Some of the cases were sent to jail for treatment and either were withdrawn from the drug or supplied by smuggled drug. A number of them died. Eventually the use of four rooms in the jail was secured for the treatment of these cases but because of the inadequacy of equipment and of the difficulty in stopping the smuggling of the drug, this work was not successful. In 1919 the State board of health appointed a physician in Shreveport to take charge of the narcotic situation. He wrote all the prescriptions of these cases, which were filled at one authorized drug store. This arrangement lasted but 1 month, its failure being due to 3 factors: first, the expense and trouble to the patient who was required to secure daily prescriptions when he could patronize the peddler more easily; second, the impracticability of one physician's attempting to care for so many cases without assistance; third, the druggist's objection to having his store patronized by a class of people looked upon by the public as criminals. The physician who had been appointed to handle this situation resigned and Dr. Butler was instructed by the State board of health to care for these cases by establishing a dispensary. That the need of some provision was increasing is shown by the following excerpt from a letter to Dr. Butler from the president of the State board of health: "We are getting daily the names of patients being discharged from the Army and Navy who reside near Shreveport and who should be sent there for treatment, but as yet we are unable to refer them there." Dr. Butler organized his dispensary and with the assistance of a pharmacist and special assistants supplied the drug to chronic users according to State regulations which will be explained later. Quarters in the Charity Hospital were secured for the treatment of curable cases. During the first 2 years the number of patients handled at the dispensary was reduced from 494 to 188, some having been cured and others in one way or another eliminated. On March 15, 1921, the Louisiana State Board of Health after consulting with the Federal narcotic officials discontinued the narcotic dispensaries in New Orleans, Alexandria, and Shreveport. Upon the following day Dr. Butler reopened the Shreveport dispensary and moved the institution for treatment from the Charity Hospital to a house near the business center of the city. He continued to work on his own responsibility as parish physician and through the authority of the city council of Shreveport, expressed in the following ordinance: “(1) "That a public health hospital and out-patient service be, and the same is hereby established for the city of Shreveport. "(2) "That said institution shall be under the charge and control of the City Council of Shreveport and its management subject to the supervision of said Council, shall be under the direction of Dr. Willis P. Butler, parish physician, until such time as it may be otherwise ordained by this body. The purpose of said institution is declared to be for the treatment of narcotic and venereal cases. "(3) 'Be it further ordained, That whereas the police jury of the parish of Caddo defrays a portion of the expense of said institution and the said parish physician is empowered to care for and treat the same class of patients for the parish of Caddo.'" The last clause of this ordinance shows that the police jury had already taken action. In fact previous to and anticipating the State board of health's order to close the dispensary and institution, the police jury had passed a resolution to continue Dr. Butler's narcotic work. This briefly outlines the inception and development of the dispensary and institution for treatment. The need of municipal action begins with the indictment of the four local physicians already mentioned and had its final expression in the passage of the ordinance continuing the method that the council had found to be effective. During the years 1921-23 this arrangement controlled satisfactorily the narcotic problem. One hundred and forty patients were given curative treatment while the number of cases attending the dispensary was decreased to 101. Early in 1923 a conference was held in the office of the United States District Attorney between Dr. Butler and the Federal narcotic agents. As a result of this conference it was decided to close the dispensary. The agent present at the conference stated that he had been sent "to close the clinic because it was the only one left in the United States." In commenting on this Dr. Butler quoted from a letter written by Dr. L. M. Powers, health commissioner of Los Angeles, Calif., who said when the Los Angeles clinic was closed in 1921: "I have not been able to realize the actual purpose of the closing of our clinic for there has been some unseen motive prompting much opposition to clinics which I have not been able to comprehend." Method of operation—results THE DISPENSARY The dispensary was located in the director's laboratory in the Shreveport Sanitarium with the following personnel : medical director, chief clerk and