It would seem that the use of narcotics in one form or another is based on a deeply rooted universal human craving.

The manner of gratification of this craving varies in different parts of the world according to local conditions and racial customs.

The substances most commonly used are alcohol, opium, Indian hemp, coca, and tobacco.

The following table shows the annual per capita consumption of alcohol among Caucasian peoples.1

Table 14

France...

3.72 gallons

Spain..................................

2.42 "

Germany..............................

2.09 "

Great Britain and Ireland...

2.05 "

United States..........................

1.16 "

Russia....

60 "

Canada....

54 "

Opium eating is chiefly practiced in Asia Minor, Persia, and India. In the city of Balasur, British India, which may be taken as a typical example, one in every twelve of the population is an opium eater. Opium smoking has long prevailed in China and on the islands of the Indian Archipelago, although recently measures have been taken by the governments for its suppression. Various t products of Indian hemp (hashish, bhang, ganja, charas) are used very generally among the Mussulman and Hindu population of India and to a great extent also among the Arabs, Egyptians, and African negroes. Bhang is used in India for smoking and an infusion of it in water is used as an intoxicating beverage. Coca leaves are used for chewing very generally by Indians in Bolivia, Peru, Ecuador, Colombia and Rio Negro. Three or four times a day labor is suspended for chacchar or acullicar, as the chewing of coca is termed. Tobacco is used, as all know, universally for smoking, chewing, or in the form of snuff. The world's annual production of tobacco amounts to nearly two and a half billion pounds.1

1 Year Book of the Anti-Saloon League, 1908 355

In the great majority of instances these substances are used in moderation without apparent harm. But in a Certain small percentage of users pathological addiction develops leading to intemperate use and chronic intoxication. The drug in such cases becomes a necessity to the organism, and its suppression causes a train of physical and psychic disturbances known as symptoms of abstinence.

Etiology

The moderate use of any of the above-mentioned habit-forming drugs in communities where it is a general or prevalent custom cannot be regarded as pathological and therefore does not concern us here. However, the fact that such a custom prevails is responsible for the development of a good many cases of pathological addiction which would not develop under other circumstances.

In this country drug addiction is not infrequently seen among those who, by reason of their occupation or special environment, can readily procure drugs: physicians, their wives, medical students, pharmacists, nurses, laboratory attendants.

However, neither access to drugs, nor, as we have seen, its more or less habitual use in moderation suffices to produce pathological addiction. The character of the soil is an important factor. A constitutional condition somehow related to the great neuropathic group seems to be the soil on which drug addiction grows. Evidence for this is to be found in the family and personal histories of drug addicts.

1 Encyclopaedia Britannica, 11th edition, articles on Opium, China, Hemp, Bhang, Coca, and Tobacco.

In the family histories are to be found cases of psychoses, psychoneuroses, mental deficiency, inebriety, constitutional psychopathic states, temperamental anomalies, epilepsy, etc. In the personal histories are to be found for the most part psychoneuroses and constitutional psychopathic states. Thus, prior to the development of drug addiction many patients have criminal records, are gangsters, pimps, gamblers, prostitutes, embezzlers, etc.

The constitutional character defects of drug addicts become accentuated through the chronic effect of the drug. It is significant in this connection that the English word assassin is derived from the Arabic hashishin, meaning hashish eaters.

The habit is started sometimes through medication, occasionally through curiosity and the desire to experience new sensations, but most frequently through the example and proselytism of older addicts.

The drug most frequently used by addicts in this country, particularly in the Eastern states, is heroin, 95% of all being addicted solely or chiefly to this drug. Following this in order of frequency are opium, morphine, and cocaine. In France cocaine addiction is the most common.1

The age at which the habit is contracted is usually between fifteen and twenty. The most common ways of taking it are by hypodermic injection into the arms, thighs, abdomen, or chest; by snuffing; by smoking (opium); and by the mouth.

The dosage of heroin, morphine, or cocaine in established cases varies from 0.5 to 2 grams per day; in some cases this maximum is exceeded.2

The following description of the symptoms and course of morphine addiction largely holds good for other drug addictions as well.

Many morphine addicts take their injections without regularity or precaution and at any opportunity; others, in true epicurean fashion, select the moment and conditions when they can enjoy most profoundly their favorite pleasure. Some, again, have their hours regularly fixed, use only accurately prepared solutions of a certain strength, and take all antiseptic precautions; many take their daily quantity in divided doses; others take a single large dose daily in order to obtain the most intense effect.

1 J. Rogues de Fursac. In a personal communication.

2 S. R. Leahy. Some Observations on Heroin Habitues. N. Y. State Hosp. Bulletin, Aug., 1915.