In addition to the efforts made by the states reviewed above, certain municipalities have passed laws and instituted from time to time other activities directed at, the control of this problem. For the most part, these took the form of prohibitory laws similar in tenor to the state laws and hence do not require reviewing here.
In 1912, however, a different type of activity was undertaken in Jacksonville, Florida, in an effort to determine and lessen the chronic use of opium derivatives. The provisions of this local law have been outlined in a previous chapter and it is only necessary here to note its effect in regulating and controlling the distribution of certain drugs. Prior to the passage of this ordinance the only legislation dealing with the sale and distribution of opium and its derivatives was the state pharmacy law—in reality a poison law—and this law for years had been a dead lettkr. As a result it was a common practice for phar-macists to make counter-sales of opium preparations and to justify such sales by stating that indigent users could not afford to pay a physician for a prescription and then the druggist for the filling of it. The new law, through a provision that permitted the city health officer or any other medical officer of the health department to furnish free of charge prescriptions for these drugs to those unable to pay for them, eihninated the temptation and excuse for counter sales and in a very brief space of time such sales ceased entirely. It is of further interest and importance that the price of morphin at this period was so low—about sixty cents a drachm—that competition by peddlers could not be lucrative.
During the operation of this ordinance such peddling as existed was confined to one or two individuals who, as a matter of convenience, supplied certain customers in the restricted district who for reasons of their own preferred to pay the additional price than to come to the health department at, to them, inconvenient hours. Aside from this there was no illegal traffic.
When, however, the Harrison Narcotic Act was passed in 1914, the city clinic was discontinued. Those patients who were willing to take treatment were cared for at a general hospital and the giving of free prescriptions was discontinued entirely. This left a considerable num-ber of individuals who had not taken treatment as well as many who after treatment reverted to the use of their drugs. Immediately an illicit traffic sprang up, the price of the drug soared although the retail price in the drug stores remained the same, and ever since this period peddling has been as rife and as profitable in Jacksonville as elsewhere.
New York City.
In April L919 the Department of Health of the City of New York, under authorization from the State Department of Narcotic Drug Control, established a narcotic clinic. The reasons for the opening of this clinic and the objects sought are set forth in the following article by the commissioner of health, Dr. Royal S. Copeland:
"Within a few hours after the closing of their ordinary sources of drug supply, hundreds of addicts were clamoring for treatment. The doctors who had been growing rich in this traffic were frightened, and the poor victims had no means of relief. On April 10th, the New York City Health Department opened a Clinic for the temporary care of these patients. This is still in operation and up to this time more than seven thousand persons have applied there for treatment.
"The original intention in the establishment of this Clinic was to meet the urgent emergency of last April. It is now a clearing house, or admission bureau, preparing the way for the hospital treatment of the patient. Without absolute control of the patient and his complete isolation from clandestine sources of supply, there is no hope of cure. Ambulatory treatment is foreordained to failure so long as there are secret and illegal methods of obtaining the drug. Under present conditions, therefore, it is my belief it will be a very rare instance indeed when a patient is cured outside a hospital, or in the absence of equally well controlled conditions within a private house. So farreaching is the influence of this evil that no trust can be placed in persons not absolutely proof against cajolery and bribery, or in any surroundings not impregnable against assault. The cunning and ingenuity of the evil genius presiding over this practice are almost beyond belief.
"The Clinic has served a humanitarian purpose in that it has provided a place for a careful physical examination, advice as to needed medical treatment for fundamental conditions, and careful oversight of the progress of the drug disease. It has saved the addict from the victimizing methods of the doctor who heretofore has exploited the drug patients by charging excessive fees for bogus 'treatment', and of the druggist who has wickedly profiteered on the drug and not infrequently given short weight besides. Attendance at the Clinic has given the Health Department time and opportunity for study of the home surroundings, personal characteristics, and reliability of the patients.
"The gradual but consistent reduction of the daily dosage at the Clinic has shortened the period of the necessary hospital treatment. Likewise, it has increased the value of residence in hospital by sending patients in much better physical condition to begin with than would otherwise be the c,ase. The Clinic has given us a hold on hundreds of addicts who, without it, would be lost to the municipal authorities, and, lastly it has made possible a steady flow of patients to the hospital, thus justifying its necessarily large personnel, and in every way facilitating the problems of hospital administration.
"We come now to a consideration of the important feature of our program, the hospital care of the addict. It may be recalled that the Commissioner of Health had great difficulty in finding a hospital for these unfortunates. Public opinion had to be moulded and official consent gained, but finally Riverside Hospital, on North Brother Island, was set aside by the city for the admission and treatment of these patients. We have there seven hundred beds and up to this writing sixteen hundred patients have been admitted. If I had ever doubted the wisdom and propriety of this method of caring for the addicts, all doubts would have disappeared after my last visit there, two or three weeks ago. I happened to arrive at the dinner hour and saw at the tables two hundred husky, red-cheeked, bright-eyed and clear-brained young men who, a month before, were wrecks of humanity, skulking about the streets of New York, seeking narcotics at any cost, even by the commission of crime.
"The patients are now being discharged from day to day and are being re-turned to the community sound in body, if not regenerated in mind and soul. Society has a very important problem to meet in the reception and placing of these deserving persons. The Department of Health, with the cooperation of various religious and social organizations, is attempting to aid in this process of regeneration.
"I am laboring under no delusions as to the ultimate fate of many of our discharged patients. There can be no doubt that a large number of them will return to the drug. The first time sickness comes, or social disaster, there will be recourse to the narcotic. Until this community and every other is freed from the possibility of obtaining the drug clandestinely, we will have addicts to deal with. It is imperative that there shall be worked out some system of international control of crude opium. It is my opinion that in every country there must come ultimately centralization of narcotic distribution in some governmental agency. So long as it is possible for American manufacturers to prepare the derivatives of opium, ship them to near-by foreign countries and have them smuggled back across our borders, the drug evil will persist. So long as the bootlegger is permitted to operate. so long will there be addiction. Certainly it is incumbent upon the Fedeml Government, upon the officials of other governments, upon the League of Nations, upon every official body that can be considered in this connection, to move forward toward the realization of some plan for the control of the narcotic evil. There must be intense activity and alertness, otherwise all the efforts of health departments will fail. It, is possible to cure a patient of malaria, but if he return to a district abound-ing in infected mosquitoes, he' will have another attack of malaria. The phy-sician and the Department of Health can heal these poor victims and restore them to physical health, but without moral regeneration or such strict govern-mental control as to prohibit the possibility of illicit possession of narcotics, the problem will not be solved."
In an article by Dr. S. Dana Hubbard, already quoted in part in a previous chapter, general conclusions are given as to the work of the clinic as follows: 2
"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—but 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.
"Our experience, as indicated in the statistical data quoted, is tha.t nearly 70 per cent of the addicts are under 30 years of age, and have been less than ten years on their drug, and that comparatively few have any physical reason for indulging in the practice.
"The physical condition of many of these youths, male and female, indicates that most of them can be saved and reformed into useful citizens. They are down, but are very far from being out.
