Morphine Maintenance. Chapter 1"Shreveport and the Clinic in the 1920's"
| Waldorf, Dan, et al. Shreveport and the Clinic - the 1920's. In: Chapter 1. Morphine Maintenance: The Shreveport Clinic 1919-1923. Washington: Drug Abuse Council; April 1974: pp. 50.
Shreveport and the Clinic -- the 1920's Shreveport is named after Captain Shreve, a riverboat captain who was instrumental in clearing the natural river raft that blocked the Red River until 1838. Captain Shreve devised a battering ram riverboat and spent five years freeing the river of a giant log jam. He began this monumental job in 1833, clearing 60 miles the First year. The next 60 miles was a much harder job; it took him four years to finish the second half. The town itself was founded in 1837 on the site of an old Caddo Indian settlement on the Red River. The land around Shreveport is lush and fertile, and the town slowly became a thriving agricultural center. The population grew from 1700 in 1850 to 16,000 in 1900 on the basis of its agricultural production. In the next 20 years, the population nearly tripled to 44,000; World War I and the rich oil fields of the area were the reasons why. According to the Chronicles of Shreveport, gas and oil were known to exist as early as 1870: The first intimation that there might be oil or gas in Caddo parish was given by a deep well drilled to supply water for an ice factory in Shreveport in 1870, but the intimation was so far in advance of any knowledge of the oil and gas industry in this part of the country, all the oil at that time being produced in Pennsylvania, that no attention was paid the discovery except to use the gas for lighting the plant. And that was due to the curiosity of a workman who struck a match to the "wind" coming out of the hole to be blown out. Instead, the "wind" ignited. It isn't of record how the fire was put out. Thirty-five years later in 1905, three wells were drilled for natural gas. Shreveport piped it in the same year, and the following year the first crude oil was shipped to Port Arthur, Texas. Two years later, a Standard Oil Company charter was established, and a refinery pipe line was started. 1914 and World War I accelerated both gas and oil production; by 1930, 34 petroleum fields and 24 natural gas fields had been discovered. Shreveport boomed with the oil. By the time the clinic started, Shreveport, a town of 44,000, had a symphony orchestra, a motion picture house, and an occasional opera in the Opera House. The 1923 symphony orchestra season included a feature performance by a young Russian violinist, Jascha Heifetz, on his first American tour. The town claimed two colleges, five banks, a state hospital, and a Federal Court House. The Louisiana Motor Car Company was mass-producing three or four cars a week that ran around town under the new street lights. Radio Station KWKH opened in 1921 and was the precursor of today's rock stations; KWKH was the first to play phonograph records over the air. Socially, Shreveport was becoming less black (the black proportion of the population declined 10% between 1910 and 1920) and more racist. While black people immigrated north during the war years, the Ku Klux Klan surfaced again in Louisiana and Shreveport following the war. Loyalty cards were required of "loafers and idlers." These cards had to be signed and punched by an employer, and the holders had to produce them for police inspection. It was suggested by one newspaper that vagrants be arrested and forced to work to increase the labor pool. Union oil field workers struck in November 1917 for an eight-hour day, an increase in wages, and recognition of bargaining rights. Oil companies resisted the last demand, and National Guardsmen were called by Governor Pleasant. Strike breakers were brought in from Texas, and oil production was resumed under martial law. Huey Long, who practiced law in Shreveport during the twenties, took on the Standard Oil Company in the interest of independent companies. This was the beginning of many of his anti-corporation battles. In 1924, at age 30, he became a candidate for governor and ran third in his first attempt. At about the same time, he took on Governor Parker and lost in a libel suit; he received a suspended sentence and a $1 fine. Prohibition was in full swing; both liquor and narcotics were feared and condemned. The Louisiana State Board of Health brought in an outside drug expert from New Jersey in 1918 who estimated that there were 18,000 addicts in Louisiana. He was successful in alarming the state legislators who enacted a new law in July 1918 that required official narcotic prescription blanks, civil commitment (which usually meant jail incarceration) and gave new powers to the Board of Health to make sure the laws were enforced. The Clinic In 1919 two important Supreme Court decisions were made that had a large impact on addicts and the ways they were being treated by doctors. In March of that year, on the very same day, the Supreme Court decided: (1) that the Harrison Act was constitutional and (2) that doctors who maintained addicts were in violation of the Harrison Act. In the first case, the Supreme Court reversed an earlier District Court decision that dismissed an indictment against Dr. Charles Doremus. Doremus, of San Antonio, Texas, had been arrested in 1915 for providing a large supply (500 one-sixth gram tablets) of morphine to a known addict, a violation of the Harrison Act. When he appealed the arrest, the District Court decided that the Harrison Act as a revenue measure could not restrict the medical practice of Dr. Doremus. in other words, the way the law was used to prosecute Dr. Doremus was unconstitutional. The Federal government pursued the case to the Supreme Court, and in a five to four vote won a reversal of the decision of the District Court. They found Dr. Doremus in violation of the Harrison Act and thus affirmed the constitutionality of the act. In the second decision, Dr. Webb's appeal of a Harrison Act indictment was denied because he had supplied morphine to an addict with the intention of maintaining his accustomed use. This decision established that the maintenance of an addict was against the law unless it was part of a cure. Maintenance, for decades before the decision, had been a common practice. In the event that a doctor could not successfully treat some illness or disease, doctors felt justified in relieving the accompanying pain and suffering. For the addict the relief was opiates. Effects of these two decisions were immediate. Federal agents of the Narcotics Bureau of the