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INTERNATIONAL CONTROL OF DRUGS OF ADDICTION
40 after section of cortico-hypothalamic pathways in animals, and he thinks that the complete expression of the affective responses depends upon an intact hypothalamus, all strong emotions being the result of a cortical release of lower structures, but although the caudal hypothalamus seems indispensable to emotional expression, other centres are also of great importance. Indeed some maintain that the hypothalamus may merely control a wide area of cortex and basal grey matter which is all brought into play during emotional expression. When the complexity of the psychological processes resulting in changes in mood is considered, it is not surprising that the structures used in expressing these changes should be widespread and intricately interconnected. In fact, the recent investigations confirm that the anatomy of melancholy and of joy is hidden in its own complexity.
b
MOBILE UNITS FOR ELECTRICAL TREATMENT
DURING the last war the importance of physical therapy in assisting the return of function and convalescence resulted in the development of many large departments fully equipped for electrical treatment and medical gymnastics. A mobile unit on the same lines might bring the most important forms of electrotherapy to the patients bedside. Such a unit is described in a booklet Dr. B. Heald, physician in charge of the C. by medicine physical department at the Royal Free Hospital, stressing its importance under war conditions. The unit consists of a portable short-wave outfit with inductothermy attachment; two direct-
hastening
two "Piotosurge" machines-i.e., current units; Bristow an ultra-violet
improved
coils; light apparinfra-red lamp; a radiant heat lamp; a hot-air douche; and a paraffin wax outfit. The directcurrent unit can be used for ionisation. The most important items are the short-wave diathermy outfit and the modified Bristow coil for exercising immobilised muscles. Pain is a serious problem in dealing with the severely wounded. Even with up-to-date methods for immediate treatment, chronic sepsis with all the suffering it entails is bound to be common. Diathermy may therefore well find employment in wards where casualties are treated. The Bristow coil in skilful hands is the ideal method of exercising weakened muscles. It can easily be made available since the coil is run off dry batteries, but the automatic method of " surging " will help the masseur who has a large number of patients to treat. The mobile unit cannot, of course, replace a fully equipped department, for it deals only with passive treatment. In the rehabilitation of the injured, training by active voluntary movements followed by occupational therapy is even more important. Nevertheless, the first of a number of these units, which are being paid for by an anonymous donor, has already been in use in sector 3 for treating casualties from France, and has proved its value in practice. atus ;
a junior partner at New Malden. The did not appeal to him and he decided to read for the bar, being called by the Middle Temple in 1901. He joined the chambers of Mr. Richard Muir (as he then was), and practised energetically at the criminal bar; in the case of Rex v. Crippen (1910) he appeared as junior counsel to the Crown. He became associated with Dr. Danford Thomas, then coroner for the Central London district, and was for a time deputy for West London. When a vacancy occurred he was up against Sir Walter Schroeder but soon after succeeded Dr. Henry Troutbeck at Westminster and South-west London. This was the last appointment of a coroner by the Franchise of Westminster, for the gift of the Westminster coronership was transferred from the dean and chapter of the Abbey to the London County Council by the Coroners Act of 1926. When he went to Central London in 1930 Mr. Oddie still retained the coronership of Westminster. The vacancy left by Mr. Oddie’s retirement has been filled by the appointment of Mr. W. R. H. Heddy, who also has the double qualification: he has been on the medical register since 1914 and was called to the bar by Gray’s Inn in 1925. Only son of Dr. W. J. Heddy, who practised in Redcliffe Gardens, he was educated at Dover College and studied medicine at the Middlesex. After four years’ service with the R.A.M.C. he joined the staff of the Middlesex publichealth department, and in 1934 became assistant deputy coroner to Dr. Danford Thomas. He was later appointed deputy coroner for Central, Northern and Western London, and has now become coroner for the Eastern district.
