The following comprises general suggestions for the solution of the problem of chronic opium intoxication taken from reports of com-mittees, original papers, and medical editorials.
American Medicine-1915.1
"The management of drug addiction is not a police or a penological problem. On the contrary it is a medical prolalem purely and exclusively. The drug addict is sick, with a pathology as definite as that of any other toxic disorder. This is the great fundamental fact concerning drug addiction and when the medi-cal profession realizes it, the solution of the drug addiction problem will be over half solved.
"Unfortunately, the afflictions of the drug addict have made him a ehining mark for unscrupulous individuals and the dishonest and underhanded methods to which he has been subjected have been encountered not infrequently where least suspected. Some day the whole sordid story of 'The Exploitation of the Drug Addict' will be written, and a good many things will then be known that are not known now. It will make interesting reading, and be a revelation in the ways and means of unscrupulous drug habit specialists, and 'the gentle art of fleecing patients' or 'the painless removal of the last dollar.' "
S. H. Rubin-1916.2
"The aged user, the paralytic, and others too far gone for treatment must have their daily supply. Who shall prescribe for them? The question, to be properly answered, must involve the proposition limiting the manufacture and sale of narcotic-drugs to government agencies, and the right to dispense narcotic-drugs to local boards of health. By so centralizing the source of supply in local boards of health and by compelling the druggist, the physician, the dentist, and the consumer to obtain their supply from this source, the irredeemable user could be taken care of and the unscrupulous physician and druggist would be elimi-nated, permitting the crusade against the evil to progress without hindrance from that source. At the same time, the redeemable addict could be induced to enter an institution for treatment even for a protracted period, if his source is com-pletely cut off.

"These suggestions apply only to the social users, of which there are approxi-mately seventy per cent. The criminal and delinquent type, of which there are approximately twenty per cent, are subjects for the penologist and criminolo-gist. This class of users is the most hopeless and most dangerous element to deal with. They are intractable, cunning, designing, and wholly devoid of moral responsibility. It is their ambition to enlist new victims in the army of drug users, making it their business to keep them constantly supplied. In this class may be found the drug peddler, the white-slaver, the pick-pocket, the pan-handler, and the all-round crook. Therefore, the successful eradication of the evil and the uprooting of the traffic would necessarily entail a disposition of this class of narcotic-drug users. With the elimination of this class the task of caring for the social user and for those who have contracted the habit through illness would be less difficult. The latter class constitute approximately ten per cent of users, and indulge in drugs only to maintain a normal mental and physical tone.
"The activity of the authorities in rounding up drug users and meting out to them the penalty imposed by law may be commended when it affects only the criminal class of users. But when the crusade is made general, affecting the redeemable social user the responsibility rests with the medical profession for having failed to recognize the condition as a definite disease, and to urge the employment of medico-social measures instead of penal measures in the rehabilitation of the unfortunate victims. The condition may still be remedied if the Federal Government and our legislatures would provide ample and suit-able facilities for the care of the addict.
"The penal institution has never cured the drug and alcohol inebriate. Un-fortunately many addicts have been initiated to the use of habit-forming drugs in such institutions, taking it principally for the purpose of creating a euphoria to take the place of the depression which jail walls produce. On his discharge from the penal institution, the addict finds himself without moral fibre or mental strength, the need of which is obvious, if he is to be restored to his normal self."

H. C. Wood, Jr.-1916.3
"The education of the general public as to the clanger of narcotism both to the individual and to the community rests chiefly upon the pharmaceutical and medical professions. But we ourselves need to be taught our own shortcomings. Physicians must be brought to an appreciation of the fact that the too ready recourse to the hypodermic needle has led many a victim to life-long slavery. Did you as pharmacists realize the devil that lurks in the cough syrups, and other narcotic patent medicines, which you so thoughtlessly hand across the counter, you would forever banish this class of preparations from your shelves. Would you destroy the happiness, ruin both the body and the mind of your fel-low-men for a few paltry pieces of silver he gives you?
"The Harrison Act exempts preparations containing less than 2 grains of opium or 1/4 grain of morphine in each fluid ounce and most of the recent state laws have followed the national legislature in this regard. Nevertheless, do not try to salve your conscience with the thought that so small a quantity cannot do much harm. The most pathetic case of morphine habit I have ever seen was acquired from the use of a widely used Cough Syrup, by a man who was entirely ignorant of its dangerous character. One yellow-fever infected mos-quito may not be as dangerous as ten, but it is enough to kill you if it happens to bite you; so one grain of opium may not be as dangerous 8.8 ten, but it is enough to rob a human being of his home and happiness and to rob society of a useful citizen, giving in exchange a worthless, hopeless parasite or perhaps even an actual criminal.
"I believe, however, that at present the greatest gains against this enemy can be made by proper legislation. Already some nineteen or twenty states have anti-narcotic laws harmonizing more or less closely with the Harrison Act, but there is need not only for prohibitive legislation in the remaining states but also for amendments to stop up the holes which clever rogues have found. Time fails to recount the various schemes for obtaining 'dope' which have come to the attention of the Philadelphia Narcotic Committee, and I only wish to say that the great majority of them involved the partnership—either innocently or maliciously—of the doctor or druggist or both.
"Upon us, gentlemen, rests in large measure the responsibility of awakening the nation to its peril and of directing the efforts towards its alleviation Let us pray God we shall not be found wanting in our time of opportunity."

W. A. Bloedorn-1917-19.4, 5
"As long as these drugs can be obtained easily, there will continue to be a steady stream of new addicts and it is believed that one of the first steps to be taken should be the elimination of this availability of habit-forming drugs. The most stringent laws which legislators have been able to enact have failed in this respect."
"It is believed that the following recommendations will help in the general campaign against drug addiction:
"(1) The correction of predisposing causes as far as possible, such as over-crowding, insanitary surroundings, the lack of the facilities for healthful recrea-tion and the prevention of contact with drug addicts.
"(2) The after care of drug addicts following discharge from hospital is con-sidered highly advisable. A prolonged change of environment, country life, or a change of residence to avoid old associates would help to decrease the number who return to the use of drugs following discharge from hospital.
"(3) Facilities for building up these cases physically before throwing them on their own resources would be desirable as many are physically unable to secure employment immediately following discharge.
"(4) Government control of al) habit-forming drugs, including the manufac-ture, distribution, sale, and importation of all such drugs is recommended.
"It is believed that these procedures would decrease the availability of these drugs, which availability serves. to perpetuate drug addiction."
Later in 1919, Bloedorn states:
"It appears to be impossible to legislate drug addiction out of existence as long as the drugs themselves exist and are available. The most stringent laws that legislators have been able to enact have failed in great measure to reduce this availability. The addict better than any one else is familiar with the process of obtaining the drug. After passing through an institution for the cure of addiction he comes out with this knowledge still in his possession. If he should meet with reverses or suddenly be called on to face a trying situation, it is only natural that he should seek an outlet by a return to the drug.
"Heroin appears to be the drug most easily obtained at present; as a result, the great majority of addicts are heroin users. Also, heroin admits of easy adulteration, requires no apparatus to take, and can be readily distributed. While heroin occupies a place of some importance in the equipment of the physician, it is by no means indispensable, and it could be discarded entirely without serious results."

New York Psychiatrical Society—Public Health Committee, New York Academy of Medicine-4918.7
"i. We recommend that the Federal Government take such measures as are feasible to abolish the manufacture of heroin altogether.
"2. We recommend that the Federal Government be urged to adopt such legislative measure as will control and regulate the sale and distribution of opium and its derivatives and of cocaine, from the time of its manufacture to the time of its final distribution; also, that it take measures with regard to pre-venting the importation of these drugs except under proper conditions.
"3. We recommend that the Federal Government do not, at present, extend its jurisdiction to the control of all habit-forming drugs, but that the control of special drugs be taken up as occasion seems to demand. Experience in New York City and in the East Etows that there is no great prevalence of drug habit aside from that of opium and its derivatives."
"7. We recommend that an attempt be made to plan some means of educa-tion of young men and women as to the dangers of habit-forming drugs. We advise against the use of 'movies' or of any sensational methods."
"11. We recommend that the State do not at present undertake the cure of drug addiction, because the treatment and the subsequent plan of co-operative contact required for the success is long, expensive, and ditticult 'Unless carried out in the local community itself, and the State is not now equipped to under-take such work.
"We recommend that in preference to this, at the present time, the State do what it can to prevent the development of new cases and encourage provision for the relief of present sufferers.
"12. We recommend, for the relief of present sufferers and perhaps at times for radical treatment, the use of psychopathic hospitals or pavilions and that special provisions be furnished in general hospitals throughout the State to care, under proper control, for those who ask for a withdrawal treatment. This, we think, is what is due the patient who by law is deprived of the drug.
"13. Finally, pending action by the Federal Government for the better con-trol of habit-forming drugs, we recommend that the State of New York pass some law which will control the matter of drug addiction and the use of drugs by physicians in a better, more efficient, and more practical way than does the present law. We leave the definite solution of this as a separate problem in technical legislation.
"The plan now under consideration is to simplify the present law and make it mainly supplementary to the existing Federal law, and to issue licenses to those physicians who treat drug addicts."

A. Gordon-1917.8
Gordon, after reviewing the praiseworthy motives that prompted the passage of the Harrison Narcotic Act, states that only further experience can determine its practicability.
He goes on to say:
"This will be particularly observed when a legislative act is concerned with a matter of medical or other biological principles. Legislators can see only the purely utilitarian side of certain medical questions. When, however, biological principles and principles of a psychological order are to be considered, legislative acts are frequently found to be inapplicable and inadequate because of the failure on the part of legislators to consider the psycho-physical operations of an individual.
"But after the few past years of experience with the action of this law, can any one say that the desired results have been obtained? Indeed can they be obtained? Is it possible by any law to arrest a craving which is within the individual but which by the nature of its morbidity is not dependable on ex-traneous factors? Can a pathological mental condition which has created a pathological vegetative life be remedied by a forceful privation of a remedial agent which became a physiological necessity to this morbid life? Have the authors of the Harrison Law considered the untold suffering inflicted on the victims of the disease called 'Morphinism' by suddenly withdrawing the drug from them? Have they considered the host of torturing manifestations leading to syncope and even to death because of 'abstinence' from the narcotics after the latter have been used by the individual for some time? Has the new law provided for the great army of suffereri which are left on our hands because of their helplessness due to compulsory abstinence?
"Legislative acts which have for their object to prevent at the proper time the propagation of this most pernicious habit are most praiseworthy and to be encouraged. A law limiting the prescribing physician to a certain dose of the drug or to a certain number of renewals will be useful provided it does not interfere with the administration of the drug in cases in which human suffering is intense. A law that will impose a heavy penalty with imprisonment on those who sell or give away the drug without regular prescriptions or on those who forge a physician's prescription, is laudable. This is as far as legislative pro-phylaxis can go. It may by material force interfere with partaking of the drug by individuals who are but in the developmental period of the pernicious habit. Can it actually arrest its development? After a few years of continuous enact-ment did the Harrison Law succeed fully in this particular respect? I fear it did not, This is the experience of every close observer.
"But besides a legislative prophylaxis there is a medical prophylaxis whose aim is by far more important and more effectual than the first one. Its object is to investigate the physiological and especially the psychological factors which are at the very foundation of the acquirement of habit. It delves into the con-scious and particularly the sub-conscious world of the individual to discover and bring to the surface those repressed wishes and thoughts, which as we know now, are constantly at work, and which are capable of directing or disorienting our acts during our entire life, and so govern our conduct as a whole. Is it possible that any legislative act and even the best one will have the power to render any assistance in this endeavor? Morphinism usually occurs in individuals with a special make-up of their nervous system. Such persons present deficiency of the intellectual and moral faculties. In them the inhibitory power becomes an easy prey for all abnormal tendencies, particularly for alcoholism, morphinism or cocainism. The latter are results of a neuropathic constitution, the fruit of hereditary tendencies. In handling such individuals one should remember Ball's dictum, to wit: Worphinomania is entered by the door of pain, of sexual passion, of sorrow, but also by the door of contagion, viz., imitation.'
"It is therefore evident that no law established as a revenue measure or as a matter of a policy can pretend to modify in the least degree the foundation upon which the drug addicts' psychological processes have grown and developed. It would be utterly absurd to foster such expectations. A legal regulation in matters of this sort is naturally narrow in its aims and application. It can attack only the superficial side of the problem. Speaking particularly of the Harrison Narcotic Law, there cannot be any doubt as to its usefulness, despite the many inconveniences it has created, but its usefulness. does not extend beyond the limitations outlined above. It cannot aspire to remedy conditions which are out of its control."

Institute of Criminal Law and Criminology-1917.9
Committee "G" of this organization in reporting upon "the principle element in the narcotic drug problem in its relation to crime" recom-mends the following as essential to successful control:
"What is the remedy? Punish the dealer as severely as you can, but how about the user? To lock up the confirmed user for a short period of time does him no good whatever, for he will return to the drug 'again as soon as he can get it. Nothing short of a year's separation from most narcotics will break up the habit. Drug victims must be cut off from old surroundings, removed from the temptations to which they succumbed, and this separation must be maintained for a long period of time, under strict discipline at first, relaxed afterward,s by degrees as they regain self-control and not taken away suddenly. Occupation meanwhile is a prime necessity. Mind and body must have work. Idleness does not supply the alternative required. With idleness no cure is possible. This is the thought, of course, back of the so-called inebriate farms that have been started in one or two of our states. Drug-takers, as well as alcoholics should be put on farms, and kept there for long periods of time, and not allowed to go back to the lenderloins' from which they came. Some doctors will tell you that the drug-taker became what he is through an inherent weakness of char-acter. He was, they say, a weak, worthless individual before he began taking the drug that now has such a disastrous hold upon him, and therefore you need waste no pity on him. But the fact remains that in communities where drug-taking is unknown, weak individuals neither fall so low nor become such a menace to the safety of their fellow citizens. Even assuming therefore that such doctors are right in their conclusion, we should continue in every possible manner to prevent the illegitimate sale of narcotic drugs."