Internal Revenue Service started immediate indictments against a small number of doctors in various cities throughout the United States. Often these were doctors who were known to cater and prescribe flagrantly to large numbers of addicts. Exactly 36 days after the decision was made, Federal agents in New York City, led by Major Daniel L. Porter, arrested six physicians, four druggists and 200 addicts for violation of the Harrison Act (New York Times, April 9, 1919). The basis for the indictments of physicians was the Supreme Court decision that addicts could not be maintained on opiates. Both the decisions and the arrests that followed caused panic among large numbers of doctors because it was quite common for doctors to have a small number of patients to whom they regularly prescribed opiates. More often than not, these were patients who suffered some chronic or terminal illness and were being treated in good faith. But this practice now fell into question, and doctors were loathe to treat any addicts. This reticence was understandable; they were just as liable for indictment as those doctors who prescribed flagrantly. Doctors complained and sought advice. Addicts complained and sought help. The "solution" of the emergencies caused by the Webb decision were "temporary" clinics or dispensaries to treat and "cure" addicts. Some sprang up spontaneously (as did the New Orleans clinic), but others seem to have been established at the instigation of Federal agents. Obviously, Federal agents had some clinic in mind when they made the New York arrests because two days later a clinic was opened by the New York City Health Department (New York Times, April 10, 1919). The clinic must have been planned before the arrests were made. It opened very quickly and began to serve large numbers of addicts in a short period of time (12 addicts enrolled the first day, but the number jumped to 173 on the second day). Federal agents anticipated that there would be trouble from both addicts and doctors when legal supplies of opiates were cut off. Addicts would be without supplies and could clamor or become involved in thefts. Doctors would complain on the behalf of their more affluent, established addicts. There were also other considerations. World War I had ended in November of the previous year, and there was a steady stream of returning soldiers from Europe. It was expected that many returning soldiers would be addicted in the course of treatment for war injuries. This had been the case after both the Civil and Spanish-American wars, and there was no reason to expect that soldiers from World War I would be different. In other cities the same pattern developed. Doctors, druggists and addicts were arrested, and there was a clamor for some help or solution for the problems of both addicts and doctors. In Shreveport, Louisiana, at the same time (April 1919) narcotics agents came to town to begin investigations to enforce the new drug policy. They reviewed the records of druggists, contacted addict informers and solicited illegal prescriptions. Addicts were arrested and indictments against doctors were started through a grand jury. About the same time, petty thefts were said to increase, and it was thought that addicts were the cause. One particularly well-known and esteemed doctor, Dr. R------, was one of several charged with violations of the Harrison Act by Federal narcotics agents. Federal District Attorney Phillip Mecom of Shreveport knew Dr. R------ very well and was convinced that he was not indiscriminately prescribing opiates to addicts. He was not as certain about the other doctors, but felt that something had to be done about the problem. Consequently indictments were not pursued with particular vigor, since local officials felt that they could handle the situation better without making charges. Two doctors, considered to be flagrant prescribers who dispensed opiates not out of sympathy or understanding for addicts but for profit, were asked to leave town; both left. The first measure taken was a short-term prescribing procedure. The State Board of Health designated one physician to take over the job of prescribing for all the addicts in the town. Addicts got their prescriptions daily and had them filled at one official drug store. The job was too much for one doctor to handle, and addicts resented being required to go to both the doctor and a druggist every day to get the prescriptions and have them filled. Another objection came from the official pharmacist. He felt that addicts coming to his drug store daily would drive his regular customers away. This procedure lasted less than a month, when the doctor in charge of the procedure resigned. Shortly after the doctor's resignation, Dr. Oscar Dowling, President of the Louisiana Board of Health, came to Shreveport on another matter. During the course of his visit, he asked his young friend and colleague Dr. Willis P. Butler, the Caddo Parish Physician and Coroner, to visit him at his hotel. Their conversation eventually turned to the problems of addicts and the unsuccessful prescribing program. Dr. Dowling, knowing that Dr. Butler had some experience treating addicts in the county jail (as part of his normal duties as Parish Physician) asked him to visit the New Orleans clinic and see what he could do for Shreveport. New Orleans, like Shreveport, had experienced a drug panic in March when the Webb Supreme Court decision was announced. Addicts affected by the panic appealed to Dr. Marion Swords, the Secretary of the Board of Health, and lie then opened a new dispensing clinic. The principal method used by the clinic was direct dispensing to the addict, thus obviating the use of a commercial pharmacy. Its primary objectives were to provide temporary relief for addicts at a reasonable price, to cut down on rising theft committed by some addicts, and to drive the price of illegal opiates down so the illegal supplies might dry up (Swords 1920). Dr. Butler went to New Orleans and visited the clinic for two days and returned with mixed impressions. He liked the basic idea of the clinic and its security, but he did not like the methods used: I saw right away that the clinic was trying to fool their patients off of drugs. They were mixing morphine in solution and reducing their dosage drastically. The addicts knew what they were doing because some of them were doubled up in pain. I knew enough about addicts, I had seen plenty of them in the county jail [the Parish Physician is responsible for all prison patients] to know that you shouldn't try to do that to them.
