arrival under our care until his discharge a healthy, happy, and useful member of society, a gentleman whom for convenience we will name Mr. Edgerton.
Our institution is called not an "Asylum," nor a "Retreat," nor by any of those names which savor of restraint and espionage—not even a "Home," as spelled with a capital H—but simply by the name of the spot upon which it is erected—to wit, "Lord's Island."
It is erected on an island because in the more serious cases a certain degree of watchfulness will always be necessary. On the main-land this watchfulness must be exercised by attendants with the aid of fences, bolts, and bars. On an island the patient whose case has gone beyond self-control will be under the Divine Vigilance, with more or less miles of deep water as the barrier between him and the poison by which he is imperilled. For this reason, and because whatever good is accomplished on it for a class which beyond all other sufferers claim heavenly mercy will be directly of the Lord himself, our island is called "Lord's Island." Here our patient will feel none of the irksome tutelage which in an asylum meets him at every step—thrusting itself before his eyes beyond any power of repulsion, and challenging him to efforts for its evasion which are noxious whether they succeed or not; defeating the purpose of his salvation when they do, irritating him when they do not, and keeping his mind in a state of perpetual morbid concentration upon his exceptional condition among mankind in either case. Here he has all the liberty which is enjoyed by the doctors and nurses—save that he can not get at the medicine-chest.
Mr. Edgerton arrives at Lord's Island at 2 P.M. of a summer's day, having crossed by our half-hourly sail-boat, row-boat, or tug, from the railroad station on the main-land. If he is very much debilitated, either by his disease or fatigue, he has full opportunity to rest and refresh himself before a word is spoken to him professionally. If a friend accompanies him, he is invited to remain until Mr. Edgerton feels himself thoroughly at home in his new quarters.
After becoming fully rested, Mr. Edgerton is invited to state his case. The head physician must be particular to assure him that every word he utters will be regarded as in the solemnest professional confidence. Mr. Edgerton is made to feel that no syllable of his disclosures will ever be repeated, under any circumstances, even to the most intimate of his friends or the most nearly related of his family. This conviction upon his part is in the highest degree essential. Opium makes the best memory treacherous, and, sad as it may be to confess it, the most truthful nature, in matters relating to the habit at least, untrustworthy. Often, I am satisfied, the opium-eater, during periods of protracted effort or great excitement, takes doses of the drug which he does not recollect an hour afterward, and may, practically without knowing it, overrun his supposed weekly dose twenty-five per cent. I often meet persons addicted to the habit who, I have every reason to believe, honestly think they are using twelve grains of morphia daily, yet are found on close watching to take eighteen or twenty. Again, the opium-eater who by nature would scorn a lie as profoundly as the boy Washington, is sometimes so thoroughly changed by his habit that the truth seems a matter of the most trifling consequence to him, and his assertion upon any subject whatever becomes quite valueless. Occasionally this arises from an entire bouleversement of the veracious sense—similar to certain perversions of the insane mind, and then other faculties of his nature are liable to share in the alteration. If the man was previously to the highest degree merciful and sympathizing, he may become stolid to human suffering as any infant who laughs at its mother's funeral, not from wickedness of disposition but absence of the faculty which appreciates woe, and I doubt not that this change goes far to explain the ghastly unfeelingness of many a Turkish and Chinese despot whose ingeniously cruel tortures we shudder to read of scarcely more than the placidity with which he sees them inflicted. If he was originally so sensitive to the boundaries between Meum and Tuum that the least invasion of another's property hurt him more than any loss of his own, this delicate sense may become blunted until he commits larceny as shamelessly as a goat would browse through a gardener's pickets, or a child of two years old help himself to a neighbor's sugar-plums. This, too, quite innocently, and with the excuse of as true a Kleptomania as was ever established in the records of medical jurisprudence. I knew a man who had denied himself all but the bare necessaries of life to discharge debts into which another's fraud had plunged him, and whose sense of honor was so keen that when afflicted with chronic dyspepsia the morbid conscientiousness which is not an unusual mental symptom of that malady took the form of hunting up the owner of every pin he picked up from the floor, nor could he shake off a sense of criminality till he had found somebody who had lost one and restored it to him—yet on being prescribed opium for his complaint, his nature, under its operation, suffered such an entire inversion that the libraries, and on several occasions even the pocket-books of his friends were not safe from him, his larcenies comprising some of the most valuable volumes on the shelf and sums varying between two and twenty dollars in the porte-monnaie. "The Book-Hunter" writing of De Quincey, as you will recollect, under the sobriquet of "Papaverius," describes the perfectly child-like absence of all proprietary distinctions which prevailed in that wonderful man's mind during his later years as regarded the books of his acquaintance, and the innocent way in which he abstracted any volume which he wanted or tore out and carried away with him the particular leaves he wished for reference.
In many cases where the moral sense has suffered no such general bouleversement, the tendency which opium superinduces to look at every thing from the most sanguine point of view—the vague, dreamy habit of thought and the inability to deal with hard facts or fixed quantities—make it necessary to take an opium-eater's assertions upon any subject with a certain degree of allowance—to translate them, as it were, into the accurate expressions of literal life; but even where this necessity docs not exist, in cases sometimes though rarely met with, where opium has been long used without tinging any of life's common facts with uncertainty, an opium-eater can scarcely even be relied on for the exact truth concerning his own habit. He may be trusted without hesitation upon every other subject, but on this he almost always speaks evasively, and though about any thing else he would cut his hand off rather than say the thing that is not, will sometimes tell a downright falsehood. In most cases he has been led to this course by witnessing the agony or suffering the reproach with which the knowledge of his habit is received by his friends. He lies either in mercy to them or because the pangs which their rebuke inflicts would become still more intolerable if they knew the extent of his error.