- Email: [email protected]
THE WORLD MISSIONARY CONFERENCE AND THE ABUSE OF OPIUM.
114
instance,
the average maximum is above 710 or about 80 than that of last week, while at Bath and Nottingham higher the divergence was almost as striking, and although the difference from the normal was not so great at the stations further north it was very appreciable. The temperature of the nights was also low for the season. The departure from the normal, however, was much less marked at night than during the day ; in many places it was only about 2°. In many parts of the kingdom the showers were very frequent, and as the intervals between were not always accompanied by a clear sky the total duration of sunshine was generally very small. In London and some other places there were only 28 hours, an average of four hours per day, a considerable proportion of which was recorded before the world was awake, and at Manchester the figure was no more than 13 hours. Several spots along the south and east coasts, and a few inland, such as Bath, were more fortunate, but over the kingdom generally the sunshine was very meagre for the time of year.
w
THE
Days with
FOREIGN MEDICAL PRACTITIONERS
IN
ITALY.
THE General Medical Council has received from the Privy Council copy of a despatch from His Majesty’s Ambassador at Rome, enclosing a report on recent legislation affecting the position of foreign medical practitioners in Italy. He states that under the new law British medical practitioners will in future, in virtue of the reciprocity granted by Great Britain, enjoy unrestricted freedom of practice in Italy, instead of the limited rights hitherto them of conceded practising only among foreigners. As matters now stand this concession only benefits British practitioners, Great Britain being the only country that grants reciprocity to Italy. This reciprocity was accorded in 1901 when on March 9th an Order in Council was issued putting in force the second part of Our Italian correspondent the Medical Act of 1886.1 referred in detail to these changes in the letter from Italy published in THE LANCET of June 18th, p. 1724, and we refer our readers thereto for full information.
at least 0-01 inch.
NERVES OF A TELEPHONE
themselves to manifest may be received with apparent equanimity by the operator, we cannot doubt that they must have a wearing effect. For life at the telephone exchanges is neither a quiet nor a pleasant one. The work is trying and puts a constant strain on the attention, while rigid self. control is asked for in anyone who during long business hours has to enter upon incessant dialogues with a public that is generally in a hurry. Recently, Mr. H. Samuel, in answer to a question in the House, stated that in view of the large number of cases of hysteria and other nervous troubles reported amongst the operators, an investigation had been instituted. He added that the results of this investigation We hope that the were receiving careful consideration. publicity which has been given to the matter may do some. thing towards ameliorating the attitude of the public to the telephone operators, and may help the public to remember that these operators are human beings and not machines.
OPERATOR.
THERE have recently been public allusions made to the prevalence of nervous breakdown among telephone operators, and, whether the prevalence be exaggerated or not, it is certainly a fact that the public scarcely realises the excessively trying nature of the work which the telephone exchange operators perform. At present the everyday attitude to the officials at the exchanges can scarcely be called a long-suffering one. A man goes to the telephone, takes up the receiver, and rings up the exchange ; if the response is not prompt he is annoyed and shows it; if, on having given the number he requires, an immediate answer is not forthcoming he is again annoyed and again shows it; and when he is put on to a wrong number-but there is no need to tell the full story of a sad loss of self-control. Everyone is not so unreasonable, but it seems that an appreciable portion of the public believe that the operators make mistakes out of pure and unalloyed wickedness, aimed either against the mass of the subscribers in general or against the individual sufferer. We would urge, even while we admit that the number of stupid mistakes made by telephone operators does appear large, that some thought should be given to the fact that the operators are not mechanical contrivances, and that any individual operator with whom we get into communication is, himself or herself, part of a great and complicated scheme any failure in which may often be felt at a distance from its It is silly and unjust to conclude if any hitch cause. should occur that the particular exchange operator who is then in communication must be the delinquent-the And although the exdeliberate and frigid delinquent. hibitions of temper which too many of the public allow
THE
MISSIONARY CONFERENCE AND THE ABUSE OF OPIUM.
