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In rei Data relative to nareotic aS
“survey Of Washington County, Maryland.

September 27,1923.

P,AsSurgeon &B.Norment

Washington County Health Demonstration
‘12 E Washington Street :

Hagerstowm, Maryland,

‘Sir:

Referring to your letter of July 25th and to previous |
correspondence relative to the proposed narcotic survey
of Washington Couhty, Maryland, you sre authorized to
nominate @ clerk to assist you and Acting Assistant Surgeon
Albert 3,Gray in this work fora period of two months, at
4 salary of one hundred dollars per month, This clerk will
be expected to perform the travel necessary in connection
with the work without expense to the government.

There ig inclosed for your informtion a copy of a letter
from Surgeon Lawrence Kolb to As@#istant oo General
AeMeStimson showing the nature and extent of this proposed

, Survey; also a copy of Regulations No.35 and of the
Narcotic Drags, Import and Export, Act.

You will observe under article 24 of the Regulations that
dealers who fill preseriptions are required to keep them
in a separate file for a period of two years, and that under
section 6 dadarticle 134, these prescriptions are open to
inspection by duly authorized officers, agent and employers |
of the Treasury Department. The clerk employed shekld therefore
have a letter from you authorizing her to inspect the narcotic
files of the wrious drug stores and hospitals registered
to mandle these drugs. | |

The survey should be started as soon av it is possible to
make the necessary arrangements and ehould be made to cover
the period from dune 3 ,1922 to dune 20,1923. From your letter
it is expected that each do: tar, dentist and veterinarian
will vooperate to let you know how much opium and cocaine |
they had on hand at the begk&nkng ani at the end of this period.

Ca mmid ere
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If they 40 not cooperate examination of their records can

be insisted upon. In addition to the information to be

obtained in this way each one should be asked if during

the stated period they suffered any loss of these drug: by

| theft or other means “ot in the regular course of practice,
‘and, in the event of such loss, an effort should be made to
ascertain the emount as nearly as possible o.ALl.such losses —
and any unusual diversion of narcotics into unauthorised

channels thet may come to your attention should be noted

and explained in your report to the Bureau, The same information
should be seoured from hospitals, sanitariums, etc. : ee

The informtion to be obteined from drug stores does not
ineiude the amount of opium on hand at the beginning and end
of the year. The records these dealers keeo and the reports
they am required to make differ from those required from .
physicians and it is doubtful whether such information,
even tho it conld be obtained, would show the amount of

drugs dispensed by them. Druggiste my, if they so desire,
register as wholesalers and sell drugs in unbroken packages,
If this shonld be done large quantities might be sold outside
of the county. There are several other sources of error to
be feared from this method, but a tabulation of narcotic
prescriptions filled by them should give accurate results.

If it is found that going over preseriptions to pick

out narcotics requires more accuracy and more knovledge of

pote ray the clerk could be expected to show, a copy .

of the body of each prescription should be mde and forwarded

6 te cnaaee te where the necessary seperation of narcotic —
items will then be made. Your report should be in such shape

thet results from each drug store oan later on be separated

if necessary. 3 : 3 e

Your survey should include in addition to opium, morphine,
heroin, etcetera all preparations such as Dowr's powder,
Brown Mixture, laudanum ani others which contein enough
narcotics to bring them under the restrictions of the law,

_ Exempt preparations (Section 6 and articles 159-148)
may be sold without prescriptions and by persons other than
physicians and druggists, Such preparations contain ve
Little narcoti os the report of the Burean of Interna
Revenue shows that the amount of narcotics put up in them
in this eountry is insignificant in comparison with the
total amount used, You should therefore make no attempt to
find how much paregoric and patent medicines containing
narcotics is sold by dealers othor then druggiste and
physicians, Druggists ani phyeicians are required to keep
@ record of such gales and in all cases these records should
be asked for and the amount of such sales, for the period

o
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vevaiied by the survey, ino luaea in your vonert: tt is to |
be remembered physicians my write prescriptions that would be
exempt and the narcotics in sueh prescription wuld not be
included in the Bureau's report of narcotics in exempt
preparations. ;

It is important rv fina in your survey of we itals and
Sanitesriums which ones, if any, treat drug addicts because
such institutions ordinarily use much more opium than 0others-
and also because it ht be found desirable to communi cate
with them about some phase of the subject later ‘Ons

An effort will be mide by the Bureau to furnish you w th
a list of persons registered to handle other than exempt
siecaretions in Washington County during the period sovered
by the survey, but you should not wait for this list, and,
in the course of the survey inquiry should be m@de as to
sanitariumes and drug stores which may have closed and
~~ gy may have abes or mov @ ont of me county Since
o % °

You may, write to Surgeon Neovenes Kolb at the Neste
Laboratory, Washington, D.C., for any other informatiogn
desired about this workeand the data collected should be .
sent en to hin, — the mircetir, |

“Repeottuliy, :

HSC oe ENS age 6. Cunainge
LK~1 | | ‘Surgeon General