I came back to Shreveport and made my report of what I saw. It was generally unfavorable as regards their methods, and I said that if I were going to do it, it would have to be my way. Well, they let me do it my way [Interview 1973]. The next thing Dr. Butler did was go to the Shreveport Medical Society and tell them of his plans for the dispensary. The Society, which consisted of over 100 doctor-members, approved the plan and passed a resolution that thenceforth they would not treat addicts, but would send them to the clinic for treatment. Dr. Butler agreed that neither he nor the clinic would interfere with their regular practice regarding the use of opiates to non-addicts, but that addicts would be treated only at the clinic. On May 3, 1919, the clinic was opened at Schumpert Memorial Sanitarium, the largest hospital in Shreveport, under Dr. Butler's direct supervision. The day they opened, four patients came. The first patient was a 24-year-old waiter who had been addicted four years and was using 5 grains(3) of morphine a day. He was a new resident in Shreveport, having arrived three years earlier. Joe Sing, a 39-year-old Chinese restaurant worker, was the second patient. Mr. Sing had become addicted to opium in China before coming to the United States, and when he came to the clinic he was using twelve grains of morphine. The first female patient was an attractive, young store clerk who had been addicted for five years when she arrived at the clinic. She was suffering from syphilis and was using 12 grains of morphine daily. The plan of treatment shown on her record was to treat her syphilis first, and then to reduce her morphine dosage gradually in preparation for detoxification. On the second day the clinic was open, six patients arrived; and by the end of the first week, 23 patients had enrolled. The clinic grew slowly during the first month to 42 patients, and by the end of the second month, 60 patients. During the first month of the clinic's operation it was decided, upon the urgings of Oscar Dowling, to combine the narcotics clinic with a planned venereal disease clinic. At the time, Shreveport was experiencing a venereal disease epidemic. The new VD clinic would use a new form of treatment for syphilis developed in Germany. Previously, the syphilis treatment had been to use a preparation of mercury, and the new method used arsenic preparations called "606." Patients were given two or three injections of the new 606 over weekly intervals, and then a series of monthly Wasserman tests to determine the outcome. When three negative Wassermans were taken, the patient was considered cured. This new treatment was provided by the State Board of Health, as were funds for the staff. The VD clinic utilized the same facilities as the narcotics clinic, and the staff was the same. This proved a good thing for the addicts, as a large percentage (approximately two out of five) also suffered some venereal disease. Gradually, as the numbers of patients increased, Dr. Butler and the staff realized that they needed a separate facility to conduct treatment of "cures." Patients usually could not be successfully detoxified in the out- patient clinic, and Dr. Butler felt that jails were no more successful, so an isolated hospital facility was planned. Toward the end of September 1919, space was provided at Charity Hospital to start the "cures." During September, one patient was detoxified, followed by five in October, and three in November. December was a bumper month for these treatments as 10 persons were treated. it would seem that they were preparing for the Christmas holidays. By the end of the year 1919, the townspeople were well apprised of the clinic's work. During the ensuing eight months, 264 patients had enrolled at the clinic, and eighteen had been detoxified in the Charity Hospital facility. The clinic received good coverage in the local newspaper, and officials in the town were pleased with its operation. Prior to the clinic's opening, a number of addicts had been arrested for theft and robbery — medical bags were being stolen, doctors' offices were being broken into, and numerous petty thefts were committed by addicts. These crimes dropped off dramatically after the clinic was operating. On January 7, 1920, an editorial appeared in the Shreveport Journal, one of the largest papers in town, that praised the work of the clinic and supported its continuation. The editorial also suggests that there was some Federal pressure to close the clinic in the form of "reported withdrawal of government and state support." The editorial seems to have been written to forestall the closing of the clinic. It is very likely there were some rumors to the effect that the narcotic clinics would be closed by the Narcotics Bureau because in December 1919, a major reorganization of the Federal Bureau of Narcotics took place. With passage of the Volstead Act (National Prohibition Act), the Prohibition Unit of the Internal Revenue Service was given the responsibility of enforcing the Harrison Act, and a month later (December 1919) a new organization was put into effect. The new arrangement put Prohibition agents in charge of policy making over narcotic agents (Lindesmith 1965). Prohibition, as the reader will recall, was a very vociferous, zealous movement, which had elements of a red scare (Musto 1973). Advocates of prohibition felt, not unlike other "true believers," that all the sins and evils of the world could be eradicated by prohibiting the use of liquor and drugs. Furthermore, they were very effective in convincing the public that opiates were as evil as liquor. This undoubtedly had a great effect upon the way doctors and the public viewed narcotic addicts. The effects of the changes in the Narcotics Bureau were not felt immediately in Louisiana, but they were felt elsewhere. David Musto, in his excellent historical study The American Disease (1973), contends that a policy decision to close the clinics was made late in 1919 or early 1920. The New York clinic was used by the Treasury Department as a model of a failed clinic. The clinic served extremely large numbers; it was not uncommon during its peak period to serve 700-800 addicts every day. There were, to say the least, excesses in prescriptions. The upper limit for dosage was 15 grains, and many persons received that amount. Many addicts cheated, and there were several identification procedures used. None was really, effective, which is perhaps understandable given the large numbers of patients attending one facility. it is interesting to note that most present-day methadone maintenance programs avoid these problems by keeping the numbers of patients attending a clinic relatively small (usually 100-200 patients). Detoxification was also a problem for the New York clinic. New York communities were unwilling to accept addicts or the hospitals which were to treat them, and eventually addicts were sent to Riverside Hospital on North Brother island (this was also used for treatment of juveniles in the 1950s). The clinic itself attempted gradual reduction and placed some of the patients in Riverside Hospital when beds were available. The