By properly drawn up and widely spread notices, couched in simple language, a man should be able to see-
(a.) The reason why the nation wants to rid itself of this habit;
(b.) How the Government can help him as a smoker to do so with a minimum of discomfort;
(c.) What penalty he must incur if he does not do so within a reasonable time.
A great number of people cannot read. These could be reached if the bureau had a system whereby professional story tellers would be employed or could earn a small fee if they recited the notices in their booths or in tea-shops.
If these helpful measures resulted in a cure of, say, 20 per cent, of smokers during the first year without harsh treatment, domiciliary visits or any encounters between the officials and people such as now not infrequently take place, it is not expecting too much to say that those cured would of themselves popularize the treatment, and a much greater percentage would voluntarily submit themselves the following year with similar results.
It is therefore in the direction of devising means to lessen the demand on the part of the consumers, and only secondarily in curtailing the supply that the work of the coming Shanghae Conference should be directed.
It would be well if the Commission could deal with the following questions:~
1. What is the best antidote for opium?
[Note. I merely outline these points. There are many more details requiring elucidation.]
There is much difference of opinion on this.
Various drugs, such as atropine, codeine, caffein, potassium permanganate, &c., are employed; these affect the body in different ways and some of them cause a distaste for opium if taken long enough. Some of the drugs are dangerous to use and should be avoided in certain bodily states. For example, it would be harmful to give atropine or belladonna in any quantity to a man suffering from kidney disease. Under this heading could be considered the special treatment associated with the name of Mr. C. B. Towns. Is it applicable to every case? What is the nature of his remedy? Can it be administered by any one or is it of a sufficiently toxic nature to require the presence of a trained medical man? How long do its effects last? No matter what the drug is it cannot remain in a man's system for more than a week or so; it must sooner or latter be eliminated leaving the body as before with nothing but the remembrance of a time when the patient felt some nausea or distaste for opium. It yet remains to be seen whether or not relapses do not frequently take place unless the treatment is combined with a sufficiently long period of restraint which in its turn gives rise to the point as to whether the period of restraint of itself would not be sufficient without the help of any special drug. The experience, for example, of prison authorities goes to show that compulsory abstention alone suffices to overcome the habit-in many cases permanently.
2. What is the best method of suppression?
It would be well to have a decision on this point. Is it better to withdraw the drug suddenly or is there less suffering if this is done by gradually diminishing the quantity used? Should drug treatment be administered to help the patient in his trouble, e.g., by giving hypnotics to combat the resultant sleeplessness and stomachic tonics to overcome the nausea and depression complained of?
3. Can the people be cured in their own homes or is it absolutely necessary to order every known smoker to undergo seclusion in a refuge and submit to discipline?
This is a most important point which should be dealt with authoritatively soon. It would appear so far to be quite useless to attempt the cure of a victim to the habit in his or her house. A wife can have no control over her husband and he cannot turn a deaf ear to her entreaties to be allowed another pipeful. A smoker trying to overcome the habit suffers from restlessness and irritability. During this time his family place every temptation in his way by preparing the pipe, lamp, &c., to induce him to smoke and become quiet and contented again. I have often had evidence of this.
4. What is the average time it would ordinarily take to overcome the craving?
It should not be difficult for the Commission to come to some finding on this point. Business men and bread winners have a right to ask this when complying with the State's demands in order that they may make arrangements previous to submitting themselves to the cure.
5. What are the dangers most likely to be encountered?
The reports of a few deaths here and there can only add to the difficulties of the situation and the popular prejudice against entering refuges. Thus, sickness, violent diarrhoea, insomnia, collapse, &c., may ensue in an ordinary case, while in those people who suffer from latent heart, lung or kidney trouble, an acute outbreak causing death may ensue. To obviate these dangers it would be best to have the cause watched carefully by competent men under convenient conditions.
6. The question of opium refuges and their general management. Should private opium refuges be allowed or should they all be licensed and made subject to visits by Government Inspectors? Or should the Government only permit official refuges without private gain where patients would be treated on definite lines as laid down in Regulations and under the superintendence of the medical officer appointed to each refuge. It would be worth while starting an anti-opium medical service, preferably under a certain amount of foreign organization at first, for a necessary part of the scheme would be that the right class of men were employed. The Government retreats could be made bright and comfortable and, if so, would get for themselves a reputation that would make the people less unwilling to enter them. Discipline outside the requirements of the actual case is not called for to any extent and would only incur the repugnance of the people.
