|3 The Harrison Act|
|Books – The American Disease|
|Written by David F Musto|
|In January 1912 Wright returned to the United States with two goals: increasing the number of signatories to the Convention and dispelling any doubt that this nation would pass the necessary domestic legislation. Southern resistance to any invasion of states’ rights made Democratic control of the House especially significant for the narcotic reformers. Representative Francis Burton Harrison, a well-born Tammany Democrat, agreed to shepherd the antinarcotic legislation through the House. Harrison’s task was to assure his colleagues that the various trade interests and concerned parties had achieved a generally acceptable narcotic bill or at least one that would engender no unyielding hostility. He did not display as much interest in the specific form or philosophy of the legislation as in its political viability.
Strongly backed by such adamant reformers as Drs. Harvey Wiley, Alexander Lambert, and William Schieffelin, Dr. Wright believed that the legislative goal should be elimination of narcotics except for medical purposes. As a result, the first Harrison bill in the 62nd Congress did not differ greatly from the ill-fated Foster bill off 1910.1 It contained no provision for exempting small amounts of narcotics in patent medicines. Revenue stamps, record keeping and various details such as bonds, license fees, and severe penalties were retained, although still strongly opposed by the retail druggists. Wright could not easily bring himself to compromise. Weakening the bill would have made him susceptible to the same criticisms he heaped on the foreign governments that did not rigorously and heroically stamp out the evil of narcotics.
THE NATIONAL DRUG TRADE CONFERENCE
Believing that the movement to control narcotics was gaining strength and that some legislation was likely to be enacted, the American Pharmaceutical Association sought to give the various components of the drug trades a united voice, or at least a forum, in which the interests of each would receive the maximum possible support of the others. Meeting in Denver during October 1912, the association called for a convocation. As a result, the National Drug Trade Conference ( NDTC) was created and met in Washington, D.C., on 15 January 1913, with its chief business the proposed antinarcotic bill. Each major trade association was permitted three representatives, and no resolution could be passed unless it was unanimous.2 This set of rules worked relatively well for the problem at hand because pressure from outside forces was considerable. During the three-day meeting, constituent members were able to compromise on a common position. In later years, however, and on other subjects, the NDTC reached unanimity less often.
All groups opposed the Harrison bill as it then stood. The American Association of Pharmaceutical Chemists and the National Association of Medicinal Products (NAMP), both makers of prescription drugs, were against the legislation on grounds of its “too complex procedure.” The National Association of Retail Druggists (NARD ) found inconsistencies, especially in the keeping of records. The National Wholesale Druggists’ Association would abide by the law if enacted but also found it inconsistent in various respects. The principle of the law was endorsed by the APhA although the details appeared to be a burden on the retail drug trade, especially the record-keeping provisions. In a familiar jousting for superiority, Wright invited the NDTC to meet with him at the State Depart-ment, but the NDTC, as its first unanimous resolution responded by inviting Wright to meet with them at the Hotel Willard.
He accepted, and Wright and Representative Harrison heard the druggists’ criticism. The NDTC members found that evening session an irritating encounter with the federal bureaucracy for they had worked at great length to prepare a detailed and unanimously approved criticism of the bill. For Representative Harrison, who had to meet his wife at the theater, “or she would fear I had taken an overdose of narcotics,” it was a rushed evening. Wright got so angry with the proposed changes to his bill that he walked out of the meeting declaring that any further discussion would take place at the State Department. This hectic encounter strengthened the NDTC’s resolve to approve no bill until its views were taken into consideration. Wright’s angry action had helped unify opposition to the Harrison bill.3
A few days after the confrontation, Harrison decided that Wright would have to work out a bill suitable to the NDTC; he would then see to its passage through the House. Several revisions suggested by the NDTC were accepted into the bill.4
The NDTC established an Executive Committee based primarily in Washington and able to meet quickly to discuss the sometimes rapidly changing status of legislation.5 The American Medical Association, which also had been consulted about the Foster bill, was always represented in the NDTC conferences, either by Martin I. Wilbert, a pharmacist in the Public Health Service and a member of the AMA’s Council on Pharmacy and Chemistry, or by a leading legislative adviser to the AMA, the able lawyer-physician Dr. Wil-liam C. Woodward, Health Director of Washington, D.C. Both men had had prominent roles in health legislation.
Dr. Woodward participated in legislative eonffict from about 1910 to 1940. He fought in the initial Harrison bill battles, against federal health insurance and for uniform state narcotic laws. One of his last appearances before Congress in regard to drug abuse was to oppose on behalf of the AMA the Marijuana Tax Act of 1937. Although in 1913 he was concerned with framing and passing a satisfactory federal narcotic law, later enforcement activities caused him to fight the Harrison Act during the 1920s.
Both Wilbert and Woodward favored restrictive legislation and were opposed to narcotic-containing proprietary and patent drugs, but both also favored legislation with a maximum chance of actual passage. Through one or the other representative the AMA was constantly apprised of the actions of the NDTC and was able to cooperate in influencing Congress.
THE AMA AND NARCOTIC LEGISLATION
The AMA’s role in narcotic legislation reflected its stage of institutional development. By 1913 the American Medical Association, from a relatively small group centered mostly in the eastern states, was well on its way to consolidation of American medical practitioners. Like the American Pharmaceutical Association, it represented a group desire to strengthen the education and raise the status of physicians. Although founded in 1847, it did not begin its period of rapid growth and powerful influence until this century. Membership increased from 8,500 in 1900 to 36,000 in 1913, and to more than 44,000 by 1920. The AMA realized the need to enter into political activity in order to achieve its professional goals. It maintained surveillance on laws affecting its interest at each political level. The battle for the Pure Food and Drug Act in the first decade of the century whetted the AMA’s legislative weapons, and from then on it knew when, how, and whom to contact in the state, local, or federal echelon involved. The Council on Health and Public Instruction, created in 1910, contained within it the Bureau of Legislation, headed by Dr. Woodward. This bureau was permitted to use its discretion in legislative matters not specifically covered by resolutions passed at general business sessions. Further impetus to the collection of laws and decisions, formulation of model laws, and improvement of communication with the public occurred at the beginning of 1913 with the establishment of the Medicolegal Bureau, also within the council.6
Prior to World War I, the AMA was guided by a rather small coterie of physicians who were strongly influenced by the reform enthusiasm of the Progressive Era. The AMA supported uniform licensing procedures, a federal department of health, the Pure Food and Drug Act, and federal support of worthy medical schools. In 1916 Wright’s comrade, Dr. Lambert, as the head of the AMA Judicial Council, submitted a favorable report of the European experience with social insurance.7 Lambert, as well as the English-born Dr. George H. Simmons,8 editor of the Journal of the American Medical Association (JAMA), admired the British health insurance scheme for the poor that resulted in better. health care for millions of the needy as well as in higher incomes for physicians. During this stage of its development, the AMA welcomed the federal government as a valued collaborator in achieving its professional goals.
