In the old days, before the police shattered the opium joints, those who had become friendly with opium from social custom carried out their ceremonial by "laying in" for smoking the pipe. But with the disappearance of these resorts, old smokers and recruits also were obliged to turn to other forms of opium-taking, and about five years ago they deserted for the most part all other habit-forming drugs for a new derivative of opium. This new drug, which was heroin, won an immediate and widespread popularity. It had advantages over all rivals since the days of the pipe. It was cheap, it demanded neither layout nor hypodermic syringe, and could be taken for a long time without disturbing the health. It stopped the craving without diminishing working capacity to a degree which would prevent the earning of money to buy the drug, and last, but not least, as it is sniffed through the nose on a "quill," the addict could take it without much fear of being interfered with. A guess may be hazarded that three-fourths of all the drug-takers in New York, of whom there are many thousands, place their chief reliance to-day on heroin.

As a result there has developed a distinct class of heroin addicts, with a certain amount of freemasonry and cooperation among themselves. These latter are necessary to make it easy for users to procure heroin and to safeguard one another in the indulgence of a practise strictly forbidden by law. As a result, heroin addicts exist in large groups, the individuals of which know and help each other; in this way the habit is not only maintained but spreads rapidly. The majority of the present takers are boys and young men whose easy sociability has been developed in the gangs who later flock together in leisure hours at the dance halls, the movies and at that form of entertainment which they all seem to like best, vaudeville. For a long time the boys remain for the most part in good health and all along they possess a fair degree of intelligence. Some examined by the Binet-Simon test show mental defects, but the majority are not materially defective in intellectual qualities. Like most adolescents with social tendencies, they lack individual initiative, are imitative and easily led; they fall into the habit easily and-this is the tragic part of it-ignorantly and innocently. Once the habit is established, they lose their interest in work, become late and irregular, throw up their jobs easily. Many are good workmen but will only work for the purpose of getting money with which to buy heroin.

The individual habit is formed through the force of imitation and suggestion, and is rarely the result of continuing a drug which was taken in the first instance to allay pain. Cholera cures, soothing syrups, cough medicines and other remedies which contain habitforming drugs have little to do with the formation of the modern heroin habit. Neither can it often be laid at the doors of physicians. Responsible as they may be for many cases of drug habituation, more in the past than to-day, thanks to recent laws and a wider dissemination of the knowledge of the dangers, the present heroin habitu6 rarely accuses a physician of being the one who introduced him to his cruel master. The first dose of heroin is neither pill nor hypodermic injection taken to alleviate some physical distress, but is a minute quantity of fine powder "blown" up the nose at the suggestion of an agreeable companion who has tried it and found it "fine."

Oftentimes one old addict will corrupt at one sitting ten or twenty boys. A common story is of a group of boys being together at a dance, or a show, at some outdoor gathering in the summer. One of the number produces a "deck" or "package" of heroin and tells the others that the taking of it is wonderfully enjoyable "try that and you won't have no trouble," he says-, he sniffs it up his nose and has enough of it on hand or within reach to supply all the others who wish to try it. They, of course, all wish to follow exactly as the majority in any group of small boys who wish to imitate someone whom they see smoking tobacco. The first taking is generally not agreeable, but they try it again, and about twenty-five per cent become victims of the habit within a few months.

Heroin takers have a more definite conception of what a habit is than many physicians. A habit has been acquired, according to them, when an individual can no longer work unless he has his "dope," or else falls ill unless he has it. They maintain that many heroin takers never really become dependent on it, although it seems highly improbable that a constant taking of heroin will not sooner or later establish the habit. Once the habit is acquired, the addict will not try to work without "dope." He will, as he expresses it, "do almost anything to get the 'dust.' " It is at this point particularly that heroin habituation becomes an important incentive to crime. Among the frequent misdemeanors charged against the heroin boys besides those directly concerned with the use or possession of the drug, are stealing and destruction of property. The customs entailed by the habit and the effects on character of the drug itself are doubtless potent factors in forming and holding together that criminal class which certain idealists do not seem to believe exists. Certain it is that large numbers of those sent to penitentiaries and state prisons are drug users.

