159 * * * * * THE NATIONAL PROHIBITION LAW * * * * *

Mr. CODMAN. Mr. Chairman, my next witness will be Doctor Woodward. While Doctor Woodward is stepping up here I will just explain who he is. Doctor Woodward comes here as a representative of the American Medical Association, and he will speak in regard to the bill which has been presented by Senator Edge which suggests changes in the provisions of the Volstead Act in regard to physicians and the control under which they are now suffering.

TESTIMONY OF DR. WILLIAM C. WOODWARD, 535 NORTH DEARBORN STREET, CHICAGO, ILL.

(The Witness was duly sworn by Senator Means, chairman of the Subcommittee.)

Senator MEANS. Doctor Woodward, give your full name to the reporter.

Doctor WOODWARD. William C. Woodward, appearing as the representative of the American Medical Association. My address is 535 North Dearborn Street, Chicago, Ill.

Senator MEANS. Go ahead in your own way, Doctor.

Doctor WOODWARD. I Want to make it clear that so far as the American Medical Association is concerned its interest lies solely in the question of the medicinal use of liquor and what I shall say will have reference only to that. With the larger question of the prohibition of the use of liquors as beverages the American Medical Association as an organization is not concerned.

In the effort to carry into effect the prohibition of the beverage use of liquor it was deemed necessary to apply certain restrictions on the medicinal use of liquor. There is no question under the law as to the necessity or the advisability of the use of liquor in medicine.

160 * * * * * THE NATIONAL PROHIBITION LAW * * * * *

The law clearly recognizes that necessity, and permits its use. The difficulty lies, however, in the restrictions that the law has placed on the physician who would prescribe liquor; in the first place the restrictions that relate to the quantity he may prescribe, and in the second place the restrictions upon the frequency with which he may prescribe.

The Volstead Act itself forbids any physician or physicians from prescribing for any one person in any 10-day period more than 1 pint of liquor. The Willis-Campbell Act supplemented that by forbidding, of course, the prescribing of all of malt liquor and by limiting the quantity of vinous liquor that might be prescribed. The quantity of vinous liquor was fixed at 1 quart, the alcohol content not to exceed 24 per cent. There was the further provision that no combination of spiritous and vinous liquor is to be prescribed in any 10-day period for any one patient if the alcohol content exceed one-half pint, so that we have in effect a prohibition of the use of more than one-half pint of alcohol for any one–––

Senator MEANS (addressing the audience). I really must request again that you be quiet. If you can not, please go elsewhere. We want to hear the witness, and the reporter can not hear him if you do not keep quiet. Pardon me, Doctor.

Doctor WOODWARD. We have, then, the absolute limit of one-half pint of alcohol in 10 days that may be prescribed by any one or more physicians for any one patient under any conditions except one.

The law apparently recognizes that under certain conditions the dosage allowed is inadequate, and for an alcohol patient who can go into an asylum or hospital for the treatment of inebriety the law allows a limited quantity. That is under regulations, of course, made by the Commissioner of Internal Revenue, but the use is in accordance with the usage of that particular institution.

The Volstead Act allowed the use of this amount, the amount fixed in the Volstead Act, 1 pint in 10 days, for internal use. The Willis-Campbell Act was silent as to whether the allowance there was for internal use or external use or both. Under regulations made by the Commissioner of Internal Revenue, that act is interpreted so that this maximum of one-half pint of alcohol in 10 days for any one patient covers both internal and external use.

The position of the American Medical Association, and I think I might say, the medical profession, is that the determination of the dosage of alcohol, in whatever form it may be given, should be left to the physician himself. We consider any law illogical and unsound that prescribes the same dosage for an infant in arms that it does for an adult, that prescribes the same dosage for a man with a cold that it does for a man with pneumonia, that allows the same dosage for a man that has never taken a drop of alcoholic stimulant as a beverage in his life that it allows for a man who has been a chronic drunkard. We contend that a law is illogical that says to a man who is on the border of delirium tremens, "Yes, you ought to have an allowance of alcohol considerably in excess of your I pint in 10 days, and if you are so fortunate as to be able to enter an asylum or sanitarium where patients of your class are treated you may have it, but nowhere else. Not in your home, in the hospital, in the station house, or jail if you are locked up, can you have the required dosage."

