Morphine Maintenance. Chapter 2 "The Patients"

The Patients

During the era of the clinic, the public image or conception of addicts was that of the stereotypical dope fiend. Addicts were considered to be, on the whole, young, working-class criminals who used drugs primarily for some forbidden and mysterious pleasures. Reading newspapers of the time one is struck by the recurrence of words such as "decrepit" and "derelict." Moral, productive citizens (by implication, the middle classes) were thought to be above such drug use, and "good" people did not use opiates. People who did use opiates or cocaine were thought to be morally inferior, and so beneath human consideration. Shreveport addicts did not fit these stereotypes at all. In general, the patients attending the clinic cut across all class groups; they were middle-aged and relatively productive citizens who held steady jobs (when their physical condition allowed it). Like the larger society, some were more "productive" than others. The list of patients included among other prestigious occupations, four doctors, two ministers, two retired judges, an attorney, an architect, a newspaper editor, a musician from the symphony orchestra, a printer, two glass blowers, and members of rich oil families, etc. There were, as well, day laborers, carnival workers, domestic servants, and other traditional occupations of poor and working-class persons.

Dr. Butler was familiar with the public's misconceptions about his patients. He tells a story about his experience with a grand jury:

I had been called to testify in front of a grand jury about the clinic. During the course of this testimony, several of the jury members made deprecating remarks about patients, and I felt that it was my duty to put them right about patients. As it happened, one of tile windows of the jury room looked out on the tallest budding in Shreveport. This building had been built by one of my patients. So I quietly told them so, "Gentlemen, do you see that building out the window there? It's the tallest building in town, isn't it? Well, that building was built by one of my patients." [He had been addicted to morphine for 40 years.] "And furthermore, two of Mr.------ ------, the United States District Attorney's predecessors were patients of my clinic, as are two ministers in town." My patients came from all classes, but few people knew that.

Data on the long-term patients show that two out of every five patients (39.8%) worked in either white collar (19.4%) or skilled (20.4%) occupations, with the highest percent holding semi-skilled jobs (33.5%). Only 6.4% worked in unskilled jobs. These data undoubtedly reflect the economic life of the community. Shreveport, during the time of the clinic, was a rich oil and agricultural center in northern Louisiana, and the people who lived there had plenty of opportunity for good employment.

The most recurrent occupation reported were waiter and waitress; one in ten (10.4%) gave that occupation. Professionals (doctors, lawyers, judges, etc.) made up 3.0%, and 1.8% said they owned their own businesses. Such businesses ranged from a small Chinese restaurant run by a 43-year-old Chinese man who had been addicted for 24 years, to the largest dry goods store in town. Of the 176 women for whom we have data, the majority reported occupations; only a little more than a third (35.2%) said they were housewives.

The following are brief descriptions of five selected patients to demonstrate the range of patient occupations and the extent of their addiction:

Maude was a 48-year-old nurse who became addicted during the course of her treatment for gallstones. She was addicted 11 years to morphine and reported she took 11 grains a day. She attempted treatment 18 different times, failing each time.

John was a 52-year-old physician who said he became addicted to morphine when he used it for his insomnia caused by overwork. He was addicted 15 years and received 5 grains of morphine a day from the clinic. The clinic staff did not advise detoxification, and the patient died of cancer during the first year he was attending the clinic.

Charles was the editor of a small newspaper in a town near Shreveport. He was 61 years old when he came to the clinic, and was addicted when he was 41. His addiction was the result of medical treatment for rheumatism caused by gonorrhea. He attempted treatment 15 different times before coming to the clinic.

Paul was a $30-a-week glass blower who became addicted when he was 31 years of age and had been so for four years when he applied at the clinic. He began to use morphine to treat his syphilitic rheumatism. He claimed that he used 10 grains a day, but received only 6 grains. The clinic cured his syphilis and detoxified him within the first year.

Mrs. Dash was addicted by her husband, a doctor, when she became "insane" at age 30. She was addicted to morphine for 27 years and lived in Bossier City [a town across the river from Shreveport] during the full course of her addiction.

The mean age of the patients for whom there are records was 35 years. Unlike present populations of opiate users, there were few of the very young. The youngest was 18 years, and there were only 10 (1.3%) younger than 21 years. At the other extreme, there were 30 (3.9%) patients over 60 years; 14 of them were over 70 years of age. The oldest patient was a 82-year-old confederate war veteran who had been addicted 55 years. This veteran had been shot in the head during the Civil War, and was treated with morphine by an army doctor. He received morphine regularly from his family doctor, and when he came to the clinic, he was using 2 grains a day. The second oldest patient was an 80-year-old housewife who had been addicted for 30 years. She attributed her addiction to asthma and rheumatism, and the clinic staff considered her a "pitiful, incurable case."

