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?

In publishing his case I am not violating that Hippocratic vow which protects the relations of patient and adviser; for, as I dropped my friend's wasted hand and stepped to the threshold, he repeated a request he had often made to me, saying:

"It is almost like Dives asking for a messenger to his brethren; but tell them, tell all young men, what it is, 'that they come not into this torment.'"

Already perhaps—by the mere statement of the case—I might be considered to have fulfilled my promise. But since monition often consists as much in enlightenment as intimidation, let me be pardoned for briefly presenting a few considerations regarding the action of opium upon the human system while living, and the peculiar methods by which the drug encompasses its death.

WHAT IS OPIUM?

It is the most complicated drug in the Pharmacopoeia. Though apparently a simple gummy paste, it possesses a constitution which analysis reveals to contain no less than 25 elements, each one of them a compound by itself, and many of them among the most complex compounds known to modern chemistry. Let me concisely mention these by classes.

First, at least three earthy salts-the sulphates of lime, alumina, and potassa. Second, two organic and one simpler acid—acetic (absolute vinegar), meconic (one of the most powerful irritants which can be applied to the intestines through the bile), and sulphuric. All these exist uncombined in the gum, and free to work their will on the mucous tissues.

A green extractive matter, which comes in all vegetal bodies developed under sunlight, next deserves a place by itself, because it is one of the few organic bodies of which no rational analysis has ever been pretended. Though we can not state the constitution of this chlorophyl, we know that, except by turning acid in the stomach, it remains inert on the human system, as one might imagine would happen if he swallowed a bunch of green grass. Lignin, with which it is always associated, is mere woody fibre, and has no direct physical action. In no instance has any stomach been found to digest it save an insect's—some naturalists thinking that certain beetles make their horny wing-cases of that. I believe one man did think he had discovered a solvent for it in the gastric juice of the beaver, but that view is not widely entertained. So far as it exists in opium it can only act as a foreign substance and a mechanical irritant to the human bowels. Next come two inert, indigestible, and very similar gummy bodies, mucilagin and bassorine. Sugar, a powerfully active volatile principle, and a fixed oil (probably allied to turpentine) are the only other invariable constituents of opium belonging to the great organic group of the hydro-carbons.

I now come to a group by far the most important of all. Almost without exception the vegetable poisons belong to what are called the "nitrogenous alkaloids." Strychnia, brucia, ignatia, calabarin, woovarin, atropin, digitalin, and many others, including all whose effect is most tremendous upon the human system, are in this group. Not without insight did the early discoverers call nitrogen azote, "the foe to life." It so habitually exists in the things our body finds most deadly that the tests for it are always the first which occur to a chemist in the presence of any new organic poison. The nitrogenous alkaloids owe the first part of their name to the fact of containing this element; the second part to that of their usually making neutral salts with acids, like an alkaline base. The general reader may sometimes have asked himself why these alkaloids are diversely written—as, e.g., sometimes "morphia," and sometimes "morphine," The chemists who regard them as alkalies write them in the one way, those who consider them neutrals, in the other. Of these nitrogenous alkaloids, even the nuts of the tree, which furnishes the most powerful, swift poison of the world, contains but three—the above-named strychnia, brucia, and ignatia—principles shared in common with its pathological congener, the St. Ignatius bean. Opium may be found to contain twelve of them; but as one of these (cotarnin) may be a product of distillation, and the other (pseudo-morphia) seems only an occasional constituent, I treat them as ten in number—rationally to be arranged under three heads.

First, those whose action is merely acrid—so far as known expending themselves upon the mucous coats. (Pseudo-morphia when it occurs belongs to these.) So do porphyroxin; narcein; probably papaverin also; while meconin, whose acrid properties in contact with animal tissue are similar to that of meconic acid, forms the last of the group.

The second head comprises but a single alkaloid, variously called paramorphta or thebain. (It may interest amateur chemists to know that its difference from strycchnia consists only in having two less equivalents of hydrogen and six of carbon—especially when they know how closely its physical effects follow its atomic constitution.) A dose of one grain has produced tetanic spasms. Its chief action appears to be upon the spinal nerves, and there is reason to suppose it a poison of the same kind as nux vomica without the concentration of that agent. How singular it seems to find a poison of this totally distinct class—bad enough to set up the reputation of any one drug by itself—in company with the remaining principles whose effect we usually associate with opium and see clearest in the ruin of its victim!

The remainder, five in number, are the opium alkaloids, which act generally upon the whole system, but particularly, in their immediate phenomena, upon the brain. I mention them in the ascending order of their nervine power; narcotin; codein; opianin; metamorphia, and morphia.

The first of these the poppy shares in common with many other narcotic plants—tobacco the most conspicuous among the number. In its anti-periodic effects on the human system it has been found similar to quinia, and it is an undoubted narcotic poison acting on the nerves of organic life, though, compared with its associates in the drug, comparatively innocent.

The remaining four act very much like morphia, differing only in the size of the dose in which they prove efficient. Most perfectly fresh constitutions feel a grain of morphia powerfully; metamorphia is soporific in half-grain doses; [Footnote: American Journal of Pharmacy, September, 1861.] opianin in its physical effects closely approximates morphia; codein is about one-fifth as powerful; a new subject may not get sleep short of six grains; its main action is expended on the sympathetic system. It does not seem to congest the brain as morphia does; but its action on the biliary system is probably little less deadly than that of the more powerful narcotic.

Looking at the marvellous complexity of opium we might be led to the apriori supposition that its versatility of action on the human system must be equally marvellous. Miserably for the opium-eater, fortunately for the young person who may be dissuaded from following in his footsteps, we are left in no doubt of this matter by the conclusions of experience. In practical action opium affects as large an area of nervous surface, attacks it with as much intensity, and changes it in as many ways as its complexity would lead us to expect. I have pointed out the existence in opium of a convulsive poison congeneric with brucia. The other chief active alkaloids, five in number, are those which specially possess the cumulative property. Poisons of the strychnia and hydro-cyanic acid classes (including this just mentioned opium alkaloid, thebain) are swifter agents; but this perilous opium quintette sings to every sense a lulling song from which it may not awake for years, but wakes a slave. Every day that a man uses opium these cumulative alkaloids get a subtler hold on him. Even a physician addicted to the practice has no conception how their influence piles up.