By 1918, with a vastly enlarged membership drawn from the nation’s general practitioners, a different attitude arose within the AMA—a fear of federal control leading, perhaps, to “state medicine,” rejection of state-supported health insurance schemes, opposition to widespread building of Veterans Administration hospitals and federal funding of state maternal and child care programs, and antagonism to almost any other government-sponsored action in the health field that would limit the prerogatives of the independent practitioner.9 After Prohibition, the AMA opposed the Willis–Campbell Act’s limit on each physician of one hundred prescriptions in every ninety days for medicinal wine or whiskey as another example of governmental interference in what was dearly a health issue.10
The Harrison antinarcotic legislation, enacted in December 1914, came during the AMA’s transition from favoring federal assistance to an antipathy toward Washington’s entry into the health field. By the 1920s the AMA felt medical standards could be most effectively maintained by the profession itself, without federal help. Therefore it is not surprising that the Harrison Act received strong opposition from the AMA in the early 1920s, when fear of federal domination affected all political issues involving the medical profession. If the government could establish control over one part of the practice of medicine, even if the goal was admirable, what could the government not do? 11
Before the watershed of World War I and during the controversy over the Pure Food and Drug Act, Dr. Simmons had taken a very strong stand with regard to habit-forming drugs. In an editorial,12 the JAMA declared unalterable opposition to any provision in the Act that would permit manufacture of medicines containing small amounts of opium, morphine, heroin, chloral hydrate, and other narcotics. Such an exemption was “as vicious as [it was] . . stupid.” The insidious small dose carried the great danger of gradual increase leading to addiction. In words similar to those of Bishop Brent a few years earlier concerning the Philippine opium monopoly, Simmons said there should be no compromise with crime. Opponents of the doctor’s stand suggested the profession wanted a monopoly on all narcotic sales to the public and wanted a fee for every citizen’s head cold.
THE PHARMACISTS AND NARCOTIC LEGISLATION
Although sensing the value of cooperation, one point at which the doctors and pharmacists diverged was on the extent to which each profession should dispense narcotics. The druggists insisted that a physician prescribe only after examination and diagnosis. Without such a provision, they feared physicians could set up narcotic dispensaries in their offices and “prescribe” for all who came in. Pharmacists conceded that the physician could dispense to his patients, but to them only.13 Establishing this distinction was not specifically linked to narcotics but had been a long-standing goal of druggists. The dispensing physician, a rarity now, was then the target of pharmacists’ ire. But as competition among physicians decreased and they became more prosperous, their need for a sideline declined and with it, dispensing.
Similarly, friction was caused by any suggestion that physicians need keep fewer records than pharmacists, as provided by some of the early narcotic bills.14 Druggists felt that such a requirement reflected on the pharmacist’s honesty and was a consequence of the growing prestige and influence of the medical profession. Also, druggists suspected that physicians, by not having to keep records of all transactions, would continue to sell huge amounts of drugs.15 Eventually a compromise permitted the physician to abstain from record keeping when out of his office, say at the bedside of an ill patient; or, as the law finally read, when “in personal attendance” on his patient. Neither the retail druggist nor the practicing physician welcomed the record-keeping duties that were anticipated from the antinarcotic legislation, but any requirement that would rest more heavily or more effectively on the druggist than on the physician was opposed by the NDTC.
PASSAGE OF THE HARRISON ACT
The presidency of Woodrow Wilson began in March 1913, with Democrats now in control of both Houses. Initially Wright was delighted with this change. Wilson and Secretary of State William Jennings Bryan supported strict regulation of narcotics and seemed to have nothing but admiration for America’s initiative in international control. Wright gave a glowing report of his first meetings with Bryan. According to Wright, his account of the fight for worldwide narcotic control was repeatedly punctuated by Bryan’s amazed exclamation: “How did you manage it?” 16
A joint committee set up by the State and Treasury Departments attempted to write a bill acceptable to the drug trades, the medical profession, and the Internal Revenue Bureau, which would have enforcement responsibility. Wright felt he was close to the end of a three-year fight with trade interests. At last, on 10 June 1913, the chairman of the NDTC signed a draft of the bill, which was then introduced into the first session of the 63rd Congress by Harrison as HR 6282, destined for eventual passage as the Harrison Act 17
The descendant of the stricter Foster bill, the Harrison bill of 1913 had incorporated numerous compromises. Records were simplified; standard order blanks would be filled in by any purchaser of narcotics and kept for two years so that the revenue agents could inspect them at will. Copies of the orders were to be kept by district internal revenue offices on permanent file. Physicians could dispense drugs without keeping records if in actual attendance on their patients. Numerous patent medicines containing no more than the permitted amounts of morphine, cocaine, opium, and heroin could continue to be sold by mail order and in general stores. Everyone dealing in narcotics except the consumer would have to be registered. Retail dealers or practicing physicians could obtain a tax stamp for one dollar a year. No bond was required, the drugs were not taxed by weight, and chloral hydrate and cannabis were omitted in the final version.
The Harrison subcommittee of the House Ways and Means Committee assured the full committee that the bill now had approval of both the medical and trade interests. On 26 June 1913, only sixteen days after the NDTC had accepted the draft, the House passed HR 6282 with only minor changes in the phraseology.18 When the bill went to the Senate, however, progress slowed, for efforts to give special interests an advantage started over again. Not until 18 February 1914 did the bill come out of the Senate Finance Committee. One change by this committee particularly aroused the anger of the American Pharmaceutical Association: physicians were to be permitted to provide narcotics when they “shall have been specifically employed to prescribe for the patient receiving such drug or article.” 19 This change permitted anyone to apply by mail for a drug from a physician. The amendment was inserted’, the Journal of the APhA believed, to accommodate a physician-owned business that sold asthma cures by mail after having the patient fill out a form describing his illness and asking for treatment.20 Other amendments of an unpalatable nature to one group or another were now being offered. One proposed amendment to the committee version simply exempted physicians and their aides from the provisions of the Act.21 The response to this change can be well imagined. Dr. Woodward thought it possible that these amendments were intended not to revise but to defeat the bill arduously worked out the previous summer.
