Popular Science Monthly/Volume 27/July 1885/An Experience with Opium
| AN EXPERIENCE WITH OPIUM. |
By S. T. MORTON.
THE subject of the "opium-habit" is one that recurs with ominous frequency in public print. Whenever touched upon, the intensity of interest elicited in the minds of certain readers (alas! how large a number) would be incomprehensible to one not drawn personally to it. That the literature of this subject is mainly very discouraging and unhelpful to this class is perhaps not the fault of its authors; but such is uniformly the case. Of innumerable articles in periodicals and books by the dozen which I have read, it must be said that, while the evils of the "habit" are pictured in burning lines, when the discussion of treatment is reached, the habitué is left to believe that, in his case, if it be not impossible of cure, an attempt at total abandonment with whatever medical skill he could command would be attended with such hazards, and would inflict such tortures, mental and physical, as would be beyond the average power of endurance.
Unquestionably but a small portion of the general public—of those, too, who know something of its blighting evils—have any adequate idea of the strength of this "habit," and of the great difficulty, or impossibility, in most cases, of unaided cure. The chief responsibility, indeed, with the habitué lies in his initiation rather than in his continuance of the "habit." He can not, like the user of alcohol or tobacco, by a strong effort of the will shake off his chains.
A pathetic story has lately come to my knowledge of a young man, an undergraduate in an Eastern college, who had become a victim of the hypodermic use of morphia. He went with his father, who was engaged in the lumbering interest, into the primeval forests of Maine, hoping that during a stay of months with the wood-choppers he would be able to fight out the battle of gradual abandonment successfully. Through a strange fatality, when the party had just arrived at their camping-place, and were transporting their goods across a stream, the case of morphia was broken by an apparent accident and its contents scattered into the water. None but the haggard young man could, at the moment, comprehend the appalling magnitude of the calamity—there, as he was, two hundred miles from the nearest settlement! He survived the terrible ordeal, but no words could express, he has said, the tortures and agony through which he passed during the succeeding weeks. He was closely watched, else, at times, he would have drowned himself or have beaten his brains out upon the rocks. Months afterward he came back to the world a skeleton, worn and haggard, from his terrible contest. It was an experience to which he could never afterward refer without the most painful emotions.
Not the least significant point in this veritable account is the fact that the young man always believed that his father had purposely brought about the catastrophe for the sake of bringing matters to a speedy end! Has the usual treatment of the disease by physicians at this day anything to offer that is much better than this man's summary method? Perhaps no work on the subject has appeared in recent years more careful and thorough in its scientific intention than Dr. Levinstein's "Morbid Craving for Morphia." It is evident that he has brought no common accuracy of observation to bear upon the subject. His clinical notes on a considerable number of cases of the disease treated by him are of absorbing interest to the morphia habitué.
There is a striking parallel between the method of the Maine lumberman I have described and that of advanced German science in the treatment of this disease. In both cases the patient suffers from the intense cruelty of ignorance! The best thing to do for the unfortunate victim of morphia, according to this learned work, is to secure him in rooms under charge of a competent keeper or nurse, his person and baggage having been searched, and from the rooms "all opportunities for attempting suicide having been removed. Doors and windows must not move on hinges, but on pivots; must have neither handles, nor bolts, nor keys; being so constructed that the patients can neither open nor shut them. Hooks for looking-glasses, for clothes, and curtains, must be removed." Certainly these are ominous preliminaries to a course of scientific medical treatment! Within this prison the patient is totally deprived at once of morphia in every form, and here he must struggle through the terrible weeks succeeding as best he may. So far as appears, he has but the slightest medical aid. His symptoms are closely watched, however, for the portentous shadow of one special danger looms ever near his bedside that of a sudden collapse of his vital powers. A few moments' delay in such a contingency may prevent all power of resuscitation; in any case, the situation is very critical. Fortunate will it be if morphia, which is always the immediate resort in such emergencies, have not lost its potency!
I will not recount the story of the tortures through which the patient passes the days and nights of writhing, the sleeplessness, the restlessness, the thirst, and endless vomitings and purgings; his vain pleadings for liberty, for morphia, for anything which will relieve the intolerable anguish! These clinical notes of Levinstein's, in form cold and terse as a hardware catalogue, are fairly burning with their burden of tragedy. But this treatment he offers as the best known, and its attendant sufferings he evidently believes are inevitable in any cure!
