possibility that persons inflated to an extreme degree could be led to commit murder or robbery. One intelligent, but highly abnormal patient who derived intense pleasure from narcotics described an exquisite "don't-care, fatalistic state" into which several hours of excessive indulgence in cocaine and morphine or cocaine and heroin raised him. There was, he admitted, a certain stage of short duration in his debauches during which, through suggestion, he might have been led to commit violent crime because of his peculiar attitude that nothing mattered, but during this stage there was no ambition or spontaneous impulse to do anything. Another patient, a shrinking, temperamental neurotic, described a cocaine-heroin spree that lasted a week, during which time he would consume an ounce of each of these drugs while lying in bed oblivious of the passage of time and in a state of happiness approaching ecstasy. He had no willpower or ambition to do anything during these sprees, but was no doubt highly suggestible. These two cases exemplify an extreme state of inflation during which a certain type of addict is suggestible, but lacking in ambition and aggressiveness. It is reasonable to suppose that such cases could be influenced to commit murder while in the inflated state, but the soothing effect of narcotics far outweighs in importance the suggestibility they produce under some circumstances, and neither of the suggestible states above referred to are comparable in danger with the aggressive, maddening influence of alcohol on certain types of individuals.

The effect of morphine and heroin in reducing courage and aggressiveness is illustrated by statements of addicts examined, as well as by the testimony of their relatives and friends. The experience of the wife who said she could turn her husband around her finger when he was under the influence of heroin, but that at other times he was irritable and disagreeable, is paralleled by numerous other cases illustrated by quotations from the remarks of addicts given below"If there is any yellow in you, heroin will bring it out."

"A man can slap you in the face and you would not resent it."

"It would be impossible to commit a crime, but you do dirty things that there are no risks in."

"You have no guts when you take this drug."

A patient who, as a boy, had been several times arrested for fighting, said: "I have not been arrested for fighting since I took the stuff. It makes a coward of you because you are ashamed of it and you are less aggressive."

Although the immediate effect of all opiates is to curb criminal tendencies, the continued effect of the drug is to create petty thieves because the lethargy, loss of ambition, idleness, and physical depletion produced by the drugs, together with the social and legal difficulties of an addicts' career, result in moral deterioration and financial embarrassment. Many of the cases studied have been physically and morally depleted by their addiction and its attendant social handicaps. Addicts understand and speak of the demoralizing effect of addiction on them, and their records prove it to be true. It thus happens that the good resulting from the soothing effect of narcotics on vicious, aggressive criminals is more than counterbalanced by its deteriorating effects on less abnormal addicts.

Although addiction was harmful to most of the neurotic and mildly psychopathic individuals among these cases, only a few who were regarded as having had in the beginning potentialities for growth into first-class citizens became thieves in order to satisfy their addiction. The more normal addicts continued to work and support themselves honestly. When this became impossible, they as a rule sought cure in order to relieve the financial burden.

CRIMINAL RECORDS

In this series of 181 cases, 98 had been arrested 1 or more times during their lives for offenses ranging in degree from fighting and drunkenness to attempted murder, 59 of them for violations of narcotic laws. The only arrest in 31 cases was for violating these laws, while 39 were arrested for other offenses alone, and 28 for both narcotic-law violations and other offenses. The total number of arrests was 284, counting only 1 arrest for each of 2 habitual criminals about whom definite information was not available.

Some of the arrests were for offenses committed before addiction occurred, and most of them, excluding the narcotic-law violations, were for offenses such as fighting, drinking, soliciting, and fornication. All of the arrests for drinking, and most of those for fighting, were of drunkards before they became addicted or during short periods after they had been cured of addiction and before they resumed the taking of drugs. Of the total number of arrests, 81 were for violations of the narcotics laws; 40 for drinking; 25 for fighting, and disorderly conduct; and 50 others unclassified occurred in 3 habitual offenders. Most of these were

for disorderly conduct, chiefly drinking and fighting. The remaining arrests were chiefly for stealing, soliciting, adultery, bootlegging, or on suspicion. Only a few were for more serious offenses, and these were committed by extreme psychopaths who would have been criminals in any event.