7. After treatment and relapses.
It might be found necessary to have provision made at each refuge for keeping in touch with inmates who have passed through it and returned to their homes. Many a man can avoid the drug comparatively easily in a refuge who would relapse on being subjected to the stress of life and fresh temptations when again outside the institution. There should be some definite plan of after cure or modified surveillance by which control could be kept up especially over these cases of recurrent craving that beset the recently cured.
It would be well to disseminate the findings of the Conference or Commission, after they have received the Imperial assent, as widely as possible among all classes of the population in order to thwart the schemes of the numerous charlatans and quack vendors of secret remedies who are taking advantage of the present state of affairs to push the sale of noxious drugs which are only adding to the nation's troubles without in any way enabling the people to respond effectively to the benevolent aims of the Imperial Government.
Note on the Toxic Properties in Opium.
Recent researches in physiological chemistry in England have shown that the ill-effects of opium smoking are due in great measure to some qualities in the smoke which have an intoxicating effect. Picoline and pyridine are two of the intermediate products which analysis has been able to separate out and which have been proved to be possessed of physiological activities. It is known that the opium of different countries vary with regard to the proportions of morphia they contain. Thus, the Indian drug only contains 4 to 8 per cent. of morphine, while the Turkish variety contains 8 to 12 per cent.
Experiments have shown that opium prepared from poppies grown in the hilly districts of the Himalayas yields 50 per cent. more morphine than that obtained from plants grown in the plains.
Might it not therefore be possible (if it is admitted that a certain amount of opium will always be required, medicinally or otherwise) for the Imperial Government to initiate experiments to determine whether it is not possible to produce on a commercial scale a pure opium which will have still less toxic effects than the varieties in use at present?
GEORGE DOUGLAS GRAY, M.D.
Peking, July 1908.
(Signed)
Page 168
By properly drawn up and widely spread notices, couched in simple language, a man should be able to see-
(a.) The reason why the nation wants to rid itself of this habit;
(b.) How the Government can help him as a smoker to do so with a minimum of discomfort;
(c.) What penalty he must incur if he does not do so within a reasonable time.
A great number of people cannot read. These could be reached if the bureau had a system whereby professional story tellers would be employed or could earn a small fee if they recited the notices in their booths or in tea-shops.
If these helpful measures resulted in a cure of, say, 20 per cent, of smokers during the first year without harsh treatment, domiciliary visits or any encounters between the officials and people such as now not infrequently take place, it is not expecting too much to say that those cured would of themselves popularize the treatment, and a much greater percentage would voluntarily submit themselves the following year with similar results,
It is therefore in the direction of devising means to lessen the demand on the part of the consumers, and only secondarily in curtailing the supply that the work of the coming Shanghae Conference should be directed.
It would be well if the Commission could deal with the following questions :~
1. What is the best antidote for opium?
[Note. I merely outline these points. There are many more details requiring elucidation.]
There is much difference of opinion on this.
Various drugs, such as atropine, codeine, caffein, potassium permanganate, &c., are employed; these affect the body in different ways and some of them cause a distaste for opium if taken long enough. Some of the drugs are dangerous to use and should be avoided in certain bodily states. For example, it would be harmful to give atropine or belladonna in any quantity to a man suffering from kidney disease. Under this heading could be considered the special treatment associated with the name of Mr. C. B. Towns. Is it applicable to every case? What is the nature of his remedy? Can it be administered by any one or is it of a sufficiently toxic nature to require the presence of a trained medical man? How long do its effects last? No matter what the drug is it cannot remain in a man's system for more than a week or so; it must sooner or latter be eliminated leaving the body as before with nothing but the remembrance of a time when the patient felt some nausea or distaste for opium. It yet remains to be seen whether or not relapses do not frequently take place unless the treatment is combined with a sufficiently long period of restraint which in its turn gives rise to the point as to whether the period of restraint of itself would not be sufficient without the help of any special drug. The experience, for example, of prison authorities goes to show that compulsory abstention alone suffices to overcome the habit-in many cases permanently.
