Medical Society of the State of North Carolina. An.

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mittee, stated that at that time not more than one-fifth of the opium
imported into this country was needed for the legitimate demands of
reputable medical practice, and the Grovernment experts who have been
more recently studying anew this whole proposition believe this estimate
a fairly correct one for the present day.

Be the number of narcotic habitues what it may, in North Carolina
or in the Nation, it is manifest to us of the medical profession that a
tremendous responsibility has rested in the past, and in no less a degree
rests today upon the individual members of the guild in connection with
the users of narcotic drugs. Just what shall be done for those now in
the thralldom of narcotic habit is a problem that calls for immediate
legislative action. I trust that an enlightened and quickened public con-
science in this State will see to it that this important subject is carefully
considered at the next session of the State Legislature with a view to
making proper provision for these unfortunates. Certainly the State
of North Carolina should provide for the examination and treatment of
narcotic habitues as a wise and patriotic public policy ; and it may seri-
ously be questioned, in this connection, if the progressive State of Michi-
gan goes a single step too far in having enacted legislation which pro-
vides that any citizen of Michigan who is addicted to the excessive use
of intoxicating liquors or narcotic drugs may, after due examination, be
declared incompetent by a probate judge, and a guardian of his or her
person appointed. Is there a single community in North Carolina today
where the putting into force of such a statute would not be fraught Avith
beneficial results? Would not such a measure, wisely enforced, conserve
property rights of patient and long-suffering women and little children,
besides exerting a most helpful influence in restraining the subjects of
narcotic habit ? I here mention the vicarious sufferings of the opposite
sex, gentlemen, not to convey the impression that the misuse of narcotics
is solely a masculine errancy, for it is not, but especially for the reason
that I believe the chief indirect sufferers from these habits to be women
and children. Womankind, we well know, cares for and clings to
fallen man much longer than men do to women when the conditions are
reversed. When the State of North Carolina enacted its prohibition



MEDICAL JURISPRUDENCE AND STATE MEDICINE. 65

statute in 1908 the initial step in the direction of further legislative
effort "vvas taken, and it may be questioned if we are not now ready to
extend farther our lines of effort to save and to help our weaker mem-
bers of society by providing legislation along the lines of the Michigan
statute referred to.

That is a matter for future consideration, but the practical question
that confronts us of the medical profession of the State today is, What
may the Xorth Carolina physician do to further promote the beneficial
results which it is hoped Avill accrue to State and Xalion by the enforcing
of the Harrison antinareotic law ? Can we do anything ? Yes, I believe,
very much. ISTo body of men exert today a more potent influence on the
progress of the social affairs of life in this State than do the members
of this body of physicians. And this for the very excellent reason that
our medical practitioners, best of all men, understand humanity, its
aspirations, its purposes, its strength, its Aveaknesses, its capacities and
incapacities, and may best judge of the limitations of human endeavor
in its many lines of activity. Again, to none is offered the opportunities
for service that come daily to us along the lines of helping the people
to help themselves. Here, as in other phases of modern public health
work, prophylactic endeavor pays best. Primarily all physicians should
lose no opportunity to impress upon their clientele the fullest knowledge
of the inherent dangers incident to the use of drugs or medicines of any
kind whatsoever which allay pain or stimulate quickly to bettered feeling.
If every dose of sedative, stimulant, or narcotic administered, especially
in those cases where from the inherent nature of the affection there exists
a liability to a recurrence of the condition, was with knowledge on the
part of the patient of the possible dangers lurking in every pain-relieving
hypodermic, pill, potion, or powder, our duty to our patients would have
been more fully discharged. To properly impress patients with the dan-
gers of the careless and inconsiderate use of this class of remedies— valu-
able, helpful, and in fact indispensable as they are in practice — does not
necessarily mean taking him into our confidence to the extent of advising
as to the details of name or dosage; quite to the contrary. I do not
believe patients are the better for knowing such intimate particulars of
therapy.

