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Enclosure 1 in No. 46.

MEMORANDUM ON RESOLUTION NO. X OF THE FINAL ACT OF THE BANGKOK OPIUM CONFERENCE.

(i) The effects physiological and psychological on the individual of the practice (a) of

smoking opium, (b) of smoking opium dross.

Useful information on these points is obtainable in Volume II of the Proceedings of the Commission appointed to inquire into matters relating to the use of opium in the Straits Settlements and the Federated Malay States, published by the Government Printing Office, Singapore, in 1908.

The evidence of the following witnesses has a special bearing on the subject :-

(a) Dr. W. Gilmore Ellis, page 1 of the Report.

(b) Dr. H. J. Gibbs, page 21 of the Report.

Dr. Lim Boon Keng, page 38 of the Report. (d) Dr. Suat Chiwa Yin, page 409 of the Report.

(e) Dr. Gnoh Lean Tuck, page 631 of the Report.

All these medical witnesses expressed opinions, based upon their experience, regarding the effects of smoking opium and the use of opium

dross. I am sure that the Committee in charge of research measures will find it profitable to peruse the evidence of these and other witnesses.

The Report of the Proceedings of the Committee, appointed to inquire into matters relating to the use of opium in British Malaya, published by the Government Printing Office, Singapore, in 1924, also contains useful information on these points.

(ii) What are the constituents of opium which produce those effects, and whether and how it is possible to eliminate, replace by some harmless substance, or otherwise render harmless such constituents.

This appears to be a question for chemical and pharmaceutical inquiry, and actual experiments on smokers themselves.

(iii) Methods of cure of addiction of opium smoking. There is reason to believe that many of the so-called “ prescribed in the past have contained morphine and the result, in many cases, has been for opium smoking

to convert some opium smokers into morphine addicts.

cures

In 1925, the Government took steps to provide facilities for recognized treatment. and beds were allocated in the larger hospitals of the Straits Settlements for the treat. ment of the opium habit. The cure consists of :-

(a) the complete withdrawal of opium and its derivatives;

(b) hypodermic injections of atropine sulphate, commencing with a dose of 1/75th of a grain and increasing the dose daily until 1/25th of a grain is reached on the fourth day and then continued daily for ten days;

(c) to promote sleep, ammonium bromide, grains 30, is given nightly. If this

fails, chloretone, grains 10 to 15, is given;

(d) in order to counteract depression, simple tonics are given by the mouth, and symptomatic treatment is given to control the discomforts following withdrawal of opium. In a few cases it is found necessary to give injections of small doses of morphine to relieve symptoms of severe distress.

During the first year, the following figures were obtained at Tan Tock Seng's Hospital, Singapore :-

Completed the full course, apparently cured

Absconded during treatment

Discharged for breaking rules

BAL

Unfit for treatment Remaining at end of year

745

$$30

14

5

24

1,318

A brief account of the effects of this treatment, and the results, may prove of interest to the Committee. It was found that during the first 72 hours after withdrawal of opium, most patients suffered from great discomfort, and some from severe distress.

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It was during this period that the majority of patients absconded. It was found that during the first few days most patients lose weight, but then their appetites increase and the majority leave-hospital having gained, on an average, 5 to 6 pounds weight. It is difficult to estimate to what extent the cure of the habit is permanent, owing to the elusiveness of the patients after discharge.

Experience of the anti-opium treatment in Government Hospitals, since the first wards were opened in 1925, has, unfortunately, not fulfilled the early hopes entertained when the treatment was introduced, and has not justified an extension of activities in this direction. Experience taught us that many of the cases applying for admission during the last few years were not addicted to opium smoking, but merely sought a rest cure in a comfortable ward for a definite period. Of those who were genuine heavy smokers, many absconded during the first few days, and some of those who remained and completed the cure did so with the full intention of continuing the habit after discharge on a much reduced daily ration, as it was found that after the enforceu abstinence and the course of treatment, the desired effects could be gained with a smaller dose of opium. It is believed that the number of opium smokers who were permanently cured of the habit, with this line of treatment, was very small. During the past two years, the numbers seeking admission to the Anti-opium Wards has diminished considerably. Only 340 patients were admitted for anti-opium treatment to Tan Tock Seng's Hospital in 1931 compared with 1,318 in 1925, and other centres report a similar decrease in applicants for treatment.

(iv) Provision of a test which can be readily applied for determining the character of dross brought in, e.g., whether it has already been re-smoked or is adulterated, or is the produce of other than Government opium.

This is a chemical question and requires no comment, except that, perhaps, the Committee may find it helpful to refer to the evidence given by Dr. Frankland Dent before the Committee appointed to inquire into matters relating to the use of opium in British Malaya and recorded in page C275 of the Proceedings published at the Govern- ment Printing Office, Singapore, in 1924.

(Sgd.) R. D. FITZGERALD. Acting Director of Medical and Health Services.

Straits Settlements.

Enclosure 2 in No. 46.

MEMORANDUM ON RESOLUTION NO. X OF THE FINAL ACT.OF THE BANGKOK OPIUM CONFERENCE.

I can comment on two only of the four questions detailed in Resolution No. X of the Bangkok Opium Conference.

1. The examination of Question 2 will, I think, have to await the solution of Question 1. I am not sure that it has ever been proved beyond doubt that opium smoking in reasonable amount is injurious. The analysis of chandu smoke has already received attention and it has been proved that the morphine present in the smoke amounts to only 0.1 per cent. of the weight of the original chandu and apart from this the other constituents of the smoke are less toxic than those of tobacco smoke.

2. With regard to Question 4 we have already a system which enables us to control the purchase of chandu dross in the Colony. That is to say, that while Govern- ment offers a price of $7.50 per tahil for good chandu dross we are able to ensure that the dross so purchased is not re-smoked, nor adulterated, nor illicit. The amount thus offered for sale by smokers is, however, only a small percentage of what is produced.

The Conference may require a method of testing which would be capable of dealing with a greater number of purchases It is my belief, founded on a number of years experience of chandu dross that tests which are easily applied are easily evaded, and I know that reliance on such tests has in the past cost Malayan Governments a great deal of money. Moreover, the method of differentiation between Government and non-Government dross must be a jealously guarded secret.

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