view. Although the committee members, at first blush might seem to have their own opinions about certain proposals that have been made, we will make a conscientious effort to keep an open mind on new methods that might be suggested. We shall also do our best to conduct a full, complete, and fair hearing even on recommendations that we might already have some preconceived notion on. I have talked this over with Senator Butler, and it certainly will be our effort to hear all of the conflicting evidence on this matter with an open mind.

If any of you are interested in the subject, and have questions that you would like to pass up to the committee so that we might ask various witnesses who might appear, we will be glad to do so if we feel they are relevant questions; and since you cannot cross-examine we will do our best to cooperate with anyone who thinks that there are certain matters that should be answered before the committee by any of the witnesses who appear at this hearing, so you might keep that in mind. Our first witness this morning is Dr. Hubert S. Howe. Dr. Howe, will you step forward, please, sir.

I am sure you understand that on matters of opinion we know you and all the other professional witnesses are going to tell the truth without the necessity of an oath, but in order to have uniformity, I suppose we should swear all of the witnesses who appear before the committee.

So, therefore, if you will rise and hold up your hand. Do you solemnly swear that the testimony you are about to give before the subcommittee of the Senate Judiciary Committee will be the truth, the whole truth, and nothing but the truth, so help you God? Dr. Howe. I do.

TESTIMONY OF DR. HUBERT S. HOWE

Senator DANIEL. First, let me say, Dr. Howe, we appreciate your appearance before us today, and the work you have done on this problem in which we are interested. In order that you may be properly identified as to your experience in this field, I would like for us to place in the record a biography that the committee has, and a list of publications that you have authored.

(The document referred to follows:)

HUBERT SHATTUCK HOWE, M. D.

January 1, 1955

A. B.-Denver University, 1908. A. M..-Denver University, 1909. M. D.-College of Physicians and Surgeons, Columbia University, 1912. Licensed to practice medicine in New York State November 12, 1912 (license No. 11365). Clinical professor of neurology, College of Physicians and Surgeons, 1936 to 1953.

Diplomate in neurology; qualified psychiatrist, Department of Mental Hygiene, New York State.

Fellow of the New York Academy of Medicine; vice chairman on the committee on public health, New York Academy of Medicine.

Member of the New York State Medical Society, New York County Medical Society, American Medical Association, American Neurological Association, New York Neurological Society, Harvey Society, and Association for Research in Nervous and Mental Disease.

Chairman of subcommittee on treatment, of the committee on narcotics among teenage youth, of the Welfare and Health Council of New York City. Chairman, subcommittee on narcotics, committee on public health relations, New York Academy of Medicine. Trustee of the Thomas Alva Edison Foundation. Member of the board of directors of the National Society for the Prevention of Juvenile Delinquency, Inc. Member of Medical Board, Correctional Institutions of New York City.

BIBLIOGRAPHY OF HUBERT S. HOWE, M. D.

Diseases of the Seventh to Twelfth Cerebral Nerves, Textbook of Medicine, Cecil. 1947, pages 1612-1619.

Neurological Problems, Preventive Medicine in Modern Practice, Edited under the auspices of the Committee on Public Health Relations of the New York Academy of Medicine. 1942, pages 557-569.

Epidemic Encephalitis (book), Frederick Tilney and Hubert S. Howe, published by Paul B. Hoeber, 1920.

The Technique of Insulin, Metrazol and Electric Shock Treatment in Psychiatry, Journal of the Mount Sinai Hospital, volume IX, No. 4, 1942.

Tonics and Sedatives in Neurologic Practice, New York State Journal of Medicine, volume 39, No. 1, 1939.

Acute Hydrocephalus, Neurological Bulletin, volume II, No. 6, 1919, pages 247-252.

Cerebral Glioma and Acute Hemorrhagic Encephalomyelitis, Neurological Bulletin, volume II, 1919, pages 349–359.

Aneurism in the Posterior Cranial Fossa, Neurological Bulletin, volume II, 1919. pages 323-328.

Fever in Hysteria, Neurological Bulletin, volume II, 1919, pages 137-151. Gliosis of the Bulb and Upper Portion of the Spinal Cord, Neurological Bulletin, volume II, 1919, pages 209–214.

Normal and Abnormal Variations in the Pituitary Fossa, Neurological Bulletin, volume II, 1919, pages 233–238.

The Pathological Changes in the Cerebellum in Acute Anterior Poliomyelitis, Neurological Bulletin, volume II, 1919, pages 261-266.

The Thalmic Syndrome in Epidemic Encephalitis, Neurological Bulletin, volume II, 1919, pages 190-198.

A Case of Hemiplegia With Hemianesthesia, Neurological Bulletin, volume I, 1918, pages 282-284.

Tumor of the Posterior Cranial Fossa, Neurological Bulletin, volume I, 1918, pages 285-288.

Progress in Neurology and Psychiatry During the First Half of the Twentieth Century. Published in the New York State Journal of Medicine, January 1, 1950.

