But the doctors, in my opinion, are no longer responsible in any great amount for the type of addicts which we are having trouble with now.

But the minute you cut off the doctors, which you had some control over, the doctors wrote prescriptions, and they go them in the drug stores, so you could at least find out the way they do in England.

In England they do not pay any attention to the doctors much, but they do follow the prescription; and so the doctors were largely at fault.

They introduced this to people who could buy it so, naturally, you could crack down on the doctors. But I think it is a different condition now. I think every social legislation after 40 years should be looked at and examined.

One of the directives that we had was they do not admit the fact that this is not a curable disease.

Senator DANIEL. I do not quite understand if you are saying "curable" or "incurable."

Dr. Howe. You see, the Harrison law was passed, but that did not say anything about addicts at all. It did not even mention it. It said that doctors could take care of patients in their regular practice.

Well, that needed clarification. Then the Treasury Department made these directives, and one of them was-if you want to read them I will give them to you.

Senator DANIEL. Were you saying a minute ago that the Federal officials of the Treasury Department had considered that narcotic addiction was curable or incurable?

Dr. Howe. As curable.

Senator DANIEL. They consider it as curable?

Dr. HowE. They would not accept the fact they could not be cured, and could not be rehabilitated.

Senator DANIEL. Which do you think is correct, is it a curable or incurable disease?

Dr. Howe. As far as anybody says, I am sorry to say it is practically an incurable disease.

Senator DANIEL. Incurable?

Dr. Howe. Incurable.

Senator DANIEL. In your opinion.

Dr. Howe. By any method we have. Again it depends upon the individual's cooperation. As I said this morning, I cannot stop you from smoking. I can tell you how terrible it is for you and all that. But if you could buy cigars and you do not want to stop, you are not going to stop.

Well, that is the same way with this disease. We can cure the addiction, yes, and we can remove it, but we cannot keep you, when you get in any kind of trouble, you have learned that here is a panacea for any kind of trouble, it will relieve, so you go back to it.

Senator DANIEL. You think some of the addicts then can be cured, depending solely on the will power of the individual?

Dr. Howe. The addict may cure himself. You cannot cure him; that is my feeling.

Senator DANIEL. Yes.

Dr. Howe. You may persuade them-Alcoholics Anonymous, certainly they help a lot of alcoholics.

We should have guidance for these people, but it is mainly a matter of trying to persuade them to stop. You cannot do it otherwise.

Senator DANIEL. Doctor, back in the eighties there was no black market because they could get the drugs from the doctors or the druggists without prescription.

Dr. HowE. That is right.

Senator DANIEL. Is it not true that back in those days we had the greatest known number of addicts, I mean, insofar as accurate figures are concerned? I have heard these later figures of a million challenged. Dr. Howe. Well, proportionately to the population, yes; it was about 1 percent.

Senator DANIEL. Yes.

Dr. Howe. But they were largely women. It is an entirely different class.

They were nervous women; there were many more women addicts than there were men. They were adults, they were people in middle life.

They got it to relieve something. They used it as a medicine, but the doctors were wrong, I think, in using it so freely and introducing them to it and letting them have hypodermic syringes and all that. But that period, I think, is largely over.

I do not say there are not bad doctors, the way there are anybody else. But at the present time if anybody started this wholesale giving of drugs to anybody, I think you could stop it; the medical profession could stop it.

Senator DANIEL. Senator Butler, do you have any questions?
Senator BUTLER. No.

Senator DANIEL. Doctor, I have one or two I have put down here as we have gone along, and I again apologize for keeping you so long. I wanted to ask if you think this is the type of disease that the Federal Government, under our Constitution, has the right to step in and provide a program to try to combat.

Dr. HowE. Yes; I think that you certainly have a right to do that. I think that what you should do in some way is to work it out with committees of lawyers and doctors.