bookkeeper, assistant clerk and fingerprint expert, pharmacist, dispenser, three inspectors selected with the approval of the police department, the local board of health and the medical director; other assistants for special work were employed when needed. The dispensary days were Monday, Tuesday, Thursday, and Saturday from 8:30 to 10 a. m. and from 4: 30 to 6 p. m. Where these hours created a hardship on the patient he was cared for at some more convenient time. Morphine was dispensed in solution, the container being labeled to show the amount in grains and the price. The doses varied from 1 grain to as much as 12 grains a day for certain patients, the average being 8 grains. In each case the amount of morphine dispensed was the least that the patient could take and still remain in "drug balance." Since the dispensary was not intended for curative treatment but as a means of caring for incurables and those physically unable to undergo treatment, no effort was made to reduce the amount finally decided upon as the patient's proper dose. The cost of morphine as supplied at the dispensary was an important matter as will be explained later. The wholesale price of the drug varied from 2 to 3 cents a grain. The dispensary price was 6 cents a grain as against the druggists' price of 10 to 25 cents a grain, exclusive of the prescription fee, and the peddlers' price of $1 a grain. Under the dispensary management the difference between the cost and the selling price paid the actual operating expenses of both the dispensary and the institution for treatment, the entire undertaking being selfsupporting. Patients admitted to the dipensary were carefully examined and recorded. In the beginning any patient applying was admitted but the number was necessarily limited later to residents of the State and again later to residents of Caddo Parish. They were divided through examination into the curable and incurable cases, and place in 1 of the 2 classes. Complete medical histories were taken, together with information relating to age, sex, color, length of time during which the drug had been used, former treatment, and the causative factors, together with an exhaustive physical description. Fingerprints with personal description were sent to the local police department, to the local detective agency, and to Leavenworth. Before being dispensed to, the patient was requested to sign a pledge not to sell, give away, lend, borrow, or otherwise obtain any of the drug. His residence and business addresses were secured and frequently checked by inspectors. All patients able to do so were required to work and to secure proper food and clothing. No loafers were tolerated. These rules governed patients who were not infirm, decrepit, or bedridden. A monthly record sheet contained the names of the patients. Upon receiving their medicine patients signed this register, the clerk entering opposite the signatures the amount dispensed in grains and the price paid. This daily record was kept of those coming to the dispensary in person. For those who were bedridden or who held a doctor's certificate as to infirmity a special order form printed on safety paper was employed. These were serial in number, dated and signed, and gave the reasons for the individual's inability to come in person, together with the name of the authorized proxy. Only one order form was issued at a time and a strict record kept of each. The institution for treatment was located at the Charity Hospital until the work was discontinued by the State board of health in 1921 when it was established in another locality. It was called the Public Health Hospital and in addition to treatment for chronic users of opium it provided treatment for cases of venereal disease either free or at the cost of the medicine. This institution had a resident physician, superintendent, nurses, guard, and attendants. The rules governing the institutional treatment of the narcotic patients were as follows: "(1) Institutional treatment is free to any resident of Caddo Parish. "(2) An addict who is able physically to undergo treatment must sign voluntarily an application for commitment to the institution. (If he is judged physically able and will not take the treatment he is no longer dispensed to.) "(3) He also signs a request to be placed in the parish jail to complete the treatment if for any reason this may be deemed necessary by the director. "(4) He is required to make a deposit of $25 for his own use at the end of treatment, unless he is known to be in good financial circumstances. "(5) The medical method of treatment is divided into three parts, (1) Previous preparations; (2) the period of narcotic withdrawal under restraint; (3) aftercare. By the first term is meant, assurance that the physical condition is strong enough to endure the rigor of the withdrawal. The salient features of the treatment proper, are rapid withdrawal and substitution, proper elimination, abundant food, rest and warm baths. By the third term is meant, a place of convalescence, preferably in the country." RESULTS Dr. Butler states that the results from the points of view of the users, physicians and druggists, and society at large from a properly operated dispensary and institution for treatment have a distinct medical and sociologic value. First: The patient.