Senator DANIEL. That brings to my mind another question I would like to ask each of you gentlemen: Do you know of any attitude in the medical profession or any doctors who believe that they should be permitted to administer narcotic drugs to addicts for the purpose of maintaining their addiction or keeping them comfortable? Dr. BARTEMEIER. I do not.

Senator DANIEL. Do you, Dr. Plunkett?

Dr. PLUNKETT. No, sir.

Senator DANIEL. Do you think it is a fair statement to say that the medical profession generally has opposed such use of narcotic drugs by doctors?

Dr. BARTEMEIER. Oh, yes; very specifically, and that is contained in the statement which I have handed here to you.

Senator DANIEL. Do you agree with that, Dr. Plunkett?

Dr. PLUNKETT. Yes, sir; I do.

Senator DANIEL. That is all.
Senator BUTLER. Thank you.

The committee will stand in recess until 2: 15.

(Whereupon at 1:05 p. m., the subcommittee took a recess to reconvene at 2: 15 p. m. the same day.)

(The biographical statement of Leo H. Bartemeier, M. D., follows:)

LEO H. BARTEMEIER, M. D.

Medical director of the Seton Institute, Baltimore, Md.

Chairman of the council on mental health of the American Medical Association. Past member of the National Advisory Mental Health Council.

Past president, American Psychiatric Association.

Past president, Psycho-Analytic Association.

Past president, International Psychiatric Association.

Member of the board of directors, World Federation for Mental Health.

Former associate professor of psychiatry, Wayne University.

Present associate professor of psychiatry, Georgetown University Medical School. Senator DANIEL. Gentlemen, I will ask this imposing array of experts to please stand and be sworn together.

Do you, and each of you, solemnly swear the testimony you are about to give to this subcommittee of the Senate Judiciary Committee will be the truth, the whole truth, and nothing but the truth, so help you God?

Dr. HUNT. I do.

Dr. FELIX. I do.

Dr. ISBELL. I do.

Dr. CHAPMAN. I do.

Dr. HIMMELSBACH. I do.

Dr. LowRY. I do.

Dr. TRAUTMAN. I do.

TESTIMONY OF DR. G. HALSEY HUNT, ASSOCIATE CHIEF, BUREAU OF MEDICAL SERVICES, PUBLIC HEALTH SERVICE; DR. ROBERT H. FELIX, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH, PUBLIC HEALTH SERVICE; DR. CLIFTON K. HIMMELSBACH, CHIEF, DIVISION OF HOSPITALS; DR. JOHN A. TRAUTMAN, MEDICAL OFFICER IN CHARGE, PUBLIC HEALTH SERVICE HOSPITAL AT FORT WORTH, TEX.; DR. HARRIS ISBELL, IN CHARGE OF RESEARCH UNIT, LEXINGTON HOSPITAL; DR. JAMES V. LOWRY, MEDICAL OFFICER IN CHARGE, PUBLIC HEALTH SERVICE HOSPITAL, LEXINGTON; AND DR. KENNETH W. CHAPMAN, SPECIAL CONSULTANT, NATIONAL INSTITUTE OF MENTAL HEALTH

Senator DANIEL. I believe that we have with us, first, Dr. Hunt. You are going to present a statement first, Dr. Hunt?

Dr. HUNT. Yes.

Senator DANIEL. Suppose we first identify each of those who are here from the Federal Government. Dr. Hunt, if you will do that, if you will identify them by name and by position.

Dr. HUNT. Yes, sir.

Senator DANIEL. First yourself.

Dr. HUNT. I am Dr. G. Halsey Hunt, Associate Chief of the Bureau of Medical Services of the Public Health Service, formerly Chief of the Division of Hospitals, which has responsibility for operating all of the hospitals of the Service, including the hospitals at Lexington and Fort Worth.

On my immediate right is Dr. Robert H. Felix, who is a psychiatrist of many years' standing and of high standing in the country.

He is the Director of the National Institute of Mental Health of the Public Health Service, and was some years ago stationed at Lexington as clinical director and later as executive officer for some time, so that he has both personal, direct knowledge of drug addiction and its problems, and more recently the administrative responsibility for the whole mental-hygiene program of the Public Health Service in its relation to States and local communities.

