sire to get drugs. Most of them, if they were absolutely deprived of the stimulation afforded by drug administration, would not hesitate to commit murder in order to satisfy their wants.

The health commissioner of Chicago says that fully fifty per cent of all crime in that city is committed by drug addicts; that more than twenty-five per cent of all prostitutes are morphine users; and the majority of male addicts are supported by women of the street.

Practically every criminal charged with major offense taken into custody used drugs in some form.

The morphinist is an individual of at `double personality. After the injection, he is in good humor, conciliating, capable of labor. After the cessation of its action, he is restless, repulsive, unable to concentrate himself, dull and apprehensive. A new injection reanimates him. The longer the morphinist continues the shorter become the intervals between the injections, and the shorter the euphoric stage. The most prominent characteristic mental symptom which is brought forth by the abuse of morphine is the perversion of moral feelings; they will lie, and steal, and slander without the slightest compunction, and there is a rapid change to psychic contrast-weeping, laughter, irascibility, dramatic pose-and their unreliability reveals a state of mind closely akin to hysteria. In ninety per cent of the cases, the morphinist is hypochrondriacal and constantly desires to discuss his malady. Recent investigations and analysis of many cases in drug inebriety have shown certain functional nervous disturbances, which, in all probability, antidated the drug habit, and the majority of these cases have psychoneurotic tendencies.

Serious as are the injuries inflicted by morphine on the intellectual faculties, the loss of the inhibitive capacity is a hundredfold more detrimental. To these must be added the progressive paralysis of the will.

great, but infinitely more destructive are the decrease of control and the benumbing of volition. The addicts know what they are doing, and some hate with a perfect hatred their excesses, but are unable to exert their will and are helpless under the fascination of the drug. Their normal faculties are even more deadened by the poison than are their intellectual. Morphine is a will paralyzer. An addict is a captive, retaining his senses though these may be slightly involved, and the will is powerless to make an effort at deliverance. Again and again does he resolve to free himself, but his resolution is overcome by the dominating drug impulse or craving. The crave for the delusive consolation of narcotization is imperious to all other considerations.

The physical effects of morphine vary widely with the persons and their occupations. Probably the most prominent are anemia, with spasmodic muscular efforts. rapid exhaustion and want of endurance.

Some writers have laid great stress upon the changes observed in the eye. Beyond that of contracted pupil there is a wide divergence of symptoms here. In the latter stages of morphinism, the impaired vision gives a certain fixity to the gaze and produces a staring expression. Crothers says: "Prolonged gaze and furtive movement of the eye is very significant, while it may not be pathognomonic of secret use of morphine, would indicate some condition of the brain that is abnormal." The contracted pupil is almost a constant sign, although many physician addicts use atropine with morphine to dilate the pupils, which masks this symptom.

The general marasmic appearance of the face is also another very significant sign; pale lips and ears and clear, pearly skin are associate symptoms.

Some writers assert that a morphinist of long standing can be readily detected by watching his gait and manner of walking. This condition I have never been able to

and eyes, do not believe there is anything to indicate the real condition physically. A fixed tremor is often present, and neuralgias are sometimes quite prominent. Nutrition fails, with loss of flesh.

The mental symptoms of morphinism, as defined by Dr. Lentz, who tabulated what he considers the most prominent changes in morphinism, are:

First, diminished power of recollection, increasing amnesia or disability to recall past mental images and ideas.

Second, diminished power of attention and volition.

Third, diminished power of initiativeness and energy of conduct.

Fourth, diminished muscular power, frequently marked by trembling.

Fifth, blunting of the higher moral and ethical senses.

Sixth, insomnia, loss of desire for sleep, and nutritive disturbances of the whole cortical sphere.

These divisions undoubtedly describe the conditions which occur more or less prominently in every case and there are very few cases that escape special sense involvement. One cannot use morphine long without suffering from weakened, obscure ideas of duty and right relations to others; conceptions of truth and discriminations between truth and falsehood become more and more cloudy; egotism, selfishness, childish prevarication, are quite marked in the majority of cases; a decreasing sense of honor, less pride in character and appearance follow; forgetfulness to carry out promises, suspicion of wrong from others, with delusions that they can conceal their condition and deceive friends and associates is an ordinary accompaniment of morphinism. A man previously truthful and honest who suddenly falsifies and does disreputable things without apparent motive may be expected to be under the influence of some powerful drug. According to Pouchet, forty per cent of our morphinists are physicians, and the wives of physicians also constitute a consid

The physician addict is less hopeful, so far as a cure is concerned, than the average cases and we have more relapses among physicians than any other class, owing to the fact that when they return to their professional duties they are obliged to handle narcotics and this constant temptation is held before them, and with their will power and self-control diminished, they very often return to their former drug addiction.