practice as night-work
an
LONDON CORONERS
LAST month Mr. Samuel Ingleby Oddie retired from the coronership for Central London, having reached the retiring age of seventy. He had long been one of London’s leading public figures. Mr. Oddie had a varied career before he finally found the life which suited him. He first intended to become a civil servant, but failing to master the higher mathematics he studied medicine at Edinburgh and qualified there in 1891. He joined the Naval medical service and served afloat for a few years in three of H.M. ships. The Admiralty then desired to send him to China,,but he preferred to get married, and set up in general
INTERNATIONAL CONTROL OF DRUGS OF ADDICTION
THE minutes of the 24th session of the advisory committee on traffic in opium and other dangerous drugs, recently published, provide much miscellaneous information. The situation in the Far East continues to occasion grave apprehension. According to the Chinese representative, Dr. Hoo Chi-tsai, the cultivation of the opium-poppy, under the six-year plan is due to terminate in 1940 so far as the area under the Chinese government is concerned. The opium crop is being replaced by cotton, cereals, tea, tobacco, sugarcane and the like. Active measures are being employed for the " disintoxication " of opium addicts and for their physical culture and moral rehabilitation in workshops. On the other hand it was alleged at the session that in the territory occupied by the Japanese government the cultivation of opium is encouraged, opium-smoking dens and clandestine drug-factories are tolerated and inadequate penalties are imposed for breaches of such regulations as exist for the restriction of the traffic. The United States representative (Mr. Fuller) referred to the great increase in drug addiction during the past year and the enormous quantities of Iranian opium imported into the Japanese-controlled areas of China. He urged that the Japanese Government should restrain the importation of opium and the manufacture of its derivatives in the occupied areas, and that the Iranian authorities should suppress the illicit traffic to the Far East, which appears to be increasing. A further suggestion was that the Portuguese government should prevent their colony of Macao from being used as The chairman of the coma base for illicit traffic. mittee, Major Coles (United Kingdom) spoke of the situation in the Far East as of "the utmost gravity and a source of extreme anxiety to other countries "; and he observed that the most important of the ques-
41 tions under consideration was " the work in connexion with the future convention for the limitation of the production of raw materials." A draft of the principal articles to be embodied in the convention was considered in private session, of which no minutes So this fundamental question has were published. been again adjourned, though it is stated that ’ substantial progress has been made." HOUSE-APPOINTMENTS
weeks ago a newly qualified man described correspondence columns the plight of those who, having registered with the B.M.A. for war service, were compelled when war broke out to hold themselves in readiness to be called up at some unspecified future A
in
FEW
our
date. The obvious way for a young doctor to fill this period of waiting is to take a house-appointment, but the applicants for the available jobs much exceed the supply and the chances of the average man getting A further obstacle is now being placed one are small. by certain hospitals in the way of those waiting their call to the services. For example, in their advertisement in our last issue for a house-surgeon one hospital inserted the clause: "Preference will be given to candidates without military commitments." The hospital committee’s point of view is that their primary duty is to ensure having an adequate staff when emergency arises, and hence they do not want to take on a man who may be called away at short notice at any time. While taking it for granted that every possible applicant would have volunteered for service of some kind, they hoped to find one in the category " for home service only." But the clause as it stands is undoubtedly directed against those who have acted with the highest patriotic motives, and seems clearly to be contrary to national interest. We are glad to learn that this particular clause has now been withdrawn. Let us hope that hospital committees will make up their minds that the possibility of frequent changes of house-officers is one of the extra burdens that they have to face in war-time. Although it may be too much to ask that they should give preference to potential members of the fighting services, they should at least consider their claims without prejudice. RED-CELL SIZE IN INDIA ACCURATE red-cell measurements have been made
both in Europe and America, but little knowledge has hitherto been available about cell size in India. Dr. H. N. Chatterjeehas now reviewed the relative value of different methods of estimating cell size and has applied these methods to both normal and pathological bloods of residents in Bengal. He has interested himself particularly in the question of red-cell thickness. His investigation of the anaemias associated with pregnancy has shown that the increased cell volume in the macrocytic type of anaemia has been closely associated with a cell thickness greater than normal. On the other hand, the increase in cell diameter has been less constant in these cases and has not been present in all cases of increased cell volume. The finding of this increased cell thickness is not surprising in view of the evidence brought forward by Evans and Willsthat pregnancy may result in increased red-cell fragility. Cassels,3 who also studied red-cell changes in pregnancy in England, while noting the increased fragility, was unable to correlate this change with any increase in red-cell 1. Studies in the Dimensions of
Erythrocytes of Man. By H. Chatterjee, M.B., University of Calcutta, 1939. Pp. 36. 2. Evans, B. D. F., and Wills, L., J. Path. Bact. 1939, 48, 437. 3. Cassels, D. A. K., Ibid, 47, 603.