161 * * * * * THE NATIONAL PROHIBITION LAW * * * * *

Senator HARRELD. Doctor, from the proof of the amount of illicit liquor that is sold I should say you ought to have no trouble in that respect.

Doctor WOODWARD. I think you will probably find some testimony from medical men as to how that need is supplied. But if I may interject at this point, I want to say that the American Medical Association has not countenanced any violation of law on the part of its members.

Senator REED of Missouri. I understand the position of the Senator from Oklahoma to be that the doctors ought to join the bootlegging gang because we passed an idiotic law.

Senator HARRELD. Not at all. What I mean to say is this. There is plenty of liquor going around, and a sick man can call in a bootlegger and get all he wants.

Doctor WOODWARD. I think that is not infrequently done. But as I say, the American Medical Association has expressly counseled its State and county societies not to tolerate known violations of law among its members. We stand for compliance with the law, even though we may object to the law.

So, in the first place, we are in favor of the legislation that is pending here, in so far as it raises the limit on the quantity that may be prescribed.

The law goes a step further and imposes another restriction on the prescribing of liquor, limiting the number of prescriptions that may be issued by any one physician to 100 in 90 days. The man who is just out of medical school and has taken his license for the first time and has opened his office only yesterday may get 100 prescription blanks. The man who is doing a large metropolitan practice can get 100 prescription blanks. Quite obviously that is not a logical arrangement.

It is true that the Willis-Campbell Act does provide that if the physician can show to the Commissioner of Internal Revenue some extraordinary reason why he should have more at some particular time he can get the additional quantity, but in order to get the additional blanks he must make application to the local prohibition administrator, showing why he should have them, the local prohibition administrator must investigate the case and report to the Commissioner of Internal Revenue, and if the Commissioner of Internal Revenue is satisfied that the physician, off in some remote part of the country, ought to have a few extra prescription blanks, he sends word back to the local prohibition administrator that that doctor may have them. There again we think the law is illogical. Something was said this morning with respect to the use of counterfeit prescription blanks, and I gathered from what was said that it was understood that those prescription blanks were being used and signed by physicians. That was the first time that I had heard that intimated. mated. I had heard before that there were innumerable counterfeit prescription blanks, as many as 5,000,000 at one time in the drug stores of New York City, but I did not understand that the doctors were alleged to have used them.

It would hardly be a safe thing for a doctor to use those prescription blanks, because the local prohibition administrator has a record of the prescription blanks that are issued to each physician. All of

162 * * * * * THE NATIONAL PROHIBITION LAW * * * * *

them are numbered, and if he picks up anywhere, in any of the drug stores in the district over which the administrator presides, prescriptions signed by that physician that do not correspond in number with those issued officially, or if he picks up duplicates of any number that was issued officially, he knows the doctor has done wrong, and he has ample power under the law to summon him to his office, to hear the evidence, and to revoke his license. I do not believe you will find that the counterfeit prescription blanks are being used by physicians. At any rate, we believe the limit ought to be taken off.

There is another objectionable thing with respect to the Volstead Act and with respect to the regulations that are made under the Volstead Act and under the Willis Campbell Act, and that is the requirement that a physician disclose in his records and in his reports that he makes to the prohibition administrator the nature of the illness from which his patient is suffering.

The statute itself requires that the physician keep in his record a record of the nature of the illness or the cause for which the prescription is issued. That record book is open to inspection, not merely by officers of the prohibition forces, but by peace officers generally in that jurisdiction. A thing of that kind tends to break down the confidential relations between physician and patient.

Then, going a step further, every physician must enter on the stub of his prescriptions the nature of the illness, and then when he gets his new book of prescriptions he must turn in those stubs, placing in a public office the nature of the disease. Quite obviously, as is recognized very generally by the statutes governing privileged communications over this country, it is desirable to encourage a confidential relation between the physician and the patient. Otherwise a man who is suffering from a disease or a condition that might disgrace him will hesitate to consult a physician as promptly as he ought, or if he consults a physician he will try to conceal that disgraceful condition that he does not care to have disclosed. Or in the present instance a physician who is inclined to protect the reputation of his patient will be tempted to use some remedy other than alcohol when he may know that alcohol is, after all, the very best remedy that can be used.

