The wave of reform that carried Teddy Roosevelt to the door of the White House in 1900 had its origin in the steam engine, the evolutionary device that took us from the ox to the locomotive in a single leap. It wreaked havoc with the social order just as the microchip does today. When the North embraced the steam engine and the South chose to stick with the 18th century, the rift between the two cultures widened into the bloodiest conflict in history. The industrialization that followed the Civil War brought rising power to the cities, along with slums, saloons, political corruption, and a spectacular concentration of wealth in the pockets of a handful of people.
Ranged against these evils was a broad coalition that stretched from Kansas to Brooklyn—ordinary Americans fed up with machine politics and robber barons who trampled the little people underfoot. The progressive wing of the Republican party had undeniable claim to the leadership of this movement, for this was the party of Lincoln. These people had freed the slaves. And though it took a war to prove the point, the progressives had
shown that the federal government could play a decisive role in the improvement of the human race. By the end of the century, these highly motivated reformers thought they could see the millennium—a chance to do away with, not just corruption, but evil itself. All they had to do was pass the right laws and humanity would purify itself.
When McKinley was assassinated in 1901, Vice President Teddy Roosevelt unexpectedly mounted to the throttle of this powerful social dynamo. One of his first moves was to dust off the all-but-forgotten Sherman Anti-Trust Act and go after major-league Monopoly players Morgan, Rockefeller, Harriman and Hill. The roar of public approval enabled him to make an end run around a surprised Congress, and over the next seven years he would change the country so profoundly that his face would wind up on the side of Mt. Rushmore.
For the average upstanding American, the most visible evil of the day was the saloon, filled with brawling immigrants whose votes could be bought for a pint of beer. Here was the social sinkhole where the working man spent his paycheck, then went home in a stupor to beat the wife and kids. Eliminate the saloon—no, eliminate alcohol—and you would dry up the tap root of crime and human weakness. By the end of Roosevelt’s second term, seven states already had prohibition laws on the books and the groundswell was clearly building to outlaw alcohol nationwide.
It was in this collision of social reform and religious fundamentalism that the narcotics issue first came to focus in the United States. Another time, another place, and the results might have been far different, but at this moment it would only take a handful of chance meetings to profoundly alter world history.
May first, 1908 was a blustery Friday in Washington with broken clouds scudding in from the northwest. An intense cold front had moved up the Ohio Valley the night before and there
were storm warnings along the Atlantic Coast from Maine to Florida. A few blocks north of the White House, a 41-year-old research physician named Hamilton Wright was crossing Massachusetts Avenue at Scott Circle when he heard somebody shout his name. He turned and there was Cal O’Laughlin, the Washington correspondent for the Chicago Tribune.
Wright was known to the press. After graduating near the top of his class at McGill University, he had gone to the Far East and established a laboratory in the Malacca Straits to study tropical diseases. While still in his thirties, he became famous for discovering that beri-beri was a bacterial infection. He was wrong, unfortunately—it’s a vitamin deficiency—but that turned out to be irrelevant since he had already married the daughter of industrialist W. D. Washburn, the powerful Republican senator from Minnesota. When Dr. Wright and his bride arrived in Washington just after the turn of the century, he discovered he liked politics better than medical research, and he let it be known through his father-in-law that he was available for some kind of suitable governmental employment.
Cal O’Laughlin was eager to help the son-in-law of one of the country’s major power brokers. “In his usual direct way,” Wright later noted, “He asked me if I would like to be a member of an opium commission about to be appointed by President Roosevelt.” The commission was news to Wright. He didn’t know much about opium but he had no trouble recognizing the possibilities. “I saw at a glance that it was bound to be a large and extensive bit of work.”
The opium commission that the Tribune had just got wind of was a creation of the U.S. State Department, and it had less to do with drug control than selling shoes. The object of this mission was to ingratiate ourselves to the Chinese in hopes of opening up their markets. By helping them with their notorious opium problem, we might be able to impress them with our moral concern, and simultaneously pull the rug out from under the British who had created the problem in the first place. For
most of the last century the British East India Company had been forcing China to accept Indian opium in payment for Chinese tea and silk. The Chinese fought a couple of wars over this issue, lost both times, and wound up giving the British the port of Hong Kong along with a burgeoning opium trade that began to disgust even the English. Though the Americans arrived late in the Far East, the opportunity to help carve up China’s commercial markets—“one of the greatest commercial prizes in the world,” according to future president William Howard Taft—had U.S. businessmen of every stripe lusting after a slice of the pie.
Using the opium issue as a wedge, Teddy Roosevelt saw a chance to soften up the Chinese with diplomacy instead of gunboats, and it would be virtually cost-free since the U.S. was not a player in the opium trade. The State Department began agitating for an international conference and the other great powers were soon shanghaied into signing on. The meeting was set for January of 1909, fittingly, in Shanghai. The Americans would send three delegates. The Episcopal Bishop of the Philippines would head the mission, the number two man would be from the American Legation at Peking, and the third slot was up for grabs. And on that windy morning in Washington, Cal O’Laughlin advised Hamilton Wright to talk to the White House right away. Wright got there “shortly thereafter,” and eight weeks later he was named as the third U.S. delegate to the International Opium Commission at Shanghai. And though his career at the State Department would end in disgrace, he would leave a profound imprint on the Twentieth Century, for Dr. Hamilton Wright is personally responsible for shaping the international narcotics laws as we know them today.
When Wright first began wading through the state department files on the opium problem, he assumed he was dealing with some distant plague like yellow fever or leprosy. He had no
idea there was widespread opium addiction in the United States itself. But he was trained as a researcher so he set out to see for himself. He toured the major cities and sent out hundreds of questionnaires to prison wardens, police chiefs, doctors and drug companies. The survey was not scientific, and the spotty responses left a huge margin for error, but Wright was now a man with a cause and he began to put the worst-case spin on everything he saw. In short order he managed to convince himself that the U.S. not only had an opium problem, but that it was worse than China’s.