At length some terrible dawn rouses him out of a bad sleep into a worse consciousness. Though the most untechnical man, he must already know the disorder which has taken place in his moral nature and his will. For a knowledge of his physical condition he must resort to his medical man, and what, when the case is ten years old, must a practitioner tell the patient in any average case?

"Sir, the chances are entirely against you, and the possession of a powerfully enduring constitution, if you have it, forms a decided offset in your favor."

He then makes a thorough examination of him by ear, touch, conversation. If enough constitution responds to the call, he advises an immediate entrance upon the hard road of abnegation.

If the practitioner finds the case hopeless he must tell the patient so, in something like these words:

"You have either suffered a disorganization of irreproducible membranes, or you have deposited so much improper material in your tissue that your life is not consistent with the protracted pain of removing it.

"One by one you have paralyzed all the excretory functions of the body. Opium, aiming at all those functions for their death, first attacked the kidneys, and with your experimental doses you experienced a slight access of dysouria. As you went on, the same action, progressively paralytic to organic life, involved the liver. Flatulence, distress at the epigastrium, irregularity of bowels, indicated a spasmodic performance of the liver's work which showed it to be under high nervous excitement. Your mouth became dry through a cessation of the salivary discharge. Your lachrymal duct was parched, and your eye grew to have an arid look in addition to the dullness produced by opiate contraction of the pupil.

"All this time you continued to absorb an agent which directly acts for what by a paradox may be called fatal conservation of the tissues. Whether through its complexly combined nitrogen, carbon, or both, the drug has interposed itself between your very personal substance and those oxidations by which alone its life can be maintained. It has slowed the fires of your whole system. It has not only interposed but in part it has substituted itself; so that along with much effete matter of the body stored away there always exists a certain undecomposed quantity of the agent which sustains this morbid conservation. [Footnote: I frequently use what hydropaths call "a pack" to relieve opium distress, and with great benefit. After an hour and a half of perspiration, the patient being taken out of his swaddlings, I have found in the water which was used to wash out his sheet enough opium to have intoxicated a fresh subject. This patient had not used opium for a fortnight.]

"When this combination became established, you began losing your appetite because no substitution of fresh matter was required by your body for tissue wrongly conserved. The progressive derangement of your liver manifested itself in increased sallowness of face and cornea; the organ was working on an inadequate vital supply because the organic nervous system was becoming paralyzed; the veins were not strained of that which is the bowels' proper purgative and the blood's dire poison. You had sealed up all but a single excretory passage—the pores of the skin. Perhaps when you had opium first given you you were told that its intent was the promotion of perspiration but did not know the rationale. The only way in which opium promotes perspiration is by shutting up all the other excretory processes of the body, and throwing the entire labor of that function upon the pores. (When the skin gives out the opium-eater is shut up like an entirely choked chimney, and often dies in delirium of blood- poisoning.)

"For a while—the first six years, perhaps—your skin sustained the work which should have been shared by the other organs—not in natural sweat, but violent perspiration, which showed the excess of its action. Then your palms became gradually hornier—your whole body yellower—at the same time that your muscular system grew tremulous through progressively failing nervous supply.

"About this time you may have had some temporary gastric disturbance, accompanied with indescribable distress, loathing at food, and nausea. This indicated that the mucous lining of the stomach had been partially removed by the corrosions of the drug, or that nervous power had suddenly come to a stand-still, which demanded an increase of stimulus.

"Since that time you have been taking your daily dose only to preserve the status in quo. The condition both of your nervous system and your stomach indicate that you must always take some anodyne to avoid torture, and your only anodyne is opium.

"The rest of your life must be spent in keeping comfortable, not in being happy."

Opium-eaters enjoy a strange immunity from other disease. They are not liable to be attacked by miasma in malarious countries; epidemics or contagions where they exist. They almost always survive to die of their opium itself. And an opium death is usually in one of these two manners:

The opium-eater either dies in collapse through nervous exhaustion (with the blood-poisoning and delirium above-mentioned), sometimes after an overdose, but oftener seeming to occur spontaneously, or in the midst of physical or mental agony as great and irrelievable as men suffer in hopeful abandonment of the drug, and with a colliquative diarrhea, by which—in a continual fiery, acrid discharge—the system relieves itself during a final fortnight of the effete matters which have been accumulating for years.

Either of these ends is terrible enough. Let us draw a curtain over their details.

Opium is a corrosion and paralysis of all the noblest forms of life. The man who voluntarily addicts himself to it would commit in cutting his throat a suicide only swifter and less ignoble. The habit is gaining fearful ground among our professional men, the operatives in our mills, our weary sewing-wormen, our fagged clerks, our disappointed wives, our former liquor-drunkards, our very day-laborers, who a generation ago took gin. All our classes from the highest to the lowest are yearly increasing their consumption of the drug. The terrible demands especially in this country made on modern brains by our feverish competitive life, constitute hourly temptations to some form of the sweet, deadly sedative. Many a professional man of my acquaintance who twenty years ago was content with his tri-diurnal "whisky," ten years ago, drop by drop, began taking stronger "laudanum cock-tails," until he became what he is now—an habitual opium-eater. I have tried to show what he will be. If this article shall deter any from an imitation of his example or excite an interest in the question—"What he shall do to be saved?"—I am content.

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.

It is therefore always proper that the opium-eater should find in his physician a confidant who will not violate his secret even to parent or wife. The closer the relation and the dearer the love, the greater will be the likelihood that the optum-eater has shrunk from revealing the full extent of his burden to the friend in question, and the greater will be the temptation to deceive the doctor unless the patient be made to feel that his revelation is as sacred as the secrets of the bridal-chamber.

I solicit from the friend who accompanied Mr. Edgerton the thoroughest statement which he can give me of the case, ab extra. Such a statement is of great value—for the inroads which the habit has made upon the system are often visible to an outsider only. Furthermore, a friend may give me many circumstances connected with the inception of the case: family predispositions and inherited tendencies; causes contributing to the formation of the habit, such as domestic or business misfortune, prior bad habits of other kinds, illnesses suffered, and a variety of other agencies concerning which the patient might hesitate or forget to speak for himself. Then I make Mr. Edgerton the proffer of that inviolable confidence which I have mentioned, and having won his perfect faith in me, obtain the very fullest history of his case which can be elicited by searching, but most kindly and sympathizing cross-examination. The two statements I collate and enter for my future guidance in a private record.