Next to him is Dr. Clifton K. Himmelsbach, who is now Chief of the Division of Hospitals. For some 8 years during the thirties and early forties he was in charge of the research laboratory at Lexington, and did much of the early work on the pharmacology of drug addiction.

Senator DANIEL. That is Dr. Clifton K. H-i-m-m-e-l-s-b-a-c-h? Dr. HUNT. Yes.

Senator DANIEL. Thank you.

Dr. HUNT. On the end, to my right, is Dr. John A. Trautman. Senator DANIEL. That is T-r-a-u-t-m-a-n?

Dr. HUNT. Yes, sir. He has been for something over a year the medical officer in charge of the Public Health Service Hospital at Fort Worth. Prior to that time he was Director of the Clinical Center of the National Institutes of Health in Bethesda.

On my left is Dr. Harris Isbell.

Senator DANIEL. I-s-b-e-1-1?

Dr. HUNT. Right; who is now in charge of the research unit at the Lexington Hospital.

I might say that both Dr. Himmelsbach, the former director of the research unit, and Dr. Isbell, the present director, are trained primarily in internal medicine, with later training and experience in pharmacology and the special problems of narcotic drugs.

Dr. James V. Lowry, next to Dr. Isbell, is now medical officer in charge of the Public Health Service hospital at Lexington.

Some years ago he was stationed there in the capacity of clinical director, and during that period had immediate contact on the clinical side. He then spent several years with Dr. Felix at the National Institute of Mental Health, and has been back at Lexington as medical officer in charge for the past 16 months or so.

Finally, Dr. Kenneth W. Chapman, who also has had experience at Lexington as clinical director, followed by administrative experience in the Washington headquarters office. He was later medical officer in charge at Lexington and is now at the National Institute of Mental Health as special consultant to States and local communities which call upon the Public Health Service for assistance in attacking their prob lems of drug addiction.

I should like to add one statement, Mr. Chairman, if I may.

The Surgeon General was not able to be here with us today, and that is the reason I am acting as his substitute.

He is giving one of the principal addresses at the annual meeting of the American Hospital Association today, and regretted his inability to stay over and be with the group during the complete testimony.

Senator DANIEL. Well, Dr. Hunt, these men must have worked with all of the drug addicts who have been in the hospital at Lexington, at least since it was established; is that right?

Dr. HUNT. This group before you, Mr. Chairman, represents a great many years of direct experience in the treatment of drug addiction at Lexington and Forth Worth, and additional years of administrative experience and of overall consultation experience with States and local communities, particularly with States on the part of the National Institute of Mental Health.

Senator DANIEL. What I am getting at is, I believe we have already had this before the committee, that there are about 25,000 individual drug addicts who have passed through the hospitals at Fort Worth and Lexington.

Dr. HUNT. Yes, sir.

Senator DANIEL. Now, these men, one or more of them, have been in the Service in some capacity seeing those 25,000 addicts. In other words, these men together represent all of the years those hospitals have been in operation and one or more of these men have been in those hospitals during the entire period of the operation.

Dr. HUNT. Almost entirely, yes.

Senator DANIEL. Almost entirely.

Do you know of any panel of men in the country whose experience together has put them in touch with more drug addicts?

Dr. HUNT. I think that the Public Health Service does have the greatest concentration of people with long experience in the treatment

of drug addiction, and most of those people are sitting before you today.

Senator DANIEL. Dr. Hunt, do you have a prepared statement? Dr. HUNT. I have no prepared statement, as such, Mr. Chairman. Senator DANIEL. Let me explain to Senator Butler, at a meeting or during the time Senator Butler was working on another committee, Dr. Hunt and Dr. Chapman appeared before the committee and explained the operation of the hospitals at Lexington and Fort Worth.

Now, then, we would like you to offer anything you would like on this problem of causes and treatment of addiction, and then we will ask you some questions.

I believe you have an official statement on behalf of the Public Health Service?

