and are added expressions of the warped mental attitude that he displayed when a boy. The patient has been treated for syphilis contracted from the woman who practiced fellatio upon him. He now has a heart lesion and is somewhat emaciated from the effect of drugs.

In reviewing the life history of this man, those who have studied the evolution of psychopathic characters from the standpoint of heredity and environmental influences may doubt whether narcotics have had much to do with his downfall. The outlook was no doubt bad from the beginning, and it is impossible to determine definitely what the result would have been without narcotics. nonaddicted persons with his original faulty makeup turn out better. thought that narcotics have already contributed to his deterioration, and it seems sure that he will never be cured. Further deterioration is, therefore,

inevitable.

Some

It is

Contrasted with the spoiled, complaining, selfish neurotic weakling just described, who in any event would have made a contemptible showing in the world, is the case of the man cited below who was undoubtedly ruined by narcotics and the associations that so often go with addiction.

Case 35, now 38 years of age, started smoking opium 20 years ago. After the importation of smoking opium was prevented by law, he used morphine and when this could no longer be secured, he changed to heroin. Cocaine was indulged in from time to time, but he discontinued this because of its obvious harmfulness. During one period of 9 months, he used regularly one-eighth of an ounce of morphine and from 12 to 15 grains of cocaine daily.

The patient's father was a prosperous businessman, but drank heavily. There are 3 brothers doing well in a business way and 1 normal sister. All of the brothers drink, but none is a drunkard. His mother is intelligent and healthy, and the patient has always been fond of and obedient to her except in relation to his narcotic habit.

As a boy, he was healthy and is supposed to have been normal in every way, but got into bad company, and this naturally became still worse after his addiction. During school years he was too much engaged in having a good time to become seriously interested in his studies. He has worked in numerous positions, but never regularly after the production of narcotics was made difficult. He at one time drove a cab, and other addicts claim that he was discharged for attempting to rob patrons and say that he has a reputation for being pugnacious and a fighter. His only serious contact with authorities has been for violation of narcotic laws, for which he served 2 terms amounting to nearly 4 years. His pugnacity, which was considerably augmented through drinking during two short periods when he was off the drug, and his prison record make him a well-known character to the police, and it has had a bad effect on his personality to be questioned about numerous affairs of which he knew nothing.

About 1 year ago he was taken off the drug, but within a week after leaving the hospital, he got drunk and had a fight with the police, who arrested him, and 2 weeks later he relapsed to heroin. For the past 7 months he has held a position as a salesman which pays him $40 per week. He is apparently highly efficient and is well liked by his employer, but he spends a large part of his salary for the drug and lives in continual fear that something in connection with his habit will happen to deprive him of his job. Insomnia was a distressing symptom after his last treatment, but he is anxious to take treatment again and thinks that, with work to keep his mind employed, a cure might be permanent.

This man still has some remnants of a strong personality similar to that possessed by his brothers. Unlike the spineless psychopath previously described who projects his trouble on the environment and appreciates nothing done for him, he blames no one but himself for his present plight, is ashamed of the disgrace his conduct has brought on other members of the family, and is grateful for the efforts that have been made to help him. While devitalized by morphine and cocaine, he could not resist the influences of an evil environment, but the family history and his own personality lead one to believe that, barring the accident of addiction, he, like his brothers, would have been a law abiding, industrious citizen in spite of the mild inebriate impulse that would probably have led him to drink a great deal in early life.

The deterioration so common in the class of addicts in which narcotics were found to be most harmful did not effect all of them. Some have worked and lived within the law for periods ranging from 5 to 20 years. Most of these had a poor moral tone in the beginning which was apparently not affected one way or the other, but the general effect of continued use of narcotics, especially if cocaine was used in conjunction with morphine or heroin, has been to lower both the moral and physical tone.

Effect of addiction on industrial efficiency

2355

In connection with the deterioration caused by addiction, the industrial records of 172 of these cases have been surveyed. The records were considered to be good or fair in 88, and irregular or unsatisfactory in 84 cases.