As citizens we should encourage and lend our aid to eveiy intelligent
effort to secure needful legislation regarding further limitations of the
sale of all such drugs and remedies, and, in addition, the providing of
places for the treatment of all narcotic habitues. And when I say
this I mean to include in the legislative program measures for the
relief of alcoholics, to the end that they may be laAvfully considered and
5



66 NORTH CAROLINA MEDICAL SOCIETY.

treated as unfortunately defective members of the body politic, and re-
stored, as near as may be, to their normal physical condition. To further
these beneficent ends results of the scientific study of the subject in gen-
eral, and the work of other States and countries in caring for similar
conditions, should be placed before our citizens as opportunity is afforded,
and especially should our boards of health, county, municipal, and State,
carefully consider and treat this whole subject of the use and abuse of
narcotics and alcoholics as an essential and vital portion of the up-to-date
public health program.

What shall we do with that other menace to securing greater freedom
from the uses and misuses of narcotics in the community, the counter-
prescribing druggist ? His class is readily divisible into two groups : the
one composed of really honest druggists desiring to do only a thor-
oughly legitimate drug trade, but who are daily importuned to sell nar-
cotic drugs and remedies by the public, a portion of whom are the
victims of the careless prescribing of narcotics by physicians in some
former illness, when the foundation for a narcotic habit was laid. This
type is entitled to our kindly consideration, and all thinking medical
men recognize the great difficulties' druggists have in complying at all
times with the spirit and the letter of antinarcotic regulations, and give
them due credit for doing their duty, in the main, and trying to avoid
catering to the weakness of habitues. The other type of druggist, always
ready to dispense at the fountain almost any sedative or narcotic known
to the materia medica, and to suggest one that possibly the patient may
not have tried, besides being ever ready, willing, and anxious to exhibit
his thorough command of not only the remedies used in the treatment
of disease and their manner of compound, but by prescribing for every
pathological unfoldment of body or mind from abscess to zygodactylism —
well, I frankly admit my incompetency to prescribe the best disposition
to be made of him, though I am putting my trust in an enlightened
public sentiment, plus the subtle assistance of the Federal deputies
operating under the Harrison antinarcotic law, as probably in the end
sufficing to accomplish either his destruction or reconstruction.

Lastly, my brothers of the profession, but far from being least, let us
as individual citizens each strive to keep ourselves personally as well as
professionally clean and free in our own daily lives from the vice of
narcotic misusage, carefully seeing to it that our daily lives in both
personal and professional practices are so ordered and conducted in our
every relation to all narcotics that we may be viewed in every com-
munity in North Carolina as men whose personal examples in living
their theories emphasize the value to society of the clean-bodied physician
as a helper and a savior to his fellows of the race.



MEDICAL jrRISPRUDEXCE AND STATE MEDICINE. 67

A FEW REMAEKS ABOUT THE HARRISOI^ ANTI^^ARCOTIC

LAW BASED UPON^ ITS ENFORCEMENT SINCE

LAST MARCH.



S. M. Crowell, M.D.. Charlotte.



Ladies and Gentlemen: — In tlie first place, I wish to apologize for an
impediment in my voice, caused by the absence of a piece of the upper
jawbone, a result of a professional "encounter" with a dentist recently.

Before beginning to read my paper as prepared, I will make a remark
on a phase of this subject Avhich came to my mind during the reading of
the other papers in this symposium, and allied subjects.

In the first place, I feel that it is a calamity that we, as doctors, really
know so little of the subject of drug addiction and the condition of those
enslaved, and still less about the best methods to relieve the habitue. It
seems to me that even Dr. Lambert of Mr. Towne's Sanatorium, judging
from his writings, does not yet have tlie best idea about this subject or
its treatment. Really, it appears to me that his logic is poor for one of
his ability and reputation. But perhaps Dr. Lambert does not see so
much of his patients at first hand, much of his information coming
through assistants and nurses. However this may be, it behooves us as
professional men in charge of these unfortunates to study and become
more familiar with this subject, for these thousands of people are de-
pendent almost wholly upon our advice for treatment, care, comfort, etc.