We believe that in connection with the prescribing of liquor a certain amount of protection should be given the physician by the legislation that has been proposed providing penalties for those who counterfeit prescription blanks and for those who forge prescription blanks. We believe, further, that the doctor ought to be protected somewhat and that the man who comes to a doctor pretending and fraudulently endeavoring to obtain a prescription or to obtain liquor for supposed medicinal purposes and then converts it to beverage purposes ought also to be penalized.

I think you will find that no inconsiderable number of young doctors beginning practice, and, it may be, in need of money, are tempted to do wrong when they should not be tempted, and if they were not tempted they would remain law-abiding citizens. We believe it would protect them if some provision were made whereby the man who comes in and misrepresents his case or undertakes to buy prescription books or anything of that kind will be a criminal along, with the doctor.

163 * * * * * THE NATIONAL PROHIBITION LAW * * * * *

Finally, we believe that some provision should be made whereby when a physician undertakes to obtain pure liquor for a patient he will obtain it, and by that we mean that retail sales of liquor should be limited so far as possible to bottled in bond packages.

At the present date everyone knows there is considerable adulteration of liquor. It seems to be a thing that is very difficult to cope with, and for various reasons. One is the temptation to adulterate and the other is the difficulty of obtaining fair samples for tests.

You can not go into a drug store and pick up a sample of liquor without the druggist knowing what it is for, unless you can get somebody to write a prescription. And there is nothing in the law that I know of that authorizes a doctor to write a prescription that a prohibition officer can take into a drug store and that the druggist does not know is not to be used for medicinal purposes.

We believe that sales of whisky should be limited as far as possible to bottled-in bond packages.

The medical profession is not asking freedom from restrictions, and I want to make that perfectly clear to this committee. We realize that with 150,000 physicians in the United States, representing the average group of human beings, that if the doors were thrown wide open for prescribing that the medical profession might get into the bootlegging class sure enough. So, in lieu of the restrictions on the quantity that may be prescribed, and on the number of prescriptions that we may issue, it has been proposed, with the sanction of our board of trustees, that when a physician prescribes more than one pint in 30 days he be required to certify in connection therewith that in his judgment it is a medical necessity and will relieve the patient from some known illness; and that he be required at the same time to send a copy of that certificate to the local prohibition administrator.

Any local prohibition administrator getting certificates of that kind, coming into his office day after day, and keeping track of them by physicians and by patients, could very readily under the power he has, if he felt any physician was prescribing for other than medicinal purposes, summon that physician into his office, as he has a right to do under the Volstead Act to-day, and could revoke his permit if he found that physician was prescribing unlawfully.

What we are asking is not ultimately in the interest of the medical profession, but what we are asking is we feel for the benefit of the sick, to enable doctors to treat the sick as they should be treated according to their best judgment. So far as the medical profession is concerned they have only the human interest and the professional interest that lies with seeking some means properly to treat their patients.

Senator REED of Missouri. What about absolute prohibition of malt liquors, as to its effect in cases of illness?

Doctor WOODWARD. That has not been taken up by the medical profession itself. In fact, an effort was made to have the medical profession, that is, our organized medical profession, pass upon the therapeutic value of liquor, but after mature consideration one of our committees reported that it was not a matter that could be settled by a vote of the organized medical profession, but was rather. a scientific problem to be settled at the bedside and in a scientific way, after a scientific study.

164 * * * * * THE NATIONAL PROHIBITION LAW * * * * *

Senator REED of Missouri. Is it fact that the amount of whisky that you can legitimately prescribe is insufficient?

Doctor WOODWARD. From the action of our house of delegates, a representative body of medical men from all over the country, and from the correspondence I have, there is no question-but that the limit is inadequate. The I pint of whisky in 10 days represents 32 tablespoonfuls, or 3 tablespoonfuls a day. That is not a very heavy dosage. One would say that an average dose of whisky would run from 4 to 6 ounces.

Senator MEANS. You mean it is not heavy for some people?

Doctor WOODWARD. It is not heavy for some people, but would be heavy, for instance, for infants. And it may be that some patients will not need more than that for a full 10 days, but the doctor who administers in any case and increases the average at the beginning may before the end of the illness find himself unable to give any liquor at all. He has no means of looking ahead.

When it comes to a man brought in after a debauch and who has been using moonshine, or in the case of a workman who has been using moonshine and is brought in with an injury, where according to one school of physicians, or one school of thought, you ought to cut down his liquor at the rate of 2 or 3 ounces a day. And some others start at 24 to 26 ounces a day; and if so, he can not get enough liquor to last him 24 hours.