2. What is the best method of suppression?
It would be well to have a decision on this point. Is it better to withdraw the drug suddenly or is there less suffering if this is done by gradually diminishing the quantity used? Should drug treatment be administered to help the patient in his trouble, eg, hy giving hypnotics to combat the resultant sleeplessness and stomachic tonies to overcome the nausea and depression complained of?
3. Can the people be cured in their own homes or is it absolutely necessary to order every known smoker to undergo seclusion in a refuge and submit to discipline?
This is a most important point which should be dealt with authoritatively soon. It would appear so far to be quite useless to attempt the cure of a victim to the habit in his or her house. A wife can have no control over her husband and he cannot turn a deaf ear to her entreaties to be allowed another pipeful. A smoker trying to overcome the habit suffers from restlessness and irritability. During this time bis family place every temptation in his way by preparing the pipe, lamp, &c., to induce him to smoke and become quiet and contented again. I have often had evidence of this.
(
5
4. What is the average time it would ordinarily take to overcome the
craving?
It should not be difficult for the Commission to come to some finding on this point. Business men and bread winners have a right to ask this when complying with the State's demands in order that they may make arrangements previous to submitting themselves to the cure.
5. What are the dangers most likely to be encountered?
The reports of a few deaths here and there can only add to the difficulties of the situation and the popular prejudice against entering refuges. Thus, sickness, violent diarrhoea, insomnia, collapse, &c., may ensue in an ordinary case, while in those people who suffer from latent heart, lung or kidney trouble, an acute outbreak causing death may ensue. To obviate these dangers it would be best to have the cause watched carefully by competent men under convenient conditions.
6. The question of opium refuges and their general management. Should private opium refuges be allowed or should they all be licensed and made subject to visits by Government Inspectors? Or should the Government only permit official refuges without private gain where patients would be treated on definite lines as laid down in Regulations and under the superintendence of the medical officer appointed to each refuge. It would be worth while starting an anti-opium medical service, preferably under a certain amount of foreign organization at first, for a necessary part of the scheme would be that the right class of men were employed. The Government retreats could be made bright and comfortable and, if so, would get for themselves a reputation that would make the people less unwilling to enter them. Discipline outside the requirements of the actual case is not called for to any extent and would only incur the repugnance of the people.
7. After treatment and relapses.
It might be found necessary to have provision made at each refuge for keeping in touch with inmates who have passed through it and returned to their homes. Many a man can avoid the drug comparatively easily in a refuge who would relapse on being subjected to the stress of life and fresh temptations when again outside the institution. There should be some definite plan of after cure or modified surveillance by which control could be kept up especially over these cases of recurrent craving that beset the recently cured.
It would be well to disseminate the findings of the Conference or Commission, after they have received the Imperial assent, as widely as possible among all classes of the population in order to thwart the schemes of the numerous charlatans and quack vendors of secret remedies who are taking advantage of the present state of affairs to push the sale of noxious drugs which are only adding to the nation's troubles without in any way enabling the people to respond effectively to the benevolent aims of the Imperial Government.
Note on the Toxic Properties in Opium.
Recent researches in physiological chemistry in England have shown that the ill- effects of opium smoking are due in great measure to some qualities in the smoke which have an intoxicating effect. Picoline and pyridine are two of the intermediate products which analysis has been able to separate out and which have been proved to be possessed of physiological activities. It is known that the opium of different countries vary with regard to the proportions of morphia they contain. Thus, the Indian drug only contains 4 to 8 per cent, of morphine, while the Turkish variety contains 8 to 12 per cent.
Experiments have shown that opium prepared from poppies grown in the hilly districts of the Himalayas yields 50 per cent. more morphine than that obtained from plants grown in the plains.
Might it not therefore be possible (if it is admitted that a certain amount of opium will always be required, medicinally or otherwise) for the Imperial Government to initiate experiments to determine whether it is not possible to produce on a commercial scale a pure opium which will have still less toxic effects than the varieties in use at present,
GEORGE DOUGLAS GRAY, M.D.
Peking, July 1908.
(Signed)
168
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