AVENA SATIVA, '■the. Treatment of OPIUM ADDICTION. A Therapeutical Fraud, a Delusion and a Snare. BY J. B. MATTISON, M. D., BROOKLYN, N. Y. REPRINT: Medical Bulletin, October, 1885. AYENA SATIYA IN THE TREATMENT OF OPIUM ADDICTION. A THERAPEUTICAL FRAUD, A DELUSION AND A SNARE. BY J. B. MATTISON, M. D. BROOKLYN, N. Y. A T the annual meeting of the New York State Medi- cal Society, in February, 1882, Dr. Sell, of New York City, presented a paper on the treatment of opium addiction by a tincture prepared from oats, asserting it “ the very best remedy in the distressful, and, in many cases, hopeless malady of the opium or morphine habit,” and expressing his belief that “ he had not lived in vain were he to have accomplished nothing else in life than to have discovered that the avena sativa is a cure for the opium habit.” As was to be expected, a claim so remarkable, made under the auspices of aucli an organization, attracted attention, and when was added to this the business enter- prise of the drug-tirm manufacturing the article in ques- tion, who, by an extensive distribution of reprints of the paper mentioned, doubtless secured for it the notice of many physicians, we shall at once appreciate the im- portance of evidence that will tend to confirm or refute the claim presented. Dr. Sell’s paper has been repeatedly criticised, pro- fessionally, for the loose manner in which his cases were observed and recorded. Four were cited. In. the first, 2 it is admitted “ the patient was not cured.” As to the second, evidence from a reliable medical gentleman was not lacking that, despite the patient’s denial, the opiate was continued in a different form. In another, the at- tending physician, after a recital of the varied and futile efforts of his patient to obtain relief at the hands of sev- eral charlatans, wrote that, despite the use of the avena, “ he has paroxysms of weakness, which he himself ex- presses as an entire goneness, and an unearthly feeling and restlessness at night. At such times he resorts to morphine.” (Italics ours.) “If you could suggest any- thing to aid in overcoming them the victory would be ours. Should we succeed, it will be the greatest victory yet obtained.” Not the slightest evidence is afterward offered that the “ greatest, victory” was ever secured ! On the contrary, the medical attendant in this case wrote to us as follows : “ The person to whom you refer, and ot whom Dr. Sell spoke in his pamphlet, started on a visit just as his case was making every indication of yielding to the treatment he was receiving at my hands.” The “ indications” referred to consisted simply in the morphia reduction, after a time not stated, to one quarter his original daily taking! And this result—which is not uncommon from simple, gradual decreasing, apart from any medication—was not due to avena alone, for the Doc- tor expressly states, “ I used the avena and coca alter- nately. Gave the avena through the day and coca at night. Sometimes I combined the two.” “ I gave of the avena from one-half to an ounce at a dose, and about the same of coca. The coca—fid. ext.—appeared to over- come the great prostration and lassitude of which he complained when not taking it.” In the fourth, of which the details as to treatment are very meagre, it was asserted that the patient, who had used morphia for twenty years, reaching 32 grains per 3 diem, was treated with the avena, and had used no mor- phine since she began the tincture, “ except for the first two weeks, when she occasionally took small amounts to relieve extreme distress.” The patient’s condition during “ those two weeks” is left to conjecture. Is it not likely that they were pain- fully eventful weeks to her—as to another patient, whose case will be cited later—for the words “ extreme distress,” and the repeated need of morphia, are very sig- nificant, and probably are the essence of what was the true cause of success ; that is to say, it was, practically, a case of abrupt opiate withdrawal, uninfluenced by avena; hence the “ extreme distress,” to relieve which morphia was repeatedly taken. Now, it must be conceded, we think, that these cases present very slender support on which to rest one’s claim to posthumous fame, fie must be a modest man, indeed, who is willing to have his name go down to posterity as a public benefactor—one who “ has not lived in vain”— with no stronger proof of his alleged benefactions than the history of these cases afford! The first was an ad- mitted failure; the success of the second was disputed ; the hoped-for result of the third was never reached; and the fourth gave striking