N.
thickness. This observation that changes in red-cell fragility are associated with pregnancy is of considerable interest, and no explanation has yet been put forward. POISON GASES AND FOOD
THE repeated allegations made by the Germans that other countries are using mustard gas, and their latest ridiculous suggestion that we are adding a dash of mustard to our naval shells may possibly be preparing the way for gas-attacks on Britain itself. The civilian population is now fairly well protected and except in crowded areas the menace does not seem formidable so far as direct injury to the person is concerned. Gas might, however, seriously contaminate our food and water supplies.1 Food in porous containers-sacks or paper or cardboard wrappings-may merely absorb or adsorb a poisonous vapour, without itself undergoing any alteration, but when it is removed to uncontaminated air the vapour may be given off in the air of the store or larder. The cooking of contaminated food is likely to lead to rapid emission of vapour, though heat will also accelerate hydrolysis into harmless but possibly eviltasting products. What is left unchanged in the food may still lead to digestive disturbances, for it may behave in the stomach much as it does when absorbed by the skin. The risk is of course greater in the case of food like butter and margarine, in which mustard gas is readily soluble, and which are eaten uncooked. The more persistent lacrimatory gases may also be absorbed by foods in the cold and given off on airing or cooking. Lewisite (chlorovinyl dichlorarsine) and other arsines may interact with the water in foodstuffs, leading to the formation of arsenious acid, and organic cyanides may yield hydrocyanic acid. Phosgene easily hydrolyses, producing hydrochloric acid which will not be appreciated in food or drink by any but the confirmed achlorhydric. Tea and tobacco are drastically affected by this gas, as is the baking quality of flour. Airing or rejecting the outer layer of packages of food which have been exposed to gas may allow the rest to be used safely if it is carefully tested, but the safest plan is to use trustworthy containers only. Metal canisters or wellstoppered bottles and jars are the best, and Cellophane is practically gas-proof, but ordinary greaseproof paper and waxed containers cannot be relied on. When food has been contaminated by liquid mustard or other persistent gases the only sound advice seems to be to destroy it.
Dr. J. MIDDLETON MARTIN, who died at Cheltenham Dec. 30, was formerly county M.O.H. for Gloucester and then conceived one of the first practical schemes for the extension of medical services. on
1. See Cox, H. E., Analyst, 1939, J. Pharm. Belg. 1939, 21, 793.
64, 807, and Schoop, F.,
GENERAL. MEDICAL COUNCIL.—At
a
meeting
of the
executive committee of the council held on Nov. 27 it was reported that the following names had been restored toI the register after removal (under section 14 of the Medical Act 1858) on failing to keep the council in touch with their whereabouts : Vincent E. N. Allen, Hugh G. Bruce, Alexander C. Farquharson, Neville C. Gwynn, Gerald B. Kirkland, Noel E. Laurence, Samuel R. Mackenzie, Thomas H. K. MacLaughlin, Henry O. Martin, Alexander Milne-Thomson, David Morrison, Constance A. Mortlock-Brown, Arthur J. de Lyse O’Connor, Edgar F. J. Peregrine, Walter A. Propert, Shaikh A. H. Qureshi, William Reikan, Charles E. Rice and Chung Ching Wang.
b
MOBILE UNITS FOR ELECTRICAL TREATMENT
DURING the last war the importance of physical therapy in assisting the return of function and convalescence resulted in the development of many large departments fully equipped for electrical treatment and medical gymnastics. A mobile unit on the same lines might bring the most important forms of electrotherapy to the patients bedside. Such a unit is described in a booklet Dr. B. Heald, physician in charge of the C. by medicine physical department at the Royal Free Hospital, stressing its importance under war conditions. The unit consists of a portable short-wave outfit with inductothermy attachment; two direct-
hastening
two "Piotosurge" machines-i.e., current units; Bristow an ultra-violet
improved
coils; light apparinfra-red lamp; a radiant heat lamp; a hot-air douche; and a paraffin wax outfit. The directcurrent unit can be used for ionisation. The most important items are the short-wave diathermy outfit and the modified Bristow coil for exercising immobilised muscles. Pain is a serious problem in dealing with the severely wounded. Even with up-to-date methods for immediate treatment, chronic sepsis with all the suffering it entails is bound to be common. Diathermy may therefore well find employment in wards where casualties are treated. The Bristow coil in skilful hands is the ideal method of exercising weakened muscles. It can easily be made available since the coil is run off dry batteries, but the automatic method of " surging " will help the masseur who has a large number of patients to treat. The mobile unit cannot, of course, replace a fully equipped department, for it deals only with passive treatment. In the rehabilitation of the injured, training by active voluntary movements followed by occupational therapy is even more important. Nevertheless, the first of a number of these units, which are being paid for by an anonymous donor, has already been in use in sector 3 for treating casualties from France, and has proved its value in practice. atus ;
a junior partner at New Malden. The did not appeal to him and he decided to read for the bar, being called by the Middle Temple in 1901. He joined the chambers of Mr. Richard Muir (as he then was), and practised energetically at the criminal bar; in the case of Rex v. Crippen (1910) he appeared as junior counsel to the Crown. He became associated with Dr. Danford Thomas, then coroner for the Central London district, and was for a time deputy for West London. When a vacancy occurred he was up against Sir Walter Schroeder but soon after succeeded Dr. Henry Troutbeck at Westminster and South-west London. This was the last appointment of a coroner by the Franchise of Westminster, for the gift of the Westminster coronership was transferred from the dean and chapter of the Abbey to the London County Council by the Coroners Act of 1926. When he went to Central London in 1930 Mr. Oddie still retained the coronership of Westminster. The vacancy left by Mr. Oddie’s retirement has been filled by the appointment of Mr. W. R. H. Heddy, who also has the double qualification: he has been on the medical register since 1914 and was called to the bar by Gray’s Inn in 1925. Only son of Dr. W. J. Heddy, who practised in Redcliffe Gardens, he was educated at Dover College and studied medicine at the Middlesex. After four years’ service with the R.A.M.C. he joined the staff of the Middlesex publichealth department, and in 1934 became assistant deputy coroner to Dr. Danford Thomas. He was later appointed deputy coroner for Central, Northern and Western London, and has now become coroner for the Eastern district.
