133THE TRAFFIC IN DANGEROUS DRUGS.

Annotations.

SEAMEN’S HOSPITAL SOCIETY.

"XI’ quid nhnla."

THE week has seen another milestone passed in Ithe adventurous career of the Seamen’s HospitalSociety, for on Monday last the Duke and Duchess of York declared open the new pathological labora- Itories built to the design of Sir Edwin Cooper,which are to serve the needs not only of the Seamen’sHospital itself but of the whole neighbourhood inwhich it lies. Another building opened at the sametime was the nurses’ home, situated within the gardensof the Royal Hospital School, which is to provide aseparate room for each of the 130 nurses who staffthe " Dreadnought " itself and its local extensions.The capital cost of both buildings has been fully metout of the fund raised by Viscount Devonport, in1915 and after, as a lasting memorial to the work ofthe mercantile marine, and there is a small balancefor maintenance. Not as large certainly as some ofthe optimists on the staff would like. Responding atthe banquet to the toast of the laboratories proposedby Lord Devonport himself, the dean, Mr. PercivalCole, spoke of their double function in supplying theknown needs of the moment and in organising researchto meet the unknown needs of the future ; andProf. R. T. Hewlett, who was in the chair, picturedthe endowment of research scholarships as the nextobjective in view. The scheme has in fact come tofruition at an opportune time. Even in their previousdomicile the laboratories, under the joint direction ofProf. Hewlett and Dr. Arthur Davies, had served thehealth departments of five London boroughs and theneighbouring poor-law hospitals. The new unit isfit to play an integral part in any new organisation ofa local health service if only for the remarkablefaith shown by the promoters of a great fund inallotting it to the development of pathology ratherthan to the provision of beds or clinics. Sir JohnRose Bradford, in giving eloquent expression at thebanquet to this feeling, was but echoing what was nodoubt in the minds of many of his listeners, and hisremarks were endorsed by the Member of Parliamentfor Greenwich who, while disclaiming knowledge ofpathology or of the sea, said he knew something ofhuman values at the Seamen’s Hospital. It mustnot be assumed by those who do not know all thefacts that the " Dreadnought " is now nothing morenor less than a school of pathology. Since 1901 when,according to Prof. Hewlett, the palaeolithic period inthe Society’s history came to an end, the hospitalsfor sick and injured merchant seamen under theauspices of the Society have increased remarkably insize and number ; there are now 627 beds in theseven establishments, including the sanatorium atBramshott and the hospital at Marseilles. The pointis rather that pathological research has always beena tradition in the Society-was it not at Greenwichthat one of the first cases of acromegaly was

described ?-and that this tradition is now assuredfull scope in its further development.

RETROPHARYNGEAL ABSCESS IN INFANTSAND CHILDREN.

ALTHOUGH retropharyngeal abscess is not common,its recognition is important owing to the risks attend-ing spontaneous rupture. According to Greenwaldand Messeloffl the majority of cases occur during thefirst year of life, and it is just at this time that anadequate examination of the throat is difficult.Inspiratory and expiratory stridor, aggravated by

1 Greenwald, H. M., and Messeloff, C. R. : Amer. Jour.Med. Sci., June, 1929, p. 767.

the horizontal position, is, of course, the outstandingsymptom, but diagnosis should usually be possiblebefore it becomes the presenting symptom. Aprevious history of acute nasopharyngitis is the rule,and in any case in which this is followed by restlessnessand unilateral enlargement of the cervical glands,the question of a retropharyngeal abscess should arise..Owing to difficulty in swallowing, mucus collects inthe throat and causes the rattling and stertorousbreathing so often heard in the later stages. Asnoring, gurgling respiration during sleep is, in fact,one of the most constant symptoms. Further, theyounger the patient and the more rapid the courseof events, the more pronounced are these findingsTorticollis is nearly always found, and its presenceshould suggest retropharyngeal abscess before any-thing else. As Greenwald and Messeloff point out,the examiner must have a clear conception of a normalthroat in infants and children in order to determine,from his brief glance, whether or not there are patho-logical changes. Even then inspection of the throatin infants is rarely conclusive, and should be followedin all suspicious cases by palpation with the finger.In older children, difficulty is encountered in theexamination because of trismus. The pushing forwardof one faucial pillar is an outstanding sign found oninspection and one that may easily be overlooked.Slight oedema of the soft palate may also be seen insome cases. The mucosa covering the swelling is atfirst red, and later, when there is suppuration, theredness fades and the pharyngeal wall becomes paleand somewhat yellowish, feeling elastic and boggyto the finger. Once an abscess has formed, surgicalmeasures and evacuation of the pus are obviouslyindicated, but in the stage of lymphadenitis, beforetrue suppuration, great harm may be done by incision,because generalised sepsis may follow. In Greenwaldand Messeloff’s opinion, the best results are obtainedunder light ether anaesthesia, unless the child isdesperately ill; the outlook as a rule is excellent.