WORLD
A GREAT English consultant of the nineteenth century pronounced opium and its pharmaceutical derivatives to be the "gift of God to man," and medical practice throughout
Christendom has ratified his dictum. But, like alcohol and other powerful agents operating on the nerve centres, opium and morphia may become not a blessing but a curse, causing disease and death physically, and degeneration and disaster morally and socially, if indulged in without medical warrant and consumed habitually to excess. Evidence to this effect was brought before the recent World Missionary Conference by speaker after speaker, particularly by those whose evangelising work had lain in the far East, where, in China particularly, the consumption of opium had deepened and widened and intensified into a racial calamity, arresting all healthy evolution and proving a well-nigh insurmountable barrier to the nation’s falling into line with the march of civilisation. The Chinese themselves have long been feelingly persuaded of this, and their organised attempts to reduce the opium habit, and finally to restrict its use to medical prescription, have for years been strenuously in operation. But, lamentable to admit, it is the "Christian civilisation " from whence proceeds the temptation, and the means, to contract and to continue the habit-the evidence of this adduced by the medical missionaries being simply appalling. From Edinburgh itself, the chosen seat of the World Conference, there was, according to Mr. D. D. Main of Hangchow, a brisk export 1
See London Gazette of March 9th, 1901.
115 of pills, nominally designed to break the habit of opium- Ihealth of New York City at once gave their cooperation, smoking, but by their composition, largely impregnated with smd the Rockefeller Institute of Medical Research also lent morphia, only encouraging the habit under another name. its active support to the work of the committee. Under The pills, said Mr. Main, "sent out and labelled as kegs oftihese happy auspices the labours of the Collective Investigabicarbonate of soda," were a secret preparation ; " no manu- ttion Committee have been most productive, if we are to facturer would tell where they were exported to," and yet, heijudge by the reportwhich has just been published. To -added, ’’ most of the morphia that found its way to China ]put briefly the more important of their conclusions, it ad be said that epidemic poliomyelitis differs widely from had its place of origin in Edinburgh." Other speakers, to hmay similar purport, followed, and the Rev. Dr. Griffiths, givingthe old-time conception of infantile spinal paralysis; that his experience of Assam, assured the Conference that the it is an infectious, if not a contagious, disease, which may tribes in that country were, thanks to the indulgence, " in a involve the lower portion of the brain-stem as well as the state of disintegration." Young and old, men and women, spinal cord ; that it behaves like other acute infectious diseases of childhood ; that in some instances the general even children of tender years, were slaves to it-mothers
selling their offspring, after their husbands had sold their cattle, for means to buy the drug ! Difficulties no doubt-difficulties arising from commercial interests protected by treaty rights-confronted the movement to antagonise and ultimately to modify the opium traffic so as to restrict it to purely medical requirements, and the members of the conference were assured, on the authority of more than one political delegate, that responsible statesmen like Lord Morley and Sir Edward Grey were in full sympathy with the restrictive policy, and doing their best towards its consummation, in which they had no more sincere and energetic auxiliaries than the Chinese themselves. A resolution submitted at a meeting held in connexion with the Conference and carried nenzi-rze contradicente, urged" (1) that the opium traffic, morally indefensible, should, in response to China’s heroic efforts, be ended much more speedily than the existing 10 years’ arrangement contemplated ; (2) that meanwhile China should be left free to control the import of opium as she finds best in her own interests ; and ’(3) that the invitation from the United States to an International Conference be accepted by the British Government so that the principles embodied in the Shanghai Conference may be fully carried into effect." This resolution was declared by its mover, Mr. Theodore Taylor, M.P., to prelude a " crusade against the unauthorised (that is, the non-medical) use of all dangerous drugs," a crusade which would be strengthened by the new allies which, from no profession more largely than that of medicine, would be brought into the field.