On 15 August 1914 the Senate passed HR 6282 but with amendments unsatisfactory to the House Conference Committee. Professional and trade organizations put pressure on the House and Senate Conference Committee to achieve a workable compromise. These efforts in the autumn of 1914 by the NDTC, the medical profession, Wright, and the administration were successful; in October agreement was reached.22
The Senate had increased the heroin exempted in one ounce of proprietary medicine from 1/12 grain, which the NDTC and the House had approved, to ¼ grain, but this was reduced to 1/8 grain in the compromise. The reduction was opposed by some makers of proprietary medicines, but their opposition was not fatal. A few minor changes were made, such as lessening the effect of the bill’s impact on our insular possessions, which already had stringent laws and were not part of the internal revenue system of the United States. Final action was delayed until the December 1914 session of the 63rd Congress, when the Conference Report was accepted without opposition.
On 14 December the bill passed and was signed by the President on the 17th. Finally the American government had redeemed its international pledges; a federal law brought some control to the traffic in opiates and cocaine. The practical significance of the Harrison Act, however, was still debated among the groups affected. There was no general agreement on what would be the desirable or actual enforcement of the law.
Wright had been gravely concerned by the impasse that had threatened the Harrison bill, but he had been removed from his prominent position in the State Department for the second time in June 1914. During the Democratic administration, antagonism to Wright had been a significant cause—at least in Secretary Bryan’s view—of repeated refusals by the Appropriations Committee of the department’s request for funds to participate in the Second Hague Conference.23 After House passage of HR 6282., Wright had asked for a ministerial appointment, anywhere, on the basis of his good work on the opium matter. He was refused, allegedly because both the Secretary and the President had more Democratic applicants than they could satisfy.24 Wright’s influence had declined since 1911 and he found himself increasingly isolated from congressional and trade leaders.
In early 1914 some Democratic members of the House Appropriations Committee criticized Wright’s proposed appointment to the Third Hague Conference. Secretary Bryan, increasingly uncertain about Wright’s value and having occasionally detected liquor on Wright’s breath, called him and demanded that he take the pledge of abstinence, at least for the duration of the Hague Conference. Humiliated, Wright refused and was thereupon dismissed from the State Department and from the Hague delegation.25
In the autumn of 1914, while the nation followed reports from a disintegrating Europe, Wright was totally absorbed in his private political career. Desperately he had sought support from medical authorities and the drug trade to influence the Conference Committee to reconsider the House and Senate versions of the Harrison bill, to include nothing unsatisfactory to any of the interested parties. He also wrote and telegraphed the President. After the antinarcotic bill passed, he began searching for “some large task” to take up. His correspondence is a pathetic series of rejections from prominent individuals and institutions.26 Although having denied that he was an office-seeker or wanted any personal connection with the new legislation, Wright asked the Treasury Department in January 1915 whether he might be needed for three months or so to get the whole apparatus set up and coordinated, or perhaps’ to write the regulations enforcing the Act. The Treasury, however, did not need him.27 He maintained an interest in the Harrison Act, but after 1914 his antinarcotic activities diminished. He still cultivated Theodore Roosevelt as well as regular Republican politicians, but nothing came of his efforts. Casting about for activity, he went to France in 1915 to help the Allied cause. While there he was,injured in an automobile accident from which he never fully recovered. Wright died in Washington, D.C., in January 1917 at the age of 49.
Wright had recognized defects in the law. He especially regretted Section 6, which permitted exempt narcotic preparations, but he agreed with Representative Harrison that without such a provision the proprietary interests would have scuttled the bill.28 He also regretted that the provisions for record keeping were less strict than originally proposed, but here he accepted the opinion of Representative Mann, who believed more strenuous requirements would result in the retail druggists’ blocking the law.
Wright believed he had a powerful remedy for these defects. Since the statute was the outcome of an international agreement, he assumed it could employ police powers within a state in addition to the traditional powers associated with a federal revenue measure.
This would give great importance to the words “prescribed in good faith,” enabling the federal government to argue, as it did, that this phrase prevented addiction maintenance. Without some legal sanction for- federal police powers in the states, the Act would be limited to record keeping. Wright based his optimistic expectation on the principle that a treaty to which the United States had become a signatory and which had been ratified by the Senate, would take precedence over state law. On this reasoning, if the Act did employ police powers within a state, such extension of federal activity would not be unconstitutional because the Act carried out a treaty, the Hague Convention. This issue was later considered by the Supreme Court in the case of Jin Fuey Moy (1916 ). Wright’s view was not sustained, the court majority holding with Justice Holmes that the specific form of the Harrison Act was not required by the Hague Convention. Charles Evans Hughes and Mahlon Pitney dissented, prompting Wright to express his appreciation and to assert that he had had Hughes’ own teachings on the subject in mind when the law was drafted.29
The Federal Position
A position similar to Wrighfs on the extension of federal police powers was uneasily anticipated by Frank Freericks, although not on grounds of treaty-making powers of the federal government. The prominent lawyer—pharmacist maintained in the Journal of the APhA that the Harrison Act did involve police powers and would attempt to regulate the selling and mode of selling of narcotics to consumers. Freericks strongly disagreed with those who maintained that the Act was merely an information-gathering device that relegated the policing of drug traffic to the states. Those who had proposed it, he maintained, understood that the states were not successfully curbing the abuse of drugs and that the Act’s purpose was to accomplish by federal power’s what the states were unwilling or unable to do.30
Strong objection to Freerick’s view was expressed by the Journal’s editor James H. Beal, one of the key NDTC negotiators with the federal government’.31 Also a lawyer and pharmacist, he disputed Freericks on the crucial question of police powers in the Harrison Act. In Bears opinion there were no police powers whatsoever. If police powers were implied in the Act, or if anyone tried to develop such powers under its authority, the Act would be quickly declared unconstitutional. Beal had only loathing for any “physician [who] has so far lost his sense of professional responsibility as to be willing to sell habit-forming drugs to habitués.” But the sole purpose of the Act was to gather information, which could then be conveyed to the state and local authorities. The states would continue to regulate the relationship between professionals and their clients. If the states failed in this task, then the Harrison law would be a failure: it could in no way remedy the states’ inability to enforce, or refusal to enact, drug-abuse laws. Freericks had argued that should the Act lack police powers to regulate the physician’s prescription of narcotics to his patients, then the law would merely transfer widespread selling of narcotics into a profitable monopoly for unscrupulous physicians. Beal answered that the phrase “in the pursuit of his professional practice only” would enable conviction of any unscrupulous physicians who simply sold drugs and prescriptions to satisfy the cravings of addicts.32