When this law was first called to our attention it came like the "thief
in the night" of Holy Writ, causing surprise and astonishment; the
majority of physicians and druggists, at first thought, condemning the
law and its author on account of the inconvenience to these professions.
However, after more mature consideration it was decided that it was a
pretty good law after all.

As to why the law was passed, primarily, God and our all-wise United
States Congressmen only know, as the bill seems to have been rushed
through before any one scarcely knew it ; but the presumption is that it
was to stamp out the great and gi-owing National evil of drug "barter-
ing" and using in America, and especially to eliminate the many dives
and dens, and their accompanying evils, of the larger cities where the
evil has become such a serious problem. Even in my own small city
certain drug stores and individuals made it a practice to sell opium and
cocaine in large quantities to certain persons, who would in turn "retail"
it to habitues and "sniffers" for so much per "hop" or "sniif." The re-



68 NORTH CAROLINA MEDICAL SOCIETY.

suit was that we had many purse snatchers, and highway rohberies
were frequent. So frequent were these "hold-ups" that it was not safe
for a lady to w^alk the streets alone. ISTo, these assaults were not con-
fined to the fairer and weaker sex at night. Really, one of our prominent
young attorneys was waylaid and assaulted by a cocaine habitue not
many weeks since. A great number of these cocaine victims have been
convicted of these crimes and sent to the chain-gang, practically all the
subjects being confined to the negro race. I find that these assaults
are confined to the cocaine habitue when any drug is involved.

Perhaps another reason for the adoption of the law Avas to create a
revenue, or "war" fund, for at one dollar each for registration fee, plus
the amount for order blanks for every doctor, druggist, dentist, and
veterinarian in the United States, and its "world-wide annexes" or
dependencies, quite a snug sum would be realized to help fill the treasury
at Washington City, to pay off the departments' many employees.

In reply to my question as to what they thought of the Harrison
law, many doctors, dentists, and druggists have replied that it had made
it almost impossible to secure the drugs except in a legitimate manner.
Personally, I think it a most excellent start in the right direction ; how-
ever, I think there should be some provision made for the indigent or
poor habitues, and shall refer to this feature later in this paper.

Under my observation since last March have come many appealing
and pitiable cases of drug habituation. First was the pooi'er class who
were scarcely able to secure the drug under the slack laws and "merciful
hearts" of the druggists under the old regime. Many have been forced
to go without the drug until their sufferings were beyond the compre-
hension of those not so familiar with this class of patients. I have
known them to go hungry and cold, often selling their scanty clothing
as a last resort to secure prescription and drug. Upon interviewing the
chief of police of Charlotte, ]^. C, he gave me the following opinion
and information: "First, the Harrison law gives me about three (3)
crazy people per week," and that he thought that the laAv would ulti-
mately solve the dope evil; "that we are just now passing through the
crisis." I, too, feel that the law will very soon solve to a large extent the
"bartering" and "dive" and "Red Light" District and evils arising from
these narcotics there ; but those addicted to the drugs must be cared for
or treated by the Government, also, before it's possible to solve the prob-
lem in toto, for they must continue to have the drug till treated ; hence,
the problem is not yet solved, but much improved.

The second class was confined to those Avho had no trouble in getting
the drug, or those termed the "better class." As a rule this class has



:medical jurisprudence and state medicine. 69

plenty of money, hence escape the above troubles. But some of them
had their troubles, too, as they had their supply furnished through
servants and friends in general to avoid exposure and publicity. When
this law became effective and their supply was exhausted, their pride
would not allow the habitue to expose him or herself, hence there xvas
all I'inds of trouble to all parties concerned.

For instance, one case, the wife of a prosperous business man in
another State, who had secreted the addiction from her husband and
friends for nearly ten years, became very ill, wild, hysterical, and then
semiconscious, etc., when her faithful servants could no longer supply
her, and she was brought to my sanitarium March 26, 1915, by her
physician, a physical and mental wreck — a woman whose modesty or
pride would not allow her to divulge her misfortune even to her loved
husband and faithful family physician. After a few "shots" of mor-
phine and a good stiff drink of Avhiskey her mental faculties were suffi-
ciently restored for her to tell me the story of her secret addiction, con-
sequent suffering, etc., and in substance, the above history. After a mor-
phine treatment of about five weeks she was sent home a well, wiser, and
happier woman of forty-six years.