Let us suppose an average hopeful case.

I find that my patient is about thirty years of age—of the energetic yet at the same time delicate and sensitive nervous organization which is peculiarly susceptible to the effects of opium, from which it draws the vast majority of its victims, and in which it makes its most relentless havoc; with a front brain considerably beyond the average in size and development. My patient's general health, apart from the inevitable disturbances of the drug, has always been fair, and his constitufion, under the same limitations, is a vigorous one. His habit, as in nine cases out of every ten, dates from the medical prescription of opium for the relief of violent pain or the cure of obstinate illness. He was not aware of the drug then administered to him, or at any rate of the peril attending its use, and his malady was so long protracted that opium had established itself as a necessary condition of comfortable existence before he realized that it possessed the slightest hold upon him. When the prescription was discontinued he suffered so much distress that he voluntarily resumed it, without consulting his physician, or, if he did consult him, receiving no further warning as to his danger than that "he had better leave off as soon as practicable." Or else, on leaving off his use of opium, the symptoms for which it had originally been administered returned with more or less severity, and under the idea that they indicated a relapse instead of being one of the characteristic actions of the drug itself, he resumed the dose. It gradually lost its power; little by little he was compelled to increase it; and having begun with 1/3 grain powders of which he took three per diem, he is now taking 18 grains of morphia per diem at the end of five years from his first dose.

If I find him tolerably vigorous on his arrival, as will be the case when he has come to Lord's Island after calm deliberation and the conviction not that he must, but on all accounts had better abandon the habit, I leave him to recover from the fatigues of his journey and get acquainted with his surroundings before I begin any treatment of his case. If, however, as sometimes occurs, he reaches us in desperate plight, having been so far injured by his habit as to show unequivocal signs of an opium-poisoning which threatens fatal results; if, as in several cases known to me, he has summoned all his remaining vitality to get to a place of refuge, being overtaken either by that terrible coma which often terminates the case of the opium-eater in the same fashion that persons new to the narcotic are killed by an overdose, or by that only less terrible opium-delirium belonging to the same general class as mania potu—then his case admits of not a moment's delay. Opium-eaters differ so widely—every new case furnishing some marked idiosyncrasy which may demand an entirely different management and list of remedies from those required by the last one—that for any general scheme of treatment a week's study of the patient will be necessary. During that week our attitude will be simply tentative and expectant, and at its close the proper fidelity and vigilance will have authorized us in making out something like a permanent schedule for the patient's upward march, though even then we must be prepared, like skillful generals, to meet new emergencies, take unforeseen steps, even throw overboard old theories, at any stage of his progress. In no disease is there such infinite variety as in that of opio-mania, in none must the interrogation of nature be more humbly deferent and faithfully attentive; in none do slight differences of temperament, previous habits, and circumstances necessitate such wide variation in the remedies to be used. Notice, by way of illustration, the fact that one opium-eater under my care was powerfully affected and greatly benefited by the prescription of one drachm of the fluid extract of cannabis indica, while another, in temperament, history, tendencies, and all but a few apparently trifling particulars almost identical, not only received no benefit but actually experienced no perceptible effect whatever from the absolutely colossal dose of four fluid ounces. [Footnote: I am aware how incredible this statement will seem to those who have never had any extensive experience of the behavior of this remarkably variable drug, and get their notion of its action from the absurd directions on the label of every pound vial I have seen sent forth by our manufacturing pharmaceutists. "Ten to twenty drops at a dose," they say, "cautiously increased." Cannabis should always be used with caution, but ten or even twenty drops must be inert in all but the rarest cases, and I have given an ounce per diem with beneficial effect. But four ounces of the best extract (Hance & Griffith's) producing literally no effect of any kind on an entirely fresh subject, is a phenomenon that I must have needed eye-witness to imagine possible.] I may add that in the latter case, bromide of potassium was administered with the happiest result—in fact as nearly approaching in its efficiency the character of a succedaneum as any remedy I ever used to alleviate the tortures of opium, while in the former no result attended its administration salutary or otherwise. The vast diversity of operation exhibited in different patients by the drug scutellaria is still another illustration of the careful study of idiosyncrasies requisite for a successful treatment of the opium disease. But when the case comes into our hands at a desperate period there are many means of instant alleviation which may anticipate without interfering with future treatment based on study.

