hospitals and the amount consumed, to obtain a fairly accurate idea of the amount of opium and its alkaloids used in the legitimate practice of medicine. From previous investigations it is known that from 2 to 2.25 per cent of the populaton are sick in the year, and that from 18 to 23 per cent of these patients are sufficiently ill to be in the hospital. On the basis, therefore, of 23 per cent of 0.0225 per cent; that is, that 0.005175 per cent of the population are hospital patients, one obtains an approximation of the amount of opiates used in the practice of medicine. If, therefore, without taking any account of the illness or the injury which brought the patient to the hospital, without discussing the therapeutics, and scattering the hospitals over a sufficient area in the United States to prevent local peculiarities from coming in, it would seem that a fair estimate can be obtained. This has been done, and the statistics here presented are from the records of hospitals for the years 1920 and 1921, and these hospitals are scattered from New England to the Pacific coast; from the populous Middle Atlantic States; from the Northwest and Great Lakes down the Mississippi Valley to the Gulf and the borders of Mexico; and along the Rocky Mountain States to complete the area covered. They are from hospitals dealing with general medicine and surgery; special hospitals devoted to the care of children and maternity cases; industrial hospitals of large industries, and hospitals caring for cancer cases, in which the use of the opiate is a necessity in large amounts; so that they comprise hospitals using a minimal amount of opiates, hospitals using a maximal amount, and large hospitals in general medicine and surgery using average amounts. The intention, at the beginning, was to calculate only from hospital patients; but the statistics of some of the hospitals have made it impossible to separate hospital bed patients from the ambulatory dispensary patients. This seemed, at first appearance, a disadvantage, but on second thoughts it proved the reverse, as it gives the difference between the amounts used among all patients and the amounts used solely for bed patients. There is an interesting difference between the two in that the amounts of morphine, codein, and heroin used are less among the dispensary patients, but the amount of opium is more per patient. This agrees with the rational therapeutics that one would expect to find for the morbid conditions usually presented. In Tables 2 and 3 the variation between the two years is averaged up in the total. We see, therefore, that in carrying for the hospital patients there is prescribed during the year an amount equivalent to giving each patient onethird grain of morphin, one forty-second grain of heroin, one-third grain of gum opium, and practically one-half grain of codein. In hospital and dispensary patients we find necessary an amount equivalent to giving each patient about one-ninth grain of morphin, one-one hundred and sixty-fourth grain of heroin, one-half grain of gum opium, and practically onethird grain of codein. To obtain the amount of opium necessary to be imported into this country we must translate these terms of alkaloids into terms of gum opium, and we must therefore consider for a moment the chemistry of their preparation. Inf every 100 parts of opium, the United States Dispensatory states, there are 10 parts of morphine and three-tenths of a part of codeine. Cushing gives fivetenths of a part of codeine. We will use the three-tenths, as it will produce a larger total, and we shall thus obtain an amply sufficient supply. The amount of opium required is therefore governed by the amount necessary to obtain the amount of codeine used. Codeine, moreover, is obtained from the mother liquor of opium after the morphine is crystallized out. If we, therefore, have enough opium to give us the codeine, we shall have an excess of morphine. Heroin is diacetylmorphine, and is made by treating morphine with acetyl chloride. Dionin, on the other hand, is ethylmorphine, and is made by the action of ethyl iodid in the presence of an alkali or morphine. The necessary amounts of dionin and heroin, therefore, are easily obtainable from the excess of morphine which remain after the demands in medicine are satisfied, since, as we have said, the opium used to obtain the codeine contains thirty-three and one-third times as much morphine as codeine. In calculating, therefore, the amount of opium required on the basis of the amount of codeine desired, we are amply providing for the alkaloids here mentioned and usually employed in medical practice. Among the hospital patients taking 0.4637 grain as the necessary amonut of codein for each patient yearly, it must be equivalent to 0.3 per cent of the total amount of opium required for each patient yearly, since gum opium contains three-tenths part