Case Of Opium Habit And Chloral Habit Combined
Art. XI.?D. :Author: Edward C. Mann, M.D.
Upon the 21st day of January, 1878, there was admitted at Sunnyside, the following unique case, which is a very interest- ing one in many respects.
Mr. an officer in the army, who has been addicted to the use of opium for 35 years, was treated in 1856 for it with no success whatever. Is 53 years of age. At the age of 13 years he went to China, and from thence to India, where he discovered by experiment the fascination of the drug when eaten, and commenced the habit as a luxury. He was in the British Army in India for twelve years, during which time he continued the habit until, in the year 1856, he had reached the amount of 200 grains daily. Previous to this time he had re- peatedly endeavoured to break off from the habit, by voluntarily discontinuing the use of opium, but each time succumbed to the intolerable suffering which he experienced. He applied at this time for treatment to an Indiana physician, who failed to eradicate the habit, or even to quiet the craving for opium. He therefore continued to take this dose of 200 grains of opium per day in the form of the alkaloid morphia, although he felt convinced that it was impairing his mental faculties very markedly. The will-power had become so impaired that the morbid impulse or craving impelled him irresistibly, regardless of all consequences. He served through the Mexican war, and also through the late civil war. During the progress of the war, feeling that his memory was failing rapidly, and that his physical health was being undermined, he reduced his daily allowance to 125 grains of opium per day. He was so fearful of being taken prisoner and thus losing his opium, that he carried about his person a small pistol, determined in the event of his capture to commit suicide, rather than undergo the torture which the sudden deprivation of his stimulus would cause. This is a striking instance of the moral cowardice which this disease induces, as the patient was noted for his personal bravery on the battle-field, having repeatedly led desperate charges. At the close of the war he commenced to take chloral as soon as he heard of its effect, hoping that he should be enabled to leave off opium. This, however, he did not do, but continuing the opium habit and the chloral in addition, soon reached the amount of half an ounce daily. Upon his admission to Sunnyside he was on the verge of insanity ?emaciated, feeble, pale and anaemic, feeble gait, no ap- preciation of condition or surroundings, hallucinations of sight and hearing, and delusions of fear and persecution. Was very much excited. Several doses of a combination of the bromide of sodium and cannabis indica were administered, also chloral and hyoscyamus, and toward morning he became quiet.
The next morning he was partially aware of his condition, but excited with rapidly changing delusions and hallucinations; was given beef tea and milk, in small quantities, at short intervals. A bi-temporal current from four cells of the galvanic battery was applied for some minutes twice in the day, with the effect of calming the excitement, and the same medicines continued internally. The following night he slept a few hours ; on the third day of treatment, there was marked im- provement ; the bowels, which had been obstinately constipated for a long time, were opened by enemata containing turpentine, and the intense restlessness and the delusions disappeared, and the patient expressed the desire to be cured. The constant current was used as central galvanisation, the negative pile at the epigastrium, and the positive applied successively over the cranial centre, cilio-spinal centre, and the cervical sym- pathetic. The induced current was applied after the manner of general faradisation, particular attention being paid to the brain and spinal cord, which so stimulated him that he bore the entire withdrawal of the chloral. At the time of admission he was taking 5 grains of morphine and 240 grains of chloral daily, as he had been obliged to cut off his opium a few days before admission, fearing death might result from its excessive use. This treatment has been continued daily since admission, with the happiest results. At the time of sending this com- munication, February 20, nearly one month since admission, there are no delusions or hallucinations remaining, no excite- ment ; patient is fully conscious of and realises his position, and expects to be cured. He takes 2 grains of morphine per diem, which is being gradually reduced, and the stimulus which the induced current supplies to the nervous system enables him to bear the gradual withdrawal of the opium and the total deprivation of the chloral, and there is no craving for it. At present he is taking phosphorus, strychnia, and cod liver oil, with the bromide of sodium and Indian hemp at bed time. Eafs and sleeps well, and in a few months it is believed that the cure will be accomplished.
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