It has happened to me to know, through personal experience, that the unfortunate victim of this "habit" can be freed from his bondage without passing through such an ordeal.
I had been an habitué ten years, having reached at the end of that period the daily amount of thirty-six grains of gum-opium, taken only into the stomach. The "habit" had been begun by a very small amount, and its increase had been extremely gradual. I knew not where to turn for help in effecting a cure: one thing seemed certain, it could not be done without help. At a venture merely, I called upon the late Dr. George M. Beard, feeling that, at any rate, I should be free from the risk of charlatanism; and I shall always remember him with gratitude, for it was through his recommendation that I placed myself under the care of another physician, who immediately undertook the treatment of my case.
The gentleman whom, through the good fortune of Dr. Beard's introduction, I thus came to know, I found to be a young man in the prime of good health and spirits, and one who at once inspired me with that confidence so important in such a case. His residence, it was manifest, was no ordinary "institute" or "asylum." I was simply a courteously received guest in a private family. Here were two bright children quietly pursuing their games when I first entered; and I was soon introduced to a pleasant circle embracing the cultivated ladies of the doctor's family, as well as the three who were to undertake the new path simultaneously with myself. Among these good fellows, as I soon found them to be, I was a simple layman in a medical "ring" as it were, for my comrades were young physicians, each under the hypodermic spell, doctors though they were, helpless like myself in the well-riveted chains. In this situation it is in no wise easy to follow the injunction, "Physician, heal thyself."
Placed in these easy and pleasant relations, with every comfort, and—a most important material consideration—an appetizing table, everything outward was calculated to inspire a feeling of freedom and cheerfulness. I speak particularly of these favorable surroundings, for they seem to me to form a very important accessory of the treatment.
This treatment differed in important respects from preconceived ideas, such as are fostered by almost everything written upon the subject. The patient here, for instance, was under no surveillance and restraint. So far from being a prisoner, he was encouraged in taking walks and drives alone, or, with his fellow-patients, in attending evening amusements, etc. It was the doctor's theory that a person of any sensitiveness of nature could not rest under constant suspicion without a sense of resentment which would be prejudicial to the cordial relation which should always exist between physician and patient. "I ask for and extend confidence," he said, "and believe I largely enhance a good result in so doing. Nor do I share in the opinion, largely held, that no reliance is to be placed upon the word of the opium habitué." Though he was well aware that this morbid habit in many cases exerts a baneful influence on the moral character, it is manifest that—were the doctor's theory of his patient's reliability and truthfulness altogether erroneous—any plan of treatment based upon it would be entirely impracticable, however agreeable to the patients this view of their character.
Within a week after the beginning of treatment my opiate was all withdrawn. What I had undergone at the end of that period, and, indeed, for a day or two subsequent to the total discontinuance, could scarcely be called suffering; it was rather a dull, heavy listlessness, as little painful as enjoyable. There was no mental or physical elasticity; exercise was not inviting—nor, indeed, was there the physical ability for it. It became impossible to read or even to think, except in an idle way. There was no pain or nervousness; but principally a feeling of passive discomfort during this period, when the discontinuance of opium, unaided, would have brought on penal tortures.
Thus "the Rubicon was crossed"—this being the exultant phrase with which the doctor greeted one after the other of our little band, as he passed over that hitherto impassable stream. But the few days succeeding the total deprivation were not so passive. Though I had landed on the other bank of that classic stream, the tug of war was yet to come. That power in the human system which at times seems endowed with a personality of its own—that dual existence, as it were, with its Briarean arms of nerves—revolted. There was a period of disturbance and prostration of strength, with some restlessness. I was for a while the prey of illusions of sight and sound. "Materialized spirits" from the other world seemed at times to hover about my bed, as visible, if not as palpable, as the furniture of my room. But more deceptive still was a loud, sharp voice by which I was addressed occasionally, it seemed, by some person concealed behind the head-board of the bedstead; no speech of man will ever sound more real to me. These were illusions of my waking hours. But the period of prostration which they accompanied was short; and within a few days I again took my place at the table with the family.
More or less insomnia is probably inevitable under any circumstances after the discontinuance of opium. In my convalescence and the experience was parallel with that of my fellow-patients—it was the principal difficulty to overcome. At the worst, however, I passed no night without some sleep. Hypnotics were used at first, but were very soon altogether discontinued; for the sooner the system should discover, so to speak, that no outside aid was to be expected, the better.