In truth, there was an opium problem in the United States, but hardly the “numberless dope fiends” Wright began to see. At the turn of the century the typical American addict was a middle-aged Southern white woman strung out on laudanum (an opium-alcohol mix) and the highest credible estimates put the number of U.S. addicts at about three people in a thousand. Others thought it was half that. Most of these people had become unwittingly dependent on the vast array of over-the-counter patent medicines that were laced with everything from morphine to cocaine. A popular cough syrup spiked with heroin was available by mail order: “It will suit the palate of the most exacting adult or the most capricious child.” 
At a time when medical science was still bleeding people with leeches, bottled pain-killers with this kind of power were a godsend. Doctors everywhere prescribed them freely for every conceivable ailment because the patients always said they felt better. It was not until the late 1800s that the public began to realize that some of their favorite medicines could be highly addictive. Ironically, just as Hamilton Wright was discovering that narcotics addiction in the U.S. was soaring out of control, it was actually on the decline. All the leading authorities now agree that addiction peaked around 1900, followed by a steady drop. The reason was simple common sense coupled with growing awareness. The Pure Food and Drug Act of 1906 finally forced manufacturers to list ingredients on the label,
and when people began to realize their favorite nostrums were laced with addictive drugs, the ones who could stopped using them.
But for Hamilton Wright it was no longer possible to be objective about the facts. Having persuaded himself that opium addiction was a global scourge, he set out to eradicate it personally. Handsome and imposing, tall, square-jawed, with his hair parted in the middle and a trim little handlebar moustache, he looked like a well-preserved Yale quarterback and he had the ego to match. His tendency to go for the jugular, to overstate the case and stretch the numbers, proved to be a powerful weapon in the opening volley in the war on drugs, but his bulldozer style infuriated a lot of people. Chastened by the Secretary of State’s warning to watch his step, Wright sailed for the Orient in October of 1908 aboard the steamship Siberia.
The Shanghai Opium Commission was a smashing success for U.S. diplomacy. The Chinese were deeply impressed with the American effort. This was the first time they had been treated as an equal partner in an international conference, and it was the first time in memory that the folks who called the meeting did not walk off with a piece of Chinese real estate. But the impact on the drug trade was negligible. The delegates at Shanghai were allowed to exchange information and make recommendations but that was all. Nobody was obligated to follow through. And some of the key players—England, France, the Netherlands—did not share the American delegation’s horror of opium. A British study had recently concluded that opium addiction was no worse than alcoholism, and maybe not as bad. As one public health official put it, “There is more violence in a gallon of alcohol than a ton of opium.” Most of the countries involved thought this conference had gone far enough, and when the Americans proposed a second meeting, the British torpedoed the idea. But Hamilton Wright and his colleagues had managed to get agreement on a few resolutions, and that would make all the difference.
The sleeper was Resolution 5, which called on all the signatory governments to clamp down on opium and its derivatives
within their own borders. It was easy for the British to go along with this idea—in fact they proposed it—because it had no effect on the international drug trade. It was simply a way of saving face while the Americans held their feet to the fire. But in the hands of Hamilton Wright, Resolution 5 would become a sledgehammer to fashion his dream of world-wide narcotics prohibition.
In the spring of 1909, Wright returned to Washington triumphant, energetic, and fired with a sense of mission. His first job was to convince his bosses at the State Department to demand a follow-on conference in spite of British and Dutch opposition. And to embarrass the rest of the world into going along with his idea, Wright planned to transform the United States into a shining beacon of drug morality. For the next two years he was a one-man Washington pressure group, pitching to Congress, threatening and cajoling foreign ambassadors, twisting arms, and drafting model narcotics laws for the people of the United States.
Despite his relentless enthusiasm, Wright faced a couple of daunting problems. For one thing, there was the U.S. Constitution. A national drug law would call for a national police force—an idea discouraged by the Tenth Amendment. After a year of trying to work his way around this obstructionist document, he complained to his boss, “it has been a difficult business… The Constitution is constantly getting in the way.” But the Supreme Court had recently opened the door to a possible way around the Founding Fathers when they ruled that the government had the right to regulate anything it was taxing. Perhaps, thought Wright, the narcotics law could be disguised as a tax act. By the winter of 1909, he had drafted a model bill that would require anyone who dealt with drugs—doctors, druggists, manufacturers—to register, pay a license fee, and keep scrupulous records. And since the revenue men could refuse to license anyone they didn’t approve of—addicts, for example—the government would have absolute control over the distribution of narcotics. But despite his certainty about everything else,
Wright was still grappling with the question of who would enforce the law once it was enacted.
The main resistance to federal police authority came from the south of the Mason-Dixon line. The Senators from Dixie did not want the federal government tramping through their carefully crafted segregation laws. A national drug law, enforced by a national police force, would breech the moat of States’ Rights, and God knows what would follow that. But Wright now saw a chance to remold Southern prejudice into an asset, and it was at this point that his genius took an evil turn. Motivated no doubt by patriotism and a deep concern for the future of mankind, he decided to play the race card.
The “drug-crazed Nigger” was already a popular bogey man among racists. All Wright had to do was fan the flames. He began feeding the Congress lines like “cocaine is often the direct incentive to the crime of rape by the Negroes…” While it was true that Blacks in the South used cocaine—it was sometimes supplied by white employers trying to get more work out of them—there is no evidence that African Americans abused the drug any more than anyone else. But to the Southern Senators, cocaine was particularly ominous because they heard that it transformed the black man into a powerful zombie who not only forgot his place, but was impervious to bullets. Some say the reason the .38 calibre revolver was adopted as the police standard in the U.S. is because of the belief that the lighter .32 calibre slug could not stop a black man high on cocaine.