The Public Health Service shared Beal’s view of HR 628z. In a revealing letter to a woman who had taken morphine for many years and now complained that her supply would be cut off because of the Harrison Act, the Surgeon General replied in March 1915 that the Act was intended simply to gather information, and she could continue to receive morphine from her physician.33
The Bureau of Internal Revenue, on the other hand, took a some-what more stringent view. It prepared to bring actions against druggists and physicians as well as addicts who were violating the bureau’s understanding of the Harrison Act’s moral principle—that taking narcotics for other than medicinal purposes was harmful and should be prevented.34
The American Medical Association, in the person of Dr. Simmons, opposed the selling of narcotics to users without medical reasons. Whether or not the majority of physicians agreed that the habit was harmful is uncertain. But economics was only one factor complicating the physician’s relationship to narcotics. The number of physician-addicts was high. Medicine was ( and is ) the leading profession in rate of addiction, about 2 percent according to Wright’s survey. The profession was commonly believed to be one of the causes of most of the other addicts in the nation, and evidence, nowhere contradicted before Congress, revealed that physicians were the principal offenders.35 Perhaps the attitude of the public was not unreasonable, for a small percentage of physicians could maintain a considerable number of addicts if no restrictions were placed on their prescription powers. In contrast to such high-minded spokesmen for the AMA as Drs. Lambert and Simmons, a minority of physicians made substantial profits by prescribing narcotics to addicts and intended to continue this practice until forced to stop. Others devoted only a small portion of their practice to addicts. Although some physicians continued to feel no discomfort in maintaining habitués, medical experts as well as laymen commonly believed that addiction promoted criminal appetites and inclination, ruined the reproductive organs, and caused insanity.
Some of the public believed the Harrison Act prohibited simple maintenance, and, in fact, the Internal Revenue agents would begin enforcement on the premise that maintenance violated “good faith” in the practice of medicine. Detailed records would now be available to indicate the number of prescriptions and the amount of narcotics sold by doctors. If the “nonmedical” consumption of narcotics did not decrease substantially, the licensed professional was an obvious and relatively easy target for legal action.
DRUGS, ALCOHOL, AND THE PUBLIC
Passage of the Harrison Act came after consultation with the trade and professional interests concerned, from the obligation of America to other nations, and with the support of reform groups, but it was not a question of primary national interest. Although drugs later became a great popular issue, the passage of the Harrison Act in 194 seemed a routine slap at a moral evil, something like the Mann Act or the Anti-Lottery Acts. It went largely unnoticed because the question of controlling narcotics had none of the controversy associated vvith the prohibition of liquor. Perhaps half the nation saw nothing evil in moderate drinking. Most Americans described themselves as in favor of temperance, which could be interpreted as being opposed to public drunkenness. But almost no one ever used the term temperance in discussing the use of opiates or cocaine after 1900; by the teens of this century both classes of drugs were deemed in public debate to have no value except as medicine. The closest a public spokesman would come to defending such drugs would be to say that they were not especially harmful as compared say, with alcohol, and with a vigorous effort in progress to outlaw alcohol, the description did not protect narcotics from criticism.36 By 1914 prominent newspapers, physicians, pharmacists, and congressmen believed opiates and cocaine predisposed habitués toward insanity and crime. They were widely seen as substances associated with foreigners or alien subgroups. Cocaine raised the specter of the wild Negro, opium the devious Chinese, morphine the tramps in the slums; it was feared that use of all these drugs was spreading into the “higher classes.” 37
The only question publicly debated with reference to narcotics was how to control, not ( as in the case of liquor ) whether to control. Addiction and liquor prohibition were linked only in an indirect way in congressional consideration of the Harrison and related acts. First some congressmen were concerned that the prohibition of interstate commerce in drugs might be extended by teetotaling zealots to liquor, which had a brisk and legal interstate traffic flowing from wet to dry states. This question was settled in early 1913 with the passage of the Webb-Kenyon Act, forbidding shipments of liquor to states that prohibited its sale. The fact that Congress passed this Act over President Taft’s veto indicates the prohibitionists’ growing strength in both houses.38
Some congressmen feared that strict prohibition would only drive liquor and drug traffic underground. This reasonable concern was apparently overcome by the conviction that compromise should not be made with unquestioned evils. Liquor prohibitionists argued effectively that some illicit traffic would be better than national overindulgence in alcohol. The image of the ubiquitous saloon was a powerful propaganda weapon, for the saloon tempted not only the native American but especially the immigrant, whose moral qualities were under continuous attack by such groups as the Anti-Immigration League. Prohibitionists believed that their reform could be made to work, perhaps not perfectly but well enough to rid the nation of such glaring evils as the saloon. The movement was. supported by the characteristic Progressive assumption that government could change or neutralize the habits of large groups by well-written legislation and honest enforcement.
Public and congressional distinction between narcotic control and liquor prohibition was clearly shown during the middle weeks of December 1914. Part of a rush of legislation, the Harrison Act was approved in a few minutes, a fact not even noted that week in the New York Times summary of that session’s work.39 On the other hand the House set aside the entire day of 22 December for debate on a resolution introduced by Alabama Congressman Richmond Hobson to submit to the states a constitutional amendment mandating prohibition of alcohol. Parades and speeches marked the entry of thousands of supporters into the Capitol. The visitors’ sections of the House were packed with prohibitionists, and from the gallery was draped a petition with six million signatures calling upon Congress to submit the amendment to the states: the petition was the largest ever sent to Congress. At the Speaker’s dais charts depicted the progress of Prohibition across the nation, and between the side columns, until removed for violating House rules, large cartoons attacked liquor.40 Hobson, a hero of the Spanish-American War and in the 1920s and 1930s leader of a national lay movement against narcotics, delivered the day’s longest and most impassioned appeal for Prohibition. Hobson’s speech was modeled on his platform address “The Great Destroyer,” which he was to deliver many more times in the future as the Anti-Saloon League’s highest-paid publicist.41
Supporting the Prohibition resolution, Representative Charles A. Lindbergh, Sr., of Minnesota spoke for the opportunity to “record our votes in favor of our race—to save the boys and girls who will become the future citizens and rulers of our country.” 42
The attack against Hobson’s resolution was led by Speaker of the House Oscar W. Underwood, also of Alabama.43 Underwood, who had shepherded the Harrison Act through the House the previous week, described the Prohibition Amendment as a “tyrannous scheme to establish virtue and morality by law.” 44 Congressman Mann, who had joined Harrison in arguing for the antinarcotic act the previous year, proposed that the Prohibition Amendment be submitted to conventions in the several states, an obstacle quickly rejected by the dry forces.
