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89 times bleeds freely; and that when it has separated, very little blood flows. But I find that tying this free end of the funis helps the placenta to separate where it has not done so. In entertaining the old notion of the pla- cental capillary courses, which I have quite disproved by experimental injections, much must necessarily be overlooked in this branch ofphysiology. I remain, Sir, yours obediently, R. STEVENS. Kennington, April 8, 1843. FEMORAL HERNIA.-At a late meeting of the London Medical Society, Mr. PILCHER, the president, detailed some particulars of a case of femoral hernia which terminated fatally, and which was observed during life by a very prominent condition of the os pubis, and an exostosis of the upper part of the thigh-bone. The usual symptoms of hernia were unequivocal, and a very careful examination of the parts in which hernia is usually situated was made. No kind of tumour could be detected in the femoral region. After death, however, a small femo- ral hernia was found, and it was then disco- vered that the small portion of gut which was strangulated had lain in a hollow formed by the pubis and exostosis, as men- tioned above. CASE OF VOLVULUS REMOVED BY INJECTIONS. At the same meeting Mr. PiLCHER also re- lated a case of volvulus in a child to which he was called after all the usual remedies for the removal of the disease had been in- effectually employed. Recollecting the bene- ficial effect of an injection in a case of this kind some, years before, he recommended that as much thin gruel as could be thrown up into the bowel should be injected by the common injection-syringe. The quantity thrown up was very large, and the bowels were much distended by it. The effect was almost immediate and quite decided, the ob- struction gave way, and the patient reco- vered. INTESTINAL OBSTRUCTION.-The London Medical Society was occupied at its meeting on the 3rd April, with a discussion on ob- struction in the intestinal canal, and ad- dressed itself chiefly to the question as to whether we possessed sufficient information on this subject to be always able to deter- mine on what cause the obstruction imme- diately depended. Could we unequivocally ’, declare the presence of intus-susception ; or could we pronounce the constipation to arise from mere accumulation of faeces, or from the absence of bile in sufficient quantity to produce the peristaltic action of the !intes.. tines ? The discussion was desultory, and could not be made available for a report. R. STEVENS. THE LANCET. London, Saturday, April 15, 1843. LONDON MEDICAL SOCIETY.—THE " OPIUM QUESTION." THE great military and political events which the importation of opium into China, or, rather, the prohibition of such importa- tion, has produced, would not qualify the " opium question" to receive notice in the pages of THE LANCET. Since, however, that question has a very important relation to hygiene, we propose to institute a fair examination into its principal points, a course which we feel the more inclined to adopt because the evils that really result from the abuse of opium have been greatly exaggerated, while a very false political view of the subject is entertained in some highly respectable quarters. And, first, with regard to the actual amount of evil resulting from the consump- tion of opium as an article of luxury. This is generally stated and believed to be infi- nitely greater than that arising from habi- tual intoxication with alcoholic liquors. We may observe, in limine, that although the constant use of substances which are calculated to induce an unnatural state of the nervous system is, in most in- stances, highly injurious, the pernicious effects of such substances have generally been over-rated. Now this is in itself an evil, because where the simple truth affords a a sufficient condemnation of any prevalent practice, the smallest exaggeration or dis- tortion of that truth tends merely to weaken the case by placing a certain amount of ex- perience in opposition to it. For example: dram-drinking is one of the most formidable evils that beset this country, and produces truly deplorable effects on the minds, bodies, and estates of a large portion of the popula- tion. But if it be asserted, as it often is, that the invariable result of the practice is an utter prostration of every power of body and mind, followed by premature senility and death, hundreds of men who have been dram-drinkers from their youth upwards, but
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89

times bleeds freely; and that when it has

separated, very little blood flows. But Ifind that tying this free end of the funis

helps the placenta to separate where it hasnot done so.

In entertaining the old notion of the pla-cental capillary courses, which I have quitedisproved by experimental injections, muchmust necessarily be overlooked in thisbranch ofphysiology. I remain, Sir, yoursobediently,

R. STEVENS.Kennington, April 8, 1843.

FEMORAL HERNIA.-At a late meeting ofthe London Medical Society, Mr. PILCHER,the president, detailed some particulars of acase of femoral hernia which terminatedfatally, and which was observed during lifeby a very prominent condition of the os

pubis, and an exostosis of the upper part ofthe thigh-bone. The usual symptoms ofhernia were unequivocal, and a very careful examination of the parts in which herniais usually situated was made. No kind oftumour could be detected in the femoralregion. After death, however, a small femo-ral hernia was found, and it was then disco-vered that the small portion of gut whichwas strangulated had lain in a hollowformed by the pubis and exostosis, as men-tioned above.

