This was not a very satisfactory case, as he was not long enough under treatment. He was about the same weight on discharge as oil admission. There was no tendency to collapse, but on the contrary his physical condition was improved. I

TREATMENT OF OPIUM-EATERS.

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Indian Medical Gazette." once endanger life 1 Ought opium to be stopped at once or gradually 1 The effects of stopping it gradually is said to cause less pain (?) than stopping it suddenly ; if this is really so and the effect the Can it be shown that same, why advocate the other plan 1 sudden stoppage is the better plan, more effectual, and giving much less pain ? These are the important questions which I venture upon, knowing that authorities are advocating diametrically opposite lines of treatment. During the past 12 months I have had under my charge 429 prisoners ; 12 per cent have been notorious opium-eaters, whose opium was stopped suddenly at once on admittance into jail, and the result has been in every way satisfactory. I have had no deaths : five of these neither gained nor lost in weight: one lost one lb. The lightest weight was 72 lbs., and the heaviest 144 lbs. 4 ozs. The average weight on admission was 98 lbs. 5 ozs., and on discharge 106 lbs. The whole gained on an average 7 lbs. 5 ozs., and they were on an average 3 months 17 days under confinement. Some of the cases were very exaggerated instances. Puna and Arjan came in almost skeletons : these two together gained 84 lbs. 4 ozs. Would these have gained so much by the gradual method ? I think not. Fourteen gained 14 lbs. and over. Could the gradual method ensure this ? I think not. Taking some 50 prisoners, could the gradual method ensure their gaining on an average in the above period what is herein stated ? I think not. This represents so much energy saved with increased productiveness. Could the gradual method make sure that the energy of the prisoners would be increased ? I think not. The following statement shows the cast they belonged to : most were of the Mahomedan faith. 17 Mahomedans 10 Brahmins, religious beggars, writers 10 Lower castes 9 Cultivators Rajpoot, Lodhis, silversmiths & shopkeepers 9 of In Narsingpur representatives every caste go to the madak Bhop with the exception of the Kostahs, a class among weavers. The following are brief notes made. When these were recorded I had no idea of publishing them, or else I should have made them more complete. Humped-back Kalanshah, sentence 15 days' hard labour, previously a Hindoo, but now a Mahomedan ; by profession a beggar : extremely addicted to the madak pipe. To describe him, he was a frightfully emaciated object scarcely able to get about, with chronic disease to judge from clubbed finger nails, cough and weezy respiration : skin shrivelled, bowels loose and anorexia extreme. This worthy was on his third visit to jail. With reference to dieting him, sweetmeats ho was very fond of. Unaccustomed to eat mutton broth, as milk disagreed with him no doubt he suffered a good deal ; pulse averaged S6. 9th day respiration visibly improved. Skin perspired naturally, and he appeared relieved, spirits were better ; bowels moved gradually less frequently : four days before release they were moved only twice. No hyperpyrexia. He was provided with a thick blanket and allowed to move freely about, not confining himself to regulation bed ?, baths were almost daily administered. These were very reviving, and his appetite began to show signs of improvement. Before discharge from jail he walked about. I am told that on the day he was released from jail he went to the madak shop. This opium-eater and smoker had of distress of a mental nature. I think it a good deal would be a great thing if the State established restrainfor such as these analogous to those which have ing houses been set on foot with considerable success for dypsomaniacs in Europe. The Government of India derived upwards of Rs. 35,000 from the sale of opium in this district last yea^, and the sale is on the increase ; about 13 per cent more than in the previous year has resulted from sale3. To the Editor of the

Sir,?Does stopping opium at

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mention this case to show that those under short sentence can have this treatment without endangering their lives. The next case is a prisoner with a long sentence. Ohunderband Gosain alias Din Mahomed Jakri, an emaciated toothless old man, formerly a Hindoo beggar ; several times previously convicted: sentence 12 months' rigorous imprisonment : scarcely able to walk ; .accustomed to smoke pipes of madak all day long. Chiefly suffered from mental distress. This almost amounted to mania ; insomnia, looseness of bowels : at lirst vomiting and extreme anorexia. After Given some days bowels became natural : average pulse 59. daily baths. These appeared most invigorating, and had a dilute very tonic effect, with sulphuric .acid and tonic medicine, and conji as a diet. At first he hated the mention of his and food, conji out of his mouth. Being repeatedly spat unfit to work for some days, he lay about wrapped up in his blanket. After ten days he became more reconciled to his sentence and gained his spirits. As soon as the stomach was able to take food, he rapidly progre.-sed and gradually did work. He became quite stout, and in a few months increased 27 lbs. in weight. For some days he was quite inconsolable, but by firm, steady treatment he comparatively quickly came out of his suffering. He is now I think one of the most grateful patients possible. This I believe is a very satisfactory case, and one which shows that in about 20 days a confirmed opium-eater can be placed in comparative comfort and free from all