of codein per hundred parts of opium. Each patient, therefore, will require 154.56 grains of opium yearly to make the necessary amount of codein. By adding to this 0.3277 of gum opium, required as opium, we have 154.88 grains. If we add the maximal amount of gum opium, as calculated for the dispensary patients of 0.4384, we get 154.99 grains. In either case it is practically 155 grains of opium that is necessary to produce the amount of codein plus the amount of gum opium necessary to obtain both gum opium and its alkaloids of codein, morphin, and the synthetic heroin and dionin. One hundred and fifty-five grains of opium will give 15.5 grains of morphin; and as each patient in the hospitals requires, according to our calculations, only 0.3387 grains yearly, there will each year remain an excessive amount of morphin. Two and twenty-five hundredth per cent of all the population are sick in this country each year. At present, the population of the United States is given as being 106,000,000. Two and twenty-five hundredths per cent of this number is 2,385,000. Multiplying this by the 155 grains for each patient and dividing the result by the 437 grains in an avoirdupois ounce, and again dividing that quotient by 16 ounces, we obtain 55,943 pounds of opium. Opium is distributed medically in Troy ounces of 480 grains to the ounce and 12 ounces to the pound, but is bought in avoidupois ounces of 437 grains to the ounce and 16 ounces to the pound. This is calculating on the basis of every one being as sick as the hospital patients. Taking, however, the amount required by the hospital and dispensary patients combined, which perhaps is a fairer estimate, we find that the amount of codein required is 0.3045 grain; and, adding the amount required of gum opium in the dispensary, 0.4365 grain for each patient, we have 101.9 grains for each person required to give the desired amount. Multiplying therefore, the 2,385,000 patients by 102 grains, we find that 37,117 pounds will be required. Thus, it is seen that the amount of opium required in the practice of medicine depends on whether we calculate by the amount of codein used only among hospital patients, or whether we calculate by the amount of codein required in hospital and dispensary patients together. Somewhere between 37,500 and 56,000 pounds is probably nearer the truth. Calculating from the 77 per cent dispensary patients and 23 per cent hospital patients combined, we have 23 per cent of 2,385,000, or 545,550 patients as hospital patients, requiring yearly, at 155 grains for each patient, 12,796 pounds of opium, and 1,839,451 patients as dispensary patients requiring, at 102 grains each, 28,393 pounds of opium, or a total of 41,189. To assure an ample amount for even an increased demand of codein, 45,000 pounds of opium may well be considered an abundant amount of opium to be imported each year for medicinal use. This is less than one-tenth the actual amount now imported, and supports the statement of the Treasury report on traffic in narcotic drugs that 90 per cent of the amounts of these drugs entered for consumption is used for other than medical purposes. These figures do not include the practice of dentistry and veterinary medicine; but the excess of morphin obtained in making the codein beyond that required in the practice of physicians will be more than ample to supply the legitimate needs of the dentists and veterinary surgeons. (Thereupon, at 12.15 o'clock p. m., the committee adjourned to meet again at 10 o'clock a. m., Wednesday, February 14, 1923.) COMMITTEE ON FOREIGN AFFAIRS, HOUSE OF REPRESENTATIVES, The committee this day met, Hon. Stephen G. Porter (chairman) presiding. STATEMENT OF MR. WILLIAM J. SINEK, OF CHICAGO, ILL. The CHAIRMAN. Mr. Sinek, you are the exalted ruler of the Benevolent and Protective Order of Elks? Mr. SINEK. Exalted ruler, Benevolent and Protective Order of Elks, of Chicago, Ill. The CHAIRMAN. I noticed in the newspapers recently that you appeared at the White House and urged the President to take every possible means to suppress the traffic in habit-forming narcotic drugs. I asked you to appear before the committee and you have very kindly presented yourself this morning. Mr. SINEK. Yes, sir. The CHAIRMAN. I also understand that you desire to read a statement and then will be glad to answer any questions that may be put to you thereafter. Mr. SINEK. Yes, sir. The CHAIRMAN. Then just proceed in your own way. Mr. SINEK. I want to say, Mr. Chairman, that when I received your telegram yesterday morning I was leaving on the Brodway Limited, and my time here was rather limited, so I prepared a statement on the train, and I am going to read it to you gentlemen: The CHAIRMAn and Members Foreign RELATIONS COMMITTEE, House of Representatives, Washington, D. C.: The privilege of appearing before this honorable committee relative to the subject on hearing