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Among industrial workers I believe drug tippling to be as common as among other employed people, but, so far as I can ascertain, and I have made rather wide special inquiry along this line, drug addiction is not at all common among the better class of industrial workers. The better the enforcement of law, the less tippling with drugs exists, for the tippler will not go the same length to obtain drugs irregularly as will the addict. With adequate laws definitely enforced, drug tippling could be all but eliminated; and with the laws as they are, the executives of manufacturing plants could suppress drug tippling in their communities to a very great extent. Stop drug tippling in a community by arresting the right people-usually a few peddlers, one or two degenerate doctors, and perhaps a crooked druggist-and the making of new drug addicts would soon come to an end. There are communities where this has been done in which drug addiction has almost disappeared. There remain, of course, a few confirmed addicts and some aged and infirm people who seem to be unable to break the habit.

Industries have this matter largely in their own hands. The authorities will cooperate in any town where they are definitely asked to do so and are backed up by public sentiment without political flavor. But where there is timidity, a shutting of eyes to actual conditions and to the people responsible, where no one will appear willingly at hearings to testify to what he knows, where somebody has to be "protected," where professional reformers of no experience with addicts and their devious ways are placed in chame, and where the whole plan leaks out before arrests are made -in these communities little can be done. It is a business, legal and police matter, just the same as an epidemic of petty larceny in a community.

There are addicts who seem to keep in good condition for many years. Yesterday I examined one such and could find no symptoms of note. He is a man 53 years of age, holds a responsible position, is highly respected-in short, a man of refinement and education and possessed of many virtues. He looks well, works hard and has no disease except a slight prostatitis. Yet this gentleman takes 25 grains of morphine daily and has done so for fourteen years. He has taken as high as 40 grains in a day and is in a state of marked nervous trepidation if he reduces below 15 grains a day. Such cases, and there are many of them, baffle the theorists who essay to account for drug addiction on the basis of some disease complex. Yet such cases bear out my contention that drug tippling may never become drug addiction in some people, in fact in many people. When I say these people do not become drug addicts, I mean in the commonly accepted sense. Their peculiar form of addiction seems to be necessary to maintain their normal efficiency; and they display not the slightest desire to stop taking opiates.

I never knew how many individuals of this type there are until after the law made it necessary to report them to this bureau. Almost invariably they are people of importance in their communities, some of them executives in banking, business or industry. The dosage taken by them varies widely, some take as little as one-half grain of morphine a day. These people differ from the drug tippler, for the tippler takes the drug intermittently.

The worst class of drug-takers are not found in the industries at all, so the industrial world does not have to meet the situation in its more serious phases. The industrial worker, if he becomes one of the degenerate type of addicts, does not remain an industrial worker; he is physically unable to work and would not be tolerated by his fellows if he tried to do so. The average industrial worker despises the "dope" and promptly reports any such discovered. Labor unions rarely tolerate the confirmed drug-taker, and he loses his union card. Yet a degree of prophylaxis in an industrial organization is advisable. Morale should be kept up in every way and the idea disseminated that it is not manly to tipple with "dope." The "Treat’em Rough" idea as regards peddlers of drugs will make this cowardly class keep away from the works. Good housing, prompt attention to illness and disability, sanitary surroundings, a minimum of night work, reasonable regulations regarding the use of alcoholic liquors, and an interest in the men and their families, will go a long way to prevent drug tippling.

Having discussed the problem in general, we will now consider a survey of some of the industries. This survey is not based wholly on our own observations, since numerous industrial physicians have furnished us with data, some to be credited to them and some already embraced in what has preceded.

Drifting labor-the casual workman and the gangs collected to meet industrial emergencies-must first be noted, for there is a great incidence of addiction and drug tippling among this class. This is not true of foreigners, for there is no great amount of narcotic-using among the races from Europe most employed in industry. The physicians of Europe employ narcotics most sparingly, and the European laborer, in consequence, seldom is a drug addict. But the class of native Americans who drift, many of them men who have left regular occupations on account of their babits, are deplorably given to the use of alcohol and narcotics.