"No doubt, with suitable organization and funds to institutionalize and adequately and properly care for them, not only to effect withdrawal of drugs', but to rehabilitate by several months after-care in the open country, together with efforts to get the individuals away from bad and demoralizing associates, into new and more useful environments, many will revert, to useful and normal lives.
"Many of these addicts have never had a square deal, and only need a fair chance to change their ways. Already many of them have been returned tp useful lives, and ma,ny more can be revamped with proper and necessary help.
"With success in many instances, in spite of the disadvantages under which the clinic has operated and under which this study has been made, we report our experiences; that others may be induced to enter iuto this work, appreci-ating its difficulties and complexities, but knowing that success is possible, in many cases.
"We are more than pleased with our efforts, and the results of these labors, and appreciate the cordial support and advice given so freely by all those who co-operated. It is impossible to name any of these persons, but we desire to hereby register our public appreciation of their aid and assistance.
"With reduction of addiction, generally, the incidence of the abuse of drug tippling, especially in the industrial world, will make future prevention and control easier.
"Many lectures to hundreds of persons have been given by the staff of the Bureau of Public Health Education and this publicity will no doubt deter many from taking up addiction through curiosity or ignorance."
In connection with the clinic the health department provided treat-ment for such cases as desired' it at Riverside Hospital. Dr. A. R. Braunhell, Visiting Physician at Riverside Hospital, in an article out-lining the method of treatment pursued by him, comments.as follows: 3
"it is my personal opinion that we are putting the cart before the horse in attempting to cure cases when they are able to procure the drug after treat-ment. I believe a very large percentage will relapse sooner or later, regardless of the form of treatment they have had, if it is possible to procure their drug. I am willing to admit, however, that proper treatment, covering a protracted period of time, will result in more cures than slip-shod, stereotyped methods, used by many advertising institutions for pecuniary reasons. The treatment at Riverside Hospital withdraws the drug, builds up physically, and we hope a large number will stay cured."
About one and one-half years after the closing of the New York City Clinic, following the repeal of the state anti-narcotic law, known as the Second Whitney law, another type of municipal activity was under-taken in New York. On July 25, 1921, the Board of Health of the City of New York passed certain amendments to the Sanitary Code to be known as "Article 8-A, Habit Forming Drugs." The various sections follow:
"Section 132 . . Prohibited Acts Constitute a Public Menace
"Any unauthorized possession, sale, distribution, prescribing, administration or dispensation of cocaine or opium or any of their derivatives, or cannabis indica, cannabis sativa, or any of their derivatives, is hereby declared to be dangerous to the public health and a menace to the public welfare.
"Section 133 . . Prohibited Acts
"It shall be unlawful for any person to possess, sell, distribute, administer, dis-pense or prescribe cocaine or opium or any of their derivatives, or cannabis indica, cannibas sativa, or any of their derivatives; provided however that nothing herein contained shall be deemed to prohibit the possession, selling, distributing, administering, dispensing or prescribing of any of the drugs or their derivatives as in this article hereinafter provided.
"Section 134 . . Authorized Acts of Trades and Professions
"A manufacturer, wholesaler, apothecary, physician, dentist, veterinarian, private hospital, sanitorium or institution maintained or conducted in whole or in part for the treatment of, disability or disease or inebriety or drug addic-tion, may purchase, receive, possess, sell, distribute, prescribe, administer or dispense cocaine or opium or their derivatives, or cannabis indica, cannabis sativa, or any of their derivatives, provided he shall have complied with all provisions as required by the Act of Congress of December seventeenth, nineteen hundred and fourteen, known as the Harrison Narcotic Law, as the same exists and may be amended.
"Section 135 . . Hypodermic Syringe
"No person except a dealer in surgical instruments, apothecary, physician, dentist, veterinarian or nurse, attendant or interne of a hospital, sanatorium or institution in which persons are treated for disability or disease shall at any time have or possess a hypodermic syringe or needle or any instrunient or implement adapted for the use of cocaine or narcotic drugs by subcutaneous injections and which is possessed for that purpose unless such possession be authorized by the certificate of a physician issued within the period of one year, prior thereto.
"Section 135--A . . Exemptions
"The provisions of this article restricting the possession of cocaine, opium or their derivatives or cannibas indica, or cannibas sativa, shall not apply to com-mon carriers or warehousemen or their employees engaged in lawful transporta-tion or storage of such drugs, nor to public officers or employees while engaged in the performance of their official duties, nor to temporary incidental possession on the part of employees or agents of persons lawfully entitled to possession.
"Section 135--B . . Commitment of Addicts: Procedure: Treatment: Discharge
"The habitual use of cocaine, opium or their derivatives, except as adininis-tered, prescribed or dispensed by a physician is hereby declared to be dangerous to the public health and safety and in violation of this article. Upon the volun-tary application of an addict, any Court or Magistrate, may, if satisfied of the truth thereof and that the person is suffering from such drug addiction, commit such person to a county or city hospital or institution maintained by the City of New York, or any correctional or charitable institution maintaining a hos-pital in which drug addiction is treated, maintained by the City, or any private hospital, sanatorium or institution authorized for the treatment of disease or inebriety. A court or a Magistrate may likewise on voluntary application com-mit for treatment to any reformatory or correctional institution, maintaining a hospital or place where drug addiction may be treated, to which institution com-mitment could be made from the City of New York on conviction of a misde-meanor. Any court having jurisdiction of a defendant who is a prisoner in a criminal action or proceeding, if it appears that such defendant is an habitual user of any such drug:3 and is suffering as a result of such addiction, may if it commit an addict making voluntary application require the return to the Court of any such addict when such addict is cured or at a time stated in the order of commitment. Whenever the medical officer or superintendent or the head of such an institution shall certify to the committing Magistrate or Court that any person so committed has been sufficiently treated or give any other reason which is deemed by the Magistrate or Court to be adequate and sufficient, he may in accordance with the terms of commitment discharge the person so committed, or return such person to await further action of the Court, as above provided.
"Section 135--C . . Fraud, Deceit, Et Cetera
"Any fraud, deceit, misrepresentation, subterfuge, concealment of a material fact or the use of a false name or the giving of a false address in obtaining treatment in the course of which cocaine or opium or their derivatives shall be prescribed or dispensed or in obtaining any supply of such drugs shall con-stitute a violation of the provisions of this article and shall not be deemed a privileged communication. The wilful making of any false statement in any required prescription blank, older or record shall constitute a violation of this article.
"Section 135—D . . Penalties
"A violation of any of the provisions of this article shall constitute a misde-meanor. The Department of Health, shall by virtue of the authority conferred by the provisions of the Inferior Criminal Court Act of the City of New York as amended by Section 44, Chapter 531, of the Laws of 1915, except in a case where commitment is made in the Magistrate's Court for treatment, request upon proceeding being had before a Magistrate that violations of this article be triable in the Court of Special Sessions, held by three justices."
This placed the control of the problem as a whole under the courts and the police department of the city administration.