Men outnumbered women considerably; for every woman there were three men. This seems to be only slightly more than the present male to female ratio of 4:1. White patients were predominant; nine out of ten patients were white (91.1%). The numbers of black people were extremely small, given their large numbers (17,500 or 40%) living in Shreveport at the time; only 4.9% of 762 patients. Quite obviously opiates were not used by black people as they are today. According to the 1920 Shreveport census, there were 10 Orientals living in the town. Two of these ten attended the clinic; both were middle-aged men with long addictions (24 and 18 years).

Drugs Used by Patients

Unlike addicts attending a similar clinic in New York City at the same time, there were very few heroin users in Shreveport. Nearly all the Shreveport addicts used morphine (97.90/o), with only four using heroin, and a smattering of paregoric (7), codeine and laudanum (2) users. Users tended to stick with one drug, as only five persons said they were addicted to two drugs (usually heroin and morphine). Persons would occasionally use another drug when they could not get their drug of choice, but there was nothing like the poly-drug use practiced today.

The principal method of use was subcutaneous and intravenous injection. Dr. Butter said but for a small number they were "all vein shooters by the time they got to the clinic. They could hit a vein a lot better than I could. They would take an eye dropper, needle, and cigarette paper and make a very efficient hypodermic." This seems little different from the presently used "works" or paraphernalia. Neither needles nor hypodermics were offered or provided to patients. It was up to them to provide their own. Some rudimentary sterile procedures were taught, but only a very few made any efforts to employ them.

Doses were large compared to present-day use. Upon entering the clinic, each addict was asked how much he was using at the time. These reports ranged from a quarter grain to 30 grains a day. The mean dosage reported was 10 grains a day, but a good number (9.1%) said they used more than 15 grains a day. At the other end of the spectrum, there were only 8 persons who reported using less than 1 grain. These were all persons who were taking opiates for some terminal illness. Male and younger patients tended to claim more drugs used than women and older patients.

Like addicts today, Shreveport patients attempted to get as much of their drug as they could. As a consequence, there was a good deal of bartering and negotiation between the clinic and the patient. The clinic usually set an upper limit of 10 or 12 grains, irrespective of how much the patient claimed. The median dose according to records was 7 1/2 grains, and Dr. Butler said there was little difficulty in stabilizing the dosage. He believed that the clinic should be honest and aboveboard with patients in every respect. Every patient was told his dosage, and there were no secret or surreptitious attempts to lower a patient's dosage while he was an outpatient. Some were encouraged and supported to lower their dosage, but it was done with the full knowledge of the patient. Detoxification was another thing. When patients entered the detoxification unit, it was understood that they would receive decreasing doses of a substitution drug or drugs. According to Dr. Butler, patients had little difficulty stabilizing their dosage, and there was little tendency to escalate dosage once they reached a certain level. Slight increases were allowed up to 10 or 12 grains, but seldom over these limits.

During the life of the clinic, there were never any problems with overdose: "I never found one we could give an overdose to, even if we had wanted to. I saw one man take 12 grains intravenously at one time. He stood up and said, 'There, that's just fine,' and went on about his business." Dr. Butler was also the Caddo Parish Coroner at the time, and said he would have known had any of his patients died from an overdose. He and his staff conducted approximately 100 autopsies on patients who had died, but he could never confirm overdose or any other pathological complications from the use of morphine.

Length of Addiction

For the most part, the majority of addicts at the clinic were long-term addicts. More than half (51.7%) reported that they had been addicted for six years or more, and a quarter (24.5%) said they had been addicted for 11 years or more. The longest was a 79-year-old preacher who had been addicted for 63 years. He was addicted by a physician after he had been struck by lightning and lost an eye. The shortest was a 52- year-old man being treated for cancer of the face who had been addicted only four weeks. The mean length of addiction was eight years.

As one would expect, length of addiction was associated with age. The older a patient, the more likely he was to have a long term addiction. Age of initial addiction usually occurred during the patient's twenties or thirties, but there were a few exceptions. One 46-year-old man said he had been addicted to paregoric at 3 years of age. A 36-year-old woman cotton picker said she was addicted to morphine at age 10.

