436 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



The symptoms of opium-eating or morphine habit are not always 

 very marked, even where the patient's life is rendered a burden by 

 it ; they vary greatly in relation to the time which has elapsed since 

 the dose last taken. While the effect is recent, and the nerves are 

 " keyed up," the patient may be lively and unusually bright ; as the 

 effect begins to wear off, there comes a quiet, rather drowsy time, 

 and those who are entirely regardless of the results do not go be- 

 yond this stage while their digestion and nerves will stand repeti- 

 tion of the dose, for they at once resort to their stimulus. But if 

 limited means, a troublesome conscience, or other cause prevents 

 the use of more than a certain quantity daily, the second stage is 

 followed by a third, where we have what are usually given as the 

 symptoms of opium habit, viz. : sunken features (as if the skin were 

 drawn tightly over the cheek-bones), lack of healthy color, furred 

 tongue, constipation, loss of appetite, sleeplessness, shaky hands 

 covered with clammy moisture, and great mental depression or rest- 

 less longing for more of the drug. Cold hands and feet, tendency 

 to sweat, and complaints of most varied pains and discomforts are 

 common. An almost universal symptom is emaciation, which is 

 magnified by the sunken look above referred to. Mentally the pa- 

 tients are depressed, suffer from loss of memory and energy, and 

 are apt to be untrustworthy. 



If the use of the drug be suddenly and completely stopped, a 

 state resembling delirium tremens may supervene and result in 

 death. In strong patients, however, this sudden arrest is one of the 

 modes of treatment recommended ; but if we have the earnest co- 

 operation of the patient, or have complete control of him, we may 

 pretty certainly break off the habit without this rude shock, by 

 gradually reducing the amount of the drug, substituting for it if 

 necessary a variety of other remedies, not relying on any one for a 

 length of time for fear of replacing the opium habit by some other 

 only a little less pernicious. During the period of withdrawal the 

 doses of opium given will have to be regulated to some extent by 

 the previous habits of the patient ; i. e., if he has taken his dose 

 only at night, we have simply to reduce this dose gradually (with- 

 out the patient's knowledge). If it has been taken more frequently, 

 it is well to give a dose of the opiate with a tonic shortly before the 

 midday meal ; this will enable the patient to eat well, and possibly 

 the effects may last till the evening meal. If we can get along with 

 two doses daily, the second dose should be given about bedtime. 

 Administering the two doses in this way gives the best chance for 

 plenty of nourishment and plenty of sleep, which will be found 