main problem was illegal sources for the drug. Persons attending the clinic used both legal (from the clinic) and illegal drugs. Many of the patients detoxified at Riverside Hospital relapsed immediately or shortly after leaving the hospital (which is not unlike the present-day situation). The failures of the New York clinic were well known, and the Narcotic Division seized upon the adverse publicity as justification for their anti-clinic policies. The New York clinic was the first to close. Reports from the New York Times say the clinic closed on March 6, 1920, less than 11 months after it began. There was little, if any, resistance from the staff. Drs. Royal S. Copeland and S. Dana Hubbard both came to believe that ambulatory treatment should be abandoned for institutionalization (hospitals and jails) and strict law enforcement against illegal suppliers. Earlier in the history of the New York clinic, Drs. Copeland and Hubbard were enthusiastic about the prospect for ambulatory treatment, but they soon took the opposite line. Their clinic certainly was not run very well, so perhaps like many "drug experts" since then, they conveniently blamed the addicts for their own failure. Dr. Copeland was not above playing to the newspapers for as much publicity as he could get out of the problem. Before the clinic opened, he estimated populations of 150,000 and 200,000 addicts in New York City. These were properly deflated during the clinic's operation; during the year the clinic opened, it reported only 7,400 addicts treated. Dr. Copeland went on to become Senator of New York State. He, like others who have followed him, used the publicity generated by addiction and the problem of treating addicts to further his larger career. First Investigations David Musto reports that the first full-scale investigation of the Shreveport clinic took place in March 1920. He reports the results of the investigation as follows: The investigation viewed the clinic as a means leading to institutional treatment believed to be curative. It was not presented nor perceived by the agents as a maintenance clinic. The strong support of enforcement and other public officials was impressive, and the agents "were very favorably impressed with the clinic, and also with Dr. Butler, who seems very efficient, and seems to have one idea of curing the addicts by treatment in the hospital" [Musto 1973:167]. Dr. Butler recalls an earlier visit by two agents who came to Shreveport to attempt to buy or procure illegal morphine: One day during the first year of the clinic, I got a call from some newspaper men down at City Hall who wanted me to make a statement about a press conference just held. Two narcotic agents came to town and attempted to buy narcotics, but could not get a drop. They said they wanted to make a public statement so held a press conference. I did not see either one of them but heard one was from New York. The first anniversary passed with no further intimations of any enforced closing. During that year, the clinic had treated over 450 patients, of which 46 had been detoxified. The clinic was firmly endorsed by most of the public officials in Shreveport and this was demonstrated in August of that year (1920) when pressures for closure seemed imminent. Steps were being taken in New Orleans to close the dispensary there. During August, several officials wrote letters of endorsement to Dr. Dowling and Dr. Butler. These included Federal Judge George Whitfield Jack, U.S. Marshall J. N. Kirkpatrick, Sheriff T. R. Hughes of Caddo Parish, and Shreveport Commissioner of Public Safety R. L. Stringfellow. The clinic, over the 15 months of its life, had substantial endorsement. Dr. Oscar Dowling sent Dr. Butler 22 letters that commended or praised the clinic and its operation. Dr. Dowling seemed proud of the clinic's record and continually sought some recognition of his role in its establishment. Pressure to Close The intimations of pressures to close the clinic became more apparent when Dr. Dowling wrote the following letter to Dr. Butler on September 27: New Orleans, La. Dear Doctor Butler, I understand there is a very definite movement to have closed all the dispensaries giving ambulatory treatment, but of this I know too little to advise of the details, and I shall ask you to keep the matter to yourself until I know something more definite. Oscar Dowling had generally advocated the dispensaries in Louisiana as a reasonable and humane service. He most certainly was instrumental in suggesting a clinic operation to Dr. Butler and more than likely did the same for the clinic in Alexandria. During the first year of the dispensaries' operation he visited the Shreveport dispensary several times and offered it considerable support primarily through financing of the VD services. Relationships between Drs. Dowling and Butler were very cordial; both were graduates of Vanderbilt University Medical School. Although there was considerable age difference between the two men, Dr. Butler considered him a close and valued friend. Dr. Dowling reciprocated these same sentiments. After receiving the letter from Oscar Dowling, Dr. Butler met with the Shreveport Medical Society and told them there were some rumors that the clinic might be closed. They were, understandably, concerned about the fate of the clinic. The clinic had taken over most of the addict cases for doctors of the town. If the clinic should close, it would be very likely that some patients might return to their doctors. The Society appointed an investigation committee composed of three doctors. On October 5, they reported their findings to the rest of the Society as follows: To the Shreveport Medical Society: ... We were most favorably impressed by the conduct of the clinic including the details of complete records of all addicts coming under care, classification of addicts and treatment according to classification, the elimination of non-residents of Louisiana and careful treatment of curable cases UNDER RESTRAINT, the procuring of employment for addicts who are able to work while attending at the dispensary and for cured patients who wish to remain in Shreveport after recovery, are all of this work that strongly commend the conduct of this institution. It is significant that Dr. Butler's judicious and tactful conduct of the clinic has secured for him the unqualified support and cooperation of the Federal, State, Parish, and City authorities, and the State and City Boards of Health. In brief we wish to express our unqualified support and approval of the Shreveport Narcotic Clinic and its systematic and effective administration by Dr. Butler. W. H. Billingsley, M.D. Levi Nutt visited Dr. Dowling in November; the visit had important effects upon Dowling's attitude toward the clinics. Dr. Dowling, up to that date, had been a staunch supporter of the Louisiana clinics, but Federal pressure to close them was persistent. David Musto has documented a threat of indictment by Prohibition Commissioner John Kramer against Dowling unless he closed the clinics. This threat was made by Kramer's general counsel during December 1920 (Musto 1973:166, 314). Dr. Dowling responded by