When the vote was taken the drys outnumbered the wets by 197 to 19o,,although they fell short of the two-thirds majority needed for adoption of the resolution. But it was a strong warning of what was to come; three years later almost to the day, the House passed a Prohibition resolution (282 to 128 ) differing little from the one submitted by Hobson. It outlawed the manufacture, sale, and transportation of liquor within, into, and out of the United States. The amendment was to become effective one year after three-quarters of the states had ratified. The Senate passed the proposed amendment on 18 December 1917, by 47 to 8, and within thirteen months it was part of the Constitution.
The funds spent annually by the liquor lobbyists, the Anti-Saloon League, the Women’s Christian Temperance Union, and other organizations went into the millions of dollars. National Prohibition, even though twenty-seven of the forty-eight states were prohibitionist already, was bitterly debated. If the vote on the resolution to submit the amendment to the states had been secret it is unlikely it would have been passed. Since the vote was by roll call, the well-organized strategists for Prohibition were able to use political threats effectively. Many congressmen feared for their political careers should they vote nay. The United States had been at war since April 1917, and the hysteria that gripped the nation in its crusade against the Kaiser extended to a firm belief that liquor sapped the nation’s strength and will power, and even depleted the cereal grains that could be used in bread for the troops and starving Europeans. Prohibition was not, however, merely the result of wartime excitement and fears: it had been steadily gaining ground since before 1900, beginning in the South and West and extending eventually over most of the country.45 Prohibitionists, who favored the “pledge” against all liquor and would profess such a standard in their own lives, favored narcotic prohibition; the combatants in the fight against narcotics, however, were often divided on the liquor question. Bishop Brent had early distinguished between narcotic and liquor prohibition. He believed that liquor had a “beverage value” and therefore was in the class of nutrients; but narcotics, unless taken for medical reasons, had no value whatsoever. Wright’s views on liquor seemed to go at least as far as Brent’s; Representative Harrison was never accused of abstemiousness.46
During the four years between Hobson’s resolution and ratification of the Prohibition Amendment, the control of addiction moved toward a more prohibitory style of enforcement. The required tightening of restraints on narcotics came from an amendment and Supreme Court rulings in early 1919, a few months after the national victory of the temperance forces. Occasionally breaking into newsprint, the evolution of the Harrison Act’s enforcement policies, after initial setbacks, ended in the triumph of those who believed the law had a moral effect and was designed to prohibit the use of narcotics for the maintenance of “mere” addiction.
1 The first Harrison bill (HR 1969 ) was introduced in 1912.
2 For the rules under which the NDTC operated and its initial membership see JAPhA 2 : 238-39 ( 1913 ) .
3 The PAA officials, who happened to be in the New Willard Hotel at the time of the meeting, assured the NDTC that they were “entirely satisfied with the provisions of the proposed legislation regarding narcotic drugs as it would not in any way affect the interests of the Proprietary Association” (JAPhA 2 : 236-37 ). The PAA, having noted inclusion in the Harrison bill of the standard exemption dating back to the 1905 model law, was uninterested by other provisions of the bill which dealt with transactions of narcotics above the exempt amounts. Nevertheless, there were efforts made by proprietary interests to raise the exempt amounts eventually adopted by the House the following June. The Harrison Act when approved in December 1914 had exemptions above those recommended by the NDTC and the House in June 1913. See also NARD Notes which described Wright’s behavior as “distinctly antagonistic” toward the retailers (15 : 1004,23 Jan. 1913).
4 JAPhA 2 : 247 ( 1913); J. H. Beal, editorial, JAPhA 2 : 737-40 ( 1913 ). The NDTC delegates visited Harrison’s office and angrily denounced HR 1969 and demanded the changes which had been unanimously approved by the NDTC. Wright returned to negotiations and did not submit a revised bill to Harrison until differences were reconciled. Wright insisted that passage was important before the Second Hague Opium Conference met on i July.
5 At the next meeting of the NDTC, April 1913, the executive committee met both before and after the plenary sessions. Of great significance in regard to the drug trades’ view of federal police powers was an executive committee resolution, later adopted by the NDTC, that the proposed bill affected suppliers but not consumers ( i.e. patients). Relationships between them and retailers and practitioners would be regulated as usual by state law ( JAPhA 2 : 628-33 [19131).
6 James G. Burrow, AMA, Voice of American Medicine (Baltimore: Johns Hopkins Press, 1963), pp. 51-52,62 ff.
7 The issues of the Medical Economist ( New York) and the Illinois Medical Journal (Chicago), two of the outspoken defenders of the “humble general practitioner,” contain voluminous references to the elitist reform notions of national medical leadership prior to 1919-20. Fishbein’s interview ( ch. 3, n. 8 below ) also provides evidence that “liberal” views predominated in the AMA’s pre-World War I leadership, which included such men as Drs. George Simmons, Frederick Green, and Alexander Lambert.
8 “Report of the Judicial Council,” JAMA 65 : 73-92 ( 1915); see Burrow, AMA, pp. 141-45; R. Stevens, American Medicine and the Public Interest (New Haven: Yale Univ. Press, 1971), pp. 136-39. George H. Simmons was a journalist who received a rather sketchy medical training at Rush Medical School in Chicago, obtaining his degree in 1882. He eventually entered obstetrical and gynecological practice in about 1885 in Lincoln, Nebraska, where he established a hospital. Dr. Simmons aroused a furor over alleged abortions, and he quit practice to become in 1899 the first full-time executive secretary of the AMA and editor of the JAMA. His remarkable organizational abilities assisted the rapid growth of the association after 19oo and his editorial talents raised its journal to a respected and powerful status as the leading voice of medical opinion. In 191i he relinquished the post of executive secretary, but remained the single dominant figure in the AMA until his retirement in 1924. He was succeeded by Dr. • Morris Fishbein who had been assistant to Dr. Simmons since 1913; upon retirement Dr. Simmons burned his personal papers (my interview with Dr. Morris Fishbein, 13 Jan. 1972, New York); Morris Fishbein, M.D., An Autobiography (Garden City, N.Y.: Doubleday, 1969), pp. 36-38, 93; Burrow, AMA, pp. 28 ff., 51.