Reasons for Addiction

Contrary to the position (propaganda may be a more accurate term) of the Narcotics Bureau of the Internal Revenue Service at the time which said that the majority of addicts were addicted for non-medical reasons, the patients of the Shreveport clinic were usually addicted for medical reasons. Only 65 (8.6%) cited non- medical reasons for their addiction, most of whom had become addicted through friendship or association with other users or addicts. By far the majority (88.8%) cited some medical reason for their initial addiction.

Often the medical reason given was some venereal disease; more than a quarter (27.2%) cited syphilis or gonorrhea as the reason for initial addiction. This was usually accompanied by rheumatism, a recurrent secondary symptom of the original gonorrhea or syphilis. In those instances where the patient still had a venereal disease (there were large numbers), the clinic would treat the disease before it expected them to undergo detoxification.

The next most recurrent illnesses cited for initial addiction were respiratory conditions (11.8%) such as asthma and tuberculosis, followed by accidents and injuries (1l1.1%) and surgical operations (8.4%). It would seem that opiates were a common medical treatment for all these conditions prior to the 1920s, and doctors regularly prescribed them. Perhaps the most surprising of these are asthma and tuberculosis, but one must realize that the incidence of both was high during that period.

Another item of data on the third revision of the patients' cover sheets indicates the role of physicians in the addiction of patients. This was a question asked of 184 persons: "Was a doctor responsible for your addiction?" Of the 184 persons asked this question, more than half (53.1%) said that a doctor was responsible, while 41.3% said that a doctor was not responsible for their addiction. Unexpectedly, younger patients attributed their addiction to doctors more than older patients did; 63% of those 18-30 years of age attributed their addiction to doctors, while only 45% of those over 40 years did. We had expected, because of the relatively widespread prescription of opiates by doctors in the nineteenth century, that older patients would cite doctors more than younger patients, but this was not the case.

Reasons for the present addiction of patients (at the time of their addiction) were incorporated on the second revision of the face sheet, and were asked of 488 patients. The answers most often cited were "habit," venereal disease, rheumatism, and respiratory conditions. One in five patients (21.9%) attributed present addiction to "the habit," with 1 in 10 attributing venereal disease (12.9%), rheumatism (11.0%), or respiratory conditions (9.7%). The remaining answers were spread over a wide range of other diseases and conditions from cancer to "female troubles." Again age seemed to figure in these responses. Younger patients tended to cite "habit" and venereal diseases more than older patients. Perhaps the incidence of venereal disease was more prevalent among the young.

Chronic Cases

The clinic treated a number of patients with chronic and terminal illnesses. By agreement with local physicians, the clinic became responsible for all persons taking opiates in Shreveport and Caddo Parish. Because of the continuing threats of arrest by narcotics agents, many doctors were quite willing to give up the responsibility of prescribing narcotics to the clinic. Patients usually continued treatment with the doctor, but went to the clinic for the needed opiate. This is illustrated very well by the case record of Harvey Stacy, a 77-year-old resident of Oil City, who had cancer of the tongue. The record contained a letter from the family physician to Dr. Butler:

May 26, 1921
Shreveport, Louisiana
Dear W. P. Butler,
I am referring to you Dr. Harvey Stacy, aged 77, who is suffering with an inoperable cancer of the tongue, involving the floor of the mouth and both sides of his lower jaw. He requires morphine daily to alleviate the constant pain, and his financial condition is such that he cannot purchase it through a physician's prescription in the usual way.

I would respectfully recommend him to you as a worthy patient to put on the clinic, for say 5 grains a day.

Respectfully, J. M. Ehlert, M.D.

After examination, the clinic considered the patient "uncurable" — he had been addicted for 1 1/2 years — and maintained the man on 5 grains a day. There were other similar cases of long-term addicts who had chronic illnesses. The following selections yield a good cross-section of these cases:

Thomas was a 24-year-old, white factory worker who had been addicted for 8 years. He suffered from "chronic gonorrheal arthritis and tuberculosis of the bone." This diagnosis was ascertained by his family physician's certificate. He died 15 months after he entered the clinic.

Mrs. Evans was a 21-year-old housewife who had become addicted at age 13 years following an operation for gangrene. She was taking 3 grains a day. She died 4 months after she enrolled at the clinic.

Everett ran the local pool hall for which he earned S30 a week. He became addicted when both of his feet were amputated. He was 30 when he came to the clinic, and had been addicted for 9 years.