An Extensive Spinal Arachnoid Fibroblastoma, Neurological Bulletin, volume III, 1921, pages 216–229.

Cortical Word Blindness, Neurological Bulletin, volume III, 1921, pages 44-71. Dystonia Musculorum Deforams, Neurological Bulletin, volume III, 1921, pages 253-258.

Extra-Medullary Fibroneuroma, Mainly Involving the Posterior Columns of the Spinal Cord, Neurological Bulletin, volume II, 1921, pages 123-143.

The Morbid Anatomy of Epidemic Encephalitis as Regards the Endocrine System, Neurological Bulletin, volume III, 1921, pages 92–99.

A Contribution to the Study of the Pathology of Human and Experimental Poliomyelitis, Based on Cases Occurring During the Epidemic of 1916 in New York City, The Journal of Nervous and Mental Disease, volume 49, 1918, pages 97235; and volume 50, 1919, pages 409-424.

Trial by Ordeal, Neuropsychiatrists' Viewpoint, Industrial Medicine, volume XIV, No. 9, 1945, pages 702-704.

Cerebral Circulation, Archives of Neurology and Psychiatry, volume 18, 1927, pages 81-86.

Reduction of Normal Cerebrospinal Fluid Pressure by Intravenous Administration of Hypertonic Solutions, Archives of Neurology and Psychiatry, volume 14, 1926, pages 315-326.

Physiological Mechanism for Maintenance of Intracranial Pressure. Secretion and Absorption of the Cerebrospinal Fluid; the Relation of Variations in the Circulation, Proceedings of the Association for Research in Nervous and Mental Disease, volume VIII, 1929, pages 7-24.

Chapter in Book Issued by the New York Academy of Medicine on "Convalescent Care."

Narcotics and Youth, Published 1953 by the Brook Foundation.

Treatment of Withdrawal Symptoms of Persons Addicted to Narcotic Drugs, Published 1954 by the Welfare and Health Council of New York City.

A Physician's Blueprint for the Management and Prevention of Narcotic Addiction, New York State Journal of Medicine, volume 55, No. 3, February 1, 1955, pages 341-349.

Senator DANIEL. Doctor Howe, do you have a prepared statement? Would you like to proceed with your statement and recommendations ? Dr. Howe. Yes, sir.

Senator DANIEL. Would you like for us to interrupt you as we go along or save questions until the end?

Dr. Howe. Well, I think it might be a little better if you saved them until the end. Still, I will try to answer them at any time.

Senator DANIEL. All right, sir. We will try to save them until the end unless there is some point we feel we might overlook.

Dr. HowE. Thank you.

My views were expressed in a prepared statement before the State medical society in May 1953, and published in the State medical journal, and I would like to offer this article as evidence. These are my views concerning this problem.

Senator DANIEL. This article entitled, "A Physician's Blueprint for the Management and Prevention of Narcotic Addiction," will be made a part of the record as exhibit 1 of this hearing.

(The document referred to will be found in the appendix at p. 1680.) Dr. HowE. Senator Daniel and Senator Butler, ladies and gentlemen, none of the members of this committee will doubt that under circumstances as they now exist in the United States, drug addiction, and its attendant crime, is a serious problem.

As addiction and related crime have both legal and medical aspects, and as I feel that the medical aspects of addiction have not always been fully understood by those who frame and adjudicate our laws, I am grateful therefore for an opportunity to appear before this committee to emphasize some of the points which have come up in my study of the subject. It may be well to say at the outset that when I speak of narcotics, or drugs, or narcotic drugs in this paper, I wish to be understood to mean opium and its alkaloids, and certain synthetic narcotics. Therefore, morphine, heroin, and Demerol are those particularly referred to unless the context clearly indicates otherwise. Marihuana and cocaine are not included.

It may be appropriate to start out by saying there is no "wonder" drug or magic treatment for the cure of drug addiction. Addiction produces habits of both body and mind, as well as habits of association and conduct which result in a complex of great subtlety.

Addiction to a narcotic drug is medically considered to be an altered condition of the cells, tissues, and organs of the body, brought about by the continuous administration of the drug, with the result that the coordinated body functions require the presence of the drug in the body fluids. Cessation of use of the narcotic causes painful physical and mental disturbances.

Nonaddicted persons generally do not fully realize the suffering an addict experiences whenever the concentration of the drug in his body is diminished below a certain point. To maintain this necessary concentration, administration must be repeated at intervals of 4 or 5 hours.

The physical pain resulting from absence of the drug can be overcome by proper withdrawal procedures in a relatively short time. Relief from this physical distress, however, has frequently been mistaken for a cure.

In addition to the physical bondage, there remains a mental dependence of much more stubborn character. Not only does the mental dependence become a condition reflex which is not easily broken, even if the individual himself desires to do so, but the situation is further complicated by the fact that one of the physiological effects of narcotic addiction is to diminish the mental stamina, or will power, of the individual, as well as his ability to withstand pain or discomfort of any kind without returning to his drug.