In February, 1922, Judge Cornelius F. Collins of New York City reviews and comments on the New York situation as follows: 4
"Since our last conference, Chapter 639 of the Laws of 1918, known generally as the Whitney Law, relating to narcotic drug control, has been repealed, by an act approved by the Governor, on May 13, 1921. At the present time, this State is without any law on the subject of cocaine or narcotic drug control.
"The Federal law known as the Harrison Narcotic Law is inadequate to cope with the the drug evil, from a standpoint of legal control in this State, for many reasons, and particularly because of a decision in the case of U. S. v. Jin Fuey Moy, 241 U. S., page 394, holding that the provisions of the Harrison Act refer only to persons required to register under that act, which generally speaking, includes only those who might be grouped within the term 'the trade,' including manufacturers, wholesalers, retailers, physicians, veterinarians andn dentists, and thus precluding the Federal authorities in this State, even if their force were sufficient, from properly coping with the evil, particularly with the underworld traffic by peddlers and distributors, and the possession of the drug by unauthorized persons.
"Your Committee is constrained to report that the drug evil in this State unrestrained by statute, has grown to very serious proportions in its underworld aspect, the extent of which can only be estimated. Illicit peddling, distribution and possession prevail to such an extent as to make the problem, at this time, from a social standpoint, as serious as it has ever been. Some idea may be had of the extent of the prevalence of the evil in the underworld, by referring to the condition existing in the city of New York. Immediately following the repeal of the State law, May 13, 1921, arrests for violation of the drug law by State officers ceased. A sanitary code provision was adopted, which became effective July 25, 1921. Immediately a large number of arrests were made for peddling or unlawful possession. In one month, over 450 cases were arraigned in Special Sessions. This is approximately a 300 per cent greater number than ever brought into the court for violation of the drug law, in a similar period. Some explanation can be made, of course, from the fact that during the period when no law was in operation justifying arrests, the police were alert in obtaining information that made apprehension available immediately on the enactment of the sanitary code.
"In a period between July 25 and December 31, 1921, there were 1,029 cases arraigned in Special Sessions. This is a much greater number than ever before in a similar period, and is over 15 per cent of the entire business of the court. It is extremely likely that similar results proportionately would be shown through-out the State, but where there is no sanitary code provision, there is no means of obtaining statistics. It should be borne in mind, in estimating the extent of the underworld problem, that the actual number of cases amigned for violation of the drug law refers only to that number of offenders arraigned for the viola-tion of the drug law, and does not include addicts arraigned for the commission of other crimes. That number added to those arraigned under the drug law would swell to much greater proportion the number of drug addicts arraigned in court.
"In the judgment of your Committee, the drug situation has been further hampered by the attitude of the Federal authorities in the enforcement of the Harrison Law, especially in connection with interpretations and rulings made by the Federal authorities. The Harrison Law provides in part, the law shall not apply
" `(a) To the dispensing or distribution of any of the aforesaid drugs to a patient by a physician, dentist or veterinary surgeon registered under this Act in the course of his professional practice only.
"(b) To the sale, dispensing or distribution of any of the aforesaid drugs by a dealer to a consumer under and in pursuance of a written prescription issued by a physician, dentist or veterinary surgeon registered under this Act ; provided, however, that such prescription shall be dated as of the day on which signed and shall be signed by the physician, dentist or veterinary surgeon who shall have issued the same.'
"On October 19, 1921, the Federal authorities issued over the signature of the Federal Prohibition Commissioner and the Internal Revenue Collector, rulings or interpretations, which say in part as follows:
" 'This Bureau cannot under any circumstances sanction the treatment of mere addiction where the drugs are placed in the addict's possession, nor can it sanction the use of narcotics to cover a period in excess of thirty days, when personally administered by the physician to a patient neither in a proper institution nor unconfined. If a physician, pursuant to the so-called reductive ambulatory treatment, places narcotic drugs in the possession of the addict who is not confined, such action will be regarded ab showing lack of good faith in the treatment of the addiction and that the drugs were furnished to satisfy the cravings of the addict.'
"The attitude of the Federal enforcement officers had been along similar lines, especially in the vicinity of this State, for a long time prior to the issuance of this ruling. The effect of the whole has been to absolutely discourage doctors in the treatment of drug addiction, by the prescribing of the necessary drug for its alleviation. This step was taken by the authorities in an effort to stop what is known as the ambulatory treatment of a patient and to bring about hospitalization in all cases. This phase of the subject will be referred to later in this report.
"The Federal courts have interpreted the Harrison Law with respect to the treatment by physicians of drug addicts, to limit the doctor in his treatment of the addict, to the exercise of good faith only; U. S. v. Doremus, 249 U. S. 86; Webb v. IT. S., 249 U. S. 96, and other cases.
"The Harrison Law provides that `The Commissioner of Internal Revenue, with the approval of the Secretary of the Treasury shall make all needful rules and regulations for carrying the provisions of this act into effect.' It would seem, as a legal proposition that this authority did not confer the right to make rules which would, in effect, supersede the law; and one cannot conceive of a situation that would enable a Federal prohibition commissioner or an internal revenue collector to substitute their rulings for an act of Congress, or to super-sede the powers of Congress and legislative enactment, which must necessarily receil e the approval of the President, and which would even then be open to serious question, if forbidding treatment under certain conditions, as to con-stitutionality in infringing on the power reserved to states. Yet, it may be said, that the effect of the rulings has gone almost to this extent. The Federal decisions are numerous to the effect that an executive department cannot en-large a statute, so as to make conduct criminal that is not made so by statute, nor to go any further with respect to a provision similar to the one in the Har-rison Act than 'to regulate the mode of proceeding to carry into effect what Congress has enacted.'
"The general situation is such as to demand immediate action upon the part of this State, to remedy existing conditions, if the drug evil is to be controlled, and the baneful extension of its consequences arrested. Statement has been made and perhaps with some degree of justification, that the prevalence of crimes and violence throughout the country is due in a measure to the drug evil. It is undoubtedly true that in a very large number of arrests of those accused of felonious assault, highway robbery and burglary, by the dramatic methods recently resorted to, it has been disclosed that the perpetrators were drug addicts.
"The necessity for rational legislation on the subject is therefore, made the more apparent."
Commenting on the amendment to the Sanitary Code of New York City and on the situation as it subsequently developed, Judge Collins continues:
"Under the provisions of the New York City Sanitary Code, it was intended to allow the doctors to practice in accordance with the Harrison law, on the as-sumption that this permitted a physician to proceed in the course of his profes-sion in good faith, to administer drug if necessary. Immediately following its enactment, however, the doctors obtained the impression that the Federal authorities would regard as a violation of law the treatment of a patient with drug while the patient was at large, unless such patient was at the time suf-fering from some disease other than drug addiction, with the result that a large number of addicts were forced to resort to the underworld for the purpose of obtaining the drug. This, of course, tended to give added impetus to the traffic in the underworld which immediately after the repeal of the State law had grown to a far greater extent than any that had ever heretofore prevailed.