evidence of being a case in which the good result was secured by enforced abstention, giving rise to intense reflex irritation, continuing a fort- night, and, despite avena, requiring repeated doses of morphia! Of what scientific value are they ? And what a palpable absurdity to vaunt the virtue of any remedy on such evidence as this! So much for the supposed direct testimony to the value of avena. Now for evidence of a somewhat different order, though quite as direct. Subsequent to the reading of the paper containing these cases, Dr. Sell wrote more at length on avena, 4 which, with the original article, appeared in the reprint to which we have alluded. This addition, while lauding sativa in the treatment of various disorders, presented copies of letters from a number of physicians commend- ing it, and, among them, several who claimed to have used it with success in the treatment of opium addiction. To each of the latter we sent a request lor information in detail, and inclosed the following queries as to the habitues treated by avena. Sex ? Age? Cause of addiction ? Form of addiction ? Duration of addiction ? Amount per diem ? Dose of avena ? liow often daily? IIow long continued ? Was avena only used ? If other remedies, what ? Was opiate suddenly or gradually abandoned ? If gradual, how long in withdrawing? What proof was given of entire opium quitting ? AVas any examination of urine made to determine ab- sence of morphia ? From all these replies were received, and we invite attention to the contrast between the original letters—in reprint—and those in answer to us. Dr. A. wrote : “lam giving the cone, tinct. avena sativa for the morphia habit, and I find it will cure, I believe, all cases, no matter how long they have been the slave of this opium monster. I think this is the greatest discovery of our age.” His reply to our request, was : “ I felt sure of avena being the long looked-for cure for the opium habit, but 5 find that all the cases that I treated have used opium, in some form, all the time I was treating them, and positively declared that they were cured and dis- charged as sound. All is failure with me so far.’’ Dr. B. : “The cone, tinct. avena sativa worked to a charm in the morphia habit. Having tried cannabis indica, Jamaica dogwood, coca, etc., in this case, I am so well satisfied with the avena that I intend, to try it next time I have a case of the kind.” In answer to us, he said : “ In reply to yours of 20th inst., would say that no categorical reply is necessary. I sent for a bottle of avena, and thought my patient was receiving great benefit from it. In ordering the second bottle I used the words which B. K. & Co. quote. I had no idea that my words would be so used, and am sorry, as the avena, aside from being a pleasant stimulant and slightly nervine, is, I think, nearly inert. Now, I am stating the whole thing freely for your benefit. Ver- bum, sap!" Dr. 0.-: “ I have been experimenting with the cone, tinct. avena sativa with favorable effects in the opium habit.” To us he wrote: “In my first attempt I was quite sanguine that the avena alone was to become a most valuable remedy,—almost equal to what has been claimed for it. To my great regret I soon found my cherished hopes unrealized ; that my patients would not endure the suffering ; therefore, they had stealthily again returned to their old friend (?) for relief.” Dr. D.: “I am also using it, avena, in a case addicted to the use of opium, and find that it enables the patient to do with half the quantity of the opium that he used before.” Answering us, he said: “ As you will see by referring to the questions propounded to me, the answers are not 6 very satisfactory. The patient did not use the avena more than a month, and did not stop the use of opium at all. I do not believe it would support the nervous system, and prevent that terrible aching and nervous prostration caused by the entire abstinence from opium.” Dr. E. : “I have tried a small amount of the cone, tinct. avena sativa, and am more than'pleased with it in the opium habit. A bad case of' the opium habit is doing everything that could be expected.” In reply to our letter he mentioned three patiojits who had used avena, but not one had quit opiumif! “ The severe 'pain called for some anodyne,” and resort, was again had to the opiate ! Dr. F. wrote: “The cone, tinct. avena sativa has been more successful in the treatment of the opium habit than anything I have ever tried, and I have tried various other remedies, amongst them the advertised nostrums.” After repeated effort to elicit further information from Dr. F., he replied