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the holding of an International Conference on the OpiunQuestion. The chairman of the Commission at the beginningof the deliberations expressed the hope that the resolution;passed would be unanimous ; that the recommendation;would be of a practical, broad, and wise characterand that before coming to any decision the whole questiorwould be studied from all its aspects-moral, economicalcommercial, and diplomatic. We learn with some regrelthat the views of this broad-minded cleric upon the attitudfto be adopted in examining this difficult question have noigiven satisfaction to a section of the more irreconcilabh

anti-opium enthusiasts in his own country and elsewhere,Before proceeding to propose and pass resolutions the variousdelegations put forward a brief statement of the opium ques.tion as it related to their own country or its dependencies.From what the chief Chinese delegates said it appeared thatthe national conscience of China has been recently awakened,and that there was a general movement on foot to rid thecountry, if possible, of the degrading opium habit. Hemade an impassioned appeal to the other nations to givetheir help in suppressing the abuse of opium in his country.Owing to the imperfect manner in which statistics are com-piled in China it was not possible for him to give precisefigures as to the number of persons who were addicted to theabuse of opium in the Chinese Empire, but it was safe to saythat more than 25 per cent. of the adult population usedopium habitually in excess. It was also impossible to statethe amount of opium grown in China or the amount importedfrom India or elsewhere into the Empire, as much of it wassmuggled into the country. A change was coming overthe subject by the substitution of morphia, taken by themouth or injected hypodermically, for opium smoking.Enormous quantities of morphia were now being importedclandestinely into China, the comparative cheapness of thisdrug (1 dollar’s worth going as far as 3 dollars’ worth ofopium), the facility with which it can be obtained, andthe ease with which it can be administered, all makingit clear to the coolie that economy and conveniencewere attained by its use in place of opium. Morphia ofJapanese origin could be sold cheaply, and consequently ithad a virtual monopoly in Manchuria, the Yangtse valley,and other populous parts of China. A peculiar and recentphase of the opium question, especially in China, is the factthat nowadays, perhaps in response to the growth of publicopinion against the opium habit, a large number of so-calledanti-opium remedies, chiefly in the form of pills, are in themarket, and are sold to the public in large quantities. Un-

fortunately, these remedies for the most part contain

morphia or opium in one form or another, and thishas been proved by analysis, so that the result isthe substitution of opium eating for opium smoking.Although the opium smoking divans have in manyplaces been closed this cannot be regarded as evidenceof diminution in the amount of misuse of the drug,for the victim of the habit can now drug himself athome without resorting to a divan at all. Another remedynamed Peking tea " is merely black tea impregnated withmorphia. Although to some perhaps these so-called anti-opium remedies may be taken in good faith with a view ofcasting off the yoke of the opium habit, nevertheless it iswell known throughout China that these remedies are onlysubstitutes for the opium pipe. Unfortunately, the demandfor them is so great that many drug stores, native and

foreign, are doing a lucrative business in making and sellingthese specifics. While the laws of China appear to beunable to deal satisfactorily with these I I medicines " con-taining morphia, the selling of that alkaloid for illegitimatepurposes is punished, when detected, by the penalty ofdecapitation. The chief Chinese delegate went so far as toassert that in Shanghai, where the commission was sitting,British, French, Austrian, and Japanese druggists, as wellas others, were selling anti-opium pills which on analysishad been shown to contain morphia or opium. Oneparticular pill of this sort manufactured by a Japanesefirm commands the largest sale in China, and is carried toall the corners of that empire owing to the enterprise of its

proprietors.The evils, moral and physical, produced by the opium

habit are universally admitted, and the Chinese delegationspoke in strong terms as to this. He said that WesternChina especially had been ravaged by this accursed habit."Visit," said he, "the dismal and wretched hovels which

n were it not for this opium would be happy homes; see theemaciated, depraved multitude of victims to this vice;

s observe the abject poverty, and notice for the cause of it alls the wide fields once covered with the waving gold of ripening

; grain now given over to the culture of the poppy." Hen concluded his speech with a fervent request to his fellow, delegates for help from their Governments towards crushingt the opium curse in China. He asserted that the Chinesee nation had at last awakened to its evils, and the sentimentst of the people had been stirred as they had never been stirrede before during 2000 odd years of history. All classes were. united in the determination to get rid of the curse. Chinas looked for the fullest assistance and cooperation of all- civilised powers in her attempt to " throttle the opium evil.". He hoped in conclusion that such restrictions of the existingt treaties as might be found to hamper her efforts in dealing, with this question would not be used to this end. Thej British chief delegate then pointed out that the task ofe prohibition of opium in India was impracticable in the near

future, and he added that the British delegation was unable, to accept the view that opium should be confined simply and- solely to medical uses. He objected to the Chinese delegate’s

suggestion that England should abrogate its treaties withChina on the opium question, but he affirmed that the BritishGovernment would strictly adhere to its agreement so recently

L made as in 1908 to restrict for the next ten years the im-) portation of opium from India by 5100 chests annuallyl into China until a fixed minimum of 16,000 chests a years was reached, notwithstanding that this arrangement would

entail a heavy loss of revenue to the Government of India., The Japanese view was that the best and most practical way

of dealing with the opium habit was by gradual abolition,so that men and women addicted to the vice might break offthe habit with least inconvenience to themselves.