is considered an honor by myself and the Order of Elks. At the outset I would like to say that I am not here as an expert either from the medical side of the question or from the law-administration side. Therefore I am not armed with statistics on this important subject of narcotic drugs, realizing that these are available to the committee from more authentic sources. When your chairman telegraphed me to appear here to testify I readily accepted the invitation because I believe the subject of habit-forming drug addiction is, without doubt, one of the most serious menaces that society has faced in many years, and that no man who had become interested could conscientiously hestitate for a moment to lend every power at his command to the cause. I am here to testify entirely as a public citizen and from the humanitarian viewpoint of the growing evil. In the charity work of the Elks organization we have had a very good opportunity to observe the ravages of habit-forming drugs in all its horrors, because we have come directly in contact with the victims of it. We have found drug addicts in dire despair begging for help against the so-called dope affliction. Appeals, pitiful and heart-rending, have come to us from men and women, young and old, who had fallen slaves to the habit. They have come to the Elks Club in Chicago and whispered their dark secrets; others sent pleading, imploring letters for help from their addiction. But even more pitiful, if possible, is the condition we found among families of the victims-destitute, in misery and distress, little children without food, coal, and raiment in the cold weather, because the breadwinner of the family had become a hopeless, confirmed "dope" fiend. We began to run into destitute families where dope had done its deadly work several years ago. We found it in connection with the Elks charity work. We discovered it in the work of the Salvation Army, of which I happen to be one of the advisory board, and in connection with the Big Brothers organization, of which I am the president, which has for its purpose the upliftment of the boy and the steering of wayward lads to the better roads of life. Each year as our work went forward we began to discover a greater number of cases of drug addiction, until the increasing number amazed us and started us thinking seriously. The Elks discovered drug fiends in its charitable undertakings, the Salvation Army was receiving dope fiends in growing numbers in their shelter places, and in the Big Brother movement every now and then we would find a boy-and inherently good boys-who had fallen into the hands of the boys' courts or juvenile officers with the taint of the dope habit. We became thoroughly acquainted with the evil of habit-forming drugs and the misery it was spreading in rapidly growing proportions to the human family. It was only natural then that the Elks organization, with the intimate knowledge at hand, decided that the agitation against the narcotic drug evil was a movement worthy of all its force and influence throughout the United States, with the result that hundreds of lodges took up the subject and decided to fight it through until something is done to eradicate the terrible scourge. The nation-wide spread of the dope evil might easily be observed from the hundreds of letters received from lodges in cities of every State of the Union, small provincial towns, as well as large cities, where it was stated that the members of the lodges were familiar with the drug evil because of the cases of drug addiction and the traffic in dope which had come under their very eyes. Mr. FISH. May I interrupt you there, Mr. Sinek. The CHAIRMAN. The witness has asked leave to conclude his statement without interruption. I think it best that he not be interrupted. Mr. FISH. Excuse me; I did not know about that request. Mr. SINEK. I will be very glad to then answer any questions to the best of my ability. Since the Elks started the movement within its own organization the revelations of drug addiction have been even more startling than its previous discoveries. Hundreds of addicts in the Chicago territory have appealed for aid. They wanted a place to be cured. But there was no haven, unless it be confinement in the house of correction hospital or the county jail, which meant that they must submit to arrest and be branded as jail birds." 