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B 103
[ApPENDIX LXXI.-Contd.
The second of the conditions insisted on is directed against the drug
laddiction. There are few smokers who have' not, at some time or other,
land, certainly from circumstances over which they had no control, passed
the usual hour of their indulgence and experienced the effects of its
deprivation. There remains' in their memory a vivid recollection of their
'sensations then and a dread of their recurrence, and a doubt if they can be
obviated by any means.
, The reason for complete annulment of the effects of the deprivation is
to remove that doubt. Once he knows that the matter is wholly in his hands,
the rest is easy and, by gradually lessening his dose he can eradicate the
'habit within one, rarely, two months. It is better to over-annul than
otherwise, the only effect being a headache and some giddiness.
After much experimentation the drug I now exclusively use is Morphine.
,The chandu sold in these colonies has a fairly high morphine content
(probably in the vicinity of 121 per cent) and I begin by giving ha1£-agrain
of morphine hydrochlorate by the mouth for every chi smoked. . I
find that the effects vary a little but that is due to the fact already
·mentioned that some smokers obtain more from their chandu than others.
The dose can be increased or diminished at will. It is best given in pill
form and the pill made of a fair size to permit of gradual morcellement.
Many refinements can be incorporated in the. treatment as there are frequently
minor ailments requiring attention which can be efficiently treated at the
same time.
The full dose is taken for about a week and then steadily diminished.
Relapses do occur, but not many, and I generally find that, in the meantime,
the individual has been to China and has re-acquired the habit .. Success
with women is small. They do not seem to have the strength of will to
give up the pipe habit, even after complete annulment of the drug element.
As would be expected from the gradual emaciation which follows the
smoking of opium, one of the first effects is an increase of bodily weight
even while treatment is in progress and. this increase may go on to actual
obesity.
Excess.-
Stigmata of excess were found in 59 of my series and the amounts
required to produce these are set out in Table 6.
The only constant and reliable sign of excess is the "facies" which is
as distinctive as is the "kidney face" of chronic renal disease. There is
a deposit of black pigment at the muco-cutaneous junctions of the mouth,
nose and eyes, most marked in the last situation so that sometimes the eyelids
seem as if touched with "kohl". There is also a darkening of the irides so
that the small pupil is difficult to distinguish. In the fairer northern races
of Chinese the skin assumes a dull earthy pallor but in the darker southern
races, especially if employed out-of-doors, there is a bronzing of the skin.
Lividity is generally, I might say always, present with a rapid heart action,
A loose phlegmy cough, most prominent just before the time of smoking,
is present and there is a. red scorched condition of the soft palate not
extending forward to the hard palate. Pyo-alveolitis was very common.
The cc.ndition of nutrition was variable. I have on my list several persons
who are fat, even corpulent, and who are consuming one tahil daily. But
these are the great exception, and leanness, amounting to emaciation, is the
rule especially in those who have taken to "compromise" methods of using,
opium and still more evident in those who only swallow.