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November 4, 1974

Heroin Addiction

JAMA. 1974;230(5):728-731. doi:10.1001/jama.1974.03240050056031

Her name was Lilly or Sally. She was tough, beautiful, angry, and terribly sick. Through the rage of fever and delirium she screamed that she was a "prostitute and a junky—and damned proud of it!" She was barely 19, and she had Staphylococcus aureus growing on her tricuspid valve.

We cured her with penicillin—in doses so timid that a contemporary clinician would wince in disbelief. She never did smile, but when she left the ward, she put two pink and green doilies wrapped in tissue paper on the nurse's desk—for me. They had been crocheted in secrecy with hands encumbered by needles and tubes. It was a shy expression of gratitude for nonjudgmental kindness. The penicillin had sterilized her valve.

That was in 1947, my first exposure to the nether world of narcotic addiction. In 1944, my mentor, Hugh Hussey, and some colleagues1 published an unusual report. Of four heroin