Mr. Edgerton, though by no means a man of ruined constitution, has brought himself temporarily into a critical place by the fatigues and anxieties of harassing business, by exceptional overwork which kept him at his desk or in his shop until inordinately late hours; even, let me say, by going for entire nights without sleep and neglecting his regular meals day after day for a period of several weeks; performing and enduring all this by the support of extra doses of opium. Perhaps, finding the stimulus to which he has become accustomed too slow in its operation, he has violated his usual custom of abstinence from alcoholic drinks and reinforced his opium with more or less frequent potations of whisky. This is no fancy sketch, Our overtasked commercial men frequently go on what might with propriety be called "a business spree," in which for a month at a time, whether using stimulants or not, they plunge into as mad a vortex with as thorough a recklessness as those of the periodical inebriate; finding out in the long run that the fascinations of speculation, and the spring and fall trade, bring as dire destruction to soul and body as those of the bowl and the laudanum vial. During times of great financial pressure or under the screws of preparation for some great professional effort, the moderate opium-eater finds that he must inevitably increase his dose. When he adds liquor to it (and this addition to an old opium-eater is often as necessary as liquor alone would have been before he used opium at all) he is indeed burning his candle at both ends. Mr. Edgerton reached the commencement of his period of extra exertion with as sound a constitution—in as comfortable condition of general health—as is enjoyed by any man habituated to opium for four or five years; and such cases are frequently found among men who appear to enjoy life pretty well, attend to their business with as much regularity as ever, and show no trace of the ravages wrought by their insidious foe to any but the expert student. After six weeks of exciting labor and solicitude, during which his sleep and his rations were always delayed till exhaustion overpowered him, and then cut down below half the normal standard, he wakes one morning from a slumber heavy as death into a state of the most awful vigilance his mind can conceive of. He even doubts for some moments whether he shall ever sleep again, and in the agony of that strange, wild suspicion, a cold sweat breaks out over him from head to foot. Waking from the most utter unconsciousness possible to a wide-awake state like having the top of one's skull suddenly lifted off by some surgeon Asmodeus, and the noonday sun poured into every cranny of his brain, he suffers a shock compared with which any galvanic battery, not fatal, gives but a gentle tap. The suddenness of the transition—no gentle fading out of half-remembered dreams, no slow lifting of lids, no pleasant uncertainty of time and place gradually replacing itself by dawning outlines of familiar chair and window frame and cornice—the leap from absolute nonentity into a glaring, staring world—for a moment almost unsettles Mr. Edgerton's reason. Then the fear for his sanity passes and a strange horror of approaching death takes its room. His pulse at the instant of waking throbs like a trip-hammer; an instant more and it intermits. Then it begins again at the old pace. He snatches up his watch from the bureau with a trembling hand and counts—the beat is 130 a minute. Again it stops; again it begins; but now little by little growing faster and threadier until it runs so swiftly yet so thinly as to feel under his finger like some continuous strand of gossamer drawn through the artery. His feet and hands grow deadly cold. He seems to feel his blood trickling feebly back to his heart from every portion of his body. He catches a hurried look at the glass—he sees a dreadful spectre with bistre rings around the eyelids, an ashen face, leaden lips, and great, mournful, hollow, desolate eyes. Then his pulse stops altogether; his lungs cease their involuntary action; and with a sense of inconceivable terror paralyzing the very effort he now feels it vital to make, he puts them under voluntary control and makes each separate inspiration by an effort as conscious as working a bellows. I doubt not that many men have died just at this place through absolute lack of will to continue such effort. Then the metaphorical paralysis of fear is seconded by the simulation of a literal one, extending through the limbs of one side or both; the sufferer reels, feeling one foot fail him—tries to revolve one arm like a windmill, that he may restore his circulation, and that arm for some instants hangs powerless. Presently, with one tremendous concentration of will, his brain shouts down an order to the rebellious member—it stirs with sullen reluctance—it moves an inch—and then it breaks from the prison of its waking nightmare. Summoning his entire array of vital forces, our patient leaps, and smites his breast, kicks, whirls his arms, and little by little feels his heart tick again. By the time a feeble and sickly but regular pulse is re-established he has gone through enough agony to punish the worst enemy, my dear Sir, that you or I ever had. The vague, overpowering fear of death which during such an attack afflicts even the man who by grace or nature is at all other times most exempt from it is one of this period's most terrible symptoms. This passes with the return of breath and circulation.

But the clammy sweat continues—pouring from every point of the surface—saturating the garments next the skin as if they had been dipped in a tub of water. Presently our patient begins to suffer an intolerable thirst, and runs to the ice-pitcher to quench it. In vain. He can not retain a mouthful. The instant it is swallowed it seems to strike a trap and is rejected with one jerk. He seeks the sedative which up to this hour has allayed his worst gastric irritations. Now, if never before, opium in every form produces nausea. Laudanum instantly follows the example of the water, and even a dry dose of morphia, swallowed with no moisture but saliva, casts itself back after agonizing retchings. To liquor his rebellious stomach proves yet more intolerant—food is almost as irritating as liquor. In a horror he discovers that even pounded ice will not stay down—and he is parching like Dives. His anguish becomes nearly suicidal as the fact stares him in the face that he has come to the place where he can not take opium any more—though to be without it is hell—that food, drink, medicine, are all denied him.

A merciful, death-like apathy ensues. He lies down, and with his brain full of delirious visions, appalling, grotesque, meaningless, beautiful, torturing by turns, still manages to catch an occasional minute of unconsciousness. He hears his name called—tries to rise and answer—but his voice faints in his throat and he falls back upon his bed. Friends enter his bed-chamber—in an agony of alarm rouse him—lift him to his feet—but he has not the strength of an infant, and he falls again. In this condition he may continue for a day or two, then sink into absolute coma, and die of nervous exhaustion, or his constitution may rally as the effects of the last overdose pass off, and the man, after a fortnight's utter prostration, come gradually back to such a state of tolerable health and comfort as he enjoyed before he overtaxed himself.

Mr. Edgerton is brought to Lord's Island in the condition I have described, living near enough to be transported on mattresses in carriage and boat. A few hurried questions put to his friends reveal that although his condition is alarming it is by no means necessarily fatal; being one of those in which the habit is of such comparatively short standing, and the constitution still so vigorous, that even at home he might come up again by natural reactions.

He is immediately undressed and put to bed, with hot bricks and blankets at the extremities, and the galvanic battery is judiciously administered by placing both feet in contact with a copper plate constituting the negative electrode, while the operator grasps the positive in one hand, and having wetted the fingers of the other, follows the spine downward, exerting gentle pressure with them as he goes. "Judiciously," I say, because there is a vast deal of injudicious use of the battery. In many cases, for instance, a powerful and spasmodic current is used to the absolute injury of the patient, where the greatest benefit might be secured by an even one so light as scarcely to be perceptible. But I can only mention the battery. Its application is by itself a science, and demands a book. The practitioner who treats opium patients needs that science as much as any one interested in whatsoever branch of nervous therapeutics. The battery in the hands of a scientific man is one of our most powerful adjuncts throughout every stage of treatment, both of opium-eating and its sequelae. Paralysis following the habit, and persistent long after its abandonment, I have cured by it when all other means failed. Here, however, we have only room to indicate the weapons in our armory.