even
symptoms of infection are as prominent as are the symptoms of paralysis ; that it is a more fatal disease than was supposed, and yet recoveries are more common than was that the
symptoms are unusually stages of the disease; and that epidemic polioencephalomyelitis occurs, though rarely.
suspected ; common
in
meningeal
earlier
The disease can be transmitted from man to animals through several generations, and some light has already been thrown on the properties of the virus of epidemic poliomyelitis. As regards the epidemiology of the disease, the epidemic began in June and reached its height in September. The date of onset" curve is very similar to that given by Wickman for the cases in the epidemic in Sweden in 1905, except that the latter reached its height in August. The disease spread rapidly along ordinary lines of communication into the surrounding country, appearing more particularly in the state of Massachusetts. The fact that of 750 cases reported only two occurred in negro children is remarkable. While the disease was moderately communicable, about as much so as epidemic cerebro-spinal meningitis, the path of infection could not be determined, although some evidence pointed to the upper respiratory tract as being the route of invasion. In the epidemic there were 18 houses each with two cases, and five houses each with three cases. The estimated mortality was 5 per cent., which is low, as far as epidemics go ; in other words, the infection was of a mild type. Evidence points to an incubation period of less than ten days. Among the symptoms preceding the onset of the paralysis, fever, restlessness, and vomiting were common ; rigidity of the neck was remarkably frequent, pain and tenderness almost universal. Sometimes the pain was EPIDEMIC POLIOMYELITIS. excruciating. It was commonest in the lower extremities, less frequent in the spine and trunk, and least common in the IT is probably no exaggeration to state that acute polioneck and arms. The well-known flaccid paralysis typical of myelitis is endemic in London and the south of England. was reported in 632 patients, and yet rigid Fresh cases of the disease appear with unfailing regularity poliomyelitis was distinctly recorded in 38 patients. This is to at the out-patient departments of our hospitals all through paralysis be regarded, no doubt, as a symptom of sensory irritation the summer months, and, indeed, during other seasons of the reflected in the motor neurons, and it may be due, also, to year as well. But acute poliomyelitis in epidemic form is All sorts of combinations of some meningeal involvement. practically unknown in this ;country. The same was true of and legs were noted: the face is of face, arms, paralysis Germany till last year, when the first real epidemic of the to as having been paralysed in 27 cases ; disease ever recorded in that country began to rage in the specifically referred in was not affected. 681 it The left side of the body was district of Rhenish Westphalia. It has consisted of hundreds more frequently affected than the right. In 47 per cent. of of cases, moderately severe, and it has been especially notethere was a marked cases regression of all symptoms worthy for the occurrence of gastro-intestinal symptoms. reported in a residual and 5’ 3 per cent. a complete paralysis, The curious fact that epidemics of poliomyelitis have followed except all was noted. Much the most paralysis outbreaks of cerebro-spinal meningitis in various parts of disappearance of common residual in the was palsy peroneal, anterior tibial, the globe (this has been the case in the German epidemic or deltoid group. Bulbar cases and cases referred to above) is suggestive when we remember the recent calf, quadriceps, acute resembling Landry’s ascending paralysis epidemics of the latter disease in Scotland and Ireland, as closely occurred. The pathology of epidemic poliomyelitis has bren well as in England. The epidemic of acute poliomyelitis in Greater New York in the summer and autumn of 1907 was recently referred to in THE LANCET.2 The chapters in this with the subject are contributed by Dr. the first to be reported in any of the larger American cities, report dealing when at least 2500 cases occurred. Recognising the im1 Epidemic Report of the Collective Investigation portance of the subject, the New York Neurological Society Committee onPoliomyelitis New York: Journal of the New York Epidemic of 1907. 1910. Price S2. and Mental Disease Publishing Company. appointed a Committee of Investigation in October, 1907. Nervous No. 6 of Nervous and Mental Disease Monograph Series. The New York Academy of Medicine and the Department of 2 THE LANCET, Feb. 19th, 1910, p. 524. -
instance,
the average maximum is above 710 or about 80 than that of last week, while at Bath and Nottingham higher the divergence was almost as striking, and although the difference from the normal was not so great at the stations further north it was very appreciable. The temperature of the nights was also low for the season. The departure from the normal, however, was much less marked at night than during the day ; in many places it was only about 2°. In many parts of the kingdom the showers were very frequent, and as the intervals between were not always accompanied by a clear sky the total duration of sunshine was generally very small. In London and some other places there were only 28 hours, an average of four hours per day, a considerable proportion of which was recorded before the world was awake, and at Manchester the figure was no more than 13 hours. Several spots along the south and east coasts, and a few inland, such as Bath, were more fortunate, but over the kingdom generally the sunshine was very meagre for the time of year.