’ Ultimately, after the proceedings had lasted over 14sessions, from Feb. lst to Feb. 26th, and as a result of con-siderable discussion, the Commission passed a series of resolu-tions, having for their object the suppression of the morphiahabit and the gradual eradication of opium-smoking. Otherrecommendations related to the correcting of the abuse ofopium and its derivatives in foreign concessions and settle-ments in China, that there should be a revision of the existingsystem of regulations in countries where opium is not pro-hibited for other than medical purposes, and that eachdelegation should advise its own Government to investigatescientifically for itself the matter of anti-opium remediesand the effect of opium and its products. Finally, inter-national cooperation was advocated to prevent the smugglingof opium into countries where a prohibitory law prevails.The report is of special interest in view of the statement

made by Sir Edward Grey in the House of Commons onNov. 4th to the effect that the British Government was con-

sidering a proposal made to it by the Government of theUnited States that an International Conference on the OpiumTrade should be held shortly at the Hague.

MEETING OF METROPOLITAN PRACTI-TIONERS AND THE DIRECT REPRE-

SENTATIVES ON THE GENERALMEDICAL COUNCIL.

DR. J. FORD ANDERSON presided at a meeting of themembers of the medical profession who reside in London andits neighbourhood which was held under the auspices of theMetropolitan Counties Branch of the British Medical Asso-ciation at the St. James’s Vestry Hall, Piccadilly, W., onthe evening of Nov. 22nd.

Dr. H. W. LANGLEY BROWNE, who spoke first, after brieflysketching the history of the General Medical Council, whoseposition, duties, and possibilities, he said, were not fullyunderstood either inside or outside the profession, pro-ceeded to refer to an inconvenience in the arrange-ment of the medical constituency for election purposes.Each representative, he thought, should represent a

division of the country and not the whole. At thetime of the last election for Direct Representatives,although the clearest regulations were sent out, 1503 of thereturned papers were invalid because they were inaccuratelyfilled up. Out of a total number of 24,659 only 11,000 odd

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- -were returned in the proper time and 11,000 odd were notreturned at all. This had a bad effect, because it fosteredthe idea that medical men were apathetic with regard totheir interests. The speaker then referred to the com-

mittee which the Council had appointed to inquire into

,unqualified practice in this and other countries. Lord Crewe,the Foreign Office, and the Colonial Office had rendered greathelp in this inquiry, with the result that a large amountof information had been obtained and a digest hadbeen made which could be obtained at the offices of the’Council. This inquiry showed that in almost every countryexcept our own unqualified practice was not allowed to existor was greatly restricted. He did not think there wouldnow be much difficulty in getting the unsatisfactory Clause 40of the Medical Act altered. The Local Government Boardhad sent out circulars to medical officers of health asking forinformation with regard to unqualified practice in theirdistricts, but he thought that the general practitioners hadbetter means of knowing the condition of things in theirrespective areas than medical officers of health, and hebelieved that in some cases the inquiry forms had beenreturned without investigation having been made.

Dr. H. A. LATIMER said that the limitations of theCouncil were not rightly understood, and he gave severalamusing instances of irrelevant questions which were put to,him when standing before his election by some of his con-stituents. The Act of 1858 was faulty and failed to protectthe medical profession as it should do. Referring to the un-satisfactory nature of Clause 40 he said he knew of cases wheremasseurs and bonesetters had given evidence in courts of lawas to injuries. The colonies were far ahead of this country inregard to the protection of the public and the profession,and the new colonial enactments of Bermuda, Newfoundland,and British Central Africa went further than any legislationin this country. Of late our legislators were becoming morecareful of the health of the country. A Midwives Act hadbeen passed which had been rather detrimental to themedical profession, but which in the end he believed wouldbe beneficial for all parties. That was a great step in the rightdirection, but if the health of the country was to be properlysafeguarded no unqualified person whatever should be allowedto practise. Although the Council had not been able to domuch with regard to individual quackery, it had done some-thing towards preventing what he called corporate quackery,for the charters of opticians and medical herbalists hadbeen successfully opposed. A part of the lay press wereresponsible for the sale of many quack remedies, and it was

significant that some newspapers had refused to advertisethe publication relating to proprietary remedies whichhad lately been issued by the British Medical Associa-tion. The Council as a body kept a very jealous eyeupon medical education. The penal work of the Council,under the able guidance of its distinguished presidents,of whom Sir Donald MacAlister was not the least, hadbeen so carefully done that attempts to upset it had almostinvariably failed in the courts. He thought that the DirectRepresentatives had been successful in doing the work theywere required to do, and an additional representative hadbeen granted., With regard to the method of electing DirectRepresentatives, he was strongly in favour of creating con-stituencies.