requesting time to garner support against the clinic in his state. This was only the beginning of Dowling's troubles with the Narcotic Division; there would be more to come. Meanwhile, the clinic was soliciting more support from the local community. U.S. Assistant District Attorney C. H. Blanchard and Commissioner Stringfellow both wrote letters to Oscar Dowling urging him to keep the clinic open. On November 16, the City Commission Council (the mayor and four commissioners) voted unanimously to support the clinic and urged state authorities not to disturb the clinic. The clinic was obviously getting solid backing from the community. New Orleans and Alexandria Close The next move by the Narcotic Division was an investigation of the New Orleans clinic. A report of the investigation was eventually sent by the narcotics agent in New Orleans to Governor John Parker. Along with other members of the State Board of Health, Governor Parker advocated and supported the work of the clinics. The narcotics agent's report on the New Orleans clinic was negative, but as Musto points out, the conclusions were unjustified. Examination of Truxton's report reveals that he found only a small percentage of faulty dispensing and his most substantial statistics, the number of residents with criminal records, was actually irrelevant to whether, if addicted, people with criminal records should receive narcotics until treatment in an institution was available [Musto 1973:166]. This report was the basis for a meeting held in February 1921 of the State Board, Governor Parker, the principals of the three dispensaries, agents of the Narcotic Division, and a special committee of the Board to investigate the New Orleans and Shreveport clinics. The clinic in Alexandria did not present any particular problems to the Board. They did not present the same defense as did the New Orleans and Shreveport clinics. The investigation committee of four Board members chaired by Dr. Thomas A. Roy made a compromise recommendation. They recommended that both clinics (New Orleans and Shreveport) be continued until a hospital could be established to treat "curable" addicts. When the hospital was established, the clinics would continue to provide services to the incurable, aged and infirm, and cases waiting to be cured. Federal agents at the meeting singled out the New Orleans clinic for attack. Dr. Swords was accused of making money off addicts of the clinic, but the agents were reluctant to charge him. This was a common tactic of narcotic agents in their attempts to close the clinics and a tactic that generally worked. Dr. Swords denied the charges and Governor Parker supported Swords' stand. By this time, Dr. Dowling was fully in the camp of the Narcotic Division. Dr. Dowling and the Federal agents were adamant in their attack on the clinics, but the final decision was put off until March. March came and the State Board of Health decided against the New Orleans clinic, most particularly Oscar Dowling. Dr. B. A. Ledbetter, a member of the investigating committee, contended that if the New Orleans clinic should be closed so should the other two. Two other doctors on the committee, Drs. Chamberlain and Roy, opposed this position because Federal Judge Jack favored the institution [Shreveport], especially since Dr. Willis P. Butler, in charge of the narcotic dispensary at Shreveport, had established a real hospital for treatment of drug addicts, renting a ten room house in which to treat them" (Shreveport Times, March 16, 1921). (The Shreveport clinic had anticipated the issue of a separate hospital and had rented a large house in downtown Shreveport to treat "curables.") An impasse was anticipated, and Dr. Chamberlain of the Board introduced a resolution that all the clinics be closed: "We must bring this matter to a crisis, and might as well close all, and let the people howl" (Shreveport Times, March 16, 1921). This resolution was passed, and all three clinics were ordered closed. During the Board meeting there was some discussion about utilizing city authority to authorize the continuation of the clinics, and this is what Dr. Butler did in Shreveport. Dr. Butler returned to Shreveport and got support from staff physicians of the T. E. Schumpert Memorial Hospital, the site of the dispensary, to continue the work of the clinic. Eighteen doctors voted unanimously to continue the clinic on March 15, 1921. On March 23, 17 doctors from the staff of the North Louisiana Sanitarium made a similar resolution. Second Opening Dr. Butler complied only symbolically with the order of the State Board. The Louisiana State Board of Health Narcotic Dispensary and Institutional Treatment Department was closed, but the facility re-opened as the Public Health Hospital Institution and Out-Patient Service the same day. Dr. Butler sought legal advice from a District Attorney of Caddo Parish about the powers of his office as Parish Physician and Coroner to dispense narcotics, and was given legal authority to do so. This move was unanimously endorsed by the City Council upon the suggestion of Mayor John McW. Ford, and the City Attorney was instructed to draw up a city ordinance to authorize the hospital. At the beginning of April 1921, the ordinance was passed by the City Council and became city law. The ordinance gave the hospital and out-patient service authority to treat narcotics and venereal disease cases, and specified funds to pay a portion of their costs. Operating as a city clinic, patients were treated in the clinic until February 1923. More Investigations Dr. Willis Butler was and is a soft-spoken, persistent man. His gentle and humorous manner is only one part of the man; the other is a staunch fighter. Confident of his clinical work and the full support of the community, Dr. Butler did not hesitate to fight for what he considered a much needed humane service. His fight was not without some threat to himself. He was a holdout who became an embarrassment to Oscar Dowling and the Narcotic Division. Dr. Dowling became so incensed with Dr. Butler that he issued his own threats of indictment: "He told me if it was the last thing he did, he would have me in Atlanta [the Federal prison]. Well, I hadn't left anything in Atlanta, and I wasn't about to go there." (In subsequent efforts at retaliation, Butler was investigated by two grand juries.) During the next two years, agents from the Narcotic Division visited Shreveport on numerous occasions. Musto found evidence of two full-scale investigations and five or six visits by a single agent from the Kansas City office during this phase of the clinic's operation. Dr. Butler's recollection of these visits was: The government seemed to send agents into Shreveport continually, usually on the sly. Some I saw, some I only heard about. Mostly, they would come attempting to buy drugs from peddlers or get prescriptions from doctors. They were usually discouraged in this because there were no peddlers; and if you went to a doctor to get morphine, they would just tell you to go to my clinic. Both the patients and the doctors told me of these visits, once a newspaper reporter let me know what was going on.
