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BRIEF CONTENTS
DOCUMENTS XIII 8 THE UNITED STATES, CANADA, AND LATIN

MAPS XIV AMERICA 169
FEATURES XV 9 BRAVE NEW WORLD: THE RISE AND FALL OF
PREFACE XVI COMMUNISM IN THE SOVIET UNION AND EASTERN
EUROPE 190
I NEW WORLD IN THE MAKING 1
10 POSTWAR EUROPE: ON THE PATH TO UNITY? 210
1 THE RISE OF INDUSTRIAL SOCIETY IN THE WEST 2
11 TOWARD THE PACIFIC CENTURY? JAPAN AND THE
2 THE HIGH TIDE OF IMPERIALISM: AFRICA AND ASIA LITTLE TIGERS 231
IN AN ERA OF WESTERN DOMINANCE 25
3 SHADOWS OVER THE PACIFIC: EAST ASIA UNDER IV THIRD WORLD RISING 251
CHALLENGE 47 12 THE EAST IS RED: CHINA UNDER COMMUNISM 252
II CULTURES IN COLLISION 69 13 NATIONALISM TRIUMPHANT: THE EMERGENCE OF

INDEPENDENT STATES IN SOUTH AND SOUTHEAST
4 WAR AND REVOLUTION: WORLD WAR I AND ITS ASIA 271
AFTERMATH 70
14 EMERGING AFRICA 291
5 NATIONALISM, REVOLUTION, AND DICTATORSHIP:
ASIA, THE MIDDLE EAST, AND LATIN AMERICA FROM 15 FERMENT IN THE MIDDLE EAST 308
1919 TO 1939 94
V THE NEW MILLENNIUM 329
6 THE CRISIS DEEPENS: THE OUTBREAK OF WORLD
WAR II 121 16 THE CHALLENGE OF A NEW MILLENNIUM 330
GLOSSARY 343
III ACROSS THE IDEOLOGICAL
INDEX 348
DIVIDE 147
7 EAST AND WEST IN THE GRIP OF THE COLD WAR 148
vi
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DETAILED CONTENTS
DOCUMENTS
MAPS XIV
XIII
2 THE HIGH TIDE OF IMPERIALISM: AFRICA
AND ASIA IN AN ERA OF WESTERN
FEATURES XV DOMINANCE 25
PREFACE XVI
The Spread of Colonial Rule 25
The Myth of European Superiority 26
PART I NEW WORLD IN THE The Advent of Western Imperialism 26
MAKING 1 The Colonial System 27
1 THE RISE OF INDUSTRIAL SOCIETY IN
THE WEST 2
The Philosophy of Colonialism 28
O P P O S I N G V I E W P O IN T S
WHITE MAN’S BURDEN, BLACK MAN’S SORROW 29
The Industrial Revolution in Great Britain 2 India Under the British Raj 30
The Nature of British Rule 31
The Spread of the Industrial Revolution 3
New Products and New Patterns 4 The Colonial Takeover of Southeast Asia 33
The Imposition of Colonial Rule 33
The Emergence of a Mass Society 6 Colonial Regimes in Southeast Asia 34
Social Structures 6
Changing Roles for Women 7 Empire Building in Africa 36
Africa Before the Europeans 37
Reaction and Revolution: The Decline of the The Growing European Presence in West Africa 37
Old Order 9 Imperialist Shadow over the Nile 39
Liberalism and Nationalism 9
The Scramble for Africa 39
The Unification of Germany and Italy 11
FILM & HIST O RY
Roots of Revolution in Russia 12 KHARTOUM (1966) 40
The Ottoman Empire and Nationalism in Bantus, Boers, and British in South Africa 42
the Balkans 13
Colonialism in Africa 43
Liberalism Triumphant 14 Conclusion 44
The United States and Canada 14 Chapter Notes 46
Tradition and Change in Latin America 15
The Rise of the Socialist Movement
The Rise of Marxism 17
17
3 SHADOWS OVER THE PACIFIC: EAST ASIA
UNDER CHALLENGE 47
Capitalism in Transition 19
Toward the Modern Consciousness: Intellectual and China at Its Apex 47
Cultural Developments 19 Changeless China? 48
Developments in the Sciences: The Emergence of a
New Physics 19
Traditional China in Decline 50
Opium and Rebellion 50
Charles Darwin and the Theory of Evolution 20
The Taiping Rebellion 51
Sigmund Freud and the Emergence of
Psychoanalysis 20 Efforts at Reform 51
Literature and the Arts: The Culture of The Climax of Imperialism in China 52
Modernity 20 The Collapse of the Old Order 54
Conclusion 23
Chapter Notes 24
vii
Chinese Society in Transition 56 The Failure of the Peace 85
The Impact of Western Imperialism 57 The Search for Security 85
Daily Life in Qing China 57 A Return to Normalcy? 86
Changing Roles for Women 57 The Great Depression 87
Building Socialism in Soviet Russia 89
Traditional Japan and the End of Isolation 58
A “Closed Country” 59 The Search for a New Reality in the Arts 90
The Opening of Japan 59 New Schools of Artistic Expression 91
Culture for the Masses 92
Rich Country, Strong Army 60
Conclusion 92
The Transformation of Japanese Politics 60
Meiji Economics 60 Chapter Notes 93
Building a Modern Social Structure 61
Joining the Imperialist Club 62
O P P O S I N G V IE WP O I N T S
5 NATIONALISM, REVOLUTION, AND
DICTATORSHIP: ASIA, THE MIDDLE EAST, AND
TWO VIEWS OF THE WORLD 63
Japanese Culture in Transition 64
LATIN AMERICA FROM 1919 TO 1939 94
Conclusion 65 The Spread of Nationalism in Asia and Africa 95
Chapter Notes 65 Traditional Resistance: A Precursor to Nationalism 95
Reflections Part I 66 Modern Nationalism 96
Gandhi and the Indian National Congress 98
FILM & HIST O RY
GANDHI (1982) 100
PART II CULTURES IN COLLISION 69 Nationalist Ferment in the Middle East 100
O P P O S I N G V I E W P O IN T S
4 WAR AND REVOLUTION: WORLD WAR I AND
ITS AFTERMATH 70
ISLAM IN THE MODERN WORLD:
Nationalism and Revolution 106
TWO VIEWS 104
The Coming of War 70 Revolution in China 108

Mr. Science and Mr. Democracy: The New Culture
Rising Tensions in Europe 71
Movement 108
Crisis in the Balkans, 1908–1913 71
The Nanjing Republic 110
The Outbreak of War 72
Social Change in Republican China 113
The World at War 72 Japan Between the Wars 113
Illusions and Stalemate, 1914–1915 72
Experiment in Democracy 113
The Great Slaughter, 1916–1917 72
A Zaibatsu Economy 114
O P P O S I N G V IE WP O I N T S
Shidehara Diplomacy 114
“YOU HAVE TO BEAR THE RESPONSIBILITY FOR
WAR OR PEACE” 73 Nationalism and Dictatorship in Latin America 115
The Widening of the War 75 A Changing Economy 115
O P P O S I N G V IE WP O I N T S The Effects of Dependency 116
THE EXCITEMENT AND THE REALITY OF WAR 76 Latin American Culture 118
The Home Front: The Impact of Total War 77 Conclusion 119
The Last Year of the War 77
Chapter Notes 120
F IL M & H I S T O R Y
LAWRENCE OF ARABIA (1962) 78
Seeking Eternal Peace 79 6 THE CRISIS DEEPENS: THE OUTBREAK OF
WORLD WAR II 121
The Vision of Woodrow Wilson 79
The Peace Settlement 80
The Rise of Dictatorial Regimes 121
Revolution in Russia 80 The Birth of Fascism 122
The March Revolution 81 Hitler and Nazi Germany 122
The Bolshevik Revolution 82 The Spread of Authoritarianism in Europe 124
The Civil War 84 The Rise of Militarism in Japan 125
viii DETAILED CONTENTS
The Path to War in Europe 126 The Second Indochina War 161
Stalin Seeks a United Front 126 O P P O S I N G V I E W P O IN T S
Decision at Munich 127 CONFRONTATION IN SOUTHEAST ASIA 163
O P P O S I N G V IE WP O I N T S An Era of Equivalence 165
THE MUNICH CONFERENCE 128 An End to Detente? 165
The Path to War in Asia 129 Countering the Evil Empire 166
A Monroe Doctrine for Asia 129 Toward a New World Order 166
Tokyo’s “Southern Strategy” 130 Conclusion 167
Chapter Notes 168
The World at War 130
The War in Europe 131
The New Order in Europe 133
War Spreads in Asia 134 8 THE UNITED STATES, CANADA, AND LATIN
AMERICA 169
The New Order in Asia 135
The Turning Point of the War, 1942–1943 137
The Last Years of the War 138
The United States Since 1945 169
An Era of Prosperity and Social Commitment 169
The Peace Settlement in Europe 139 America Shifts to the Right 171
The Yalta Agreement 139 Seizing the Political Center 173
Confrontation at Potsdam 140
The War in the Pacific Ends 140
The Changing Face of American Society 175
A Consumer Society, a Permissive Society 176
LETTERS FROM IWO JIMA (2006) 141 The Melting Pot in Action 176
Conclusion 142 Women and Society 176
The Environment 177
Chapter Notes 143
Science and Technology 178
Reflections Part II 144
The World of Culture 179
Art and Architecture 179
New Concepts in Music 179
PART III ACROSS THE IDEOLOGICAL New Trends in Literature 179
DIVIDE 147 Popular Culture 180
7 EAST AND WEST IN THE GRIP OF

