OPIUM AS AN INTERNATIONAL PROBLEM.

609 that no ratifications had so far been deposited. Mr. GAVIT believes that, given the will and the necessary powers, the production of manufactured narcotics can be controlled. There is only one place where this can be done, and that is the place whence every ounce of morphine, heroin, and cocaine must emerge at the outset of its search for victims-namely, the LONDONSATURDAY, SEPTEMBER 19, 1925. factory. Drug factories are relatively few, and the Governments know exactly where to find them. The character of the problem has, he contends, changed greatly since international agreement was first OPIUM AS AN INTERNATIONAL PROBLEM. registered in 1912. The evil is not now an exotic THE Opium Committee of the League of Nations affair of the Far East-the eating, drinking, and of raw and prepared opium are injurious recently concluded its discussion of the annual smoking but are surpassed by the present-day enough, reports from various States. The notes published in abuse of the they of opium and other highly derivatives THE LANCET from time to time’have shown how of addiction. concentrated These, being less drugs difficult is the problem with which this Committee are more profitable and more easily disguised, bulky is grappling. Since The Hague Convention of 1912 to behind them the have Also, they smuggle. the control of the traffic in dangerous drugs has been of the Western genius for business organisaa matter of anxious and prolonged discussion wherever push and the subtle effect upon conscience of absentee tion, nations have gathered in congress. The second It is not generally realised that, since the League Conference held 28 sittings, and any definite ownership. Convention and during and after the World results were prejudiced by the regrettable withdrawal Hague has developed with appalling the situation War, of the American and Chinese delegates. Much difference swiftness. The old enemy, opium, in a new and of opinion now exists as to the value of the advances and devastating form, more venomous made. Prof. PERROT, a French delegate, writes with immensely with new allies and in overwhelming quantities, has some satisfaction in the Revue Scientifique of July 1 lth, while Sir WILLIAM CoLLiNs in the August Contem- become a very real menace to civilisation. Mr. GAVIT gives some interesting and disquieting figures. It porary Revietf1 doubts whether the proposed Permanent will be remembered that the Health Commission of Board a of Central procrastina- the may not prove means League of Nations, the Opium Advisory Comtion rather than an agent for forward movement. and a mixed subcommittee representing mittee, The idea of this Central Board originated in the an estimate showing the amount of raw both gave Opium Advisory Committee of the League of Nations, opium and crude cocaine needed per capita per and was endorsed by the United States and Great annum for medical and scientific use by the populaBritain. Its principal business would be to gather tion of the world within reach of modern medical information about the production of, and interservice. This amount was 450 mg. of raw opium and national traffic in, narcotics, and especially to watch 7 mg. of cocaine. On the basis of an estimated the channels of illicit trade smuggling. It was the world’s assumed total population 744,000,000 (of intended by those who devised the idea of this of 1,747,000,000) as the population represented in Central Board that it should have very wide and the phrase " medical and scientific needs," the total drastic powers of inquisition and publicity, and it needs of the world work out in tons as legitimate was to be in a position to ration raw material and follows : 100 for medicinal opium, 136 for morphine, manufactured narcotics among the nations, with 84 for codein, and 15 for heroin-a total of 335 tons. strict reference to their needs and available supplies. After bringing up this total to 340 tons by allowing In the preliminary discussions, the American, British, for such of the natives of Asia and Africa as might and certain other delegations sought to give this access to doctors, Mr. GAVIT writes : " But let Board such powers, but the obstruction encoun- get us’go the limit’ and allow 450 mg. of raw opium a tered was sufficient to whittle down the proposed year for every man, woman, and child in the world. powers to an authorisation, in the event of an excessive That will give us the outside total as the conceivable and unexplained accumulation of narcotics in any medical and scientific needs of the whole world of country, and a belief by the Board that this country 786 tons of raw opium per year." What is the actual was in danger of becoming a centre of illicit traffic, No one knows. But amount of opium produced ? "to recommend that no further exports of the conservative estimates converge with remarkable substances covered by the present Convention or closeness towards a total production of about 8600 any of them shall be made to the country concerned tons, including 5000 tons attributed to China. In until the Board reports that it is satisfied as to the other words, less than one-tenth of the total amount situation in that country." The Board would also of opium produced is for legitimate medical and be authorised to publish a report in any such situaStill less is known about the scientific purposes. tion ; and the Convention also declares it to be the of cocaine, of which only little more than output friendly right of any country party to the agreement 5 tons a year would be needed for the 744,000,000 of to draw the attention of the Board to any matter the population of the world supposed to be within which appears to it to require investigation. reach of modern medical service. But a clue can be Writing in the September number of the TVo2-ld’s given to the liberality of the supply actually availHealth, the journal of the League of Red Cross able by the fact that Japan alone in 1922-23 manuSocieties, Mr. JOHN PALMER GAVIT, who until recently factured It is 15,432 lb. (Times, August 27th). was managing editor of the New York Evening Post, that the of narcotics evident, therefore, production and was a close observer of the conflict of interests in the world is at least ten times as great as the most in the winter of 1924-25, attaches considerable importestimate of its legitimate needs. ance to this Board. He hopes that the Governments extravagant While we wait for the efficient Government control concerned will ratify the Convention, but a reply in of the drugs of addiction, it is to be hoped that the House of Commons on June 17th last indicated voluntary associations, such as the national Red Cross Societies, may take up the educational side of 1 THE LANCET, 1925, i., 878.