that the patient to whom he referred had re- cently died, but the habitual opiate had not been aban- doned / Here are eight cases advanced in support of avena, and yet, on thorough trial, in every instance it proved a failure ! But let us examine other cases. Dr. G. narrates this extraordinary instance : Patient had been a habitue three years, taking from 15 to 30 grains of morphia, by the mouth, daily. The narrator says: “I obtained the avena and prescribed it in 15-drop doses whenever he felt the need of morphine, which was four times a day, and for two nights I gave him about a one-fourth grain of morphia, when he said he could do without it. Thus he left off taking morphine, and he has never taken an- other dose of it. The first night without morphine he slept reasonably well, and each succeeding night better, 7 until five nights, when he slept well. All this time he rested very well,” etc. Now this is a most astounding statement. That any one taking 15 to 30 grains of morphia, daily for three years, should quit all at once,—for, practically, this is what is claimed, inasmuch as only two one-quarter-grain doses, twenty-four hours apart, were given,—sleep well every night, have no reflex disturbance, “ all the time resting very well,” is quite beyond our credence. Per- sonal experience, covering many cases, has never afforded a like instance, nor has our reading ever furnished one. This stands unique and alone, an unparalleled case, or a great deception. Dr. II. was the attending physician of Miss , who asserted that she used opium twrenty years and was cured by avena. In response to our request, he courteously gave us details of her case. The dose of avena was “from 15 to 25 drops three or four times a day.” It was con- tinued “ in all seven months.” “ Was avena only used “ No ; other remedies. For first two or three weeks occasionally gave some nervine, as potass, brom., valerian, castor, etc. At bed- time, on the fourth or fifth day, gave 15 grains chloral with brom. potass. Used tonics and stimulants, iron, quinine, carbonate ammonia, and brandy. After di- arrhoea ceased did not use brandy, but gave tonics in some form for two months.” We shall again refer to this somewhat remarkable therapeutical exhibit. The Doctor further wrote : “ I saw her several times a day. For a long time it was a desperate fight. She had several attacks of diarrhoea ; also, two or three severe attacks of pain in the bowels; at those times I gave a small amount of opium with other remedies.” Desiring further testimony,the writer not long since ad- dressed Dr. Sell, requesting the names of those who had 8 used oats in this disorder, and received a list, all of which with one exception, to which we shall refer, were in the reprint mentioned, consequently we gained little addition- al information. Having his assurance that “should the above number not suffice for your purpose, more can he furnished,” we again wrote him to which he replied, but failed to mention any other, and referred us to the manu- facturers. To them we wrote and received a printed slip, having an added testimonial, of which more later. Dr. II., the additional party named by Dr. Sell, gave us the following case. Patient five years addicted to mor- phia, 15 grains per diem. Was treated by avena, 15 to 20 minims three to four times daily, and continued “ about a year.” The opiate decrease extended through “ three months.” The renal secretion was not examined for morphia, and the proof of opiate quieting was “hus- band’s word and payment of account.” In explanation of the latter, it may be stated that treatment was begun on the principle of “ no cure, no pay,” and the fact that “ the bill has been paid, and the husband says she has no desire for morphia,” was the evidence of cure. Dr. K. the gentlemen named by the makers of avena, reported, in request to our inquiry, as follows : Mrs. , set. 60, two years addiction ; morphia by mouth, and on ulcer; amount “not less than two grains a day.” Was treated by “avena in 10-drop doses in hot water three times daily, and 15 drops at night in cold water.” It was continued “three months nearly.” As to other rem- edies, “ some potass, broin. early in connection with the case,” and “ she got about a pint of whiskey.” As a re- sult of the avenal medication, “she complained so of her bones aching that I suspected syphilitic complication, and gave potass, iodid., and she complained of sore throat, and I withheld that and gave the avena and constitutional remedies,—as quinine, iron, etc.” Having this therapeu- 9 tical insight of the case, let ns note progress. (Italics ours.) The