J. C. Densten-1917.1°
"Laws have been suggested and passed, with a view to lessening the evil of drug addictions. So far law has failed in its purpose. There are good laws and bad laws, effective and ineffective laws. A law which fails in its ultimate purpose is ineffective and bad. A law passed for the purpose of benefiting weak humanity is commendable, altruistic, and well meaning. But a law which benefits or cures a drug addict must have as a motive more than these attributes of sentiment; it must also contain sympathy and intelligence. A law whose ultimate object is revenue does not have philanthrophy, sympathy or intelligence behind it.
"The Harrison Antinarcotic Law exhibits to a superficial judgment the trinity of good intention, sympathSr, and intelligence, but becomes perfidious in its execution and ultimate endeavor and fails miserably in its purpose. The addict is seldom benefited and the physician becomes the depositary for censure, criticism, and failures to cure through the law's unintelligence.
"A law to be effective in curing the drug addict must be liberal, demanding and commanding; liberal in providing eleemosynary institutions throughout the States, each with a presiding physician and a necessary number of interns, whose sole and bounded duty it shall be to use every means, method, and contrivance to effect a cure of the addiction; demanding in compelling every known addict to enter one of these institutes and not to be released until cured or dead; and commanding in holding the respect of patient and public in the choosing of physicians and interns whose qualifications shall be sobriety, sympathy, intelli-gence, dominant will, forbearance and honesty. This law should be a Federal law and should be ratified by each State, so that it would be nationwide. Not one addict should escape its demands, for a drug addict if not cured must have the drug, go insane, or die. It becomes as necessary for hint as food. It is food to the addict."

C. L. Dana-1918."
"What seems most indicated is a federal law that will make the methods of control uniform throughout the country.
"One simple and efficient measure would be a federal law abolishing the manu-facture of heroin altogether. These are two courses which I would recommend.
"Furthermore, it is well established that addicts cannot be treated effectively except in institutions or in institutionalized homes. Possibly a law compelling the treatment of addicts only under institutional conditions and only by specially authorized physicians might well be passed. But at present the State is not equipped in rural districts to enact such measures."

C. Scheffel-1918.12
"1. Prophylaxis is the most potent remedy to eradicate the drug evil, and could perhaps be best carried out under the strict control of federal authority. Espe-cially the manufacture, distribution, and sale of habit-forming drugs should be much more accurately supervised.
"2. A wide-spread educational campaign on the subject that includes both professional and laymen is needed.
"The public should be made acquainted with the dangers attending the use of habit-forming drugs and the intense suffering caused by drug addictions. They should also be cautioned as to what is to be avoided masquerading under the guise of cure for these addictions.
"3. The legal and medical professions should realize that the treatment of drug habits has to an amazingly large extent been left to the judgment and opinions of laymen. They should also know that some of the most popular methods for treating these addictions today are entirely empirical and are by no means based on scientific principles, or even good common sense. The average busy physician is too apt to take the misleading and extravagant advertising propaganda of those catering to this class of patients for grartted without doing a little thinking of his own.
"Just because the propaganda and advertising happens to have gained access to the official publications representing organized medicine, does not in itself prove that the patient would be benefited thereby.
"This credulous attitude on the part of the medical profession has resulted in the country being over-flooded with institutions catering to drug addiction, many of which are conducted entirely for private gain with no idea of really curing the patient sent by the unsuspecting physician.
"Remember, confining a patient in an institution and in a few days or less taking away his drug is apt to cause unnecessary suffering, is not humane, and by no means constitutes a cure of the habit. The after-effects of such treat-ments have been disastrous.
"Physicians are prescribing habit-forming drugs too promiscuously for trivial causes and thereby create a large number of drug addicts themselves.
"4. Our legal brethren should assist in preventing the financial exploitation, in and outside institutions, of the unfortunate victims of the drug habit. They should aid in legislation intended to supervise and control more strictly institu-tions for the treatment of these addictions that are conducted by private individuals for private gain. And last but not least they should aid and assist in the enactment of laws that will ensure the poorer victims addicted to drugs of humane and intelligent treatment in those institutions where they are usually confined after a sentence by the courts.
"Appropriations should immediately become available for a thorough study of this subject. The horrors of war are creating drug addicts by the thousand, therefore let the country as a, whole be prepared to care for our share of them in a humane and scientific manner when the need arises. The drug evil cannot be eradicated overnight, but it can be done in a reasonable time by proper methods. In the meantime let the government take the reins so that the half million addicts now in our midst, and those that war will create, shall be efficiently and humanely treated and not looked upon as outcasts to be either robbed or abused."

American Medicine--1920.13
"From a consideration of all phases of the narcotic drug problem, it is apparent that in spite of all that has been accomplished and the very real progress that has been made, the paramount need of the hour is for education, and this not alone of the people, but also of a large portion of the medical profession. The laity needs to be taught that drug addiction like the majority of human ills is an accident; that in most instances it has developed without the patient's knowledge of its nature or dangers; that it is a real disease with as definite a physical basis as any other human ailment; that it is not an evidence of mental degeneration or criminal tendencies; that it is not attended by pleasure or enjoyment, but on the contrary, almost always causes those afflicted antold suffering, misery and distress; that it is very rare to find a person addicted to narcotic drugs who would not go to any lengths to be sure of getting cured of his disease; that those afflicted deserve sympathy and pity, and not hasty criti-cism, condemnation and intolerance; and finally that there are many fine, highly intelligent and proud men and. women—capable, hard-working individuals—who are living honorable, useful lives, but who, thru accident or by reason of some painful physical disease, have became confirmed users of narcotic drugs. Of course, there are many weak, more or less ignoble and defective people who become addicts. But it should be remembered that in many of these individuals their drug addiction is more often incidental than casual. Every community has its quota of spineless, incapable and depraved individuals who may or may not become afflicted with drug addiction, depending on their environmental conditions. By the same token, these people may or may not become tuber-culous. It should be borne in mind, therefore, that when this disease of drug addiction does occur, it does not necessarily exist as either a cause or as a con-sequence of their mentality or general character. Nevertheless, like every other serious disease, it is a grave misfortune and the afflicted individual deserves our raost sympathetic thought and attention.
"The medical profession also needs education, not infrequently along the same lines required by the laity, for so many doctors have kept sedulously aloof from the problem of drug addiction that they know little of the views developed during the past few years. Especially do medical men need to study the nature of addiction disease and how to combat the pathologic conditions created in the addict's body,"

S. D. Hubbard-1920."
"Having demonstrated certain peculiar conditions regarding the narcotic drug addict, with a study of several thousand, covering a long period, and after consultation with many well informed on this subject (and who were not in any way economically concerned except for social betterment of individuals), we concluded that narcotic drug addiction serves no useful purpose; that there is no justifiable reason at all for its continuance, and that the certainty with which this indulgence benumbs and blunts moral fibre, the practice being indulged in the majority of instances (69 per cent) by the young boy or girl, makes its control absolutely necessary. That the control is not a correctional problem from the prison viewpoint, but one for medical supervision. That ambulatory treatment is farcical and useless, and is only putting off what should be immediately done. Physicians should not be permitted, under guise of treatment, to prescribe narcotics for such indulgence. Laws should be so amended that the narcotic addict, when determined, should be sent by due process of commitment to a suitable institution and held there until a medical officer considers it safe for him to return to society. That after-care should be in an open-air environment--a farm, or outdoor gymnasium, or recreational izustitute being preferable and continued until the psychic phase is entirely passed, and the addict can again resume his nlace and maintain himself in society."

"Strict, adequate, and proper as well as uniform enforcement of the law,— the Harrison Act,—throughout this city and country is now demanded, and is easential towards preventing recruits to these miserable ranks.
"The work of reclaiming the narcotic drug addict in this vicinity at least-- judging from those we have seen and helped—is more than worth while.
"The clinic is not the solution-A:out it aids in bringing the secretive addict out of his lair. He becomes friendly disposed and, deprived of his supply, he is willing to be cured."
In another article of the same year, he states:15
"The control of the narcotic menace, to be effective, will necessarily not only have to correlate the professions directly interested but also secure the cooperation of all charitable and social agencies in order to work out a pro-gram for the effective administration of anti-narcotic laws, as well as the re-building of those unfortunate persons afflicted with the drug habit.
"Our men and women in the shops, factories, offices and homes must be properly protected from this growing evil, and all individuals and organiza-tions should concern themselves regarding the unsatisfactory conditions pre-vailing and aid in better enforcement of the statutes regarding narcotic drug addiction.
"One of the very first needs is to make compulsory the reporting by phy-sicians and others of addicts (Class 2) in order that these persons may be known and given careful and suitable consideration. Another regulation is that all prescriptions issueci for opiates and cocain should be in duplicate, one for the druggist and the other for some central agency (preferably a local depart-ment of health), that the practice in this particular may be independently checked and controlled."
American Medical Association-1920.16
The Report of the Committee on the Narcotic Drug Situation in the United States of the American Medical Association states: 17
"If a proper scheme of vocational guidance can be put into operation, we shall have a better satisfied and happier industrial population, with fewer misfits from this social stratum to become gangsters and narcotic addicts. And since the heroin user is young, it is not too late to reclaim him to normal and happy living by vocational guidance and training in an institution which will teach him to face a new and useful life after he is cured of his habit. The therapeutic value of vocational training has been evidenced with the cases of shell shock among the soldiers who are being reclaimed to happiness and usefulness under the direction of the federal Bureau of Vocational Education; and doubtless the same results can be obtained in the reclamation of youths who have lost their touch with reality in a less noble cause.
"It is already understood that much of the success of vocational guidance depends on the follow-up, even with normal children, to counteract the rest-lessness of youth which impels them to move on at the first difficulty. Sta-tistics show an average of three jobs for working children in the first two years. To counteract this tendency with the cured addicts, it will be imperative to devise a wise probation system. Many an otherwise hopeless misfit can be permanently saved by the supervision of a wise and experienced probation officer, acting with authority.
"Under a proper system of classification in the institution for the after-care of the addict, it will be necessary to segregate the correctional, the mental defective, and the social misfit groups. We already have state provision for the care of correctional cases and mental defectives. The facilities may have to be increased, but the plan for care and training is already known through the work of such institutions as Letchworth Village for defectives and Elmira for correctional cases. But the problem of the misfit and of the drug user who appeals normal except for the drug weakness has yet to be solved. That a solution is worth while is shown by the economic loss to the community resulting from their productive failure, their irregularity at work, and the tendency through their example toward an increase in the number of addicts.
"When addicts of these types (social misfits and otherwise normal persons) are sent to an institution where they are to be restored to normality by both mental and physical therapy, the misfit can be aided by vocational guidance, as we have shown. By a study of the addict which will include intelligence and vocational -tests, there is no reason why his aptitudes may not be recog-nized and developed as well as in the cases of the wounded soldier who finds it necessary to change his life work. And the very interest aroused by this new occupation, together with the absorption necessary in learning a new process, will lead the addict to forget the past. When the new vocation is entered, a judicious follow-up system should be maintained lest in moments of discouragement old memories reawaken and urge a return to the old haunts and habits.

Addicts Otherwise Normal
"As to those persons otherwise normal who have become drug addicts, here we have a complicated problem. We may be dealing with a man or woman who has been doing work for which he is well trained and fitted. We may have such a person working under too great strain. Then the 'last straw' is laid on the burden, and in the altogether human search for relief, even for a few hours, the drug is perhaps taken occasionally, and the habit finally formed. The literary genius who has to finish his manuscript for the pub-lisher; the social worker whose district must be covered at whatever cost to herself; the physician or nurse with an epidemic sweeping the city, and who must not stop--any of these may realize too late that he has become slave to the drug. What shall we do with him?
"The newer psychology has distinguished the conscious activities of the human mind from its subconscious activities--those that take place on another level, and which include lost memories, impressions from the earliest period of infancy, and the effects of shock which have expanded beneath the level of the daily activities and which have spread from one association center to another until all the activities of life are influenced by the background of experiences that can be recalled with the greatest difficulty, if at all. This subconscious life, sometimes of great intensity, has a tremendous pull on the conscious daily life. We like people because of their resemblance to others whom we have forgotten. In the domain of smell are registered impressions a thousand times as intense as those of taste. We have here a causa.tion of likes, dislikes, attractions and repulsions whose origin we cannot under-stand. And buried in this part of the mind's activities is often the answer to the question why an otherwise normal person, physically well developed, makes decisions which we call regressions. Such regressive tendencies, if yielded to, mean disaster to the very soul.
"Psychoanalysis as a form of mental therapy undertakes the reclamation of this unexplored part of the ego. And here is the greatest hope for the salvation of the otherwise normal person whose will is not strong enough to shake off the drug habit.
"If, under psychoanalysis, the 'sore spot' in the individual subconscious mind is discovered and a process of reeducation begun, the theory holds that there will be released an increased energy. And then reclamation of this 'normal' addict will depend on the power he will have, under guidance, to direct this libido into higher thought and emotional levels. Studies made of individuals much given to day dreaming indicate that these dreamers have an over-sensitive ego which makes their outer adjustments difficult, and thus makes for regression. The power to generalize their experiences is of the greatest assist-ance to these persons. And the pain of the world can be expressed in music; the longing of the world in marble, in painting, and in other creative forms. It is well recognized that man is a constructive animal, and is willing to spend himself in work in which he has joy and which brings him the respect of his fellow men. Teach this otherwise normal drug addict to irradiate and sublimate this libido which he is so wantonly wasting on the fetish of drug addiction. His strong desire is a measure of his energy. Let him be taught to direct that energy into wholesome channels which will give him as great pleasure and which will recreate his soul.
"Such is the task of the men and women in charge of the institution for the educated men and women who are drug addicts: They are to be both trained and sympathetic, wholesome and strong-willed; friends and guides into a new life in which the base desires for self-gratification is, not suppressed, but directed into new channels which will make for the happiness of the individual and the race.

Recommendations
"We therefore recommend:
"1. That the ambulatory treatment of drug addiction, as far as it relates to prescribing and dispensing of narcotic drugs to addicts for self-administration at their convenience, be emphatically condemned.
"2. That heroin be eliminated from all medicinal preparations, and that it should not be administered, prescribed or dispensed; and that the importation, manufacture and sale of heroin should be prohibited in the United States.
"3. That the bills introduced by Senator France, No. 2785, and Representative Rainey, No. 11778, to provide aid from the United States for the several states in prevention and control of drug addiction and the care and treatment of drug addicts be approved, and that Senator France, and Representative Rainey be so notified.
"4. In view of the statement in a government report that about 90 per cent of the amount of narcotic drugs entered for consumption is used for other than medical purposes, the Treasury Department is respectfully urged to con-tinue to study and report on the narcotic drug situation, including the question of government control of these drugs.
"5. That the Bureau of Public Health Service of the Treasury Department be respectfully requested to continue the compilation of state laws and regula-tions relating to habit-forming drugs and bring them up to date."

