morphine if the Government has a program of giving that out free or at low cost to those who become addicted, and if the Government follows your argument and tries to convince the people of the country these people are simply sick and they can work, even though they are under the influence of the opiates, in other words, won't there be a conflict there?

Dr. Howe. Well, of course, that is true, and we hesitate to broadcast the fact that, perhaps, only 2 percent of addicts are cured. We want anybody who is an addict to try to be cured, naturally.

Well, the minute we say that your chances are 98 percent that you will not be cured-we do not like to do that either, I mean.

But this is a committee-I am trying to tell you facts.

But I think there are certain disadvantages of that, of telling people that a cure is almost unknown. I am not talking about doctors, of the people of real intelligence, but I am talking about the ordinary addict, as we see it at the present time.

Now, of course, I think more of them would because they would be taken care of by the doctors, and there is a certain lure about doing something that you should not.

During prohibition an awful lot of people used alcohol that never used it before and didn't use it, perhaps, afterward, and that is true

now.

These kids glorify somebody who has been over at Rikers Island or something, "Oh, he is a hero."

There is all that kind of business, which we think would disappear with education and taking it out of the prohibition area.

Senator DANIEL. Of course, that idea is only in the minds of a small minority of the juveniles and of the adults of the country.

I

Dr. Howe. Well, of course, when you look at this, this is, perhaps, a minority business anyhow. Nobody knows how many there are. have often wondered how much-we estimate 60,000. They will say we get this tremendous amount of this narcotic drug.

The other day we had 21 pounds, or whatever it was, and Mr. Ryan here estimated that was one-eighth of the total supply.

Well, if that is true, if that much is coming in, that is probably enough drug for 150,000 addicts.

So, I don't know. I am not saying how many there are, I have no idea. I am sure they have more ideas than I have.

But here, on the one hand, we say there are not any addicts, and then we get a tremendous amount of drugs. What happens to it? Don't people use it? I don't know.

Senator DANIEL. The point to that is when you say the kids think a person who has gone over here to Riverside is a hero, that is only a minority that would feel that way about it. Certainly the majority of our people look down upon drug addiction.

Dr. Howe. Of course, that is true. But this comes from these minority groups.

What we are trying to fight is not so much your children and mine as it is these people up in Harlem, and it might not be so bad either if they did not, every last one of them, turn into criminals. I mean, 60,000 unnecessary criminals is something to contemplate.

In the Detroit report, the Detroit mayor's report, where they studied a hundred or so of their addicts, they only found one who could support it by legitimate means.

If you take a lawyer or a doctor or a musician, who has his profession, he could, perhaps, support it. But these kids cannot, and they are the ones that become the problem.

If a person can support it, why, he is not as much a problem anyway.

Now, the only reason that I want to tell you a few things about the clinics is that there has been so much, I think, misinformation or at least as to why they were started, what they did and what they could not do.

They naturally could not cure. They say you should not have clinics because they did not cure anybody. If that is the criterion, we ought to shut all the hospitals, too.

But the first one or the one here in New York City, was started by Royal Copeland, who was the health commissioner, and here is what he says about it-I mean, this is a little excerpt of what he says:

Within a few hours after the closing of their ordinary sources of drug supply, hundreds of addicts were clamoring for treatment. The doctors who had been growing rich in this traffic were frightened, and the poor victims had no means of relief. On April 10, the New York City Health Department opened a clinic for the temporary care of these patients. This is still in operation, and up to this time more than 7,000 persons have applied there for treatment. The original intention in the establishment of this clinic was to meet the urgent emergency of last April.

Senator DANIEL. This is all in 1919?
Dr. Howe. All in 1919.

It is now a clearinghouse, or admission bureau, preparing the way for the hospital treatment of the patient. Without absolute control of the patient and his complete isolation from clandestine sources of supply, there is no hope of cure.

It isn't that ambulatory treatment might not be effective if you could control the drug, but if he can get it from somebody else, why, it is ridiculous.

Ambulatory treatment is foreordained to failure as long as there are secret and illegal methods of obtaining the drug. Under present conditions, therefore, it is my belief it will be a very rare instance indeed when a patient is cured outside a hospital, or in the absence of equally well-controlled conditions within a private house. So far reaching is this evil that no trust can be placed in persons not absolutely proof against cajolery and bribery, or in any surroundings not impregnable against assault. The cunning and ingenuity of the evil genius presiding over this practice are almost beyond belief.

