OPIUM HABIT (Morphinism).
The treatment of chronic morphinism is a serious undertaking which can only be expected to prove successful when the patient is removed from his home and thoroughly isolated from his relatives and environment in a proper nursing institution provided with an experienced resident physician and a staff of highly trained nurses.
After removal the question of the method of withdrawing the narcotic must be decided upon. Unless the drug is to be replaced by Hyoscine in the plan of treatment to be described later on, the withdrawal must not be either sudden or very rapidly accomplished.
The rapid diminution of the ordinary daily amount is justified in those rare cases where the progress of the morphinism has been acute, and even then the reduction of a daily dose must be spread over at least ten days or a fortnight.
By the majority of physicians the gradual method of withdrawal is accepted as the best, the last attenuated dose being administered about the fortieth day from the beginning of the treatment. The dose of morphia permitted to the patient will depend upon the amount which he has been able to consume before submitting himself for treatment. About three-fourths of his previous daily allowance may he administered during the first few days, and this should be evenly spread over the "4 hours. The quantity should then be so gradually reduced that by the end of six weeks the dose is practically nil.
It is best to administer the narcotic hypodermically, and when the routine of the nursing home or institution permits it should be given by the physician himself, and when this is not always practicable the physician should measure out the next dose and name the exact hour at which it is to be injected by the nurse. Schroeder stoutly maintains that the onset of severe and threatening symptoms is never the result of sudden withdrawal, and he affirms that such dangers are purely imaginary; the drug is always stopped in the Breslau clinique on admission.
No matter what method of treatment is adopted the sufferings of the patient are always most agonising, and he must never be trusted for a moment during the course, as he will bribe his friends to procure his narcotic surreptitiously if these be permitted to visit him, notwithstanding his most solemn promises and protestations to the contrary.
Weak and attenuated individuals should he kept in bed during the first few weeks of treatment, but in ordinary cases the routine of permitting the patient to he up in his room or even to move about in the open air under the close surveillance of his nurse may be permitted.
Feeding should he as liberal as the weakened gastric organs will permit; a modified Weir Mitchell treatment may be resorted to in some cases; rarely will rectal feeding be needed; strong soups should be freely ad ministered at short intervals. Baths and douchings are valuable adjuncts; the hot-air or thermo-electric bath may be administered as the patient lies in bed; the portable Turkish is more soothing and gives better results than the ordinary warm or hot plunge bath.
When the latter is employed it should be immediately followed by a tepid and cold douche to counteract any depressing effect upon the heart. The general moral discipline is strengthened by arranging that the bathing, douching, feeding and such exercises as are permitted should be carried out at stated hours, to fill in as far as possible the wearying day of the patient.
Next to the difficulty in minimising the terrible cravings of the victim of morphinism comes the serious problem of inducing sleep. The in somnia is always most distressing, and it is a judicious routine in pro portioning the amount of the narcotic and the times for its administra tion to so arrange that the largest dose should be permittted to fall due just before bed hour. It need never be expected, however, that this will sufficiently meet the requirements of the insomnia; hypnotics are always demanded.