In using racism in his quest for narcotics legislation, Hamilton Wright was following a hallowed tradition. Almost every drug prohibition ever enacted has had some racial or political component. When Moslems established the death penalty for coffee drinkers in the 17th century, it wasn’t the caffeine they were after, it was the coffee houses, which were filled with plotting malcontents. In the United States, the first anti-narcotics law ever passed—the San Francisco opium ordinance of 1875—was aimed squarely at the Chinese. They had been imported by the
tens of thousands to build the western railways, but when these monumental projects were finished, the Chinamen were a glut on the market. Their principal sin—working too hard for too little money—could hardly be outlawed, so the authorities had to find something else. One thing that set these people apart was their taste for opium. “Many arrests were made, and the punishment was prompt and thorough.”
Wright was happy to play the Chinese race card as well, warning that “one of the most unfortunate phases of the habit of smoking opium in this country is the large number of women who have become involved and are living as common-law wives or cohabiting with Chinese…” The specter of unbridled Negroes and coolies waiting at the foot of the bed to carry off wives and daughters proved to be more than the Dixie Democrats could countenance, and they began to knuckle under to the doctor’s relentless fear-mongering.
Looking back on Wright’s dogged and uncompromising efforts with nearly a century of hindsight, one must marvel at his innocence. Today, we know that a narcotics habit can be a lifetime ordeal, and even addicts who successfully kick may go through rehab a dozen times before they make it. Yet Wright gave no consideration whatsoever to the problems of people who were already addicted. He seems to have imagined that he could cure them by simply passing the law. But it turns out his naivete can be easily explained: Wright and his colleagues were the victims of a spectacular medical hoax.
In 1909, the medical profession was informed that a miracle remedy for drug addiction had been discovered. It was almost infallible and it took about five days, tops. This amazing revelation meant that opium addiction was no more difficult to overcome than nail biting. All you needed to kick the habit was a little discipline and a long weekend. Not surprisingly, the man who planted this silly idea in the minds of the American medical establishment wasn’t a doctor himself, although he was often referred to as “Dr. Towns” in the press. He was in fact an
insurance salesman from Georgia—a self-taught farm boy who went on to become the Colonel Harlan Sanders of the drug treatment industry. And like the silver-haired Colonel Sanders, his success was based on a secret formula.
Charles B. Towns arrived in New York in 1901 with a plump nestegg from his foray into the life insurance business, and enough guts to take on Wall Street. But as many another farm boy has learned, the Street devours amateurs and he was quickly picked clean. Defeated for the first time in his life, Towns was still in shock when an acquaintance came up to him one day and whispered, “I have got a cure for the drug habit—morphine, opium, heroin, codeine—any of ‘em. We can make a lot of money out of it.”
“That’s a job for a doctor.”
“It’s a job for a man with an almighty nerve. You’ve got that. I’ve got the formula.”
The formula turned out to be a powerful laxative mixed with a couple of deadly poisons. Needless to say, it had a profound impact on the patient. The first volunteer Towns and his partner experimented on tried to escape from the hotel room after the initial dose, and had to be held down for two days to keep him from committing suicide. Then, “At the end of forty-eight hours, the divide was crossed… He was offered a hypodermic of the drug… and he declined it.”
“This is a cure!” cried Wright. Unfortunately, word of this vitriolic cure spread quickly on the streets and after that it was impossible for Towns to get any more volunteers. So he finally kidnapped a junkie no one would miss—a racetrack tout—and locked him up like the first victim. Though the formula had been modified, this patient didn’t like it either—“When I get out of here and tell the boys what you’ve been doin’ to me, your life won’t be worth twenty cents!” But after five days they sent him home “a well man.”
Convinced he was onto something monumental, Towns began pushing for recognition in the medical establishment. In his high white collar and pince-nez glasses, he certainly looked like a doctor, but with no diploma he was easily dismissed as a
snake-oil salesman. So he decided to leap over all these small-minded practitioners and present his case directly to one of the country’s leading authorities on addiction and alcoholism. Dr. Alexander Lambert of Cornell University was, above all else, an open minded scientist and he agreed to let Towns demonstrate his cure on a few addicts at Bellevue. The results were impressive, or so they seemed, and the fact that Dr. Lambert had personally witnessed it was another star-crossed collision, for Lambert happened to be Teddy Roosevelt’s personal physician. Word of Towns’s magical mystery cure quickly made it to Washington, and everybody was so relieved that any questions were swept aside.
The reason for the apparent success of this poisonous remedy was that nobody ever bothered to do a follow-up study. Since it was the rare individual indeed who showed up for a second treatment, Towns claimed his method was 90 percent successful. A full decade later, it finally occurred to Dr. Lambert that there was a gaping hole in the evidence, and he set out to track down a number of ex-patients to see how they were doing. He was stunned. Of some 200 people he had treated at Bellevue, “I found that about four or five percent really stayed off.” So the 90 percent cure rate was in fact a 95 percent failure rate, but by then the damage had been done. The mistaken idea that there was a cheap, easy cure for addiction had become one of the founding myths underlying our narcotics laws. It explains to some degree why the several hundred thousand citizens who were already addicted—many of whom had acquired the habit innocently—would soon be simply cast adrift to fend for themselves. By 1920 Towns and his cure had been discredited, but our unforgiving approach to dealing with addicts was already institutionalized.[23
The Second International Conference on Opium was finally set for December of 1911 at The Hague. By badgering his superiors at State, and threatening and tormenting foreign
ambassadors and congressmen, Hamilton Wright had managed to pull this meeting out of the hat in spite of resistance from almost everybody else involved. His style—overstatement, bluster, and manipulation—infuriated the British. They accused him of misrepresenting the Shanghai agreement and exaggerating the dangers of opium in his report to the U.S. Congress. The State Department was alarmed. Afraid that Wright’s heavy-handed approach could blow the whole deal, they asked him to find some other line of work, but he was now armed with the terrible swift sword of moral truth and he wasn’t about to be deflected by a mere bureaucracy.