9 Burrow provides evidence in many areas of the growing conservatism of the AMA after 1918 (AMA, pp. 146 if.).
10 “An Act Supplemental to the National Prohibition Act,” 23 Nov. 1921, 42 Stat. L. 222.
11i Like other medical journals, the JAMA, under Simmons’s leadership, condemned simple maintenance of addiction: “merely to satisfy the cravings of the victims of the drug habit . . . would clearly appear [to be] an offense against the welfare of the community . . . much more serious than the mere infraction of a revenue law of the United States” ( “State Rights, State Duties, and the Harrison Narcotic Law,” JAMA 67: 37-38  ).
12 “Protection against Dangerous Drugs,” JAMA 46 : 1208-09 ( i906 ).
13 One of the reasons the APhA originally saw some merit in the British health insurance scheme was that it clearly spelled out the relationship between pharmacists and physicians. See JAPhA 6 : 314-17 ( 1917 )• Like the AMA, the APhA soon turned against federal and state control of the health professions. See Burrow, AMA, p. 146 n.
14 The NARD under the leadership of Frank Freericks led the battle for equality in the onerous burden of recording retail narcotic transactions. By making dispensing for the doctor as cumbersome as for the pharmacist, it was hoped that the dispensing physicians would revert to prescribing ( “The Harrison Conference Bill,” JNARD 17 : 134-35  ). Pharmacists also resented the massive public relations and lebbying tactics of the AMA ( editorial, “Legislative Organization: Have a Laugh with Us,” JNARD 17 : 73-74 ).
15 Physicians were pictured by pharmacists as well as by many reformers as the leading culprits in the creation of addicts. To omit physicians from strict record keeping, claimed an editorial of the JNARD, would leave “a loophole through which dispensing physicians if so disposed may continue to cart wagon-loads of narcotics for improper purposes” ( 17 : 965  ). The NARD created a scare among proponents of the Harrison bill in the summer of 1914 when it reopened the question of equalizing burdens among physicians and pharmacists. The NARD explained that it merely wished to suggest changes, not demand revision, but the telegram sent by the Philadelphia Convention to Treasury Secretary McAdoo did not seem very conciliatory (i8 Aug. 1914, PHSR ).
16 HW to Lloyd Bryce, Minister, The Hague, 18 March 1913 ( WP, entry 36); HW to WJB, 31 May 1913 ( WP, entry 36),
17 In formulation of the opium bills in 1912 and 1913, Wright mentions a joint committee of the State and Treasury Departments. During the Taft Administration the bills were examined by Treasury Assistant Secretary James F. Curtis and Commissioner of Internal Revenue Royal E. Cabell. The Commerce Department was also involved, but in a less intensive way because the burden of enforcement would be in the Treasury ( see HW to Francis W. Taylor, private secretary to the Secretary of the Treasury, 27 Nov. 1912; HW to Francis Burton Harrison, 10 Feb. 1913; HW to WJB, 31 May 1913, WP, entry 36). Wright, therefore, mediated between the interdepartmental committee and the NDTC in formulation of the final form of the Harrison bill, HR 6282, introduced so June 1913. The President assisted momentum for the bill by strongly urging its passage in a message asking for an appropriation to cover participation in the forthcoming Second Hague Conference. Wilson termed failure to take the few final steps in the worldwide movement “unthinkable” (Cong. Rec., Senate so : 265, 21 April 1913, 63rd Cong. Special Sess.).
18 For the debate in the House see Cong. Rec., House, 50, pt. 3 : 21912211, 63rd Cong., 1st Sess., 26 June 1913 ( GPO 1913); for the Committee report see “Registration of Producers and Importers of Opium,” etc., House Rept. no. 23, 24 June 1913, 63rd Cong., 1st Sess.. (GPO, 1913). President Wilson urged the Senate to adopt the legislation “recently passed by the House of Representatives without a dissenting vote [to which] this government is now pledged . . . as soon as possible during the present session of Congress.” This request accompanied Wright’s report on the Second Hague Conference, Second International Opium Conference, Senate Doc. no. 157, 63rd Cong., ist Sess. (GPO, 1913).
19 For changes see Senate Finance Committee’s “Registration of Persons Dealing in Opium,” Senate Report no. 258, 18 Feb. 1914, 63rd Cong., and Sess. (GPO, 1914). Among other changes, the committee added hypodermic syringes and needles to the list of controlled items.
20 [J. H. Beal], “The Senate Amendments to the Harrison Bill,” JAPhA 3 479-81 (1914). The report of the President’s Homes Commission stated that a course of the Tucker Asthma Cure cost $12.50 [Report of the President’s Homes Commission, Senate Doc. no. 644, 8 Jan. 1909, 6oth Cong., and Sess. (GPO, 1909), pp. 269-701.
21 Cong. Rec., Senate, 51, pt. io : 760, zo June 1914, 63rd Cong., and Sess. In later withdrawing his amendment, Senator Atlee Pomerene claimed it was prompted by an overly strict recording requirement directed at physicians by Senator Knute Nelson. When the Nelson threat passed, Senator Pomerene dropped his opposing amendment (Cong. Rec., Senate, 51, pt. 23 579, 15 Aug. 1914, 63rd Cong., and Sess.).
22 “Conference Report and Statement,” Cong. Rec., House, 51, pt. 16 : 16, 818-19 submitted zo Oct. 1914, 63rd Cong., 2nd Sess.
23 Bryan reported to President Wilson shortly after the Second Hague Conference that “some of the members of the [House Appropriations] Committee even objected to Wright’s being continued at any price.” At the time Wright was being paid out of the Secretary’s emergency fund ( WJB to WW, 2.2 Aug. 1913). In May 1913 Bryan penned a personal note to the President that “the doctor looks like a drinking man” ( WJB to WW, 24 May 1913, Library of Congress: Woodrow Wilson Papers, ser. 4, box 93, case file 77, “Opium”).