Dr. L. S. MCMANUS, after paying a tribute to the able

leadership of Dr. Langley Browne, said that the constitutionof the Council was radically wrong, and was likely to remainso unless pressure were brought to bear from outside. The

representatives of the corporations were not in touchwith those whom they were supposed to represent. He

briefly sketched the way in which penal cases were

dealt with, remarking that, contrary to the general idea,the Council always leaned to the side of leniency. Referringto the method of electing representatives he said that

England should be divided into three districts, north, middle,and south, and Wales should have the fourth representative.There should be legislation which would allow the Council todeal with quacks of all sorts. The watchword of the pro-fession should be cooperation and organisation, things whichit had lacked in the past. The medical profession ought to berepresented in Parliament by medical men. If such had beenthe case would any Cabinet Minister have dared to put thatobjectionable clause in an Act requiring medical men to bedned if they failed to notify a birth within 36 hours ?

Dr. MAJOR GREENWOOD asked for some expression of

b opinion from the Direct Representatives on the Poor-lawi Commission report.) Dr. LANGLEY BROWNE said that his sympathies were to a- large extent with the Minority Report, but that he was not) prepared at the present moment to make a statement with, regard to the matter.ti A very brief discussion took place with regard to prescrib.b ing chemists, Dr. G. A. HERON remarking that he had inter-1 viewed many of the leading chemists who had told him that} they were quite willing not to prescribe if medical men would7 undertake not to dispense.b The CHAIRMAN, reading a:question that had been handedI up to him, asked Dr. Latimer whether there was an early) prospect of suppressing the sale of patent drugs.I Dr. LATIMER thought that at present it was impossible,: but that much might be done by requiring their exact’ composition to be stated on the label. The public would1 then be careful not to pay Is. l-kd. for a box of pills whichr cost 3/4d.

The proceedings terminated with a vote of thanks on Siri

VICTOR HORSLEY’S proposal, to the three representatives for

their attendance at the meeting.

ASYLUM REPORTS.

! City of Cardiff Mental Hospital (Report for the Yecur,

1908).-The total number of cases under treatment duringthe year was 764, this being also, as the hospital is a

new one, the number of admissions. The discharges amountedto 49, and of these 28 were recovered. The deaths numbered31, and necropsies were held in 30 cases. Upon Dr. EdwinGoodall has fallen the brunt of the work in the preparationof this hospital for the reception of mental patients, and the

: careful planning and organisation which have been devoted toI it are characteristic of modern methods utilised and de-

i veloped by a physician who has appreciated their enormousvalue. We cannot do better than quote from Dr. Goodall’sreport. " The institution is equipped much above the averagein respect of scientific apparatus for clinical and patho-

, logical research. Such equipment is necessary in every. hospital for mental diseases if the medical spirit, withoutl which these institutions would rank merely as places of: detention, is to be fostered, and young medical men of a; desirable stamp are to be attracted. More than ever is it incumbent to have such in a mental hospital in touch with a

town possessing medical laboratories and trained workers in, all departments of medicine, which provides post-graduate: instruction, and which aims at possessing a complete medical

school." When we read of this or that asylum having a. remarkably low rate of maintenance, we are not, therefore,l to envy that institution forthwith, and to set it up as a model

to be followed. Before congratulating the authorities wei require to be satisfied upon a few points. What, in brief,

are their ideals ? Is the institution merely a home of rest,l where the ’’ patients

" are clothed, fed, and amused, where the

medical service wholly or mainly consists in a perfunctory, round, and attention to the " primæ viæ " ; where employees,

to whom courtesy accords the designation of "nurse," patrolthe wards in the proportion of 1 to 10 or 12 patients? How many of the patients drift into dementia because they

. have not, for reasons of want of confidence, been sent inearly enough, and because they have received no treatmentworthy the name, in order that expenses may be keptdown ? Dr. Goodall is of opinion that if people appreciated

that an extra 4d. per head per week or so meant to theirrelatives a better chance, better medical attention, morerefined and skilled nursing, constant effort to preventdementia and promote more rapid recovery, a putting offof the evil day of extensions to buildings, they would con-sider the extra expenditure not only justifiable but desirableand in the long run a real economy. Nothing could bebetter than that these objects should be the aim of everyauthority in lunacy in the country.

Suffolk District Asylum (Report for the Year 1908).-Atthis asylum the total number of cases under treatment duringthe year was 1100. There were 230 admissions. The dis-

charges numbered 166, and of these there were 42 recovered.The recovery rate, calculated upon the net admissions, was22 - 4 per cent. The death-rate, calculated on the average,