THE COLD WAR 148
Canada: In the Shadow of Goliath
Democracy, Dictatorship, and Development in
180
Latin America Since 1945 181

The Collapse of the Grand Alliance 148 An Era of Dependency 182
The Iron Curtain Descends 149 Nationalism and the Military: The Examples of
The Truman Doctrine and the Beginnings of Argentina and Brazil 183
Containment 149 The Mexican Way 185
Europe Divided 150 The Leftist Variant 186
Cold War in Asia 154 Trends in Latin American Culture 187
The Chinese Civil War 154 Conclusion 188
The New China 156 Chapter Notes 189
The Korean War 156
Conflict in Indochina 157
From Confrontation to Coexistence 158 9 BRAVE NEW WORLD: THE RISE AND FALL OF
COMMUNISM IN THE SOVIET UNION AND
Khrushchev and the Era of Peaceful
Coexistence 158 EASTERN EUROPE 190
The Cuban Missile Crisis 160
The Sino-Soviet Dispute 160 The Postwar Soviet Union 190
F IL M & H I S T O R Y From Stalin to Khrushchev 190
THE MISSILES OF OCTOBER (1973) 161 The Brezhnev Years, 1964–1982 193
DETAILED CONTENTS ix
Ferment in Eastern Europe
Unrest in Poland 198
197
11 T OWARD THEPACIFIC CENTURY? JAPAN AND
THE LITTLE TIGERS 231
The Hungarian Uprising 198
The Prague Spring 199 Japan: Asian Giant 231
The Persistence of Stalinism in The Occupation Era 232
East Germany 199
The Transformation of Modern Japan: Politics and
Culture and Society in the Soviet Bloc 200 Government 232
Cultural Expression 200 The Economy 234
Social Changes in Eastern Europe 202 A Society in Transition 236
Women in the Soviet Bloc 202 Religion and Culture 239
The Japanese Difference 239
The Disintegration of the Soviet Empire 203
The Gorbachev Era 203 Taiwan: The Other China 239
Eastern Europe: From Soviet Satellites to Sovereign Taiwan Under Nationalist Rule 240
Nations 203 Crafting a Taiwanese Identity 241
End of Empire 204
South Korea: A Peninsula Divided 242
The New Russia: From Empire to Nation 205
The Korean Model 242
Conclusion 208
South Korea: The Little Tiger with Sharp Teeth 243
Chapter Notes 209
Singapore and Hong Kong: The Littlest Tigers 243
10 PU OSTWAR EUROPE:
NITY? 210
ON THE PATH TO On the Margins of Asia: Postwar Australia and
New Zealand 245
Conclusion 246
Western Europe: Recovery and Renewal 210 Chapter Notes 247
The Triumph of Democracy in Postwar Europe 211 Reflections Part III 248
The Modern Welfare State: Three European

Models 211
France 211 PART IV THIRD WORLD RISING 251
Germany: Across the Cold War Divide 214
Great Britain 215 12 TC HE EAST IS
OMMUNISM
RED: CHINA UNDER
252
THE LIVES OF OTHERS (2006) 216
The Fall of the Iron Curtain 219 China Under Mao Zedong 252
New Democracy 252
Western Europe: The Search for Unity 221 The Transition to Socialism 253
The Curtain Rises: The Creation of the Common The Great Proletarian Cultural Revolution 255
Market 222
FILM & HIST O RY
The European Union 222 THE LAST EMPEROR (1987) 256
Plans for Expansion: A Bridge Too Far? 222
Beware of Greeks Seeking Gifts 224 From Mao to Deng 257
The Four Modernizations 257
Aspects of Society in Postwar Europe 224 Incident at Tiananmen Square 258
An Age of Affluence 225 Back to Confucius? 258
A Transvaluation of Values 226 O P P O S I N G V I E W P O IN T S
Expanding Roles for Women 226 STUDENTS APPEAL FOR DEMOCRACY 259
The Environment 227
Serve the People: Chinese Society Under
Aspects of Culture in Postwar Europe 228 Communism 261
Postwar Literature 228 The Politics of the Mass Line 261
Music and the Arts 229 Economics in Command 262
Conclusion 230 Evaluating the Four Modernizations 264
Chapter Note 230 Chinese Society in Flux 265
x DETAILED CONTENTS
China’s Changing Culture 268 Urban and Rural Life 302
Culture in a Revolutionary Era 268 African Women 302
Art and Architecture 268 African Culture 303
Literature 269 O P P O S I N G V I E W P O IN T S
Conclusion 269 AFRICA: DARK CONTINENT OR RADIANT LAND? 305
Chapter Notes 270 Conclusion 306
Chapter Notes 307
13 N I ATIONALISM TRIUMPHANT: THE EMERGENCE

OF NDEPENDENT STATES IN SOUTH AND 15 F ERMENT IN THE MIDDLE EAST 308
SOUTHEAST ASIA 271 Crescent of Conflict 308
South Asia 271 The Question of Palestine 309
The End of the British Raj 272 Nasser and Pan-Arabism 309
Independent India 272 The Arab-Israeli Dispute 311
O P P O S I N G V IE WP O I N T S Revolution in Iran 313
TWO VISIONS FOR INDIA 273 FILM & HIST O RY
The Land of the Pure: Pakistan Since PERSEPOLIS (2007) 315
Independence 275 Crisis in the Persian Gulf 315
Poverty and Pluralism in South Asia 276 Revolution in the Middle East 317
South Asian Art and Literature Since Society and Culture in the Contemporary Middle
Independence 280
East 319
What Is the Future of India? 280
Varieties of Government: The Politics of Islam 319
Southeast Asia 281 The Economics of the Middle East: Oil and Sand 320
The End of the Colonial Era 282 The Islamic Revival 322
In the Shadow of the Cold War 282 Women in the Middle East 323
On the Road to Political Reform 284 Literature and Art 324
F IL M & H I S T O R Y Conclusion 325
THE YEAR OF LIVING DANGEROUSLY (1983) 285 Chapter Notes 326
Regional Conflict and Cooperation: The Rise of
Reflections Part IV 327
ASEAN 287
Daily Life: Town and Country in Contemporary
Southeast Asia 288
Cultural Trends 289
Conclusion 290
PART V THE NEW MILLENNIUM 329
Chapter Notes 290
16 TM HE CHALLENGE OF A NEW
ILLENNIUM 330
14 E MERGING AFRICA 291
After the Cold War: The End of History? 331
Uhuru: The Struggle for Independence in Contemporary Capitalism and Its Discontents 331
Africa 291 Europe: Speed Bumps on the Road to Unity? 331
The Colonial Legacy 292
The United States: Capitalism Ascendant? 331
The Rise of Nationalism 292
Asian Miracle or Asian Myth? 332
The Era of Independence 294 Eliminating World Poverty 332
The Destiny of Africa: Unity or Diversity? 294 From the Industrial to the Technological
Dream and Reality: Political and Economic Conditions in Revolution 333
Independent Africa 294
A Transvaluation of Values 334
The Search for Solutions 296
The Family 334
Africa: A Continent in Flux 300
Religion 334
Continuity and Change in Modern African Societies 301 Technology and Society 335
Education 301 The Impact of Capitalism 336
DETAILED CONTENTS xi
One World, One Environment 336 The Arts: Mirror of the Age 341
Facing the Issue of Global Warming 337 Chapter Notes 342
The Population Debate 338
GLOSSARY 343
Global Village or Clash of Civilizations? 338
The Future of Liberal Democracy 339 INDEX 348
Civilizations at War 339
Globalization: The Pros and the Cons 340
xii DETAILED CONTENTS
DOCUMENTS
C H A P T E R 1 C H A P T E R 9
DISCIPLINE IN THE NEW FACTORIES 8 KHRUSHCHEV DENOUNCES STALIN 194
ESCAPING THE DOLL’S HOUSE 10 THE RIGHTS AND DUTIES OF SOVIET
THE CLASSLESS SOCIETY 18 CITIZENS 196
THE THEORY OF EVOLUTION 21 THE BREZHNEV DOCTRINE 200
C H A P T E R 2 C H A P T E R 1 0
INDIAN IN BLOOD, ENGLISH IN TASTE AND THE TRABI LIVES! 217