24 WJB to WW, 12 Aug., and 16 Aug. 1913 (LC, Woodrow Wilson Papers, “Opium”).
25 The Appropriations Committee had remained hostile to Wright, but the State Department needed to send a representative to the Third Hague Conference, preferably Wright because of his long association with the work. The need became more urgent, although by spring 1914 Bryan wished he did not have to deal with Wright. He was, however, the acknowledged expert in the legislative negotiations and was brought back to the State Department early in the year to coordinate both domestic and foreign aspects of the antiopium campaign. In March Secretary Bryan wrote the President that “Mr. [William] Phillips [Assistant Secretary of State] also notes what I have reported on former occasions, viz., that Dr. Wright’s breath smelt of liquor” ( 21 March 1914, Woodrow Wilson Papers, “Opium”). The demand that Wright “take the pledge” came on the 6th or 7th of June. Wright’s lengthy memorandum to the President giving his side and the pressing need to leave on the 9th if he was to get to The Hague on time, is dated 7 June 1914 (WP, entry 36). President Wilson’s affirmation of Bryan’s dismissal of Wright is dated 17 June 1914 (Woodrow Wilson Papers, “Opium,” and WP, entry 36).
26 “Free for some large affair,” HW to William H. Welch, Professor of Pathology, Johns Hopkins Medical School, 26 Oct. 1914 (WP, entry 36). See also E. G. Adami, McGill Univ., to HW, 22 Sept. 1914; William Loeb, Jr., Guggenheim Exploration Co. to HW, 8 Dec. 1914; George Wickersham to HW, 19 Sept. 1914 (WP, entry 36).
27 HW to Andrew J. Peters, Asst. Secretary of the Treasury, 16 ran. 1915; A. J. Peters to HW, 2o Jan. 1915 (WP, entry 36). At about this time Wright was preparing an article which for his career had a prophetic title: “The End of the Opium Question,” American Review of Reviews, April 1915, pp. 464-66.
28 “I have no sympathy with these proprietary or patent medicine people. I would like to exclude the use of narcotics entirely from ever» one of these patent medicines if I thought we could do it,” declared Rep. Harrison during the House debate, in opposing an amendment to HR 6282 which would have cut in half the permissible limits for exempt preparations in Section 6 (Cong. Rec., House, 50, pt. 3 : 2211, 26 June 1913, 63rd Cong., 1st Sess. ). The amendment was defeated on a voice vote. In arguing against reduction in the exemption limits Rep. A. P. Gardner of Massachusetts predicted that unless the section was approved as negotiated with the drug trades, “interminable delay is in store for this bill” (p. 2210). Similarly, Rep. James Mann of Illinois: “Unfortunately I am forced to believe that if we should attempt in this way to attack all the proprietary medicines which contain opium, the bill would have a rocky road to travel, and would be consigned to oblivion. That may not be a very good excuse, but, after all, it is practical” (p. 2210).
29 241 US 401 (1916). HW to Charles Evans Hughes, 28 June 1916 (WP, entry 36). Wright was unaware that Hughes did not wish to stand alone in dissent against the Holmes decision, and voted against it only after Justice Pitney determined to take exception. Neither explained the grounds for his dissent. See Merlo J. Pusey, Charles Evans Hughes,vols. (New York: Macmillan, 1952), 1 : 286-87.
30 “More about the Harrison Bill,” JAPhA 3 : 1-4 (1914).
31 Beal had introduced the resolution to the NDTC in April 1913 that the Harrison bill would not affect the consumer ( see above, ch. 3, n. 5).
32 Editorial JAPhA 4 : 4-8 ( 1914 ).
33 The Public Health Service followed a consistent policy toward the many requests for aid directed its way after March 1915. The service could legally care only for merchant seamen and a few other small groups such as some Indians, and made this very clear to importunate local officials and distressed individuals ( Asst. Surgeon General to H. L. Lea, 24 March 1915, PHSR ). There was also a request from Shreveport, Louisiana, that a hospital be established there to care for drug addicts because “a large number of helpless people are becoming mentally deranged on account of the nforcement of this law” ( Rep. J. T. Watkins, 4th Louisiana District, to the SG, 11 May 1915, PHSR ). This request is of interest since Shreveport was the site of the still controversial narcotic clinic operated by Dr. Willis P. Butler from 1919 to 1923 ( see ch. 7).
34 The attitude of the Bureau of Internal Revenue is clearly revealed in its immediate steps to indict “dope doctors” and unscrupulous pharmacists. That such a disparity should exist within two branches of the same department ( the PHS was at this time part of the Treasury) is partly a reflection of the peripheral place the PHS held in social policy planning of the federal government.
35 Considerable evidence was submitted, without effective rebuttal, that the percentage of physicians addicted was very high. In 1899, Dr. T. D. Crothers reported on a nine-year , study involving 3,244 physicians and warned that 6% or more used morphine or opium regularly. He was convinced that 8—io% of physicians were secret or open drug and morphine habitués ( “Morphinism among Physicians,” Med. Record 55 : 784— 86 ). When the Medical Economist of New York opposed a state legislative proposal which would rescind the licenses of physician-addicts, their response did not deny that there were a sizable number of addict’s, but recommended that the economic conditions of physicians should be improved so that a “great many of the gifted members of the profession [would not need] to seek relief in narcotics” (2 : 52  ). See S. Garb, “Drug Addiction in Physicians,” Anesthesia and Analgesia 48 : 128-33 (1969); R. B. Little, “Hazards of Drug Dependency among Physicians,” IAMA 218: 1533-35 (1971).
36 The Prohibitionist rarely belittled the narcotic problem, since he was opposed to the use of both drugs and liquor. Narcotics have been perceived as so mysteriously evil that few antinarcotic reformers ever felt the propriety of showing the often greater damage done to the physique and to society by alcoholism. One of the authorities in America who consistently tried to put narcotics and alcohol into perspective was Dr. Lawrence Kolb, Sr., of the Public Health Service. He liked to quote the British writer on inebriety Norman Kerr, who said in the late 19th century, “Whisky maddens man, while opium soothes him.” Kolb had his own saying that there was more violence in a gallon of alcohol than in a ton of opium ( Use of Narcotics in the United States, Hearing before the Committee on Printing, 3 June 1924, 68th Cong., ist Sess. [GPO, 1924], p. 27).