Once again Wright confounded his critics. The British eventually calmed down and the Americans managed to get an agreement at The Hague that more or less formalized the document signed in Shanghai three years earlier. The Hague Opium Convention called for each country to exercise absolute control of the cultivation, manufacture, and distribution of cocaine, opium, and its derivatives. In his zeal to set an example for the less enthusiastic representatives, Wright made a sweeping promise. Without bothering to run it past the folks back home, he single-handedly obligated the United States to pass a federal anti-narcotics law. And when he got back to Washington, of course, he used this promise as a double-edged sword, telling Congress that this new treaty gave them no choice but to enact such a law.
Eighteen months later there was a follow-up meeting at The Hague to iron out the kinks, and this time Wright took the reins as head of the U.S. delegation. But this was to be the apex of the doctor’s amazing arc. Though his relentless arm-twisting had created enemies around the world, it was not his enemies who would undo him. It was Demon Rum. Dr. Wright may have been a dauntless foe of the opium poppy, but it seems he couldn’t keep his hands off the bottle. Alcohol at that moment in U.S. history was an evil equal to opium, and people were starting to talk about Wright’s drinking habits. When Secretary of State
William Jennings Bryan smelled liquor on Wright’s breath once too often, the two men got into an argument, Bryan threatened to fire him, and Wright left in a huff. Wright assumed that he was indispensable, and he wrote the President asking him to intervene. The reply never came. And thus, the man who had guided the nations of the world toward international narcotics prohibition was suddenly yanked off the stage. After an embarrassing round of begging for another assignment, he left for France to join the war effort as an ambulance driver, and he died three years later as the result of injuries from an auto accident. He was not quite 50. His legacy, however, is with us still.
The anti-narcotics legislation that Wright fashioned finally made its way through Congress in the winter of 1914. The Harrison Narcotics Act, named for the Tammany Hall Democrat who ushered it through the House, appeared on the surface to be nothing more than a means of gathering information. It called on everybody in the drug trade to purchase a license and keep precise records. The debate had little to do with the evils of addiction, focusing instead on the nation’s international obligation under The Hague Convention. At the final reading, the bill passed in a few minutes. The New York Times didn’t even mention it.
Although the medical profession had largely been brought around in support of the act, they were in for a rude awakening. Hamilton Wright had installed a couple of land mines in the bill, and the tripwire was hidden in a clause the doctors thought was supposed to protect them. There was one extra word in the sentence. A physician could prescribe narcotics “in the course of his professional practice only.” The interpretation of this phrase was left to the Treasury Department, and to the revenue agents, giving dope to an addict was not “professional practice,” it was simply feeding a bad habit—not only immoral, but now illegal.
The medical profession was completely unaware of this development. When one middle-aged morphine addict expressed her fear that the Harrison Act would cut her off, the Surgeon General
of the United States personally reassured her. He said the Act was intended simply to gather information. Meanwhile, down at Treasury, they were sharpening their lances.
It should be remembered that the men who were about to enforce the Harrison Narcotics Act were under the impression that a foolproof cure existed for addiction. If the Towns formula could cure an addict in five days, obviously withdrawal was no big deal. Any weak-willed pervert unwilling to take a simple treatment and get straight would have to be dealt with forcefully. Armed with righteous indignation, they set out to rid the nation of drug addiction. And thus Congress, without any clear sense of the enormity of what they had done, had set the stage for the criminalization of a quarter of a million drug addicted citizens.
Six weeks after the Harrison Act went into effect, the New York Medical Journal carried an ominous observation: “…the immediate effects of the Harrison antinarcotic law were seen in the flocking of drug habitués to hospitals and sanitorium. Sporadic crimes of violence were reported too, due usually to desperate efforts by addicts to obtain drugs… The really serious results of this legislation, however, will only appear gradually and will not always be recognized as such. These will be the failure of promising careers, the disrupting of happy families, the commission of crimes which will never be traced to their real cause, and the influx into hospitals for the mentally disordered of many who would otherwise live socially competent lives.”
One way to understand the mind of a drug addict is to use food as a metaphor. Imagine you’ve just been told by the government that food is so bad for you it’s been taken off the market. You might be able to handle it for a couple of days, and after that you wouldn’t be able to think about anything else—food—how to get it, where to get it, and where to steal the money now that a hot dog with mustard is suddenly $50. But even this metaphor is an inadequate measure of the addict’s urgency
because a junkie, though starving, will trade food for dope. This consuming desperation, never clearly grasped by either the lawman or the average physician, would prove to be the fatal flaw in the plan to free humanity from the scourge of addiction. What Hamilton Wright and his colleagues had expected to be a brief skirmish would turn instead into the longest running war in U.S. history. As one contemporary put it: “we had counted without the peddler. We had not realized that the moment restrictive legislation made these drugs difficult to secure legitimately, the drugs would also be made profitable to illicit traffickers.”
The man who wrote those words was in a position to know. In 1914 Dr. Charles E. Terry was the City Health Officer for Jacksonville, Florida. He’s considered one of the leading authorities on this period, and his book—The Opium Problem—is quoted in every history of the era. Terry’s study flew in the face of conventional wisdom when he found that most addicts were women, and that whites outnumbered blacks two to one. And the cure rate—even with the famous Towns formula—was never more than five percent. But his report contains one fact that is as stunning today as it must have been to Dr. Terry: “One of the most important discoveries we made at that time was that a very large proportion of the users of opiate drugs were respectable hard-working individuals in all walks of life, and that only about 18 percent could in any way be considered as belonging to the underworld.” In other words 80 percent of his patients had jobs, homes, families, and reputations. And while it may seem bizarre to read that narcotics addicts could hold down jobs and be useful, productive citizens, it turns out there is no scientific evidence to the contrary. In fact, the medical literature is filled with thoroughly documented records of addicts who functioned normally throughout their lives. Among the mountain of case histories, one of the most remarkable is the story of Dr. William Stewart Halsted, “the father of modern surgery.”
