STATEMENT OF DOCTOR C. E. TERRY, EXECUTIVE OF THE COMMITTEE ON DRUG ADDICTS, NEW YORK CITY. The CHAIRMAN. Will you kindly state your full name. Doctor TERRY. Dr. C. E. Terry. The CHAIRMAN. What is your occupation? Doctor TERRY. I am the executive of the Committee on Drug Addicts. The CHAIRMAN. Of what organization? Doctor TERRY. That is the organization, the Committee on Drug Addicts, associated with the Bureau of Social Hygiene in New York. I am chairman of the committee on habit forming drugs of the American Public Health Association. Mr. COLE. Is that a municipal organization? Doctor TERRY. It is an association of health officers of state and municipal health officers, a national organization. Mr. ROGERS. Are you a public health officer? Doctor TERRY. I have been. I was health commissioner of Jacksonville, Fla., for a good many years, and have been in public health work since 1910. The CHAIRMAN. Are you familiar with the effect of these drugs upon the health and morals of the addict? Doctor TERRY. Yes, I think I am. The CHAIRMAN. Will you kindly describe it to the committee. Doctor TERRY. The effect of the drug on the health has been gone into pretty thoroughly. There are so many angles to this thing that have not been touched upon, it seems to me that I might leave the effects to the morals to those, and talk possibly about some of the physical conditions and results. The CHAIRMAN. Very well, Doctor. Proceed in your own way. Doctor TERRY. The underworld aspect of this problem has been presented here before the committee by a good many that have spoken, and I feel that that is but a very small part of the problem itself. It is a much bigger proporisition than the underworld problem, and I think available records would show than an underworld addict forms but a very small percentage, certainly not over 20 per cent, of the total number of narcotic addicts. The narcotic addict as a class is a sick man or woman. They are men and women who have become addicted chiefly through the therapeutic use of narcotic drugs. They are not guilty of any offense. Many have become addicted, sometimes because family doctors had to prescribe these drugs in chronic or subacute illnesses, and many men and women who take opium or an opium product for more than a brief period of time, say two or three or four weeks, unless he is a very uncommon exception to the general rule, becomes addicted. Changes that we do not understand take place in his body chemistry, and he develops a pathological condition. He is a sick man from that time on, and he requires one of two things. He requires either intelligent treatment to break up this addiction, or this biochemical state developed, or he requires the drug of his addiction to be normal, to be able to do his work and maintain his position in society and in business. Mr. SABATH. I can not hear you very well. I wish you would talk a little louder. Doctor TERRY. To give you a concrete example that will at once eliminate, I think, every possible claim of vicious association or evil environment, or weak will, or anything of that kind, I would like to state that a baby, a new-born baby, born of an addicted mother, is a narcotic addict at birth. A few hours after the birth that baby will go into what is known as withdrawal symptoms, the same symptoms that an adult addict will go into, if he is given what is known at present as "cold turkey" if the opium drug is withdrawn. That baby for nine months--its blood contains morphine, because its mother's blood contained it, and it is inevitable that the baby's blood wonld contain it in solution, and 8, 10, or 12 hours, maybe a little longer after the birth, the baby will begin to sneeze, stretch and yawn, and get extremely restless, and will cry, drawing its legs up, vomiting and developing an uncontrollable diarrhea, and if it does not get the drug of its addiction in suitable dose it may die, and a great many of them do die in collapse. If that drug is given until the milk flow of the mother is established on the third day, it can tide over, and then it will get the drug through the mother's milk, but it is still a narcotic addict, and in a few weeks, under proper treatment, it can be withdrawn from the drug, put on artificial feeding, and grow up into a healthy baby. Those babies may be perfectly normal physically at birth, and very frequently are. There is no reason why they should not be, but they have that addiction, and the baby can stand a dose of morphine that would kill a child seven years old. They have a tolerance from birth, and have the dependence, which developed with this tolerance. We require a tolerance to a great many drugs, those enormous doses of cocaine to the coal tar products, but all those drugs can be withdrawn without any serious symptoms. We do not develop a dependence on those drugs like on opium products, The dependence which is so vital, which is so powerful that unless it be supplied, or unless it could be corrected by suitable treatment, may lead to death if the drug is withdrawn. It is not at all uncommon for prisoners thrown into jail, addicted, whose condition is not recognized, or is not considered important enough to require medical treatment, to die. I have known a number of cases, and in practice I have been responsible for the death of three cases myself. I failed to recognize one case of congenital addiction. I only found out afterwards that the mother was addicted. Another child, two years old, was a paragoric baby. The mother had been an addict. The child was born addicted, and the mother recognized its need for opium, and put it on paragoric, and it had gotten up to very large doses of paragoric, in the neighborhood of two teaspoonfuls at a dose several times a day; less than 2 years old, this baby was, and one teaspoonful would put me sound asleep. I withdrew the paragoric from that baby and it died. Another woman, middle aged, a woman in good physical health, organically sound, was treated while I was health officer of Jacksonville in the city hospital, treated by a popular treatment known as Townes-Lambert treatment, and died on the second day of withdrawal. She was treated to the best of our knowledge then. We know better now. She died in collapse. Her heart went back on her. In other words, we have got not only a vicious problem, but a moral problem, an underworld problem, and we