Our first witness is Dr. Nathan Kline, director of research, Rockland State Hospital, New York Department of Mental Hygiene.

Both of our witnesses have been most helpful in preliminary exploritory and investigatory work on the part of the staff of the committee, and both witnesses have been subpenaed in this appearance.

Dr. Nathan Kline, you are the first witness. I notice you have a prepared statement. Would you introduce yourself, and give a summary statement of your background, your field of professional work, and any additional material that may be put into the record?

Mr. MEADER. Mr. Chairman, I notice he has a curriculum vitae here.

Dr. KLINE. I was going to save running through my obituary by having it written out. If I may, I would like to submit that as exhibit A.

Mr. BLATNIK. Without objection, it is so ordered. (Document referred to is as follows:)

NATHAN S. KLINE, CURRICULUM VITAE

PERSONAL HISTORY

Born at Philadelphia, Pa., March 22, 1916, and raised in Atlantic City, N. J. Married June 1942 to Margot Hess of Elberfeld, Germany. One child, Marna Ellen, born April 1945 in New Orleans, La.

Scholastic training

1934: Graduated high school, Atlantic City, N. J. Extra curricular activities included editorship of school magazine and yearbook, captaincy of debating team, presidency of literary society, and membership on tennis team.

1934-38: Swarthmore College; bachelor of arts degree with honors in the division of mathematics, and the natural sciences. Comajored in philosophy and psychology.

1938: University of Pennsylvania (summer session).

1938-39: Harvard University graduate student in the department of psychology, graduate school of arts and sciences.

1939: Harvard University (summer session).

1939-43: New York University College of Medicine (doctor of medicine, 1943). 1940-41: New School of Social Research; special courses in psychology. 1943-44: Washington School of Psychiatry courses.

1946-47: Princeton University; graduate work in the psychology department. 1947-48: Rutgers University; graduate course in neuropsychiatry.

1950-53: Clark University; graduate studies in psychology (master of arts in psychology, 1951).

Licenses and certificates

1. State licenses: Maryland, February 1944; District of Columbia, May 1944, No. 782; New York, October 1946, No. 44877; New Jersey, September 1946, No. 12004; California, June 1949, No. C-12145; Massachusetts, May 1950, No. 22491. 2. Diplomate, American Board of Psychiatry and Neurology (in psychiatry, May 1948, No. 2934).

3. Qualified psychiatrist (New York State No. 1262).

Positions

1943-44: St. Elizabeths Hospital, Washington, D. C.; intern and resident. 1944-46: United States Public Health Service; wartime service as psychiatrist. 1946-47: Union County Mental Hygiene Society's clinic; part-time child psychiatrist.

1946-50: Veterans' Administration hospital, Lyons, N. J.; supervision and carrying out of various research projects and assisting in the educational program.

1947-50: Columbia-Greystone; associate.

1948-50: New York State brain research project; associate.

1950-52: Worcester State Hospital, Worcester, Mass.; director of research. 1952 to present: Rockland State Hospital, Orangeburg, N. Y.; director of research.

Academic appointments

1948–50: Columbia University, College of Physicians and Surgeons, department of neurology; research assistant.

1952-55: Department of neurology, research associate.

1955-57: Department of psychiatry, research associate.

1957 to present: Department of psychiatry, assistant clinical professor of psychiatry.

1955 to present: Rutgers University; visiting lecturer, school of education. Nonacademic appointments

1956 to present: Manhattan Society for Mental Health, professional advisory committee.

1957 to present: National Institute of Mental Health, member of Clinical Advisory Panel, Psychopharmacology Service Center.

1957: World Health Organization; temporary adviser, Study Group on Schizophrenia (September).

Awards

1956: Newspaper Guild of New York; page 1 award in science.

1956: Association for Improvement of Mental Health; Adolf Meyer award. 1956: Rockland Hospital Guild; outstanding service in the field of mental research.

1957: Albert Lasker award; outstanding achievements in the development of the uses of Rauwolfia.

Membership in National Societies

1947 to present: American Psychiatric Association; fellow (1949); member of research committee (1951-57), (chairman 1956-57).

1947 to present: American Psychological Association.

1947 to present: Association for Research in Nervous and Mental Diseases. 1949 to present: American Association for the Advancement of Science; fellow (1954), program committee for psychiatric section (1952), council representative from the American Psychiatric Association (1956-58).

1949 to present: American College of Physicians; fellow (1956).

1950 to present: Sigma Xi.

1950 to present: New York Academy of Medicine; fellow.