The misuse of morphine may be brought about:

First, by ministering drugs because of the surgical treatment over a protracted period. Second, by protracted medication for bodily ailment and disease.

Third, by insomnia.

Fourth, by general ill feeling, sorrow and

cal.

Fifth, by bad example, which is specially of physician's wives.

The chief obsession of the drug addict is to gain converts to the cult. Often the experiment is made "just for fun," but indifference soon turns to longing. The pleasurable sensation which the injection produces urges to the second injection when th effects of the first have worn off, and thu necessitates at in a short time an increase of the dose with a development of the imperious craving.

This is a craving which causes men to dare all danger, run any risk, forfeit friendship, destroy affection, relinquish honors in possession or in prospect, to associate with

criminals, reduce themselves to beggary and those dependent upon them to pauperism, want and wretchedness, expose their families to contemptuous pity, and defy any fate, all in order to gratify this craving.

There are many who vigorously opposed the classifying of drug addiction as a disease and who considered it a habit, only requiring correctional measures for its control. Adherents to the habit theory have contended that any existing diseased condition, whether mental or physical, is due to wilful indulgence and should be considered vice. There is little question about the fact that the addiction is a vicious habit, but also when an individual has lost selfcontrol and will power, it should be accepted as a diseased condition.

The Emperic treatment of drug addiction is rapidly passing away and the public has little confidence in anything that depends on secrecy and pretention, as did many of the highly advertised çures of a few years ago. There is no therapeutic specific for the cure of this habit. It requires long detention where it is impossible for the individual to secure the drug, and must be given sufficient time to build up and regenerate the will power and self-control.

In the withdrawal of morphine, three methods are commonly used:

First, the abrupt and entire withdrawal. Second, the rapid reduction, extending over six days.

Third, the gradual reduction, lasting two or three weeks. The first method, or abrupt withdrawal is used in the Knoxville hospital, as this system is best administered in an institution. In fact, I cannot comprehend how a case of morphinism can be handled successfully outside of an institution without legal control over the addict. The sudden withdrawal of the drug does not expose the patient to any serious danger. We have never had a death or a serious case of collapse following the suddenly withdrawal of morphine.

opposed and pronounced inhuman, but we believe it is the best and as safe as any other system. The gradual reduction treatment simply prolongs discomforts of the case and delays reconstructive changes. There is a certain amount of discomfort attendant upon the withdrawal of drugs either by gradual or abrupt withdrawal. In the latter, the discomforts are more acute for the first three days than in the other withdrawal treatments and the phenomena of abstinence appear more marked. There are based, according to Marme, on the toxic action of oxide of morphine found in the body by the chronic misuse of that drug. Many morphinists use from fifteen to forty. grains a day. When the drug is taken in more than six grains per day, it does not show a proportional stimulating effect, as the phenomena of abstinence is no greater in those cases taking large amounts of morphine than those taking smaller quantities.

The most disagreeable phenomena of abstinence consist of vomiting, yawning, sneezing, profuse perspiration, twitching of muscles, precordial anxiety, pupils become dilated, and occasionally we find disturbances of speech, diarrhea, coughing, changeable pulse, and a subnormal temperature, patient is anxious, excited and at times there are states with hallucinations and delusions. These conditions, however, do not last longer than three or four days. There is also a marked hypersecretion of hydrochloric acid in the stomach. The most persistent withdrawal discomforts are the pains in the lower extremities and spasmodic contractions of the abdominal muscles. Also insomnia, which usually persists for four or five days.

The Treatment

At the State Hospital for Inebriates the ordinary routine treatment consists as follows: On admission the patient is given a hot bath, put to bed and given eliminatives. consisting of sulphate of magnesia or compound cathartic pills. The second day he