-Such a treatment prevents or alleviates a great deal of physical suffering. The dispensary and treatment institution treated all cases including the parish prisoners. The curables were treated first for whatever physical conditions they were suffering from and then for their drug intoxication, while the incurables were improved physically and their doses properly regulated. Many cases who had been "down and out" were raised to a plane of decent living. With their drug inexpensive and regularly supplied they were enabled to work and provide for their families. In the opinion of the Associated Charities, Federal and parish authorities and the city police department, crime was prevented and the narcotic problem from every angle was ameliorated by the medical care of these patients. Second: Physicians and pharmacists.-The system was helpful to physicians and druggists in that it saved much of their time and prevented annoyance from the insistent demands of individuals for whom they could not regularly care. It prevented duplication of work for one patient and neglect of others. That the medical profession appreciated this work is shown by its unqualified support and approval of the clinic as evidenced by the passage of resolutions to this effect. Third: Society as a whole.-That the work of the clinic was beneficial to society as a whole is apparent. It reduced the number of future users and the system that made the dispensary effective became an auxiliary to the city's police department. Dishonest and unworthy cases were detected, cut off from the dispensary and because of the absence of peddlers in the city were forced to move away. Thus crime was prevented, as there was no profit possible for criminal addicts or peddlers. A considerable burden of indigency was saved the city by the rehabilitation of these patients. Relation of clinic to 1. Peddling. 2. Federal and State-control measures. 3. Other methods of control. 1. It prevented peddling and the pauperizing of the user. It prevented illicit sale by (a) providing for the incurable cases, preparing the curables for treatment and treating them, whereas the peddler deliberately increased his sales by creating new users and (b) eliminating the vicious type of user. 2. The chief manifestation of Federal control has been the arrest of users in order to stop the illicit traffic. This method of control, according to Dr. Butler, only aggravates the situation as it makes dependents of the user's family, which thus creates a social and economic problem. Dr. Butler quotes the United States marshal as having stated that through taking advantage of the facilities afforded at the clinic he was able to secure quick relief without the unnecessary resorting to redtape required under other circumstances. Through the detective system practiced by the dispensary many arrests of peddlers were made and evidence sufficient to convict them secured, but Dr. Butler states these cases when brought into court were either repeatedly postponed or dismissed. 3. Another method of control that Dr. Butler claims is a complete failure is that of the enforced treatment of users. This procedure results in repeated relapses, deaths, or suicides during the withdrawal, or smuggling of the drug into the institutions in which these cases are confined. In this connection Dr. Butler gives the following acknowledgment from the State board of health president: "Your statistics in cures are decidedly higher than those of any others we have received." In conclusion he states that Federal and other State control measures employed have failed to give such good results as were derived from the operation of the dispensary and the institution for treatment, namely: One responsible organization to control supply. Proper facilities for observation, examination, and treatment of patients. Ability to care for incurable cases without expense to the community and at but slight expense to the patients. A self-supporting system. Since the closing of the dispensary, Dr. Butler reports the deaths of several former patients, three of these in jails in other cities, while a number of his patients have been sent to the State penitentiary. Of the remainder of the 101 incurable cases, Dr. Butler continued to care for 40 for about a year. The others he states were supplied by peddlers at $1 or more a grain inasmuch as their physicians refused to care for them. Individuals who during the life of the dispensary were leading decent lives and supporting their families reached a condition of wretched poverty. In 1924, the number of incurables attended by Dr. Butler was reduced to 24 and then to 21. These were continued until March 1925, when he ceased prescribing for them. Of the 40 cases remaining in his care after the closing of the clinic, 4 have died, 2 or 3 found other physicians to care for them