The passage of the Harrison law, which put habit-forming drugs under federal control, spread dismay among the heroin takers. They saw in advance the increased difficulty and expense of obtaining heroin as a result of this law; then the drug stores shut down, and the purveyors who sell heroin on street corners and in doorways became terrified, and for a time illicit traffic in the drug almost ceased. This was particularly acute just before the law went into effect on March 1, 1915, a period which is referred to by the "cokies" as "the panic." Once the law was established the traffic was resumed, but under very different circumstances. The price of heroin soared. From costing before this eighty-five cents a drachm, its retail illicit price has been raised to seven dollars and fifty cents a drachm-and it is adulterated at that. This put it beyond easy reach of the majority of its adherents, most of whom do not earn more than twelve or fourteen dollars a week. Being no longer able to procure it with any money that they could lay their hands on honestly, many were forced to apply for treatment for illness brought about by result of arrest for violation of the law.

The treatment of the heroin habit as now being carried on in city and state institutions among the boys and young men just referred to, few of whom have taken it over three or four years, is painful but is neither hazardous nor protracted. Three days is usually the limit of the worst suff ering, and a fatal outcome is rare. One hundred and thirty-nine cases were successfully treated in the King's County Hospital without one death (report by Dr. S. R. Leahy). Generally the patients are permitted some heroin at the beginning of the cure, but this is rapidly withdrawn. Many refuse any remedy or "cure," preferring, they say "to suffer it out," i.e. to take no medicine at all. It is rather a commentary on the efficacy of the many advertised withdrawal cures to observe that those who "suffer it out" seem to get along almost as well as those who take the cure.

It is often represented that all drug habitu6s are seriously desirous to be freed from the habit. As far as the heroin addict is concerned, this representation is open to great question. At times, the victim of any habit bewails its domination over him, but this does not necessarily mean that he really wishes to be free, any more than that every man who complains of his wife wishes to leave her. If heroin addicts really desired to shake off their bondage, it would be natural to suppose that they would appeal voluntarily in large numbers to dispensaries and to hospitals. Yet it is the experience of dispensary and hospital physicians that heroin addicts hardly ever apply for treatment, except under pressure. This pressure is supplied by parents and by the laws which have put up the price of the drug or made the getting of it hazardous or impossible. Unless under some such duress, the young heroin addict drifts along, for several years at least, not only not applying for medical relief, but maintaining for the most part that the drug, as long as he can get it, does not injure him.

The heroin habit is essentially a matter of city life, as in rural communities it does not exist as it does in New York. For example, the records of the State Hospital at Trenton, New Jersey, which recruits from a rural community, show that of the drug addicts who have gone there for treatment since the passage of the Harrison law, not one has been a taker of heroin and not one has acquired the habit through social usage.

From all these considerations, which are drawn from the class of boys who have gone to the public schools, it would seem that heroin taking is closely allied with the factors which make inebriety in some form inevitable in the poorer classes in large cities. Boys and young men seem to want something that promises to make life gayer and more enjoyable, and the particular "fillip" they hit upon depends on their personal temperament and their surroundings. Often one choice excludes others. The heroin addicts are rarely given to drink, and under the use of the drug, their sexual appetites dwindle rapidly so they are not often offenders in sexual matters. It would almost seem that their desire for something to brighten life up is at the bottom of their trouble and that heroin is but a means; and that if this means failed them, they would turn to something else which might be worse.

This is said not in a spirit of pessimism, but in the conviction that the treatment of the heroin habit, or of any other destroying habit of social origin, should be begun before that habit or some other is formed. Tendency precedes habit formation, and it seems that the special weakness of those now doomed to fall might be recognized before they left school. The heroin habit offers a particularly good opportunity for work on these lines. The victims are young, some having begun the habit while still in school. Those who have taken treatment average about twenty. Few are married. They are generally healthy and able to work, and are fairly intelligent. Many are of engaging personality but, as often happens with personalities who are engaging, they are all unstable, suggestible and easily led. It seems possible, or even probable, that if they could be kept, or if their parents could be induced to have them kept, under some form of industrial or educational control until they were eighteen or twenty years of age, their characters might stratify to such a degree that they might be headed off from a course of self-destruction and that, instead of menacing society as they do now, they would benefit it. Boys of this class could also be expected to do well in rural communities, although it would be hard to get them to go there. It would be happy philanthropy which would make farming attractive to this class.

There is, of course, much more promise of gratifying results at this early period than with those who have been taking heroin two or three years. After that, a cure is hardly to be hoped for, unless steps are taken to keep the addict away from the environment that enslaved him in the first place. He often realizes this himself toward the end of his "cure." There is reason to doubt that many heroin takers wish to be cured as long as they can get heroin easily. But under arrest and confinement, some seem to acquire a clearer conception of reality and sincerely wish to avoid in future what tripped them up in the past. But now they are practically forced back where they came from, as a result the number of "recidevists" is very large.