"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 I have had several patients whom during this period I plunged into water at [Footnote: On some occasions, by repealed additions from the hot faucet as the temperature of the water in the bath-tub fell, I have raised the bath as high as 120° F. without causing any inconvenience to the patient. Most bath-tubs—all in our own city houses—are too capacious, and too broad for their depth. To prevent cooling by evaporation the tub should be just the width of a broad pair of shoulders and about two feet deep.] 110° F. as often as fifteen times in a single day—each bath lasting as long as the patient experienced relief."
Science and experience have thus far revealed no other way of making tolerable the agonizing pain which Mr. Edgerton now endures. This pain is quite inconceivable by the ordinary mind. It can not be described, and the only hint by which an outsider can be let into something like an inkling of it is the supposition (which I have elsewhere used) that pain has become fluidized, and is throbbing through the arteries like a column of quicksilver undergoing rhythmical movement. If the arteries were rigid glass tubes, and the pain quicksilver indeed, there could not be a more striking impression of ebb and flow every second against some stout elastic diaphragm whose percussion seems the pain which is felt. This is especially the case along the course of the sciatic nerve and all its branches, where the pulse of pain is so agonizing that the sufferer can not keep his legs still for an instant. There is occasionally severe pain of this kind in the arms also, but this is very rare. The suffering which usually accompanies that of the legs is a maddening frontal headache, and a dull perpetual ache through the region of the kidneys, described as a sensation of "breaking in two at the waist;" nausea, burning, and constriction about the epigastrium, and intense sensitiveness of the liver—besides general nervous and mental distress which has neither representative nor parallel.
All these symptoms are instantaneously met and for the time being counteracted by the hot-bath. When the patient gets tired of it, and it temporarily loses its efficiency from this cause, great advantage may be gained by substituting either the Russian bath or the common box vapor-bath, with an aperture in the top to stick the head out of, and a close-fitting collar of soft rubber to prevent the escape of the steam.
I must here refer to another means of alleviation, concerning which I can not bear the witness of personal experience, but which has been highly recommended to me. Even this brief sketch of treatment would be imperfect without at least a mention of it, and if it possesses all the value claimed for it by persons of judgment who have reported it to me, it will form an indispensable part of our apparatus on Lord's Island. This is an air-tight iron box of strongly-riveted boiler plates, with a bottom and top fifteen feet square and sides ten feet high; thick plate-glass bull's-eyes in each side sufficiently large to light the interior as clearly as an ordinary room; and a cast-iron door, six feet in height, shutting with a rubber-lined flange, so that all its joints are as air-tight as the rest of the box. Inside of the box, in the centre, stands a table, suitable for reading, writing, draughts, cards, chess, or games of any similiar kind, with comfortable chairs arranged around it corresponding in number to the people who for an hour or two could comfortably occupy the room. In one side of the box is a circular aperture connecting with an iron tube, which in its turn is joined to a powerful condensing air-pump outside, and on the other side is a pressure gauge with its index inside the box. Sufferers from severe neuralgic pain being admitted, the air-tight door is shut; they seat themselves, and the condensing pump is set in motion by an engine until the gauge within indicates a pressure of any amount desired. I am told that the severest cases of neuralgia have found instantaneous and thorough relief by the addition of six or eight atmospheres to the usual pressure of air upon the surface of the body. There is no reason why the condensation might not be continued to twenty or more, the increased density causing no uneasiness to those within the box, the same equilibrium between internal and outward pressure that exists everywhere in the air being maintained here. Persons who have made trial of this apparatus speak of the cessation of their pain as something magical; say they can feel it leaving them with every stroke of the pump; and although as yet we may not be able to offer a scientific explanation of the relief afforded, we can not fail to see its applicability to the case of the reforming opium-eater. If it does all that is claimed for it, it probably acts both mechanically and chemically—the pressure, even though imperceptible from its even distribution, affecting the body like the shampooing, kneading action of an attendant's hand, and the vastly increased volume of oxygen which it affords to the lungs and pores accelerating those processes of vital decomposition by which the causes of many a pain, but especially that of our patient, are to be removed.
