The problem of chronic opium 1 intoxication, as occidental countries have come to know it of recent years, is so extremely complex and far reaching, so intimately interwoven with public health, commerce and trade, and social customs, and has been evolved so insidiously that we may well ask if the use of opium ever was confined to its sole valuable function, namely, that of a therapeutic agent. So very complex, indeed, is the problem that it would be impossible and needless, at the present time, to attempt to delineate it in its entirety. The last thirty years. however, and especially the last ten or fifteen years, have brought one phase or another with ever-increasing frequency to public, scientific, and official notice.

Among the western nations, the United States seems to have acquired the reputation,—whether deservedly or not need not be considered here—of being more widely and harmfully affected than any other. Certainly, in this country there has been much more interest evinced in control measures both of an international and national character than elsewhere. Whether the problem is really greater in the United States than in other countries or whether, perhaps, the question simply has been more agitated here by virtue of a better appreciation of its extent are matters for speculation. Certainly, our news agencies have not minimized the importance of the problem or lessened the public's interest in it and today, on almost every hand, individuals, local organisations, scientific bodies, and legislative groups have become aroused to what is considered generally a health and social peril of magnitude.

Unfortunately, among those who have become interested from a professinal, legislative, administrative, sociologic, commercial, or other point of view, there has been an almost continuous controversy as to practically every phase of the narcotic situation, with the result that all the way from the causes on through the development, course, and treatment of the condition, to say nothing of its underlying nature and methods of control, there has been a lack of unanimity of opinion. These differences have been expressed in reports of scientific research, textbooks on medicine, legislative acts, judicial opinions, and administrative procedures,—in general, in the opinions and efforts of all who, from one motive or another, have appeared to seek a solution.

In view of the importance of the problem it is astonishing that little specific information on even the main features of this condition is available in any one place. In general, students and writers appear to have approached the subject from only a limited experience—with too meagre a basis of fact—and to have emphasized unduly one or another feature to the total exclusion of related data. This tendency quite naturally may have led the more or less casual reader as well as possibly legislators, administrators, and others officially or professionally connected with the individuals involved, to prejudicial attitudes and unwarranted generalizations.

The actual work involved in accomplishing the objects of the Co mittee consisted in the collection of all available useful data from:

1. A review of the medical literature as contained in standard textbooks on practice, nervous and mental diseases, therapeutics, materia medica and pharmacology, as well as in treatises, monographs, journal articles, theses, and special reports for a period covering approximately fifty years of medical progress.

2. A review of lay work, reports of investigations, individual studies, and the findings of official commissions.

3. A review and digest of the international, national, and state covenants and laws and the regulations relating thereto.

4. Addressing questionnaires to—

Medical heads of national, state, county and municipal penal and correctional institutions of the United States

Neurologists and psychiatrists

Medical heads of private hospitals for nervous and mental cases and those treating this condition

Medical heads of state, county and city hospitals for the insane Internists and general practitioners including
Members of special societies on pediatrics and internal medicine

"    " Association of American Physicians

"    " American Surgical Association

"    " American Association of Pathologists and Bacteriologists

"    " American Climatological and Clinical Association

"    " American Medical Editors Association

Individuals suggested by state health officers as being interested in the problem

Authors on materia medica, therapeutics, practice of medicine, etc.

Authors of books, general articles, etc., covering the subject

Municipal health officers and state health officers

Chiefs of police

5. Addressing questionnaires to heads of clinics and others whose professional connections had supplied them with special data relating to certain particular phases of the problem

in the belief that such a procedure would supply a fairly composite picture of the professional and official opinion and attitude of the day as to the medical and sociologic aspects of the problem.

Contrary possibly to the general belief, the bibliography on the sub-ject is very extensive;—that compiled for the Committee numbers more than six thousand items. Obviously this bibliography contains much valueless material and much which is almost wholly repetition under differ9nt authorships. Therefore, in the prosecution of the re-view of this material it seemed desirable to select that which would best represent existing knowledge and portray the views commonly expressed. This was done and in the selection the following matters were considered ;—the eminence of the authors in their respective fields, their known interest and experience in the problem under considera-tion, their influence in shaping medical and lay opinion, their official or semi-official connections, the employment of their writings for teaching purposes, the original or unusual attitudes held, their con-nection with public or private institutions of repute and their known efforts in research.

In any process of selection, no matter how great care is exercised, omissiens of more or less important material are always possible. The whole of the bibliography was not covered, but every reasonable effort was made to include all valuable material and the report submitted contains practically everything of a nature to assist in a determination of the present status of our knowledge of the subject.

Naturally greater space is given to more recent works, though it was deemed wise to include a few individual pieces dating as far back as 1850 or 1860, as the background so obtained assists very materially in understanding and evaluating more recent developments. For a really complete appreciation of certain of the phases of the opium problem as it exists today, a far more comprehensive historical review would be necessary as without it certain sociologic, economic, and political aspects may not be made wholly clear; but for the purposes of the Committee it seemed advisable to omit any comprehensive consideration of such matters as do not directly concern the handling of the problem as it exists in the United States today.

Whatever omissions may exist, it is believed that a sufficient portion of the best thought of the day on every important aspect of the problem has been covered to enable any one interested. without depending on the unsupported statement of single individuals, groups, or schools of thought and without further prolonged search, intelligently to draw conclusions as to the nature and needs of the situation, at least in so far as modern recorded thought will enable him so to do. The quotations are sufficiently extensive to convey accurate pictures and the material has been selected with the object of giving an eminently fair picture of the various theories current within recent years.

It should be noted that where not otherwise stated the quotations from foreign authors are our translations of the originals.

One further matter requires consideration, namely, the terminology employed. As elsewhere, here also controversial subjects are involved, for different writers have used terms and definitions which in them-selves have indicated particular attitudes toward the nature of the problem. Thus habit, craving, appetite, mania, addiction, addiction-disease, all may be interpreted significantly if desired by those using or reading them. We have tried to select some name for the condition of chronic opium-using that would not carry a partisan, restricted or incomplete implication as far as the nature of the condition is con-cerned. The phrase chronic opium intoxication seems to fulfill this purpose better than any other but it has the disadvantage of length and is at times an awkward expression. We decided, therefore, not to restrict ourselves to any one term, but to employ whichever of those in common use today seemed best suited to the individual need. We would emphasize the fact, however, that adherence to no school of thought or theory of the nature of the condition under consideration is to be inferred from the terminology employed in the present volume.

1. Opium as here employed includes all opium preparations and derivatives as morphine, heroin, codein, laudanum, etc.