Another class is represented by another case, a widow of forty-five
years of age, from a prominent family from another State also, who was
brought to my place April 1, 1915, in a semicomatose state. Had used
laudanum for twelve or thirteen years, known and unobjected to by
family and immediate friends, but on account of the trouble and no-
toriety gained by securing the drug under the present law, decided to
have a local doctor treat her at home after having tried the various
"sent-off for" cures. After she had become wild, and presented a serious
aspect, after having stopped the laudanum, this "home" doctor hurried
her to my place, after having restored her usual dose of opium. The
above history was elicited from a party who accompanied her. We
found her urine literally loaded with albumen and tube casts. She was
put on Sparteine sulphate in gr. 2 doses and strychnine nitrate gr. 1-30,
both hypodermically, every four hours, as well as morphine sulphate,
gr. 1/4 every two to four hours. She was also given, by force, large quan-
tities of water and milk to drink. Under this course consciousness was
soon restored, urine cleared up, and she was given the opium treatment
as in a normal case with the best results.

Another class observed is represented by those who secured lai'ge
supplies before the law became effective and continue its use under
"cover"; however, a number have begun inquiries about treatment, not
knowing what will be the ultimate effect of this law.



70 NORTH CAKOLINA MEDICAL SOCIETY.

As the Grier or antijug law will very materially reduce the drink evil,
so will the Harrison law very much reduce the consumption of the
narcotic drugs, (1) by avoiding the heginning by careless or malicious
prescribing of these drugs, and (2) by the reduction of the number of
habitues, who will be cured rather than secure the drug as they must
under present regime.

In closing, I wish to emphasize what I have said before this body
several times previously: Every State should make provision to care
for and treat its indigent habitues and inebriates. It is high time for
us to stop sending this class of our sick-poor to the chain-gang when
they should be placed in a well-equipped sanitarium for scientific treat-
ment, which feature we cannot consider at this time. We care for our
syphilitics and alcoholics, and this class has just as good right to be
cared for in a similar manner.



WHAT l^OKTH CAKOLINA SHOULD DO IN THE EEGULA-
TION OF THE SALE AND USE OF NAECOTICS.



By Hon. J. W. Bailey, Collector of Internal Revenue for the Eastern
District of North Carolina, Raleigh.



Mr. Chairman, Ladies and Gentlemen: — I consider it an honor and
a distinction to be invited to address this society of learned scientists
and leading citizens of our Commonwealth. I did not expect to be
introduced as the guest of honor ; that is, I am sure, a great deal more
honor than I am worthy of. I am on the program for discussion of
what North Carolina should do in the regulation of the sale and use of
narcotics, and I am going to take the liberty of discussing the whole
field of the Federal and State regulation of the sale of narcotics with a
view of determining my answer.

The United States has enacted within the last three years three very
great and far-reaching acts in the form or the nature of police regula-
tions — the White Slave Act, the Webb-Kenyon Act, and the Harrison
Narcotic Act. The greatest of these in its significance and in its actual
object is the Harrison Narcotic Act. For my part, I have been amazed
to see with what ease so great and far-reaching a measure was passed,
significant in its relation to the fundamental law and policy of our
country and of the States, and significant, too, in its relation to hundreds
of thousands of individuals; significant also in its relation to trade. I



MEDICAL JURISPRUDENCE AND STATE MEDICINE. 71

say that I liaA'e been astonished that so great and far-reaching an act
could have been passed by our Congress practically without opposition
and almost without observation. I dare say a great many members of
this society and a great many leaders of the political parties, not to
mention the great rank and file of the people, did not know the Harrison
law had been enacted until its enforcement was on the way by means of
the offices of the collectors of internal revenue in the several States.