THE

LANCET.

610 the problem, teaching the public the nature and the immensity of the narcotic peril. Such a campaign would not only educate the public, but would also probably convert some of the static power of Govern-

sick should be better met, and it is to be hoped that action is approaching. The section dealing with infectious diseases leaves a rather mixed impression of satisfaction and the ments into kinetic energy. reverse, when we study the record of progressive work in the metropolis to provide for the treatment of the epidemic group. story of scarlet fever is a cheerful one ; it can be seen from the figures that the disease can now be regarded as one which is THE METROPOLITAN ASYLUMS normally unlikely to end fatally, the case-mortality is considerably under half what it was 30 years ago, BOARD.1 while the notifications are less, though the average THE annual report of the Metropolitan Asylums population of the area concerned is greater by some Board, which has just appeared, contains, as usual, 80,000 persons. Measles must always be a difficult a large amount of well-arranged information condisease to summarise in statistical terms, because of cerning the treatment of infectious diseases in the its sudden incidence in large epidemics and their important area of its work, and it is to this section rapid cessation. Further, the Board deals only with that the main attention, both of the medical profession a proportion of the cases, as accommodation for and of the public, will be paid. The responsibilities measles is found elsewhere during the early stage of an of the Board, however-and it is sometimes forgotten outbreak, the demand for hospital treatment only -are of a much wider range than this section indicates. occurring after a certain limit has been reached. If we include the work in tuberculosis done by the Therefore an epidemic may make grave demands Board under the heading of the care of infectious on the accommodation of the Board suddenly, diseases, there still remain some six other principal which demand declines with proportionate rapidity. directions in which services are discharged which Reference to the statistical table supplied in this are invaluable to the public ; for the duties of the report will show how the help of the Board is sought Board include the management of hospitals and with increasing urgency for brief periods, during institutions for children suffering from specified epidemics of measles, and how promptly the need contagious diseases as well as for those requiring for assistance dies away. The figures for small-pox special treatment in hospitals or convalescent homes ; are satisfactory, the past year being the twenty-third the provision for certain classes of mental defectives in succession since the disease has secured any firm and epileptics ; the care of Poor-law lads in training hold throughout the metropolitan area. A brief for the sea, both for the Navy and the mercantile history of small-pox in London, so far as the activities marine ; while a certain proportion of the casual poor of the Board have been concerned, is included in an fall under their jurisdiction as an authority which was appendix, and would make salutary reading at the instituted more than half a century ago by an order present moment for a good many persons. The of the then Poor-law Board. Arrangements have been references to encephalitis lethargica are significant, made only this week with the Ministry of Health, and are supported by a note on the arrangements under which cases of puerperal fever to be referred which have been secured for the treatment of cases, to the Board are to be grouped in certain hospitals written by Dr. GORDON PuGH, chief medical officer for special care and study. The Board also furnishes of the Children’s Service of the Board. The note shows London with ambulances. Under these headings this that the need for institutional treatment in juvenile report makes a clear statement of work done and cases of encephalitis lethargica is great and may be results obtained, and it is possible that the figures increasing in urgency, having regard alike to the recent in connexion with the last-named activity will be extension of the disease in London, the non-existence a surprise to many, having regard to the frequent of facilities for dealing with the cases, and the special complaint that the metropolis is lacking in proper dimcultics incidental to the mentality of patients facilities for the transport of the sick. The ambulance in the later stages. During the second quarter of service, by land and river, of the Board during the 1924 there was a high notification rate of the disease, year in question, dealt with over 72,000 removals, 391 cases out of 611 occurring during that quarter, an increase on the previous year of 10,000, while the while it is now recognised that, quite apart distance covered in the combined journeys amounts from its intrinsic seriousness, apparent cure of the to a total mileage of 725,000 miles, being an increase disease is frequently followed by obscure afterof about 40 per cent. over the mileage of the previous effects, developing into physical, and especially year. This increase is indicative of a growing practice psychical, disturbances of an anxious nature. on the part of the medical profession and the general Abnormalities of conduct have been observed which public to employ the ambulances of the Board in might bring, and which possibly have brought, patients lieu of less specialised means of transport for the within the sphere of the criminal law, when their conveyance of patients and invalids over considerable actions have been dictated by the remaining influences distances. This willingness to use the ambulances of the disease, and this is a state of affairs to the remedy of the Board accentuates the fact that public comments of which attention should be directed at once. on the dearth of ambulances in London nearly always We refer, finally, to the anxious position revealed have the same origin; they are aroused by some by the figures in relation to diphtheria, whose prevaldefault in dealing with cases of accident in the street. ence is sometimes regarded with complacency because The whole of this question has been under anxious the antitoxin treatment, devised 30 years ago, consideration for some time, and was referred by produced such wonderfully favourable results. But the Minister of Health over two years ago to the steady though the progress, which can be recorded, Voluntary Hospitals Commission, when a conference may have been in the treatment of diphtheria, it was held on the position of ambulance services has been too slow, for the figures show that, in London generally in the metropolitan area. The need for at any rate, the forces of the disease have latterly better organisation and supply of transport of the been gathering power. Compared with the septennial period 1897-1903, the. septennial period 1918-1924, 1 Annual Report of the Metropolitan Asylums Board, gives only superficially the idea of any progress at 1924-25. Pp. 364. Office of the Board. 5s.