Dr. HUNT. With respect to the

Senator DANIEL. To the clinics. I did not know we were going to get to that so early. But do you have an official statement of the Public Health Service on the proposed clinic system of free drugs to addicts?

Dr. HUNT. The Service has not taken an official position, Mr. Chairman.

I think this might be the time, however, to amplify somewhat the brief statement which the Surgeon General made yesterday afternoon toward the close of his testimony.

We do not believe that the report of the New York Academy of Medicine can be considered all good or all bad.

We believe that it is a thoughful attempt to rethink some of the problems of drug addiction and the methods of treating addiction by highly qualified physicians.

It may be useful to discuss the report point by point and comment on each of the points.

The academy proposes a six-point program to stop the formation of new addicts and rehabilitate as many presently addicted persons as possible.

The academy emphasizes that all 6 measures are to be instituted, not just one.

The six points and our comments on each are as follows: We have paraphrased and condensed the various points, we think accurately, but we are using the condensation of the academy report on each of these points simply as a stepping stone, as a springboard upon which to base our own comments.

Point 1: There should be a change in the attitude toward the addict. He is a sick person, not a criminal. That he may commit criminal acts to maintain his drug supply is recognized, but it is unjust to consider him a criminal simply because he uses narcotic drugs. That is our condensation of the committee's point 1.

And our comment is: That we agree with the concept that the addict is a sick person, and that that concept should be fostered.

For those who were criminals first and later became addicts, the approach should probably he as with other criminals. However, for those who have no real criminal history prior to addiction, and whose subsequent antisocial behavior is definitely related to addiction, we

believe that treatment of the illness should be the first consideration. Point 2, and this is a quote and not a condensation:

The committe believes that the most effective way to eradicate drug addiction is to take the profit out of the illicit drug traffic. They believe that the formation of new addicts is principally the result of commercial exploitation. They propose, therefore, that the addicts should be able to obtain their drugs at low cost under Federal control in conjunction with efforts to have them undergo withdrawal. They believe if this were done, agents and black markets would disappear from lack of patronage.

Our comment: If we accept the theory that addiction occurs in sick persons who are especially prone to drug use, it is hard to believe that the sole cause for the spread of addiction is the profit in the illicit trade.

We believe that the causes of addiction are multiple and complex, and we find it a little hard to believe that attacking one of the causes, which may or may not be a prominent cause in respect to most addicts, would of itself solve the problem.

3. An integral part of the program would be medical supervision of existing addicts, with vigorous efforts toward rehabilitation.

By a change in social attitude which would regard him as a sick person, and by relieving him of the economic oppression of attempting to obtain his supply of drugs at an exorbitant price, it will be possible to reach existing addicts in an orderly, dignified way, not as a probationed person or sentenced criminal. They would come under supervision in the interest of health, not because of entanglement with the law.

That is the end of that quotation.

Then another quotation:

Addicts resistant to undertaking therapy and continuously refractory to therapy, despite all efforts, should be supplied legally and cheaply with the minimum amount of their drug needs; and efforts to persuade them to undergo rehabilitation should be continued.

Now, to continue our condensation of this point: The academy proposes a system of dispensary clinics, preferably attached to hospitals, through which drugs would be made available to the addicts.

There are proposals for registration, including fingerprinting, photographing, maintenance of records, in a central agency, and other actions to control the distribution of drugs to addicts.

Another part of the plan would be treatment in reverse order. Instead of sending the addict to a hospital or clinic and withdrawing him, following which he would be treated or rehabilitated, the suggestion is that the reverse be tried.

For example, in appropriate institutions he would be maintained on drugs while rehabilitation was in process, and efforts would be made to get him employment, after which he would be taken off drugs. The theory is that with the strain removed of getting drugs, he would be willing to get training in skills and become successful in leaving before withdrawal.

Our comment on this is that our many years of experience with addicts and our studies of the pharmacology of the addiction drugs lead us to have serious doubts that this program would work.

However, because our knowledge is based on experience with limited types of patients, and because of the earnestness and the scientific standing of the proponents of this proposal, we would hesitate to make this an absolute answer.