E. H. Williams-1921.18
This author, after reviewing briefly the objects and machinery of the Harrison Narcotic Law, says that it seems to be the consensus of opinion among federal, state and county officials who are most closely in touch with the situation that after five years of enforcement the number of drug takers and the amount of drug consumed are just as great if not considerably greater than before. The closure of legitimate channels for obtaining narcotics has brought into existence an illicit traffic of tremendous proportions and without really affecting the evil we have made what was formerly merely immoral a criminal matter.
He states that from a medical viewpoint the law has the funda-mental defect of not giving sufficient consideration to the underlying cause of opiate addiction as it regards it as a purely criminal act wil-fully indulged in by normal individuals without considering that disease may be a cause as well as a result of the condition.
He says that the majority of cases present an abnormal mental and physical condition closely akin to insanity and the present narcotic laws present many features similar to the older legislation for the con-trol of mental disease. He states:
"The opiate addict, like the psychopath, is an abnormal individual. But in most instances his physical and mental abnormalities are not apparent to casual observation so long as his system is supplied with a sustaining quantity of the drug. When this necessary stabilizing narcotic is withdrawn, however, the abnormal physical and mental conditions quickly assert themselves with absolute certainty.
"Yet even when the f3imilarity between insanity and opiate addiction is recognized, our attitude toward the two conditions is utterly different, and is determined by the supposed underlying cause of each condition, rather than by the conditions themselves. We punish the opiate addict because his infirmity is self-imposed, just as formerly lunatics were punished because it was believed that they wilfully associated themselves with evil spirits.
"But the present legal attitude is not consistent even if we accept the dictum that the result of self-imposed vices should be punished, while unavoidable misfortunes should not. For it so happens that one of the most important and prevalent forms of insanity, general paresis, is the result of venereal vice—a self-imposed condition. At least 10 per cent of all cases of insanity are at-tributable to this vicious cause. Yet the law makes no distinction between paretic patients with their virtually self-imposed disease, and any other types of insane persons. The paretic is not punished, although in acquiring the specific infection which is the cause of his condition, he gratified a wilful in-dulgence scarcely more compelling, and generally regarded as far more repre-hensible, than the craving for a drug.
"It is evident, therefore, that the cause of insanity does not influence the legal attitude toward this disease. Such is not the case with opiate addiction. A drug addict is a malefactor in the eyes of the law whether he acquired his habit through pure viciousness, or whether, as is often the case, his addiction was thrust upon him willingly, as in the case of many maimed veterans from Fmnce."
"The important thing about the existing narcotic laws, however, regardless of inconsistencies, is the fact that they do not appear to be getting adequate results.
"One modification of the present law that naturally suggests itself is to increase still further the scope and stringency of the statute. But it would seem that this is scarcely possible without curtailing the legitimate use of opium. And opium, bear in mind, is our most useful and most important drug. Curtailing its legitimate use would cause untold suffering among countless numbers of innocent persons afflicted with painful diseases. These persons far outnumber the addicts. So that even the complete elimination of this rela-tively small handful of drug habitues would be scant recompense for such a sacrifice.
"A less objectionable plan would be some slight modification in the existing narcotic laws tending to emphasize the medical side of the narcotic problem.

There is nothing novel in this suggestion. Indeed a practical step in this direction was taken in certain cities recently. For example, the Narcotic Clinics conducted in the cities of Los Angeles and San Diego for a brief period in 1920, were based on this principle, and produced results that were en-couraging, to say the least.
"The Los Angeles clinic was staited as a department of the Board of Health, with the approval and assistance of the municipal authorities, for the purpose of giving preliminary medical treatment to the narcotic addicts. This clinic endeavored to supply persons who required the constant use of an opiate with the necessary amount of their narcotic in gradually decreasing doses and at a nominal price. It was conducted by physicians detailed by the Health Com-missioner, and under the immediate direction of a Narcotic Board composed of prominent physicians, public spirited citizens, and Federal, State, and municipal officers who volunteered their time and services.
"It was not the purpose of this clinic merely to supply the opiate addicts of the community with narcotics. On the contrary, the clinic was established for the purpose of medical treatment, with gradual withdrawal of the drug, and final cure when possible. Complete cure by this method would not be possible. in most cases, of course; but it was possible to reduce the amount of drug used, and improve the patients' physical condition so that they could be treated successfully in some suitable institution at the proper time."
Summarizing the important things accomplished by the clinic the author says:
"For one thing, illicit peddling was reduced to a minimum. When the patient could get morphine honestly for ten cents a grain, why be dishonest at ten times that price with a good chance of landing in jail into the bargain? The peddlers complained, almost openly, that they were 'being ruined' by the clinic
"To the class of persons suffering from painful afflictions, such as tuberculosis and cancer, whose condition made the continued use of an opiate an absolute necessity, the clinic was a veritable godsend, for it enabled them to procure their necessary drug at a reasonable price and in a legitimate manner Thus they were able to reduce the amount of the narcotic, since, curiously enough, the uncertainty of being able to get a supply of the drug always tends to make the addict use more of it.
"The clinic made it possible for several individuals to engage in honest occu-pations for the first time in many months. Heretofore, the uncertainty of the source of supply, and the ruinous prices demanded by the peddler had kept these patients in such a state of physical dilapidation that they were unable to work. Thus the clinic enabled many of these victims to again become honest bread winners. Several of them were now able to provide for their families and again live in a respectable and self-respecting manner. And meanwhile their general health was improved by the gradually reduced doses dispensed at the clinic, and the release from the harassing anxiety about obtaining their drug."
The author thinks that the clinics should be reestablished with such modifications as are always necessary in any progressive experimental work. Hospital provision should also be made and there should be some governing body of qualified medical examiners to determine the requirements of each case. He adds that perhaps the best solution of the whole problem would be to place it in the hands of the United States Public Health Service.

A. C. Prentice-1921.19
"Any solution of this vexing problem must necessarily resolve itself into some plan for abolishing the total supply of drug that may be available to the addict from any and all sources. There are two main sources of supply, viz., the peddlers, most of whom are themselves, addicts; and the trafficking doctor, the narcotic practitioner, the 'script doctor' who prescribes or dispenses the drug to them for self-administration. The peddler, who deals largely in smuggled drugs, constitutes a comparatively simple police problem easily solved by thor-oughgoing enforcement of existing laws. The doctor is more difficult of appre-hension for he hides behind the cloth of a reputable profession, and pretends that he is treating a 'disease' when he is really selling his professional privilege in a sordid market for a very large return in money."
"The remedy consists in abolishing the addicts' drug supply, first by prohibiting the prescribing or dispensing of these drugs to them by physicians, under severe penalty for such violation, and secondly through vigorous enforcement of both federal and state laws dealing with narcotic abuse."

American Medical Association-1921.2°
The Report of the Committee on Narcotic Drugs of the Council on Health and Public Instruction contains the following suggestions for the control of the problem:
"4. The use of apomorphin and codein rarely if ever leads to the develop-ment of addiction to these drugs. Their physiological effects are such as to pre-clude the probability of their becoming of any importance as habit-forming narcotic drugs. The committee recommends that the American Medical Asso-ciation respectfully urge on Congress such amendment of the Harrison Law as will per-nit the prescribing of apomorphin and codein by physicians without the limitations which it is recognized as suitable to impose on those prescribing other habit-forming narcotic drugs.
"5. In view of the fact that enforcement of the prohibition laws is at present assigned to the same unit of the Intemal Revenue Bureau of the Federal Gov-ernment that is also charged with the enforcement of the Harrison Narcotic Law, and since prohibition enforcement necessitates a much larger appropriation of funds and a greater field force, and occupies a larger share of the public attention, it is feared that the important duty of efficient enforcement of the narcotic law may be neglected. Therefore, your committee recommends that the American Medical Association urge the appointment by the Commissioner of Internal Revenue of a special deputy commissioner in charge of a separate unit for the enforcement of the narcotic law, and that due prominence be given to that service in the accomplishment of its effective functioning.
"6. Your committee recommends that the Harrison Law be supplemented in the several states by uniform state laws, in harmony with and supplemental to the Harrison Law, which shall base their control of any medical abuse of nar-cotic drugs on those powers possessed by the states to punish crime as well as to revoke the license to practice medicine, dentistry, pharmacy or veterinary medicine.
"The committee recommends that it be authorized to invite the appointment of committees by organizations representing the profession of dentistry and veterinary medicine, pharmaceutical organizations, and organizations representing the various branches of the drug trade, and to cooperate with such committees, when appointed, in the preparation of a model state narcotic law; it further recommends that it be authorized to request the appointment of a Committee on Uniform State Narcotic Law by the National Conference of Commissioners on Uniform State Laws, and to cooperate with such committee, when appointed, in the preparation of such a law; it further recommends that state narcotic laws should follow the general principles set forth below:
"A model state law need not be a tax law; and in fact, the taxing feature should be abolished. Its clear purpose, like that of the fedeml statute, should be definitely the control of distribution of the narcotic drugs, limiting to the utmost every poasible abuse, while conserving the absolute right and duty of the practitioner to exercise his judgment regarding their proper use in the lawful practice of his profession. Such state law should closely follow, and not in any way conflict with the provisions of the federal law of paramount authority. The regulations and details of administration under the two laws should, there-fore, be parallel, in order to avoid confusion and to facilitate compliance there. with; and the machinery of enforcement of a state law should be as simple as possible consistent with effective operation.
"Unnecessary duplication of records under federal and state laws should be eliminated, the state accepting the records kept under the Harrison Law
"Power to make and enforce special regulations of any sort, except those abso-lutely necessary in administrative application of the law, should not be entrusted to state officials. Those regulations considered necessary should be submitted for approval, before being promulgated, to the State Medical Board or other professional body of competent jurisdiction, and to the Attorney-General of the state.
"A state law should embrace recognition of the clear purpose and intent of the Harrison Law, evidenced by the words, 'in the course of his professional practice only,' to prohibit distribution of narcotic drugs through physicians prescribing or dispensing them to addicts for self-administration, under the guise of administering the so-called 'ambulatory reductive method of treatment' (since such method does not constitute treatment in good faith, nor has it the sanction of professional practice). Such proper control should be the basis of both state and federal laws. This intent ought to be clearly defined in a state law, i.e., by definitely prohibiting the `ambulatory treatment' of addiction, either by the private physician, or in institutions such as the so-called 'narcotic clinic.'
"Unlawful possession of narcotic drugs should be made 'prima facie evidence' of violation of the narcotic law, as in the Harrison Law.
"Legal commitment of addicts on their own application, as well as their penal commitment, should be made equally effective in order to insure complete control of them while under treatment for the cure of their addiction.
"Provision should be made by the state law for the treatment of those addicted to the use of narcotic drugs, in suitable institutions, existing or proposed for that purpose, or by private physicians, in either case, under the most rigid regulations.
"Institutional care and treatment of addicts unable to pay for such care and treatment should be provided for through a state law. In case special institu-tions are provided for this purpose by the state, the industrial colony plan will approach nearest to the ideal solution of that problem.
"All institutions should be required to maintain complete records and make annual reports to the State Department of Health, including all items called for by that body.
"Administrative provisions of the narcotic laws in each state should be ateigned properly to the State Department of Health, or to a special bureau under its jurisdiction. The department of health in each state should be clothed with plenary police powers in dealing with narcotic addiction as a menace to the public, as power is vested in it for the control of communicable diseases. Public sentiment should demand their effective application.
"Penalty for violation of the narcotic laws, or narcotic addiction on the part of a physician, dentist, veterinary surgeon, nurse, druggist, or other practitioner, should include suspension or revocation of the license to practice his, or her, profession, in addition to the legal penalty for the criminal offense imposed by the court, on legal proof of such violation or addiction.
"7. Your committee is of the opinion that a study of the need for habit-forming narcotic drugs in the practice of medicine should be undertaken and pursued through the channels of the organized medical profession, as well as by the federal and state authorities. On the basis of such study, it may be deter-mined whether or not the necessity exists, for the limitation of the amount of narcotic drugs imported, manufactured or prepared in the United States. It is the unanimous opinion of the committee that there are, at present, no available data on which could be based any practical plan for limiting imports, or for establishing a government monopoly in the importation, manufacture, prepara-tion and distribution of the habit-forming narcotic drugs (if each plan could be legally adopted by the government, except by an amendment to the Constitution of the United States); and further, that such study could attain results of value, only after a considerable period of years, or when the members of the medical profession shall have been educated to supply accurate records of their actual needs for these drugs in the treatment of disea.ses and the relief of pain and suffering.
"8. Your committee desires to place on record its firm conviction that any method of treatment for narcotic drug addiction, whether private, institutional, official or governmental, which permits the addicted person to dose himself with the habit-forming narcotic drugs placed in his hands for self-administration, is an unsatisfactory treatment of addiction, begets deception, extends the abuse of habit-forming narcotic drugs, and causes an increase in crime. Therefore, your committee recommends that the American Medical Association urge bot,h federal and state governments to exert their full powers and authority to put an end to all manner of such so-called addiction, whether practiced by the private physician or by the so-called 'narcotic clinic' or dispensary.
"In the opinion of your committee, the only proper and scientific method of trea-ting narcotic drug addiction is under such conditions of control of both the addict and the drug, that any administration of a habit-forming narcotic drug must be by, or under the direct personal authority of the physician, with no chance of any distribution of the drug of addiction to others, or opportunity for the same person to procure any of the drug from any source other than from the physician directly responsible for the addict's treatment.
"9. Your committee recommends, in view of the fact that habit-forming nar-cotic drugs have defmite, valuable and indispensable uses in the practice of medi-cine, there should be permitted no encroachment on the right and duty of the physician to exercise his judgment unhampered in the legitimate use of such narcotic drugs. Therefore, your committee recommends that the bills now before Congress which propose to limit the total amount of narcotic drugs which may be imported into the United States be disapproved, and their passage opposed by the American Medical Association, for the reason that such limita-tion, at the present time, would inevitably make these drugs more expensive and difficult to obtain for proper medical purposes; and that such limitation of the total supply would certainly encourage smuggling of habit-forming drugs into the United States.
"10. Your committee also recommends that the several state and county medical societies, constituent to the American Medical Association, be urged to obtain on their own initiative and through their own officers, such information as may be necessary to bring about the effective prosecution by local, state and federal authorities, of that small number of the members of the medical profession who are now acting in violation of the federal or state narcotic laws.