This thing could be perfectly well worked out, in my estimation, so that the incurable addict, of which there is a great proportion, could be taken care of, gotten out of crime, and I think you would largely stop the formation of new addicts which, to me, is one of the most important parts of the problem. The old ones will die off some time. Senator DANIEL. Now, as I understand it, your experience and actual treatment of addicts is largely confined to medical addicts and to physicians who became addicted themselves?

Dr. Howe. That is right.

Senator DANIEL. And as far as basing your opinions and your recommendations upon your own personal experience with addicts, it is limited largely to addicts who came in that classification?

Dr. Howe. That is right.

Senator DANIEL. I believe you have already indicated that it is entirely possible that the medical addicts and the doctors who became addicted are in a different class as far as the possibility of applying this kind of treatment and benefiting from it, than your underworld addicts?

Dr. Howe. That is right. Another thing that this book pointed out was that while fear of imprisonment and everything else might deter some normal individuals from using drugs, it would do nothing to the psychopaths which are, in their opinion, largely the group that drug addiction-I mean, that this kind of drug addiction takes place in. They did not have any belief that that would frighten psychopaths at all.

Senator DANIEL. I believe you said they taught in medical school that most drug addicts were psychopathic?

Dr. HowE. That is right.

Senator DANIEL. Is that still being taught in medical schools?

Dr. Howe. I am not completely sure. I think that it is. I think that it is practically all drug addicts, and that has been one thing that has been very serious because it makes doctors and other people think that they could not be addicted. "You could not adict me; I am a normal person."

Well, you could. You give enough drugs to anybody, you could make an addict out of them.

Senator BUTLER. Doctor, what would be the propensities of the psychopathic people you talk about?

Dr. Howe. What would be what?

Senator BUTLER. What are their propensities? They certainly do not come within the classification of being normal people, do they? Dr. Howe. I think the best definition I have ever seen of a psychopath, if you want that, is given by Dr. Pescor, here it is, Dr. Wilson and Dr. Pescor, in a book Problems of Psychiatry, prison psychiatry: The psychopath is one whose personality shows a functional hereditary defect, heredietary partially modified by environmental conditions manifested by an arrested development of the nonintellectual medical factors. These people could be perfectly bright, and it is characterized by infantile reactions to adult situations without inner emotional conflict and without loss of contact with reality.

Now, in many ways these individuals are people who have-they have a loss of emotional control, I mean, their intellect. If they see something that seems to them to be a good idea, their intellect, even though it knows, it does not seem to have control-it cannot control them the way it can a normal individual.

If something seems like a good idea, they do it.

Senator BUTLER. That would not be a safe person to drive a car, would it?

Dr. Howe. What?

Senator BUTLER. Would that be a safe person to operate a car on the city streets?

Dr. Howe. Oh, I think so. He doesn't want to hit anybody. If he had a special desire to have accidents-but they don't.

Senator BUTLER. Well, he may have a special desire to get through a tight spot that a normal man would not want to.

Dr. Howe. I know. But when I speak of emotions, there are the things that he wants to do that give him pleasure, and I don't think that anybody gets much, the average individual gets much, pleasure out of automobile accidents.

Senator BUTLER. Isn't that the kind of psychopath you would want to appoint a committee to take care of them?

Dr. Howe. Well, I think that that is an important part of this whole business. It has to be considered that a great many of these

chronics may be psychopaths, but I do not think the jails are the proper place for them.

I think the doctors can do more for them, perhaps, with the administration of the drug. As I said here, they definitely state that as far as they can determine, many psychopaths are better behaving on drugs than they are off of them. I think you will find other doctors will tell you the same thing.

Senator DANIEL. I noted a minute ago you said that you had not in your report or your paper recommended clincs. Is there any significance to be taken from that statement as compared with the recommendation of clinics made by your New York Academy of Medicine?

Dr. Howe. Well, we both feel and, as I say, I was chairman of that committee

Senator DANIEL. Yes. I am just wondering if the committee convinced you in favor of the clinics.

Dr. HowE. No. It simply was we all of us believed that they should be in medical hands.