There was as well another group of chronically ill patients; these were patients who had been using opiates only a short time. In every case, they were persons who were suffering considerable pain, and the opiate was used to give them some relief.

Mrs. Jones was a 71-year-old widow who was receiving 1 grain of morphine a day for cancer of the liver (this diagnosis was certified by Drs. Hendricks, Lloyd and Parsons from Highland Hospital) and was bed-ridden. Clinic doctors would visit her each week and deliver her supply to her daughter.

Rodney was "confined to his bed with a severe case of pyothorax." He was 5'4" and weighed 75 lbs. when was referred to the clinic. He had been taking 1/4 grain of morphine for 3 months. He died in 1923.

T. R. Williams was paralyzed from the waist down. He had been addicted for two months and was taking 2 grains. Notation on the record said that he was "incurable, a very pitiful case."

Previous Treatment

Treatment and "cures" for addiction are not particularly unique to our present era. Cold Turkey, as used by Synanon and other therapeutic communities, was known as early as 1854. Substituting one drug for another, as methadone is used today, and gradual withdrawal of the second drug was first written about in 1880. Terry and Pellens in their classic book The Opium Problem list numerous treatment procedures that include hypnosis; substitution of such drugs as belladonna, hyoscene, and cocoa; gradual and abrupt withdrawal; and combinations of substitution and withdrawal. All of these methods are what we now call detoxification treatment. "Cure," and that broad, euphemistic term "rehabilitation," are words that should be used cautiously as regards addiction. At present, there are no effective "cures." Drug free rehabilitation programs are effective with only a very small percentage of addicts, and methadone maintenance is a substitution of one opiate for another. Shreveport patients reported a broad experience with drug treatment. Nearly half (45.7%) of all the 762 patients reported participating in some treatment, and more than a quarter (26.6%) had been in treatment two or more times. Fourteen (1.8%) patients reported undergoing treatment seven or more times, and a 46-year-old, white-collar worker who had been addicted 21 years reported taking treatment 24 times. Another patient, a 36-year-old nurse, said she had been in treatment 18 times.

As expected, the longer a patient was addicted, the more likely he would go to treatment. Only 15% of 47 patients who had been addicted less than a year reported having gone to treatment, while 56% of those addicted more than 10 years said that they had been treated previously. Such treatment usually took place in a hospital and outside of Louisiana. Ft. Worth, Texas, Kansas City, Missouri, and Memphis, Tennessee, were the sites of many of these treatments. Nearly all of these treatments had failed as "cures," since all who came to the Shreveport clinic eventually had become readdicted after previous treatment. There were some "successes"; some patients were able to abstain (one stenographer did not use opiates for five years after her first "cure"), but half (52.1%) said that they had not been "cured." This seems to imply that they did not finish detoxification. Some were detoxified, but returned to opiates because of recurrent illnesses (14.0%) or new illnesses (5.2%).

Criminality

Present-day addicts in the United States by virtue of Federal, state, and local laws against illegal possession and sales of opiates and paraphernalia to use them, are criminal. Some, but not all, also commit criminal acts to get money to support their opiate habits. Few Shreveport addicts were criminal. As a regular precaution, most of the addicts were fingerprinted routinely. Persons of high status in Shreveport were often not fingerprinted. The businessman who owned the largest dry goods store in town was not fingerprinted, nor was the mother of the Commissioner of the Shreveport Department of Safety (Commissioner of Police). These fingerprints were sent to the Shreveport police, Leavenworth, Kansas, and New York State to determine the criminal records of the patients. At that time, there was no central FBI fingerprint identification file, and the largest files were in Leavenworth and New York State. According to Dr. Butler, 14 patients left the clinic and Shreveport after fingerprints were taken; these patients never returned, and the inquiries returned saying that they had criminal records.

There are on record self-reports by patients of criminality. On the second revision of the face sheet, patients were asked if they had an arrest or court record. Of the 489 persons answering this question, 7 out of 10 (70.1%) reported no police or arrest record; a quarter (26.0%) did report such records. The majority of these self-reports were for minor crimes such as drunkenness, gambling, etc. Several did report serious crimes such as robbery or burglary; one man said he had been arrested for suspicion of murder but was exonerated of that charge.