The American negro is, seerpingly, a willing addict. This is especially the case in the South and in the slum districts of northern cities, as well as among domestic servants and hotel employees; but many of the industrial workers of this race become addicts, drift from place to place, and often have police records. Some of the negro labor camps in the South simply breed addicts. They are deplorable places, as I can testify from observation. The men work about four days in the week and "celebrate" the rest of the time, usually by taking a trip to another camp, where high carnival is held-carnival which involves the use of considerable cocaine or other narcotics when they can be obtained. The supply is usually irregular, and hence there is more of drug debauchery than of regular addiction; but the participants become regular addicts if they leave the camp and take up city residence.

Gang labor at seaports is notoriously given to drug addiction. Baltimore and New Orleans are especially bad in this respect, for there are many vessels putting in at these places from South American ports, mostly tramp steamers, and their crews have a good opportunity to bring in opiates. The large vessels have better crews under better discipline, and there is less drug traffic from such vessels. The internal revenue agents keep this traffic down in large measure but are unable wholly to suppress it. Negroes are also employed largely at these ports-a fact which accounts for many of the bad conditions. I was told at Baltimore that probably much of the narcotic supply smuggled in there comes from Brazil. At New Orleans the geography is such as to make smuggling from small vessels very easy. Then, too, the Mississippi traffic is extensive, and I noted a preponderance of negroes on many of the boats, even up as far as St. Louis, where negro labor is employed largely along the waterfront.

Gang labor along the Mexican border is less of a problem, for the Mexican has an assortment of strong alcoholic beverages which make mere opiates superfluous to him. Yet he is keen for an easy profit, and I learned at Tia Juana, near San Diego, Cal., as well as at other border towns, notably Juarez opposite El Paso, Texas, that smuggling of narcotics is profitable. I was in California during one of the I. W. W. disturbances, and learned that this group of men is partly recruited from workmen who became industrial outcasts from indulgence in alcohol and narcotics.

New York and Boston harbors are under such close surveillance that it is not probable that great quantities of narcotics come in undiscovered; but along the Maine coast there are so many places where small vessels can put in undetected that there is plenty of opportunity for smuggling. The Bay of Fundy offers splendid opportunity for the smuggler from Canada, since small vessels come and go under very slight supervision, and the fisheries employ thousands of men of the drifter class. They live in camps and move on after the season is over. Yet at Eastport I was informed that if such traffic exists it is not noted locally, for the typical population of New England is not of the sort given largely to drug addiction. Inquiry among some of the industries in New England revealed very little of a narcotic problem.

We get, however, great quantities of narcotics through smuggling from Canada, probably principally from the lake traffic, through Detroit, Buffalo, Chicago and Cleveland. My own observation in these cities has been too casual to justify expression of opinion, except to say that in all of them there is considerable drug addiction among floating industrial forces. So far as I know, however, there has been no intensive study of the problem in these cities.

We need special treaties with Canada and Mexico designed to suppress the traffic in narcotics which, if reports are correct, has grown to rather large proportions.

There is always a danger that the floating labor gangs will corrupt the regular forces. Some of this was noted during the pressure of war production, when labor was hard to procure and few questions were asked. We heard of instances in Pennsylvania, but the trouble was promptly corrected. There was also similar trouble reported in Connecticut, though I do not know the facts. There are drug peddlers among floating labor, and these men must be carefully watched.

With reference to war conditions, the chief physician of a large electrical manufacturing company in Pennsylvania writes:

"Last summer, during the unusual labor conditions, when almost anyone applying was able to find work of some sort, I believe two or three addicts were emploved whose babit was afterward discovered and which made them ill-fitted for their work, and they were discharged."