INTELLECT 32 MARGARET THATCHER: ENTERING A
TRAGEDY AT CAFFARD COVE 38 MAN’S WORLD 218
TOWARD A UNITED EUROPE 223
C H A P T E R 3
AN APPEAL FOR CHANGE IN CHINA 52 C H A P T E R 1 1
PROGRAM FOR A NEW CHINA 56 GROWING UP IN JAPAN 238

RETURN TO THE MOTHERLAND 246
C H A P T E R 4
C H A P T E R 1 2
ALL POWER TO THE SOVIETS! 83
LAND REFORM IN ACTION 254
C H A P T E R 5 LOVE AND MARRIAGE IN CHINA 266
THE DILEMMA OF THE INTELLECTUAL 97

A CALL FOR REVOLT 111 C H A P T E R 1 3
SAY NO TO MCDONALD’S AND KFC! 278
C H A P T E R 6 THE GOLDEN THROAT OF PRESIDENT
SUKARNO 284
JAPAN’S PLAN FOR ASIA 136
C H A P T E R 1 4
C H A P T E R 7
STEALING THE NATION’S RICHES 295
THE TRUMAN DOCTRINE 151
MEETING THE CHALLENGES OF
A PLEA FOR PEACEFUL COEXISTENCE 162 INDEPENDENCE 298
C H A P T E R 8 C H A P T E R 1 5
“I HAVE A DREAM” 172 THE ARAB CASE FOR PALESTINE 310
I ACCUSE! 318
ISLAM AND DEMOCRACY 321
xiii
MAPS
MAP 1.1 The Industrial Regions of Europe at the End MAP 11.1 Modern Japan 233
of the Nineteenth Century 4 SPOT MAP Modern Taiwan 239
MAP 1.2 Europe in 1871 12 SPOT MAP The Korean Peninsula Since 1953 242
MAP 2.1 India Under British Rule, 1805–1931 31 SPOT MAP The Republic of Singapore 244
MAP 2.2 Colonial Southeast Asia 34 SPOT MAP Hong Kong 245
SPOT MAP The Spread of Islam in Africa 37 MAP 12.1 The People’s Republic of China 260
SPOT MAP The Suez Canal 39 MAP 13.1 Contemporary South Asia 274
MAP 2.3 Africa in 1914 41 MAP 13.2 Contemporary Southeast Asia 283
MAP 2.4 The Struggle for Southern Africa 42 MAP 14.1 Contemporary Africa 293
MAP 3.1 The Qing Empire 48 MAP 15.1 Israel and Its Neighbors 312
SPOT MAP Area Under Taiping Rebellion Control 51 SPOT MAP Iran 313
MAP 3.2 Foreign Possessions and Spheres of Influence MAP 15.2 The Modern Middle East 316
About 1900 54 SPOT MAP Afghanistan 317
MAP 3.3 Japanese Overseas Expansion During the SPOT MAP Iraq 317
Meiji Era 62
MAP 4.1 Europe in 1914 71
MAP 4.2 World War I, 1914–1918 74
MAP 4.3 Territorial Changes in Europe and the Middle
East After World War I 81
SPOT MAP British India Between the Wars 98
SPOT MAP The Middle East in 1923 101
MAP 5.1 The Northern Expedition and the Long
March 110
MAP 5.2 Latin America in the First Half of the
Twentieth Century 117
SPOT MAP Central Europe in 1939 127
SPOT MAP Japanese Advances into China, 1931–1939 129
MAP 6.1 World War II in Europe and North Africa 132
MAP 6.2 World War II in Asia and the Pacific 135
SPOT MAP Eastern Europe in 1948 149
MAP 7.1 The New European Alliance Systems During
the Cold War 153
MAP 7.2 The Chinese Civil War 155
SPOT MAP The Korean Peninsula 157
SPOT MAP Indochina After 1954 158
MAP 7.3 The Global Cold War 159
SPOT MAP South America 181
MAP 9.1 The Soviet Union 191
MAP 9.2 Eastern Europe and the Former
Soviet Union 205
MAP 10.1 Territorial Changes in Europe After
World War II 212
MAP 10.2 European Union, 2013 220
xiv
FEATURES
FILM & HISTORY

