I therefore permit Mr. Edgerton, as soon as his stomach will bear it, to return to the use of opium.
But before giving him his dose I make the stipulation that from this moment he shall deal as frankly with me as he does with his own consciousness--that we shall have no opium secrets apart.
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.