The criterion for a good or fair record was continued employment and satisfactory work. Housewives who performed their household duties with average efficiency for the social class to which they belonged were classified with those having good records. has, in this classification, not been allowed to vitiate an otherwise good industrial A sojourn in the penitentiary for violation of narcotic laws record. Some cases who were self-sustaining, but who worked in inferior positions because of their addiction, have been classified as having poor records. The percentage who have good records is probably surprising to those who accept the general view that addicts are almost invariably useless characters. centage might have been higher but for the inconvenience caused in some of these cases by necessary narcotic laws. The per

Of the entire number, 51.2 percent had good industrial records, but if the professional men and colored people are excluded from the reckoning, only 42 percent had good records. men, and in 18 of 24 colored persons. The reason for the percentage of good The records were good or fair in 18 of 24 of the professional records shown by the colored addicts is that most of them were recruited from normal individuals. The professional men maintained themselves on a higher plane of industrial efficiency because of their superior intelligence, higher average of nervous normality, and more advantageous position from a financial standpoint. Three of the six professional men rated as irregular or poor owed their industrial inefficiency to excessive drinking before they became addicted to drugs, Two, one of whom is rated as very poor, were harmed by morphine and cocaine, but the probabilities are that both of these cases would have made an unsatisfactory showing in any event. The other one has always been self-sustaining, but is rated irregular because his struggle with narcotics impelled him to accept for a time a position financially and socially less satisfactory than his education and training should have afforded.

No case classed as nervously normal in this entire series showed a poor industrial record, but in some abnormal cases the record was good. The psychopathic nature of some of these cases was such that even without narcotics nothing but an idle, aimless life could have been expected. industrial records, and the history presented by a few of them seemed to indicate that had they not changed from alcohol to opium, they would have been useless Some of the inebriates had good drunkards.

Effect on marital condition

The moral character and social efficiency of any group is reflected in the marital records of the members of it. surveyed, 52 were single. Most of these were below 31 years of age and some will Of 152 addicts in whom the marital records were no doubt be married later on. the cause of being single. Some of the older cases gave their addiction as psychopaths from marrying. Of the 118 married cases, 46, or 39 percent, were This reason apparently had not deterred the extreme divorced or separated and a few others were temporarily estranged. That some other factor besides addiction was responsible for the unsatisfactory marital history of these cases in indicated by the fact that 17 of 19 married professional men were still living with their wives. Excluding these from the larger group, 46.5 percent of married cases were separated or divorced. One of the separated professional men had been an extreme drunkard and the other was an extreme psychopath. The high percentage of marital infelicity in the remaining cases was traced to several factors, the most important of which was the unusual or unreasonable behavior that naturally flowed from the psychopathic or neurotic character that was the original basis for the addiction of so many of them. due to dissipation with drugs, accounted for some cases, and in a few others sexual weakness, from the same cause, was a contributing factor. Failure to provide, have been more important in some of these cases than was determined, but it was learned from addicts in this series that potency is not completely abolished Sexual weakness may until the daily dose of heroin or morphine is 15 to 30 grains. Desire is reduced by much smaller doses, but considerable potency remains. raised 10 children. men beyond 60 who had been addicted 20 years or more reported sexual compeOthers addicted for years had families of average size, and One 35-year-old addict tency.

SUMMARY

Opiates apparently do not produce mental pleasure in stable persons, except a slight pleasure brought about in some cases by the reflex from relief of acute pain.

In most unstable persons opiates produce mental pleasure during the early period of addiction. The degree of pleasure seems to depend upon the degree of instability.

A large number of addicts experience a pleasurable physical thrill following injection of morphine or heroin. Normal addicts experience this thrill in only

a very slight degree, if at all.

Cocaine may produce pleasurable stimulation in both the normal and abnormal, but the pleasurable effect is slight in nervously normal individuals.

Nervously normal opium addicts apparently do not undergo appreciable mental or moral deterioration, but this class of addicts constitutes only a small proportion of the total number in the United States.

Much of the moral deterioration attributed to narcotics in the past was not deterioration, but an original nervous instability and moral obliquity.

Mildly psychopathic individuals deteriorate more because of their addiction than any other class of addicts.

No preparation of opium produces any appreciable intellectual deterioration. If there is any difference in the deteriorating effect of morphine and heroin on addicts, it is too slight to be demonstrated clinically.

Cocaine is much more harmful than opiates and long-continued use of addiction doses of cocaine is destructive both to the physical and mental well-being of any type of person.

Who can separate his faith from his actions, or his belief from his occupation? Who can spread his hours before him, saying, "This for God and this for myself; this for my soul and this other for my body"? —Kahlil Gibran, in The Prophet.