According to Musto, Colonel Nutt of the Narcotic Division ordered the second major investigation in October 1921. Musto, using records of the Narcotic Division, described the results of the investigation as follows: Two agents, one of whom was Dr. B. R. Rhees, secretary of the recent Special Narcotic Committee of the Treasury, went to Shreveport. First they visited the drugstores. No prescriptions were found for narcotic addicts, a significant fact to the investigators; the reputable druggists of Shreveport unanimously praised Dr. Butler as "honest and sincere in his efforts to help the City of Shreveport." Then they visited three prominent doctors and again approval was unanimous — they were no longer bothered by drug addicts except an occasional visitor to the city. The physicians warned that "there would be serious objection to the clinic's discontinuance." The agents saw little if any opportunity for morphine to be improperly disposed of. Every grain was accounted for. One hundred twenty-nine patients had been declared incurable and were receiving maintenance supplies. Each incurable was so certified by three or more physicians.
Various officials were also interviewed. Federal District Judge Jack again affirmed his high opinion of the clinic, which now had been operating for over two years. He warned that he would vigorously oppose any steps taken toward a discontinuance of the clinic, because from his own knowledge it had lessened crime in the city. The city judge was even more outspoken than the federal judge in his praise of Dr. Butler. He particularly favored care of the incurable addict which enabled him to work and not be a charge on the city. Both the chief of police and sheriff said that crime, such as petty thievery which might be resorted to to pay for illicit drugs, had lessened since the inauguration of the clinic. The U.S. marshal was of the same opinion.
The agents discovered a political environment which they found unique among communities with clinics: "There is absolute cooperation between Dr. Butler, the Police Department, the City officials, and the Federal officials." They recommended that the clinic not be discontinued since it was "operating under the full sanction of officials charged with the preservation of peace and order in the City of Shreveport and the Parish of Caddo" [Musto 1973:168]. Dr. Butler recalls another large-scale investigation of the clinic that most likely did not appear in the records of the Internal Revenue Service because it was clearly an embarrassing incident. I recall one incident vividly. One of the narcotics agents sent to investigate our dispensary turned out to be an addict himself.
Occasionally we used to confiscate illegal drugs from patients. In one instance a doctor came from New York City to be treated in the hospital and he had a jar, a handsome jar, with two or three ounces of morphine. He turned over the jar to the clinic. The custom was to keep such drugs in a safe until I could take them to the federal District Attorney, Attorney Mecom that is. Before I took it and other confiscated drugs to the Attorney's office, I stopped by a druggist I knew to weigh it. I got a receipt for it and then took it to Mecom's office.
Well, this Federal agent came to town with two other state agents from New Orleans and went to see Mecom. And as it was their custom, the federal agent collected the confiscated drugs, but for some reason the agent returned the drugs temporarily to Mecom. Attorney Mecom told me of this, and I became a little suspicious. So just to cover myself, I went to the Attorney's office, got the drugs and had it weighed a second time. When the drugs were weighed a second time, 60 or 70 grains were missing. I had both receipts of the measures.
The next day the three agents came to my office to review my dispensary records. The review was a rather long job, and as noon approached I noticed that the Federal agent was getting very nervous and irritable. I began to suspect him of being an addict and kept him there in the office as long as I could. The longer he stayed, the more he perspired and became nervous. He was exhibiting obvious withdrawal symptoms.
Finally, I just asked him, "How much morphine do you use?"
He got very indignant at this question, saying that he would not stay there and be insulted. He left the office as mad as an old wet hen.
After he left, I had some second thoughts about what I had done. I wondered if I hadn't torn my britches. So just to check I called the druggist to make sure of the amounts. He confirmed my figures. And then it wasn't any more than an hour or so when I got a call from the two agents accompanying the Federal agent. Agent I said that I was right about the Federal agent. He was an addict, but they did not know what to do about it.
Well, I knew what to do. As coroner I had the right to arrest him. I went and got a warrant for his arrest, but before I could get to him, he had left town.