If Mr. Edgerton's digestive apparatus is still as intolerant as at the commencement of the attack which hurried him to Lord's Island, we may hope for a marked mitigation of this symptom, in the use of the battery by passing a mild current transversely through him in the region of the solar plexus. As soon as it is possible for his stomach to retain any thing we administer a bolus of capsicum, compounded of five grains of the powder with any simple addition like mucilage and and liquorice to make it a coherent mass. The remaining nausea and irritability will in great likelihood be speedily relieved as by magic, and with these will disappear some of the most distressing cerebral symptoms—the horror and frenzy or comatose apathy among them. In few cases will a patient reach the Island in time for the advantageous use of belladonna. That is a direct antidote—exerting its function in antagonism to the earlier toxical effects of the opium. In cases where a single overdose has worked the difficulty and produced the coma which Mr. Edgerton's now resembles, it may be given to an old habitu of the drug with as good advantage as to a person whose overdose is his first experience of opium. It is of especial value where the absorbents have carried the excess beyond the reach of an emetic, any time, indeed, within fifteen or twenty hours after the overdose, when sulphate of zinc and the stomach-pump have failed to bring the poison. If our patient on the Island has taken his overdose so recently, and it seems still worth while to act by antidote, we shall be obliged to get over the difficulty presented by his stomach's lack of retention by administering our belladonna in the form of atropin in solution as a hypodermic injection. The many eminent researches of late made in this interesting method of administering remedies, and the practitioner's own judgment, must guide him as to the proportions of his dose—whether one-fortieth grain, one-twentieth, or larger. Of this operation, with opium-eaters, I have seen several most successful instances.

In all probability, however, there will be a better field in such cases as Mr. Edgerton's for the use of nux vomlca than of belladonna. Where the prostration is so great as to call for the most immediate action to avoid a syncope from which there shall be no rallying, it will be unwise to await the soothing action of the battery, capsicum, or any other means preparatory to giving nux votnica by the mouth. Strychnia in solution (it is needless to say with what caution) must be administered like the atropin, subcutaneously, or else nux vomica tincture in the form of the ordinary enema in about the same dose as it would be given by the mouth. The former method in wise hands is the better, both as the speedier, and, considering the opiate torpidity of the intestines, by far the more certain. In cases where the stomach tolerates fluid, as our ability to await the action of the battery and capsicum have now enabled us to find Mr. Edgerton's, we may give from fifteen to twenty drops of the ordinary pharmaceutical tincture of nux vomica in a table-spoonful of water.

In the course of ten minutes we find a decided improvement in the pulse of the patient; he experiences great relief from his feelings of apprehension and distress about the epigastrium; and the most powerful tonic known to science begins dispatching its irresistible behests to every fibre of the organic life. That painful as well as agitating subsultus—that involuntary twitching and cramp in the muscles of the limbs and abdomen which often characterizes this form of the opium malady, by degrees gets lulled as under a charm, and it may not even be necessary to repeat the dose in two and a half hours to remove it so entirely that the patient gets ten or fifteen minutes of refreshing sleep.

The earliest symptoms of this species of attack sometimes indicate such prostration as make any bath of the ordinary kind unsafe; yet rare indeed are the cases (not one in a hundred I should say) where there is any danger of further depressing the nervous system (of course the great thing to guard against) by putting a patient like Mr. Edgerton into a Russian bath. I need not enlarge upon the value of this most admirable appliance—all the most enlightened men of the medical profession know it and esteem it as it deserves, though its use in rheumatic affections and cutaneous diseases has hitherto received more study than in the class of maladies where its employment is perhaps the most beneficial of all—the nervous. Pre-eminently valuable is it in the treatment of delirium tremens and in every stage of the opiomania.

As your book is for the purpose of the public rather than professional men, I may perhaps properly say a few words about this bath by way of description. We have one, as a matter of course, at Lord's Island.

A room forty-five feet long and twenty broad, with a vaulted ceiling twenty feet high at the crown, is provided along each of its two longer sides with a series of marble slabs rising in three tiers from eighteen inches above the floor to a couple of feet below the ceiling. The idea may be gained more accurately by supposing three steps of a giant staircase mounting from an aisle three feet wide through the middle of the room, back and upward to the parallel cornice. The level surface of each of these steps is sufficiently wide to accommodate a man stretched on his back, and the upright portion of each step is an iron grating. Under the series of steps on both sides runs a system of sinuous iron pipes pierced with minute holes, and connected by stop-cocks with a boiler out of sight.

The steps occupy in length twenty-five feet of the room, and its entire breadth except the narrow aisle between the is occupied by a tank sunk beneath the floor, sixteen feet square by four and a half deep, filled with water kept throughout the year at a uniform temperature of about 70 F., and by the gallery which runs round the railing of the tank on the floor level. About the sides of the gallery are arranged hot and cold water-pipes with faucets and hose connections, the hose being terminated by a spray apparatus similar to the nose of a watering-pot. Opening off the gallery at the end furthest from the steps is a small closet fitted up with ascending, descending, and horizontal shower apparatus, by means of perforated plates connecting with the water-pipes by faucets set in floor, walls, and ceiling.

After the battery, the capsicum, and the nux, if Mr. Edgerton can retain it, we feed him by slow tea-spoonfuls from one-half to a whole cup of the most concentrated beef-tea—prepared after Lieblg's recipe or another which I have usually found better relished, and as that, where food must be administered to fastidious stomachs, is half the battle, which I prefer. (I will give it hereafter.) Should his stomach reject it thus administered, it must be given as an enema. Its place in the plan of all enlightened medical treatment is too lofty to need my insisting on. We must rely on it at Lord's Island every step of our way. It will not have been within our patient's system five minutes before the pulse shows it, nor ten before he feels from head to foot as if he had taken some powerful and generous stimulant. It is always wise to give beef-tea, even just before a bath of any kind, and it is never well to enter the Russian bath on an empty stomach.

