Chronic opium-poisoning, resulting from the habitual use of opium, its most active constituent morphine, or its salts, is undoubtedly one of the most pernicious habits to which the human body can be subjected, its mental, moral, and physical phenomena being among the saddest and most terrible known to therapeutics.

The conditions inducing the opium habit are frequently caused, or are largely influenced, by the therapeutic employment of the drug - as was the case with De Quincey, whose graphic analysis of the Pleasures and Pains of opium, if possibly to be taken cum grano salis, is at once the most powerful and the most eloquent ever written. The patient who has once experienced the anodyne influence of the drug - as captivating to his senses as though it were a draught of the fabled Lethe - readily yields to it upon the slightest occasion, as, for instance, to alleviate trivial indispositions for which, in ordinary circumstances, he would ridicule the idea of medical treatment. With repeated indulgence - often promoted by a casuistic reasoning of which by degrees the subject is scarcely conscious, or by persistent and intentional deception - comes the craving which knows no restraint, and which can be quieted only by complete mental and physical regeneration or the merciful release of death.

The symptomatology observed in the chronic habitues varies considerably. Many people take opium or morphine for many years without showing many evil effects. Beyond a marked grade of peculiar anemia, often skilfully hidden by women, and certain eccentricities of behavior, even the trained observer may not be able to detect even the confirmed habitue, especially when such is found under good hygienic and social conditions. These high-grade habitues often live a sweet-do-nothing existence, their habit constituting one of the family skeletons.

In the more abject phases severe anemia, with marked pallor, extreme emaciation, and greatly depreciated physical, mental, and ethical powers are characteristic.

During the life history of practically every habitue attempts are made to overcome the habit. The discontinuance of the drug invariably brings on a series of abstention or withdrawal symptoms characterized mainly by stages of vasomotor paresis. Thus, diarrhea with marked painful peristalsis, running from the nose and eyes, intense neuralgic pains, and a most distressing restlessness are very constant. If the patient can fight it out for thirty-six to seventy-two hours these symptoms abate, and there is hope for a cure, temporary at least.

In the treatment of this condition much can be accomplished from the purely personal side. Treatment is usually best carried out in a trustworthy sanitarium, where a reliable trained nurse should be in constant attendance. This surveillance should be continued long after the drug has been discontinued and the cessation of active treatment. A morphine habitue is by no means cured when the drug is discontinued. The general outline will consist of substituted sensations, substituted ideas, and general tonic and supportive treatment. To accomplish the former purpose, after almost complete withdrawal of the drug has been brought about, codeine, heroin, dionin, hyoscine may be used to create a sense of euphoria, which differs in some respects from the old euphoria of the drug. One of the best hypnotics is a combination of sulphonal with a vegetable neurotic like conium or hyoscyamus. The bromide salts in large doses may be employed. The morphine user is always a victim of toxemia from arrested functions of the kidneys, liver, and adrenals, and intestinal antiseptics, laxatives, and cathartics are a necessary part of the treatment. Hydrotherapy properly employed is invaluable. Static electricity or electric baths are of great value in some cases, but not in all. The immediate surroundings of the patient should be made as pleasing as possible. Food and medicine should be given in the most agreeable forms consistent with usefulness, and the same kind of attention paid to every method of treatment employed.

Suggestion is a potent factor in the treatment of morphinism, and the physician should employ it constantly and encourage his patient in every possible way. After the withdrawal of the morphine, the treatment should combine nerve and mental rest, tonics, diversion, and, by all means, elimination, suggestion, encouragement, and close surveillance for some months. An excellent tonic and supportive drug during the withdrawal of morphine is strychnine nitrate in small doses frequently repeated (gr. 1/200), so as to secure a cumulative effect.

The treatment of so dire a malady - for such the chronic use of opium must be regarded - demands the utmost forethought, patience, and tact. The method of sudden, absolute withdrawal of the drug is admitted by the wisest observers to be fraught with danger commensurate with that of the indulgence to be overcome. Collapse, delirium, and other serious results have attended so drastic a measure, the general opinion obtaining to-day being that a gradually reduced dose of the drug is the safest and most rational mode of procedure. The conditions are extremely difficult to combat successfully, repeated hypodermic injections being eradicated from the system far less readily than opium from the stomach. The moral nature of the patient, too, has become so perverted that little or no reliance can be reposed in his veracity, the physician being thrown upon his unaided resources, supplemented by the untiring vigilance and fidelity of the attendant.

The gravity of the situation should from the first be fully realized, since it is too often simply a case of life or death, the patient being not infrequently seized with the desire of self-destruction in the extremity of mental anguish occasioned by the ordeal imposed by unwonted abstinence. Could he be put upon his honor, and that honor be steadfast, his co-operation would be invaluable. But this assistance is seldom at command, the patient's loyalty of purpose and unswerving resolution, as professed, being wholly subservient to a volition long since weakened, if not annihilated, by pitiful sophistries and moral degradation. Nevertheless, the case must be approached from the sympathetic side, and every means of inspiring confidence employed, remembering that a human will, as well as body, is under treatment, and that mental sanity, as well as physiological health, is to be restored.