Again, the present general opinion of these patients is such that once a case comes into court to settle the question of an opiate using, the defendant, desirous of protecting himself, by denying his drug taking, makes it essential that evidence be secured to disprove his statement, and if certain signs be wanting, the habitué may quite outwit the medical expert. The writer noted a case of this sort last summer. A lady, cultured and refined, who had fallen a victim to morphia years before, and who was party to a suit in court, was examined by two well-known female physicians of this city, who, failing to apply the one infallible test of an opiate using, testified that she was not an habitué. They were mistaken—the lady was taking morphia, though she has since recovered. The point involved, to spare the chagrin of such an error, is obvious.
Lastly, what is the trend of a more rational view of this question as regards the treatment of these cases? Reference has been made to the statement that “no morphia habitué can be depended on to tell the truth”—a statement so often at variance with the fact that it must be the outcome of an experience with the baser class of cases—and I submit the wrong of regarding all as liars because some fail to tell the truth; or, added evidence of the “cruelty of ignorance;” or, an unwarranted libel on a worthy class of unfortunates, who, Heaven knows, have enough to bear without loading them with the reproach such an injustice implies.
Nevertheless it is just such an opinion, and consequent lack of confidence in the honor of these patients that influences their management by some medical men. Looked upon as the victims of their own wrong-doing, or as unworthy the sympathy that should ever exist between physician and patient, or treated on the erroneous belief that such is the only proper method, they are consigned to the brutal ordeal of abrupt and entire opiate disusing, which, while it may end in the desired result, entails such suffering of mind and body as to be utterly inexcusable—because a more humane method will avail—except under conditions peculiar and beyond control.
I am well aware that such coercive measures are the only hope of cure in some cases, but I also know that such patients are not of the better class, and that, once the drug abandoned, the prospect of continued recovery is small, because they lack one of the essential requisites for a permanently good result—that is an earnest desire to be cured.
And the promise of good results from this better way in regarding such patients is more far reaching than on first thought might appear, for the ex-opium habitué forced to stem a tide of distrust—special, as to his cure, and general, as to the permanence of that cure—finds himself hampered in continued well-doing by the lack of that hopeful trust that would largely conduce to his good getting on.
In a recent letter from a lady who honored the writer with her care, nearly three years ago, she referred to the permanence of her recovery, and added—“but as I found it difficult to make every one believe this, much less acknowledge it in my favor, I resorted to the best means I could think of to establish corroborative testimony that would avail, and during all the time I have been in or near—the past two years, I have gone regularly every few days to a physician of prominence here, my old friend and medical adviser of many years’ standing, and had him make every test he desired, placing on record my exact condition, and showing the real truth of the matter. I continue to do this, and intend to do so, and have let people generally know that such a record is being made. I need not tell you that I am proud of my victory. The struggle against ungentle and unfair judgment of those around you make a combination of overwhelming power against the reformed opium taker. It is there that the real conflict begins.”
The writer’s professional work among this class has long been along the line here noted. He has extended confidence—very rarely has it been broken; he has asked for confidence, and the general result can be truly and tersely stated—increasing satisfaction and success.
And now, gentlemen, what are the conclusions of this whole matter? These.
Reason and right alike demand a more rational and correct idea as to the origin of the toxic neurosis we have noted.
This demand complied with—regarding such patients, with certain exceptions, as creatures of conditions beyond control, and so no more culpable than the subjects of other functional disorder—will be most helpful against the protective temptation to untruth.