In addition to these problems, there are matters of environment, evil associates, lack of skill to earn a living by honest means, and a highly developed skill to provide a living by resort to criminal expedients. As most addicts acquire their addiction between the ages of 16 and 24, and as they are almost immediately forced into criminal pursuits to pay the very high prices charged for illegal narcotics, most of them acquire no training in the art of supporting themselves by honest work. They are quickly ostracized by their nonaddicted acquaintances, so that they turn to criminals and crime both for friendly association and for financial requirements. Thus, their habits, associations, and motivations are all in the wrong direction.

Cure, then, is a very difficult problem, involving much more than simply getting the addict "off the drug" for a few days, a few weeks, or a few months. Institutions sometimes seem to proceed as though this were all there were to it, with the result that they are processing, and often reprocessing, an ever widening stream. Permanent cures are few and far between.

Genuine, permanent cure involves social and economic rehabilitation, rebuilding habits of moral and mental stamina, and self-reliance, as well as relief from the physical bondage of the drug. Such a program is unlikely to succeed as a result of filling larger and larger penal institutions with more and more addicts.

This is especially true because of the fact that while in institutions, addicts are in contact with many other addicts and criminals from whom they obtain further education in all the ramifications of addiction and the techniques and contracts of organized crime. Placing addicts in institutions under compulsion-unless they are to be imprisoned for life-woud be simply to establish under the aegis of the State, greater incubators of addiction and crime. Addicts should be privately treated and kept away from other addicts as much as possible.

Rehabilitation, under the present regulations, can only be carried out after the patient has undergone withdrawal treatment. Rehabilitation of addicts skilled only in the devices of crime is not simple; it involves not alone teaching them some peaceful occupation, but remedial, psychiatric, and social guidance over a considerable period of time. In the Report on Drug Addiction recently issued by the New York Academy of Medicine, in regard to rehabilitation in our Federal hospitals, it is stated, and I quote:

The

Under the present system, rehabilitation ceases before it is finished. addict, following his stay at the institution, is given carfare to his home and a warm farewell; then he is dumped as a solitary figure, peniless, very often friendless and without work, in a hostile society. It would test the mettle of a healthy man to undergo this experience; it must be a real trial to the discharged addict.

71515-56-pt. 5- -2

Under these conditions, it is to be expected that a large proportion of these discouraged individuals will quickly return to drug use.

Under present regulations, it is rarely possible to keep the addict away from drugs long enough to effect even the most superficial rehabilitation. It seems reasonable to suggest that rehabilitation could be undertaken first, and when the individual has regained a place in society and had training which will enable him to support himself by productive means, he may be relieved of his physical dependence with more expectation that cure will be enduring.

So much has been said about the partnership of addiction and crime, that it may be useful to comment on the conduct of addicts while under the influence of their drug. Many uninformed persons believe that addicts, under the influence of opiates are dangerous. This is a false conclusion, resulting probably from common familiarity with the effects of alcohol.

There is, however a fundamental difference between the disease of alcoholism and that of opiate drug addiction. The alcohol habitue is normal only when he has no alcohol, while the narcotic addict is normal only when he takes his drug. Thus, the narcotic addict is dangerous not when he has his drug but when he is without it. This is a very important fact and one that has escaped many observers. Crime comes, not from the use of the drug, but in order to assure a supply of it.

Senator DANIEL. Doctor, what about those addicts who commit heinous crimes such as murder for pay, and robbery and burglary, and take the drug in order to get them into a mental state in order to preclude worry about what they are doing?

Dr. Howe. Well, that has been stated, but there is no definite evidence that anything like that occurs as far as opiates go.

Opiates are sedatives. If they take enough of them they put them to sleep. We are not discussing marihuana and cocaine, of course. Senator DANIEL. Will the drugs that you are discussing-heroin and morphine-take away from a person his usual inhibitions and feelings and restraints?

Dr. Howe. That is true, but there is no evidence in other countries or anywhere else that addicts really commit crime for anything except to get their drug.

Senator DANIEL. The reason that I would like for you to comment on this, either now or later, is that the committee already has evidence of several criminals operating, at least one ring of them, who took heroin or sometimes possibly morphine, before they would commit a crime. For instance, in one case, several safe crackings and robberies in which murders were included, and in another case where there was an actual payoff for these people to kill a man the evidence before us was that they would take heroin or morphine in order to be in a position to go out and commit a cold-blooded murder in accordance with their plans.

Dr. Howe. Well, it certainly relieves fear, but if these people were addicts they would have taken it every 4 hours anyway, so I don't know how you can definitely say they did it for that purpose.

If they are nonaddicted people and took things for that purpose. I can see how that might be possible.

Senator DANIEL. The taking of heroin and morphine would relieve fear?