The shampooing just referred to, and previously mentioned as forming one process in the Russian bath, is another means of relief constantly in use while the patient is going through his terrible struggle. Our attendants upon Lord's Island are picked men. We do not proceed on the principle in such favor among most of our public institutions, asylums, water-cures, and the like, of procuring the very cheapest servants we can get, and thinking it an economical triumph to chuckle over if [Footnote: This is all that the "canny" business men who compose the managing boards of some of the first asylums in this country permit the heads of the institutions to offer those who must for twenty-three hours of the twenty-four be responsible for the moral, and physical well-being of a class of patients (the insane) who require, above all others, wisdom, tact, benevolence, courage, fidelity, and the highest virtues and capacities in those who attend them.] we can manage our patients with the aid of subordinates at twenty dollars a month. We know that in the long run it will pre-eminently pay to engage the best people, and we pay the wages which such deserve—wages such as will ensure their quality. Our attendants are selected from the strongest, healthiest, best-tempered, most cheerful-minded, kindest-hearted, most industrious and faithful men and women we can find—people not afraid of work and indefatigable in it—people who understand that no office they can perform for the sick is degrading or menial, and who will not object, when the patient needs it, to lift him like a haby and rub him vigorously with their hands for an hour at a time. This rubbing our patient often finds the most heavenly relief, not only right after a bath, but at any hour of the day or night. There is, therefore, no hour of either during which Mr. Edgerton can not procure this means of relief from some servant upon duty. Applied to the back and legs especially, it is a sovereign soother for both the opium-eater's acute pain and that malaise which is only less terrible. In very severe cases it may be necessary to rub the patient for many consecutive hours, and in such cases It may be necessary either to assign an attendant to the patient's sole care, or, better yet, to have several attendants relieve each other in the manual labor. If the patient could afford and desired it, I should approve of his having his own private servant during the worst of the struggle to perform this labor for him, with the distinct understanding, however, that he was to be private only in the sense of devoting himself to this patient solely, and to receive all his orders from the head of the institution. The expense of such an arrangement would be trifling compared with the amount and intensity of agony which it would save, and in a case of no longer standing than Mr. Edgerton's need last only through the first fortnight or so after abandoning the drug.
Another most important means of alleviation is the galvanic bath. House's patent is an excellent apparatus for the purpose; convenient in shape and size, comfortable, not easily deranged, affording a variety of simple and combined currents, adjustable so as to pass the current either through the whole body or along almost any nervous tract where it is especially wanted for the relief of local suffering like that of the opium sciatica, and manageable by any intelligent child who has ever watched attentively while it was getting put into operation. Many a sufferer who seems quite a discouraging subject under the dry method of administering galvanism responds to it at once transmitted through a bath, and in any case this is a no less beneficial than delightful way of using it. The skin is so much better a conductor when wet, and the distribution by water so uniform, that in most cases it may be pronounced the best way. The Turkish bath I have seen used with excellent result during the earlier days of suffering. It will seem almost incredible to any one who has taken a Turkish bath for other purposes, and knows the tax which it seemed to inflict upon his nervous system for the first few minutes after entering the heated chamber and till profuse perspiration came to his relief, when I say that I have seen a man brought to the bath in that almost dying state of prostration some pages back described as belonging to the acute attack of opiomania, at once subjected to the temperature of 130° F., and in ten minutes after to thirty degrees higher, not only without rapidly sinking into fatal collapse, but with a result of almost immediate and steady improvement. To my own great surprise his pulse began getting fuller, slower, steadier, and in every way more normal from the moment that the attendant laid him down upon his slab. When he came in he was obliged to be carried in the arms of his friends like an infant; his pulse one minute was 140, the next 40-60, or entirely imperceptible, and when fastest alarmingly thready; his countenance was corpse-like, he breathed nine or ten times a minute, and his general prostration so utter that he could scarcely speak even in a whisper. He stayed in the bath an hour and a quarter, in a streaming perspiration for the last forty minutes, and much of the time sleeping sweetly. He came out walking easily without assistance, and in the cool anteroom fell asleep again upon the lounge, not to wake for an hour longer. This one bath entirely broke up the attack. He kept on improving, and with the aid of beef-tea was well enough to go to business in a week. The value of the bath in treating Mr. Edgerton at present will he greatest when he suffers most severely from acute neuralgic pains in the legs and back, especially if the efficiency of the hot full-baths and vapors seem temporarily suspended through frequent use. His own feelings are the best criterion of its worth at any given time. It operates very differently on different people and in different conditions of the system. To some persons it is less debilitating than the use of hot water, and others, myself among the number, find it so excessively disagreeable from the apoplectic sensation it produces in their heads, and the difficulty of breathing which they suffer from it, that nothing but a discovery that it was the only means in their particular case of relieving sufferings like those of opium would induce them to enter it. Many persons profess to like it as well as the Russian (which, singularly enough, in no case have I ever known to produce the disagreeable feeling in head or lungs), and it certainly ranks with the foremost alleviatives of the opium suffering—the agonizing rythmical neuralgia of which I have spoken usually becoming magically lulled within two minutes from the time of entering the first heated chamber, and ceasing altogether as soon as the perspiration becomes thoroughly established. At Lord's Island our Turkish bath-room will immediately adjoin our Russian, and the temperature being supported by pipes from the same boiler which furnishes vapor to the other, will be no heavy addition to our expense in the way of apparatus. I don't know whether it is necessary to tell any body that the Turkish bath is merely an exposure of the naked body (with a wet turban around the head) to a dry heat varying from 110º F. to a temperature hot enough, to cook an egg hard—followed by ablutions and shampooings somewhat similar to those of the Russian bath.