Only 4 of 30 Negroes had escaped arrest. Nineteen of them had violated the narcotic laws. There were 78 arrests of Negroes, 12 of which were for soliciting and 25 for narcotic-law violations. There were 7 pure-cocaine addicts among them who were arrested 29 times, and 47 of the total number of arrests were accounted for by 6 psychopathic Negroes.

An examination of the data in connection with the type of individuals arrested showed that those who had been normal or who had approached normality before becoming addicted had escaped arrest as a rule, except for violations of the narcotic laws. The most significant finding is the absence of arrest for fighting and drinking in those who were addicted to opiates at the time of arrest.

The habitual offenders in this series were no doubt either actual or potential offenders before they became addicted. The cases cited below are types of criminal addicts who exemplify this.

The mother of patient No. 6 is repulsive in appearance. A fighting, quarrelsome disposition and fondness for another man led to her separation from the patient's father. She confessed to four self-induced abortions. The father is normal in appearance and manner. He worked for the Government for years and finally confessed to the theft of thousands of dollars worth of stamps. The father's mother has spells following excitement during which she trembles and screams. The patient, now 24 years of age, went through the third year in high school and has an intelligence quotient of 100. During his 14th year, he began to drink heavily and was arrested for being drunk 3 times before he became addicted. He says that he has always had an "abnormal hereditary craving for something." When 18 years of age, he went with a girl to another city and used her as a decoy in schemes to compromise and then extort money from wealthy men. He was arrested and put under heavy bond for this, but because of his youth and, he claims, through some influence, was allowed to go, with the understanding that the charge would not be pressed unless he returned to that city. Some time after this he began to take morphine and since then has used morphine, heroin, and cocaine. According to his description, the first dose "satisfied every craving he ever had." Since he became addicted, there has been no more drinking, but he has been arrested several times for possessing narcotics. He has had in all about six treatments, none of which were voluntary. Once he was brought in by the police in a delirious state, having taken a number of hyoscine tablets. On all occasions he relapsed immediately on being released. At the present time he is serving a year in jail for possessing narcotics. In a letter to the writer he says, "The deserved lesson has been sufficient," and he promises to "go straight hereafter," but from his makeup we may safely predict that within a few days after release, he will be using alcohol or some narcotic again.

The only question we need ask about this case is: Did the change from alcohol to opium, by sapping his vitality and more effectually soothing his cravings. save him from the commission of more aggressive crimes?

Case No. 7, according to his own statement, is 1 of 9 children in a prominent family, all of the other members of which are prosperous and normal, but the father had a very high temper. When 10 years of age, the patient killed an older boy with whom he had a quarrel by piercing his heart with an awl. He was free to come and go in the custody of the sheriff for 2 months and was then cleared, after which, when 11 years of age, he was sent by his father to a school where discipline was strict in order to get him away from his surroundings. He stayed 5 years, and the head of the school says of him that while there "his moods varied from time to time, but he was usually affable, agreeable, cheerful, happy-go-lucky, and decidedly irresponsible, and under strict supervision he always responded with alacrity to studies, labor, and moral standards, but there was always a tendency for him to sag in all of these respects if the controlling power was released.' From the time he left this school until he was 20 years of age, he wandered aimlessly between 2 preparatory schools and his home. The principal of the school that he attended as a boy reports that after leaving there, he got in with bad companions who used him for their own evil purposes. He left school and enlisted in the Army against the advice of his parents, and claims to have served creditably for 2 years.