have the pathologic state, just what it is nobody knows. Very little work has been done on it. In Europe, Germany, France, and Italy, a great deal of scientific work has been done on it, but unfortunately that work has not been related. Every man has worked along certain lines that interested him, and we have got, however, an accumulation of work done on the continent, which is of extreme importance, but which is not complete. Much more work is needed, especially in this country. Our laboratory workers are clinical men, and have done practically nothing. with the exception of a handful, and we are trying apparently to legislate and demoralize and control by police measures against a condition which is a matter of pathology, a matter of biochemistry, a branch of medicine which is least understood of any branch of medicine, and concerning which we are only beginning to scratch the surface. It is a toxic condition which is not understood, but which must be understood if we would intelligently control the situation. The CHAIRMAN: I understand that addicts do not get admission to hospitals. Doctor TERRY. It is the general rule that hospitals taking the run in medical and surgical cases are not taking these cases. There is a very good reason for it. The great majority of physicians do not know how to handle them, and no one knows that better than the addict. As a matter of fact, the intelligent individual who becomes addicted to opium in some form, from whatever cause, and uses his common sense and observes the effects of the drug on him, does not become the dope fiend of the underworld we have heard about. He knows he has to have a certain definite dose of that drug, if he is to maintain his work and maintain his position in society. He knows that too much will render him unfit, and too little will do the same thing, and finds out how much he has to have and takes that amount. If that case goes to a physician and receives unintelligent treatment, as he will, nine cases out of ten, he is going to be made desperately sick, and he knows from experience he may die, because he has heard of those case, and has known of them, and becomes rather an unsatisfactory patient, partly because the physician can not relieve his condition, and partly because he is only human and objects to an unwarranted amount of suffering in treatment. As a result they do not take these cases in the general hospitals. About the only public institution in the country-this is the general statement-that we have to-day are the jails and insane asylums. The CHAIRMAN. Does that account for the fact that occasionally, addicts unable to secure treatment, commit a minor offense so they may be sent to jail? Doctor TERRY. Yes, a good many cases of that kind. Where it becomes known, and this applies more generally to the worse types of addicts, there is a good treatment in a public institution, treatment that has really cured cases, sent them out in good shape, the word goes around, and they want to get into it. They will commit themselves to the police court, will commit offenses to be sent where they can get this treatment. In many of those institutions they have to be admitted for misdemeanor, and that is the reason there is so much smuggling in hospitals and jails. The CHAIRMAN. While you are on that point, is it possible to keep it out of the jails or penitentiaries? Doctor TERRY. Yes, it is quite possible to keep it out, but it can not be kept out by guards or any of the usual ways employed. The only way it can be kept out of any institution, private or public-it is smuggled into private institutions just as well—is to raise the type of medical service in those institutions; when the patients realize they are getting rational treatment, and are not going to be subjected to undue suffering, that they are not going to be turned out in such shape that they can not sleep, eat or concentrate or digest their food, that they are going to be turned out well and going to be treated as sick people, and not as criminals, that moment smuggling will stop in that institution, and will not stop under any other condition... The CHAIRMAN. You can not stop it? Doctor TERRY. I do not believe you can, no. You would probably kill some if you did. The CHAIRMAN. Your testimony shows these unfortunate people are very anxious to be cured, and it was testified here the other day they are the most grateful of all patients. Doctor TERRY. I have known hundreds of them. I knew probably every case of narcotic addict in the city when I was health officer in Jacksonville. It was the first city in the country in 1910 to take this up as a public health problem. We made a very careful investigation through the operation of a local law, as to the extent of this, and its causes, and the type of people addicted, and we found all types were. We had preachers and prostitutes, and all types in between, professional men, responsible business men, club women, and every other type. There is no type of narcotic addict. They are of all types. Any sick man or woman may become a narcotic addict, and will become one if he is given a narcotic drug over a long period of time; it does not matter what his physical, mental, or moral fiber is. A dog will become a narcotic addict if you will give it morphine over a period of weeks, and he will show withdrawal symptoms exactly like those shown by human beings when you stop the drug. It is not a vicious habit with a dog or with a baby. The CHAIRMAN. It is not a vicious habit with 90 per cent of the people in becoming drug addicts. Doctor TERRY. I could not state figures. I know the best of available records, and I have studied them pretty carefully, and have collected them, and they will show that 75 per cent of all cases were made so through the therapeutic use of drugs in sickness. Doctor TERRY. I mean the administration of morphine or the conditions requiring the use of morphine over a sufficient period of time to establish this condition. Mr. SABATH. Could not that be minimized by the physician, somehow or other? Doctor TERRY. Probably it could, but it has not in the practice of medicine, and the patient is not responsible for it. Our medical teachings are responsible for it, largely. Mr. FAIRCHILD. Is it your opinion that there is no substitute? Doctor TERRY. It is my opinion that there is no substitute for opium products for