LIMITATION OF OPIUM PRODUCTION

LIMITATION OF OPIUM PRODUCTION

94 portal tract or where collateral circulation allows of by-passing the liver. By reason of the country where this work was done, S. japonicum did n...

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portal tract or where collateral circulation allows of by-passing the liver. By reason of the country where this work was done, S. japonicum did not come under observation, but it can hardly be doubted that a like investigation where it is ’endemic will give equally fruitful results. OPTIC ATROPHY

IN

PERNICIOUS ANÆMIA

OPTic atrophy in Addisonian pernicious anaemia is rare ; and when it occurs it is usually attributed to ischaemia rather than to an intrinsic degenerative process. Henry Cohenhas described two cases in which visual impairment was the presenting symptom. R. K. Kampmeier and E. Jones2 now give an account of two patients who complained of symptoms referable to the eyes when first seen. A tentative diagnosis of tabes dorsalis was made but subsequent investigations showed that both patients had typical pernicious ansemia. The authors discuss also a third case in which the diagnosis was more doubtful owing to incomplete investigation and failure to obtain a post-mortem. One patient gained definite improvement in vision following adequate liver treatment. In the other vision was unaltered after a short period ; but since the nervous system responds much more slowly to therapy than does the haemopoietic it is possible for improvement to occur after the lapse of years rather than months. The authors believe that the atrophy is more likely to be an intrinsic degenerative process than due to ischaemia, since though severe grades of anaemia with red cell counts below a million are quite often seen in Addisonian anaemia optic atrophy is rare. The fact that their cases had red cell counts between 1 and 2 million rules out, in their view, an ischaemic origin for the atrophy. They emphasise the importance of bearing in mind the possibility of pernicious anaemia when investigating cases of optic atrophy, so that treatment may not be delayed.

York City residents it was found that the majority of the cases occurred in October to December, following, that is, the holiday season. In the United States as a whole, the maximum incidence occurs during the spring and summer months. This difference in distribution, together with the practical absence of indigenous cases of undulant fever, leaves little doubt that the effective pasteurisation of milk and cream results in the virtual abolition of milkborne brucella infection. Experience in London, it may be noted, where over 90 per cent. of the milk is heat-treated, is very similar to that in New York City. Very few cases of undulant fever have occurred, and practically all of them have been traced to infection outside London, or to the consumption of raw graded milk in the city itself. LIMITATION OF OPIUM PRODUCTION

Two years ago both the council and the assembly of the League of Nations urged the importance of limiting the cultivation of the opium poppy. The latter body held that such limitation " constituted a decisive step in the campaign against the abuse of narcotic drugs and a logical and necessary crowning of the efforts of the League." The problem doubtless presents difficulties but there is no justification for further procrastination. Questionnaires have been issued and replied to by producing countries, much documentation has been furnished and considered at private sessions, and preparatory conferences have been held. Statistics show that, except in Yugoslavia, Soviet Russia, Bulgaria, and Japan, the amount of production increased by some 660 tons between 1935 and 1936, and the area under opium poppy cultivation also increased in all producing countries except Korea. The world production of raw opium, excluding the quantities produced in China, Manchukuo, and Afghanistan, was 2300 tons in 1936, whereas the world consumption was said to be only 1120 tons. Thus production was said to be INCUBATION PERIOD IN UNDULANT FEVER more than twice as great as the legitimate world IN New York City an ordinance has been in force needs. During the same year the export trade from for the last ten years requiring the pasteurisation the producing countries rose from 391 to 463 tons, of all milk and cream, except certified milk, sold while the world stocks increased from 2550 tons in commercially. The opportunity, - therefore, of con- 1935 to 3474 tons in 1936. The advisory committee tracting brucella infection in the city itself has been has resolved itself into a preparatory committee to practically confined to users of certified milk, which pave the way for the urgently needed international has formed only about 1-2.5 per cent. of the total conference for limiting cultivation and production. supply. Very few indigenous cases of undulant The secretariat has presented to the committee fever have occurred during the years 1928-37 proposals for establishing in future the world needs among a population of seven million. In fact only of raw opium, for allocating to each producing four cases were recorded in which some obvious country the amounts required for internal consource of infection, such as certified milk, could not sumption and for export to non-producing countries, be incriminated. Most of the cases that occurred and for securing effectuation of the proposed convention. They again emphasise that the lack of were in persons who had been infected outside the a farm on control of traffic in narcotics in the Far East, notably often while vacation. during city, staying of fact has been taken this by Hardy, in Manchuria and the occupied provinces of China, Advantage Frant, and Kroll3 two ascertain the usual length of constitutes a world-wide peril. the incubation period of undulant fever. Seventeen ADMISSION OF AUSTRIAN DOCTORS The time from the cases were available for analysis. ON Monday last Sir Samuel Hoare, the Home date of exposure to the onset of the first symptoms varied from about 2 to 30 weeks. The most usual length Secretary, accompanied by Lord Winterton, met of the incubation period was 6 to 7 weeks. These representatives of the British Medical Association,’ findings are of particular value in lending support to the Royal College of Physicians of London, the Royal the current belief, founded on numerous individual College of Surgeons of England, and the Society of Apothecaries of London for a discussion on the cases, that the incubation period in undulant fever admission of Austrian doctors to practise in England. is very variable and may exceed 6 months in dura" It was agreed that it would be possible to admit tion. It is probable that all the cases under review were examples of infection with Br. abortus. Analysing only a limited number, and that any such admissions Committees must be the subject of careful selection. the seasonal distribution of undulant fever in New the medical and dental professions are to representing 1 2 Amer. J. med. Sci. 1938. 195, 633. Lancet, 1936, 2, 1202. be set up to assist in the selection of doctors and 3 Hardy, A. V., Frant, S., and Kroll, M. M., Publ. Hlth Rep., dentists seeking admission. Wash. 1938, 53, 796.