Halsted, the dashing young son of a distinguished New York family and former captain of the Yale football team, was already
a prominent surgeon in Manhattan while still in his twenties. In the decade after the Civil War Halsted was experimenting with the recently invented hypodermic syringe and the new drug, cocaine, and he made a significant discovery. When he injected cocaine into the skin, the nerves were deadened. It was the first effective local anesthetic and it was a major leap for modern surgery. Unfortunately, Halsted was also experimenting on himself and he found that when he injected the drug directly into his veins he got a rush that was better than sex. “Cocaine hunger fastened its dreadful hold on him,” a colleague wrote. “He tried to carry on, but a confused and unworthy period of medical practice ensued. Finally he vanished from the world he had known.”
Halsted didn’t vanish. He was shanghaied. His friends chartered a schooner with a trusted crew and sailed him to the Virgin Islands and back in a desperate attempt to wean him from his habit. They managed to keep him clean for a couple of months but as soon as he hit the beach he started shooting up again. In a last ditch effort he checked himself into a hospital in Providence, and after one relapse—through sheer will power and inner strength—he emerged triumphant, completely cured. Or so the story went.
Shortly after that, in 1886, Halsted joined with Osler, Welch and Billings—the “Big Four”—to found the prestigious Johns Hopkins Hospital. Halsted’s skill and ingenuity as a surgeon made him world famous. His private life was exemplary. He married a thoroughbred Southern belle and they lived together in “complete mutual devotion” until Halsted’s death thirty-six years later. The fairytale would have ended there except for a small black book with a silver lock and key.
In 1969, on the eightieth anniversary of the Johns Hopkins Hospital, the book was formally opened according to the instructions of its author, Sir William Osler, one of the four founders. In it was the “secret history” of the Hopkins, and here Sir William revealed that Halsted had cured his cocaine habit by
switching to morphine. In other words, one of the four founders of Johns Hopkins was a morphine addict for over forty years, and while one of his colleagues knew all about it, the others apparently never suspected. According to all reports, it had no observable effect on his performance at home or at the office. Listen to British surgeon Lord Moynihan on Halsted’s technique: “frequently light, swift, sparing movements with the sharpest of knives, instead of free, heavy-handed deep cutting… the minimum of hemorrhage instead of the severance of many vessels…” Throughout his career Halsted tried to kick the habit and couldn’t. He was never able to get by with less than 180 milligrams of morphine a day. “On this,” said Osler, “he could do his work comfortably and maintain his excellent physical vigor.”
Halsted’s story is revealing not only because it shows that a morphine addict on the proper maintenance dose can be productive. It also illustrates the incredible power of the drug in question. Here was a man with almost unlimited resources—moral, physical, financial, medical—who tried everything he could think of and he was hooked until the day he died. It brings into focus the plight of those addicts all over the country who were about to be cut off with nothing.
But the problem which seemed so daunting to medical men like Terry and Halsted looked like a piece of cake to the lawmen. Addicts—and the doctors and pharmacists who enabled them—were to be hunted down and forced to change their ways or else. Another hint of their naivete about the scale of the problem is contained in the Harrison Act itself. It calls for an appropriation of $150,000 for enforcement. Eighty years later we are spending that much every three minutes.
The Justice Department strategists understood quite clearly that the Harrison Act was on shaky ground constitutionally. Hamilton Wright and his colleagues had been so skillful in disguising it as a tax law that judges all over the country were interpreting it as a tax law. And when the first case reached the
Supreme Court in 1916, Justice Oliver Wendell Holmes, Jr., blew the government’s brief out of the water. In a 7-to-2 decision the court tossed out the indictment against a Pittsburgh doctor who had sold a narcotics prescription to an addict, and a host of other doctors, druggists, and addicts who had already been convicted had to be turned loose. The Treasury Department lawyers scrambled to deal with this unexpected damage and immediately began agitating in Congress for additional legislation. In the short run, they managed to keep the medical profession in line through sheer intimidation. According to the Narcotics Division’s own numbers, they indicted some 35,000 people over the next couple of years without ever bringing the cases to court—thus terrorizing the medical profession into compliance without risking defeat at the hands of the judiciary. Meanwhile, they went looking for a better case—something vividly outrageous that might change the minds of at least three judges on the High Court.
At a different moment in our history, this kind of rough-and-tumble federal intimidation might have been met with public outrage. But in the second decade of the 20th century, the American people were going through a sea change in attitudes. Among the major losers in this transformation would be the victims of drug addiction. Back in 1900, the country had looked upon addicts as unfortunate citizens with a medical problem. By 1920, they had become “drug fiends,” twisted, immoral, untrustworthy. Like vampires, they infected everything they touched. There was no room for compassion here. The only way to get rid of a vampire is to drive a stake through his heart.
This image—the Drug Addict as Vampire—was to become a driving force in the public mind and the origin of this powerful symbolism can be traced to a single individual, Spanish-American war hero Richmond Pearson Hobson. At one time, Captain Hobson, “the Hero of Santiago,” was the highest paid lecturer in America, and after each of his public appearances the women in the audience would line up to kiss the dashing young naval officer. He was known as “the most kissed man in
America,” and they even named a caramel candy after him—“Hobson’s Kisses.” President McKinley personally decorated him for valor in the Cuban engagement where he was said to have single-handedly stopped the Spanish Fleet. In fact his mission had been a total failure. His assignment was to sail the aging USS Merrimac into the channel entrance at Santiago harbor and scuttle her there to trap the Spanish fleet—as Hobson himself put it: “Homeric manhood, erect and masterful on the perilous bridge of the Merrimac…” Unfortunately the rudder jammed, the ship never made the channel, and Hobson had to be rescued by the Spaniards. But it was a short war and there were hardly enough heroes to go around, so the navy promoted him to Captain and by 1906 the Hero of Santiago was a Congressman.