As it is our aim to cure the opium-eater by bringing to bear upon his most complicated of all difficulties every means which has proved effectual in the treatment of any one of its particulars, however caused in other instances, we ask no questions of any appliance regarding its nativity, but take from the empiric whatever he has stumbled on of value as freely as the worthiest discoveries of the philosopher from him. There have been various attempts to erect into a pathy every one of the applications we have already mentioned, and I shall close this brief outline of our therapeutic apparatus at Lord's Island with one more valuable method of relief and cure whose enthusiastic discoverers (or rather adapters) have outraged etymology worse than the regular practice by trying to build on their one good thing an entire system under the title of "Motorpathy." [Footnote: I see that some scholar has lately got hold of them and forced them to respect philological canons by kicking the mongrel out of their dictionary and calling themselves Kinesipathists, instead of the other Graeco-Latin barbarism.] The "Movement Cure" contains some very good ideas, which, like many of the Hydropathists', ought to be taken up by Science, in whose hands and their proper place they can do fine service.
As we have found in the case of shampooing, a great deal of the suffering of any part can be taken out by giving it something else to do. A portion of the good done by rubbing an aching leg is no doubt accomplished by setting the nerve at work upon the sensations of pressure and of heat and so diverting it from that of pain, but another portion is probably due to the fact of motions producing changes, in the nature of mechanical and chemical decompositions, in the substance of the tissue; thus by a well known physiological law summoning a concentration of the nervous forces to the particular part. Nature is thus accelerated in her action there, and as that action is always toward cure (so long as life and hope exist), the nerves of the part are reinforced to act sanely. To be weak is to be miserable—to be strong is to be free from pain—thus the nerve's returning vigor eliminates its suffering. The fresh blood that is pumped into the part by motion brings about another set of ameliorating changes of more especial importance where the pain is caused by a local lesion instead of rather being sympathetic with the whole systematic debility. Whatever be our theory, the tenet that motion relieves pain, as a tenet, is as old as the "back- straightening" process used in some shires by the British turnip-hoers who on coming to the end of their rows lie down and let the rest of the women in the field walk over their toil-bent spine and cramped dorsal muscles, while as a fact it is as old as pain itself.
On Lord's Island, therefore, we have a room fitted up with apparatus intended to give passive exercise to every part of the body which the pain of abandoning opium is especially likely to attack.
Mr. Edgerton is suffering extremely, about the close of the third day after his last 1/2 grain dose of morphia, from the agonizing rythmical neuralgia of which I have spoken, throbbing from the loins to the feet; and although with good effect we have given him galvanism, shampooing, baths of several kinds, and a number of internal remedies, still, wishing to keep each of these appliances fresh in its potency, we make a change this time to the "movement-room." He is stripped to his shirt, dressing-gown, and drawers, and laid on his back along a comfortable stuffed-leather settee, running quite through whose bottom are a number of holes about four by three and a half inches. These holes are occupied by loose-fitting pistons which play vertically up through the cushion—lying level with it when at rest, and when in motion projecting about two inches above it at the height of their stroke. Motion is secured to them by crank connection with a light shaft running beneath the settee, revolved by a band-wheel, which in its turn connects by a belt with the small engine outside the building, by which all the drudgery of the house is performed. Mr. Edgerton is adjusted over the holes so that, in coming up, the pistons, which are covered with stuffed leather pads, strike him alternately on each side of the spine, from about the region of the kidneys to just beneath the shoulder-blade. The shifting of a lever throws the machine into gear, and for the next five minutes, or as long as he experiences relief, the artificial fists pummel and knead him at any rate of speed desired, according to the adjustment of a brake. This process over, if he still feels pain in the lower extremities, his foot is buckled upon an iron sole which oscillates in any direction according to its method of connection with the power, from side to side, so as to twist the leg about forty-five degrees each way, up and down, to imitate the trotting of the foot, or with a motion which combines several. A variety of other apparatus gives play to other muscles; but I have said enough to show the idea of its modus operandi. The passive exercise thus afforded is an admirable substitute for that active kind which in his first few days of deprivation the intensity of his agony often incapacitates him from taking. I have seen men at this period almost bent double from mere pain, and hobbling when they attempted to walk like subjects of inflammatory rheumatism. Their debility also is often so great as to prevent exercise, especially when the characteristic diarrhea has been for some days in operation, though different people differ astonishingly in this respect. I knew one case where an opium-eater of three years' habituation to the drug endured in its abandonment every conceivable distress without suffering from debility at all, as may be inferred from the fact that as his only way of making life tolerable he took a walk of twelve miles every morning while going through his trial. The majority, however, suffer not only pain but prostration of the most distressing character—a combination as terrible as can be conceived, since the former will not let the victim remain in one position for a single minute, and the latter takes away all his own control of his motion, so that he seems a mere helpless, buffeted mass of agony—an involuntary devil-possessed, devil-driven body, consciousness at its keenest, will at its deepest imbecility—almost fainting with fatigue, unable to limp across the room on legs which seem dislocated in every joint and broken in a thousand places, yet unable to stop tossing from side to side, and writhing like a trodden worm all night, all day, perhaps for weeks.