"On the publication of the rulings of the Federal Prohibition Commissioner and Collector of Internal Revenue above referred to, as chairman of your committee I caused the following notice to be sent to the various members of the committee:
" 'November 21, 1921.
" 'The Commissioner of Internal Revenue has issued under date of October 19th, some new rulings on the subject of drug addiction, signed R. A. Haynes, Prohibition Commissioner, approved by D. H. Blair, Commissioner of In-ternal Revenue. I am forwarding you copy of the rulings which are issued in the weekly bulletin of the Department of Health of this city, dated November 19, 1921.
" 'The first intimation I received of the fact that such rulings were adopted was on last Thursday, at the convention of the American Public Health Association. If these rulings prevail, a very serious situation is threatened.
" 'It seems to me that, the Commissioners have exceeded any authority conferred on them by law, have superseded the rights of the State and have even gone beyond the expressed provisions of the Harrison act.
" 'Under the rulings, a physician would be prevented from prescribing drugs for the treatment of drug addiction, notwithstanding the provision of
the Harrison law, to the effect that that act would not apply to a "physician
. . . registered under this act, in the course of his professional practice only."
" 'The number of addicts is by far too great, even if they were all willing to submit, to be accommodated by hospitals available for such purposes. The result bound to follow would be that the addict would be forced, in most instances, to resort to the underworld to obtain the drug, which means increased peddling, increased illicit distribution, increased smuggling and incidental crimes in the wake of the underworld addict.
" 'I, therefore, feel it absolutely necessary to call a special meeting of the Committee on the Drug Evil of the State Association of Magistrates, and believe that three p.m., Tuesday, November 29th, at my chambers in the Children's Court, 137 East 22nd Street, New York City, the most con-venient time and place.
" 'Won't you please make every effort to attend, and if you can not, please communicate with me on the subject at your earliest convenience.
" 'Faithfully yours,
"(Signed) Cornelius F. Collins, "'Chairman, Committee on Drug Evil, State Association of Magistrates.
" `P.S.—It has occurred to me that I ought to have said in the foregoing that the basis of the Commissioner's conclusion is largely error:
"1. As to the evil being a medical question only (it needs no argument to prove that it is sociological as well).
" '2. As to the report of a committee in the "A. M. A." expressing the consensus of medical opinion—which is incorrect.
" 'C. F. C.'
"In response thereto, there was a general agreement of approval and an indica-tion that action should be taken at this conference.
"I have had statistics prepared which are attached to this report, showing the number of cases coming into the Court of Special Sessions, from the time of the enactment of the first drug law, and those figures bear out the contention that was made, that the extreme interference with the doctor in the treatment of the drug addict is a serious mistake. The figures show t,00, that the average age of the addict in each year between 1916 and 1921 inclusive, was as follows:
"1916—The average age of all addicts coming into Special Sessions was between 23 and 24 years.
1917-26 and 27 years.
1918--25 and 26 years.
1919--26 and 27 years.
1920-25 and 26 years.
"The number of addicts coming into the court increased and decreased ac-cording to varying legislation and shows the effect of regulations and the like. The lowest number came into the court in 1918 (540), when the State law oper-ated without any undue restrictions."
Judge Collins gives the following statistics of cases passing through his court:
"Drug Cases in the Court of Special Sessions
Jan. to July 25 to
"1914 1915 1916 1917 1918 1919 1920 May 13 Dec. 31 Total
1,415 1,503 1,686 1,283 540 846 1,266 599 1,029 1,628
"Note as to Above
"The 'Boylan law' became effective April 14, 1914. The year prior to the enactment of the 'Boylan law' there were only 106 cases received in this court.
"The first 'Whitney law' became effective May 9, 1917. The second 'Whitney law' became a law May 13, 1918 and went into active operation, as to crime, February 1, 1919.
"The 'Miller act' became effective May 13, 1921, although that part of the act dispensing with the services of the Commissioners and for the final transfer of records to the State Health Department was effective June 30, 1921.
"The City of New York Sanitary Code amendment became effective July 25, 1921. . . ."
Reporting again to the New York State Association of Magistrates,5 in 1923, Judge Collins says:
"The bill recommended by your body for enactment failed to pass the Legis-lature, and there is at present in the State of New York no law regulating the subject of the drug evil except wherever local provision is made by sanitary codes or local health laws. I am unaware of any existing except in the City of New York.
"The arguments presented by your committee and adopted by the Association to the effect that there is no general increase of the drug evil but that there is an increase of the aspect of the evil, as indicated in the so-called 'underworld,' is more manifest this year than before, and the experience in the Court of Special Sessions of the City of New York, for instance, bears out the arguments hereto-fore made by your Association as to the necessity for State law regulation along the lines referred to in the formal report.
"I caused the report to be printed and forward to your body some copies, sufficient number of which can be obtained upon request for any purpose the conference may desire.
"Permit me to recommend that the printed report be read to the conference as the report of the Committee on the Drug Evil, with this addenda:
"In the Court of Special Sessions, which is the pulse of the 'underworld' cases, to the extent of showing the number arrested for illegal possession or for trafficking in drugs, in that it shows the numbers arraigned in that court, showed that during the year 1922 there was a total of 2,211 cases.
"In the appendix to the report of one year ago, the number of cases of each year, from 1914 to 1922 inclusive, are shown.
"The total number for 1922 indicate a larger number of cases than ever before coming into the Court of Special Sessions, and is fully 20 per cent of all kinds of cases coming into the court. That in itself gives an indication of the horror of the situation.
"The increase in percentage of cases over 1921, the total of which was 1,628 cases, is 35.8 per cent.
"The increase over the year 1918, when the Whitney Law was in operation, when doctors were permitted to treat addicts under reasonable regulation, is 309.4 per cent. In other words, in 1918 there were only 540 cases of the kind coming into the Court, and in 1922 there were, as above stated, 2,211 cases.
"Attention is called to the fact that the average age has increased. In 1921 the average age of all addicts was placed at 26 years. The number of addicts coming into the Court, 21 years and under, was 12.32 per cent, and of addicts, under 21 years of age, 6.16 per cent.
"In 1922 the average age has been increased to 29 years while the percentage of those 21 years and under has been reduced to 8.2 per cent, and the number under 21 years of age reduced to 4.7 per cent.
"These figures compellingly show the logic of the arguments advanced by your association, namely, that the failure to have State regulation permitting treat-ment by medical men in their general practice, as well as treatment in hospitals, has largely increased the 'underworld' traffic and distribution of the drug, and that is shown by the very large increase in the number of cases coming into the Court.
"It further shows, by the change in the average age of all addicts, that the Court is dealing with old addicts instead of newly formed addicts; that the increased average age, 29 years, and the decrease of those 21 years and under, and those under 21 years, to percentages almost negligible, significantly prove that the old addicts are driven to the 'underworld' market for their drug."
After reviewing the attempts to secure state legislative action and their failure he continues:
"The very great conflict referred to in the printed report as to the solution of the drug evil, from the standpoint of legislation, is in such a state of chaos that it may be that legislation recommended by either school of thought may not be successful in paasing the Legislature, but the seriousness of the situation is so great that something must be done.