Now accustomed to the limelight, Hobson became uneasy when he felt it edging away. So he reincarnated himself as a champion of the temperance cause and once again found himself at center stage. He had a way with words. He called liquor “the Great Destroyer,” and when he coined that term in a House debate, his admirers demanded that a copy of the speech be sent to every household in America. But his most remarkable contribution was his quasi-medical analysis of the human brain. Hobson had no more medical training than the eminent Charles Towns, and he was equally undaunted. The brain, he explained, is divided into various vertical layers like a building, with the baser instincts in the basement. Alcohol attacks the penthouse—”the top of the brain … organ of the will, of the consciousness of God, of the sense of right and wrong, of ideas of justice, duty, love, mercy, self-sacrifice and all that makes character.” Unfortunately, he said, Negroes and Indians were particularly susceptible to alcohol because their mental buildings were not as tall as the white man’s. According to Hobson, when alcohol reached the top of the brain of Negroes, “they degenerate … to the level of the cannibal.”
When his campaign was crowned with success in the enactment of Prohibition, Hobson needed a new focus for his unlimited moral indignation, and he retired from the scene for a few
months in search of a worthy demon. It’s hard to imagine what took him so long. The evil drug heroin was practically tailor made for a moral crusade. Not only could it be held accountable for all crime and vice, it had the added advantage of being a foreign import. In a frenzy of public appearances, lectures, and writings, Hobson introduced a chilling new concept. Heroin, he said, transforms the addict into a monster who has no control over himself and is compelled to spread his disease like Count Dracula. It was a masterstroke in the art of propaganda. “The addict has an insane desire to make addicts of others,” said Hobson, and he horrified audiences with stories of wretched young zombies infecting their pals with heroin-laced ice cream cones. “One addict will recruit seven others in his lifetime,” he said, and he claimed there were over four million addicts in the United States—a figure sixteen times higher than the Public Health Service estimates. 
Hobson’s impact would have been powerful under any circumstances but the early 1920s saw the dawn of commercial radio, and almost overnight the great crusader found himself addressing the whole country at once. NBC, one of the new national networks, gave him uninterrupted free time on four hundred stations—an unprecedented audience—and he warned America that there was evil afoot: “Suppose it were announced that there were more than a million lepers among our people. Think what a shock the announcement would produce! Yet drug addiction is far more incurable than leprosy… more communicable… and is spreading like a moral and physical scourge. The whole human race, though largely ignorant on this subject, is now in the midst of a life and death struggle with the deadliest foe that has ever menaced its future.”
In fact there was never a shred of evidence to back Hobson’s psuedo-scientific speculations, but his crusade quickly united all the old prohibition allies—the Kiwanis, the Masons, the Elks, the WCTU—and they simply overwhelmed the handful of scientists who tried to put the brakes on this juggernaut. And
despite the fact that fifty years of medical research has consistently debased each of Hobson’s assumptions in detail, his terrifying stereotype of the addict as infected blood-sucker lives on in the headlines—and in the American psyche—to this day.
But a phenomenon like Hobson is only possible when there is a receptive audience. His amazing success was the product of two powerful social currents that collided just before World War I. First, the moral surge that crested with national alcohol prohibition had been building for fifty years. And second, rural America’s growing fear of the immigrant tide—specifically the flood of European Catholics pouring into the cities—had been hammered into a powerful sword by the Anti-Saloon League. “Besodden Europe,” wrote one prohibitionist editor, “sends here her drink-makers, her drunkard-makers, and her drunkards… with all their un-American and anti-American ideas of morality and government… ” Into this xenophobic hotbed came the First World War. When wartime propaganda painted the Germans as thick-necked beasts, the venom inevitably spilled onto Germans in America, and again the Anti-Saloon League wasted no time in lighting the torches: Pabst and Busch and most of the major brewers were Germans, so beer was obviously subversive. Drunken soldiers couldn’t shoot straight. Worse, brewing used up eleven million loaves of barley bread a day that could have been used to feed our starving Allies. Clearly, brewers and distillers were guilty of treason. “In this orgy of simplicity,” writes historian Andrew Sinclair, “the arguments of the drys seemed irrefutable. They were for God and for America, against the saloon and against Germany. The wets therefore must be for Satan and for Germany…”
The narcotics reformers naturally climbed on board this flag-decked bandwagon. To these people it was becoming clear what the evil Hun had in mind. An editorial in the New York Times passed on this rumor of German fiendishness: “Into well-known German brands of tooth paste… habit-forming drugs were to be introduced; at first a little, then more, and as the habit grew
on the non-German victim, and his system craved ever greater quantities…” then the Huns would cut off the supply and the Yanks would be on their knees.
By 1919 public attitudes about narcotics had shifted so radically that even government documents were referring to addicts as “dope fiends,” and the Treasury Department decided the time was ripe to make another run at the Supreme Court. After three years of patient sifting, they found a case involving an outrageous hack named Webb who sold prescriptions for fifty cents apiece to any and all comers. His patients numbered in the thousands and he never bothered to examine anybody. He wasn’t practicing medicine, he was dealing drugs. But the genius of the prosecutors was to proceed as if Webb was just an ordinary physician who’s method of treatment happened to include giving his patients unlimited quantities of dope. The question they posed to the court was: is this legitimate medical practice? This time Justice Holmes came down on the side of the lawmen. “To call such an order… a prescription… would be a perversion of meaning…” It was a major win for Treasury, and because of the skillful way they had framed the case, they were now able to state that any doctor who prescribed narcotics to an addict was looking at a possible jail term. This decision was soon reinforced by a couple of others and in no time at all the medical profession more or less washed their hands of the narcotics problem.