"Respectfully submitted by the Chairman, for the Committee on Narcotic Drugs:
Haven Emerson, M.D., Chairman, George W. McCoy, M.D.
Thomas S. Blair, M.D.
Alfred C. Prentice, M.D."

American Public Health Association-1921.21
The Report of Committee on Narcotic Drug Addiction states in part:
"As a result of this study your Committee begs to report as follows:
"The group of addicts variously spoken of as criminals, degenerates and feeble-minded is unwilling and unable to cooperate in the necessary treatment, and should be kept under official control. In the opinion of your Committee, the control of this group is essentially a police problem.
"The group of addicts who suffer from physical conditions necessitating an indefinite continuance of their use of the drug constitutes a medical problem.
"Furthermore, the group of addicts in whom the clinical condition, which was the reason for beginning the use of the drug, no longer exists, or who began the addiction for other than clinical reasons, is also a medical problem. These three groups, which include all addicts, do not constitute a public-health problem in the ordinary sense of the word.
"Your Committee feels, however, that in so far as prevention of new drug addiction may be considered as a public-health problem, there are two points it would urge:
"First, that international measures leading to the reduction of the uncontrolled supply of drugs be taken.
"Second, that the importance of the education of the physician as to the dangers of inducing addiction through medical practice, and as to the best methods of avoiding such dangers be emphasized.
"In view, however, of the present unsatisfactory state of this medical prob-lem, and of the very diverse opinions existing as to its bearing upon legislation and police regulations, your Committee believes it to be to the public interest that a research Committee of clinicians, biochemists, and psychiatrists, should be appointed with official sanction, to investigate all phases of the question and thereafter to make an authoritative pronouncement on the medical problems involved.
"Your Committee further recommends that the Executive Board of the Ameri-can Public Health Association be authorized to cooperate to this end with other official bodies, should it be invited to do so.
Roger G. Perkiias, M.D., Chairman, George W. McCoy, M.D.
Peter H. Bryce, M.D."
Conference of State and Provincial Health Authorities of North
America-1921.22
The Committee on Drug Addiction of the Conference, Dr. Oscar Dowling, Chairman, reported as follows:

"The factors of the narcotic problem are now generally recognized as medical, legal and sociological. The complexity involved is the fundamental reason why no law, federal or state, has proved entirely satisfactory; it is also the reason why legal enactments alone will not prove adequate. The problem is made more difficult because of the divided opinion of the physicians themselves as to whether drug addiction is a disease or a habit.
"Scientific knowledge in studies which have a bearing on the cause of drug addiction for example, studies in heredity, in functions of the internal secretions, in methods of mental examination and classification and in experiments in psychoanalysis has increased but the progress has not been sufficient to give more than suggestion for the solution of the problem.
"Without going into further analysis, the outstanding facts seem to be:
"I. The need for an international agreement and international legislation which will control the illegal importation and exportation of the habit-form-ing drugs.
"2. The clarification, if necessary, the redrafting of the provision of the Harrison Law which relates to professional practice.
"3. Amendment of state narcotic laws to insure accordance with the Harrison Law, and more effective methods of enforcement of state narcotic laws.
"4. The separation of the narcotic agencies from Prohibition enforcement in the administration of the Harrison and Prohibition Acts.
"5. An intensive educational campaign that the public may become better informed relative to the danger of acquiring the habit and the menace which drug addiction is to our people."
In 1922 the same Committee reported as follows:
"The recent orders issued by the Treasury Department assigning every agent in its service to assist in narcotic work are evidence of unsatisfactory progress in the control of the drug evil.
"The Government evidently thinks it wise to extend its operations for further control of smugglers and traffickers in narcotics.
"As was suggested in the last report, the complexity of the problem explains why Federal and State laws have proved inadequate; also, why their enforce-ment is so difficult. Some progress has been made toward enlisting the assist-ance of other countries in the control of smuggling of drugs into the United States. Cuba, Mexico and Canada have promised cooperation to prevent, as far as they can, this illegal traffic. Control of importation from these sources would lessen to a degree the quantity of the drugs imported, but this coopera-tion would have to be extended to European or even Asiatic countries if the supply of narcotics is to be controlled to meet only necessary medical requirements.
"It is the conviction of the Committee that many physicians are more careful in the prescribing of narcotics, and that the rulings of the Federal Courts are more drastic as to penalties.
"From our experience in the investigations of two years it does not seem pertinent to go into a more detailed analysis, but to recommend what seems to be most practicable.
"Whereas: The importation of opium and coca leaves and their derivatives is greater in amount than is necessary for proper medical requirements and a. great proportion of such importations is illegally sold and distributed; and
"Whereas: The lack of cooperation between federal government and the states and the absence of proper and effective state legislation throughout the country has made possible the abnormal growth of the illicit drug traffic, therefore be it
"Resolved: That this Committee urgently recommends that Congress pass such legislation as will provide for proper and effective federal regulation of the importation of narcotic drugs and of the sale and distribution thereof, to the end that sufficient quantity thereof may be available only for proper, legitimate medical purposes, through the establishment of properly regulated distributing agencies; and be it further
"Resolved: That copies of these resolutions be sent to the President' of the United States., the Vice-President, the Speaker of the House of Representatives and Senators and Representatives in Congress."
In discussing the above report, Dr. Fulton of Maryland questioned the wisdom of involving executive state health officers in a confusion between the powers of the health officer and the police power as they are generally understood.
Dr. Turner of Washington stated that he believed the narcotic evil to be a menace to public health and that every state health depart-ment had by law jurisdiction over the public health. He goes on to say:
"So the whole situation comes down to two points. First, the control of the drug. Make regulations that it cannot be sold; and that will probably be taken care of if the President signs the Jones-Miller bill which has passed the Senate and is now up for the President's signature. This bill has been fought for tremendously by the press and prominent individuals in the State of Wash-ington as well as Oregon. The White Cross has also been very active and we hope that the enactment of the Jones-Miller bill will terminate one phase of the problem. Of course, it will necessitate using some of the power of the police department, a whole lot of it perhaps, but primarily narcotic drug control. is public health matter, and we have got to have in any public health matter police cooperation.
"The other thing is that the addict himself must be taken care of. It is quite true that it will be a waste of money to try and take care of the addicts under present conditions. As soon as we can get a federal law that will make conditions possible so that the addicts may be treated efficiently, then the community will have to prepare itself to give them this treatment and bring them back to normal citizens.
"The present distribution and consumption of drugs is going on so insidiously throughout our population in the west that I c,annot tell you how serious the matter is. There is a White Cross in our section—a tremendously enthusiastic organization; I think the activities of the organization together with the work of the health authorities will bring about much better conditions throughout the country. I want to appeal to you to promote the White Cross in so far as you are able."
Dr. Nicoll of New York agreed with Dr. Turner stating:
"It is a matter which we haVe had on several occasions to bring before com-mittees of the State Legislature during hearings on bills for Narcotic Drug Control. It may be conceded that indirectly narcotic drug addiction is a matter with which public health authorities should concern themselves, but I believe that the control of the manufacture, selling and dispensing of narcotic drugs is a function which can no more logically be assigned to health authorities than that of the enforcement of the Volstead Act for the control of alcoholism. These are primarily police matters and I speak from experience of one year during which the State Health Department was given legislative control of narcotic drugs in warning you to make every effort to prevent such prerogative being forced upon you by legislative action. You will accomplish little or nothing and what you do accomplish will be at the expense of strictly public health work."
Dr. McCormack of Kentucky stated the following:
"As a member of the Committee on Resolutions I would be very glad to hear a discussion of the committee report because I would like to be advised by members on their views in regard to this important matter. My own experience is so directly contradictory tb that of those who have spoken on the subject. I feel that in our state, while the evil is comparatively a small one, we have not accomplished such definite results from the exercise of police power as through the health department. I am a little surprised at the trend of the discussion. We have found that there are two great sources of this evil as far as its initiation is concerned. Indeed, in going back, it is the constitutional psychopathic state that underlies the whole thing, and I believe Dr. Nicoll's reasoning is not right, showing that the constitutional psychopath is not relieved either by the adminis-tration of the drug or the withdrawal of the drug or by any other means. But the drug addict can be cured whenever you stop the supply of the drug, and that is the only way he can be cured."
"I know we are getting results. There is no question about it. It is not a matter of petty offences but a matter of stopping the supply of the drug. The experience I had in Panama is of value so far as this country is con-cerned and I believe the plan adopted there would control the narcotic drug in the United States. The health department had all the drugs supplied and we furnished the doctors with doses in the original containers. They brought the original containers back when they wanted a new supply. That way nobody else got it. I believe its supply should be controlled in the same way as alcohol, morphine, cocaine, etc. In the meantime certain manu-facturers and commercial houses in this country that are manufacturing the drug knowing it is supplied illicitly ought to be put in the federal peniten-tiary. Until that time comes and big business knows it cannot sell, the traffic will not be controlled. That is a federal matter entirely and should be attended to as a federal matter, promptly."
Dr. Crumbine of Kansas addressed the following question to Dr. McCormack:
"I would like to ask Dr. McCormack if after all he is not operating a board of examination and registration in connection with the state board of health? While I am on the floor I would like to add my word of caution and protest to what Dr. Nicoll and Dr. Fulton have said. On a number of occasions the matter has been checked up by the state legislature and I have very vigorously opposed any such measures as giving this responsibility to the state board of health. I can see where the combination of the board of examination and regis-tration with the board of health might alter conditions but that goes so far that I doubt very much whether the state boards of health should attempt to exercise such police measures."
In reply Dr. McCormack stated:
"I am very glad indeed to answer Dr. Crumbine's question. A state board of medical inspection and examination that is not in the state board of health is not a nominal and economic system and I hope that it would be abolished. The public has no interest in the medical profession except in so far as it pro-motes public health. There is no reason for the state board of examination to be in existence, no more than it would be to have a state board of registration for plumbers, or locomotive engineers and firemen. I don't believe in any of them only in so far as they protect the public welfare and public weal. I believe the state health departments are doing everything to promote public health. We are attempting to protect our people from doctors furnishing poison in water, food, or any other way which would affect the health of the people. I believe that the state board of health should take proper action in this matter."
The report of the Committee was accepted and the resolutions were referred to the Committee on Resolutions for redrafting.

J. W. H. Crim-1922.23
"As a practical condition, the Government situation is this: The conscientious physician is loath to and often will not prescribe for the addict; the addict is, therefore, in many instances practically tmable to get the narcotic legitimately. He is driven by the cravings of an appetite, frequently excruciating pain (if he has been denied a narcotic for a considerable period of time) into criminal associations, wherein he can procure it only by the commission of crime. Once started on this downward path, he is ultimately apprehended and prosecuted its a criminal. Not infrequently he arranges a fictitious sale in the presence of an officer of the law, that he may be convicted, with the hope that incarceration may cure him. Once in prison, with the brand of felon, in association with other addicts, and the opportunity to obtain it within prison walls, any degree of cor-rection, reformation, or cure, is a remote probability. The fact is on serving his sentence he is invariably a greater liability to society than before conviction."
"Concretely, I submit that any solution of this problem must have for its basis a demonstrated policy from the medical profession.
"Government must provide some asylum for the unfortunate addict that the present conditions, which too frequently drive him into criminal associations, and ultimately crime, may be brought to an end. The door of hope must be kept open.
"Local self-government throughout the country must see to it that the local officials make better efforts to destroy the illegitimate traffic in each community.
"The United States Government must give greater consideration to the prevention of the introduction of narcotics into this country, by more intense policing of the harbors and seaports. These sources—these gateways to the channels of this trade must be closed.
"The Government, by international agreements and treaties, must see that this traffic is outlawed throughout the world and no narcotic manufactured anywhere, except under the eyes of the visitatorial power of a responsible government.
"With the criminal addict, I have this suggestion, in so far as the United States Government is concerned, that Congress immediately enact into law the bill submitted by the Department of Justice for the taking over of a part of the Government reservation at Camp Grant and creating there an industrial reformatory, where first offenders between the ages of 17 and 30 (not guilty of the more heinous crimes of treason, murder, rape, or arson) may be sent and taught the rudiments of a grammar-school curriculum and a useful trade under sanitary conditions. This will relieve the congestion with which we are now confronted in the Federal prisons, and which, I wish to assert with all of the emphasis I can command, is rapidly resulting in conditions so immoral as to be a stain on and a disgrace to the American Government."

R. G. Perkins--1922.24
"1. As noted earlier, there is no hope of checking the underground traffic with-out international agreement.
"2. The present laws show the disposition of all drugs legitimately obtained by the physician.
"3. If the smuggled supply were unobtainable, the only source for the under-world supply would be thefts from legitimately obtained supplies.
"4. It is generally agreed that this would be a small matter and in no way competent to supply the peddling trade.
"5. The percentage of dispensers of legitimately obtained drugs who cater primarily to addicts is small and easily ascertained.

"There are really two problems, one for the future, one for the immediate present.
"Granting the removal of the underground trade through national agreement, and adding to this the time-worn factor of education of the medical practitioner to prevent the type of a.ddiction for which he has been responsible, it is clear that the addiction cif the future generation, as far as opium and its derivatives are concerned, would not be serious.
"For the present, however, the problem is more complex. We cannot get international action all at once. We carmot develop adequate hospital facilities all at once, and if previous contentions are accepted, mere hospitalization with-out convalescent care would be unwarranted expense.
"The mere forbidding of an action without removal of the means to carry out the action has never been more than temporarily successful, and it is well known that the best of 'reforms occur in waves, with long intervals between waves.
"In reality, how serious is the condition, and how much of a menace is it? In the earlier propaganda, the percentage of our population who were addicts was placed as high as four per cent. Now it is claimed as affecting one-fourth of one per cent or less, a notable drop, and one not claimed as the result of the execution of the law.
"The great majority of the addicts who may be considered as a public menace are in the large cities, and according to such statistics as we have available, are for the most part in the criminal classes. Inasmuch as addicts of this type are resistant to all treatment save by force, the only way they can be cared for is in correctional institutions, in which they may be retained until detoxicated. At least this portion then may be considered as a police problem rather than as a public health problem.
"If this is true, the fact that the reason for relapse is the accessibility of the drugs through peddlers brings us back to the same point in the circle, namely, the checking of smuggling and its checking by the only possible means, removal of the foreign source of supply.
"If the peddlers' supply were limited to thefts from registered stocks, it would certainly be insufficient to spread addiction, even if it was adequate for the present group. The problem would be self-limiting, far more than would even adequate hospitalization and after-cure.
"In summation, it seems to me that the solution for the future lies primarily in the international limitation of the sale of opium products to registered and responsible persons, and secondarily in the education of physicians and the public as to the development of addiction.
"The solution for the present is far more difficult. The supply is accessible, there is no adequate hospitalization in sight, the educational side is incomplete. There is little disagreement among reputable persons as to the disposition of most of the cases. The main argument concerns the interpretation of the proper control and treatment in a limited number of individual cases. There are, it seems to me, two main points of difference. First, can the physician be trusted to play fair with the law? Second, is the number of such cases and their relation to society a menace?