CASE OF VOLVULUS REMOVED BY INJECTIONS.

At the same meeting Mr. PiLCHER also re-lated a case of volvulus in a child to whichhe was called after all the usual remediesfor the removal of the disease had been in-effectually employed. Recollecting the bene-ficial effect of an injection in a case of thiskind some, years before, he recommendedthat as much thin gruel as could be thrownup into the bowel should be injected by thecommon injection-syringe. The quantitythrown up was very large, and the bowelswere much distended by it. The effect wasalmost immediate and quite decided, the ob-struction gave way, and the patient reco-

vered.

INTESTINAL OBSTRUCTION.-The LondonMedical Society was occupied at its meetingon the 3rd April, with a discussion on ob-struction in the intestinal canal, and ad-dressed itself chiefly to the question as towhether we possessed sufficient informationon this subject to be always able to deter-mine on what cause the obstruction imme-diately depended. Could we unequivocally ’,declare the presence of intus-susception ; orcould we pronounce the constipation to arisefrom mere accumulation of faeces, or fromthe absence of bile in sufficient quantity toproduce the peristaltic action of the !intes..tines ? The discussion was desultory, andcould not be made available for a report.

R. STEVENS.

THE LANCET.

London, Saturday, April 15, 1843.

LONDON MEDICAL SOCIETY.—THE " OPIUM QUESTION."

’ THE great military and political eventswhich the importation of opium into China,or, rather, the prohibition of such importa-tion, has produced, would not qualify the" opium question" to receive notice in the

pages of THE LANCET. Since, however,that question has a very important relationto hygiene, we propose to institute a fair

examination into its principal points, a

course which we feel the more inclined to

adopt because the evils that really result

from the abuse of opium have been greatlyexaggerated, while a very false politicalview of the subject is entertained in some

highly respectable quarters.And, first, with regard to the actual

amount of evil resulting from the consump-tion of opium as an article of luxury. This

is generally stated and believed to be infi-

nitely greater than that arising from habi-tual intoxication with alcoholic liquors.We may observe, in limine, that althoughthe constant use of substances which are

calculated to induce an unnatural state

of the nervous system is, in most in-

stances, highly injurious, the perniciouseffects of such substances have generallybeen over-rated. Now this is in itself an

evil, because where the simple truth affordsa a sufficient condemnation of any prevalentpractice, the smallest exaggeration or dis-tortion of that truth tends merely to weakenthe case by placing a certain amount of ex-

perience in opposition to it. For example:dram-drinking is one of the most formidableevils that beset this country, and producestruly deplorable effects on the minds, bodies,and estates of a large portion of the popula-tion. But if it be asserted, as it often is,that the invariable result of the practice is

an utter prostration of every power of bodyand mind, followed by premature senilityand death, hundreds of men who have beendram-drinkers from their youth upwards, but

90 REMARKS ON THE EFFECTS OF

who, nevertheless, have lived to an ad- will easily convince himself that, in an im-

vanced age, in a very fair state of mental mense majority of instances, the use of to-and bodily efficiency, could at once rise up bacco exerts no ap preciable influence on thein defence of their favourite vice, and offer a smoker’s state of health, or the duration of

living confutation of the position. his life ; that in some peculiar constitutions it

Again, a candid view of certain statistical is decidedly injurious, and in others as deci-facts will equally show the position to be un- dedly beneficial.

tenable, by bringing to light the circumstance But to the question of opium. It is, wethatthe average term of life among our dram- have said, generally stated and believed thatdrinkers is not shorter than that of the classes the actual amount of evil resulting from theoccupying the same position in society in abuse of opium is infinitely greater than

more abstemious countries. All this, how- that which arises from habitual intoxication

ever, by no means demonstrates that, dram. with alcoholic liquors. Now we doubt the

drinking is not a disgusting and pernicious accuracy of this notion, and suspect that it

practice, injurious alike to the corporal has been derived from the hasty general state-

, frame and the intellect. Observation has ments of inconsiderate authors, made without

,

sufficiently proved that the instances in due reference to statistical observations.

which no very marked bad effects result Take, first, the instance of China, thatfrom it, are exceptions from a general rule, being more immediately under consideration.and that, in most instances, it does occasion Mr. MEDHURST, in his " China," tells us

very grievous results, although not quite so that Previous to the year 1796, opium wasbad as those persons who derive their views admitted into China on the payment of a