66 The Chicago Medical Society recently took up the question of curing dope addicts in a laudable way, offering secret cure through hospitals free where the patient was without funds, with the result that hundreds have applied for treatment. A few weeks ago a polished, gentlemanly young fellow with a pallid face came to see me. He said he would like to see me very privately, as he had a secret to tell. "I am a dope fiend," he stated. "Can't you help me? I want to be cured." We investigated the young man's case and found that he was a veteran of the World War with a record of 44 months on the battle front with the Canadian forces and that he had been awarded two of the highest medals of the British Army for valor on the battle field. He told of how he had started using morphine in Texas, where a doctor gave him an injection for rheumatism, and how, after receiving a number of similar treatments, he had disappeared, leaving a young bride while on their honeymoon, to find a cure of the habit he had formed. This young veteran, we found, came from a reputable Canadian family. We sent him out to the House of Correction Hospital to be cured. He came out a picture of health, a well man, looking for work. "I'll never touch it again," he said, "but please help me find a job away from the places where one is always tempted with dope." That is why so many addicts who are cured go back to it. Once back in the old surroundings, they are tempted and fall. I have the name and address of this young man, which the committee may have if it wishes. It is not given here because of the desire to keep the young man's family from publicity which might injure the lad's future. There was another case three weeks ago that came to us of a young woman who was working to support herself and husband who was afflicted with tuberculosis in its latter stages. She had become addicted to morphine, and it had reached a point where it was costing her more than she earned to satisfy her craving. She wanted to be cured, to be her normal self again so that she might take care of her dying husband. She, too, had to be sent to the workhouse hospital for treatment and was cured. In a little suburban town west of Chicago, a young couple had purchased a home with garden, flowers, and all that goes with suburban life. The woman had become ill, and a doctor had given her morphine regularly until she had become an addict. In an affidavit made, the woman swore that when she had run out of funds and had mortgaged everything to get money for dope the doctor refused to help her unless she produced something of intrinsic worth. "I told him-the doctor-that I would go to the Government and ask for treatment" her affidavit read. "He told me not to do this, as the Government people would undoubtedly look me up, and I would get my name in the papers, and that my husband and I would be disgraced. "I was unable to comply with his demands for cash payments. “He refused to furnish me with morphine unless I paid cash or demanded that I supply him with other articles. At various times I supplied him with chickens, eggs, pork, vegetables, and finally gave him our $30 set of silverware for $5 worth of dope." (Copy of this woman's complete affidavit, with names of all concerned, is in my hands, and I shall be pleased to turn same over to this committee with the request that the names be withheld from publication.) These cases are submitted to show that the use of habit-forming drugs is not an exclusive commodity of the underworld, as some people are inclined to believe. They are concrete cases taken from hundreds of others in our city, more or less similar, which prove beyond all doubt that narcotic drugs are eating their way into the better classes of our civilization at an alarming rate. We have found, in addition to the inroads it is making into our upper classes, that public institutions, in some instances, are becoming hotbeds for dope, and it isn't even safe nowadays to send a well man to a jail or penitentiary for fear that he may come out a dope fiend. In Chicago a jail guard was recently convicted of smuggling dope to a prisoner. Many other cases have been found in our penitentiaries, our hospitals, and jails where it is comparatively easy to secure narcotic drugs. As to the solution of this awful problem, there is, to my mind but one positive sure cure, and that is to stop the production of opium and kindred products so that only the bare needs of the medical profession may be provided. So long as narcotic drugs are produced in abundance, so long as it is a commodity of international commerce, it will be brought into the United States and remain a menace to society, decency, and civilization. Respectfully submitted. WILLIAM J. SINEK, Exalted Ruler Chicago Lodge, No. 4, The CHAIRMAN. Mr. Sinek, how many members of the Elks are there in the United States? Mr. SINEK. There are between 900,000 and 1,000,000 Elks. The CHAIRMAN. You stated to me that most of the complaints you were receiving came from the Mexican border. Mr. SINEK. Yes. The CHAIRMAN. Will you give the committee some information on that point? Mr. SINEK. I would like to state that we asked all the Elk lodges of the United States to cooperate with us-1,400 of them. They are responding and we are receiving hundreds and hundreds of resolutions in reply to the request made, and I do want to say that the cities along the Mexican border com |