Having taken his beef-tea, Mr. Edgerton is carried or propelled in a wheel-chair by attendants to the Russian bathroom. Having stripped in an anteroom, upon entering the vaulted chamber he finds himself in an atmosphere of steam at 120 F., which fills the apartment, even obscures the skylights, yet to his surprise does not impede his respiration or produce any unpleasant sense of fullness in the head. He is now stretched on his back upon one of the lowest slabs, where the atmosphere is coolest and the vapor least dense; a large wet sponge is put under his occiput for a pillow, and another sponge in a pail of cool water placed by his side with which he, or in case of too extreme debility his attendants, may from time to time bathe and cool the rest of his head. As soon as he has become accustomed to the heat and moisture, a sensation of pleasant languor steals over him; all remains of his nausea and other gastric distress vanish; his nervous system grows more and more placid; his clammy skin is bedewed by a profuse and warm natural perspiration. Perhaps, as in cases of extreme debility and where the nerves have suffered tension from protracted pain, he even falls into a pleasant sleep. He is allowed to lie quietly on this lower slab for about fifteen minutes. An attendant then lathers him from head to foot with a perfumed cake of soap and gives him a gentle but thorough scrubbing with an oval brush like that in use among hostlers—finishing the operation by vigorously shampooing, Oriental fashion, each separate joint of his whole body, with a result of exquisite relief not exaggerated by Eastern travellers as applicable to well people and quite beyond expression when its subject is the poor, long-tortured frame of a sick opium-eater. The process over, the patient is taken to the gallery and stood up before the hose apparatus above-mentioned. One hand of the attendant directs over his body a fine spray of steam and the other follows it up and down with a spray of cool water (either of which by combining and graduating appropriate faucets may be made as warm as you like), producing a fine glow and reaction of the whole surface. The up, down, and lateral showers are then administered, after which the patient is sent to plunge into the tank, and if able to swim, a stroke or two. Emerging, rosy as Aphrodite, and with a sense of vigor he can hardly believe, he again lies down on the slab-this time taking the next higher tier, and in about ten minutes more, mounting, if so disposed, to the highest, where the perspiration rolls from him in rivulets, and with it as makes him feel like a new being. Finally, in about an hour from the time he entered the bath-room he is treated to one last plunge in the tank and carried back to the anteroom. The thermometer there marks but 70 F., or half a hundred degrees cooler than the steam from which he has just emerged; still his blood has been set in such healthful circulation, and during the last hour he has absorbed such an amount of caloric, that the change seems a very pleasant one, and his skin has been so toned that he runs not the slightest risk (even were he the frailest person with pulmonary disease) of catching cold. Singular as it may seem, the first case of such a result has yet to be recorded.

This is all the more remarkable when we consider that instead of being immediately wrapped up after his vigorous drying with furzy bath-towels, he is kept naked for five minutes longer during a further process of hand-rubbing and shampooing by an attendant. The shampooing takes place as he lies prostrate on a couch and thus gives his debility all the advantage of rest and passive exercise at the same time. Whether we explain it upon the yet unsettled hypotheses of friction, the suppling which the patient gets in this part of the process from the hands of a strong, faithful, cheerful-minded and hale-bodied servant is one of the most valuable means which can be relied upon for the relief of opium suffering at any stage whatever. After coming from the anteroom our patient who entered more dead than alive may feel vigor that he would like to give his recovered powers play in walking back to his room, but it is best not to humor him by letting him draw on his first deposit. He should be tenderly wheeled back as he came—put to bed, and if it does not revolt his appetite, fed slowly as before another cup of beef-tea. After that he will probably fall into a refreshing slumber from which he is on no account to be roused, but suffered to wake himself. On his waking another cup of beef-tea should be given him, and no other medicine, unless his pulse becomes alarming and he shows signs of return to the original sinking condition in which we found him—when the nux may be repeated.

It is now improbable, after the happy change described has taken place in him, that he will succumb to the acute attack of opium-poisoning which led him to us. Alarming as it appears, it is seldom dangerous or persistent. The patient who has not constitutional strength to rally at once, goes down rapidly and dies in a few days, while he who rallies once gets well, pro hc vice, without much medical treatment save that which was promptly given at the critical moment, or treatment of any kind but nourishing food, rest, baths, and vigilant, tender nursing. As soon as the chronic appetite calls for its habitual dose, and the stomach receives it without revenging its grudge against the recent excesses, the patient may be considered out of danger as far as the acute attack is concerned.

Here I will be asked (as I am constantly out of the book), why not begin the abandonment of the drug as soon as this acute attack is over? When the terrible and immediate peril has been staved off by such a mere hair's-breadth, why listen again to "the chronic appetite" which "calls for its habitual dose?" Surely, now that the patient has gone for forty-eight hours or more without that dose, would it not be better never to return to it? Must he begin his former career again and afterward have all the same ground to go over?

I answer that he will not have the same ground. That which he has just traversed was the ground separating between an excess and his normal life—and he is in reality in a worse condition to try the experiment of instant abandonment than he was before the struggle. It is a very different thing to cure a man of acute from curing him of chronic opium-poisoning; and my own large experience, together with that of all the most experienced, the soundest and most skillful men that I have ever known as successful practitioners among these cases, points to the unanimous conclusion that it is not safe, either to mind or body, to make the abrupt transition required of an old opium-eater who must give up his drug in toto and at once, especially after such an acute attack as that just described. He would be very likely to die of exhaustion, to endure an amount of agony which would permanently enfeeble his mind, or to commit suicide as his only way of escape from it, if we cut him short from the equivalent of 15 or 20 grains of sulphate of morphia after having used the drug for five years. The most terrible case of opium-eating which I ever saw instantly cu short was one where the patient used 33 grains of morphia per diem, but he had used it for less than a year, and possessed a constitution whose physical grit and mental pluck anybody would pronounce exceptional, though even that did not save him from the tortures which endangered his reason. I am always in favor of a man's "breaking off short" if he can. I believe that the majority of people who have used the drug less than a year can, but the number who are able to do it after that diminish in geometric ratio with every month of habituation.

I therefore permit Mr. Edgerton, as soon as his stomach will bear it, to return to the use of opium.

But before giving him his dose I make the stipulation that from this moment he shall deal as frankly with me as he does with his own consciousness—that we shall have no opium secrets apart.

In advanced cases, where opium has been used long enough to break down the will and the sense of moral accountability, I may feel it wise to ask of the friend who accompanies my patient that he go through the baggage and clothes of the latter before leaving him, and report to me that no form of opium is contained in them. But in most cases I prefer to rely entirely upon the good understanding established between my patient and myself for my guarantee that no opiate is smuggled into the institution, and upon my own daily examination of the patient to determine whether this guarantee is kept inviolate. To an expert reader of opium cases it will soon become apparent whether in any given case a patient is taking more than the amount prescribed—and after total abandonment is resolved upon, the question whether the patient is taking opium at all may be decided by a tyro.