practice as night-work
an
LONDON CORONERS
LAST month Mr. Samuel Ingleby Oddie retired from the coronership for Central London, having reached the retiring age of seventy. He had long been one of London’s leading public figures. Mr. Oddie had a varied career before he finally found the life which suited him. He first intended to become a civil servant, but failing to master the higher mathematics he studied medicine at Edinburgh and qualified there in 1891. He joined the Naval medical service and served afloat for a few years in three of H.M. ships. The Admiralty then desired to send him to China,,but he preferred to get married, and set up in general
INTERNATIONAL CONTROL OF DRUGS OF ADDICTION
THE minutes of the 24th session of the advisory committee on traffic in opium and other dangerous drugs, recently published, provide much miscellaneous information. The situation in the Far East continues to occasion grave apprehension. According to the Chinese representative, Dr. Hoo Chi-tsai, the cultivation of the opium-poppy, under the six-year plan is due to terminate in 1940 so far as the area under the Chinese government is concerned. The opium crop is being replaced by cotton, cereals, tea, tobacco, sugarcane and the like. Active measures are being employed for the " disintoxication " of opium addicts and for their physical culture and moral rehabilitation in workshops. On the other hand it was alleged at the session that in the territory occupied by the Japanese government the cultivation of opium is encouraged, opium-smoking dens and clandestine drug-factories are tolerated and inadequate penalties are imposed for breaches of such regulations as exist for the restriction of the traffic. The United States representative (Mr. Fuller) referred to the great increase in drug addiction during the past year and the enormous quantities of Iranian opium imported into the Japanese-controlled areas of China. He urged that the Japanese Government should restrain the importation of opium and the manufacture of its derivatives in the occupied areas, and that the Iranian authorities should suppress the illicit traffic to the Far East, which appears to be increasing. A further suggestion was that the Portuguese government should prevent their colony of Macao from being used as The chairman of the coma base for illicit traffic. mittee, Major Coles (United Kingdom) spoke of the situation in the Far East as of "the utmost gravity and a source of extreme anxiety to other countries "; and he observed that the most important of the ques-
41 tions under consideration was " the work in connexion with the future convention for the limitation of the production of raw materials." A draft of the principal articles to be embodied in the convention was considered in private session, of which no minutes So this fundamental question has were published. been again adjourned, though it is stated that ’ substantial progress has been made." HOUSE-APPOINTMENTS
weeks ago a newly qualified man described correspondence columns the plight of those who, having registered with the B.M.A. for war service, were compelled when war broke out to hold themselves in readiness to be called up at some unspecified future A
in
FEW
our
date. The obvious way for a young doctor to fill this period of waiting is to take a house-appointment, but the applicants for the available jobs much exceed the supply and the chances of the average man getting A further obstacle is now being placed one are small. by certain hospitals in the way of those waiting their call to the services. For example, in their advertisement in our last issue for a house-surgeon one hospital inserted the clause: "Preference will be given to candidates without military commitments." The hospital committee’s point of view is that their primary duty is to ensure having an adequate staff when emergency arises, and hence they do not want to take on a man who may be called away at short notice at any time. While taking it for granted that every possible applicant would have volunteered for service of some kind, they hoped to find one in the category " for home service only." But the clause as it stands is undoubtedly directed against those who have acted with the highest patriotic motives, and seems clearly to be contrary to national interest. We are glad to learn that this particular clause has now been withdrawn. Let us hope that hospital committees will make up their minds that the possibility of frequent changes of house-officers is one of the extra burdens that they have to face in war-time. Although it may be too much to ask that they should give preference to potential members of the fighting services, they should at least consider their claims without prejudice. RED-CELL SIZE IN INDIA ACCURATE red-cell measurements have been made