It may seem strange that a guild as powerful as the American Medical Association would allow a bunch of Treasury men to wade into their profession and start telling them how to write prescriptions, but the fact is most doctors found the narcotics issue disgusting. Addiction wasn’t studied in medical school, nobody seemed to know much about it, and the only experience for most physicians these days was the occasional junkie who showed up wild-eyed, unwashed, and desperate, terrorizing everybody in the waiting room. Every word from his mouth was likely to be a lie and if you turned your back he’d clean the place
out. (The average physician would probably have been astounded to know that only a decade before, many of these wretched desperadoes had held down jobs, owned homes, and raised families.) The medical profession was more than happy to turn this ugly problem over to the Treasury Department.
But there’s always somebody who won’t go along with the program. In this case it was a doctor in Shreveport by the name of Willis P. Butler. Like his contemporary, Charles Terry in Jacksonville, Dr. Butler was a local health official who happened to be in the forward trenches at the start of the drug war. In 1919, as the federal enforcement efforts began to cut into the availability of drugs throughout the country, Shreveport city officials became alarmed at the sudden increase in crime among addicts who were trying to finance their habit. “Thievery was bad,” said Butler, “They were stealing stuff off front porches.” State officials suggested that Butler set up a treatment program for addicts like the one they were running in New Orleans. He went down to take a look. “I saw right away that the clinic was trying to fool their patients off of drugs. They were mixing morphine in solution and reducing their dosage drastically.” But the state medics were only fooling themselves. “The addicts knew what they were doing because some of them were doubled up in pain.” Butler had enough experience as a jailhouse physician to know this approach wouldn’t work. So when he got back to Shreveport he came up with a triage system that some authorities still consider the best single model of community opiate control and treatment in American history. In the four years the clinic was in business, Butler and his staff admitted some 1200 patients and they were sorted into three groups: 1) addicts who needed some kind of immediate medical care, 2) those that were physically healthy, and 3) the incurable. The first group had their habit maintained until they were cured of their other ailments, then they were put into a detox program that included up to a month of intensive hospital care. The second group got drugs until a bed was available, then
they too were pressured into gradual reduction. And the patients that Butler and his staff determined to be incurable—often people with untreatable cancer or advanced venerial disease—simply got whatever drugs they needed. Once their dose was stabilized, everybody who could work was expected to, and if they didn’t have a job, Butler would get them one. The same with a decent place to live.
It was this last group, the “incurable,” that got Butler in trouble with Washington. Although the Treasury Department had originally encouraged the idea of public treatment facilities, federal policy had recently undergone a change in thinking. By 1920, Charles Towns and his magic formula had been completely discredited, along with every other form of treatment then available. The U.S. Public Health Service had reviewed them all and concluded that under the best of circumstances “only about 10 percent of cures have been reported… Our present methods of treating drug addiction must be considered failures.” Rather than interpret this warning as a caution signal, Treasury took it as a green light. Since treatment didn’t work—if in fact these people were going back on drugs the minute you turned them loose—gradual reduction was a waste of time. Cold turkey was the answer. And to make sure they stayed drug-free, the government would simply have to dry up all sources of supply—including well-meaning but deluded physicians like Willis Butler.
But the success of Dr. Butler’s operation was apparent even to the narcotics investigators who came to Shreveport to shut him down. First they checked the local drugstores looking for evidence of criminal activity and found nothing. Then they talked to the city’s leading physicians and got a chorus of praise for Butler and his clinic. Then they met with the local Federal District Judge, and he warned them flat out not to make any move to close the place. He said he could personally testify that the clinic had reduced crime in the city. They got the same story from the chief of police, the sheriff, and the U.S. Marshall’s
office. At this point, the agents recommended to headquarters that they just leave Dr. Butler alone.
In Washington, this finding was unacceptable. The federal government didn’t have the authority to restrict maintenance to some physicians and not others. Addict maintenance would have to be allowed nationally or not allowed at all. Discrimination on the basis of “responsible” prescribing would put the government in even more trouble with the Constitution since this would clearly be the licensing of doctors.
In January of 1923 Butler was invited to a closed meeting in the office of the U.S. attorney and there he found three Treasury Department officials waiting for him. They were polite but firm. He was told that he was not in any way accused of wrong-doing, but his operation was going to have to close down. Other cities were asking questions: if Shreveport could have a clinic, why couldn’t they? “No records were gone over,” said Butler, “no patients, officials, or doctors were called, and nothing was gone into except the closing of the dispensary.” But he could see the handwriting on the wall. One way or another they were going to pull the plug. Defeated but unbowed, Butler agreed to shut the clinic down. But he kept on writing prescriptions for a handful of addicts on his own authority. Given his political clout, the T-men apparently decided they’d better not push him any further.
Six months after the clinic closed, the Shreveport Journal checked out the local scene to see what had happened since the federal intervention. They found that while street traffic in heroin and morphine had been practically unknown before the clinic was shuttered, both drugs were now being sold freely everywhere.
On the Old Testament ritual of Yom Kippur, a goat was chosen by lot as a sacrifice to the wilderness demon Azazel. The priests would symbolically burden the scapegoat, or “goat of removal”
with the sins of the people, then they would toss it off a cliff outside Jerusalem, and the nation would be cleansed of its iniquities. The ancient Greeks used human scapegoats— pharmakos—and it is from the healing process associated with throwing rocks at these people that we get the word “pharmacy.”
In the Roaring Twenties, the United States needed plenty of scapegoats, and the narcotics addicts were almost designed for the job. They were a tiny, powerless minority, and though their numbers might include plenty of powerful individuals like William Stewart Halsted of Johns Hopkins, they didn’t dare open their mouths. Defenseless and indefensible, this pathetic aggregation turned out to be a godsend for the politicians. From this point on, whenever senators or congressmen found themselves outflanked on the right, they could come down on addicts like avenging angels to prove how tough they were on crime.