According to Dr. Butler, the clinic did not want "bums" or "loafers," and admission to the clinic was often refused to persons suspected of being criminal. Such persons were usually forced to leave town, which seems today a rather convenient and high-handed way to avoid the problem of addict crime. It also was a convenient way to pass on trouble to the next town, and in this day of at least some "civil liberties," it is not a recommended method. We do, however, have perhaps current counterparts to running people out of town. The new laws (1973) passed by the New York State legislature that specify mandatory life sentences for sale and possession of narcotics could drive many of New York's addicts to New Jersey or surrounding states. One can expect that the next step will be for New Jersey, Pennsylvania, and Connecticut to pass similarly harsh laws to avoid being considered havens for addicts.

Clinic staff also took precautions with cocaine users. Cocaine at that time was considered to be an extremely dangerous drug. We say at that time because, while the drug is illegal in most countries today, it is not considered dangerous by users. On the contrary, it is today a drug of high prestige, used by the wealthy and considered far less dangerous than opiates (especially as regards physical withdrawal) or amphetamines. Cocaine is today the drug of the "jet-set." The clinic staff asked patients, in the second revision of the cover sheet, if they used cocaine. Of the 480 persons asked this question, only 14.2% said they had ever used cocaine, and many were careful to say that it had been months or years ago. One might, given the extreme onus attached to the drug at the time, expect that patients held back or were less candid with the clinic staff about cocaine use.

The Southern Rural Addict

One of the continuing efforts of both researchers and clinicians in the field of addiction has been the search for some method to type addicts. Most often these efforts have been around psychological characteristics or functions of either individuals or the actions of the drug. These efforts have not been very successful; clinicians find most types of little use, and the addicts rarely fit the types.

Addicts have been designated at one time or another addictive personalities, escapists, double failures, sociopaths, and psychopaths; but the truth about present-day addicts is that they tend to elude all of the labels attached to them. This is most apparent in recent ethnographic investigations that study the addict in his own environment. On the street, in his own community, the addict appears to be quite different from descriptions that come out of jails, mental hospitals, or treatment programs. Patrick Hughes, in a study of a Chicago "copping area" found no particular psychopathology among addicts (Hughes et al. 1971). Edward Prebble and John Casey found that addicts on a New York street were not necessarily passive, withdrawn, or escapists as they have been described by researchers in institutions (Prebble and Casey 1969). Michael Agar, in an ethnographic study of Lexington Hospital, found that treatment staff would resort to their own white middle-class values or a priori theories in their dealings with addicts, and that addicts' own experiences did not necessarily fit these value systems or theories (Agar 1973).

If we are to truly understand and treat the behaviors of addicts, perhaps another approach is necessary — one that does not set the addict apart from the non-addict or society. In society, there are most certainly working typologies of people — typologies that categorize people according to wealth, social class, occupations, urban-rural, and geography. Poor people have different experiences from the rich; different class groups have different cultures; musicians are quite different from attorneys; Westerners and Southerners are different from each other and from Northerners. People know and use these typologies. Addicts may demonstrate similar differences. Rich addicts do not usually go to jail; different classes use different drugs; large-scale drug dealers have different statuses from the run-of-the-mill hustlers — just to name some of the most obvious differences.

Geographic differences are another consideration as a typology. John Ball, in an article in The Journal of Criminal Law, Criminology and Police Science in 1965, was one of the first to notice the differences between Northern, big-city addicts and Southern, small-town addicts at Lexington Hospital. Very briefly, the Southern small town addicts were usually older, used doctors as a source for legal drugs, and used morphine. Northern, big-city addicts were younger minority members, went to illegal sources for their drugs, and used heroin. Our data supports Ball's "Southern type," and suggests that the model is at least 50 years old.

*Sums may not equal 100% because "no answer" and "data unavailable" codes have been excluded from the tables.

Another comparison supports the idea of geographic types. This is the comparison with data presented by S. Dana Hubbard describing the patients of the New York City clinic (which was operating at approximately the same time as the Shreveport clinic). Dr. Hubbard, in an article published in the Monthly Bulletin of the Department of Health, City of New York in 1920, presented data on the 7,464 patients who came to the clinic. This data is presented here to facilitate the comparisons.

Differences between patients of the two clinics are dramatic. New York patients were a good deal younger; more than three-quarters (78.2%) were under 30 years of age, while only 39.2% of the Shreveport clinic patients were that age. Breaking the numbers down further, we find that more than a quarter (27.8%) of the New York patients were under 19 years of age, while only 1.3% of the Shreveport patients were under 20 years. New York addicts obviously started their drug use much earlier than Shreveport addicts.

Differences in self-reports on the causes of initial addiction are equally dramatic. Shreveport addicts cited medical reasons for their addiction (74.1%), while New York addicts were largely addicted for non-medical reasons (73.3%) with most citing associations.