You will be interested to know the origin of the Harrison act. It
originated at Shanghai, China, in an international conference : that is,
a conference representing the far Eastern nations, the nations of Europe,
and the more leading nations of our hemisphere. That conference took
j)lace five years ago, and let it be said to the credit of the Kingdom of
China, now the Republic of China, that that nation took a leading part
in this cause. The United States was represented there. Two years
later a conference of the representatives of the powers that first met at
Shanghai met at the Hague, and there the signatories to the conference
agreed that they would return to their several nations and move the
immediate enactment of a law to prohibit the use of opium for other
than strictly medical purposes. So our act was passed, not in response
to popular appeal in the United States and not in response to a popular
realization of its need, but in response to what well may be termed inter-
national conscience, and that is where it got the great force that swept it
into form and into the law without any popular propaganda in this
country.

So much for the origin of the act. Now for the object.

The object of the Harrison act is to get hold of the opium habit, the
slavery to narcotics other than the alcohol narcotic ; to prevent the in-
crease of the opium habit and at the same time to reduce the use of
opium and to cut down the number of habitues to the greatest extent
possible. It is an immense measure of national and international con-
servation and it is the most tremendous conceivable sort of moral enter-
prise. It is world-wide. It is a magnificent spectacle, gentlemen of the
society, to see all the great nations of the earth rising so readily and
with such force to a cause like this. I do not hesitate to say that it is
something new under the sun ; and at a time when the world seems to
be filled with muck-rakers and the evil that men do is brought up in
heaps before our eyes with every newspaper and every monthly maga-
zine, it must be infinitely refreshing to all men whose faces are in the
light of the morning, it must be infinitely refreshing to see not only our
Nation, but all the nations of the earth, rise to the moral height of
undertaking to save millions of men and women from the hopeless and
horrible slavery of opium and its derivatives. And may I turn aside



72 NORTH CAEOLINA MEDICAL SOCIETY.

liere to pay tribute to the one class of men who might have made an
argument against this law, the pharmacists and druggists of this country ?

At a time when our country is said to be in slavery to the almighty
dollar, we have the magnificent spectacle of the pharmacists and the
druggists and the physicians of our land not only not opposing this act,
but being the chief responsible sources of its passage. That, too, is a
magnificent tonic for a world that has been dosed, if I may use the
language of the doctors, with the doses of the muck-rakers for the last
twenty years. It is one of the good and beautiful things of our time.

So much for the origin and so much for the object. Now, a word as
to the method. The method of the Harrison act is in the first instance
the method of publicity. I may turn aside here to say that since as
Collector of Internal Revenue for the Eastern District of North Caro-
lina I began to put this act into effect early this year I have had very
few complaints from physicians against the irksome red tape of the act.
I bear you that testimony. I think we Southern people, we North Caro-
linians, rather resent the tyranny of close-knit laws; we rather chafe
under what we call red tape and blanks and complying with all manner
of little details; and I was prepared for some protest. I did receive a
very hot letter from a physician whom I esteem. He was going to sever
political relations with the party that put the act in force. The next time
I see him I am going to tell him that the movement was started with one
party and finished with the other; that it has no political aspects what-
ever, and that its origin is deep as the conscience of an enlightened
universe, and not political at all.

The method is the method of publicity. The Government requires
that all opium — I use the word opium to cover the whole reading of
narcotic — purchased shall be reported upon blanks furnished by the Gov-
ernment. It proposes to keep up with every ounce of opium from the
hour it reaches our shores until it has been consumed. We have our ex-
ternal revenue system. Every ship has to declare herself when she starts
and make manifest. We'll know how much opium comes, we'll know
where it comes, and we'll hold to the strictest accountability under this
Harrison act the receivers of this opium. Now, that gets it into the
hands of the first distributors. From these it is purchased by the drug-
gists under Government regulations and supervision ; and the physicians
obtain it from the druggists.

The physician is permitted, of course, to prescribe it, but he prescribes
it under a registered number, and that number is one by means of which
you can trace whatever he does. Now, all this is a broad contrast to the



Online LibraryMedical Society of the State of North Carolina. AnTransactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) → online text (page 9 of 58)