"In view of that fact, your committee respectfully recommends, in the alter-native of a bill similar to that which is above referred to, not, being adopted, that your Association go on record as urging the appointment of a new joint committee of the Senate and Assembly to investigate the subject of the drug evil and to report back to the Legislature of 1924, this with the aim of recon-ciling all conflicting opinions on the subject and of ascertaining the true state of facts and intelligently reporting to the next Legislature so that action may be taken looking to a practical solution of this serious social problem."
Sitnon reports on present conditions in the City of New York as follows:
"In the city of New York, narcotism has decidedly decreased during the last three years. This is evidenced by the fact that a beginner is now rarely found among the addicts recently apprehended. Constant vigilanc,e is necessary, for relaxation on the part of the police results in the immediate influx into this city of thousands of addicts from all over the country, and addiction would claim many new victims.
"Only about 10 per cent of the addicts arrested by the police are women. The percentage of female to male addicts is, however, much greater. They are not so liable to arrest, as comparatively few of them personally make their purchases on the street. It is delivered to them or bought usually through some male addict.
"Evidence of the control of the situation is shown by the statistics of the ages of addicts. In 1921, when we were several months without a suitable narcotic law, in New Yo.rk City, a large number of persons became addicts, mostly in the ages of 18, 19 and 20, and the peak age then was around 25 years. That is to say, there were more addicts giving the age of 2,5 years than any other age. In 1922, this peak age was 27 years, while this year the ages 27 and 28 are almost equal."
The following is a brief history of the life of the narcotic clinic and hospital treatment at Shreveport, La., instituted as control measures
under authority of the State Board of Health of Louisiana. We have already quoted from the minutes of the board and from opinions of the state attorney general and' assistant attorney general upon whose authority the board's action was taken in establishing the New
Orleans dispensary. While the Shreveport clinic was begun as a state activity, the greater part of its existence occurred under the authority of the municipality. It is included, therefore, in this chapter.
From the unpublished' reports with which W. P. Butler, medical director, has supplied us, we have obtained the following outline of the clinic as operated under his supervision. Inasmuch as this clinic has given rise to much discussion we are including also such expressions of opinion from organizations and copies of correspondence as dealt with it during the diffPrent periods of its existence.
Inception, Development, Municipal Activity, Reasons f or Closing
During 1916 four physicians of Shreveport were indicted for violat-ing the Harrison Act. They were not convicted but the incident had a psychological effect upon the medical profession as physicians hesi-tated, as Dr. Butler says in his report, to care for cases of addiction lest they unintentionally violate the federal law, avoiding the handling of these cases rather than studying the law, the case itself and the problem as a whole.
This state of affairs became apparent to Dr. Butler, the parish physician, as the chronic users of opium applied to him for assistance and very quickly developed a sociologic problem which the community was not equipped to handle. Some of the cases were sent to jail for treatment and* either were withdrawn from the drug or supplied by smuggled drug. A number of them died.
Eventually the use of four rooms in the jail was secured for the treatment of these cases but because of the inadequacy of equipment and of the difficulty in stopping the smuggling of the drug, this work was not successful.
In 1919 the state board of health appointed a physician in Shreve-port to take charge of the narcotic situation. He wrote all the pre-scriptions of these cases, which were filled at one authorized drug store. This arrangement lasted but one month, its failure being due to three factors: first, the expense and trouble to the patient who was required' to secure daily prescriptions when he could patronize the peddler more easily; second, the impracticability of one physician's at-tempting to care for so many cases without assistance; third, the druggist's objection to having his store patronized by a class of people looked upon by the public as criminals.
The physician who had been appointed to handle this situation re-signed and Dr. Butler was instructed by the state board of health to care for these cases by establishing a dispensary. That the need of some provision was increasing is shown by the following excerpt from a letter to Dr. Butler from the president of the state board of health:
"We are getting daily the names of patients being discharged from the Army and Navy who reside near Shreveport and who should be sent there for treat-ment, but as yet we are unable to refer them there."
Dr. Butler organized his dispensary and with the assistance of a pharmacist and special assistants supplied the drug to chronic users according to state regulations which will be explained later. Quarters in the Charity Hospital were secured for the treatment of curable cases. During the first two years the number of patients handled at the dispensary was reduced from 494 to 188, some having been cured and others in one way or another eliminated.
On March 15, 1921, the Louisiana State Board of Health after con-sulting with the federal narcotic officials discontinued' the narcotic dis-pensaries in New Orleans, Alexandria, and Shreveport. Upon the following day Dr. Butler reopened the Shreveport dispensary and moved the institution for treatment from the Charity Hospital to a house near the business centre of the city. He continued to work on his own responsibility as parish physician and through the authority of the city council of Shreveport, expressed in the following ordinance :
"(1) 'That a public health hospital and out-patient service be, and the same is hereby established for the City of Shreveport.
"(2) "That said institution shall be under the charge and control of the City Council of Shreveport and its management subject to the supervision of said Council, shall be under the direction of Dr. Willis P. Butler, Parish physician until such time as it may be otherwise ordained by this body. The purpose of said institution is declared to be for the treatment of narcotic and venereal cases.
"(3) 'Be it further ordained: That whereas the Police Jury of the Parish of Caddo defrays a portion of the expense of said institution the said Parish physician is empowered to care for and treat the same class of patients for the Parish. of Caddo.' "
The last clause of this ordinance shows that the Police Jury had already taken action. In fact previous to and anticipating the state board of health's order to close the dispensary and institution, the Police Jury had passed a resolution to continue Dr. Butler's narcotic work.
This briefly outlines the inception and development of the dispensary and institution for treatment. The need of municipal action begins with the indictment of the four local physicians already mentioned and had its final expression in the passage of the ordinance continuing the method that the council had found to be effective. During the years 1921-23 this arrangement controlled satisfactorily the narcotic problem. One hundred and forty patients were given curative treat-ment while the number of cases attending the dispensary was decreased to one hundred and' one. -
Early in 1923 a conference was held in the office of the United States District Attorney between Dr. Butler and the federal narcotic agents. As a result of this conference it was decided to close the dispensary. The agent present at the conference stated that Ile had been sent "to close the clinic because it was the only one left in the United States." In commenting on this Dr. Butler quoted from a letter written by Dr. L. M. Powers, Health Commissioner of Los Angeles, California, who said when the Los Angeles clinic was closed in 1921:
"I have not been able to realize the actual purpose of the closing of our clinic for there has been some unseen motive prompting much opposition to clinics which I have not been able to comprehend."
Method of Operation--Results
The dispensary was located in the director's laboratory in the Shreveport Sanitarium with the following personnel: medical director, chief clerk and bookkeeper, assistant clerk and finger-print expert, pharmacist, dispenser, three inspectors selected with the approval of the police department, the local board of health and the medical di-rector; other assistants for special work were employed when needed.