Another difference between the clinics was the type of drugs used by patients. While the Hubbard report of the New York clinic did not mention or discuss the drugs used, an earlier report written by Royal S. Copeland which appeared in American Medicine (1920) did. Dr. Copeland's study was not, however, of all the New York patients, but of the first 3,262 (or roughly half) of the total number who attended the clinic during its eleven months of operation. Comparing the two clinics, Shreveport addicts were predominantly morphine users (98.4%), while New York addicts were largely heroin users (66.5%). New York patients were also inclined to use combinations of drugs-more than a tenth (11.9%) said they were multiple drug users, while less than one percent (0.6%) of the Shreveport patients reported combinations of drugs.

*Sums may not equal 100% because of rounding.

The pattern of heroin use by New York addicts appears to have been a relatively recent phenomenon at the time. According to a little known study conducted by W. A. Bloedorn (appearing in a 1917 U.S. Naval Medical Bulletin) of addicts admitted to a Bellevue Hospital drug program during the period 1905- 1916 the use of heroin appeared suddenly to accelerate during and after 1914, while the use of morphine and cocaine declined. Up to 1910 there were no heroin addicts among admissions, but during the years 1911-1913 there was a sudden appearance of heroin addicts. In 1910 there appeared one heroin addict with a slow but gradual increase to 3 in 1911, 9 in 1912, and 21 in 1913. Suddenly the numbers jumped in 1914 to 146, which was a quarter (25.6%) of the 582 addicts admitted that year. Just two years later, in 1916, the majority were heroin users (81.5%). We expect that the first introduction of heroin was illegal and smuggled into the United States, but as it got around addicts began to request it from doctors. Heroin is more powerful and euphoric than morphine and New York addicts quickly learned this. Soon the majority were heroin users; by 1920 two out of every three addicts attending the New York clinic used heroin (66.5%) while only one in five used morphine (21.1%).

Heroin use did not, however, spread as quickly outside of New York. Dr. Pearce Bailey, a well known Army neuropsychiatrist who treated military addicts during World War I writing for the magazine The New Republic in 1916, made the following observation:

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 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 [Bailey 1916].(4)

Clearly, the geographic typology New York urban as distinct from rural (which later became known as the Northern urban versus Southern small town) are very distinct and were established nearly 60 years ago. Data from the Shreveport and New York clinics support this.

War Veterans Patients

Both the Civil and Spanish-American Wars saw relatively large numbers of addicted veterans returning home. Army doctors in both wars used morphine extensively in treating war injury, and many of the injured became addicted. Indeed, the large numbers of addicts in the United States during the nineteenth century are often attributed to the Civil War. During the era of the clinics, it was anticipated that World War I would also contribute large numbers of addicted veterans. These veterans would be coming home at an inopportune time — doctors would not be allowed to prescribe for them — and it was expected that there would be some demonstration or protest on their part.

Such protests and demonstrations did not take place in Shreveport. The numbers of addicted veterans were very small; only 19 out of 762 patients were war veterans, and of these 16 were from World War 1. A quarter (4) of the 16 said they had been gassed in France and became addicted during treatment for the resulting respiratory ailments. One attributed his addiction to "shell shock." Another was an invalid after suffering gunshot wounds. This 31-year-old was using 20 grains a day when he came to the clinic and said he became addicted as the result of chronic amoebic dysentery before he was wounded. The clinic considered him "incurable" and maintained him on a steady dose of 12 grains a clay. Two of the 16 responded very well to treatment. Both entered the treatment within 5 days of their arrival at the clinic and were discharged as successful "cures."

No special attention was given to veterans, as all patients but the obvious criminal were treated well. However, special concern for the veteran's benefit is illustrated by the fact that two were allowed to transfer from the clinics in New Orleans and Alexandria to Shreveport. One of these was a Spanish War veteran who was considered incurable and was maintained without being expected to take a cure. He was one of two Spanish-American veterans. The single Civil War veteran was the 82-year-old confederate soldier described earlier.

World War I veterans constituted only 20/o of the clinic's long-term patients. if, as it has been said, one of the reasons that the clinics were opened was in anticipation of addicted veterans, then there were clearly not enough veteran addicts in Shreveport to justify a clinic. This might have been a contributing reason for the change in national policy to close the clinics. Veteran addicts did not show up as expected, but there were certainly enough non-veterans to justify keeping the clinics open.