both in Europe and America, but little knowledge has hitherto been available about cell size in India. Dr. H. N. Chatterjeehas now reviewed the relative value of different methods of estimating cell size and has applied these methods to both normal and pathological bloods of residents in Bengal. He has interested himself particularly in the question of red-cell thickness. His investigation of the anaemias associated with pregnancy has shown that the increased cell volume in the macrocytic type of anaemia has been closely associated with a cell thickness greater than normal. On the other hand, the increase in cell diameter has been less constant in these cases and has not been present in all cases of increased cell volume. The finding of this increased cell thickness is not surprising in view of the evidence brought forward by Evans and Willsthat pregnancy may result in increased red-cell fragility. Cassels,3 who also studied red-cell changes in pregnancy in England, while noting the increased fragility, was unable to correlate this change with any increase in red-cell 1. Studies in the Dimensions of
Erythrocytes of Man. By H. Chatterjee, M.B., University of Calcutta, 1939. Pp. 36. 2. Evans, B. D. F., and Wills, L., J. Path. Bact. 1939, 48, 437. 3. Cassels, D. A. K., Ibid, 47, 603.
N.
thickness. This observation that changes in red-cell fragility are associated with pregnancy is of considerable interest, and no explanation has yet been put forward. POISON GASES AND FOOD
THE repeated allegations made by the Germans that other countries are using mustard gas, and their latest ridiculous suggestion that we are adding a dash of mustard to our naval shells may possibly be preparing the way for gas-attacks on Britain itself. The civilian population is now fairly well protected and except in crowded areas the menace does not seem formidable so far as direct injury to the person is concerned. Gas might, however, seriously contaminate our food and water supplies.1 Food in porous containers-sacks or paper or cardboard wrappings-may merely absorb or adsorb a poisonous vapour, without itself undergoing any alteration, but when it is removed to uncontaminated air the vapour may be given off in the air of the store or larder. The cooking of contaminated food is likely to lead to rapid emission of vapour, though heat will also accelerate hydrolysis into harmless but possibly eviltasting products. What is left unchanged in the food may still lead to digestive disturbances, for it may behave in the stomach much as it does when absorbed by the skin. The risk is of course greater in the case of food like butter and margarine, in which mustard gas is readily soluble, and which are eaten uncooked. The more persistent lacrimatory gases may also be absorbed by foods in the cold and given off on airing or cooking. Lewisite (chlorovinyl dichlorarsine) and other arsines may interact with the water in foodstuffs, leading to the formation of arsenious acid, and organic cyanides may yield hydrocyanic acid. Phosgene easily hydrolyses, producing hydrochloric acid which will not be appreciated in food or drink by any but the confirmed achlorhydric. Tea and tobacco are drastically affected by this gas, as is the baking quality of flour. Airing or rejecting the outer layer of packages of food which have been exposed to gas may allow the rest to be used safely if it is carefully tested, but the safest plan is to use trustworthy containers only. Metal canisters or wellstoppered bottles and jars are the best, and Cellophane is practically gas-proof, but ordinary greaseproof paper and waxed containers cannot be relied on. When food has been contaminated by liquid mustard or other persistent gases the only sound advice seems to be to destroy it.
Dr. J. MIDDLETON MARTIN, who died at Cheltenham Dec. 30, was formerly county M.O.H. for Gloucester and then conceived one of the first practical schemes for the extension of medical services. on
1. See Cox, H. E., Analyst, 1939, J. Pharm. Belg. 1939, 21, 793.
64, 807, and Schoop, F.,
GENERAL. MEDICAL COUNCIL.—At
a
meeting
of the
executive committee of the council held on Nov. 27 it was reported that the following names had been restored toI the register after removal (under section 14 of the Medical Act 1858) on failing to keep the council in touch with their whereabouts : Vincent E. N. Allen, Hugh G. Bruce, Alexander C. Farquharson, Neville C. Gwynn, Gerald B. Kirkland, Noel E. Laurence, Samuel R. Mackenzie, Thomas H. K. MacLaughlin, Henry O. Martin, Alexander Milne-Thomson, David Morrison, Constance A. Mortlock-Brown, Arthur J. de Lyse O’Connor, Edgar F. J. Peregrine, Walter A. Propert, Shaikh A. H. Qureshi, William Reikan, Charles E. Rice and Chung Ching Wang.