In reference to the usual routine in that extensive establishment, the same physician writes as follows:

"All employees are examined before engagement, but this examination is directly chiefly at major defects which would concern a man's placement in industry. For instance, the eyes are tested, inquiry made as to lung troubles and wherever necessary examination made for these; the heart is examined; also examination is made for the presence of hernia and any other defects which may concern the man's occupation directly. in regard to drug addicts, no direct inquiries are made and it is quite possible that some addicts are employed who do not show contracted pupil, characteristic skin or other signs which would readily call attention to their condition. I doubt very much if many confirmed addicts have been employed here, and we have no reports coming to us in the works, or in either the hospital administration or welfare work, of any case of the sort."

Yet this report comes from a city where addiction has been found to be more than ordinarily common. Doubtless drug tipplers would pass the examination, or at least some of them would; but it is altogether likely that most drug tipplers employed regularly in so well-ordered a plant would cease the use of the drug. It does not seem to me necessary for an industrial plant to set out a drag-net for minor disabilities or minor addictions.

The drifters who go out with circus labor gangs, carnivals, amusement park attractions, etc., have given us considerable trouble. Gangs of strike-breakers, men employed on large outside construction work, the extra forces engaged in loading and unloading vessels during the war, etc., are reported to have had an unusual number of drug addicts among them.

Where definite statistics have been collected, "transportation workers" have figured considerably. But when one realizes that "transportation" covers a multitude of workers, there need be no alarm felt. Transportation companies employ a great number of drifters at times and a large proportion of employees are only laborers. Then, too, every jitney driver, hotel bus driver, elevator operator, chauffeur, ferry boatman, etc., is engaged in transportation.

When one inquires as regards engine drivers, conductors, other train employees, dispatchers, motormen, etc., there is little evidence of drug addiction among the personnel. The chief medical examiner for one of our large trunk-line railroads writes:

"In our railroad relations we have come in contact with very few, if any, cases of this character [addiction], for, as a matter of fact, all employees entering our service are required to undergo physical examination by one of the company medical examiners, and those in whom drug addiction is suspected are declined employment. Furthermore, railroad employees, particularly those engaged in train service, are periodically examined, and the reaular hours of employment and nature of the work naturally precludes a tendency to the development of the drug habit."

Some ten years ago, when making studies in the sanitation of public carriers, I encountered no complaints regarding drug addiction among the workers. As regards the train operating forces of transportation companies, we have had no complaints whatever come to this bureau.

Heavy outdoor employment does not lead to addiction. Farmers are not given to drug-taking on account of employment, but they often become addicts on account of neglected physical disability and the distance which they live from a physician. In former general practice, before the Harrison Act was in force, when called to see a person some distance in the country-it was a Pennsylvania German neighborhood-I would usually find the family had not summoned me until after the patient had been ill for several days, and, if the trouble was painful, until after free use had been made of the laudanum bottle, kept well-filled in every household. Yet there was little addiction among active farmers, although laudanum was used as a matter of course for many troubles. This was not the case among retired farmers, invalids on the farms, tenants, domestic farm help, and the much-harassed farmers' wives. Among these people there was much addiction, and our reports in this bureau, while showing less free use of narcotics in rural communities than formerly, do very positively show a per capita consumption of opiates in the small towns and villages adjacent to the farms where the drugs are secured from physicians or on prescription, very far in excess of the per capita consumption in the large cities. We cannot get separate farm statistics that are worth much for the reason that the purchases or prescriptions are secured in town; but we have an altogether out-of-proportion list of rural dwellers on our addict lists. They are mostly invalids and aged people.

In welfare work, industrial medical service, sanitation, etc., the largest industry of all, farming, is sadly neglected. These factors, not the work itself, account for a very large rural incidence of drug-taking.

Much the same must be said of lumber camps, isolated mines, and other heavy industries in rural environments. There is much drug addiction in these places based on the human element, not on the character of the work itself, for work does not breed addiction. A physician in a well-managed anthracite mining industry writes:

"I have had no mine workers as patients who could be classed as drug addicts, alcoholics excepted. I have made inquiries of my fellow practitioners in my own and surrounding towns and find that as a class anthracite coal miners and mine workers are exceptionally free from the use of morphine, opium and cocaine."