It is not clear just when he began to use narcotics. It seems from his story to have been shortly before entering the Army. Since then he has engaged almost continuously in stealing, blackmailing, and confidence games. The crooks, he says, praised him for his work because he never "squealed." It seems that the weak character and low moral sense that was always characteristic of him made

him especially suitable as an accomplice in crimes of the sneak-thief variety. He was caught several times when the accomplice escaped, but avoided a jail sentence. Finally, in a blackmail plot in which his wife was used as a decoy, $2,000 was extorted from a man who later on discovered that he had been duped. Our patient's good luck with the court failed him this time and he received a sentence of 3 years. This patient has a small skull, a receding forehead, a thin face, and a cunning, forbidding expression. His countenance alone would cause most people to shrink from him.

This case received wide publicity as an example of how "dope" will drag a man down, but the only doubtful questions are: Would he, without his narcotic habit, have been an aggressive murderer instead of a thief? Or, if he had escaped the devitalizing effects of narcotics, would he have been a leader among thieves instead of a mere dupe for others? The case is one of a criminal psychopath who long ago should have been separated permanently from society.

Another type of offending addict is illustrated by case No. 7, a colored woman with strong passions and a feeble mind. She has an intelligence quotient of 55. This woman, now 31 years of age, became addicted to cocaine 21⁄2 years ago after a career of delinquency and crime which had led to her arrest about 15 times.

In such cases as this, the addiction is beneficial not to the addict, but to society, in that the violation of narcotic laws will lead to a prison sentence which will protect society for a year or more from a potential murderer, who ought to have been permanently sequestered long ago.

The interest that has been aroused in addiction in recent years by the increased number of addicts in prison has led prison officials to assume that addicts owe their criminal impulses to narcotics, especially to heroin, which is comparatively new. That this is erroneous is believed to be plain to any psychiatrist who has carefully examined criminal addicts. These addicts owe their addiction to the same instability and abnormal impulses that lead to the commission of crime, and addiction is only an incident in their lives.

There is, as before stated, a type of delinquent addict less abnormal in the beginning than the psychopathic criminal. Addicts belonging to this class often owe their delinquency to the deteriorating effects of narcotics and to the social and legal difficulties of a narcotic career. Some individuals of this class commit crimes, especially crimes like stealing that require little courage, because the motive has been greatly accentuated by the financial embarrassment incident to addiction. When cornered, such persons may, like other thieves, commit murder, although we know of no case that has been guilty of it. From the standpoint of criminality, these cases are made more dangerous by addiction, whereas the vicious psychopaths are rendered less harmful by the soothing effects of morphine and heroin.

CAUSES OF LARGE ADDICT PRISON POPULATION

There are undoubtedly many more addicts in prison than was the case 10 years or more ago. An uncritical analysis of this situation has led some to believe that addiction is on the increase, while others have attributed it to the so-called maddening influence of heroin. We have shown elsewhere that the incidence of addiction has been decreasing in the United States since 1900, and that the supply of narcotics legally imported and smuggled has never been more than sufficient to supply 264,000 addicts. Also, a careful study of the effects of heroin clearly shows that it, like morphine, soothes abnormal impulses of all kinds. It is more potent in this respect than morphine, and the mild mental stimulation produced in some cases by therapeutic doses is not evident or is obscured by the more powerful narcotic effect of large addiction doses.

Since the prevalence of addiction has decreased and heroin has no more potentiality for violent crime than morphine, it becomes necessary to look for other reasons for the increase in the addict prison population. There are several of these. One, relatively unimportant, and causing only an apparent increase, is the great interest that has been aroused in the subject, which has led prison physicians and wardens to make careful surveys of their addict populations. An illustration of this is furnished by a large State prison in which, as a result of the statement of a narcotic agitator that 90 percent of the inmates were addicts, a careful survey was made. It revealed less than 10 percent. Surveys like this have no doubt been made in other prisons in which 10 years ago the criminal addict was, like the criminal drunkard, looked upon as a psychopathic criminal, little attention being paid to his delinquent habits.