w
THE
Days with
FOREIGN MEDICAL PRACTITIONERS
IN
ITALY.
THE General Medical Council has received from the Privy Council copy of a despatch from His Majesty’s Ambassador at Rome, enclosing a report on recent legislation affecting the position of foreign medical practitioners in Italy. He states that under the new law British medical practitioners will in future, in virtue of the reciprocity granted by Great Britain, enjoy unrestricted freedom of practice in Italy, instead of the limited rights hitherto them of conceded practising only among foreigners. As matters now stand this concession only benefits British practitioners, Great Britain being the only country that grants reciprocity to Italy. This reciprocity was accorded in 1901 when on March 9th an Order in Council was issued putting in force the second part of Our Italian correspondent the Medical Act of 1886.1 referred in detail to these changes in the letter from Italy published in THE LANCET of June 18th, p. 1724, and we refer our readers thereto for full information.
at least 0-01 inch.
NERVES OF A TELEPHONE
themselves to manifest may be received with apparent equanimity by the operator, we cannot doubt that they must have a wearing effect. For life at the telephone exchanges is neither a quiet nor a pleasant one. The work is trying and puts a constant strain on the attention, while rigid self. control is asked for in anyone who during long business hours has to enter upon incessant dialogues with a public that is generally in a hurry. Recently, Mr. H. Samuel, in answer to a question in the House, stated that in view of the large number of cases of hysteria and other nervous troubles reported amongst the operators, an investigation had been instituted. He added that the results of this investigation We hope that the were receiving careful consideration. publicity which has been given to the matter may do some. thing towards ameliorating the attitude of the public to the telephone operators, and may help the public to remember that these operators are human beings and not machines.
OPERATOR.
THERE have recently been public allusions made to the prevalence of nervous breakdown among telephone operators, and, whether the prevalence be exaggerated or not, it is certainly a fact that the public scarcely realises the excessively trying nature of the work which the telephone exchange operators perform. At present the everyday attitude to the officials at the exchanges can scarcely be called a long-suffering one. A man goes to the telephone, takes up the receiver, and rings up the exchange ; if the response is not prompt he is annoyed and shows it; if, on having given the number he requires, an immediate answer is not forthcoming he is again annoyed and again shows it; and when he is put on to a wrong number-but there is no need to tell the full story of a sad loss of self-control. Everyone is not so unreasonable, but it seems that an appreciable portion of the public believe that the operators make mistakes out of pure and unalloyed wickedness, aimed either against the mass of the subscribers in general or against the individual sufferer. We would urge, even while we admit that the number of stupid mistakes made by telephone operators does appear large, that some thought should be given to the fact that the operators are not mechanical contrivances, and that any individual operator with whom we get into communication is, himself or herself, part of a great and complicated scheme any failure in which may often be felt at a distance from its It is silly and unjust to conclude if any hitch cause. should occur that the particular exchange operator who is then in communication must be the delinquent-the And although the exdeliberate and frigid delinquent. hibitions of temper which too many of the public allow
THE
MISSIONARY CONFERENCE AND THE ABUSE OF OPIUM.