In the case of Mr. Edgerton, who has voluntarily come to ask our help on the way upward, I proceed by a system of complete mutual confidence. I tell him that I am sure he feels even more deeply than myself the necessity of abandoning the drug. I promise him that he shall never be pushed beyond the limits of endurance, and ask only that he will allow any dose he may take to pass through my hands. I request that if he has brought any form of opium with him he will give it to me, and we enter into a stipulation that he will come to me for any opiate or other alleviative which he may desire. I bind myself never to upbraid or censure him—never to reveal to a living soul any confidence soever which he may repose in me—and then I ask him to name me the average dose upon which, before his late acute attack, he has managed to keep comfortable—rather, I should say, before the overwork and consequent opiate excess which brought it on. During his terrible six weeks of high-pressure, he tells me, he reached a per diem as high as 25, on one occasion even 30 grains; but for a year previous he had never taken more than the equivalent of 18 grains of morphia a day. This, then, shall furnish our starting-point.

Whether he has previously adopted the same method or not, I divide this amount into three or more doses to be taken at regular intervals during the day.

I say "the equivalent of 18 grains of morphia," because although the majorify of habitus use that principle of opium as their favorite form, there are some who after many years' use of the drug still adhere to crude gum opium or laudanum. The portability and ease of exhibition which belong to morphia—the fact that it fails to sicken some persons in whom any other opiate produces violent nausea—its usual certainty, rapidity, and uniformity of action, and the ability which it possesses to produce the characteristic effects of the narcotic after other preparations have become comparatively inert, make it the most general form in use among opium-eaters of long standing. Still, bearing in mind the wonderful complexity of opium (vide "What Shall They Do to be Saved?") and the equally marvellous diversity in the manner in which it affects different people, we can not wonder at the fact that some of its victims require for their desired effect either the crude drug or other preparations containing its principles entire. Morphia is by far the most important of these principles, and more nearly than any one stands typical of them all. Still, it is easy to conceive how certain constitutions may respond more sympathetically to the complex agent of Nature's compounding than to any one of its constituents. [Footnote: In some cases, especially of shorter standing, codeia may be used as the form of opiate to diminish on. In any case its employment is worth trying, for it possesses much of the pain-controlling efficiency of opium and morphia, with less of their congestive action upon the brain. Practically it may be treated in such an experiment as the equivalent of opium; not that it at all represents all the drug's operations, but that where crude opium has been the form in use, codeia may be substituted grain for grain. Some patiets find it quite valueless as a substitute, but there is always a chance of its proving adequate. When tried, the best form is a solution similar to Magendie's, but replacing one grain of morphia by six of codeia.] We may therefore find it necessary to carry on our reformatory process upan laudanum or M'Munn's Elixir, but by far the larger number of cases will do better by being put instantly upon a regimen of Magendie's Solution of Morphia. The formula for this preparation is:

Rx Morph. Sulph. . . . . . . . . . . . grs. xvi. Aqua Destill. . . . . . . . . . . . ounce j Elix. Vitrioli. . . . . . . . . . . quant. suff.

Mr. Edgerton has used 18 grains of morphia per diem. His equivalent in Magendie's Solution will be 9 fluid drachms.

This amount I divide into three equal doses—one to be administered after each meal. By administering them after meals I give nutrition the start of narcotism, prevent the violent action possessed by stimulants and opiates on the naked stomach, and secure a slower, more uniform distribution of the effects throughout the day. The position of the third dcse after the 6 o'clock meal of the day is particularly counselled by the fact that opium is only secondarily a narcotic, its sedative effects following as a reaction upon its stimulant, and the third dose accordingly begins to act soporifically just about bed-time, when this action is especially required.

I keep a glass for each of my patients, upon which their "high-water mark" is indicated by a slip of paper gummed on the outside. When Mr. Edgerton, pursuant to our stipulation, comes to me for his dose, I drop into the glass before his eyes a shot about the size of a small pea—then fill the glass with Magendie's Solution up to the mark indicated. (This shot varies in each case with the rapidity of diminution I think safe to adopt. In some cases it is a buckshot or a small pistol bullet.) Every day a new shot goes in—and if he bears that rate of progress I may even drop one into the glass with each alternate dose.

Midway between the doses of morphia I give Mr. E. a powder of bromide of potassium, amounting to 30 or even 40 grains at a time, and an average of about 100 grains per day. The value of this remedy has been a matter of much controversy—some practitioners lauding it to the skies as one of the most powerful agents of control in all disorders of the nervous system, others pronouncing it entirely inert. Where it has proved the latter it has probably been given in too small doses or not persevered in for a sufficient length of time. (The timidity with which it is often prescribed may be seen in the fact that one of the principal druggists on Broadway lately warned a person to whom I had given a prescription for 30 grain doses that he was running a very dangerous risk in taking such a quantity!) Its operation is so entirely different from that of the vegetable narcotics that people looking for their instantaneous sedative effect can not fail to be disappointed. It is very slowly cumulative in its action, seeming to act upon the nervous system by a gradual constitutional change rather thin any special impetus in a given direction. Because that is its modus operandi, I begin to give it thus early; and it is of peculiar value now, not only as making the daily diminution of the opium more tolerable, but as preparing the system for the time when the drug is to be abandoned altogether and the hardest part of the tug comes.