And now there was plenty of crime to be tough on. Back in 1905 only two citizens out of a hundred thousand had died at the hands of another. Thanks largely to Prohibition, the murder rate in 1923 was four times that high and climbing.
 Encyclopaedia Britannica, 15th Edition, 1982, Macropedia Vol 15, 1142
 Andrew Sinclair, Prohibition: the Era of Excess, Little, Brown and Co., Boston, 1962, p19
 David F. Musto, M.D., The American Disease: Origins of Narcotic Control, Oxford University Press, NY, 87, p31
 Musto, The American Disease, p4, n31 p292
 Arnold H. Taylor, American Diplomacy and the Narcotics Traffic, Duke University Press, Durham NC, 69; “To [Hamilton Wright], more than to any other single individual, must go the greatest share of the credit for the success of American efforts in the antiopium drive in the first two decades of the twentieth century…”
 New York Times, Mar 12, 1911, supplement p12
 David T. Courtwright, Dark Paradise: Opiate Addiction in America Before 1940, Harvard Unviversity Press, Cambridge, 82, p1. — “During the nineteenth century the typical opiate addict was a middle-aged white woman in the middle of the upper class. Mary Tyrone in Eugene O’Neill’s autobigraphical play, Long Day’s Journey Into Night, exemplifies the characteristics of the generation of addicts: female, outwardly respectable, long suffering—and thoroughly addicted to morphine.”
 Musto, The American Disease, p5, p281 n13; “By 1900 America had developed a compartively large addict population, perhaps 250,000…” The U.S. population was then 76.2 million.
 David Musto, Opium, Cocaine, and Marijuana in American History, Scientific American, July 1991, p41
Musto, The American Disease, p281 n13
 Arnold H. Taylor, American Diplomacy and the Narcotics Traffic, Duke University Press, Durham NC, 69, p60 n33
 Dr. Lawrence Kolb, Sr., U.S. Public Health Service, quoted in Musto, The American Disease, 303 n36
 Musto, The American Disease, p295 n72.
 Felsenheld v. U.S., 186 U.S. 126 (1902) quoted in The Growth of American Constitutional Law, Benjamin F. Wright, U. of Chicago Press, 1942
 Musto, The American Disease, p65: “Cocaine raised the specter of the wild Negro, opium the devious Chinese…” The New York Times, Feb 8, 1914, 1; “Those cocaine niggers sure are hard to kill…” — a Southern sheriff.
 Musto, The American Disease, p8, “The claim of widespread use of cocaine by Negroes is called into question by the report in 1914 of 2,100 consecutive Negro admissions to a Georgia asylum over the previous five years. The medical director acknowledged the newspaper reports of ‘cocainomania’ among Negroes but was surprised to discover that only two cocaine users…were hospitalized between 1909 and 1914.”
 Musto, The American Disease, p7
 Richard H. Blum et al, Society and Drugs: Drugs I: Social and Cultural Observations, Jossey-Bass, Inc., San Francisco 1969
 Edward M. Brecher, Licit and Illicit Drugs: Consumers Union Report, Little, Brown & Co., Boston, 1972, p43
 Colliers magazine, Nov 25, 1913 p16 “The ‘White Hope’ of Drug Victims.” The quoted converstion is as Towns reported it. He never did identify his partner.
 Musto, The American Disease, p80
 Musto, The American Disease, p88
 Musto, The American Disease, p89
 Taylor, American Diplomacy and the Narcotics Traffic, p90
 Brecher, Licit and Illicit Drugs, p49
 Musto, The American Disease, p64
 Brecher, Licit and Illicit Drugs, p50.
 “we counted without the peddler…” Charles E. Terry, “Narcotic Drug Addiction and Rational Administration,” American Medicine, 26 (Jan., 1920), 29-35, quoted in Lindesmith, The Addict and the Law, 21.
 “One of the most important discoveries…” ibid.
 Brecher, Licit and Illicit Drugs, 33-35.
 Federal appropriations for the drug war had reached $16 billion by 1996; total expenditures including court costs, incarceration, and state and local police are estimated at $30 billion.
 Rufus King, The Drug Hang-Up, C.C. Thomas, Springfield IL, p27.
 Edward Jay Epstein, Agency of Fear, Opiates and Political Power in America, G.P.Putnam’s Sons, NY, 1977, p27
 Musto, The American Disease, p190-194, 349n32
 NBC network, March 1, 1928, quoted in Musto, The American Disease, p191
 Alphonso Alva Hopkins, quoted in Sinclair, Prohibition, 19.
 Sinclair, Prohibition, 20
 New York Times, Dec. 18, 1918, editorial, 14.
 Webb et al. v. U.S., 249 U.S. 96
 Rufus King, The Drug Hang-up, 41
 Arnold Trebach, The Heroin Solution, 149
 Alfred Lindesmith, The Addict and the Law, Vintage Books, New York, 1965, p 149, 160; Arnold Trebach, The Heroin Solution, 149
 A.G. DuMez, “Treatment of Drug Addiction,” memo to the Surgeon General, 28 Feb. 1919, quoted in Musto, The American Disease,145
 Musto, The American Disease, 148
 Musto, The American Disease, 173
 Shreveport Journal, 7 and 9 June 1923, quoted in Musto, The American Disease, 174
 Encyclopaedia Britannica, 15th Edition, 1982, Propedia Vol VIII, 945,
 Sources: Census Bureau, Federal Bureau of Investigation, U.S. Department of Justice Statistics. Quoted in New York Times, Jan 28, 1996, E5. Though many causes contributed to the dramatic rise in the U.S. murder rate, the percentage that could be ascribed to Prohibition was revealed on Repeal in 1933, when the murder rate took a precipitious plunge for the next 11 years. [See graph, page 00]^