Senator REED of Missouri. Take a case of pneumonia, and with only the right to use––– is it a pint or half a pint in 10 days?

Doctor WOODWARD. It is half a pint of alcohol, which is equivalent to a pint of whisky or brandy.

Senator REED of Missouri. If it is full proof?

Doctor WOODWARD. Yes.

Senator REED of Missouri. Is that sufficient? I do not mean in all cases but in the average case? And are there many cases of pneumonia where a greater amount is necessary in order to preserve the life of the patient?

Doctor WOODWARD. I would say it is inadequate if you are going to use whisky at all. A dose of 4 ounces a day would not be excessive by any means, and that would last three or four days.

Senator REED of Missouri. How many ounces are there in a pint?

Doctor WOODWARD. Sixteen ounces in a pint.

Senator REED of Missouri. I had forgotten the table on that.

Doctor WOODWARD. That is it.

Senator MEANS. I have tried to follow you, and at the risk of repetition I will ask you just to give me again the regulation that you complain of, which of course, is not touched here in the bill. I did not quite get it although I tried to follow you.

Doctor WOODWARD. It is all in the law except the interpretation as to the limit on the quantity of liquor that may be prescribed for internal and external use. The Volstead Act itself limits it to a pint of spiritous liquor that may be prescribed for any one patient in any 10-day period. The Willis-Campbell Act limits the amount of vinous liquor to 1 quart in that period. There is a further prohibition that no spiritous and vinous liquors may be prescribed within any 10-day period, the aggregate alcohol content of which is greater than 8 ounces or half a pint of alcohol. So you may say the limit is one-half pint of alcohol in 10 days.

165 * * * * * THE NATIONAL PROHIBITION LAW * * * * *

Senator MEANS. That is the Willis-Campbell law. What is the regulation you complain of?

Doctor WOODWARD. In the first place we doubt whether the regulation that stretches that quantity to cover external as well as internal use is a fair interpretation of the law. The Volstead Act expressly mentions internal use. One of the other regulations is that which requires us to put on the stubs of our prescription blanks the nature of the illness from which the patient suffers. That is a regulation. It is not in the Volstead Act itself, however, that we shall keep a record book showing the nature of the illness.

Senator REED of Missouri. Since you are limited to one-half pint of alcohol in 10 days is it not frequently necessary to use that much in external use in one day?

Doctor WOODWARD. It would be if we did not have a substitute, denatured alcohol, alcohol rubs, and things of that sort. Otherwise one-half pint would go a very short distance.

Senator HARRELD. That leads me to ask this: To what extent have physicians discovered substitutes for whisky in the treatment of diseases?

Doctor WOODWARD. I do not believe we can say we have any substitute for whisky in treating diseases.

Senator HARRELD. I meant substitute for alcohol.

Doctor WOODWARD. Well, I should have said alcohol. Alcohol has certain properties that nothing else seems to have, And as to the use of those properties in any particular case of illness, the attending physician must decide.

Senator REED of Missouri. That is all I wished.

Senator MEANS. We thank you, Doctor Woodward.

Mr. CODMAN. If the committee are willing to sit and hear one more witness to-night I have one I should like to present.

Senator MEANS (the chairman of the subcommittee). I think we will.

Senator REED of Missouri. I am willing to sit until 10.30 o'clock.

Mr. CODMAN. I wish to present Mr. Hudson Maxim, who wishes to address the committee.

Senator MEANS. We have had the rule to have witnesses sworn.

Mr. MAXIM. I will be glad to be sworn.

Senator MEANS. Stand up, if you please. You do solemnly swear before the ever-living God that in the matter now under hearing before this subcommittee of the Judiciary Committee of the United States Senate you will tell the truth, the whole truth, and nothing but the truth?

Mr. MAXIM. I Will.

Senator MEANS. Will you be so kind as to give your name?

Mr. MAXIM. My name is Hudson Maxim.

Senator MEANS. And your address.

Mr. MAXIM. My address is Landing post office, N. J.

TESTIMONY OF HUDSON MAXIM, LANDING POST OFFICE, N. J.

Senator MEANS. You may go right ahead with your testimony.

Senator REED of Missouri. You are the inventor of the Maxim gun and other firearms, are you not?