temporarily, a few moved away, and the others have been forced to patronize peddlers. The organized charities, he states, recognize the evil effects of the closing of the clinic and the city police department and the sheriff report that they are having endless trouble with users and peddlers. Petty crimes are increasing and the peddlers are creating new cases. The following communications supplied Dr. Butler from professional groups are of interest in connection with the operation of the Shreveport narcotic clinic: “To the Shreveport Medical Society: "This committee appointed to investigate and report on the Shreveport Narcotic Clinic begs to report as follows: “We had an interview with Dr. Butler at his office on September 29, and wish to express our unqualified approval of the work being done by Dr. Butler and his associates. We were most favorably impressed by the conduct of the clinic including the details of complete records of all addicts coming under care, classification of addicts, and treatment according to classification, the elimination of nonresidents of Louisiana, and the careful treatment of curable cases under restraint, the procuring of employment for addicts who are able to work while attending at the dispensary and for cured patients who wish to remain in Shreveport after recovery, are all features of this work that strongly recommend the conduct of this institution. "It is significant that Dr. Butler's judicious and tactful conduct of the clinic has secured for him the unqualified support and cooperation of the Federal, State, parish and city authorities, and the State and city boards of health. "In brief we wish to express our unqualified support and approval of the Shreveport Narcotic Clinic and its systematic and effective administration by Dr. Butler. W. H. BILLINGHALEY, M. D., Committee." This report was presented to the Shreveport Medical Society at the regular meeting October 5, 1920, and was unanimously adopted. SHREVEPORT, LA., March 15, 1921. At a regular staff meeting of the T. E. Schumpert Memorial Sanitarium held at the sanitarium Tuesday night, March 15, the following resolution was unanimously adopted: "Resolved, That, in the judgment of the staff of the T. E. Schumpert Memorial, for the best interest of humanity and the community, it is advisable that Dr. Willis P. Butler continue the so-called narcotic dispensary and institution as now conducted in the city of Shreveport." The following doctors were present at this staff meeting: DEAR DOCTOR: The following resolution was adopted by the staff of North Louisiana Sanatorium, at its regular monthly meeting last night, March 22, 1921. "Resolved, That, in the judgment of the staff of the North Louisiana Sanatorium, that, for the best interests of humanity and the community, it is advisable that Dr. Willis P. Butler continue the so-called narcotic dispensary and institution as now conducted in the city of Shreveport, La." The following doctors were present: Dr. D. H. Alverson Dr. S. C. Barrow Dr. J. M. Gorton Dr. A. G. Heath Dr. M. R. Purnell Dr. R. A. Pain Yours truly, Dr. G. C. Rigby Dr. J. E. Slicer Dr. V. Simmons Dr. Wm. P. Yerger Dr. C. B. Hicks Dr. Hearn J. M. GORTON, M. D. EXHIBIT No. 9 SHOULD WE LEGALIZE NARCOTICS? By Herbert Berger, M. D., and Andrew A. Eggston, M. D. (In this article, two medical authorities offer a startling proposal to curb narcotic addiction in the United States. Their plan, now under study by a committee of medical experts, is explained here in detail. If, as the authors claim, the program is feasible, it might reduce nationwide crime to a fraction of its present proportions.-The Editors.) It might as well be faced. Drug addiction in the United States will not be stopped as long as the addict is treated as a criminal and sold down the river to the narcotics racketeer. It is typical of the chaotic situation in this country that experts are in wild disagreement as to how many addicts there actually are. In 1954, Federal Commissioner of Narcotics Harry J. Anslinger estimated that, with an increase of over 10,000 addicts since 1948, there were now about 60,000 in the United States. But in 1951, the New York Mayor's Committee on Narcotics gave a top figure of 90,000 addicts in the New York area alone. Others have placed the total for the country at 1 million. Attempts to stamp out addiction by outlawing it have failed. But this does not mean that there is no solution or that large-scale addiction is inevitable. We believe that under a new system of controls-which we have submitted for study by the AMA-the number of addicts could be reduced to a handful within a generation. This new system calls for the establishment of narcotics clinics where drugs would be administered to addicts under medical supervision and with proper safeguards. Our plan strikes at the heart of the problem-the fact that for more than 30 years, addiction in this country has been a contagion spread almost exclusively by dope peddlers who use every dirty trick in the book to expand their market by recruiting or "hooking"-new customers. |