The term of my stay under treatment was just four weeks, and the latter half of this may be considered the period of convalescence. There was soon an incoming tide of vitality that transformed the world. This came while my physical strength was still slight, and the amount of sleep to be obtained scanty. But the morning star had arisen above the horizon, and brought an indescribable feeling of renewed hope and courage. Perhaps no after-experience of life will bring again that exquisite sensitiveness to every emotional touch which lasted for two or three days at this early stage of recovery, when the soul was bathed in an atmosphere of joy, and the most commonplace incident would excite a thrill of bliss—when a chance strain of music would bring tears of rapture. This, of course, was not a normal condition, but was the effect of reaction in the newly awakened powers of the system. One main symptom thereafter was a peculiar lassitude—inertia. The will-power seemed to be under some strange thralldom, and one found himself under the greatest difficulty in bringing himself to perform some of the simplest actions. Another symptom—which persisted in some cases much longer than it did in others—was what may be called a dislocation of ideas, or at least a lack of relation between thought and its embodiment in language. The patient would have great difficulty in finding the right expression; he would use words with a most ridiculous misapplication, to his intense mortification. He could not, for the life of him, "call a spade a spade," but would call it almost any other implement or thing imaginable. In my own case, however, this trouble was slight.
At the end of my four weeks' stay I had nearly recovered my regular hours of sleep, and had gained very materially in general tone and strength. With the exception noted above, I had been receiving only tonic treatment; and after leaving my physician's care the only medicines taken were quinine, in tonic doses, and cod-liver oil. It is unnecessary to recount here all the stages of convalescence. Very soon after leaving I had a period of two or three weeks of wonderful elasticity—in fact, of the most perfect health. But this was soon succeeded by a return of the former lassitude and disturbance. There were many such oscillations in the succeeding months; there were periods when the past seemed blotted out in a sense of renewed vigor and strength, followed by weeks when, without any immediate ostensible cause, the tide was at ebb. These were not times of mental despondency, but rather of physical depression and neuralgic disturbance. But there was all the while a steady improvement in general health, with an increasing infrequence of reminders of the "old enemy." During the first three months I gained over twenty pounds in weight.
There is one thing which the habitué, wishing to be cured would perhaps anticipate with dread; that is, an insatiable craving for the old stimulant, and a consequent prolonged and weary resistance of temptation. I can only say that, greatly to my surprise, I have felt no craving for it at any time since the beginning of my treatment. This may seem a strange statement to any one under the sorcery of the drug, and conscious of its fearful grip. There is of course the knowledge, from experience, of the marvelous potency of opium in annulling all discomfort and distress of body or mind; but this is all. The sense of profound satisfaction, ever present, at the release from its slavery, as well as a lively appreciation of the great danger of again tampering with it, is sufficient to leave the temptation—whatever it may be—from such knowledge, powerless.
The special effect of opium on the system is functional. This fact is one great encouragement in attempting a cure from the "habit." The sudden recuperative power manifested, after this paralyzing deadweight is removed, is a great surprise to the patient. Difficulties which had borne to him the grave aspect of serious organic disease vanish as by magic.
There was no secret about this treatment—there were no wonderful remedies unknown to the world used. The therapeutics included bromide of sodium, hot baths, electricity, and other well-known sedative and tonic medicines. The key-stone of the treatment is in preliminary sedation; that is, while the morphia is being rapidly withdrawn—during a period varying from seven to ten days—the nervous system is, at the same time, as rapidly brought under the influence of an efficient sedative, which reaches its maximum effect at the time of complete opiate withdrawal.
Two years have passed since my escape from the thralldom of opium, and during the far larger portion of that time I could record an experience of renewed vitality—a condition of vigor and elasticity that could only have its origin in perfect health. I use no stimulants whatever, other than tea and coffee; and my health has now been so long fully re-established that I feel the better assured in giving some account of my personal experience. I shall be glad if the narrative be of encouragement to others in the same strait—those who have heretofore believed escape from their situation only possible through prolonged agonies. The inevitable chasm which must be crossed in effecting a cure of the opium-disease can be bridged, as I found. One must know something of the breadth and depth of that chasm, to be able to appreciate the achievement.