Khartoum (1966) 40
Lawrence of Arabia (1962) 78
Gandhi (1982) 100
Letters from Iwo Jima (2006) 141
The Missiles of October (1973) 161
The Lives of Others (2006) 216
The Last Emperor (1987) 256
The Year of Living Dangerously (1983) 285
Persepolis (2007) 315
OPPOSING VIEWPOINTS
White Man’s Burden, Black Man’s Sorrow 29
Two Views of the World 63
“You Have to Bear the Responsibility for War or Peace” 73
The Excitement and the Reality of War 76
Islam in the Modern World: Two Views 104
The Munich Conference 128
Confrontation in Southeast Asia 163
Students Appeal for Democracy 259
Two Visions for India 273
Africa: Dark Continent or Radiant Land? 305
xv
PREFACE
T HE TW E N TI E T H CEN TU R Y was an era of paradox. Any author who seeks to encompass in a single vol-
When it began, Western civilization was an emerging ume the history of our turbulent times faces some impor-
powerhouse that bestrode the world like a colossus. Inter- tant choices. First, should the book be arranged in strict
nally, however, the continent of Europe was a patchwork chronological order, or should separate chapters focus on
of squabbling states that within a period of less than three individual cultures and societies in order to place greater
decades engaged in two bitter internecine wars that threat- emphasis on the course of events taking place in different
ened to obliterate two centuries of human progress. As the regions of the world? In this book, I have sought to
century came to an end, the Western world had become achieve a balance between a global and a regional
prosperous and increasingly united, yet there were clear approach. I accept the commonplace observation that the
signs that global economic and political hegemony was be- world we live in is increasingly interdependent in terms
ginning to shift to the East. In the minds of many observ- of economics as well as culture and communications. Yet
ers, the era of Western dominance had come to a close. the inescapable reality is that this process of globalization
In other ways as well, the twentieth century was is at best a work in progress, as ethnic, religious, and re-
marked by countervailing trends. While parts of the world gional differences continue to proliferate and to shape the
experienced rapid industrial growth and increasing eco- course of our times. To many observers around the
nomic prosperity, other regions were still mired in abject world, the oft-predicted inevitable victory of the demo-
poverty. The century’s final decades were characterized cratic capitalist way of life is by no means a preordained
by a growing awareness of not only global interdepen- vision of the future of the human experience. In fact, in-
dence, but also burgeoning ethnic and national conscious- fluential figures in many countries, from China to Russia
ness; the period witnessed both the rising power of and the Middle East, emphatically deny that the forces of
science and fervent religiosity and growing doubts about globalization will inevitably lead to the worldwide adop-
the impact of technology on the human experience. As tion of the Western model.
the closing chapters of this book indicate, these trends This issue has practical observations as well. College
have continued and even intensified in the decade that has students today are often not well informed about the dis-
ensued since the advent of the new millennium. tinctive character of civilizations such as China, India, and
Contemporary World History (formerly titled Twentieth- sub-Saharan Africa. Without sufficient exposure to the his-
Century World History) attempts to chronicle the key torical evolution of such societies, students will assume all
events in this revolutionary century and its aftermath too readily that the peoples in these countries have had
while seeking to throw light on some of the underlying historical experiences similar to their own and react to
issues that shaped the times. Did the beginning of a new various stimuli in a fashion similar to those living in west-
millennium indeed mark the end of the long period of ern Europe or the United States. If it is a mistake to
Western dominance? If so, will recent decades of Euro- ignore the forces that link us together, it is equally errone-
pean and American superiority be followed by a “Pacific ous to underestimate the factors that divide us.
century,” with economic and political power shifting to Balancing the global and regional perspectives means
the nations of eastern Asia? Will the end of the Cold War that some chapters focus on issues that have a global
eventually lead to a “new world order” marked by global impact, such as the Industrial Revolution, the era of impe-
cooperation, or are we now entering an unstable era of rialism, and the two world wars. Others center on individ-
ethnic and national conflict? Why has a time of unparal- ual regions of the world, while singling out contrasts and
leled prosperity and technological advance been accompa- comparisons that link them to the broader world commu-
nied by deep pockets of poverty and widespread doubts nity. The book is divided into five parts. The first four
about the role of government and the capabilities of parts are each followed by a short section labeled
human reason? Although this book does not promise final “Reflections,” which attempts to link events in a broad
answers to such questions, it seeks to provide a frame- comparative and global framework. The chapter in the
work for analysis and a better understanding of some of fifth and final part examines some of the common prob-
the salient issues of modern times. lems of our time—including environmental pollution, the
xvi
population explosion, and spiritual malaise—and takes a
cautious look into the future to explore how such issues
Instructor Resources
will evolve in the twenty-first century. Online PowerLecture with CogneroV R [ISBN:
Another issue that has recently attracted widespread 9781285458212] This PowerLecture is an all-in-one
discussion and debate among historians is how to balance online multimedia resource for class preparation, presenta-
the treatment of Western civilization with other parts of tion, and testing. It is accessible through Cengage.com/
the world. The modern world has traditionally been login with your faculty account. There you will find avail-
viewed essentially as the history of Europe and the United able for download: book-specific MicrosoftV R PowerPointV R
States, with other regions treated as mere appendages of presentations; a Test Bank in both MicrosoftV R WordV R and
the industrial countries. It is certainly true that much of CogneroV R formats; an Instructor’s Manual; MicrosoftV R
the twentieth century was dominated by events that were PowerPointV R Image Slides; and a JPEG Image Library.
initiated in Europe and North America, and in recognition The Test Bank, offered in MicrosoftV R WordV R and
of this fact, the opening chapters in this book focus on the CogneroV R formats, contains multiple-choice and essay
Industrial Revolution and the age of imperialism, both questions for each chapter. CogneroV R is a flexible online
issues related to the rise of the West in the modern world. system that allows you to author, edit, and manage test
In recent decades, however, other parts of the world have bank content for Contemporary World History, 6e. Create
assumed greater importance, thus restoring a global multiple test versions instantly and deliver through your
balance that had existed prior to the scientific and techno- LMS from your classroom, or wherever you may be, with
logical revolution that transformed the West in the eigh- no special installs or downloads required.
teenth and nineteenth centuries. Later chapters examine The Instructor’s Manual contains the following for
this phenomenon in more detail, according to regions each chapter: an outline, discussion questions, learning
such as Africa, Asia, and Latin America the importance objectives, lecture launching suggestions, suggested stu-
that they merit today. dent projects, essay topics, and Web resources.
In sum, this sixth edition of Contemporary World History The MicrosoftV R PowerPointV R presentations are ready-
seeks to present a balanced treatment of the most impor- to-use, visual outlines of each chapter. These presenta-
tant political, economic, social, and cultural events of the tions are easily customized for your lectures and offered
modern era within an integrated and chronologically or- along with chapter-specific MicrosoftV R PowerPointV R
dered synthesis. In my judgment, a strong narrative, link- Image Slides and JPEG Image Libraries. Access your
ing key issues in a broad interpretive framework, is still Online PowerLecture at www.cengage.com/login.
the most effective way to present the story of the past to Companion Site [ISBN: 9781285458229] This web-
young minds. site for instructors features all of the free student assets,
To supplement the text, I have included a number of plus an Instructor’s Resource Manual (instructional objec-
boxed documents that illustrate key issues within each tives, chapter outlines, discussion questions, suggested lec-
chapter. A new feature, Opposing Viewpoints, presents a ture topics, suggested paper topics, and related Internet
comparison of two or more primary sources to facilitate stu- resources) and PowerPointV R presentations (lecture out-
dent analysis of historical documents, including examples lines, images, and maps).
such as “Islam in the Modern World: Two Views” (Chapter
5), “Two Visions for India” (Chapter 13), and “Africa: Dark CourseReader CourseReader is an online collection of
Continent or Radiant Land?” (Chapter 14). Film & History primary and secondary sources that lets you create a cus-
features present a brief analysis of the plot as well as the his- tomized electronic reader in minutes. With an easy-to-use
torical significance, value, and accuracy of nine films, includ- interface and assessment tool, you can choose exactly what
ing such movies as Khartoum (1966), Gandhi (1982), The Last your students will be assigned—simply search or browse
Emperor (1987), The Lives of Others (2006), and Persepolis Cengage Learning’s extensive document database to pre-
(2007). Extensive maps and illustrations, each positioned at view and select your customized collection of readings. In
the appropriate place in the chapter, serve to deepen the addition to print sources of all types (letters, diary entries,
reader’s understanding of the text. “Spot maps” provide speeches, newspaper accounts, etc.), the collection includes
details not visible in the larger maps. Suggested Readings, a growing number of images and video and audio clips.
now available on the companion website, review the most Each primary source document includes a descriptive
recent literature on each period while referring also to some headnote that puts the reading into context and is further
of the older “classic” works in the field. supported by both critical thinking and multiple-choice
The following supplements are available to accompany questions designed to reinforce key points. For more in-
this text. formation visit www.cengage.com/coursereader.
PREFACE xvii
Cengagebrain.com Save your students time and Writing for College History, 1e [ISBN:
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xviii PREFACE
Cengage Learning representative to explore custom solu- provided useful illustrations, while Dale and Jan Peterson
tions for your course. have been stimulating travel companions and a steady
source of useful books and news items. I have also bene-
fited from Nan Johnson’s broad understanding of the
Acknowledgments growth of the women’s movement in the United States.
I would like to express my appreciation to the reviewers To Clark Baxter, whose unfailing good humor, patience,
who have read individual chapters and provided useful and sage advice have so often eased the trauma of text-
suggestions for improvement on this edition: Marjorie book publishing, I offer my heartfelt thanks. I am also
Berman, Red Rocks Community College; Elizabeth Clark, grateful to Brooke Barbier, product manager, Margaret
West Texas A&M University; Margaret B. Denning, Slip- McAndrew Beasley, senior development editor, and Jane
pery Rock University; Hayley Froysland, Indiana Univer- Lee, senior content project manager, for their assistance in
sity, South Bend; Irwin Halfond, McKendree University; bringing this project to fruition, and to John Orr of Orr
Eduardo Magalhaes, Simpson College; and Jeffrey Martin- Book Services, Chris Schoedel of Cenveo Publisher Ser-
son, Meredith College. vices, and Pat Lewis, copyeditor, for production services.
Jackson Spielvogel, coauthor of our textbook World His- Finally, I am eternally grateful to my wife, Yvonne V.
tory, was kind enough to permit me to use some of his sec- Duiker, Ph.D. Her research and her written contributions
tions in that book for the purposes of writing this one. on art, architecture, literature, and music have added spar-
Several of my other colleagues at Penn State—including kle to this book. Her presence at my side has added
Kumkum Chatterjee, E-tu Zen Sun, On-cho Ng, and immeasurable sparkle to my life.
Arthur F. Goldschmidt—have provided me with valuable
William J. Duiker
assistance in understanding parts of the world that are
The Pennsylvania State University
beyond my own area of concentration. Ian Bell, Carol Cof-
fin, Ruth Petzold, and my daughter Claire L. Duiker have
PREFACE xix
P A R T
I
New World in the Making
Everett Collection
The Crystal Palace in London
1
C H A P T E R
Hulton Archive/Getty Images