WORLD
A GREAT English consultant of the nineteenth century pronounced opium and its pharmaceutical derivatives to be the "gift of God to man," and medical practice throughout
Christendom has ratified his dictum. But, like alcohol and other powerful agents operating on the nerve centres, opium and morphia may become not a blessing but a curse, causing disease and death physically, and degeneration and disaster morally and socially, if indulged in without medical warrant and consumed habitually to excess. Evidence to this effect was brought before the recent World Missionary Conference by speaker after speaker, particularly by those whose evangelising work had lain in the far East, where, in China particularly, the consumption of opium had deepened and widened and intensified into a racial calamity, arresting all healthy evolution and proving a well-nigh insurmountable barrier to the nation’s falling into line with the march of civilisation. The Chinese themselves have long been feelingly persuaded of this, and their organised attempts to reduce the opium habit, and finally to restrict its use to medical prescription, have for years been strenuously in operation. But, lamentable to admit, it is the "Christian civilisation " from whence proceeds the temptation, and the means, to contract and to continue the habit-the evidence of this adduced by the medical missionaries being simply appalling. From Edinburgh itself, the chosen seat of the World Conference, there was, according to Mr. D. D. Main of Hangchow, a brisk export 1
See London Gazette of March 9th, 1901.
115 of pills, nominally designed to break the habit of opium- Ihealth of New York City at once gave their cooperation, smoking, but by their composition, largely impregnated with smd the Rockefeller Institute of Medical Research also lent morphia, only encouraging the habit under another name. its active support to the work of the committee. Under The pills, said Mr. Main, "sent out and labelled as kegs oftihese happy auspices the labours of the Collective Investigabicarbonate of soda," were a secret preparation ; " no manu- ttion Committee have been most productive, if we are to facturer would tell where they were exported to," and yet, heijudge by the reportwhich has just been published. To -added, ’’ most of the morphia that found its way to China ]put briefly the more important of their conclusions, it ad be said that epidemic poliomyelitis differs widely from had its place of origin in Edinburgh." Other speakers, to hmay similar purport, followed, and the Rev. Dr. Griffiths, givingthe old-time conception of infantile spinal paralysis; that his experience of Assam, assured the Conference that the it is an infectious, if not a contagious, disease, which may tribes in that country were, thanks to the indulgence, " in a involve the lower portion of the brain-stem as well as the state of disintegration." Young and old, men and women, spinal cord ; that it behaves like other acute infectious diseases of childhood ; that in some instances the general even children of tender years, were slaves to it-mothers
selling their offspring, after their husbands had sold their cattle, for means to buy the drug ! Difficulties no doubt-difficulties arising from commercial interests protected by treaty rights-confronted the movement to antagonise and ultimately to modify the opium traffic so as to restrict it to purely medical requirements, and the members of the conference were assured, on the authority of more than one political delegate, that responsible statesmen like Lord Morley and Sir Edward Grey were in full sympathy with the restrictive policy, and doing their best towards its consummation, in which they had no more sincere and energetic auxiliaries than the Chinese themselves. A resolution submitted at a meeting held in connexion with the Conference and carried nenzi-rze contradicente, urged" (1) that the opium traffic, morally indefensible, should, in response to China’s heroic efforts, be ended much more speedily than the existing 10 years’ arrangement contemplated ; (2) that meanwhile China should be left free to control the import of opium as she finds best in her own interests ; and ’(3) that the invitation from the United States to an International Conference be accepted by the British Government so that the principles embodied in the Shanghai Conference may be fully carried into effect." This resolution was declared by its mover, Mr. Theodore Taylor, M.P., to prelude a " crusade against the unauthorised (that is, the non-medical) use of all dangerous drugs," a crusade which would be strengthened by the new allies which, from no profession more largely than that of medicine, would be brought into the field.