certain conditions. I think the use might be lessened. Mr. FAIRCHILD. What would be your opinion about heroin? Doctor TERRY. I am not a therapeutic. The medical opinion is divided very much on heroin. Doctor Hobart, here, is professor of therapeutics, and he says that heroin can not be dispensed with. Others claim that it can be. I am not qualified to express an opinion on that. Mr. ROGERS. What is your best judgment, Doctor, as to the number of addicts in Greater New York, for example? Doctor TERRY. Nobody knows how many there are. Doctor Copeland said, I think, eighteen or twenty thousand. Others have put it at 200,000, and it is somewhere probably in between, and nobody knows. Mr. ROGERS. Do you think that the ratio throughout the United States would be maintained—what I am seeking to ask is in proportion to the population New York would represent about the same fraction of addicts throughout the United States. Doctor TERRY. I doubt that, because in New York, in any great city, the illicit addict has been highly developed, and the underworld addict would be present in greater proportion than in communities where the illicit traffic has not been developed to that extent. Mr. ROGERS. But if 80 per cent of the addictions are not of illicit character Doctor TERRY. The medical and therapeutics say that they are about the same in every part of the country. Mr. ROGERS. Then New York predominance would be in respect to the other 20 per cent? Doctor TERRY. Yes. In 1878 the State Board of Health of Michigan made a survey of addicts in that State. That was before the days of heroin or before the days of any antinarcotic laws. Morphine or any other drug was sold over the counter of any drug store. The underworld aspect had not been developed at all, and this survey was made in towns between 350 and 10,000 populations, so that no red light districts of any consequence, gambling, or any of the menacings that are supposed to have a vicious influence and spread narcotic addictions in certain classes were operative, and in 96 towns and villages, as a matter of fact, there were thirteen hundred and some narcotic addicts found. Figured out, it forms about 0.33 per cent of the population, one-third of 1 per cent. That figure is not exactly right. I have not got it with me, but it is very close to it. Any way, if that percentage was applied to the then population of continental United States, there would have been a quarter of a million represented. Those cases were practically 100 per cent therapeutic cases. The population of continental United States at that time was less than 60,000,000. I forget the exact figure. That survey was made over 40 years ago, and that represented almost entirely the result of medical practice and self-medication. You must not forget these drugs • could be bought by men, women, and children, anywhere without any restriction. The patent medicines contained large percentages of opium, many of them being extolled, the virtues of them being extolled by word of mouth, one sick person would tell another, and individuals exercising their right to medicate themselves. It is the right they have to-day and always had. It was not a vicious association; it was simply a desire to less suffering, and the addict to-day who continues the drug—I am not speaking of the dissipated underworld individual, but the therapeutic case continues it, not because of any craving, not because of any vicious appetite, but simply because to stop it brings on intolerable suffering, and he would be unfit to do his work, and furthermore makes him known to those about him, because no man or woman can tell a narcotic addict when he has his drug. I doubt if any human being can. The CHAIRMAN. Is it your opinion that addiction is on the increase in the United States? Doctor TERRY. I think since the passage of the prohibitory laws, and especially since certain rulings have been made and administered, it has increased, because the illicit traffic did not exist. There was no illicit traffic when morphine was selling at 50 cents a dram. There was no illicit traffic before the passage of the Harrison Act. There were certain individual State laws, like Massachusetts and New York, and one or two others, passed before the Harrison Act. Illicit traffic sprang up at once in those States, and they were supplied. The Harrison Act was passed to control the interstate commerce of the traffic. The illicit traffic became general, and since it has become so profitable commercially to buy and sell morphine and these other drugs, I think addiction has increased more than a normal increase, but addiction will exist as long as medicine is practiced. The CHAIRMAN. Take the survey that you say was made 40 years ago, when anyone could go in a drug store and buy morphia or codein, any quantity they wanted. That was a transaction between the druggist and the user. You say you cannot tell an addict when you see one. Doctor TERRY. I said an addict, in drug balance, not over dosed or under dosed, you can not tell him. The CHAIRMAN. Would it be impossible to ascertain how many addicts there were in the United States at that time with any certainty? Doctor TERRY. Yes; this investigation was made through letters addressed to the physicians of the States at these different places. Great care was exercised to avoid duplication. One physician only was addressed in each community. The information was supplemented by inquiry made from druggists. I think that was a good deal smaller percentage of addicts than would be found to-day. It has undoubtedly increased. The CHAIRMAN. Have you any opinion as to the number of addicts in continental United States at the present time? Doctor TERRY. No, sir; my guess is as good as anybody's. The CHAIRMAN. That is what I was going to say. Doctor TERRY. We do not know. In the very nature of things it is impossible to tell. Mr. BROWN. Do you think the attempt to regulate this matter by law has increased the use of narcotic drugs? Doctor TERRY. Yes; but it need not have done so. The CHAIRMAN. The special committee appointed by the Secretary of the Treasury reports in its opinion the number of addicts in 1919 was about one million. Is that a pretty good guess? Doctor TERRY. I thin so. In 1913 in Jacksonville eight-tenths of 1 per cent of our population were addicted to opium or opium products. Figured out on the basis of |