In Mr. Edgerton's case the gradual descent to 1/2 grain per diem, when we leave off the opium entirely, consumes let us say a period of one month. It is not to be expected that this period will pass without considerable discomfort and some absolute suffering, for the nervous system can not be dealt with artfully enough to hide from it the fact that it is losing its main support. It is the nature of that system not even to rest content with the continuation of the same dose. It grows daily less susceptible to opium and more clamorous of increase. When the dose does not even remain in statu quo but suffers steady diminutions however small, the nerves can not fail to begin revenging themselves. Still, this period may be made very tolerable by keeping the mind diverted in every pleasant occupation possible, such as I shall presently refer to as abounding on our Island. Our physical treatment for the month is especially directed to the establishment of such healthy nutrition and circulation as shall provide the nervous system with a liberal capital to for at least the first ten days or fortnight after the complete abandonment of opium. The patient's digestion must be carefully attended to, and kept as vigorous as is consistent with the still continued use of the drug. Beef-tea, lamb-broth with rice, all the more concentrated forms of nutriment, are to be given him, in small quantities at a time, as frequently as his appetite will permit; and if progressive gastric irritability does not develop itself as the diminution of the narcotic proceeds, he is to have generous diet of all kinds. We must pay particular attention to the excretory functions—getting them as nearly as possible in complete working order for the extra task they have presently to fulfill when the barriers are entirely withdrawn and the long pent-up effete matters of the body come rushing forth at every channel. The bowels must be trained to perfect regularity, and the skin roused to the greatest activity of which it is capable. Exercise, carried to the extent of healthy fatigue, but rigorously kept short of exhaustion, may be secured in our bowling-alley, gymnasium, and that system of light gymnastics perfected by Dio Lewis—a system combining amusement with improvement to a remarkable degree, as being a regular drill in which at certain regular hours all those patients, both ladies and gentlemen, who are able to leave their rooms, join under the command of a skillful leader to the sound of music. This system has an advantage, even for well people, with its bars, poles, ropes, dumb-bells, etc., inasmuch as it secures the uniform development, on sound anatomical and physiological principles, of every muscle in the human body, instead of aiming at the hypertrophy of an isolated set. I do not mean by this to deny the value of the old style gymnasium, our Island will possess as good a one as any athlete could desire. Horseback riding will form another admirable means of effecting our purpose, especially where the patient suffers from more than the usual opiate torpidity of the liver. We shall have room enough if not for an extended ride at least for a mile track around the Island, and a stud, however unlikely to set John Hunter looking to his laurels, capable of affording choice between a trotter and a cantering animal. During the summer there will be ample opportunity for those who love horticulture to take exercise in the flower and vegetable garden attached to the institution, and such as wished might be assigned little plots of ground whose management and produce should exclusively belong to them. Looking for a moment from the therapeutics to the economics of the matter, I can see no reason why the house might not rely largely upon itself for at least its summer vegetables and its fruit—if the poorer patients were permitted to pay part of their dues, when they so elected and the exertion was not too much for them, by taking care of the grounds. Another admirable means of exercise will be found in rowing. Our Island must have a good substantial boat-house, containing a good-sized barge for excursions and several pleasure-boats pulling two or three pair of sculls each; perhaps, eventually, a pair of racing-boats for such of our guests as were well enough to manage a club. Bath-houses for the convenience of those who love a plunge or a swim will be indispensable—affording facilities for a species of summer exercise which nothing can replace.

In winter and summer the bath must be our principal reliance for promoting that vigorous action of the excretory system which with healthy nutrition is our great aim in treating the patient.

Quackery has to so great an extent monopolized the therapeutic use of water, and so much arrant nonsense has been talked in that pure element's name, that we are in danger of overlooking its wonderful value as a curative means. It is one of the most powerful agents at the command of the practitioner, and should no more he trifled with than arsenic or opium. Used by a blundering, shallow-pated empiric it may be worse than useless—may do, as in many cases it has done, incalculable mischief to a patient. In the hands of a clear-sighted, experienced, scientific man, who administers it according to well-known laws of physiology and therapeutics, it is an inestimable remedy, often capable of accomplishing cures without the assistance of any other medicine, and, indeed, where all other has failed. Many of the forms in which it is applied at water-cures well deserve adoption by the more scientific practitioner. Among these the pack occupies a front rank. During Mr. Edgerton's month of diminution we use this with him daily. Its sedative effect, when given about three and a half P.M., just after the second dose of bromide of potassium, is exceedingly happy-seeming, as I have heard a patient remark, "to smooth all the fur down the right way"—removing entirely the excessive nervous irritability of the opium-craving, and often affording the patient his only hour of unbroken sleep during the twenty-four. Its tendency to promote perspiration makes it a most effective means for restoring the activity of the opium-eater's skin, and this benefit will be still further increased if it be followed by sponging down the body with strong brine at a temperature as low as the patient can healthily react from, concluding the operation with a vigorous hand-rubbing administered by the attendant until the skin shines. This same salt sponge is a most invigorating bath to be taken immediately on rising. Another excellent bath in use at water-cures, of value both for its tonic and sedative properties, is "the dripping sheet," in which a sheet like that used in the pack, of strong muslin and ample size, is immersed in a pail of fresh water at about 70 F., and, without wringing, spread around the standing patient so as to envelop him from neck to feet, the attendant rubbing him energetically with hands outside it for several minutes till he is all aglow. In cases where great oppression is felt at the epigastrium—that corded sensation so much complained of by opium-eaters during their earlier period of abandonment, and that peculiar self-consciousness of the stomach which follows in the track of awakening organic vitality—the greatest relief may be expected from "hot fomentations," This is the well-known "hot and wet external application" of the regular practice, and consists of a many-folded square of flannel wrung out of water as hot as the skin can bear, and laid over the pit of the stomach, with renewals as often as the temperature perceptibly falls.

The symptom of cerebral congestion—a chronic sense of fullness in the head—is often very simply alleviated by placing the patient in "a sitz" or hip-bath, with the water varying from 70 to 90 F, Enemata will constantly be found of service where the torpidity of the bowels is extreme. Not only so, but in cases where the liver is beginning to re-assert itself, and its tremendous overaction sends down such a supply of bile as to provoke inversion of the pylorus, an enema may often act sympathetically beyond that portion of the intestine actually reached by it, and change the direction of the intestinal movement, so as to convert the deadly nausea excited by the presence of bile in the stomach into a harmless diarrhea which at once removes the cause of the suffering. Of the value of foot-baths I need not speak, and to the hot full-bath I must now make reference as the most indispensable agent in ameliorating the sufferings of one who has completely abandoned the drug.

When Mr. Edgerton's dose has reached as low an ebb as 1/2 grain of morphia he abandons the drug entirely. In my Harper's Magazine article I have fully depicted the sufferings which now ensue—as fully, at least, as they can be depicted on paper—though that at the best must he a mere bird's-eye view. During the period of diminution he has endured considerable uneasiness and distress, but these have been trifling to compare with the suffering which he must endure for the first few days and nights, at least, after total abandonment. Universal experience testifies that although the previous period of diminution greatly shortens and softens the sufferings to be endured after giving up opium altogether, the descent from 1/2 grain of morphia to none at all must involve a few days at least of severe suffering, which nothing borne during the diminution at all foreshadows.

In my Harper's article I have said:

"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.