Local Control: Jacksonville’s Narcotic Clinic

2015

In Jacksonville, Florida, Dr. Charles E. Terry established a style of addiction control which within ten years became the most controversial in America. Dr. Terry, a dedicated public health officer who took an increasingly prominent role in the debate over narcotic control, became a leading exponent of the medical approach. He worked chiefly within the framework of professional or philanthropic health organizations such as the American Public Health Association and the Bureau of Social Hygiene. Terry eventually compiled a thousand-page anthology of information on narcotics. (Charles E. Terry and Mildred Pellens, The Opium Problem (New York: Bureau of Social Hygiene, 1928; reprint ed., Montclair, N.J.; Patterson Smith, 1970). Terry (1878-1945) received his M.D. degree from the University of Maryland in 1903 and later became the first full-time health officer of Jacksonville (1910-17). After serving as medical editor of Delineator magazine, he became executive secretary of the Committee on Drug Addictions formed in 1921, funded by the Bureau of Social Hygiene, a private research organization supported by such philanthropists as Paul M. Warburg and John D. Rockefeller, Jr. He prepared The Opium Problem with the aid of Mildred Pellens, whom he later married. When his position on the bureau terminated, he served at the Harlem Valley Hospital in New York until his death. Terry was closely associated with the American Public Health Association, and many of his articles appeared in the Journal of the APHA between 1912 and 1923. For further details see Edward R. Smith, “Seven Years of Pioneering in Preventive Medicine,” J. Florida Med. Assoc. 53 : 725-28 (1966). I am indebted to Dr. Smith of the Florida State Department of Health and Welfare for providing information on Dr. Terry’s life)

In 1912, however, Dr. Terry was the City Health Officer of Jacksonville, the largest city in the state, where he practiced an approach to drug addiction that became a debated alternative to various kinds of embargo, national or personal. He established a city drug clinic so that habitues could receive free narcotic prescriptions. His work is a direct forerunner of the methadone maintenance clinics which now exist in many American cities.

Dr. Terry decided upon this innovation after the failure of existing state controls. The Florida law had proven inadequate as revealed by prosecution undertaken by the State Pharmaceutical Association which all resulted in nol prosses. Therefore he asked the Jacksonville City Council to enact an ordinance regulating in an unusual way the common drugs of habitues. In order to locate physicians who would “lend their services to the fostering of these habits,” he asked that prescriptions containing more than a normal dose of habit-forming drugs be copied and sent to his office. Druggists would be required to keep their drug prescriptions in ledgers which could be inspected by the health officer. Possession of the drugs, except under conditions of the ordinance, was made a misdemeanor. Most importantly, the ordinance permitted the health officer to provide free prescriptions to habitues if he thought it advisable. The prescriptions were provided to eliminate the excuse by druggists that sale without a prescription was necessary because the user was too poor to go to a physician. The requirement would also “bring the health officer into personal contact with the un-fortunate addicted to drug habits.” After conferences with the local medical society and city pharmacists, the law was passed by the council in August 1912. After a few early violators were promptly prosecuted and convicted, Dr. Terry felt the law was generally obeyed.

After a year of operation, Dr. Terry had registered 646 habitual users, a number equal to about 1 percent of Jacksonville’s population. Some, he does not say how many, were transient, but he guessed that this number would roughly equal those receiving drugs directly from their physicians and therefore escape the recording of prescriptions required by the ordinance. Although half the inhabitants of Jacksonville were white and half black, the number of white habitues outnumbered the blacks by almost two to one (416 to 230). He surmised that “with us at least, the whites are far more prone to drug addictions than the blacks.” Among the habituated blacks, cocaine was favored by about half; among whites, by about a fifth; opiates took up most of the remaining fraction. Of all users, about 4 percent favored heroin, 20 percent laudanum, 25 percent cocaine, and almost 40 percent morphine. Females outnumbered males by about three to two, and tended to prefer opiates to cocaine.

The relatively low rate of drug use among blacks, and the willingness of Dr. Terry and the city government to supply the dreaded cocaine to them, is further evidence of the exaggeration of “co-cainomania” in the American press and by federal government officials.

Dr. Terry gained the confidence of about one-third of the users, and although “mendacity is a common attribute of the drug fiend and information so obtained is not reliable,” his conversations with addicts led to the conclusion that 55 percent of the habits had been acquired through treatment by physicians, 20 percent from advice of acquaintances, and 20 percent through dissipation. Only 2 percent arose from chronic and incurable disease treated with narcotics. Dr. Terry stated before the American Public Health Association:

Here were 112 men and women become confirmed drug habitues through the judgment of as many physicians who elected to submit their patients to this risk, in order to relieve varying degrees of pain caused by conditions which, for the most part, were in no way permanently benefited by the administration of an opiate, no small number of which were amenable to surgical interference or other well-recognized treatment, and where, in some instances, opiates, by every rule of intelligent practice, were distinctly con-traindicated! … In many instances these first doses were not given at the bedside to allay severe pain, but handed out to office patients with apparently as little concern as a dose of calomel.

If this kind of righteous indignation could be aroused by an informed colleague, one cannot be surprised that the public believed the physician deserved to have his prescriptions of habit-forming drugs severely restricted. It is reasonable to assume that most of the physicians themselves shared Dr. Terry’s harsh view of the dope doctor.

Dr. Terry also chastised the druggists who reaped an extravagant profit from their narcotic sales, and praised the form of New York’s cocaine law of 1913 except for its omission of opiates. Any legislation must “take full cognizance of the practicing physician as a factor of prime importance in the formation of drug users and not content itself with restrictions thrown around the druggist.” Effective prohibitive legislation “must provide for the free treatment of existing users.” The users should be considered public wards for “at least one rational course of treatment.” Dr. Terry had confidence only in public institutions after his experience with home treatments, private sanitaria, and private physicians. As a result of experience in his narcotic clinic, and a belief that medical treatment could be efficacious if given in a public institution, he declared that addiction was best left to health departments and not police departments. The police were distracted by many concerns and had only spasmodic interest in addiction “whenever chance or some too flagrant act brings the matter to their attention.”

Clients were not feared by the clinic personnel but seemed an alien and pitiful group; Dr. Terry’s description of chronic indigent addicts prior to the Harrison Act is of some interest:

The social misery, the inefficiency and communal depletion resulting from this civic malady, may not be properly realized by one who has not seen for himself this pitiful array of wrecks waiting, as in a breadline, for the free dope prescription, wives fearful lest their husbands discover their condition; fathers and mothers hiding, by every artifice a stimulated cunning may devise, their habit from their own children; young men and women asking in a whisper for a fifty-cent prescription for “coke,” a vicious circle of carelessness, ignorance and cupidity involving a responsibility that has been shifted from shoulder to shoulder until no one seems willing to admit it, yet intimately associated with the public welfare and health conservation and deserving of the most careful investigation and expert treatment.

In Terry’s early work, themes appear which he developed further over the next two decades.