"Decisions and recommendations must be made on the basis of facts. It does not appear likely that further investigation will do more than to increase our statistical knowledge, and fill out the records of types and cases. The only point under serious dispute which may be cleared up by scientific investigations, and which should be most carefullY studied, is the classification of addiction as a disease or as something else. Until this is done in a manner sufficiently clear to carry conviction, the present argument will continue."
Suggestion for Model State Law-1922
There was held in New York City in March, 1922, a conference of a committee appointed by the chairman of the Council on Health and Public Instruction of the American Medical Association with represen-tatives of the American Drug Trade Conference, variou's pharmaceuti-cal organizations, the American Veterinary Medical Association, and the Narcotic Drug Control League. The purpose of the meeting as stated by the chairman, was, "to see whether we can come to an agree-ment in respect to uniform State laws which shall supplement the Harrison Act in order that there may be unanimity of professional and trade co-operation back of the narcotic law."
The "model" law which was considered at this conference, followed in the main the provisions of the Harrison Act and certain regulations thereunder. The chief points of difference are included in what follows:
Section 6, (2), provided that prescriptions containing codein or a preparation containing codein, could be refilled. This variation from the Harrison Act is explained in a footnote as follows:
"This provision is at present contrary to the regulations now in force under the Harrison Act and is approved subject to revision of the regulations by the treasury department to conform to this provision of the proposed State Model Law. The conference expressed its belief that, every effort should be made to obtain modifications of the existing treasury department regulations so that there may be agreement between them and the proposed text of the model law."
Section 10 required a physical examination to be made by a physi-cian, dentist, or veterinarian, prior to the prescribing or dispensing of habit-forming drugs.
Section 13 specified that the records required to be kept under the provisions of federal law, should be considered sufficient fulfillment of the requirements of the Act.
Section 14 provided for the revocation of licenses of physicians, dentists, veterinarians, or apothecaries for ". . . wilful violation of any of the provisions of this act," and that a copy of the sentence and of the opinion of the court or magistrate be sent by the clerk of the court or by the magistrate, to the board or officer having power to sus-pend or revoke the license or registration of the person convicted.
A penalty clause, the enforcement authority, and the administra-tion of the Act in general, were not designated in detail, in order to permit in each state the adoption of such provisions as might be cus-tomary.
The action of the conference with respect to the law, was as follows:

"RESOLVED: That the draft of the result of our deliberations as embodied in sections 1 to 17 as amended be submitted to the respective organizations repre-sented in this conference for their consideration and for such disposition as they shall respectively deem appropriate."
The narcotic law passed by the New York State Legislature in 1927 was based on this law, but did not contain all of its provisions.

L. C. Scott--1923.25
"Whatever be the reason for contracting an addiction to morphin, heroin, or cocaine, the fact remains that those persons caught in the toils are most un-fortunate. Is there an element.of justice and humanity in making it impossible or even difficult to get their necessary drug and driving them into the clutches of the conscienceless drug peddler? Is society benefited in trying to stop one evil by creating another; by stopping the bung and opening the spigot? This suggests that there must be the possibility of a common ground upon which the medical and legal professions can meet. After all this is the crux of the difficulty. A large part of the controversy and misunderstanding in which the narcotic situation has been and is still involved, is dependent upon the fact that the lawyers and doctors cannot interpret it in the same way.
"As lawyers look at the matter, the enforcement of the anti-narcotic act is the paramount issue. The act was framed, according to their views, primarily for the protection of society against the criminally inclined and the mentally defective, whose slavery to narcotic drugs makes them doubly dangerous members of this society. In short the administration of the Harrison Anti-Narcotic Act virtually penalizes the addict as a criminal and as a degenerate which, with a large pro-portion of addicts, is undoubtedly not the case."
"Theoretically the rOle of the law is to make it impossible for addicts to get their supply of drugs; it makes no distinction between criminal and non-criminal; it is oblivious to suffering; it takes no cognizance of nor makes provision for alleviating the economic side of the addicts' problem; it sees the mass but not the individual, the forest but not the trees; it is blind and solves with a common denominator. In contradiction to this attitude stands the medical viewpoint, the physician receives the human wreckage from the legal battle to patch up and make whole if he can. His motives are humane, as they must necessarily be if he is what society expects him to be, and if his training and occupation have not dulled his ability to sympathize with suffering humanity. He cannot grasp, as a lawyer apparently can, that a law devoid of the elements of humanity can be framed. He sees the addicts as sick and suffering human beings who must be cared for and, if possible, cured of their malady. He is interested more in the individual than in the mass; he cannot see the forest for trees.
"One phase in the ultimate solution of the addicts' problem is clearly a medical one. It is obviously the duty of the medical profession to devise means to meet the emergency produced by the enforcement of the Anti-Narcotic Act. Consider that the addict, of whatever social standing, becomes a liability and a menace to a greater or lesser degree when deprived of his drug. Add to these sufferers from painful and incurable diseases whose appeal is solely one of humani-tarianism, and the sociological and medical aspects are at once apparent. All must be cared for sooner or later, whether they finally land in the jail or in the hospital; there is no evading the issue. At present, the individual physician must determine the condition of the patient and take responsibility of prescrib-ing or the sufferer continues to be the prey of the peddler.
"Pertinent to both the legal and medical viewpoints of the narcotic problem is the question which is so often asked and so often evaded—gs drug addiction merely a habit or is it a disease?' The confusion and difficulty in answering this question is due to lack of definition of terms, what is meant by `habit' and what is meant by 'disease.' According to the Century Dictionary a `habit' is a customary mode of action which is instinctive, unconscious and uncontrollable. 'Disease' is a deviation from the healthy or normal condition of any of the func-tions or tissues of the body.
"Huxley's defmition is even more broad and comprehensive. He says 'Disease is a perturbation of the normal activities of a living body.' If we concede the truth of the following premises; viz: that morphinism or drug addiction is a customary mode of action and that furthermore it is uncontrollable, we must also accept the conclusion that it is a habit and, secondly, we must agree that inastnuch as disease is deviation of the normal functions of the body, and that the manifestations of drug addiction indicate at once that these functions are disturbed, we must conclude that it is a disease. Therefore, it is both a habit and a disease, but arguing by analogy we can easily prove that habit may readily act as the provocation of disease. For instance, epithelioma of the lip or car-cinoma of the tongue are assuredly diseases. It is possible that they may owe their origin to pipe smoking. But pipe smoking is a habit, therefore, lip and tongue cancers are habit diseases. Again over-eating may lead to a long series of organic defects, including arterio-sclerosis and an apoplectic stroke. Over-eating is surely a habit, and an unnecessary one. Its logical outcome is arterio-sclerosis and apoplexy, that is disease and its manifestations--ergo, habit diseases.

"Another point of view which seems equally as logical is that the state called `morphinism' or 'drug addiction' is one in which the body finds itself when its physiology is disturbed without the administration of some foreign substance not normally necessary. In the sense of the above definition this constitutes disease, for without morphin, which is beyond a doubt an abnormal substance in the metabolism of the human body, there is 'a deviation from the healthy and normal condition.' Let any one look at an individual suffering from with-drawal symptoms and argue that the bodily functions are intact.
"Another contention that morphinism is not a disease is that there are no pathological changes visible. In short, it is a habit because the microscope does not reveal cellular alteration. Has any one detected cellular alterations in the earlier stages of hebephrenic dementia or paranoia, or hysteria? But who will question for one moment that they are manifestations of disordered bodily functions, and therefore disease entities?
"Then we come to the conclusion that it is neither flesh nor fish, yet sometimes one, sometimes both; either a habit or a disease or finally a diseased condition caused by a habit which has become fastened upon the body because of disease. We argue in a circle, grasp fallacy after fallacy and in the end are little wiser than when we commenced.
"But all this does not alter the status or the suffering of the drug addict who cares but little for physiological distinctions and nothing for logical discussions. He is a fait accompli; he is there and asks what are you going to do about it? He says: if you don't help rne I shall suffer the torments of the damned and I shall make it increasingly unpleasant for you if you don't try to do something. I am not only the victim of myself but I am also the bond-servant of the drug peddler. You will not assist me and you cannot suppress him. You are the society which is responsible for my being, and yet in my misery you turn a deaf ear and ignore me completely. You may arrest me, and punish me as much as you will. It is your prerogative because you are the stronger. But you will add one more vindictive and implacable enemy to the hundreds which are already undermining your existence. Help me to get out of this slough of perdition, to become a useful member once more. Pursue a relentless war on the fiendishly cruel and rapacious drug vendor; co-operate with foreign governments to prevent the illicit traffic in narcotics and though it cost you millions in money it will not only be doing an act of justice but it will repay you richly when the final reckoning comes."

Nation's Health-1923.26
"The widespread prevalence of drug addiction constitutes a situation which may well provoke serious thought on the part of the profession of preventive medicine. It is no exaggeration to state that we are face to face with a condition which, if uncontrolled, may tend to undermine the very foundations of civiliza-tion itself. So serious is this threat that half-way measures will not do; the circumstances are such as to call for drastic and thoroughgoing measures. These are not the alarmist beliefs of fanatical reformers, but the sober judgments of capable physicians, wise jurists, and well-balanced men and women who know from personal experience and observation the way in which the great army of drug addicts is being recruited daily and the misery and degradation which is thus produced."
"Great international organizations have been formed for the marketing of narcotics. They ruthlessly violate any law of God or man to carry on their debasing trade. They fearlessly corrupt customs officers, the police and the very courts themselves in order that their contraband may reach and destroy the consumer. Certain physicians have even so far prostituted their professional standards as to become panderers to habitues, and men of responsibility in the community have so yielded to the pressure of the dollar that they have pro-tected drug peddlers from punishment by the law. From the fields of Turkey, Persia and India . . . out to the ports of the world, to centers for the distribu-tion of the drugs, to the scoundrelly vendors and their unfortunate victims, there runs a sinister line of bribery, smuggling, bestiality, deception, and murder, energized by lustful avarice and greed.
"Up to date these dark forces have been largely combated by a small group of practising physicians, the legal machinery of the Federal Government and of the various states and municipalities, and a few public spirited volunteers. In a few instances these leaders have been assisted by public health workers. They have not always displayed the greatest wisdom in their well-meant efforts, but they have honestly and whole-heartedly pitted themselves against this octopus which is stretching out its tentacles into every walk of life and every stratum of society. This group is dealing with end results and consequently is failing to affect materially the elemental cause. There is a very genuine public health problem here and it is our duty to attack courageously this mental disease which menaces industry and public safety, which has invaded our hos-pitals, asylums, and penitentiaries and has even made serious inroads upon the army and navy. Once largely confined to the criminal classes, it is now not uncommon to find the vice in the higher walks of life and, worst of all, it is claiming as its victims many youths and adolescents. The disease 'must be regarded as a highly communicable infection since one of its outstanding symp-toms is the desire to induce others to acquire the habit, and like other dangerous contagions, it must be fearlessly attacked and eradicated.
"This is not to be done easily. There is no universal panacea for the cure or the prevention of the drug habit. It is a secret mental vice which does not show itself early in the faces or comportment of its followers. It is easily contracted, and if followed for a single week may fasten itself firmly upon the unwary. It is difficult to cure, relapses and reinfections being frequent. The dope-fiend is a potential criminal from the beginning and brooks no restriction which will prevent him from his eventual self-destruction. The forces which are producing and marketing narcotics are strongly entrenched and they will not draw back from any crime in order that they may continue their profitable occupation.
"We may, and we must, arrest, prosecute, convict and punish; we may, and it is our duty, to treat the miserable habitues; we may propagandize in the hope of securing prevention through education; we may, and we should do all these things wholeheartedly, but we may do them until the end of time and never make any real progress. Just so long as there is not an absolute control of the production and sale of drugs there will be weak men to crave them and scoundrels to sell them. The place to cut off a snake's tail is just behind the ears. The place to attack this international menace is at the source, to control the raw products at the plantation, to regulate chemical works and their output to the extent that every grain of a habit-forming drug is accounted for up to and including the point where it is administered by a physician to meet an un-doubted therapeutic necessity."
"Under the system developed by modern banking it is possible to transport and deliver money to any part of the world with scarcely the chance of a single loss. The same sort of system should prevail with regard to the habit-forming drugs. It is possible to put it into. force if the nations of the world will get together and rigorously carry out a united policy. The Hague Committee tried to bring about such an arrangement and failed. The League of Nations now has a board sitting to formulate plans with the same object in view. The United States has sent observers to the meeting apparently to lend the moral influence of an onlooker sitting on the fence. Whatever may be our views regarding 'entangling alliances' this is no time to be hanging back timidly. The international traffic in dangerous drugs is not a political question, it is a great health issue. It is an affair of the greatest possible moment. It is a responsi-bility which, if dodged by- us or if not met in the open by our people, is going to do us an infinitude of damage. We cannot sit by as critics. We must get into the fight instead of telling the other nations what they should do and how they should do it. It is just as much our fight, just as much of our interest as would be a devastating plague epidemic in Europe, Asia or Africa. The civilized world must combine against this menace and we must not be too proud to fight an enemy which threatens the integrity of civilization."