even
symptoms of infection are as prominent as are the symptoms of paralysis ; that it is a more fatal disease than was supposed, and yet recoveries are more common than was that the
symptoms are unusually stages of the disease; and that epidemic polioencephalomyelitis occurs, though rarely.
suspected ; common
in
meningeal
earlier
The disease can be transmitted from man to animals through several generations, and some light has already been thrown on the properties of the virus of epidemic poliomyelitis. As regards the epidemiology of the disease, the epidemic began in June and reached its height in September. The date of onset" curve is very similar to that given by Wickman for the cases in the epidemic in Sweden in 1905, except that the latter reached its height in August. The disease spread rapidly along ordinary lines of communication into the surrounding country, appearing more particularly in the state of Massachusetts. The fact that of 750 cases reported only two occurred in negro children is remarkable. While the disease was moderately communicable, about as much so as epidemic cerebro-spinal meningitis, the path of infection could not be determined, although some evidence pointed to the upper respiratory tract as being the route of invasion. In the epidemic there were 18 houses each with two cases, and five houses each with three cases. The estimated mortality was 5 per cent., which is low, as far as epidemics go ; in other words, the infection was of a mild type. Evidence points to an incubation period of less than ten days. Among the symptoms preceding the onset of the paralysis, fever, restlessness, and vomiting were common ; rigidity of the neck was remarkably frequent, pain and tenderness almost universal. Sometimes the pain was EPIDEMIC POLIOMYELITIS. excruciating. It was commonest in the lower extremities, less frequent in the spine and trunk, and least common in the IT is probably no exaggeration to state that acute polioneck and arms. The well-known flaccid paralysis typical of myelitis is endemic in London and the south of England. was reported in 632 patients, and yet rigid Fresh cases of the disease appear with unfailing regularity poliomyelitis was distinctly recorded in 38 patients. This is to at the out-patient departments of our hospitals all through paralysis be regarded, no doubt, as a symptom of sensory irritation the summer months, and, indeed, during other seasons of the reflected in the motor neurons, and it may be due, also, to year as well. But acute poliomyelitis in epidemic form is All sorts of combinations of some meningeal involvement. practically unknown in this ;country. The same was true of and legs were noted: the face is of face, arms, paralysis Germany till last year, when the first real epidemic of the to as having been paralysed in 27 cases ; disease ever recorded in that country began to rage in the specifically referred in was not affected. 681 it The left side of the body was district of Rhenish Westphalia. It has consisted of hundreds more frequently affected than the right. In 47 per cent. of of cases, moderately severe, and it has been especially notethere was a marked cases regression of all symptoms worthy for the occurrence of gastro-intestinal symptoms. reported in a residual and 5’ 3 per cent. a complete paralysis, The curious fact that epidemics of poliomyelitis have followed except all was noted. Much the most paralysis outbreaks of cerebro-spinal meningitis in various parts of disappearance of common residual in the was palsy peroneal, anterior tibial, the globe (this has been the case in the German epidemic or deltoid group. Bulbar cases and cases referred to above) is suggestive when we remember the recent calf, quadriceps, acute resembling Landry’s ascending paralysis epidemics of the latter disease in Scotland and Ireland, as closely occurred. The pathology of epidemic poliomyelitis has bren well as in England. The epidemic of acute poliomyelitis in Greater New York in the summer and autumn of 1907 was recently referred to in THE LANCET.2 The chapters in this with the subject are contributed by Dr. the first to be reported in any of the larger American cities, report dealing when at least 2500 cases occurred. Recognising the im1 Epidemic Report of the Collective Investigation portance of the subject, the New York Neurological Society Committee onPoliomyelitis New York: Journal of the New York Epidemic of 1907. 1910. Price S2. and Mental Disease Publishing Company. appointed a Committee of Investigation in October, 1907. Nervous No. 6 of Nervous and Mental Disease Monograph Series. The New York Academy of Medicine and the Department of 2 THE LANCET, Feb. 19th, 1910, p. 524. -