The apparent increase due to this cause is, however, only slight in comparison with the actual increase due to the rigid enforcement of recently enacted laws 2 The Prevalence and Trend of Drug Addiction in the United States and Factors Influencing It, by Lawrence Kolb, M. D. and A. G. Du Mez. Public Health Reports, vol. 39, pp. 1179-1204, May 23, 1924.

which make it a prison offense for unlicensed persons to sell narcotics or to be found with them in their possession. The records of the Bureau of Internal Revenue show that the Harrison law, which became effective in 1915, has been enforced with increasing success and severity each year. Thousands of addicts who formerly were not molested are being sent to prison for violating this law. During the year ending June 30, 1923, there were 4,194 convictions, chiefly of addicts, for violations of the Federal narcotic laws, and 4,692 years of prison sentences were imposed. Under the dates October 3 and 6, 1924, there were 2,005 prisoners in the Federal penitentiaries who were sentenced for violating the Harrison law.1

In the discretion of the sentencing judge, Federal prisoners convicted for violating the narcotic laws may be sent to a State penitentiary, a city jail, a county jail, a reformatory, or a house of correction as well as to a Federal penitentiary. It thus happens that prisons all over the country care for violators of Federal narcotic laws, and to these are added the large number of addicts convicted under State and city laws and ordinances. It is no cause for surprise or alarm, then, that the addict population of our prisons has increased.

The force of recently enacted State and city laws in swelling the number of addicts in prison is illustrated by the State of Pennsylvania and by New York City. In 1923 there were 549 persons convicted 5 in the county and State courts of Pennsylvania for violating a narcotic law enacted in 1917. During 1923 the workhouse alone in New York City handled 1,292 cases that were either sentenced for violating the sanitary code (possession or selling of drugs) or were self-committed for cure, and there was a total of 2,663 cases committed to institutions in connection with drug addiction. Those not sent to the workhouse were committed to the penitentiary, the New York City Reformatory, and the city prisons. This work was done under a provision of the sanitary code of the city made effective since 1915.

7

When the situation is thoroughly analyzed, one sees that the laws enacted with the idea of reducing the number of drug addicts by punishing them are being enforced, and we have shown elsewhere the salutary effects of these laws. Because of them drug addicts seek cure and many even commit themselves to prison. This is well illustrated by the New York workhouse cases, 427 of whom committed themselves. The prison situation in relation to narcotic addiction may be summed up in the statement that the narcotic laws have made a crime out of a weakness in order to protect persons from the consequences of this weakness, and as a result many of the weaklings have of necessity been sent to prison.

Although the large addict prison population does not indicate an increase of addiction or of crimes due to the so-called maddening effect of narcotics, it is probable that, aside from those sentenced for violating the narcotic laws, there may be a few more addicts in prison than formerly. As already indicated, the high price of narcotics charged by peddlers and the difficulty of securing a supply has no doubt impelled some who would have been law-abiding to steal or commit related crimes. The increase due to this cause is believed to be small, but we have not been able to secure any reliable statistics on the subject. It is plain that if such an increase has occurred, it is not due to the direct crime-producing property of narcotics, as is so often stated, but to the motive that impels certain types of addicts deprived of their opiate to secure it at any cost.

In view of the oft-repeated statement that the introduction of heroin has caused a great increase of violent crime in the United States, the following table which shows the homicide rates in New York and Chicago is of interest. In New York addicts use heroin almost exclusively, while in Chicago the opiate of addiction is morphine, and heroin addicts are as rare as morphine addicts are in New York. Homicide rates per 100,000 population

3 Annual report of the Commission of Internal Revenue for the fiscal year ending June 30, 1923. Figures furnished by the Superintendent of Prisons, Department of Justice, Washington, D. C. Figures furnished by the department of welfare, Harrisburg, Pa.

Hearings of Committee on Ways and Means, House of Representatives, on H. R. 7079. Testimony of Sidney W. Brewster, Assistant Superintendent and Deputy Warden, reformatory, Harts Island, N. Y. 7 See note 1, p. 83.

See Homicide Record for 1923, by Frederick F. Hoffman, The Spectator, vol. 112, pp. 3, 11, 13, and 15, May 8, 1924.