’ merely from theory, may imagine. A philo- duty, when a few hundred chests annually

sophical deduction from the same statistics " were imported. Since that time the drugwould also evince that while the dram-drink- " has been openly interdicted, and yet clan-

ing population of England live as long as " destinely introduced at the rate 20,000the lower class of the people in more ab- " chests annually, which cost the Chinesestinent communities, that is owing not to the four millions of pounds sterling every

harmlessness of alcohol, but to the absence " year." But Mr. MEDHURST admits " that

of certain causes of disease which exist in " China, partly by additions to the numberthose other countries ; and that, hence, if " enrolled, and partly by the preponderancethe numerous Englishmen who belong to " of births over deaths, has doubled its

the classes of which we speak would abandon "population several times during the last

dram-drinking, they would live much longer century." One, at least, of these redupli-than the corresponding classes in other coun- cations must, then, have happened whiletries. opium-smoking prevailed extensively ; andThis disposition to exaggerate the evils yet the same writer arrives at the conclusion

that arise from the habitual use of agents that " every opium-smoker may calculate

which powerfully affect the nervous system, ‘° upon shortening his life ten years from theis still more strikingly exemplified in the time when he commences the practice."state of opinion with regard to smoking. Now, we affirm that this conclusion is evi-

While some have pronounced tobacco to be dently erroneous, and flatly opposed to thean absolute poison, inducing premature de- comparative statements previously adduced,cay, and abbreviating the term of human life, and from which we must inevitably infer,others have inquired whether certain persons either that men with constitutions under-

who are remarkable for longevity have not mined by opium produce more and healthierbeen indebted for it to the habit of smoking children than those who procreate in an

that plant? But from ordinary observation ordinary state of health, or that opium-and numerical facts, an impartial inquirer smoking in China curtails the average term

91OPIUM-SMOKING AND GIN-DRINKING.

of life only to an extent which is antagonisedby causes that tend to protract that term-which extent must be far less than ten years.The first supposition, namely, that of the

greater procreative powers of opium-smokers,cannot for a moment be entertained ; since,although opium frequently stimulates

salacity, it has never been known to in-

crease fecundity. We must, therefore, con-clude that Mr. MEDHURST greatly over-

estimates the injurious effect of opium-smok-ing upon the public health in China.

We will contrast these statements with

some others, relating to the north of India,to be found in a very useful and interesting,though clumsily-written, work, entitled" Some Account of the General and Medical

Topography of Ajmeer," undertaken (bydirection of the Government) by Dr. ROBERTHAMILTON IRVINE, and published at Cal-

cutta in 1841. Speaking of the principalityof Beekaneer, Dr. IRVINE says, ″ The in-

" habitants generally are long lived, even"the eaters of opium and bhang ; the two

" latter, however, become useless members" of society, becoming gradually listless and

silly ; they at length consume two tolas of

" opium per diem." Again, speaking of

Ajmeer, he writes as follows :-11 Opium, when attainable, is used by a

large portion of the people, especiallyRajpoots, Meenas, and Mairs. The quan-tity consumed by individuals is often verygreat. I have made, on this point, everyinquiry, and it appears that decidedly dangerous effects to the body from the ex- icessive use are very rare. Where injury ,,does result, a state of dyspepsia first ap-pears, with obstinate constipation ; the bodywastes away gradually; after a few yearsdiarrhoea supervenes, much undigested foodbeing passed ; this diarrhoea seems to

depend on partial paralysis of the sphinctersand muscular tissue of the intestines; greatemaciation and general paralysis precededeath. Another class suffers in early youthfrom the use of opium, a state of satyriasisbeing produced that, by indulgence, givesrise to excessive emaciation and death.The very large portion of those who useopium habitually and largely do not sufferat all in the body ; on the contrary, they areless liable to fever or rheumatism ; theirconsumption of food is more moderate, theappetite being less keen ; and they seem

really to be less liable to the ills that fleshis heir to. In very numerous instances theyattain to old age of a hale nature. Thequantity of opium used daily by individualsbecomes, at length, very great ; but, as inthe use of alcoholic fluids, so, in the use ofopium, there is a period up to which thedose must be gradually augmented to anacme, and beyond this, must be again dimi-nished in quantity by the consumer, thesame effects resulting still. The effect ofthe use of opium on the minds of those

habitually taking it is very deleterious.The takers of large doses become perfectlyuseless to themselves and others during theirown happy or terrible dreams. All are

rendered less useful members of society ;the indolent naturally become quite inert,and those who must work, do so with farless spirit and energy than they otherwisewould. The intoxication from opium affordsthe most ridiculous states for observation.I have seen a Mussalchee, running before anelephant at night, repeatedly set fire to hisdhotie, and a Rajpoot lolling back with histongue out covered with flies. The verystupifying effects of opium render itshabitual use among a people more injuriousto them than the use of alcoholic beverages ;but the opium is not more (if even so much)injurious to the health. Those who rejoiceat the stoppage of the opium trade to Chinaon moral grounds, do not, perhaps, reflectthat a people disposed to such artificial ex-

citement will (if in the kingdom of nature)find a worse substitute."