37 That narcotics use was spreading into the higher classes was, although without any specific evidence, the “theme of the APhA studies in 1901-03 (Proc. APhA 49 [19011’51  ); Hamilton Wright’s “Report on the International Opium Commission and on the Opium Problem as Seen Within the United States and Its Possessions” ( contained in Opium Problem: Message from the President of the United States, Senate Doc. no. 377, 61st Cong., 2nd Sess., 21 Feb. 1910); the Special Committee of the Secretary of the Treasury (1919 ); Richmond Hobson’s crusade against narcotics in the 1920S and 193os; the campaign against marihuana in the /93os, and so on. In other words dangerpus drugs have been believed to be spreading into the middle and upper classes for almost a century at an alarming rate. This must be balanced against the claim, such as that made by Dr. George Beard in American Nervousness: Its Causes and Consequences (New York: Putnam, 1881 ), that America is generally an avid drug-using country, and the statement in “Quackery and the Quacked,” Nat. Quart. Rev. 2 354 (1861), that there is a national penchant for drugs and drug use. •
38 Andrew Sinclair, Prohibition: The Era of Excess ( Boston: Little, Brown, 1962), p. 154; Peter Odegard, Pressure Politics: The Story of the Anti-Saloon League (New York: Columbia Univ. Press, 1928), pp. 139-48.
39 The N.Y. Times noted the passage of the Harrison Act on z Jan. 1915.
40 See Odegard, Pressure Politics, pp. 151-59; Sinclair, Era of Excess, pp. 155-56; for the House debate, see Cong. Rec., House, 52, pt. 1 : 4956i6, 63rd Cong., rd Sess., 22 Dec. 1914.
41 Richmond Pearson Hobson (187o-1g37) became one of the heroes of the Spanish-American War. For this he was eventually awarded (1933) the Congressional Medal of Honor and much sooner became “the most kissed man in America” as he took to the speaking circuits to describe his exploits. A confection was even named after him, “Hobson’s kisses.” He moved from his personal adventures to warning of the “yellow peril,” particularly the Japanese. He served from 1906 to 1915 in Congress, from his native Alabama, and became one of the leading Prohibitionists. Defeated in 1914 in a Senate race against the powerful Oscar W. Underwood, he still had time to introduce the Hobson Resolution on Prohibition which foreshadowed the eventual defeat of the wet forces. In 1922 he progressed from liquor prohibition to narcotic prohibition with the zeal, platform style, exaggerated fears, and pseudoscientific warnings which had marked his liquor speeches. In 1933 he published Drug Addiction: A Malignant Racial Cancer; the following year Congress approved his promotion on the retired list to rear admiral. He died in 1937.
42 Odegard, Pressure Politics, p. 569.
43 Oscar W. Underwood (1862-192g) was a representative from Alabama from 1895 to 1915, when he entered the Senate. He was House Majority Leader from 1911 to 1915, and in 1912 a candidate for the Democratic presidential nomination. His outstanding legislative achievement was the Underwood Tariff Act of October 1913 which lowered and reformed tariff in a manner generally applauded ( Arthur S. Link, Woodrow Wilson and the Progressive Era, 1910-1917 [New York: Harper and Row, 1954], pp. 35-43).
44 Underwood quoted an editorial in the Louisville Courier-Journal (Cong. Rec., House, 52, pt. S : 520, 63rd Cong., 3rd Sess., 22 Dec. 3.914). When Harrison was appointed governor-general of the Philippines, Underwood took over from his colleague the responsibility of seeing the Harrison bill through the House. Mention of narcotics in the Hobson debate occurred when Prohibitionists pointed out that the federal government had taken steps against the narcotic evils and should not hesitate to take a similar stand against alcohol (p. 513). But when Rep. Hobson linked the two by claiming in the preamble to the original HR 168 that “exact scientific research has demonstrated that alcohol is a narcotic poison,” he was rebutted by Rep. Andrew Barchfeld, a physician from Pittsburgh, who, called the statement “either a play on words or an outright misstatement. • In either event it is misleading, and flies in the face of medical practice and physiological science” (p. 555). In his major speech of the debate, Hobson frequently refers to alcohol as a “habit-forming drug,” as well as by standard epithets, “a protoplasmic poison,” and the “loathsome excretion of a living organism.” As he would say of heroin in the 1920s, alcohol attacked the “top part of the brain,” the location of man’s higher instincts (pp. 602-09). But opponents of Prohibition also used the specter of narcotics to support their arguments, as when Rep. James Gallivan of Aoston warned that drug use would increase if national Prohibition were instituted (p. 581). It appears from the debate that a strong concern of the opponents to the constitutional amendment was the precedent of invading traditional states’ rights. The South clearly expressed its fear that Congress in the future would force upon that region voting rights for Negroes, destruction of its segregation laws, etc. (see statement by Rep. R. L. Henry of Texas, p. 542). Rep. Edward Pou of North Carolina explained that voting rights had been taken away from Negroes not in anger or with malice but “as the adult takes the pistol from the hand of the child.” He feared that three-fourths of the states might approve an amendment requiring universal male suffrage if one were submitted (p. 597). Hobson attempted to assuage some of the fears of the South by claiming that liquor makes the Negro a brute, causing him “to commit unnatural crimes.” The white man has the same tendency except that “being further evolved it takes longer to reduce him to the same level” (p. 605). And for all who revered medical progress and efficiency, he called national Prohibition “scientific treatment for a deep organic disease” (p. 504).
45 In 1913 the argument for the Webb-Kenyon Act had been that the federal government should take this last step, the ultimate in helping the states that so wished to maintain Prohibition. The government was declared not to have the power to enforce it by federal constitutional powers. But the overwhelming congressional support given to the Webb-Kenyon Act, and its passage over Taft’s veto, encouraged a growing sentiment among dry forces to campaign for national Prohibition by a constitutional amendment. See Odegard, Pressure Politics, pp. 149 if; also Charles Merz, The Dry Decade, reprint of 1931 ed. ( Seattle: Univ. of Washington Press, 1970), pp. 14-17.
46 I interviewed Dr. Victor Heiser, 25 March 1970 in New York City. Dr. Heiser was Health Commissioner under Governor-General Harrison. In Dr. Heiser’s opinion, Governor Harrison’s tenure was marked by personal scandal which brought the American government into disrepute.