1953 to present: American Philosophical Association; associate member.

1954 to present: New York Academy of Sciences.

1955 to present: Society for Biological Psychiatry.

1955 to present: Society for Experimental Biology and Medicine.

1956 to present: Medical Society of the County of New York.

1956 to present: American Medical Association.

1956 to present: American Chemical Society, division of medicinal chemistry; associate.

1957 to present: The Royal Society of Medicine (England); fellow.

STATEMENT OF NATHAN S. KLINE, M. D., DIRECTOR OF RESEARCH, ROCKLAND STATE HOSPITAL, NEW YORK DEPARTMENT OF MENTAL HYGIENE

Mr. MEADER. I think he ought to translate that Latin phrase. Dr. KLINE. This is one of the cliches of applying for a job in our field. It is a résumé, in other words, giving training and professional experience. Do you want me to run through it?

Mr. BLATNIK. Please.

Dr. KLINE. I graduated from Swarthmore College with a bachelor of arts degree with honors in the division of mathematics and the natural sciences. Comajored in philosophy and psychology.

I was subsequently a graduate student at Harvard University in the department of psychology; subsequently, received my doctorate of medicine from New York University College of Medicine, more graduate work at Princeton, Rutgers, Clark University, where I obtained a degree in psychology.

Let's see what else? Training at a very estimable hospital known as St. Elizabeths in Washington, D. C., as intern and resident, and service in the United States Public Health Service during the war, then in the Veterans' Administration for 4 years doing research, director of research at Worcester State Hospital at Massachusetts, and subsequent to that, research director at Rockland State Hospital.

Some academic appointments along the line, included the department of neurology at Columbia and subsequently, the department of psychiatry, where presently I am assistant clinical professor.

A few recognitions and awards, one from the Newspaper Guild of New York, the page 1 award in science, and 1 or 2 others, the most noteworthy being the Lasker award of the American Public Health Association, in science for work in this field.

I am on the Advisory Panel of Psychopharmacology at the National Institute of Mental Health, a fellow of half a dozen or so scientific and medical societies in the field, and author or coauthor of a number of books and 70 or 80 scientific papers.

Does that about cover it?

Mr. BLATNIK. That covers it.

What is your present position, Doctor?

Dr. KLINE. Director of research at Rockland State Hospital, which is an 8,000-bed mental hospital some 15 or 20 miles outside of New York City.

Mr. BLATNIK. How many years have you been there?

Dr. KLINE. Somewhat over 5 years.

Mr. BLATNIK. Will you please proceed with your statement?

Mr. MINSHALL. You mention the Lasker award for outstanding achievement in the development of the uses of rauwolfia.

What are the uses of rauwolfia? What is that?

Dr. KLINE. Rauwolfia is the plant from which reserpine (serpasil, rau-sed, sandril, and so on) is obtained. It was one of the first drugs to be used in the treatment of mental illness. Rauwolfia, is a natural product, whereas chlorpromazine is a synthetic. Chlorpromazine (Thorazine as marketed in this country) and reserpine were the two drugs which broke open this whole field.

Mr. BLATNIK. Am I correct, that the origin was in India, in its true native use?

Dr. KLINE. Yes. Dr. Vakil, with whom I spent some time a few months ago, was the one who brought its use in high blood pressure to attention in the Western World. He was able to trace back use of this drug for high blood pressure and snakebite. It is called Rauwolfia serpentina, since it looks like a snake.

Mr. BLATNIK. Off the record.

Dr. KLINE. He has been able to trace references back to 200 B. C., which is a little staggering to some of us who feel that our modern western medicine is the latest word. They apparently have been using it in a cruder form for virtually some 4,000 years, now, which is an interesting aside.

Mr. BLATNIK. Will you proceed with your statement, and we will cover these plus other medicants as we reach them?

Dr. KLINE. Among the other useful results of the present hearings, not the least will be to bring again to public attention the enormity of the problem of mental illness, the toll it takes in human and in economic terms, and what is being done about it. There exists little

question that mental disease constitutes the Nation's No. 1 public health problem regardless of how one chooses to define public health. In terms of patient population, of the total hospital beds in the United States, half (i. e., 750,000) are for psychiatric patients. Other hundreds of thousands of patients are treated on an ambulatory basis and probably an even greater number are in need of treatment but facilities are lacking to care for them. On the basis of recent figures it has been estimated that at the present rate of hospitalization 1 of every 10 persons in the United States will spend part of his life as a patient in a mental hospital.