Henri Claude-1923."
After commenting on the lack of hospital facilities for the treatment of cases, the scarcity of physicians experienced in the handling of these cases and the undesirability of treating them in hospitals for mental diseases, the author says:
"There is here a void that would be filled by the establishment of mental hygiene dispensaries connected or not with psychiatric hospitals and of free services which would provide for the voluntary treatment of cases without com-plicated administrative red-tape and thus make treatment by competent physi-cians available. The results following the withdrawal could be made perma-nent through dispensary supervision with social visitors to watch over the environmental conditions of patients. Those who were found to be relapsing could be quickly supplied with medical help and moral support—both of which are now lacking.
"In conclusion, prophylactic education, by preventing the spreading of the evil, will diminish the number of cases and the mental and social assistance through such mental hygiene 'services and dispensaries will finally assure the competent handling of these cases.
"In France, particularly in Paris, thanks to the Mental Hygiene League and of its devoted president, Dr. Toulouse, the fight against drug taking is about to enter a phase of accomplishment."
William G. Somerville-1924.28
"Who is responsible for the care of this immense array of narcotic drug addicts, what should be done for them, and what measures can be recommended to prevent or even limit future addiction? .
"A few seek relief in private sanitaria, where they can be received only on voluntary admission and can leave when they please. This is always before they are sufficiently recovered, as there is no law by which they can be held, and fre-quently they have not the means to enable them to remain longer.
"The majority of addicts are financially unable to obtain private treatment. There are a few places in some states where they are treated in the city hospitals for a short period, but not long enough to hope for permanent results. Many are committed to county jails and workhouses as vagrants or on some technical charge, though they are not crimiaials nor are they vicious.
"Twenty states have passed laws forbidding the physician's giving morphin to a drug addict and specifying that he go to a hospital for treatment. This would be an excellent law were he financially able to bear the expense of treatment in a private sanitarium, or were provision made by the city or state for his care and treatment. But public provision for his care is very limited, in most places not obtainable, and in any case he cannot legally be held long enough to do material or permanent good.
"Our contention is that drug addicts are suffering from a malady, a disease, which absolutely unfits them for their work or else reduces their efficiency to a marked degree; that a large percentage are curable with proper treatment, and the proviso that it be made impossible for them to procure the drug; that it is the duty of the state to make provision for the care and proper treatment of all drug addicts; that they are entitled to it as much as the insane (but that they should not be treated in the same institution as the insane). Their commit-ment should be compulsory.
"If we were to have institutions in every state capable of caring for all addicts, the solution of the problem would not yet be accomplished. There is a menace with which it is difficult' to cope. That menace is the peddler, and along with him we would place the druggist and physician who sell morphin to addicts or write prescriptions for them. Until we get rid of these, 'cures' are frequen-tly temporary or in vain.
"The peddlers' trade is dependent upon supply and demand. It has been suggested to limit the supply by restricting the amount of the poppy grown This would require international cooperation and would strike at the very root of the evil. On the other hand, if the commitment of all drug addicts were made obligatory, then the demand would necessarily be diminished or abolished according to how complete were the results of the commitment.
"In addition to this, bootlegging, whether in the ordinary manner or by a druggist or physician, must be made, by statutory enactment, a very grave offense, punishable not by fines, but by a long period of imprisonment.
"The summary of our conclusions and suggestions is:
"(1) Strike at the source of supply and by international cooperation limit the growth of the poppy.
"(2) Eliminate the importation and manufacture of heroin, for which there is no need as a medicine.
"(3) Educate physicians and the public to the fact that narcotic drug addiction is a disease per se, and not a vice.
"(4) Let each state establish special sanitaria, where addicts, either by volun-tary treatment or compulsory commitment, may receive treatment from skilled physicians.
"(5) Eliminate all illegal channels of supply by proper Federal supervision and drastic laws entailing long terms of imprisonment for bootleggers and all violators of the Harrison narcotic law."

S. A. Knopf-1924."
"There are certainly not a million diabetics in this country, and yet with what justifiable joy did we not greet the great discovery of Banting and how eager are the medical centres to teach the administration of insulin I Courses are offered to the general practitioner for acquiring the latest knowledge on the treatment of diabetes mellitus by means of dietary regulation and the use of insulin.
"Why cannot something similar be done on behalf of the one million or more drug addicts? The law which forbids the private practitioner to treat the drug addicts for a longer period than thirty days, and only permits continuous treat-ment in special institutions, is absurd, at least at the present time, in view of the large number of addicts and the small number of institutions. Granted even that Commissioner Simon's statement that sixty-five per cent of those arrested as drug addicts had a record on file in the Criminal Identification Bureau of the New York Police Hospital, should not be applicable to the ent.ire country, the problem is nevertheless a criminal and social one, as well as it is a medical problem, and by its vast distribution, not a local, state or national, but an international problem.

"In addition to the suggestion mentioned above, to appoint a commission to outline the best possible treatment for the narcotic addict and to deal with the problem of the cause and prevention, etc., I would make the following addi-tional suggestion so as to avoid the possibility of even only an occasional un-scrupulous physician abusing a'nd violating his privilege by prescribing for drug addicts for financial gain. The commission should be authorized to grant special licenses only to such physicians who have, by their studies and experience, proved themselves to be competent to treat drug addicts. These physicians should be obliged to keep careful records of their narcotic cases and their methods of treatment, and the records should be subject to examination by the commission referred to. The county medical societies are perhaps best qualified to designate the men who by reason of their reputation and learning should be recommended to the commission as especially equipped for the treatment of drug addicts.
"What an opportunity for our government or our great benefactors, the Rocke-fellers and other philanthropists, to be helpful in this work by giving financial aid in creating such a commission and such urgently needed courses in the best and most approved methods of treatment of narcotic addicts. Of course, there probably will have to be created many more institutions for temporary voluntary or compulsory confinement. Research bureaus and laboratories will also be necessary. The urgent need of an energetic combat of the problem in all its aspects is obvious."
"In these international conferences the United States should take a bolder attitude and announce a policy of full coopemtion in maintaining and operating the only international machinery for this purpose now in existence. In my opinion, one or two of our leading medical men representing the physicians of this country should be sent to that conference, besides the federal representatives already there. Our profession, which is unjuitly accused of fathering the nar-cotic problem, should be the first among those who are eager to combat it."
"Over a million drug addicts, many of whom are already confirmed criminals, in a population of one hundred and ten million is a fearfully dangerous and alarming situation. It will require the combined action of wise governments, enacting and enforcing mtional antinarcotic laws, well trained physicians and experienced social workers, numerous special and well supervised institutions for the sanatorium treatment, large-hearted philanthropists who will help to defray the expenses of so vast an undertaking, and lastly, but above all, education of all the people to the fearful consequences of drug addiction."
New York State Commission of Prisons-1924.80
The special committee appointed by this commission in its report makes the following suggestions for the better handling of the problem:

"A Remedial Program.
"The narcotic drug evil is so widespread and insidious that the most strenuous and united action will be necessary to control it. So long as large commercial profits can be made off the weakness, folly, ignorance and misfortune of men, attempts, more or less successful, will be made to evade the laws and efforts for its regulation. Education, medical and lay, regulatory and sane laws, social welfare work, scientific medical treatment and justice have been the most effective agencies and forces in combating social evils, and to them society must resort for protection against the drug problem.
4(1.
"Education.
"A careful educational program should be formulated which will present to the public the evils of narcotic drug addiction. School authorities should be advised to teach the facts in the schools and warn the young of the destructive nature of the disease. Educational campaigns have materially reduced the number of the victims of tuberculosis and venereal diseases. Possibly some organization or foundation will undertake such a campaign against drug addiction. "More education is desirable in the training of the medical profession for the treatment of drug-addiction disease. The average doctor is astonishingly unin-formed on the diagnosis and prognosis of the disease. Medical schools should give its study more prominence and doctors be trained in its specialized treat-ment.
"II.
"A State Law.
"New York State should enact a State-wide law. The Federal agencies ars not sufficiently equipped to cope single handed with the evil. The full powers of the State and its municipalities should be exerted to regulate the traffic and suppress abuse.
"III.
"Drug Selling and Peddling Should Be Made a Felony.
"The illegal sale and peddling of the designated drugs should be made a felony punishable by imprisonment for a long term. Trafficking in drugs is exceedingly profitable and the venal and desperate persons engaged in it will never be dis-couraged until they are made to realize that the risks are not worth the penalty. A few months in jail or a fine, will not deter them.
"IV.  "Hospital Treatment.
"The attitude of hospital management toward drug addiction should be modi-fied. Neither public nor private hospitals care to take addicts; their suffering is intense and they are therefore troublesome. Since drug addiction is a disease, public hospitals should be compelled to receive them. The law should prescribe the process of commitment and the addict should be kept under custody as long as he remains in the institution. Philanthropic hospitals, in fulfillment of their humane purpose to relieve suffering, should equip wards or pavilions to which addicts can be legally committed, under State regulation and inspection. More hospital accommodations and competent physicians and nurses are needed to handle the number of addicts applying for treatment.
"V.  "Farm Colonies for Addicts.
"When the addict is incompetently treated and taken off the drug he is physi-cally enervated and morally unfitted to witlastand the disease and temptation to return to the drug. Some should be sent to a properly conducted farm colony where they can be physically built up and morally readjusted. The State of New York and the City of New York should each establish an institution of this kind.
"VI.  "After-Care.
"When the addict returns to the community from the institution, some form of after-care should be provided when necessary. The addict who goes back to old associations is almost certain to become readdicted if not completely treated and cured. In some cases, as in the treatment of inebriety and prostitution, con-tributing contacts must be broken if permanent results are to be secured.
"Many addicts interviewed said that return to old associations was responsible for readdiction; others said that after keeping away from the drug a long time 'discouragement', 'family trouble', 'lack of employment', 'depression', and 'sick-ness' were the causes of readdiction. If some friendly contact or association could be furnished when the need arises, many of them might be saved.
"VII.  "Coordination of State Institutions.
"More cooperation should be sought with State institutions for the treatment of drug addiction. If an addict is feeble-minded (and many of them are) he can be committed to such institutions. If a delinquent addict is mentally de-fective, there is room in Napanoch. Many addicts can be held in custodial institutions and receive treatment until they are fit to return to society.
"VIII.  "The Criminal Addict.
"Addicts charged with. crime and detained before trial and addicts convicted of crime present two distinct considerations. The detained addict is confined in a jail which often contains no hospital and gives little or no treatment. The withdrawal sufferings take place during this period. Either decent hospital accommodations and adequate treatment should be provided in the jails, which is not likely to happen, or the addicts needing treatment should be removed to a public hospital under custody previous to their final disposition.
"After sentence is imposed the addict should receive more humane and scien-tific treatment in the penal and correctional institutions. Doctors in these institutions should adopt scientific methods and give to the drug addict the same
specialized attention they give to other diseases. More individual and differentiated treatment is also needed in institutions using the gradual reduction method.

"The Non-criminal Addict.
"Because penal and correctional institutions exercise custody, the easy way for the public to dispose of addicts seeking treatment is to call them criminals and shove them out of sight into prisons or so-called correctional institutions. They are pronounced guilty of a 'vicious-habit,' or 'pernicious vice.' The criminal records of many of them consist of previous convictions of the use of drugs or previous self commitments for treatment and many have no previous convictions or commitments of any kind. Such procedure is not just; no person suffering from a disease should primarily be sent to prison for it,s treatment.
"Non-criminal addicts should not be committed to the prison on Riker's Island or to the Workhouse on Welfare Island or to Bedford Reformatory. Physical conditions are unfit on Riker's Island and the association and contacts on Riker's Island, in the Workhouse and in Bedford Reformatory are depraved and criminal. The great City of New York should not continue to misuse these unfortunates who are willing, voluntarily, to undergo great suffering in the hope that they can be cured of disease. The proposal to extend this method of treatment to non-criminal addicts throughout the State is repugnant and harks back to the time when paupers were sent to workhouses and the insane to poorhouses.
"X.
"Research.
"A good deal of study and research is necessary to understand drug addiction, especially in gathering statistic,a1 information and in medical diagnosis and treat-ment. Research work should be encouraged.
"Recommendations.
"1. That children in the schools be instructed in the facts and evils of drug addiction and warned against the causes producing the disease.
"2. That a rational State law be enacted for the intelligent regulation of the use, possession, traffic in and sale of habit-forming drugs.
"3. That the illegal sale and peddling of the proscribed drugs be made a felony with severe penalties.
"4. That public hospitals be required to receive under custody persons suffering from the disease of drug addiction and their medical and nursing staffs be trained in its proper treatment and cure.
"5. That the State of New York and the City of New York, each establish a farm colony for the treatment of drug addiction and secure intelligent and competent administration.
"6. That drug addicts eligible for admission be committed to State custodial institutions.
"7. That more humane treatment be accorded to drug addicts in public institutions; that proper scientific methods be adopted; and that more specialized attention be given to inmates suffering from the disease.
"8. That persons who are not convicted of crimes be not committed to prison and correctional institutions for treatment of the disease of drug addiction. Respectfully submitted,
(Signed) Frank E. Wade,
Chairman.
Cecilia D. Patten,
Walter W. Nicholson,
Leon C. Weinstock,
Commissioners."
Ministry of Health of Great Britain
Departmental Committee on Morphine and Heroin Addiction-1926.3'

The report of the Committee 32 deals with a question not frequently considered in this country: namely, the continued supplying of an opium preparation in certain cases in which an intercurrent malady does not exist. The report states:
"Apart from the cases dealt with in the two preceding paragraphs, we are satisfied that any recommendations for dealing with the problem of addiction at the present time must take account of and make provision for the continued existence of two classes of persons, to whom the indefinitely prolonged administra-tion of morphine or heroin may be necessary:
"(a) Those in whom a complete withdrawal of morphine or heroin produces serious symptoms which cannot be treated satisfactorily under the ordinary conditions of private practice; and
"(b) Those who are capable of leading a fairly normal and useful life so long as they take a certain quantity, usually small, of their drug of addiction, but not otherwise.
"Most of the witnesses admitted the existence of these two classes of cases, though in some instances with reluctance. Some physicians of great experience believed that if thorough treatment could be carried out in ail cases, it would very rarely, if ever, be found necessary to provide any addict with even a minimum ration of drug for an indefinite period. It was recognised, however, even by these witnesses, that under present conditions it was not possible, for reasons already stated (see paragraph 44), thoroughly to treat all cases. There must, consequently, remain persons in whom a complete cure cannot be expected.
"Further, many of the witnesses were of the opinion that, even were it possible to treat thoroughly all cases, there would still exist a certain number in one or other of the two classes above of persons who could be grouped in one or more of the two classes enumerated. When, therefore, every effort possible in the circumstances has been made, and made unsuccessfully, to bring the patient to a condition in which he is independent of the drug, it may, in the opinion of the majority of the witnesses examined, become justifiable in certain cases to order regularly the minimum dose which has been found necessary, either in order to avoid serious withdrawal symptoms, or to keep the patient in a condition in which he can lead a useful life. It should not, however, be too lightly assumed in any case, however unpromising it may appear to be at first sight, that an irreducible minimum of the drug has been reached which cannot be withdrawn and which, therefore, must be continued indefinitely. Though the first attempt entirely to free a patient from his drug may be a failure, a subsequent one may be successful. In this connection a paragraph may be usefully quoted from the precis of evidence furnished to us by one of the general practitioner witnesses who has successfully treated several cases of addiction: have encountered cases where for a time administration had to be continued on account of physical and mental distress when withdrawal was attempted. In every case, as soon as possible, further attempts to get the patient to give up the habit were made. In two cases, for a period of several months, it was necessary to continue administration of small doses of morphia to allow the patient to lead a useful life. In both cases it was finally given up.' "
The same report considers at some length what may be accomplished toward the prevention of medically formed cases of opium addiction where possibly the drug has been used ill-advisedly or for unneces-sarily long periods. The discussion of this phase of the problem follows:

"Precautions in the Use of the Drugs in Ordinary Medical Practice.
"The evidence we have heard would appear to indicate that there has been a recent diminution in t,he prevalence of morphine addiction, and that this is due to the operation of the Dangerous Drugs Acts in making it difficult to obtain the drugs except from or on the prescriptions of doctors. (See para. 24.) This enhances the importance of consideration of the precautions that are necessary in the use of these drugs in ordinary treatment, in order to reduce to a minimum the risk that a patient may develop a craving for them. These preca.utions are, we think, fairly well recognised among competent and careful practitioners in all branches of the profession, and the conclusions here stated, based on the testimony of our medical witnesses, including representative general practitioners, may, we believe, be regarded as expressing fairly the opinion of all members of the profession who have given the requisite attention to the subject.
"Where the patient is suffering from organic disease for the treatment of which the drugs are necessary, the matter may be considered under two aspects, (a) cases in which the administration of morphine or heroin may be necessary for an indefinite period and in which the probability of a cure of the disease is remote (e.g., inoperable cancer and the like), (b) cases in which administration of the drugs is called for in order to deal with conditions which, though due to organic disease, may be expected to be of a more or less temporary duration (such as renal or biliary colic, etc.). In regard to class (a), since consideration of the possibility of the establishment of a craving cannot be allowed to influence the administration of such doses of the drugs as are considered necessary for the adequate treatment of the organic disease, it will be in those rare cases only in which there is some prospect of partial or complete recovery from the disease that any attention can properly be given, during the course of treatment, to such measures as are likely to mitigate or avert the risk of subsequent persistence of any craving which may have been produced. In respect to class (b), the employment of these measures becomes of paramount importance. They are identical with those discussed in paras. 59 and 60, and consist mainly in the substitution, when possible, of other drugs for morphine and heroin, in close supervision by the practitioner of the amounts used and of the frequency with which they are administered, and in withdrawal of the drug as soon as the necessity for its administration has ceased.
"In stating the precautions which we think should be observed in cases other than those referred to in the preceding paragraph, we shall be understood to have in mind, particularly, those cases in which it is thought, necessary to administer, say, morphine, in such doses, with such frequency and for so long a period as may be requisite, for example, for the relief of pain after surgical operations, or in cases of severe neuralgia in which the necessary relief cannot be obtained otherwise.
"In cases in. which it appears that the use of morphine or heroin may be thus desirable, it must first be considered whether the purpose of treatment can be substantially as well served by other drugs that do not, involve the risk of addiction. Constant attention is necessary to adjust the dosage to the varying needs of the case. The intervals at which it is desirable to see a patient (not an addict) who requires the administration of morphine or heroin will necessarily be determined by the nature of the case. In cases of chronic disease requiring a more or less prolonged administration of the drugs, the patient need only be seen at such intervals as are appropriate on other medical grounds, but in cases such as renal or biliary colic, in which the necessity for the administration may cease at any moment, it may be important to see the patient more often than would otherwise be necessary in order to guard against the production of a craving.
"The quantity supplied or ordered at one time for use by those nursing the patient should not ordinarily exceed what will be required before the patient is seen again. Where any discretion is given to nurses as to administration it should be strictly limited by prescription, and any change made in the treat-ment should similarly be- stated in writing. The practitioner will realise that the responsibility for administration is entirely his, and cannot properly be delegated to any person not medically qualified. It is desirable also that the patient should not be informed of the name of the sedative drug employed ; particularly inexpedient is the handing over to the patient of original packages containing morphine tablets, or the like, which bear on their labels a clear statement of the exact amount in each tablet. Hypodermic administration of the. drug by the patient to himself is to be strongly deprecated.
"The use of the drug should be discontinued as soon as possible, and, if un-fortunately a craving has formed, close supervision and appropriate treatment must be maintained until the medical attendant is satisfied that the patient has been rendered independent of the drug. It is to be noted in this connection, that, in the opinion of some authorities, a month's continuous administration of morphine may suffice to produce in a person who previously appeared normal a condition of addiction (as shown by withdrawal symptoms observed on dis-continuance); and in persons with an inherent predisposition, administration for a shorter period may have this effect.
"Most of our medical witnesses have concurred as to the desirability of special instruction to medical students on the precautions necessary in the use of morphine and certain other drugs in order to avoid the development of addiction. One or two medical witnesses, on the other hand, expressed doubt whether such instruction might not accentuate the undue timidity which they believed was not uncommon among practitioners, with the untoward consequences above described (see para. 32). We think, however, that such a result need not be feared from a full exposition of the actions, both valuable and harmful, of these drugs, the indications for their use, their proper place in treatment, the dangers to be guarded against, and the best means of averting these dangers. We think also that medical practitioners already in practice should welcome the issue of a Memorandum affording guidance on this important and difficult subject."

E. Joel and F. Frankel-1927.33
As fundainental to the adoption of rational public measures against the misuse of narcotics, the authors report their findings from both their clinic and private practices, covering about 600 cases of drug ad-diction treated in Germany. Among the preparations cited as used by their cases are the following: morphin, tincture of opium, pantopon, dicodid, dilaudid, elikodal, heroin, paramorphin, trivalin, eumecon, and cocain. They state that about half of their cases obtained the drug il-legally in spite of the Opium Statute covering the distribution of dan-gerous drugs. It requires that such preparations be supplied to the public only as remedies on the written prescription of the physician, dentist, or practitioner of veterinary rnedicine. The regulations of this statute, they state, are very commonly disregarded. Among the types of violation, they montion the refilling of prescriptions, the use of "standing prescriptions" (for which there is no provision in the law), the delivery of narcotics without prescriptions by pharmacists, the forging of prescriptions--made possible through collusion or careless-ness on the part of the druggist, purchasing of prescriptions for from 20 to 50 pfennigs, the obtaining of prescriptions for the drugs by non-ad-dicts who simulate addiction and dispose of the drug to habitual users, the "legal" but reprehensible writing of prescriptions for any quantities by a certain physician, the peddling of drugs stolen from public stores and manufacturers, "speak-easies" for addicts where the injection is given by the proprietor of so-called "Pennerkneipen" or night-shelters, etc.
As remedial measures they state that "the basis of the legal traffic in dangerous drugs is the prescription." They point out that it is the duty of the druggist in preparing and delivering dangerous drugs, to make sure that the prescription is not a forgery, a matter easily verified. They further point out the duty of the physician to be care-ful in the writing of such prescriptions, and recommend that they be written on printed blanks bearing the telephone number of the phy-sician and his full address, and include directions for use. They recommend further that in the prescribing of dangerous drugs the doctor should be restricted to the drugstores of the district in which he resides; thus making it easier for the druggist to verify the authen-ticity of a prescription. As a still better provision, they recommend the use of the official prescription blank, such as is used in the United States, under the provisions of the Harrison Act.
Cocain and certain other drugs, they state, should never be delivered in pure forms but only in solutions which would be far more difficult to peddle than is the powder. In this connection they state that eukodal in a pure form is no longer placed on the market by the firm which manufactures it, even though it does not come under the Opium Statute. While it is not a derivative of morphin, biologically it is an opiate and should, they think, be included in the international opium agreement and in the German Opium Statute. In this connection they state:
". . The abuse of eukodal is not inconsiderable; it is a favorite with former cocain addicts in particular, and is obtainable illicitly. It is prized bec,ause it contains a stimulating component in addition to its narcotic effect. Many addicts declare that morphin together with a little cocain is about equivalent in effect to eukodal. It is a very frequent occurrence for former morphinists to go over to eukodal. The patients themselves explain that the druggist can give it to them without prescription, since he does not require a 'drug certificate' for eukodal."

They denounce the continued prescribing of cocain, even in decreas-ing doses, to habitual users, as it is so prescribed only for the "pleasure" it gives, and quote a decision of the Supreme Court in this connection, in which the delivery of cocain prescriptions can incur the guilt, on the part of the physician, of abetting illicit acquisition of cocain. From the legal point of view it has been said, they state, that what the Supreme Court decision says with reference to cocain, is equally applicable to morphin and similar narcotics. They continue, however, as follows:
"Theoretically, this might happen. The state of affairs with reference to morphia is, however, quite different. The morphinist, as soon as he has really suceumbed to his craving, no longer derives, as must be repeatedly emphasized, any real pleasure from his syringe; he only gets the re-establishment of his equilibrium. The morphinist, when in want of his drug, is actually like a patient with objective symptoms. This acute form of morphinism is relieved at a stroke by an appropriate dose of morphin, and is so relieved as can be done on/y through morphin (or a related opiate). The morphinist feels well again, but there can be as little talk of enjoyment in this connection as there might be with regard to the coming out of a faint or the recovery after a fit of weakness. In a pronounced case of morphinism, is morphin a remedy or a means of enjoyment? It cures the acute morphin debility, the abstinence symptoms; it does not cure morphinism, of course; it merely fosters it. On no account, however, is it a means of enjoyment. There could be talk of the latter only when, there being no need to relieve pain or to satisfy the cravings of morphinism, morphin is prescribed for incidental enjoyment, for sensual grati-fication, and the like. But this happens very rarely in the case of morphin.
"Every physician who comes to know a morphinist (without other ailment) will try to induce him to submit to a withdrawal cure; but economic or professional reasons, for example, may make immediate action upon such advice impossible. In such cases (the same is true, to a slighter extent, for cocain) the physician will have to be satisfied with reducing the doses as much as possible. There are also cases in which comparatively small doses will keep the individual fit for work ; a cure, however, brings no improvement but rather causes trouble in other directions; varied experience then causes the individual to refuse withdrawal treatment. In such cases, too, the prescription of morphin will have to be regarded as a curative measure. Above all, there can be no talk of enjoyment in those cases--rare to be sure--in which the drug compensates for a constitutional debility, a defect of vitality. Only the doctor, after a most careful examination, can render a decision as to the presence of such a condition."
As a further control measure they recommend "bureaus" for the care of addicts, stating:
"This is the point at which the community health bureau can step in with the work of bureaus for addicts, to which—at least in large cities—bureaus for alcohol-patients should be added. The physician who supposes that he is only one of many who write prescriptions for the addict, the druggist who is continually importuned for narcotics, will turn such a patient over to the physician of the bureau for a 'clearing up of the situation. This method has proved itself practical. Frequently it will then be possible to put through the withdrawal cure, long since contemplated but continually put off—or at the least, the patient can be turned over from there into one hand. It is the practitioners themselves who have from time to time proposed the duty of reporting addicts (partly, I suppose, for the sake of ridding themselves of the uncomfortable feeling induced by the constant issuing of prescriptions for intoxicating drugs). This proposal might seem at first too drastic, but a certain localizing, which would restrict the journeyings of patients from physician to physician and from drug store to drug store, would be desirable.
"Moreover, in cases where the addiction has led to neglect of the family, the bureau is better able than the individual physician to exert a certain pressure, occasionally even to have the patient declared irresponsible, at least until a final withdrawal cure has been accomplished."
In connection with the putting out by manufacturers of new prepar-ations possessing narcotic properties as safe substitutes for opium derivatives, the authors state:
"The manner in which producers make known new narcotic remedies to physicians also seems to us in need of reform. The practitioner generally thinks that among opiates, for example, he is getting a real substitute for morphin, when in reality he is being offered only a stronger or weaker morphin. This is especially important when addiction is in question. A certain amount of time is required before a remedy develops a craving, before the craving begins to need treatment, before the individual physician can observe sufficient cases, in order to be able to speak with some degree of certainty as to the question of addiction. By the time the situation has reached that point the new remedy has already firmly established itself, and it is discovered too late that it offered not the least advance so far as addiction formation was concerned.
"This holds for eukodal as well as for dicodid and dilaudid. We find that the pharmaceutical prospectuses generally treat the question of addiction as concerns the particular new remedy which they are recommending, too optimisti-cally. Too little consideration is given to the fact that in the very great majority of patients who take morphin the craving also fails to develop. A is hard to see why the danger of a craving should be smaller in the case of the new substittites than it is with morphin. The facts speak to the contrary. It is likewise dangerous to say that eukodal is not a morphin com-bination or a morphia derivative. That is correct enough, but it is of no interest to the practitioner. He is concerned with the effect and not with the chemical composition. For him eukodal is a substance akin to morphin in its action, with all the secondary effects and dangers of morphia, and the same holds for dicodid and dilaudid, which likewise do not come under the Opium Statute.
"One must not object that these are questions which can be actually answered only after a fairly long administration of the remedies. Craving springs from the soil of euphoria, and then especially when continuous use has brought increased tolerance of the drug. The question as to whether a remedy induces euphoria can frequently be determined clinically even after a single administra-tion. The .question of increased tolerance, on the other hand, can be tested without difficulty in animal experiments; it is even possible, through comparison with morphin as control substance, to arrive at a definite quantitative com-prehension of the effect of addiction (cf. the work of E. Joel and A. Ettinger). "These precautions should in the future not be neglected when a new remedy is introduced, and one might wish that Boards of Health would demand such investigations, and that on occasion they would themselves carry them out and then require that the announcements of the pharmaceutical firms contain exact information. The authorities should also take into con-sideration, when the remedies are codified, not only the chemical formula. but also the action. If, therefore, a substance, no matter how differently constituted from morphin, acts like morphin, it belongs under the Opium Statute (which, despite its name, holds for cocain as well). The Opium Statute loses its significance if it imposes no restrictions on remedies which, exactly like morphin and heroin, might lead to addiction."
"An example which borders on conscious deception is the advertisement for eumecon, a remedy for the 'treatment of morphinism.' Eumecon is a 2% morphin solution with some non-essential additions. Up to a short time ago, the firm even kept silent as to the fact that eumecon is morphin. But now it still indulges in all sorts of mystery mongery. Instead, as would be logical, of drawing a distinction between morphin as an injection and morphin as a drink, it draws the distinction between morphin as an injection and eumecon as a drink. 'Eumecon, taken as a drink, is subjected to the entire process of metabolism, which alters the eumecon adaptably to the whole and changes it into useful substances.' An abstruse statement without even an attempt at proof.
"As on a former occasion, so again here, we wish to emphasize the fact that a remedy like trivalin, which is very much misused, must disappear altogether. We cannot imagine any indication for which the prescription of a mixture of morphin, cocain, caffein, and valerian would have any meaning.
"Recently—after a lapse of 40 years—the therapeutic application of Indian hemp has again been much discussed. Since there is no therapeutic advance made in the meantime, at the basis of the discussion, it would appear as if medical practice were trying to adapt itself to the needs of the drug market. 'Hashish is peculiar for its agreeable after-effect,' says one prospectus, omitting all mention of the fact that it is an intoxicating drug of the first rank. Another says: 'Cannabis indica is a mild, innocuous hypnotic.' In a third, cannabis is even designated as 'an excellent therapeutic agent.' Quite apart from the fact
'" The international opium agreement, Art. 14, offers a means of getting at this.that there is no evidence for that (cf. E. JoM, there is nowhere a word as to the dangers of the abuse of a remedy which, incidentally, lia.s not as yet been included in the Opium Agreement, and still worse, is not even subject to the compulsion of prescription. If Casparis thinks that hashish, even if obtainable, could scarcely acquire significance as a narcotic in Europe, it niight be pointed out that similar theories, originally held with reference to coca and cocain, later proved themselves an illusion fraught with heavy consequences.