My own observation confirms this report. But it must be noted that anthracite mining is a highly developed industry, in places of considerable population and, usually, with good medical service supplied. The contract doctor, however, is not always what he ought to be; and this particular system of remuneration for medical service throws too many temptations in the way of physicians who are inclined to make a little money on the side. Some of the worst medical offenders against the narcotic laws in Pennsylvania are in towns adjacent to the coal mines. We have been obliged to take legal steps with some of them and are securing evidence against others.

I believe that conditions are worse in the bituminous industry, more especially in coke-oven towns. Bituminous mines are often in small places and the poorer grades of such coal are processed. Here there is negro labor, often a poorer grade of white labor, and the housing conditions and the general sanitation are poor. Conditions are worse in Colorado and the southern mining sections than in Pennsylvania, with, of course, an increased incidence of drug addiction. It is possible that prohibition in these latter regions turns many miners from alcohol to drugs. I was in the Colorado coal mining district during the trouble there in 1913, and I found wretched conditions in many ways. Here in Pennsylvania our trouble has been with drink, and comparatively little with narcotics.

In considering the problem of drug addiction in the more skilled lines of industry, I will quote from a number of letters received from industrial physicians. A physician in the medical department of a large optical goods manufactory writes as follows:

"I can truthfully say that during my six years' connection with this company I have seen not a single case of drug addiction.... The question is directly comparable to the venereal problem. No doubt we have our full quota of drug addicts as well as venereal diseases, but they do not under the present general policy in industry come near the medical department, for obvious reasons. This policy is in a fair way to be reversed very soon, I believe, and then we will have a different story to tell."

Another industrial physician-in the relief department of one of our largest manufacturing concerns-thinks drug addicts are little of a problem in industry, and he goes on to say:

"In the eleven years that I have been associated with this work, supervising from ten to thirty thousand men, and having all cases of a suspicious character referred to the department, I have encountered but two cases. Both were physicians, I am sorry to say, one an American and the other English.

"There may be isolated instances of drug addicts employed in the industries, but I am confident that the gravity of the situation is grossly exaggerated, and I doubt the government's figures, namely, that the per capita consumption of opium in the U. S. A. exceeds that of China. This seems to me to be a vile slander. Persons so addicted are unfit for industry, and are self-eliminated.

In the heavy industries employing skilled labor I find little evidence of addiction among the better class of workers. The chief surgeon of one of the largest steel corporations says: "We have had no trouble with the drug addicts. Through mv association with men, I recall three cases, two morphine and one cocaine. As a rule, the fellow workmen are very keen in detecting anything of this nature and report it."

As this corporation is a Pennsylvania concern, I took occasion to check up on it and found a dozen or more cases of addiction among their workers, chiefly among negroes; and, for a while, two drug peddlers were working for them. We promptly attended to these cases and stopped the two physicians, and the one drug store that were responsible for conditions. The two physicians were practising in adjoining towns, and not one of the employees retained his place for long. One peddler was sent to jail and the other absconded and has not been traced in this state. He was last reported in Cleveland, Ohio, and was duly reported to the federal authorities.

A very frank chief surgeon in another large steel industry writes:

"We have very little opportunity to accurately ascertain how much drug addiction there is in the iron and steel industries. I am inclined to think, however, it is extraordinarily small. During the past ten years, only two or three cases have come to my personal attention and they were negroes and were cocaine and heroin addicts."

The physician in charge of a large Michigan automobile factory writes:

"We have never yet had to deal with a drug addict. I don't think one could pass the employment department and get to work in the factory. If he did the foreman would detect something about him-enough to let him go without sending to the medical or welfare departments."

The director of the department of health in an extensive rubber goods plant in Ohio writes:

"In the three and one-half years in which our department has secured a fair medical control of the industry, we have not detected any drug addicts applying for employment, nor have we found any in the industryThe percentage that are in the employ, or who have been emploved, cannot be very high because of the fairly well-developed medical control."

In the lighter industries employing skilled labor I can find little evidence of addiction. It is unskilled labor, here as elsewhere, that is the more given to addiction.

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