THE TRAFFIC IN DANGEROUS DRUGS.

THE third annual report made by the BritishGovernment to the League of Nations respecting thetraffic in opium and other dangerous drugs is nowavailable. It would appear that while the admiiaistra-tion of the Dangerous Drugs Acts, 1920 to 1925,seems to have given effect to the principles impliedin The Hague and Geneva Conventions, and to havegreatly restricted illicit procedures in Great Britain,there is abundant evidence of vigorous illicit commerceelsewhere. Reports of seizures have during 1928been received from the colonies and the Dominions,in particular India and Canada, from the UnitedStates, as well as (through the Secretariat of theLeague) from other countries, notably Egypt andChina.

’ The total amount of morphine and its saltsmanufactured in Great Britain, by the two Edinburgh, firms licensed for the purpose, was 69,021 ounces, aL further reduction on the previous year. Likewise thes amount exported from Great Britain, 49,824 ounces,l was greatly less than obtained only a few years ago.

Of this exported morphine, 7058 ounces went toAsiatic Countries and 2749 ounces found their way toChina, an increase of 1831 ounces over the previousyear. The exports of British morphine to Africa,America and Australasia also show an increase overthe figures for 1927, while the consignments to

, European countries showed a considerable decrease.. Of heroin (diacetyl morphine) 10,794 ounces weremanufactured in Great Britain, of which 6038 ouncesJ were exported. It is interesting to note that Indianl opium is now almost entirely employed in this country.

for pharmaceutical purposes to the exclusion ofT Persian and Turkish opium, which latter were formerly_ regarded as the more appropriate sources of thealkaioids. It is also to be noted that in addition to

.

the import of raw opium 9647 ounces of crude morphine

134 VARIOLA IN RABBITS.—THE TAVISTOCK CLINIC.

were imported from India (presumably from theGovernment factory) and used for the production ofthe alkaloid or its salts. No less than 64,091 ouncesof morphine were last year used for the making ofcodeine, an alkaloid not at present included withinthe provisions of the Hague or the Geneva Conventions.A novel departure has been made whereby 4934 ouncesof cocaine were manufactured last year for the firsttime in this country by the one firm (May and Baker,Battersea) licensed for this purpose. The imports ofcocaine (9353 ounces) were less by 6000 ounces thanin 1927. On the other hand the exports of cocainesalts (3950 ounces) showed an increase on the previousyear, such increased exports being chiefly to Chinaand New Zealand. The exports of heroin (diacetyl-morphine), generally speaking, show a similartendency, while in the case of " artificially driedopium

" there was a curiously large increase in theconsignments to South Africa-viz., a total of195,000 lb. or an excess over the figures for 1927 of88,428 lb.From press reports it would appear that in more

than one case the diplomatic privilege which securesimmunity from search to consignments of goods toembassies and legations has been abused by theinclusion of dangerous drugs. Meanwhile thePermanent Central Opium Board has held its secondsession at Geneva. The relation of that body to theAdvisory Committee on Traffic in Opium remainssomewhat indefinite, though close cooperation isnaturally deemed to be essential. The Boardnominated certain officers for the secretariat andthese await the approval of the Council and theSecretary General of the League. After prescribingthe forms of statistical returns of import and exportof the scheduled drugs the Board adjourned tillOctober.

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VARIOLA IN RABBITS.

THE variolous origin of vaccinia is now generallyaccepted as a fact and anyone familiar with thecorrect technique has no difficulty in producing astrain of vaccinia by passing the virus of small-poxthrough an appropriate series of animals. An impor-tant difference between small-pox and the diseaseproduced by the virus thus modified consists of theinability of the latter to spread from one individualto another by any means other than actual inoculationof virulent material. So far as we are aware thedisease in animals other than man has always shownthis absence of infectivity, and if this characteristiccan be taken as the distinction between variolaand vaccinia an outbreak among laboratory rabbitsdescribed by S. Nicolau and L. Kopciowska1 fullymerits the name of variola.