The dispensary days were Monday, Tuesday, Thursday, and Satur-day from 8.30 to 10.00 A. M. and from 4.30 to 6 P. M. Where these hours created a hardship on the patient he was cared for at some more convenient time.
Morphin was dispensed in solution, the container being labelled to show the amount in grains and the price. The doses varied' from one grain to as much as twelve grains a day for certain patients, the aver-age being eight grains. In each case the amount of morphin dispensed was the least that the patient could take and still remain in "drug balance." Since the dispensary was not intended for curative treat-ment but as a means of caring for incurables and those physically un-able to undergo treatment, no effort was made to reduce the amount finally decided upon as the patient's proper dose.
The cost of morphin as supplied at the dispensary was an impor-tant inatter as will be explained later. The wholesale price of the drug varied from two to three cents a grain. The dispensary price was six cents a grain as against the druggist's price of ten to twenty-five cents a grain, exclusive of the prescription fee, and the peddler's price of $1.00 a grain. Under the dispensary management the differ-ence between the cost and the selling price paid the actual operating expenses of both the dispensary and the institution for treatment, the entire undertaking being self-supporting.
Patients admitted to the dispensary were carefully examined and recorded. In the beginning any patient applying was admitted but the number was necessarily limited later to residents of the state and again later to residents of Caddo Parish. They were divided through examination into the curable and incurable cases and placed in one of the two classes. Complete medical histories were taken, together with information relating to age, sex, color, length of time during which the drug had been used, former treatment, and the causative factors, together with an exhaustive physical description. Finger-prints with personal description were sent to the local police department, to the local detective agency and to Leavenworth.
Before being dispensed to, the patient was requested to sign a pledge not to sell, give away, lend, borrow, or otherwise obtain any of the drug. His residence and business addresses were secured and fre-quently checked by inspectors. All patients able to do so were required to work and to secure proper food and clothing. No loafers were tolerated. These rules governed patients who were not infirm, decrepit, or bed-ridden.
A monthly record sheet contained the names of the patients. Upon receiving their medicine patients signed this register, the clerk entering opposite the signatures the amount dispensed in grains and the price paid. This daily record was kept of those coming to the dispensary in person. For those who were bed-ridden or who held a doctor's cer-tificate as to infirmity a special ord'er form printed on safety paper was employed. These were serial in number, dated and signed, and gave the reasons for the individual's inability to come in person, together with the name of the authorized proxy. Only one order form was issued at a time and a strict record kept of each.
The institution for treatment was located at the Charity Hospital until the work was discontinued by the state board of health in 1921 when it was established in another locality. It was called the Public Health Hospital and in addition to treatment for chronic users of opium it provided treatment for cases of venereal disease either free or at the cost of the medicine. This institution had a resident physician, superintendent, nurses, guard, and attendants.
The rules governing the institutional treatment of the narcotic pa-tients were as follows:
"(1) Institutional treatment is free to any resident of Caddo Parrish.
"(2) An addict who is able physically to undergo treatment must sign voluntarily an application for commitment to the institution. (If he is judged physically able and will not take the treatment he is no longer dipensed to.)
"(3) He also signs a request to be placed in the Parish jail to complete the treat-ment if for any reason this may be deemed necessary by the Director.
"(4) He is required to make a deposit of twenty-five dollars for his own use at the end of treatment, unless he is known to be in good financial circum-stances.
"(5) The medical method of treatment is divided into three parts, (1) Previous preparation; (2) the period of narcotic withdrawal under restraint; (3) after care. By the first term is meant, assurance that the physical condition is strong enough to endure the rigor of the withdrawal. The salient features of the treatment proper, are •rapid withdrawal and substitution, proper elimination, abundant food, rest and warm baths. By the third term is meant, a place of convalescence, preferably in the country."
Dr. Butler states that the results from the points of view of the users, physicians and druggists, and society at large from a properly operated dispensary and institution for treatment have a distinct medical and sociologic value.
First: The patient. Such a treatment prevents or alleviates a great deal of physical suffering. The dispensary and treatment institution treated all cases including the parish prisoners. The curables were treated first for whatever physical conditions they were suffering from and then for their drug intoxication, while the incurables were im-proved physically and their doses properly regulated. Many cases who had been "down and out" were raised to a plane of decent living. With their drug inexpensive and regularly supplied they were enabled to work and provide for their families. In the opinion of the Asso-ciated Charities, federal and parish authorities and the city police department, crime was prevented and the narcotic problem from every angle was ameliorated by the medical care of these patients.
Second: Physicians and Pharmacists. The system was helpful to physicians and druggists in that it saved much of their time and pre-vented annoyance from the insistent demands of individuals for whom they could not regularly care. It prevented duplication of work for one patient and neglect of others. That the medical profession ap-preciated this work is shown by its unqualified support, and approval of the clinic as evidenced by the passage of resolutions to this effect.
Third: Society as a whole. That the work of the clinic was bene-ficial to society as a whole is apparent. It reduced the number of future users and the system that made the dispensary effective became an auxiliary to the city's police department. Dishonest and unworthy cases were detected', cut off from the dispensary and because of the absence of peddlers in the city were forced to move away. Thus crime was prevented, as there was no profit possible for criminal addicts or peddlers. A considerable burden of indigency was saved the city by the rehabilitation of these patients.
RELATION OF CLINIC TO:
2. Federal and state-control measures
3. Other methods of control.
1. It prevented peddling and the pauperizing of the user. It pre-vented' illicit sale by (a) providing for the incurable cases, preparing the curables for treatment and treating them, whereas the peddler deliberately increased his sales by creating new users and (b) elim-inating the vicious type of user.
2. The chief manifestation of federal control has been the arrest of users in order to stop the illicit traffic. This method of control, according to Dr. Butler, only aggravates the situation as it makes dependents of the user's family, which thus creates a social and economic problem.
Dr. Butler quotes the United States Marshal as having stated that through taking advantage of the facilities afforded' at the clinic he was able to secure quick relief without the unnecessary resorting to red tape required under other circumstances. Through the detective system practised by the dispensary many arrests of peddlers were made and evidence sufficient to convict them secured, but Dr. Butler states these cases when brought into court were either repeatedly post-poned or dismissed.
3. Another method of control that Dr. Butler claims is a complete failure is that of the enforced treatment of users. This procedure re-sults in repeated relapses, deaths, or suicides during the withdrawal, or smuggling of the drug into the institutions in which these cases are confined. In this connection Dr. Butler gives the following acknowledgment from the state board of health president:
"Your statistics in cures are decidedly higher than those of any others we have received."
In conclusion he states that federal and other state control measures employed have failed to give such good results as were derived from the operation of the dispensary and the institution for treatment, namely:
One responsible organization to control supply.
Proper facilities for observation, examination, and treatment of patients. Ability to care for incurable cases without expense to the community and at but slight expense to the patients.
A self-supporting system.
Since the closing of the dispensary, Dr. Butler reports the deaths of several former patients, three of these in jails in other cities, while a number of his patients have been sent to the state penitentiary.