Persons who do not belong to the medicalprofession are but little aware how exten-

sively opium-eating is practised in Europe aswell as in Asia, and especially in Great

Britain. In comparing the practice with

that of dram-drinking, observation has led usto conclude that the habitual use of opiumis about equally detrimental to the generalhealth of the individual, more subversive ofthe intellectual powers, but decidedly less

injurious to social morals, than the repeateduse of alcoholic liquors, inasmuch as in-

toxication from opium seldom induces anydisposition to the commission of crime, or

outrage, whereas it is well known that a

very large proportion of the crimes and actsof violence that are perpetrated in this coun-try are committed under the influence of

alcohol. The only case in- which opiumseems to minister to deeds of violence is

when it is used to stimulate courage in war,as among certain nations of the east. Dr.

92 POOR-LAW DOINGS IN THE ROSS UNION.

IRVINE, whose work we have just quoted,says of the Rajpoots, that,

" In all their single combats and all as-

saults, they resorted to the excitement of

opium ere commencing battle; their ownbards describe the eyes of the heroes as beingred from opium. * * * * Savage jeal-ously and opium together excited them toperform the ’johur,’and after the murder ofall they held dear, the Rajpoot men, then

taking more opium, and clothed in yellowgarments, rushed unreflectingly on the foe toreceive their deaths, dealing at the sametime as many as they could to the enemy.Acting in this way was surely not indicativeof a pure and noble courage. What can besaid of a man to whom a high state of intox-ication is requisite to make him fight; or,supposing the words gin or brandy to be sub-stituted for opium, then how would the

Rajpoot’s performance of ’johur’ be esti-mated ?"

In civil life, however, the ordinary effectof opium is to induce a dream-like existence,in which the individual is little inclined to

take cognisance of extraneous things ; and

certainly if we compare an Oriental squatting ’,on his ottoman, in a state of mystificationfrom opium, with an English labourer rollingin the gutter from the effects of gin, the

parallel is by no means favourable to alcohol.The one personage is like a moping owl,but the other copies the wallowing hog.Admitting, however, the unquestionablefact, that the eating or smoking of opium,and the drinking of spirit, are both most

degrading and pernicious vices, we in-

quire,Secondly, into the right of our Govern-

ment to interfere with the indulgence of theChinese in their favourite vice. What

business have we to forbid the fascinatingopium-smoking in the east, permitting, as wedo, dram-drinking in the north? Why, pre-cisely the same right that JOHN CHINAMANhas to drive JOHN BULL from his delicious

wine-vaults in the streets of London ;that is to say, no right at all. If, in-

deed, the Celestial Empire were tributary to,and under the protection of, our monarchy,the Chinese government, if too feeble to pro-tect its own coast against foreign smugglers,might claim our aid to keep them off. But,as matters actually stand, it would be just

as absurd for England to interfere with thesmuggling of opium into China as it wouldbe for France to send a squadron to protect

the coast of England against the entranceof 11 cogniac." The tea-dealers will hare

opium, and the emperor says that they shallnot. Let the two fight it out as they like;the English Parliament has no business

with the matter. A pretty line of coast

would the Chinese and British cutters have

to guard to stop the smuggling ! As for

laws against opium,-the very best that allthe learned descendants of CONFUCIUS could

contrive have only been followed by-a largeincrease in the consumption of the forbidden

drug, and a villainous war. Whatever line

of policy is pursued by the Emperor of

China, let not England, who has so manyvices to look after at home, make herself onthis new occasion, ridiculous or somethingworse, by ineffectual attempts to put downvices abroad. The divine caution about wipingthe mote out of your neighbour’s eye whilea great beam is sticking in your own, wasnever more applicable than in this questionof opium-smoking in China.

CONDUCT OF THE GUARDIANSTO THE

MEDICAL PRACTITIONERSAND THE

SICK POOR OF THE ROSS UNION.

THE following account of some proceed-ings in this union will be read with interest:

" Ross Union, March 27, 1843." Resolved,-That an offer be made to

the medical officers of 2201. for medicalattendance for one year, ending 1st May,1844, such sum to be exclusive of the chargesfixed for vaccination, and of those for opera-tions under the poor-law commissioners’order of the 12th March, 1842, and of extraallowances for midwifery cases, and to in-clude the workhouse and every other charge.That it be suggested to the medical

officers to divide that sum and the unionamong themselves in such proportions asthey shall select.,’And that if any one of the medical

i officers should refuse to come to the abovearrangement, the same terms be offered tothe remaining three, and if accepted, thathe poor-law commissioners be applied toive their sanction thereto."


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