The clinic has served a humanitarian purpose in that it has provided a place for careful physical examination, advice as to needed medical treatment for fundamental conditions, and careful oversight of the progress of the drug disease. It has saved the addict from the victimizing methods of the doctor who hereto-fore has exploited the drug patients by charging excessive fees for bogus "treatment" and of the druggist who wickedly profiteered on the drug and not infrequently given short weight besides. Attendance at the clinic has given the health. department time and opportunity for study of the home surroundings, personal characteristics, and reliability of the patients.

The gradual but consistent reduction of the daily dosage at the clinic has shortened the period of necessary hospital treatment. Likewise, it has increased the value of residence in hospital by sending patients in much better physical condition to begin with than would otherwise be the case. The clinic has given us a hold on hundreds of addicts who, without it, would be lost to the municipal. authorities, and, lastly it has made possible a steady flow of patients to the hos pital, thus justifying its necessary large personnel, and in every way facilitating the problems of hospital administration. * * *

It will be understood from what has been said so far, that the narcotic clinic, important as it is in corralling patients, in gaining their confidence, and classifying and clearing them for the hospital, has no very important part to play in. the real treatment.

Then he goes down to the ultimate result:

The patients are now being discharged from day to day (from the hospital) and are being returned to the community sound in body, if not regenerated in mind and soul. Society has a very important problem to meet in the reception and placing of these deserving persons. The department of health, with the cooperation of various religious and social organizations, is attempting to aid in this process of regeneration.

I am laboring under no delusions as to the ultimate fate of many of our discharged patients. There can be no doubt that a large number of them will return to the drug. The first time sickness comes, or social disaster, there will be recourse to the narcotic. Until this community and every other is freed from the possibility of obtaining the drug clandestinely, we will have addicts to deal with. I would like to give you his original article, and also one by one of his assistants in the health department, Dr. Hubbard.

Senator BUTLER. Doctor, how long were those clinics in operation during that period?

Dr. HowE. Nine months.

Senator BUTLER. Nine months?

Dr. Howe. Yes.

Senator BUTLER. What was the maximum registration of addicts during that period?

Dr. HowE. Nearly 8,000, 7,000 or something.

Senator BUTLER. Out of how many addicts known to be in the State of New York?

Dr. HowE. Well that, I have not seen the figures on.

Senator BUTLER. But there was considerable addiction at that time; was there not?

Dr. Howe. What?

Senator BUTLER. There was considerable addiction at that time. Dr. HowE. Definitely.

Senator BUTLER. Far in excess of 8,000 ?

Dr. HowE. Yes, sir. Not all addicts, by any means, came to the clinic, but quite a few of them came. There were abuses.

Senator BUTLER. What was your explanation for the reasons why they did not come?

Dr. HowE. What was that ?

Senator BUTLER. Why did they not come, in your opinion?

Dr. Howe. They did not want to become known. Of course, if you register at a clinic you are fingerprinted and photographed, and you are identified.

Senator BUTLER. Suppose you had 40,000 addicts in the State of New York at that time. You have only cured your black market by a fifth : have you not ?

Dr. HowE. Well, wait a minute. Many of these people had been accused of a crime, and these people said they were apprehended by the police for crimes they had committed in order to get this drug. They were sent back to other cities, and so on, and the addict did not want to, in all instances, expose himself to the police for that reason. So he stayed away.

Now, if the addict were free so that he would not feel he was going to be convicted for a lot of crimes that he has committed in the past, that would be something different.

Senator BUTLER. Well, of course, he could never be assured of that, because there would be no way of doing that.

Dr. Howe. Well, I don't know; it might be accomplished. But I mean that part of the problem, I think, Judge Goldstein will answer. Senator BUTLER. This article you have offered by Dr. Royal S. Copeland, appearing in American Medicine, January 1920, will be made a part of the record and will be carried in full in the appendix to the record. Also the same thing will be true with reference to the article you have offered by Dr. S. Dana Hubbard, appearing in the February 1920 Monthly Bulletin of the department of health, city of New York. It will be included in full in the appendix to the record. (The two articles referred to above, entitled "The Narcotic Drug Evil and the New York City Health Department," by Royal S. Copeland, A. M., M. D., F. A. C. S., from American Medicine, January 1920, and "The New York City Narcotic Clinic and Differing Points of View on Narcotic Addiction," by S. Dana Hubbard, M. D., printed in the monthly bulletin of the Department of Health, City of New York, vol. X, No. 2, February 1920 will be found in the appendix at pp. 1705 and 1710, respectively.)

