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.
Public-domain text, read in full here on John Shaqi.
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