The Rise of
Industrial Society Sheffield became one of England’s greatest manufacturing cities during the
in the West nineteenth century.
THE T WENT IETH CENT URY was a turbulent era, “appendage of the machine,” and the English novelist
marked by two violent global conflicts, a bitter ideological Charles Dickens wrote about an urban environment of
struggle between two dominant world powers, explosive factories, smoke, and ashes that seemed an apparition from
developments in the realm of science, and dramatic social Dante’s Hell.
change. When the century began, the vast majority of the
world’s peoples lived on farms, and the horse was still the most
common means of transportation. By its end, human beings CRITICAL THINKING
had trod on the moon and lived in a world increasingly defined
by urban sprawl and modern technology. Q What factors appear to explain why Great
Britain was the first nation to enter the
What had happened to bring about these momentous industrial age?
changes? Although a world as complex as ours cannot be
assigned a single cause, a good candidate for consideration is
the Industrial Revolution, which began on the British Isles at
the end of the eighteenth century and spread steadily The Industrial Revolution
throughout the world during the next two hundred years.
The Industrial Revolution was unquestionably one of the
in Great Britain
most important factors in laying the foundation of the Why the Industrial Revolution occurred first in Great Brit-
modern world. It not only transformed the economic means ain rather than in another part of the world has been a
of production and distribution, but also altered the political subject for debate among historians for many decades.
systems, the social institutions and values, and the Some observers point to cultural factors, such as the Prot-
intellectual and cultural life of all the societies that it estant “work ethic” that predisposed British citizens to risk
touched. The impact has been both massive and taking and the belief that material rewards in this world
controversial. While proponents have stressed the enormous were a sign of heavenly salvation to come.
material and technological benefits that industrialization has Others point out more tangible factors that contributed
brought, critics have pointed out the high costs involved, to the rapid transformation of eighteenth-century British
from growing economic inequality and environmental society from a predominantly agricultural to an industrial
pollution to the dehumanization of everyday life. Already in and commercial economy. First, improvements in agricul-
the nineteenth century, the German philosopher Karl Marx ture during the eighteenth century had led to a significant
charged that factory labor had reduced workers to a mere increase in food production. British agriculture could now
feed more people at lower prices with less labor; even
ordinary British families no longer had to use most of
their income to buy food, giving them the potential to
The Spread of the Industrial
purchase manufactured goods. At the same time, a rapidly Revolution
growing population in the second half of the eighteenth
By the turn of the nineteenth century, industrialization had
century provided a pool of surplus labor for the new fac-
begun to spread to the continent of Europe, where it took a
tories of the emerging British industrial sector.
different path than had been followed in Great Britain (see
Another factor that played a role in promoting the
Map 1.1). Governments on the Continent were accustomed
Industrial Revolution in Great Britain was the rapid
to playing a major role in economic affairs and continued to
increase in national wealth. Two centuries of expanding
do so as the Industrial Revolution got under way, subsidiz-
trade had provided Britain with a ready supply of capital
ing inventors, providing incentives to factory owners, and
for investment in the new industrial machines and the fac-
improving the transportation network. By 1850, a network
tories that were required to house them. As the historian mile Zola as
of iron rails (described by the French novelist E
Kenneth Pomeranz has recently pointed out, it was the
a “monstrous great steel skeleton”) had spread across much of
country’s access to cheap materials from other parts of the
western and central Europe, while water routes were
world—notably from Asia and the Americas—that pro-
improved by the deepening and widening of rivers and canals.
vided the assets that fueled Britain’s entrance into the
Across the Atlantic Ocean, the United States experienced
industrial age (see Chapter 2).1
the first stages of its industrial revolution in the first half of
In addition to profits from trade, Britain possessed an
effective central bank and well-developed, flexible credit the nineteenth century. In 1800, America was still a pre-
facilities. Many early factory owners were merchants and dominantly agrarian society, as six out of every seven work-
entrepreneurs who had profited from the eighteenth- ers were farmers. Sixty years later, only half of all workers
century cottage industry. The country also possessed were farmers, while the total population had grown from
what might today be described as a “modernization 5 to 30 million people, larger than Great Britain itself.
elite”—individuals who were interested in making profits The initial application of machinery to production was
if the opportunity presented itself. In that objective, they accomplished by borrowing from Great Britain. Soon,
were generally supported by the government. however, Americans began to equal or surpass British tech-
Moreover, Britain was richly supplied with important nical achievements. The Harpers Ferry arsenal, for exam-
mineral resources, such as coal and iron ore, needed in ple, built muskets with interchangeable parts. Because all
the manufacturing process. Britain was also a small coun- the individual parts of a musket were identical (for exam-
try and the relatively short distances made transportation ple, all triggers were the same), the final product could be
facilities readily accessible. In addition to nature’s provi- put together quickly and easily; this innovation enabled
sion of abundant rivers, from the mid-seventeenth century Americans to avoid the more costly system in which skilled
onward, both private and public investment poured into craftsmen fitted together individual parts made separately.
the construction of new roads, bridges, and canals. By The so-called American system reduced costs and revolu-
1780, roads, rivers, and canals linked the major industrial tionized production by saving labor, an important consid-
centers of the north, the Midlands, London, and the Atlan- eration in a society that had few skilled artisans.
tic coast. Unlike Britain, the United States was a large country,
During the last decades of the eighteenth century, tech- and the lack of a good system of internal transportation ini-
nological innovations, including the flying shuttle, the spin- tially seemed to limit American economic development by
ning jenny, and the power loom, led to a significant increase making the transport of goods prohibitively expensive. This
in textile production. The cotton textile industry—fueled by difficulty was gradually remedied, however. Thousands of
the import of cheap cotton fibers from Britain’s growing miles of roads and canals were built linking east and west.
empire in South Asia—achieved even greater heights of pro- The steamboat facilitated transportation on rivers and the
ductivity with the invention of the steam engine, which Great Lakes and in Atlantic coastal waters. Most important
proved invaluable to Britain’s Industrial Revolution. The of all in the development of an American transportation
steam engine was a tireless source of power and depended system was the railroad. Beginning with 100 miles in 1830,
for fuel on a substance—namely, coal—that seemed then to more than 27,000 miles of railroad track were laid in the
be available in unlimited quantities. The success of the next thirty years. This transportation revolution turned the
steam engine increased the demand for coal and led to an United States into a single massive market for the manufac-
expansion in coal production. In turn, new processes using tured goods of the Northeast, the early center of American
coal furthered the development of an iron industry, the pro- industrialization, and by 1860, the United States was well
duction of machinery, and the invention of the railroad. on its way to being an industrial nation.
The Spread of the Industrial Revolution 3
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circulation feeble, the respiration shallow and occasionally
interrupted by long-drawn sighs, the pupils are as a rule contracted,
constipation is present, often alternating with diarrhœa. When to
these conditions, for which no cause can be found upon careful
examination, there are added marked change in disposition, periods
of unaccountable dulness and apathy alternating with unusual
vivacity and brightness, especially when insomnia alternates with
periods of prolonged and heavy sleep, the abuse of morphia may be
suspected. If the hypodermic syringe be used the wounds made by
the needle confirm the diagnosis. These punctures are usually found
in groups upon the thighs, legs, arms, and abdomen. Close inquiry
into the habits of the patient, who either goes himself or sends at
short intervals for unusual quantities of opium or morphia to some
neighboring apothecary, is sometimes necessary to confirm the
diagnosis. Finally, the presence of morphine in the urine10 renders
the diagnosis positive, notwithstanding the most vehement
assertions of the patient as regards his innocence of the habit and
the extreme cunning with which it is concealed.
10 “According to Bouchardat, morphine, when taken in the free state or under the form
of opium, speedily appears in the urine, and may be detected by the liquid yielding a
reddish-brown precipitate with a solution of iodine in iodide of potassium. Since,
however, as we have already seen, this reagent also produces similar precipitates
with most of the other alkalies and with certain other organic substances, this reaction
in itself could by no means be regarded as direct proof of the presence of the alkaloid.
Moreover, we find that the reagent not unfrequently throws down a precipitate from
what may be regarded as normal urine, while, on the other hand, it sometimes fails to
produce a precipitate even when comparatively large quantities of the alkaloid have
been purposely added to the liquid” (Wormley, Micro-chemistry of Poisons).
The presence of meconic acid or morphine in the urine can only be positively
determined by elaborate chemical analysis. In cases of doubt the urine should be
submitted to a competent analyst. To make sure that opium or its derivatives are not
being taken, the feces must also be examined.
PROGNOSIS.—The prognosis is favorable as regards the

discontinuance of the habit for a time, doubtful as regards a
permanent cure. Relapses are apt to occur. They are more common
in men than in women, in the aged than in middle life, and in persons
of feeble physical and mental organization than in those who are
possessed of bodily and mental vigor. Relapses also occur more
frequently in those individuals addicted to alcohol, and in those who
are habitually subjected to temptation by reason of their avocation,
such as doctors, nurses, and apothecaries, than in others. The
danger of relapse is greater where the habit has been formed in
consequence of chronic painful affections than where it has been
rapidly developed in the course of acute illnesses. Of 82 men treated
by Levinstein, relapses occurred in 61; of 28 women, in 10; of 38
physicians, in 26. The danger of relapse diminishes with the lapse of
time; nevertheless, a single dose of morphine or a hypodermic
injection may, after an abstinence of months, precipitate a relapse.
Indeed, the return of the habit is in the majority of instances caused
by the thoughtlessness of medical men in prescribing in these cases
opiates for maladies which are often in themselves insignificant.
Chloral Hydrate.
The prediction made by B. W. Richardson, within two years of