CONCLUSIONS
"On the basis of the facts herein reported, we arrive at the following requirements:
"Dangerous narcotics should be prescribed on printed prescription blanks only, which should bear the full address of the physician (with telephone number) and the address of the patient. The prescription should contain directions for using.
"The introduction of a prescription pad for narcotics, to be issued officially, might be given consideration as a more far-reaching provision.
"Prohibition of the delivery of narcotics in pure form to patients.
"Inclusion of eucodal, dilitudid, and dicodid under the Opium Statute. Alter-ation of the statute to the effect that all addiction-forming narcotics should come under it.
"Establishment of bureaus for the care of addicts.
"Participation of insurance companies in provisions for preventing and curing.
"Restriction of deceptive advertisements. Prohibition of trivalin.
"In conclusion, utmost emphas.is should be placed on the fact that despite all the necessary and improvable public provisions against alkaloid addictions, the central question will always be a medical one and not a legal one. In more senses than one, the physician is responsible for the origin and treatment of addictions. He must permit his patients as little and as brief acquaintance with narcotics as is compatible with therapeutic purposes. In the cases in which intoxicating drugs are adopted as a necessity of life, he must attempt to introduce in their place something really helpful and not merely palliative, and that is a much harder task than the mere withdrawal cure, which, without some provision of that sort, generally proves useless. Of this responsibility he must ever be conscious; not even the best legislation can relieve him of that."

Resume
A review of the past and current control measures directed at the problem of chronic opium intoxication shows that, although a thorough understanding of the fundamentals of this problem is needed for its solution, an appreciation of the importance of this need all too often has been lost sight of in drafting and putting into effect such measures.
The data submitted include statements of fact and expressions of opinion supposedly based upon experience and made by individuals whose integrity and intelligence should not be doubted, and yet, with scarcely a single exception, both the facts recorded and the opinions expressed categorically have been denied by others whose honesty and judgment equally should be respected. Many of these facts and opinions are perhaps relatively insignificant, but some of them are fundamental. As an example--an instance of the utmost importance-- may be taken the difference in views regarding the general nature of chronic opium intoxication. Here have been recorded explanations varying from the vicious, deliberate habit theory to the extreme of the theories held by the strictly physical school and all grades and combinations in between. This is fundamentally a matter for ac-curate determination, as at least one essential preliminary to any plan for complete solution. Yet there is not a single variety of view which from the evidence adduced is so well supported or so thoroughly demonstrated to be correct as not to admit of doubts in the minds of any who might attempt to base thereon a program purporting ra-tionally to solve the problem. In other words, certain of the funda-mentals for the solution of the problems comprised in chronic opium intoxication are either not known or not sufficiently well-established to permit an unbiassed advocacy of any single method of procedure.
It is certainly not beyond the realm of possibility to conceive that in each one of the views expressed there is an element. of truth. In fact, in consideration of the experience, training, and apparent honesty and intelligence of those advocating them, it is more than probable that such is actually the case, and yet at this time the differences of opinion are so great as to make it impossible to devise from them any general scheme of action which may be expected to escape just criticism, if nut actual failure.
Current knowledge and common observation are sufficient to con-vince anyone of the very serious shortcomings of every program which has so far been put into general operation and every such plan has been based largely on one or another of the as yet unproved theories or opinions covered in the data submitted.

The conclusions are:
First, no single one of the widely divergent explanations of the exact nature or mechanism of chronic opium intoxication is sufficiently well supported to permit of its unqualified acceptance.
Second, granting that the above is true, any procedure based upon one or another or any combination of these views may lead to manifest errors of handling and even to widespread injustice and to failure of accomplishment.
Third, if these two deductions are correct, the basis of a sound method of control through legislative and administrative procedures is lacking, namely, accurate knowledge of the very nature of the condition with which such legislation and administration deal.
Confronted with such a situation, two courses of action are open to anyone interested in the solution of the problem. The first of these is to continue the search for further information through approved methods of investigation, to corroborate or disprove any one or all of the different theories, or to substitute a new one. Second, pending the determination of knowledge sufficient to permit of the formulation of sound measures for alleviation and control, to view with grave concern the advocacy of any policy which takes into consideration and assumes as its basis exclusively any one of the existing explana-tions of the nature of this condition. In other words, at no time in the past and as far as we know in no present plans for the future have the obvious essentials to a successful issue been taken into consideration. But in place of this, definite and specific laws and regulations have been adopted and inelastic interpretation and administration have been practiced on the basis of assumptions that may be either true or false.
In view of the extreme complexity of the problem as a whole and of what would appear at this time to be the fairest assumption of all in regard to the expressed opinions, namely, that each one may contain a partial truth, it would be well to advocate the most elastic ad-ministrative measures possible. Such an adjustable policy should be adopted towards the individuals involved in this condition and to-wards the medical profession or others whose legitimate business or profession brings them into contact with them, as will reveal—and so create a more widespread understanding of—the essential differences in the individual types and in their physiologic and psychic reactions under the influence of the chronic use of opium.
The same tolerange and elasticity of administration should be ap-plied to whatever systems tentatively are employed in the handling of these patients, especially when such systems have proved efficient in the handling of other medico-social problems or where in default of exact knowledge more hopeful measures are not available. As we have pointed out elsewhere it seems that needless difficulties have been placed in the way of the clinical, psychiatric and sociologic handling of certain types of chronic opium users. Thus certain clinics that were instituted for these purposes seem from the reports received from many quarters to have offered unusual opportunities for much needed studies along many lines. They represented a constructive experiment and offered promise of material benefits. They were closed arbitrarily, however, regardless of individual merits while still in a period of increasing usefulness and before their development had progressed sufficiently to permit of final evaluation.
Above all it is important to encourage those who by training and experience seem best qualified to carry on research or to apply existing knowledge in this developmental stage of ideal or ultimate solution.
Even the most cursory review of the development through many centuries of the opium problem; of its penetration into every country of the world; of its proper and improper relationships to individual and group life; of the fundamental human needs involved as well as the fundamental human vices; of the irreplaceable nature of the drug itself and its apparently unique biologic effects, to say nothing of the direct, indirect and frequently very complex etiologic factors involved in its chronic use, should serve to impress the thoughtful with the urgent need of more accurate knowledge, of more careful considera-tion of all of the available facts, and of more caution in the expres-sion of opinions and in the advocacy of policies that tomorrow may be shown to have been ill-judged if not maleficent.
It is our opinion that while international accord and cooperation is desirable as a step towards final solution, the most important out-growth of the various international deliberations will be, not the actual control of production with its resulting curtailment of the illicit traffic, but rather the achievement of having focussed inter-national attention on a problem that from its very nature affects actually or potentially all peoples both beneficially and harmfully, and that appears to have increased rather than diminished with scientific and sociologic advancement. This directing of attention and interest we believe will result in stimulating orderly thought and study of a subject that for a long period has commanded too little earnest consideration, while many from interest,ed motives alone have contributed to its confusion. With the development of an increasingly extended intellectual approach and a corresponding decrease of emotional, commercial and other interests it is reasonable to expect the growth of sound and well-founded policies of an international, national and above all medical and sociologic character that ultimately will re-duce the evils of opium use to the minimum consistent with its proper therapeutic employment. Until such time we should look with dis-favor upon dogmatic statements and arbitrary and unscientific rulings relating to either groups or individuals, while seeking in the experiences of all earnest and intelligent workers such elements of fact as may be uncovered and utilizing them in the gradually evolving plans for prevention and control that unquestionably will develop with an increased knowledge and eventually supersede the chaos of con-tradictory opinion that marks present-day activities.

1 American Medicine, New Series, Vol. X. No. 11, pages 799-801, Nov. 1915.

2 Rubin, S. H.—Drug addiction and modern methods for control. Boston M. & S. J. 175-792. Nov. 30, 1916.

3 'Wood, Horatio C., Jr.—Some of the Results of the Harrison Anti-Narcotic Law—Jour. Amer. Pharmaceut. Assn. 1916. Vol. 5.

4 Bloedorn, Walter A.—"Studies of Drug Addicts." Repr. U. S. Naval Med. Bull. XI. No. 3.

5 Bloedom, Walter A.—"Drug Addiction." Chic. 1919—Repr. J. A. M. A. Jan. 25, 1919.

6 'Loc. cit.

7 Recommendations of the New York Psychiatrical Society and the Public Health Committee of the New York Academy of Medicine. Medical Record, March 16, 1918. Vol. 93.—p. 468.

8 Gordon, A.—The relation of legislative acts to the problem of drug addiction. Virginia M. Semi-Month. Richmond 1917-18. XXII. 57-59.

9 Kane, Francis Fisher, Chairman. "Drug and Crime." J. Amer. Inst. Crim. Law and Criminology. Nov., 1917. Vol. VIII. No. 4.

10 Densten, J. C.—Drug addiction and the Harrison Anti-narcotic law N. Y. 1917. Repr. N.Y. MJ. Apr. 21, 1917.

11 u Dana, C. L.—Problems of drug addiction. Med. Rec. 93:177. Feb. 2, 1918.

12 Scheffel, C.—The victims of habit-forming drugs, from a medical, sociological and legal point of view. The Medico-Legal Jour. Mar.-Apr., 1918. Vol. 35. No. 2.

13 American Medicine. January, 19'10, pp. 13-14.

14 Hubbard, S. D.—The N. Y. C. Narcotic Clinic and Differing Points of View on Narcotic Addiction. N. Y. C. Health Dept. Repr. No. 87. Feb., 1920.

15 " Hubbard, S. D.—Some Fallacies Regarding Narcotic Drug Addiction. Jour. Amer. Med. Assn. May 22, 1920. Vol. 74 (2), pp. 1439-1441.

16 J.A.M.A. May 8, 1920. Vol. 74, No. 19, pp. 1324-1328.

17 According to our best information this committee was composed of Drs. E. Elliot Harris, Chairman, A. T. McCormack, Paul Waterman, and Alexander Lambert, ex-officio.

18 Williams, E. H.--Some Observations on the Narcotic Situation. Med. Rec., 1921. Vol. 100. pp. 140-143. No. 4.

19 "Prentice, Alfred C.—The Problem of the Narcotic Drug Addict. J.A.M.A. June 4, 1921. Volume 76, No. 23, pp. 1551-1556.

20 J.A.M.A. June 11, 1921, Volume 76, No. 24, pp. lt369-1671.

21 'Jour. Amer. Pub. Health Ass'n, Dec. 1921, Vol. XI, No. 21, pp. 1066-1067.

22 Report of the Committee on Drug Addiction, Proceedings of Conference of State and Provincial Health Authorities of North America. 34-36, 1919-21, p. 58.

23 Crim, John W. H.—Narcotic Addiction in the United States. Printed for the use of the Committee on the Judiciary. Senate Committee Print 67th Congress. 4th Session.

24 " Perkins, R. G.—The present situation with regard to narcotic addiction in the United States. Illinois Medical Journal, 1922. Vol. 41. pp. 44-47.

25 *Scott, Leonard C.—Acting Ass't. Surgeon, U.S.P.H.S.—The Case of the Drug Addict. Quar. Bull. La. S.B. of H. Mar., 1923. Vol. XIV. No. 1. pp. 14-18.

26 " The Nation's Health--Public Health Aspects of Drug Addiction. Editorial. June, 19'23. Vol. V. No. 6. pp. 368-368.

27 Claude, Henri.—Sur quelques poisons eociaux ; la morphine et la cocaine. Revue Scientifique, 1923. Vol. 61. No. 16. pp. 509-515.

28 "Somerville, Wm. G.—Who is Responsible for the Drug Addict? Chairman's Address, Section on Neurology and Psychiatry, Southern Medical Association, Washington, D. C. Nov. 12-15, 1923. Discussed by Drs. M. A. Bliss, M. L. Graves, E. Bates Block, Beverly R. Tucker, Tom A. Williams, and Percy D. Hickling. Southern Medical Journal, Feb. 1924. pp. 108-112.

29 Knopf S. A.—The One Million Drug Addicts in the United States. Medical Journal and Record. Feb. 6, 1924. pp. 135-139.

30 New York State Commission of Prisons. Special Report on Drug Addiction. December 2, 1924.

31 Ministry of Health. Departmental Committee on Morphine and Heroin Addiction. Report. His Majesty's Stationery Office. London, 1926.

32 For the membership of this Committee see page 131, footnote.

33 'Joel, E., and F. Frankel—Oeffentliche Massnahmen gegen den Missbrauch von Betaubungsmitteln. Klinische Wochenschrift. 1927. Vol. 6. No. 22.