He got away, but the next day we called Attorney General Palmer and told him of the incident. The next thing we heard was that the Federal agent was transferred to the Cincinnati, Ohio, office. During 1921, the number of new patients gradually began to decline. Many more were coming to take treatment at the hospital than came to the clinic. This trend continued through the third year of the clinic. Patient records show only 55 new patients attending the dispensary during 1922. Visitors came regularly to the clinic, and the clinic received a lot of favorable publicity. Dr. Butler published a description of the clinic in March 1922 issue of American Medicine. Both Ernest Bishop, a New York doctor and author of a popular book of the time The Narcotic Drug Problem, and Charles Terry, the Executive Director of the Public Health Association's Committee on Habit Forming Drugs and eventual co-author of the classic The Opium Problem (1928), championed the clinic publicly. This publicity embarrassed the Narcotic Division, as Shreveport was the last of the clinics, and Federal agents could not find cause to close it down. The Last Months Perhaps out of desperation the Narcotic Division sent a "hatchet man" to Shreveport. This was H. H. Wouters who, with a group of Federal agents, proceeded to build a case against Dr. Butler and the clinic. They made two visits to Shreveport. During the first visit, Wouters reported that a group of citizens approached him about an illegal peddler who was said to be paying off one of the clinic's inspectors to stay in business. When Wouters approached District Attorney Mecom with this information, Mr. Mecom told him to go to the sheriff, Dr. Butler, and his investigators with this information. Wouters did not do this, but rather became suspicious of the authorities and reported this to his supervisor. On the second visit, they proceeded to interview 50 of the clinic's 129 patients. The object of these interviews was to reveal that patients were simply drug addicts and not worthy of being maintained, did not work, and were possibly criminal. A personal case was built against Dr. Butler. In the report, he is accused of making money out of the clinic and keeping a large staff from the proceeds (Musto 1973:170). Wouters, except during the first visit, tried to avoid Dr. Butler and the clinic. The first meeting was heated; Wouters accused Dr. Butler and the clinic of treating prostitutes, and Dr. Butler denied this. (He later described Wouters as "ingratiating but sly.") The second meeting was like the first: During his [Wouter's] last visit here, the patients asked me about him because he was going around questioning them. Wouters was trying to get evidence on the clinic and patients on the sly. I confronted him with it, but he denied it. Eventually, he told one of the patients his intentions (trying to close down the clinic) and the patient told me. I went around to see Sheriff Hughes about it, and Hughes decided to get a local warrant to pick him up. We did not get to him in time. By the time we got to his hotel, he had left. He left a forwarding address in the Virgin Islands. By this time, Dr. Butler was getting tired of all the battles to keep the clinic open. The numbers of patients had declined to approximately 100, and he was beginning to feel that it was taking too much of his time and effort and possibly was not worth it. Toward the end of January 1923, G. W. Cunningham, a Federal narcotics agent from Richmond, Virginia, was sent to Shreveport on a "diplomatic mission" to close the clinic (Musto 1973:172-173). He, with two other agents, talked with Judge Jack and Phillip Mecom. Judge Jack stopped by Dr. Butler's house that night and told him of the meeting. Phillip Mecom telephoned the next day and asked Dr. Butler to meet him in his office: Mecom said that Cunningham was giving him a lot of trouble about the dispensary. Shreveport was the last of the clinics and they wanted it closed. Mecom was taking my part, but Cunningham wanted him to prosecute me. Mecom said there was nothing to prosecute. A meeting was arranged for January 30th. The meeting took place in the Federal Court House with District Attorney Mecom presiding. Dr. Butler was present with Cunningham and two other agents. After some discussion it was agreed that the clinic would close on February 10, 1923. Dr. Butler described the meeting later in a letter to the Atlanta Georgian newspaper as being amicable: No records were gone over, no patients, officials, or doctors were called and nothing was gone into except the closing of the dispensary. I have felt all along, and still do, that I am right, but rather than enter an endless controversy without reasonable hope of what I consider right to prevail I agreed to discontinue the so-called clinic. All was very harmonious, and I must say the Inspectors appeared to be very nice gentlemen, far different from Mr. Wouters. I was told that I am not in any way accused of wrongdoing or bad faith, but that the work that I am doing here caused trouble because other places contended that if Shreveport be allowed to have a "clinic," they should be allowed such a privilege. Mr. Cunningham read a part of Wouter's report in the conference. The addict's word was accepted by Wouters as truthful without corroboration, and without an investigation of facts that records, histories, and examination findings would reveal. For instance, several cases who have resided here for years were classed as not belonging here. Cases almost dead were called curable, so they report. The dispensary closed on February 10, but the treatment (or detoxification) hospital remained open until March 1925. The clinic arranged for some of the approximately 100 patients left on the rolls of the dispensary to either take treatment in the hospital or be transferred to private physicians. After these arrangements were made, Dr. Butler was left with 21 incurables (aged and infirm) whom he treated as the Parish Physician. The Final Charge The meeting with Cunningham on January 30 was not the end of the matter by any means. A short time later, District Attorney Mecom informed Dr. Butler that Cunningham was pressing him to prosecute. Cunningham wanted Mecom to fine Dr. Butler $5,000 for violation of the Harrison Act. Dr. Butler never quite understood all the particulars of this action, but agreed to it in order to get the District Attorney "off the hook." Cunningham accused District Attorney Mecom of protecting Dr. Butler. Mecom made some complaint (Dr. Butler did not know the particulars), Dr. Butler gave him a $100 bank draft, and that was the last he heard of the charge. It would seem that the District Attorney charged him with something and fined him $100 to close the case. Shortly after the clinic closed, Sidney Howard, a journalist and dramatist, visited Shreveport and the hospital for a week and wrote a popular eulogy to the clinic. Mr. Howard was favorably impressed with Dr. Butler, the clinic's operation, and the town's response. His re-creation of the clinic's operation in the June 1923 issue of Hearst's International magazine is one of the best on-the-spot accounts