242
82
Enclosure 1 in No. 56.
REPORT BY PROFESSOR W. GERRARD IN RESPECT OF THE PERIOD NOVEMBER, 1932, TO APRIL, 1933.
I SUBMIT the following report on the treatment of opium addicts in the Govern- ment Civil Hospital from November, 1932 to 30th April, 1933-
Out-patients: 400 opium addicts attended at the Out-patient Department. The vast majority refused to enter hospital and asked for out-patient treatment only. This was not given because of its uselessness. When it became known that out-patient treatment would not be given, there was a very rapid decline in the number of opium addicts in the Out-patient Department.
In-patients: Number of cases admitted to the University Medical Clinic from November, 1932, to 30th April, 1933 :—
Sex: Males
83
A very few after discharge from hospital have reported at the Out-patient Depart- ment. They appeared to maintain their improved physical state and declared they had not resumed the old habit.
In the treatment no heroic measures have been adopted. The abrupt withdrawal of opium from the average smoker of the class attending the hospital seems to produce only slight depression and restlessness for the first two or three days. The symptoms have never justified the administration of even a small dose of opium or its derivatives.
WILLIAM I. GERRARD, M.D., &c.,
Honourable Director of
Medical and Sanitary Services.
Physician, Government Civil Hospital.
Enclosure 2 in No. 56.
OPIUM ADDICTS at the TUNG WAH EASTERN HOSPITAL.
DR. PHOON SECK WENG reports :-
།། ༄། །
POBLI PECORD OFFICE
9
Reference
C.O.882/12
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BF REPRODUCED PHOTOGRAPHIC-
COPYRIGHT PHOTOGRAPH-NOT TO
Females
Age Distribution: 20-30 years.
11 cases
Duration of Treatment: Less than 5 days
5-20 days
Over 20 days
Average number of days in hospital
Longest duration in hospital
Shortest duration in hospital
39 cases
38
1
1.
The special ward has been open since 19th June this year.
31-40 years. 19 cases
Over 40 years.
2.
Up to date 62 cases have been admitted.
3.
All males.
9 cases
7 cases
24
4. Age distribution: Between 20 to 30
30 to 40 Over 40 ...
13
8
5.
Duration of Treatment: Less than 5 days
""
15
69
5 to 20 days Over 20 days
Less than 48 hours.
Treatment: The addicts are accommodated in the general wards and so far as ordinary treatment is concerned no distinction is made between the addict and any other patient. All possible precautions are taken to prevent the addict obtaining opium whilst in hospital.
Opium is at once stopped, and as a result of this method no untoward symptoms have been noted.
Addicts on admission are given Calomel grs. 3 and next morning Mistura Alba. They are then put on a course of a strong carminative mixture composed of-
Spirit of Camphor,.
Tincture of Capsicum,
Tincture of Ginger,
Spirit of Chloroform,
Compound Tincture of Cardamons.
This mixture seems to have a wonderful gastric effect. It stimulates the appetite- so defective in addicts, and relieves the feeling of depression which tends to appear when opium is suddenly withheld. As a result of increased appetite diet is increased and there is soon an improvement in weight. For the first week addicts are kept in bed, being allowed walking exercise only on the ward verandahs. They are never allowed outside during the course of treatment.
Special Investigations: Advantage has been taken to investigate gastric function in opium addicts. The Fractional Test Meal method has been used with considerable success. So far 28 Fractional Test Meals have been done :-
Results: Normal acidity curves
Hyperchlorhydria Hypoacidity
in 16 cases
in 9 cases
in 3 cases
These results are very interesting and the tests are being continued because a large number is required before any definite conclusions can be drawn. It does not seem that anyone has previously carried out this line of investigation in opium addicts.
General Remarks: So far all cases under my care have been opium smokers. The majority admitted have appeared anxious to co-operate and rid themselves of the habit. None have been discovered to have obtained opium whilst in hospital. Their behaviour has been examplary and the majority have left with an appreciation of what has been done for them. Their general condition has vastly improved.
Average number of days in hospital
Longest duration in hospital Shortest
|
"
24
17
20
7
37
10
14
33 days
2
23
6. Line of Treatment: A tonic of Nux Vomics with carminatives and Tincture of Opium is given every four hours. To chronic cases of over ten years standing, and also to heavy smokers, the Tincture of Opium is prescribed in full Pharmacopœal doses of 15 minims. The Opium in the mixture is gradually diminished, until the end of the second or third week, when it is wholly withdrawn. The total withdrawal depends on the severity of the symptoms present. For persistent insomnia, bromides may be given; and for headache and pains in the bones, Phenacetin and Aspirin. For gastric disturbances and enteritis Bismuth is prescribed.
While still having no Opium in their medicines, the patients are detained in hospital for a while for observation. If they show no adverse symptoms they are discharged.
7. Clinical Investigation: No special investigations have been carried out, as in the Government Civil Hospital; but attention is given to complications, such as heart and lung disease, &c.
8. The Results have been encouraging. The patients are not allowed to leave their ward. They are kept under observation.
Full diet is given. Relatives are allowed to bring in extras such as fresh fruits and eggs.
Old patients who have come to report themselves, after a few weeks, show a clearer complexion and an increase in weight, and profess to feeling stronger and healthier.
There is reason to believe that most of those, who have undergone treatment for more than two weeks, do not relapse. For one thing they have not the money any more to indulge in their former practices owing to the financial depression.
From my own observation I should say that the men who come to the hospital for treatment are intelligent and have a definite purpose in view in wishing to break off the habit.
H. L. CLIFT,
Honourable Director of
Medical and Sanitary Services.
Visiting Medical Officer, Chinese Hospitals and Dispensaries.
22nd August, 1933.
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