thoroughly established by years of indulgence and until their own efforts to cure themselves have utterly failed. If he is to be cured, his whole attitude must be changed and he must voluntarily and willingly submit and cooperate.

This is indeed a difficult step for him to take. He above all others appreciates the fact that very few are even redeemed and believes that, "Once an addict, always an addict.”

There are many cures administered and many failures. Many of the addicts' we have at the Reformatory have taken "cures" at different times.

Office treatment is always unsuccessful as the ambulatory addict has too many opportunities to secure his drug. Gradual withdrawal is considered most satisfactory by many.

At the Reformatory the custom has always been to take these people off the drug as soon as they are admitted. This practice was carried out by Dr. Beach and I am following the same course. The patients suffer greatly for three or four days and nights, but at the end of that time or by the end of a week they have a desire for food, which they are able to retain and can obtain more or less rest and sleep at night. They soon begin to put on flesh and their spirits are buoyant and they enjoy life. Of course, some of them are dissatisfied and do more or less complaining and most of them are untruthful. They all feel they are cured at the end of two or three months. We do not have one grain of morphine in our institution. The treatment given is simply making the patient as comfortable as possible. She is placed in bed, given warm baths, liquid diet, increased as they are able to retain food. They have strong coffee to drink and doses of strychnine sulphate for stimulant; atrophine sulphate is also given in one one-hundredth grain if indicated. Castor oil and other laxatives are used as needed. To produce rest at night they are given hypnotics as trional or veronal. In three or four days they wander down to the dining room and when the appetite returns, they are certainly able to take care of large quantities of food. I imagine, although these people declare when they leave the institution, they will never go back to drugs and appear to be so thankful to be in such good health and feel so normal, that many of them will go back, especially if they return to their old friends and environment. A complete change of conditions and associates is usually the only guarantee that the "cured" addict will not revert.

The Unsolved Problem.

And now what can be done to control this menace which confronts us. The Harrison Law has done much good but still there must be something wrong with a law which has been so stringently enforced since 1914 and which has resulted in an ever-increasing total consumption of habit-forming drugs. The old addict now no longer able to secure his drug through legitimate channels resorts to any measure to relieve his misery and in response to this insistent physical demand, an "underground'' illicit traffic in "dope" has developed a traffic so secret, so well organized and so far

reaching that federal and state authorities are unable to cope successfully with it.

The unsolved problem has four sides:

1. Some means must be found to limit the world's supply of opium

2.

and coca leaves.

Some method must be adopted to control the manufacture of morphine, heroin and cocaine.

3. Reputable physicians must be given a sufficient allowance of opiate derivatives to use in the treatment of addicts who apply to them for relief.

4.

An attempt must be made at public expense, if necessary, to reduce those who have fallen into the grip of this menacing vice.

The nations of the earth should get together in some sort of an international understanding, before the first aspect of the problem will be solved and the "dope" peddler will continue to ply his trade and wreck certain types of humanity. This will be more difficult to effect than to bring about a League of Nations, because most of the opium used in this country originates from Asia Minor. The Porter Resolution authorizes the President of the United States to confer with Turkey, Persia and the British Government in India for the purpose of reducing the production of opium in these countries. Cooperation means that many poppy growers must go out of business and owing to strained political relations between our country and these countries and the fact that the countries are more or less impoverished since the World War, there is little chance of cooperation. The same situation prevails with reference to limiting the supply of coca leaves in Peru, Bolivia and Java. The industry is too profitable for these countries

to consent to reduce it.

It has been suggested that measures be taken to control the manufacture and distribution of these narcotics. When the world's supply of opium and cocaine is limited to its purely scientific and medicinal needs, there will be no necessity to control the manufacture of these drugs, but it will require strict international supervision to guarantee that each nation receives its pro rata share.

All addicts should be cured if possible for two reasons; it is our duty to aid them in the same way as we assist others who are sick. In their present condition, they have a bad influence on those associated with them especially on the boys and girls just out of their teens.

Physicians avoid these people generally, because of the rigid enforcement of the law. Not a few honorable physicians with good intentions in mind have been fined severely for aiding addicts. The Harrison Act could be modified so as to protect the medical profession's permission to use a sufficient amount of morphine and heroin to effect a "cure" in patients.

It will not be so easy to persuade the Federal Government to expend money for the purpose of curing these unfortunates and not inflict punishment on them. State and national legislation should establish clinics where these unfortunate addicts can receive treatment at reasonable expense.

Some have suggested that legislation of this nature should be placed under control of the United States Public Health Service, so that trained physicians would be available to investigate existing methods of treatment, to devise new methods, and conduct government clinics for the purpose of giving treatment in the light of the latest established scientific discoveries. Since the present methods of treatment are all more or less experimental. there is need for the government to undertake the discovery of that scientific method of handling cases of addiction which will give the best results. When the nation realizes that opiate addiction is a disease not different from certain forms of insanity, it may look more humanely and tolerantly on the ills of the addict and punish with greater severity the illicit dope peddler who smuggles drugs into the United States, sells them at an enormous price and creates new victims as fast as he can. This fiend is largely responsible for the enormous increase in our consumption of opium since the passage of the Federal Narcotic Law and is the one to whom the law should show no mercy and give no quarter. He is as great a conveyor of disease as the rat and mosquito ever were, and his existence should be regarded as more menacing.

STATE OF IOWA

BULLETIN

OF

STATE INSTITUTIONS

Containing a Report of the Quarterly Conference of Chief Executive Officers of State Institutions and others with the Board of Control of State Insti

tutions with papers and addresses

and discussions thereon.

PUBLISHED QUARTERLY IN DES MOINES

BOARD OF CONTROL OF STATE INSTITUTIONS

A. M. McColl, Chairman, Woodward

MEMBERSJ. B. Butler, Fort Dodge

J. H. Strief, Sioux City

MEN'S REFORMATORY PRESS,

ANAMOSA, 10WA.

cont