Liebreich's announcement of the medicinal properties of chloral, that
its abuse would become widespread, has been abundantly fulfilled.
The consumption of this substance as a narcotic has reached an
extent in certain classes of society which raises it, after alcohol and
opium, to the third place among such agents.
SYNONYMS.—The Chloral habit, Chloralism.
ETIOLOGY.—A. Predisposing Influences.—Age exerts but little

predisposing influence. Cases occur almost exclusively in adults,
and the greater proportion of these are in middle life. The abuse of
chloral is relatively somewhat more common among males than
among females. Individuals addicted to this habit usually belong to
the refined and educated classes of society; the fascinations of
chloral remain thus far unknown to the great mass of the people.
Professional men and those engaged in literary work form a very
considerable proportion of the cases. Chloral is occasionally used by
hospital nurses, and very frequently by prostitutes. Chronic
alcoholism is an important predisposing element in the formation of
the chloral habit; in fact, morbid conditions attended by insomnia
from whatever cause tend to the formation of this habit.
B. The Exciting Cause.—Chloral is a powerful hypnotic, usually

without unpleasant after-effects. In full doses it is a depressant to the
nerve-centres at the base of the brain and to the spinal cord. It
enfeebles the action of the heart, depresses respiration, and lessens
reflex activity. It has no action on the secretions except that of the
kidneys, which it frequently augments.
The habit has in some few instances been developed in

consequence of the indulgence in a morbid desire to experience the
effects of the drug. In a majority of instances it is due to the
continuance of the medicine indefinitely after the sickness in which it
was originally prescribed has ceased. I have known apothecaries to
renew prescriptions of chloral often enough to supply a daily dose of
from forty to sixty grains for years—in one instance for more than
four years.
The dose taken by victims of the chloral habit varies greatly. Thirty or
forty grains daily is a moderate amount. Not rarely this quantity is
repeated twice or oftener within the space of twenty-four hours. The
tolerance after a time exhibited by the organism for enormous doses
of alcohol and opium is not established, as a rule, in regard to
chloral. The victim of the latter after a little time discovers the
average dose required to produce narcotic effects, and, while he
may vary it within limits, he is liable to acute toxic effects if it be
greatly exceeded. Death from such excesses is not uncommon.
SYMPTOMATOLOGY.—I. Symptoms Due to Habitual Excesses.—The

habitual use of chloral, notwithstanding its ruinous consequences in
a certain proportion of the cases, is less dangerous than that of
opium or morphine. Many individuals take chloral in considerable
doses for years without obvious ill effect. The craving for it is much
less intense than that for opium or morphine, and is readily satisfied
by other drugs. In point of fact, persons addicted to chloral very
frequently exchange it for other narcotics. For these reasons the
chloral habit is more easily cured.
Derangements of the digestive system are common, but by no

means constant. They are (1) primary, and due to the direct irritant
action of the drug upon the mucous tissues of the month and
stomach; and (2) secondary, due to its effects upon the nervous
system and the circulation. Irritation of the mucous membranes is
very common. This not rarely amounts to gastro-duodenal catarrh
with its characteristic symptoms. Jaundice is common, sometimes
intense. A sense of fulness with pain and tenderness in the hepatic
region is frequent. Constipation, with clay-colored stools, is the rule.
It occasionally alternates with diarrhœa. The tongue is often coated
and the breath foul. On the other hand, in a fair proportion of the
cases the digestive organs are not affected. Chloral has been said to
occasionally exert even a favorable influence upon appetite and
digestion when taken before meals. The recent observations of
Fiumi and Favrat11 in a man suffering from a gastric fistula and
insomnia have shown that chloral hydrate in twenty- or forty-grain
doses, administered before or at the beginning of a meal, retarded
digestion by increasing the secretion of mucus in the stomach. The
acidity of the gastric juice is diminished temporarily. The secretion of
pepsin is not changed. Taken two hours after meals, doses not
exceeding forty grains caused no derangement of gastric digestion.
11 Archives Ital. de Bioloqie, vol. vi. No. 3.
Persons not habituated to chloral usually experience a sense of

constriction upon swallowing it, and a disagreeable after-taste.
The circulation is much affected. Chloral weakens, and finally

paralyzes, the vaso-motor centre, and thus dilates the vessels; it at
the same time weakens the action of the heart. Its habitual use is
attended by flushing of the face, congestion of the eyes, and fulness
of the head. The heart's action is weak, intermittent, irregular;
palpitation occurs; the pulse is full and compressible or small and
weak. It is usually slow.
The blood undergoes changes corresponding to the general

disturbances of nutrition. What the special changes in its
composition may be is not known. Many of the cases, even after the
prolonged use of the drug in considerable doses, show few
evidences of malnutrition or of anæmia. In the greater number,
however, wasting is marked, and the physical signs and rational
symptoms of profound anæmia are present. Deterioration in the
composition of the blood is further indicated by petechiæ,
hemorrhage from mucous surfaces, sponginess of the gums, and
serous effusions.
The respiration is not permanently affected, save in grave cases. It is

then slow, irregular, and shallow. Dyspnœa is common and easily
provoked. It is usually accompanied by cough and abundant frothy
expectoration. These symptoms vanish upon the discontinuance of
the drug. In a fatal case of chloral-poisoning seen by the writer, in
which the daily use of the narcotic in non-poisonous amounts had
been for a long time varied at intervals of five or six weeks by doses
sufficient to induce prolonged coma, death was preceded by
Cheyne-Stokes respiration. This patient was a retired dentist, and
kept the solution of chloral in a large unlabelled bottle. The actual
doses taken were not ascertained.
The muscular system shares in the general malnutrition. The

muscles become flabby and wasted. Persons addicted to chloral are
very frequently of nervous organization and sedentary habits, and
hence of poor muscular development prior to the use of the drug.
The kidneys show no constant derangement. In a certain proportion

of the cases chloral acts as a diuretic, largely increasing the urinary
excretion. Albumen is present in a certain proportion of the graver
cases, when it is apt to be associated with anæmia, serous
effusions, and a tendency to hemorrhages from mucous tracts. The
occurrence of casts and the persistence of albuminuria after the
discontinuance of chloral suggest an antecedent or coincidently
developed nephritis. The reducing substance present in the urine
after small doses of chloral is uro-chloralic acid (Mering and
Musulus). It gives the reaction of sugar with the copper and bismuth
tests, but is levogyrate. Glycosuria is occasionally encountered.
Vesical and urethral irritation occurs in a small proportion of the

cases. When these symptoms vanish upon the discontinuance of the
drug and recur upon its resumption, it may be fairly assumed that
they are due to its action. A great number of morbid phenomena
relating to the genito-urinary tract and to the urine, that have been
ascribed to the action of chloral in those addicted to its use, are due
to associated conditions rather than to the drug itself.
It has been claimed upon evidence that does not appear to the writer
adequate that chloral sometimes acts upon the sexual system as an
aphrodisiac, sometimes as the reverse. More or less complete
impairment of sexual power and appetite is the rule in individuals
addicted to great excesses in narcotics of all kinds. Menstruation is
not arrested by chloral as by morphine, nor does it necessarily cause
sterility in the female.
The skin undergoes nutritive disturbances of a marked kind. As a

result of individual peculiarity, single doses or medicinal doses
continued for brief periods of time have occasionally caused
erythematous, urticarious, papular, vesicular, and pustular eruptions.
Of these, the first named is of most frequent occurrence. The
habitual abuse of chloral causes in many individuals chronic
congestion of the face, neck, and ears. This redness is often very
striking. It is increased by the use of alcohol. Erythematous patches
upon the chest, in the neighborhood of the larger articulations, and
upon the backs of the hands and feet, also occasionally occur. They
are often associated with urticaria. General eruptions resembling
measles, scarlatina, and even mild variola, are said to have been
observed after large doses of chloral. Purpura is by no means rare in
old cases, and falling of the hair and atrophy and loss of the nails
occur.
The nervous system bears the blunt of the disturbance, and the
more significant symptoms relate directly to it.
The hypnotic effect is usually preserved. Hence the chloral habitué is