If you look around the room, you figure out that this is quite a number, on a purely statistical basis. I am not doing any selecting. Repeated surveys over the past few decades have shown that of patients coming to the general practitioner approximately one-third have entirely psychological illnesses and another one-third, whatever their physical disability, have emotional and mental complications which seriously interfere with their recovery. Rather than belabor you with a specific breakdown I would like to submit as exhibit a data sheet prepared by the National Committee Against Mental Illness showing that the economic loss to the country amounts yearly to over $4 billion.

May I submit that at this point?

Mr. BLATNIK. Without objection, it is so ordered.

(See appendix, exhibit 1 p. 171.)

Dr. KLINE. Reducing this to a figure which is meaningful to the average individual is a difficult task but as an individual who pays taxes in the State of New York it is of personal interest to me that roughly one-third of the operating budget of the State goes to the department of mental hygience and I am sure that the figures for other States whether funds are obtained by direct or indirect taxation are not too different.

In other words, the cost is borne by the taxpayer, rather than by the individual family.

The cost in human suffering is almost beyond imagination. Mental illness is not a disease which merely affects one member of the family: if the patient is hospitalized the emotional drain on the family who carried this stigma plus the time and effort devoted to visiting and worrying about such a patient may go on not for weeks or months but for years and decades. If the patient is cared for privately the strain on the family in respect to adjusting to living with such an individual plus the economic sacrifices required to provide anything like adequate psychiatric care often leave families in financial and emotional bankruptcy. Under our present system these illnesses are not compensable so that no relief is provided by the ordinary protection against medical disasters.

The diseases which maim and destroy people in the declining years of their life are sad enough but frequently mental illness strikes in adolescence or young adult life and patients who have been hospitalized 50 or even 75 years are not uncommon. If they are married and with children the husband or wife faces a difficult future since while the patient still lives one must always hope that something can be done, whereas in illnesses that terminate fatally one must attempt to be reconciled to the inevitable. It is therefore small wonder that

any new treatment which offers hope for those who have failed to respond to other methods would be a subject of the greatest public as well as medical interest. Based on available figures it would not be unreasonable to estimate that well over half the families in the United States had at least one member in a mental hospital or under psychiatric care so that news about advances or dangers of treatment command a tremendous audience with intense personal interest. Until 5 years ago a great majority of mental diseases could not effectively be treated either because no adequate treatment existed or because the available techniques were so time consuming and expensive that only a handful of the hundreds of thousands of patients could even be tried. In the treatment of infectious diseases the antibotics clearly marked the beginning of a new era just as the introduction of aseptic techniques sharply demarcate the beginning of modern surgery. There were important developments in the treatment of infectious diseases and in surgery prior to these turning points but the importance of antibiotics and asepsis was so great that they revolutionized all subsequent therapy. The development and successful application of the psychopharmaceuticals was a thermonuclearlike explosion which marked the end of one era and the beginning of another; and which may, in point of fact, be of markedly greater import in the history of mankind than the atom bomb since if these drugs provide the long-awaited key which will unlock the mysteries of the relationship of man's chemical constitution to his psychological behavior and provide effective means of correcting pathological needs there may no longer be any necessity for turning thermonuclear energy to destructive purposes. It is too soon to know whether we are really across the threshold but let me present the evidence for those who hold, as do I, that a major event has occurred in the psychiatric field.

In the 185-year history of the public mental hospitals in the United States, at the end of each year there were more patients in the hospitals than there had been at the end of the previous year. In 1956, which was the first year that the drugs were used on large scale, a simple statement of the facts is the most dramatic way of indicating what happened. The anticipated increase in the mental hospital population of the country was such that at the end of the year if the projection followed through there would be between 10,000 and 12,000 patients more in mental hospitals than there had been at the beginning of the year.

Mr. BLATNIK. At that point, may I ask just a question?

Dr. KLINE. Surely.

Mr. BLATNIK. Would that rate of increase be greater than the proportion of population increase?

Dr. KLINE. Yes.

Mr. BLATNIK. Or would it be just a normal increase due to the normal increase in population?

Dr. KLINE. No; the rate of mental-hospital increase has shown a steady progress above that of the general population. I might mention as an aside that I do not believe that this is necessarily related to the pressures under which we live, or the phrenetic modern times.

I was recently in Haiti, and they have 4 million population and only 250 hospital beds. This certainly does not mean that the mental health in Haiti is that much better than ours; or, to use an example in the United States, the rate of hospitalization in Delaware, I think, is