The epizootic occurred in April of this year amongsome 50 rabbits in a room where there had been noanimal infected with vaccinia since the previousSeptember. Two animals undergoing antirabicimmunisation developed simultaneously a peculiarform of acute coryza, with purulent nasal discharge,later becoming sanguineous with the formationof blackish crusts round the nares. Respiration was difficult owing to the nasal obstruction and theanimals died on the fifth and eleventh days respec-tively. Each rabbit showed three or four small papuleson a previously shaved area on the flank. Within40 days symptoms of the illness had appeared in34 other rabbits housed in cages in the same room,which measured approximately 26 feet by 60 feet.The symptoms varied and out of 23 which died sixhad acute coryza, two acute coryza and cutaneouspapules, eight coryza and conjunctivitis or kerato-conjunctivitis, one of these having orchitis in addition,one kerato-conjunctivitis alone, three orchitis, andthree showed no definite symptoms. Of these lastthree one on dissection was found to have a pustuleon the nasal mucous membrane, and several of those

1 Comp. rend. de la Soc. de Biol., 1929, ci., 551-555.

with coryza had one or more pustules on the tongue.Orchitis did not occur among the rabbits whichrecovered, but otherwise their symptoms were

similar. Post mortem all the dead animals werefound to have a greatly enlarged spleen. Purulentpneumonia was found among those which had showncoryza before death, and the meninges were frequentlyadherent, a condition typical of cerebral vaccinia.These adhesions were more marked in the rabbitswhich had shown no definite symptoms while alive,suggesting a special localisation of the virus in thebrain in these cases. The skin papules were typicalof the lesions of vaccinia. Out of 12 attempts thevirus was successfully recovered every time from thetissues of rabbits which died in the epizootic, ninetimes from the brain, twice from cutaneous papulesor pustules, and once from the testis. This virusproved highly virulent for rabbits, killing with thetypical signs of vaccinia in four to six days whenintroduced into the testis or brain, and on skininoculation producing a characteristic eruptionintermediate between that of neurovaccine anddermovaccine. Cross-immunity experiments demon-

, strated the variolous or vaccinal nature of the, virus. Animals immunised with ordinary vaccine, were completely resistant to the virus from the

epizootic both with cutaneous and subdural; application. Likewise the animals which recovered; were refractory to ordinary vaccine. Moreover,a number of rabbits which had been through theepizootic without showing symptoms also provedto be immune to ordinary vaccine.The authors of the paper have nothing definite

to suggest as to how the infection arose or was

disseminated beyond vague speculations as to thepossibility of its having been latent in the dust of theroom for seven months and been carried by air anddust. It is noticeable that no mention is made ofthe possibility of its importation and spread by theattendants of the animals. It is- suggested thatseasonal influences played a part, mainly on thegrounds apparently that the outbreak coincided withthe " recrudescence of the epidemic of human small-pox observed particularly in England "-a recrudes-cence which actually consisted of a comparativelysmall number of imported cases of a virulent typewhich achieved a disproportionate internationalprominence.The interest in the outbreak reported by Nicolau

and his colleague seems to lie in the virulenceand infectivity of an outbreak among rabbits.Vaccinia among rabbits and other animals is generallyregarded as a mild and comparatively innocuousdisease which can be relied on to breed true to type-a fact of which advantage is sometimes taken in thepreparation of vaccine used for protective purposes.

THE TAVISTOCK CLINIC.

THE problem of functional nervous disorder isbecoming increasingly important. It is dealt with toa certain extent in consulting practice, but manythousands of patients with limited means have noone to cater for them. The Tavistock-square Clinicis making heroic efforts to fill a gap many timeslarger than its utmost capacity. Its work hasincreased by 30 per cent. in two and a half years,and the activities of the Children’s Department byno less than 57 per cent. in one year. Its servicesare in ever-increasing demand among hospitals,police-courts, and private patients who cannot afforda consultant. The Clinic has now, however, reachedsaturation point. Its work is carried on by 25regular physicians, and in only seven consultingrooms, and every part of the building is utilised tothe utmost. The result is that the waiting list hastwice had to be closed in the last 18 months.These limitations have produced what Dr. H.Crichton Miller calls " very active compensatoryphantasies of extension." The phantasies, however,are of a constructive kind, and are embodied in a