suffering. It might

be said that this was hard treatment, and that I to have gone to the expense of having a temporary madak shop for him inside the jail and so let him gradually smoke himself free. This would have taken two months or longer, and I believe the plan would have caused him in the end more pain. 1 believe my plan is the same as is pursued in the case of alcoholic poisoning, and is the more rational one, and less endangers life and entails little or no expense ; besides it keeps an indulgence from a prisoner which I believe it was never intend d he should have, and the digestion is so much more quickly restored, and, as I have already said, the sudden stoppage gives in my opinion in the end less pain. I think the suffering these voluntarily inflict upon themselves is very great, but they accustom themselves to this. I believe also there is no possibility of gauging the relative amount of pain in each method. Whether the sharp and severe pain is more bearable than the prolonged and dull, is a question which cannot be easily answered. We know that in physics to compare any two quantities a unit has first to both can be measured and their be fixed upon by which quantitative relations clearly expressed. I should now like to ask if any such unit of comparison has been fixed which we can apply respectively to acute and short pain and prolonged and mild pain, and by applying which we can definitey state that in any given case or cases the one is greater or less than the other. Does it endanger life ? I believe not, but on the contrary am of opinion that it is the only reliable means of rescuing life which has been ebbing away. The two cases here related were advanced opium-eaters and smokers, perhaps I have had many of these with as bad as can be found. their faces bearing the marks of frightful chiseling and their bodies atrophied and dried up. The poisoned blood got rid of by diarrhoea I understand improves the vital fluid. If the blood is improved then life cannot be endangered. I understand opium to be a foreign substance checking and stopping in the body the secretions. My cases do not illustrate any tendency in this direction of endangering life from the sudden stoppage. The vital powers do not sink. I have never seen a case of fainting among these. The heart acting preternaturally slowly on deprivation becomes quickened and strengthened, and the lungs returning to the normal state respire more. A demand is created in the system and greater life results. The mental distress, amounting sometimes to regular mania, does not endanger life. There is a general absence of a febrile state of the body. The diarrhoea appears usually of one color, brown, does not produce inordinate exhaustion. This seems to be part of the means by which the relief is brought

ought

90

THE INDIAN MEDICAL GAZETTE.

I have never seen these suffering from shock. The is strengthened by the deprivation. Although weak, they do not lift their legs and arms in that languid way so synonymous with great disease. The lungs especially of smokers are much benefited ; the blood is more changed and vitalized. This acts on tlie stomach which at first has the appetite nil, then this becomes capricious and gradually is re-established to normal. Then great hunger comes. This is the time to compare the Patient comfortable, willing to work with two methods. energy, enjoying his food and a refreshing night's rest after his labor. His sleep comes from his being wholesomely tired, and so refreshing that he has not had the like for years. He gets much happiness. He can scarcely tell his joys, feeling himself no longer a miserable slave. The length of time required to wean such as Chunderbaud would be very long by the gradual method. Say he had one grain daily decreased, this would take about 70 days with the opium he eat besides. If we consider the effect of J 41 minims of laudanum which is equal to one grain of solid opium, we will find that the diminution of one grain daily is a good deal. The method would cause Chunderbarid to be suffering 50 days beyond the time it takes by my method. I should like to know the amount of pain, loss of energy these 50 days represent ? If this is considered for a moment, I think it will be seen that the suffering must be considerable which lias been saved by the sudden method. The excellent results which follow the one plan and not the other, appear to me striking. Patient thankful and rapidly gaining flesh, against patient miserable and looking for his daily dose. Opium smoking and eating is often a sad debilitating luxury much in the same light as alcohol drinking is. The depression on the system caused by alcohol is considered by some very great. In England and other countries we do not hear in jail of convicts getting gradually weaned of their liquor. I wonder what some Justices of the Peace in England would think of the proceeding. On the contrary we know that it is stopped at once and that they have to suffer much. There is no consideration shown in this direction to jail drunkards. We know that alcohol can be stopped at once with benefit; and apparently we have to learn the Is not opium as foreign same thing with reference to opium. to the system as alcohol ? and if so, why should it not be treated accordingly 1 On some future occasion I hope to have the opportunity of continuing these remarks in the Indian Medical Gazette. In the meantime I trust the records of valuable experience will continue to flow into your valuable journal from native physicians and surgeons enlightening us much as regards the subject of the treatment of opium-eaters. I have the honor to be,

about.

body

Sir,

Narsinrjpur,

Your most obedient servant, Thomas Mayne, Civil Surgeon. 8th October 1880.

[March

I, 1881

Treatment of Opium-Eaters.

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