of the town's attitude toward the clinic. He noted that in the absence of the dispensary there already was a suspicion that an illegal supplier had already started operating in Shreveport in a new drug store. This suspicion of a flourishing illegal supply was amplified in a newspaper investigation conducted by the Shreveport Journal in June 1923. Both illegal morphine and cocaine were said to be readily available from peddlers. This was a quite different situation from the period of the clinic's operation when little, if any, illegal supplies were available. The Hospital "Cures" Continue The treatment hospital and venereal disease clinic (which was always an active part of the out-patient services) remained open in the same building on Travis Street in downtown Shreveport. The hospital continued to treat persons who wanted to be detoxified until March 1925, with a temporary closing in the spring of 1924. From the period October 1919 to February 1923, approximately 350 patients were detoxified at the hospital. Following the closing of the clinic (from February 1923 to March 1925) another 50 persons were detoxified. While business at the treatment hospital was slow, the venereal disease clinic was very active. Dowling's Last Stand Although the hospital seemed to gradually phase out its services over the next two years, there remained one more drama in Shreveport involving addicts, doctors, and Oscar Dowling. This occurred in February and March 1925, two years after the clinic had closed. it began with the newspaper announcing a meeting held between District Attorney Mecom, Oscar Dowling, and Federal and State narcotics agents. In the meeting, Dr. Dowling and the agents claimed that narcotics were being grossly over-prescribed in Shreveport. The Shreveport Journal of February 14, 1925, reported that Dr. Dowling claimed, "Outside of twelve doctors here, the remaining local physicians prescribed annually more drugs than all the doctors in the State of Louisiana including New Orleans." This statement seemed to charge all (except 12) of the doctors in Shreveport with over-prescribing. This statement caused an uproar among local doctors. A special meeting of the Shreveport Medical Society was called by President Sanderson the same night that the statement appeared in the newspapers. The meeting was held to clarify Dr. Dowling's allegations. During the special meeting, Dr. Dowling revised his statement to "less than twelve physicians (I could almost count them on the fingers of one hand) are writing prescriptions indiscriminately for an amount of morphine in excess of the requirements of the State Institutions or even more than the needs of the profession of the state for legislative purposes" (Shreveport Medical Society, March 1925). Many members resented the original statement that all but 12 physicians were prescribing indiscriminately and the way it was publicized in the newspapers. There were heated discussions between Dr. Dowling and the members not only about the allegations made but about the narcotics clinic as well. Dr. Butler recalls the meeting and his role in it: During the meeting, Dr. Dowling attempted to discredit the clinic and his role in its development in an effort to get the Medical Society to revoke its earlier endorsement. He said that he disapproved the clinic from the beginning and never endorsed it. This was a patent lie, and I stood up and told the society that if that were the case, one of us was lying because I had 22 letters where Dr. Dowling had praised the work of the clinic. I passed the letters around and called for a vote of censure (that would have expelled him from the Society). Any censure required all the members to approve it. All but one of the doctors at the meeting voted for censure, but it did not pass as a motion. At the same time, the Society did not retract its earlier endorsement of the clinic either. The meeting ended with the passing of a motion of resentment against the way Dr. Dowling had publicized his charges. The motion also stated that Society members "deplored the existing conditions and pledged our support in an effort to eradicate them" (Shreveport Medical Society, March 1925). Two days later, a grand jury was called by District Attorney Mecom that lasted for two weeks. According to newspaper reports, 49 cases were heard (Shreveport Journal, February 27, 1925). Dr. Butler was one of a number of doctors (as Dr. Dowling said, fewer than 12) being considered for indictment. Dr. Butler recalls that he learned of his own case being considered by the grand jury through Huey Long. Yes, Huey lived in Shreveport then. He was the State Commissioner of Railroads at the time, I believe. I knew him pretty well at that time; we were members of the same church. Well, one afternoon I was going home and stopped in front of the court house building. Huey Long stopped me and in his big way said, "Why don't you tell your friends when you are in trouble?" I didn't know what trouble he was talking about, and then he told me that the grand jury was trying to indict me with some of the other doctors. I couldn't quite believe it, but later on that evening he called me and asked me to come down to his office. In his office was one of the members of the grand jury, a Mr. E------ and he said that the jury was meeting and I was among the cases presented. Oscar Dowling was questioning my prescribing records to my old patients, about 20 of them that I had had for years, but they hadn't come to me about it. The next day I got all my records together, took them to Sheriff Hughes, and in turn he gave them to District Attorney Mecom. Mecom presented the records to the jury, and the case was thrown out. Mr. E------ told me after the jury was over that the jury was doing their best to get a case against me before those records were produced. The outcome of the jury proceedings resulted in 28 arrests — seven doctors were charged, six druggists, two illegal drug peddlers and 13 addicts. Both of the drug peddlers and seven of the addicts pleaded guilty to sales and possession. Dowling and the Federal agents, by their own admission, said that they were not interested in convicting doctors and druggists and, true to their word, they did not. Addicts, as is often the case, caught the brunt of the investigation and the charges. After the grand jury investigation, Dr. Butler decided to close the detoxification hospital. This was done on March 15 (1925), and the venereal disease clinic was transferred to Charity Hospital the same day. During an April meeting of the Shreveport Medical Society, the records of both the clinic and the hospital were turned over to a committee of members for review. The review was made with a favorable report, and that was the end of the matter as far as Shreveport was concerned (Shreveport Medical Society, May 1925). Today, there are very few people in Shreveport who remember anything of the clinic and its stormy history. During two visits to that city, we only met one person, other than Dr. Butler, who had any recollection of the clinic and its operation. This was Dr. R. T. Lucas, a pediatrician in the town for 50 years. |