I do think that you might have trouble in finding enough doctors who would, for free-we all spend half our times in clinics and hospitals for nothing-would take care of 3 or 4 addicts coming into their office.

I mean, the other patients may not like them, there would be difficulties in that.

But I personally think that you would be able to get enough doctors that would do that. They felt that, perhaps, you could not and, perhaps, they would better be taken care of in a hospital clinic, and so forth.

Senator DANIEL. That is the other members of your committee?
Dr. HowE. That is right.

Senator DANIEL. Do you endorse the report as it was filed in favor of the clinics?

Dr. Howe. Oh, well, in favor of some way of getting this drug to the incurable addict.

Senator DANIEL. Let me just read you a line or two from the New York Academy of Medicine report which you did not present to the committee when you read some of the items here, and I will just ask you to comment on them.

The service clinic should be in operation 24 hours a day, 7 days a week, to insure that no addict has the excuse that he could not obtain his supply from a legitimate source and was thus forced by his discomfort to seek his supply from illicit dispensers.

Do you agree with that statement?

Dr. HowE. Yes. Another thing that you would have to work out, whether you could give them depots, as I said, supplies. But if they came four times a day they would not have to have that depot. Senator DANIEL. The next sentence says:

At no time should he be given a supply of narcotics adequate for more than 2 days.

Dr. Howe. There is no question that medical addicts, people who have these incurable diseases, can be given a supply for a number of days, and they will use it the way they should, and I think that many chronic addicts who have been addicted for 10 years, and know they

do not want to have the withdrawal symptoms, will use it perfectly correctly if given a supply to last several days.

Senator DANIEL. Doctor, do you think though because there might be quite a few addicts who could be trusted that we ought to set up any kind of system permitting and legalizing the giving to addicts of a day or 2-day supply of the drug?

Dr. Howe. Well, I think that whatever regulations you make, they should have sufficient leeway so that each individual could be taken up individually, you see.

The minute you say that you have got to come 4 or 5 times a day to a clinic, if we do not have this depot business, how are you going to work? What are you going to do? Who is going to employ you? If you have to run from here to some place to get a hypo every 4 hours, who is to employ you?

So that while I definitely would rather have the addict not have the drug in the average case, I think that there are some people who could take it and would not do anything except what they do in England, as I say, and as they state, which I can read you here, and some other things, they have no trouble giving it to anybody else; they want it themselves.

Senator DANIEL. In our own country though the thing that would bother me with that kind of method would be the fact that these addicts might go out and sell and give to their brother, as Senator Butler said, some of these drugs, and before this very committee we have had cases of doctors doing that very thing and having the drugs sold on the market.

Some of the addicts themselves have come before the committee and told us how they went and fooled the doctors and got supplies of the drugs, and then went out and sold those on the street corner.

Dr. Howe. Well, if all profit is taken out of drugs, who are you going to sell them to?

Senator DANIEL. Well, they might be given away.

Dr. Howe. Now, half a grain of morphine you could get, I don't know, a dollar for it, I guess. But if all profit is taken out of this. from top to bottom, who are they going to sell them to?

Senator DANIEL. So far as society is concerned, we were told that new addicts were made by gifts of these drugs as if they were sold.

Dr. Howe. I know, but there is a purpose there in getting them addicted so that they can be a customer. There is a definite purpose. That does not work in England and these other countries where they have a certain amount of addicts.

Senator DANIEL. Then you would make it legal in certain cases, leaving it to the judgment of the doctor to give an addict the capsules of the drug for a day or two at a time?

Dr. Howe. I know we do that right now, as I said, in cases of medical addicts.

Senator DANIEL. And you would do so under this treatment planned with underworld addicts?

Dr. Howe. I am not sure but, as I say, I think that there are some of them who, perhaps, that can be done. But on the whole, no, I don't think so.

I agree with you that every precaution should be taken. But if you make this too rigid, you know, you can do that, too.