opiate quitting was abrupt. “ After the morphia was withdrawn, I was obliged to call and see her sometimes five and six times a day. She would be 'per- fectly frantic, and at times I almost relented, and thought of returning to the morphia. She complained so of her bones aching, etc. Only once when she was raving did I give her a dose of morphia. For several days after taking away the morphia she did not sleep until near four or five o’clock in the morning, and then from exhaustion, from crying and beating and pound- ing her arms and legs /” Dr. L. reported two cases treated by avena—females, set. 39 and 65. In reply to our request for details he wrote that in the first case the nervous disturbance follow- ing the withdrawal was “very marked the first ten days,” sleeplessness “for the first two weeks,” and diarrhoea per- sisting “ for three weeks.” In the second patient, the reflex irritation continued “ for two weeks,” the insomnia “ the first two weeks,” and the “diarrhoea for three or four weeks.” In each instance, the morphia was gradually withdrawn, and yet, despite avena, there were “ very marked ” nervous irritation, insomnia, and diarrhoea per- sisting from ten days to four weeks. Dr. M., dentist reported his own case as follows : Ten months addiction reaching a maximum of 18 grains daily by mouth. “ Stopped at once; commenced taking avena in 40-drop doses, and for the first ten days took six or seven doses a day. At the end of a fortnight,. “ eat heartily ; slept last night at least four or five hours.” “ Feel sanguine am not going back to morphia.” Now as to the truth and consequent value of the above record, we submit testimony from two reputable medical men, who were cognizant of the case, and courteously gave us the following details. Dr. wrote, “ I think 10 I saw him for a period of two or three weeks, almost daily, but after the period mentioned he ceased to visit my office, and I learned, indirectly, that he had returned to his old habit. lie became a frequent visitor of , in our village, and I have reason to believe procured mor- phia, and on the twenty-fifth of February, 1883, was found in the office of in an unconscious condition, and soon died, doubtless from over-narcotism.” At “ an inquest on his body, February 2Gth, it appeared from the evidence offered, that for several days he had been drinking hard, and had taken enormous doses of potass, brotn., chloral, and morphia.” Dr. wrote : “ Some time between December 20th and 25th, 1882”—this, be it noted, was when, as asserted, the morphia had been abandoned—“ he came to my office. Said he had been kept awake all night with neu- ralgia in his shoulder, and wanted a hypodermic of mor- phia. From his general appearance 1 became suspicious that he had used opium, but gave him the hypodermic. Next morning he returned and wished another. This I insisted on inserting, and found both of his arms, from shoulder to very near the wrist, were completely pitted with punctures, some of them fresh, also marks of former numerous abscesses. I refused to give him any more mor- phia. His condition was about the same from his first com- ing to my office, till within say a week of his death. On February 24th the day prior to his death he came to my office in an awful condition. Said ‘ he had lived for a week on morphia, chloral, and broin. potass., and that the narcotics had no influence on him now.’ I took from him a bottle, one-eighth ounce, quarter full of mor- phia, and about one half-ounce of chloral. Said ‘ he had been taking morphia for years.’” The next morning he again applied for an opiate, was refused ; went to another physician’s office, and in a few hours was dead. 11 So much for the history of this case, to which we have referred somewhat at length, simply to show its ab- solute worthlessness, as regards the fact of cure and value of avena. From a number of correspondents—medical men—who had used sativa in hope of effecting release from opium, to which, unfortunately, they had become addicted, the following testimony was elicted : I)r. N. : “I could not see as it had very much effect in my own case, although I took it quite a long time. As an antidote to the opium habit, I think it is of little ac- count. Dr. P.: “in the few instances in which 1 have tried it, the effect has been disappointing • the result being either nil, or decidedly unfavorable. As a specific for the ‘ opium habit’ I don’t believe it will ever win any great or lasting triumph.” Dr. R.: “I had a quantity of avena made by Dr. Keith, I think, understanding his was the best, and upon taking it I could not see that it had a particle of effect of any sort—good, bad or indifferent—no more than so much water.” Dr. S. : Had used avena sativa in his own case, in- creasing the dose to one ounce, and might as well have taken so much water.” Dr. T. reported the case of a relative who “took two and a half pounds of it, but could not get below one grain daily, and miss two or three days morphia; but took one ounce doses five or six times a day then.” We have here the record of twenty-four cases of opium addiction treated by avena. Nineteen of them were ad- vanced by Dr. Sell, or Keith & Co., to prove its value. Let us examine these somewhat in detail. Case I.