Of the remainder of the one hundred and one incurable cases, Dr. Butler continued* to care for forty for about a year. The others he states were supplied by peddlers at $1 or more a grain inasmuch as their physicians refused to care for them. Individuals who during the life of the dispensary were leading decent lives and supporting their families reached a condition of wretched poverty. In 1924, the number of incurables attended by Dr. Butler was reduced' to twenty-four and then to twenty-one. These were continued until March,1925, when he ceased prescribing for them. Of the forty cases remaining in his care after the closing of the clinic, four have died, two or three found other physicians to care for them temporarily, a few moved away, and the others have been forced to patronize peddlers. The organized charities, he states, recognize the evil effects of the closing of the clinic and the city police department and the sheriff report that they are having endless trouble with users and peddlers.
Petty crimes are increasing and the peddlers are creating new cases. The following communications supplied by Dr. Butler from professional groups are of interest in connection with the operation of the Shreveport narcotic clinic:
"To the Shreveport Medical Society:
"This committee appointed to investigate and report on the Shreveport Narcotic Clinic begs to report as follows:
"We had an interview with Dr. Butler at his office on September 29th, and wish to express our unqualified approval of the work being done by Dr. Butler and his associates. We were most favorably impressed by the conduct of the Clinic including the details of complete records of all addicts coming under care, classi-fication of addicts, and treatment according to classification, the elimination of non-residents of La., and the careful treatment of curable cases Under re-straint, the procuring of employment for addicts who are able to work while attending at the dispensary and for cured patients who wish to remain in Shreve-port after recovery, are all features of this work that strongly recommend the conduct of this Institution.
"It is significant that Dr. Butler's judicious and tactful conduct of the Clinic has secured fdt• him the unqualified support and cooperation of the Federal, State, Parish and City Authorities, and the State and City Boards of Health.
"In brief we wish to express our unqualified support and approval of the Shreve-port Narcotic Clinic and its systematic and effective administration by Dr. Butler.
"Signed: W. H. Billinghaley, M.D.
J. J. Frater M .D.
J. G. Pou M.D.
"This report was presented to the Shreveport Medical Society at the regular meeting Oct. 5, 1920, and was unanimously adopted."
"Shreveport, La. "March 15, 1921.
"At a regular staff meeting of the T. E. Schumpert Memorial Sanitarium held at the Sanitarium Tuesday night, March 15, the following resolution WAS unan-imously adopted:
"Resolved that, in the judgment of the Staff of the T. E. Schumpert Memorial, that, for the best interest of humanity and the community, it is advisable that Dr. Willis P. Butler continue the so-called narcotic dispensary and institution as now conducted in the City of Shreveport.
"The following doctors were present at this Staff Meeting:
J. C. Willis B. C. Garrett T. D. Boaz
J. R. Knighton R. F. Harrell M. S. Picard M. R. Purnell I. B. Hougon Thos. Ragan Dr. Harwell Dr. Yerger
J. J. Frater "Signed: W. S. Kerlin, Sec'y-Treas."
J. M. Bodenheimer
J. G. Pou F. G. Ellis S. C. Barrow
"March 23rd, 1921.
"Dr. Willis P. Butler Shreveport, La.
"The following resolution was adopted by the Staff of North La. Sanatorium, at its regular monthly meeting last night, March 22nd, 1921.
"Resolved that, in the judgment of the Staff of the North La. Sanatorium, that, for the best interests of humanity and the community, it is advisable that Dr. Willis P. Butler continue the so-called Narcotic Dispensary and institution as now conducted in the city of Shreveport, La.
"The following doctors were present:
Dr. D. H. Alverson Dr. S. C. Barrow Dr. J. M. Gorton Dr. A.. G. Heath Dr. R. F. Harrel Dr. L. H. Pirkle Dr. M. R. Purnell Dr. R. A. Pain Dr. G. C. Rigby Dr. J. E. Slicer Dr. V. Simmons Dr. J. F. Tanner
Dr. Wm. P. Yerger Dr. Thos. F. Ragan Dr. C. B. Hicks Dr. Hearn
"(Signed) J. M. Gorton, M.D."
Los Angeles, California
Another municipal effort at control was made in Los Angeles under the direction of the health department. Two reports of the medical director of the clinic, Dr. W. H. Bucher, set forth the local situation,
the nature of the undertaking, and the results obtained during the brief life of the clinic.
The objects are stated by Dr. Bucher as follows—
"(a) To care for the addicts in a humane manner, and endeavor to withdraw the morphia consistent with the health of the patient, and by personal contact give assurances that we are trying to help in overcoming the disease from which they are suffering.
"(b) By the establishment of the clinic to break up the gang of peddlers and traffickers who prey upon these unfortunates.
"(c) In caring for this class to protect society in general.
"(d) Select certain patients for a 'cure.' "
It was the intention of the clinic to supply to each user an amount sufficient for only a short period of time, but it was recognized that, in the case of patients coining from a distance as well as of those
suffering from intercurrent maladies, considerable latitude had to be exercised.
Stock solutions of morphin were employed and by the use of these solutions attempts were made to reduce the amount of the drug with-out the patients' knowledge. This system not always was found ad-visable as it was sometimes necessary to increase the dose, in which cases Dr. Bucher believed that the psychical effect was bad, that is, discouraging to patients who were making an earnest effort to become cured. He states that there were unmistakable signs in the cases of those who were not on a "balance" dose, especially among the laborers and certain other workers. In these cases too small a dose caused such weakness as to jeopardize their positions.
Where operations were needed, Dr. Bucher thought the drug should be continued until the operation was completed and health restored, as such cases would then be in a better condition to stand treatment. It was fotind that in many cases individuals purchased additional drug from peddlers after the reduction in the clinic dose had reached a certain point. Dr. Bucher concluded from this that too great a re-duction defeated one of the clinic's purposes—that of eliminating the peddlers—and that the fact must be accepted that unless the required balance was maintained certain cases would patronize illegal sources of supply. The necessity of an institution for treatment was early ap-preciated—preferably some place where an out-of-doors life could be followed by the inmates. It was pointed out that certain types of users were centers for disseminating the use of the drug and that such cases should be isolated for a period of treatment. It was also ad-vocated that a sufficient time be allowed for convalesence to build tip the patients' nervous tone to a point where relapses would not occur.
The number of cases treated at the Los Angeles clinic has already been discussed in the chapter dealing with extent. The only drug dispensed at the clinic was morphin though many of the patients had been users of cocain. In addition others had used heroin or smoked opium. Those using heroin and the opium smokers were shifted readily to morphin. It was found that new patients invariably gave the history of using large doses, 15 to 30 gr. a day, a few only using 2 or 3 grains. The fact that such large amounts were not necessary was explained and only 6 or 8 grains were dispensed. If withdrawal symptoms developed within the next few days, the statements of the patients as to the large doses were determined to be true, but if no such symptoms were apparent, a further reduction was made. Thus an effort was made to maintain these cases on a "balance" dose until they were stabilized, aft,er which, under favorable conditions, a further reduction was made. As a general rule, patients who had been using large doses became adapted to the smaller doses after a few days and were more able to work and felt better than on the larger doses. Individuals varied, however, in their ability to stand reduction. One object of the clinic was to keep the patients, where possible, at work so that their doses were cut only to the lowest possible figure which permitted of their continuing their occupations and watching for opportunities when, with their physical condition improved, a further reduction could be made. All patients were examined physically and whatever intercurrent ailments existed as far as possible were corrected. The regulation of the Harrison Narcotic Act requiring a continuous reduction in these cases was observed as far as possible at the clinic but as Dr. Bucher states—
"It would seem fair to accept the fact that a worker and a producer is of more value to the community than a non-worker and a dependent, or perchance a criminal even though he is suffering from an involuntary chronic disease or a self-inflicted one."