Reports of narcotic agents 9 for the year ending June 30, 192, show that in four States-New York, New Jersey, Pennsylvania, and Delaware-heroin was the opiate of addiction, while in other sections of the country it was morphine, and heroin was rarely used. This is still true of the West and South, but the use of heroin by addicts is spreading along the eastern seaboard as far south as Washington. In Washington the dissipated addicts now use heroin, and the latest report shows that they have been rapidly turning to heroin in Baltimore because of the scarcity of morphine. While morphine was the sole opiate of addiction in Baltimore, the homicide rate increased from 6.4 per 100,000 during the period 1912-16 to 8.6 during the period 1917-21, but since heroin has gained a hold, it decreased from 10.2 in 1922 to 7.2 in 1923. The rate has, however, increased somewhat in two heroin cities, Philadelphia and Washington, but not to the same extent as in a number of morphine cities, and the rate in Philadelphia and Washington is much lower than in some large cities where heroin is seldom used by addicts. It is thus seen that heroin is the drug of addiction in only one section of the country, and it happens that this section has a comparatively small homicide. rate. In 28 representative cities, the homicide rate increased from 8.3 per 100,000 for the period 1912-16 to 9.6 per 100,000 for the period 1922-23. It is interesting to note that the general increase in the homicide rate has occurred in the face of a decrease in one large center of population, New York City, and in this center, also the center of heroin addiction, the rate is only 57.3 percent of the general rate.

If one examines the situation as to crime from the standpoint of drug addiction alone, the conclusion would be that the introduction of heroin had retarded a general increase in the homicide rate, but we do not believe that any student of crime would accept this conclusion. The inference to be drawn from the psychological analysis of addicts, from the trend of addiction, and from the statistics on crime, is that neither the introduction of heroin, the marked decrease of addiction, nor the disconcerting influence of narcotic laws on addicts has had any measurable effect in increasing or reducing the incidence of violent crime, but that the criminal psychopath will commit murder regardless of whether or not he happens to be an addict. Fluctuations in the homicide wave and differences in rates in various parts of the country are due to factors that bear no relation to. drug addiction. A discussion of these factors is out of place here.

SUMMARY AND CONCLUSIONS

All preparations of opium capable of producing addiction inhibit aggressive impulses and make psychopaths less likely to commit crimes of violence.

The inflation of personality produced by large doeses of morphine or heroin is a state of ease, comfort, and freedom from pathological tensions and strivings brought about by the soothing narcotic properties of opiates on abnormal persons. Nervously normal addicts are not inflated and psychopathic criminals are less dangerous when inflated than when in their normal condition.

The inflating properties of heroin are similar to those of morphine.

The heroin hero is a myth.

Both heroin and morphine in large doses change drunken, fighting psychopaths into sober, cowardly, nonaggressive idlers.

Cocaine up to a certain point makes criminals more efficient as criminals. Beyond this point it brings on the state of fear or paranoia, during which the addict might murder a supposed pursuer.

Habitual criminals are psychopaths, and psychopaths are abnormal individuals who, because of their abnormality, are especially liable to become addicts. Addiction is only an incident in their delinquent careers, and the crimes they commit are not precipitated by the drugs they take.

The increased addict prison population is due to the rigid enforcement of laws enacted within the last 10 years and designed to curb the drug evil by making the possession or handling of narcotics by unauthorized persons a prison offense.

Heroin owes its reputation as a crime producer to the accident of having been introduced to the underworld addicts in the largest city of the country shortly before the new narcotic laws forced these addicts on the public attention. Heroin is the drug of addiction in only one section of the country along the eastern seaboard.

In New York City, the center of heroin addiction, the homicide rate has decreased during the past 12 years in the face of an increase in the rate for the country as a whole, and the rate for 28 representative cities is nearly double that, of New York.

4 From files of Narcotic Division, Bureau of Internal Revenue.