—An admitted failure. Case II.—Cure disputed by a reputable medical man. 12 Case III.—Not a success, and even the partial result mainly due to coca. Case. IV.—Indisputable evidence of being one treated by abrupt withdrawal,followed by the “ extreme distress'’ sequelae of that method, unmodified by sativa. How ridiculous to vaunt the virtue of sativa on such proof as this ! Then follows the record of eight cases, every one of which was a failure. And yet Dr. Sell, Keith & Co., “ rush into print” with the claim that they attest the value of avena! What a farce! We are not largely gifted in legal lore, yet we hazard little in thinking that wrere a claimant to present himself in chambers with such evi- dence as this, he would be speedily nonsuited—thrown out of court on the cross-examination of his own wit- nesses. Case XIII.—W e venture to assert this a gross deception, and to any one familiar with the history of an honest opiate quitting, this assertion will at once commend itself. We do not impugn the veracity of Dr. G—he may have had full faith in his patient—but there wTas duplic- ity somewdiere, and in this connection we are reminded of a case cited by a physician in the Med. and Surg. Reporter, February 3, 1883, in which a young man ad- dicted to morphia, two or three drachms per week, for more than two years, “stopped it at once, without any inconvenience, or the ill effects so usually experienced from its use. Had no effect on him preceivable. Says he feels as well as ever he did in his life, and lias from the day he stopped. Feeling convinced that the fellow was lying, w'e wrote Dr. , expressing our entire disbelief in his patient’s story, and asked for details. No reply was given. Later, however, came the sequel to this Munchausen tale. A medical gentleman addicted to morphia who had recover- 13 ed under our care, wrote to Dr. , expressing an opin- ion similar to ours, and received in answer, “ Undoubted- ly you are correct. I was never more deceived in humanity than I was in this case. I could have taken the young man’s word as far as most men’s oaths, but he deceived me, for I have taken pains to learn since that he is procuring the drug from another scource.” Case XIV.—This case is somewhat striking, and, as tending to prove the value of avena, worthless. The number and variety of remedies given have, doubtless, been noted, and we fail to see how it is possible to select sativa from the half-score or more of other drugs, as the one entitled to credit. Besides, the history of “ a desper- ate tight,” “several attacks of diarrhoea,” the need for repeated doses of opium, for “ carbonate of ammonia and brandy,” are all proofs of marked nervous irritation and exhaustion, for the relief of which sativa seemingly was nearly or quite inert. We do not question recovery, but we dissent in toto from the opinion that it was brought about alone by avena. Case XV.—The fact of cure is not disputed. If, however, it be remembered that the decreasing process continued “ three months,” and that the avena was given “about a year,” it will at once be apparent that the element of time—the vis med. naturoe—was a potent factor, probably, in view of the little effect from oats in other cases, the most so in bringing about a good result. Case XVI.—We invite renewed attention to this his- tory. Closing his case, Dr. K., asserted, “ It was an aggra- vated case of opium habit cured by avena.” To both these conclusions we must demur. Two years morphia- taking, two grains daily, by mouth, or on ulcer, scarcely makes an “aggravated case. ”Nor was it cured by sativa. In his published report, Dr. K.’s statement is, “ shut off the morphia, and ordered the con. tinct. avena sativa. 