Senator DANIEL. Now, Doctor, I notice here at page 35 of the article by Dr. Hubbard, that he says:

We have given the clinic a careful and thorough as well as a lengthy trial and we honestly believe it is unwise to maintain it longer.

Dr. Howe. Read his conclusion, and you will find-it is true that, as Copeland said, it was not going to be continually useful. They were trying to get all these people in a hospital.

But if you read his conclusion you will find that shall I show them to you?

Senator DANIEL. Any comment you wish to make, I would like to have. I wanted your comment on that.

Dr. Howe. In his conclusion, in there he says it has not worked as a treatment, it did not cure anybody or very few if it did.

But he also states, just as Copeland did, that there were other values to it.

If you look at it purely from a curative standpoint, it is not of any value.

Senator DANIEL. But he goes on here to say that treatment of the narcotic drug addict by private physicians prescribing and druggists dispensing, while the individual is going about, is wrong.

Ĥe condemns the ambulatory treatment all the way through his article, if it is the same one I have read.

Dr. Howe. I think if you read his entire article-I do not mean that I am in entire agreement with everything he says, but I am honest. I think, sure, there are different points of view.

Senator DANIEL. There were many abuses of the clinic treatment. Dr. Howe. There were. There were many abuses of the clinic. Senator DANIEL. And by offering this, you do not mean you agree with all that Dr. Hubbard says against this program?

Dr. Howe. I do not. But I think as there have been many excerpts published from it, that you should have the whole article. Senator DANIEL. Yes, I agree.

Dr. Howe. No, I do not agree with quite a little of it, but nevertheless, I am not trying to

Senator DANIEL. Give us just the one side.

Dr. Howe. No. I would like you to consider this from every standpoint.

Senator DANIEL. We appreciate that attitude.

Dr. Howe. And I think it is a good article to have in its entirety.
Senator DANIEL. That is right.

Dr. Howe. Now, not too much longer, but I have got some other things here I think you would like to near.

Now, as for Jacksonville, Fla., here is a statement by Dr. Charles E. Terry, who is the health officer of Jacksonville, Fla., and this is what he says:

In 1922, however, a different type of activity was undertaken in Jacksonville. Fla.

this was, of course, before the Harrison law

in an effort to determine and lessen the chronic use of opium derivatives. * ** It was common practice for pharmacists to make counter sales of opium preparations and to justify such sales by stating that indigent users could not afford to pay a physician for a prescription and then the druggist for filling it. The new law, through a provision that permitted a city health officer or any other officer of the health department to furnish free of charge prescriptions for these drugs to those unable to pay for them, eliminated the temptation and excuse for counter sales and in a very brief space of time such sales ceased entirely. It is of further interest and importance that the price of morphine at this period was so low-about 60 cents a drachm-that competition by peddlers could not be lucrative. ***

When, however, the Harrison Narcotic Act was passed in 1914, the city clinic was discontinued. Those patients who were willing to take treatment were cared for at a general hospital and the giving of free prescriptions was discontinued entirely. This left a considerable number of individuals who had not taken treatment as well as many who after treatment reverted to the use of their drugs. Immediately an illicit traffic sprang up, the price of drugs soared although the retail price in the drugstores remained the same, and ever since this period peddling has been rife and as profitable in Jacksonville as elsewhere.

That was about 1929.

Now, here is a very short brief of another article he wrote, Charles E. Terry. As I said, he was this time chairman of the committee on habit forming drugs, section of food and drugs, American Public Health Association, and formerly health officer of Jacksonville, Fla. This was published in American Medicine, January 1920:

The only way that peddling will ever be controlled is through the intelligent application of our medical knowledge of the needs of the situation in such a manner as to make peddling unprofitable. By this I mean that the moment it is realized by officials and the public that narcotic drug addicts must be supplied with the drug of their addiction until such time as successful and satisfactory treatment is available, that moment is the first step taken to undermine the profits of the peddler.

This person must be met upon his own grounds as it were, by intelligent administrators, by honest physicians and humane consideration. He is only in it for the money. Yet today one of the most prolific causes of narcotic addiction is the activity of drug traffickers in extending the scope of their operations.

In addition to these temporary measures there must be instituted and carried through a widespread program of education which shall begin in the medical schools and spread broadcast throughout society generally.

I would like to offer in evidence Dr. Terry's main article of which this is just a small brief, which appeared in American Medicine of January 1920.

Senator DANIEL. That will be received and made a part of the appendix of the record.