dull, apathetic, somnolent, disposed to neglect his ordinary duties
and affairs. He passes much of his time in a state of dreamy lethargy
or in deep and prolonged sleep, from which he awakes unrefreshed
and in pain. In one of my cases, however, even larger doses than
usual at length failed to induce more than fitful slumber, and the
insomnia which led to the formation of the habit finally reasserted
itself, reinforced by the unutterable miseries of chloralism.
Headache is a frequent symptom. It is usually general, sometimes

frontal, often referred to the top of the head. It is commonly severe,
not rarely agonizing, and is described as a pressure, weight, or a
constricting band. It is associated with injection of the eyes, flushing
of the face, confusion of thought, inability to converse intelligently or
to articulate distinctly, and other evidences of cerebral congestion.
Vertigo is common.
Sensory disturbances are frequently present. They consist in local

areas of hyperæsthesia, more frequently of anæsthesia, numbness
of the hands and fingers or of the feet, formication of the surface of
the body and limbs, and burning or neuralgic pains in the face, chest,
and extremities. The pains in the limbs are almost characteristic.
They are acute and persistent, neuralgic in character, but not
localized to particular nerve-tracts. They are more common in the
legs than in the arms, and occupy by preference the calves of the
legs and the flexor muscles between the elbows and the wrists. They
do not implicate the joints, are not aggravated to any grave extent by
movement, and are often temporarily relieved by gentle frictions. The
pains of chloralism have been described as like encircling bands
above the wrists and ankles.
Sensations of chilliness alternating with flashes of heat are

experienced. The temperature is, in the absence of complications,
normal. Excessive doses are followed by a reduction of one or more
degrees Fahrenheit, lasting several hours.
Among the motor disturbances are the following:
Tremor.—This symptom is not common. It is neither so pronounced

nor so distinctly rhythmical as that of alcoholism or the opium habit. It
is increased upon voluntary effort. It affects chiefly the hands and
arms and the tongue.
Palsy.—Loss of power in the lower extremities has been observed in

a number of instances. It varies in degree from paresis to complete
paraplegia. Its occurrence may be gradual or sudden. It passes
away upon the discontinuance of the habit. In many respects this
condition resembles alcoholic paraplegia.
Impairment of Co-ordinating Power.—Ataxic phenomena are

sometimes present. The patient has difficulty in walking in the dark,
cannot stand with his eyes closed, has trouble in buttoning his
clothes, and the like.
Impairment or Abolition of the Knee-jerk.—In a man aged fifty, who

had taken thirty to sixty grains of chloral hydrate at night for eighteen
months, the writer observed complete loss of the knee-jerk, which,
however, reappeared in the course of a few weeks after the
discontinuance of the drug.
In rare cases epileptiform seizures have occurred.
Chloral produces in certain individuals, even as the result of a single

dose, congestion and irritation of the conjunctiva. Apart from this
idiosyncrasy, its habitual use not infrequently causes conjunctivitis.
This affection is occasionally of a severe grade and accompanied by
œdema of the eyelids and great photophobia. Retinal congestion
has been noted by several observers. Amblyopia, disappearing upon
the cessation of the habit, has also been observed.
Psychical Derangements.—The mental and moral perversion caused

by immoderate chloral-taking shows itself rapidly. The transient
stimulating effects of the dose of opium or morphine in those
accustomed to these drugs are seen not at all or to a very slight
extent in chloralism. Hence the mental state is characterized by
dulness, apathy, confusion, and uncertainty. These conditions
alternate with periods of irritability and peevishness. The physical
sufferings of the chloral-taker in the daily intervals of abstinence are
greater than those of the morphine-taker; his mental depression less.
The one is tormented by the agony of pain, the other by the anguish
of craving. To the former repetition of the dose brings stupor and
sleep, to the latter exhilaration and activity. In certain respects,
however, the effects of these drugs upon the mind are similar. They
alike produce intellectual enfeeblement, inability to concentrate the
mind, habitual timidity, and impairment of memory. In the worse
cases of chloralism hallucinations, delusions, and delirium occur.
Acute mania may occur, and dementia constitutes a terminal state.
II. Symptoms Due to Abstinence from Chloral.—The symptoms

occasioned by the abrupt discontinuance of even large habitual
doses of chloral are not, as a rule, severe. In this respect the
difference between this drug and opium and its derivatives is very
marked. The chloral-taker not infrequently substitutes some other
narcotic, as alcohol or opium, for his usual doses without discomfort,
and in many instances voluntarily abstains from the drug, without
replacing it by others for periods of weeks or months.
The more important of the symptoms induced by sudden

discontinuance relate to the nervous system. Insomnia is usual. It is
not always readily controlled, and constitutes one of the principal
difficulties in the management of these cases. Headache is rarely
absent; it is in many cases accompanied by vertigo. Occipital
neuralgia frequently occurs, and is often severe. Neuralgias of the
fifth pair also occur. Darting pains in the limbs are usual, and the
fixed aching pains already described as peculiar to habitual chloral
excess are present, and often persist for a long time after the
withdrawal of the drug.
Irregular flushes of heat, nervousness, restlessness, inability to fix

the attention, formication, burning sensations in various regions of
the surface of the body, are unimportant but annoying symptoms.
In a considerable proportion of the cases delirium occurs. It is
commonly associated with tremor, great prostration, complete
insomnia, sweating, inability to take food, and vomiting, and
resembles in every particular the delirium tremens of alcoholic
subjects. In the absence of this condition gastric derangements are
not of a grave kind. The nausea, vomiting, epigastric pain, and
diarrhœa which are induced by the discontinuance of opium are
absent, or if present at all only to a slight degree. As a matter of fact,
the functions of the digestive system are in a very short time much
more perfectly performed than before. Hemorrhage from the
stomach, bowel, or urinary tract may also occur.
The conjunctivitis and cutaneous eruptions usually disappear with

promptness as soon as the influence of the habitual chloral excesses
passes away.
DIAGNOSIS.—The diagnosis of the chloral habit is attended with much

less difficulty than that of the morphine habit. In the first place, there
is general and often serious derangement of health without adequate
discoverable cause. The appetite is poor and capricious, the
digestion imperfect and slowly performed; jaundice of variable
intensity, often slight, sometimes severe, occurs in many cases; the
bowels are not, as a rule, constipated. Dyspnœa upon slight exertion
is, in the absence of pulmonary, cardiac, or renal cause, of
diagnostic importance. The circulation is, as a rule, feeble. Disorders
of the skin, persistent or easily provoked conjunctivitis, puffiness
about the eyelids, and a tendency to hemorrhage from mucous
surfaces also occur. When with these symptoms, irregularly grouped
as they are, we find a tendency to recurring attacks of cerebral
congestion, persistent or frequently recurring headaches, and the
characteristic pains in the legs, the abuse of chloral must be
suspected. This suspicion becomes the more probable if there be a
history of protracted painful illness or of prolonged insomnia in the
past. The adroitness of these patients in concealing their vice, and
the astonishing persistency with which they deny it, are remarkable.
In the absence of the characteristic association of pains,
conjunctivitis, and affections of the skin the diagnosis is attended
with considerable difficulty. It becomes probable from the association
of chronic ill-health, not otherwise explicable, with perversion of the
moral nature, enfeeblement of the will and of the intellectual forces. It
is rendered positive, notwithstanding the denials of the patient, by
the discovery of the drug or the prescription by means of which it is
procured.
PROGNOSIS.—If the confirmed chloral habitué be left to himself, the

prognosis, after excessive doses or the stage of periodical
debauches has been reached, is highly unfavorable. The condition of
mind and body alike is abject. There is danger of sudden death from
cerebral congestion or heart-failure—a mode of termination by no
means rare.
On the other hand, the prognosis under treatment may be said to be

favorable. The habit is much more readily broken up, and the danger
of relapse is far less, than in cases of confirmed opium or morphine
addiction. Nevertheless, the underlying vice of organization which
impels so many individuals to the abuse of narcotics precludes a
permanent cure in a certain proportion of the cases of chloralism.
Sooner or later relapse occurs—if not relapse to chloral, relapse to
opium, morphine, or alcohol, or into that wretched condition in which
any narcotic capable of producing excitement and stupor is taken in
excess as occasion permits.
Paraldehyde.
The use of this hypnotic is not unattended with danger. In a single