He states that in the case of tuberculosis, venereal and other chronic diseases, patients were encouraged with the help of clinic treatment and supervision to pursue their ordinary occupation but that only too often drug cases were allowed to go without assistance and thus made dependents or criminals. He points out that with his drug the user can function, that without it he is sick, unable to work and has but one object in life, namely, to secure the drug that will put him on his feet. At the price charged at the clinic, ten cents a grain, users could afford to buy what they needed, while in many instances the total earnings of these cases were not sufficient to supply them with the drug from illicit sources at the peddler's price of $1.0042.50 per grain. Dr. Bucher states that the degenerate class of users should be distinguished from the others and that with many of the latter type it is possible to accomplish much in the way of salvage. It is unfair, he states, to put all of these individuals in one class simply be-cause they are "addicts." He continues:
"Their mental make-up varies as much as any other class of diseased humanity, and we find those with courage as well as the coward, and the ones who tell the truth and many liars, some with outstanding virtues that even morphia has not been able to crumble, It should be the endeavor of the community to sift these worthy ones out and reclaim them, and generally speaking of the whole mass, it would be infinitely better to have them at work using a moderate amount of morphine than turned loose on the streets desperate . . . organization, even for morphia addicts, seems better than disorganization. . . ."
Ninety-one applications for hospital treatment were made of which eighteen were cared for by an appropriation from the city and eighteen others were treated at the county hospital.
The attitude of the clinic was that these patients were sick and in need of medical help. Dr. Bucher states:
"From the many letters received at the time of the clinic's last days we glean one salient fact that with the clinic operating these unfortunates were able to work, and have the ideal of normal men to look up to. Some who came to the clinic ragged and filthy, left it with decent clothes, a bank account, and a sense of having been a part of the machinery of production. Just what will become of those who prospered with the clinic is open to rather dismal conjec ture."
"Every day since the clinic has closed there have been patients, their relatives, and friends, come to tell us of the tragedies that followed in the wakes of these addicts' failure to get their morphia. Families have been broken up, men and women have lost their jobs, others have gone where the drug is accessible—all of this cemented together with suffering that takes courage to see.
"The problem is still with us and unsolved. It is reasonable to suppose that it will recur and recur again offering itself for solution. Perhaps later popular opinion will be influenced by the fact that this is a disease, and then in some systematic manner permit its study and it is hoped some lasting cure will be found."
Writing of the clinic under date of April 18, 1921, Dr. L. M. Powers, Health Commissioner of Los Angeles, states in part:
"Our clinic was closed in August, 1920, and we have not been able to do any successful work since then. A few patients were treated in the various private hospitals, by some of the committee who were working with us, with indifferent success."
"We regret very much that we were unable to carry to a successful issue our clinics and final treatment of addicts in Los Angeles. We saw ahead of us great results, much greater than we had anticipated when we first commenced work, but you know all of our health work depends upon somebody else's direc-tion and financing consequently we, in this matter as in others, have had to bide the time when the people could be better educated.
"I have not been able to realize the actual purpose of the closing of our clinic for there has been some unseen motive prompting much opposition to clinics which I have not been able to comprehend."
Mr. John P. Carter, formerly Collector of Customs of the Los Angeles District, writing to Doctor Powers under date of March 31, 1921, states in part:
"I never was connected with .any work that appeared to me to afford such a field for service as during my connection with you, Dr. Barrow, and the other splendid physicians who gave of their time and of their intelligence so liberally in an effort to deal with the narcotic situation. I believe there is a place in there for service to human kind that will be more richly rewarded in the way of humlui salvage than in any other field of endeavor. It is a crusade as admi-rable and as deserving of success as any other crusade in the whole tide of time.
"I can't understand the opposition to it from any other premises than that we are so thoroughly commercialized that great commercial interests are more powerful than human sympathy. Perhaps only a pessimist would take this doleful view of things and I shall gladly dub myself a pessimist if I can have the gratification of knowing that I am wrong.
"Our clinic here was closed on order of the Prohibition Director of the State of California, at that time Mr. John L. Considine. He was supposedly acting under instructions from his superior officer, the Commissioner of Prohibition in Washington, under whose direction the administration of the Harrison Narcotic Law falls. I forget the name of the Prohibition Inspector who came down and ordered our clinic closed, but he read his instructions and they were manda-tory and did not admit of any action to correct the view that they had taken of affairs. How the prohibition officials arrived at their determination to close the Los Angeles Clinic, or the reasons that impelled them so to do are unknown to me, but the case was closed when that narcotic inspector came here and it was at direct written order that the clinic was closed."
In addition to the foregoing municipal efforts at control of the problem of chronic opium intoxication, clinics were opened with or without hospital provisions in about forty other cities, including
San Diego, California; Bridgeport, Hartford, Meriden, New Haven, Norwalk and Waterbury, Connecticut; Atlanta, Augusta and Macon, Georgia; Paducah, Kentucky; Albany, Binghamton, Buffalo, Corning, Elmira, Hornell, Middletown, Oneonta, Port Jervis, Rochester, Saratoga Springs, Syracuse, and Utica, New York; Durham, North Carolina; Youngstown, Ohio; Providence, Rhode Island; Knoxville, Memphis, Tennessee; Houston, Texas; Clarksburg, West Virginia.
These were operated for varying lengths of time, but all eventually were closed by order of the Commissioner of Internal Revenue.
1 Copeland, R. S.—The Narcotic Drug Evil and the New York City Health Department American Medicine. January, 1920. pp. 17-23.
2 Hubbard, S. D.—The New York City Narcotic Clinic and Differing Points of View on Narcotic Addiction, Monthly Bulletin Department of Health, City of New York, pages 33-47. February, 1920.
3 Braunlich, A. R.—Treatment of Drug Addiction at Riverside Hospital. Monthly Bulletin, Department of Health, City. of New York, pp. 4749. February, 1920.
4 'Report of the Committee on the Drug Evil. Proceedings of the Thirteenth Annual Conference of the New York State Association of Magistrates. Feb, 6 and 7, 1922.
5 'Report of the Committee on the Drug Evil. Proceedings of the Fourteenth Annual Conference of the New York State Association of Magistrates. Feb. 5 and 6, 1923.
6 Simon, Carleton—Survey of the Narcotic Problem. J. A. M. A. March 1, 1924. Vol. 82, No. 9, pp. 675-679.