14 After three week’s use of same she sleeps well.” Very good, but what about those “three weeks?” What the patient’s condition during that time? In this report, which with others has been given such wide currency by the makers of avena, one is left to infer that, with no other treatment, this patient went satisfactorily on to re- covery. Now we respectfully submit, that, in view of the facts we have presented, this statement is grossly misleading, not wittingly, doubtless, but nevertheless misleading, for really during those twenty-one days she was bearing the torture of abrupt withdrawal. Setting aside all reference to “ brom. potass., whiskey, and con- stitutional remedies, such as iron, quinine, etc.,” that wore used, the history of this case, on the medical attendant’s own evidence, proves conclusively that it was one of enforced obstention, entire and abrupt, not controlled by avena, since it was followed by symptoms which the sativa, were it so effective, would have lessened or prevented. Clear- ly it did not, else the gentleman would have been spared the recital of his patient’s suffering. The Doctor’s trust- ful confidence in avena, while day after day, through week after week, the poor woman struggled on, actually insane from her agony—“ raving,” “ frantic,” “exhaust- ed from crying and beating and pounding her arms and legs”—is quite touching, but it must have been a trying time for the said patient. Cases XVII. and XVIII. have already been com- mented on. Case XIX.—No comment on this case is needed, other than to call attention to the utter untrustworthiness of the self-asserted history, and the positive proof that the opiate was not abandoned. Cases XX., XXL, XXII., XXIII., XXIV.-The tes- timony of these medical gentlemen is positive and direct. No other comment is called for. 15 To recapitulate: Of these twenty-four cases fifteen were admitted failures. (One), Case XIX.—Patient did not recover. (One), Case II.—Recovery was disputed, (One), Case XIII.—Is quite beyond credence. (One), Case XY.—Time and vis med. natures probably the factors in cure. (One), Case XIY.—Ten or more remedies being used, it is absorb to elect avena. (Two), Cases XYII. and XYIII:--Gradual withdrawal, despite which and sativa, marked nervous disturbance from ten to forty days. (Two), Cases IY. and XYI.—Abrupt withdrawal, with intense reflex irritation, unaverted by avena. In connection with the last four cases, an extract from another pamphlet lately gotten out by Keith & Co., in which they still laud avena, is of interest. Speaking of removing an habitual opiate under the use of sativa, they say, “ That the above can be done without much derange- ment is impossible /” Quite true, as the record of these four cases well attest. In only six of the twenty-four cases cited will we admit a cure; and in those six we assert—and of this as- sertion we invite any honest criticism—that avena was not the main factor in success. It is now nearly thirteen years since our first case of opium addiction. In the interim our professional atten- tion has been largely, and, of late years, exclusively devoted to its treatment. Such being the case, it has been our aim to avail ourself of any and every aid tend- ing to advance its therapeutics. In this effort avena has not been omitted, and our experience with it can be tersely stated. We have given it again and again, in doses large and small, in water hot and cold, at inter- vals short and long ’ have prescribed it day after day y 16 have known it taken, and the symptoms of opium abstinence steadily increase, until it was cruel to insist on f urther taking • have given the dose advised, and, doubling every half hour, increased it to one ounce, and have always found it worthless—absolutely good for nothing. Let it be distinctly understood that what we have written is germane only to the use of avena in opium ad- diction. Its value in other disorders does not here concern us, nor is it disputed. In the pamphlet last mentioned, it is asserted : “As an antidote for the opium and morphia habit, it has been proven without an equal; for, by its action, the physician lias been enabled to furnish such stimulation and tonic effect to the nervous system of the opium-taker as was necessary.” The truth of both these statements we emphatically deny, and in support of our denial offer the evidence we have recorded. As a stroke of business stategy, the enterprise of its venders, !n so widely and persistently vaunting its virture, may entitle them to credit, but, as tending to advance the interest of scientific medicine and the well-being of those so in need of true relief, it seems to us open to scathing criticism. In view of what we have written, is it not time to prick this bubble, and are we not warranted in asserting it— albeit the language seem somewhat intemperate—“ A therapeutical fraud, a -delusion, and a snare ?” 314 State Street.