case afterward under the observation of the writer paraldehyde was
used in large and increasing doses for the sake of its narcotic
properties. The patient, a young married woman whose family
history was bad, her mother having died insane, contracted the
chloral habit after an acute illness. After some months a cure was
effected without great difficulty. She relapsed into chloralism after a
second sickness which was attended with distressing insomnia. The
habit was again broken up. In consequence of over-exertion in social
life during a winter of unusual gayety insomnia recurred. For the
relief of this condition paraldehyde was prescribed with success.
Notwithstanding its disagreeable and persistent ethereal odor, and
the precautions taken by the physician, this lady managed to secure
paraldehyde at first in small quantities, afterward in half-pound
bottles from a wholesale druggist, and took it in enormous amounts,
with the result of producing aggravated nervous and psychical
disturbances corresponding to those produced by chloral, but without
the disturbances of nutrition attendant upon the abuse of the latter
drug. The patient remained well nourished, retained her appetite and
digestion, and was free from disorders of the skin and the intense
neuralgia which had been present during both periods of chloral
abuse. She suffered, however, from a persistent binding headache,
disturbances of accommodation, phosphenes, and brow-pains.
Under the influence of moderate doses she was enabled to take part
in social life with some of her old interest and vivacity. The brief
intervals of abstinence which occasionally occurred were
characterized by distressing indifference to her friends and
surroundings and by apathy and depression. At frequently-recurring
intervals the indulgence in excessive doses, constituting actual
paraldehyde-debauches, was followed at first by maniacal
excitement of some hours' duration, later by profound comatose
sleep lasting from one to three days. Upon the complete withdrawal
of the drug this patient manifested the symptoms produced by
complete abstinence in the confirmed morphine habit—yawning,
anorexia, epigastric pains, vomiting, diarrhœa, absolute
sleeplessness, extending over several days, heart-failure, collapse,
colliquative sweating, and finally well-characterized delirium tremens.
At the end of a week, under the influence of repeated small doses of
codeine, sleep was secured, and within a month convalescence was
complete. This person now continues free from addiction to any
narcotic, in good health, and able to sleep fairly well, after the lapse
of several months since the complete discontinuance of
paraldehyde.
Cannabis Indica, Ether, Chloroform, and Cocaine.
These drugs are habitually used as narcotic stimulants by a limited

number of individuals. Cannabis indica, or Indian hemp, the
hashhish of the Arabians, is said to be largely used in India and
Egypt. It is occasionally taken by medical students and other youths
of an experimental turn of mind, but no case of habitual hashhish
addiction has come under the observation of the writer.
The use of ether as a narcotic stimulant is occasionally observed

among druggists, nurses, and other hospital attendants, but does not
give rise to clinical phenomena sufficiently marked or distinctive to
demand extended consideration in this article. The same remark
may be made of chloroform, which is also used in the same way to a
considerable extent among women suffering from neuralgia and
other painful or distressing affections of the nervous system. The fact
that individuals are every now and then found dead in bed with an
empty chloroform-bottle by their side serves to indicate the extreme
danger attending the vicious use of this substance.
Cocaine, within the short time that has elapsed since its introduction
into therapeutics, has unquestionably been largely abused, both
within the ranks of the profession and among the people. Highly
sensational accounts of the disastrous effects resulting from its
habitual use in excessive doses have appeared in the newspapers
and in certain of the medical journals. No case of this kind has fallen
under the observation of the writer, and it would appear premature to
formulate definite conclusions concerning the effects of cocaine
upon the data thus far available.
Treatment.
The treatment of the opium habit and kindred affections is a subject

which derives its importance from the following facts: First, the
gravity of the disease, as regards the functions both of the body and
of the mind; second, the enormous suffering and misfortune, alike on
the part of the patient himself and on the part of those interested in
him, which these affections entail; third, the fact that they are not
self-limited, and therefore cannot be treated with indifference or upon
the expectant plan, but are, on the other hand, progressive and
gradually destructive of all that makes life worth living, and at last of
life itself; and finally, because they are capable at the hands of skilful
and experienced physicians of a cure which in a considerable
proportion of the cases may be made permanent.
The treatment of these affections naturally arranges itself under two

headings: (a) the prophylactic, (b) the curative treatment.
a. Prophylaxis.—It is impossible to overrate the importance of a true

conception of the duty of practitioners of medicine in regard to the
prophylaxis of the opium habit and associated affections. In
communities constituted as are those in which the physicians
practise into whose hands this volume is likely to fall, a large—I may
say an enormous—proportion of the cases of habitual vicious
narcotism is due to the amiable weakness or thoughtlessness of
medical men. A majority of the cases occur either in chronic painful
affections attended or not by insomnia, or as a result of acute illness
in which narcotics have been employed to relieve pain or induce
sleep. The chronic affections constitute two classes: First, those
manifestly incurable, as visceral and external cancer, certain cases
of advanced phthisis, confirmed saccharine diabetes, and tabes
dorsalis. In such cases the use of morphine in large and often-
repeated doses, although attended with evils and likely to shorten
life, amounts to a positive boon. It is neither practicable, nor would it
be desirable, to interfere with it. To this class may be added those
cases of grave valvular or degenerative disease of the heart where
the patient has become addicted to the habitual use of narcotics.
Here, notwithstanding the evils resulting from these habits, among
which the likelihood of shortening the period of life must
unquestionably be counted, the dangers of the withdrawal of the
drug are so great that it must be looked upon as neither desirable
nor feasible. Attention must, at this point, be called to the fact that
great caution is required in the management of pregnant women
addicted to narcotics. Incautious attempts to withdraw the habitual
drug are almost certain to be followed by speedy loss of the fœtus;
and it is to my mind questionable whether anything more than the
most guarded reduction of the daily dose should be attempted while
the pregnancy continues.
The second class of chronic cases includes individuals suffering

from diseases which are remediable or capable of decided or
prolonged amelioration. Among these affections are painful diseases
curable by surgical procedures, such as certain obstinate and
intractable localized neuralgias, painful neuromas, irritable cicatrices,
pelvic and abdominal tumors, and surgical affections of the joints
and extremities. Here, either before or after radical surgical
treatment, an effort to relieve the patient from the bondage of
habitual narcotism should be made. For reasons that are obvious,
measures having this end in view should be instituted by preference
subsequently to surgical treatment. To this class also belong certain
painful affections occupying the border-region between surgery and
medicine. These are floating kidney, renal and hepatic abscess,
calculous pyelitis, cystitis, impacted gall-stones, and thoracic and
abdominal aneurism. In these cases the possibility of a cure renders
it in the highest degree desirable that the opium habit should be
stopped. Whether this attempt should be made while the patient is
under treatment for the original affection, or deferred until relief has
been obtained, is a question to be decided by the circumstances of
the particular case under consideration. Finally, we encounter a large
group of chronic painful affections coming properly under the care of
the physician in which the opium habit is frequently developed. This
group includes curable neuralgias of superficial nerves, as the
trigeminal, occipital, brachial, intercostal, crural, and sciatic, and
visceral neuralgias, as the pain of angina, gastralgia, enteralgia, and
the pelvic and reflex neuralgias of women. Here also are to be
mentioned the pains of neurasthenia, hypochondriasis, and hysteria.
In this group of affections the original disease constitutes no obstacle
to the attempt to break up the habit to which it has given rise.
The practice of using narcotics, especially the preparations of opium,
in large and increasing doses for the relief of frequently-recurring
pains, especially in neurotic individuals, is a dangerous one. When
necessary at all, the use of these drugs should be guarded with
every possible precaution. In the first place, in so far as is
practicable, the patient should be kept in ignorance of the character
of the anodyne used and of the dose. In the second place, the
physician should personally supervise and control, in so far as is
possible, the use of such drugs and the frequency of their
administration, taking care that the minimum amount capable of
producing the desired effect is employed. In the third place, the
occasional alternation of anodyne medicaments is desirable.
Fourthly, an effort—which, unfortunately, is too often likely to be
unsuccessful—should be made to prevent repeated renewals of the
prescription without the direct sanction, or indeed without the written
order, of the physician himself. Finally, the danger of yielding to the
temptation to allow a merely palliative treatment to assume too great
importance in the management of painful affections must be
sedulously shunned. Too often these precautions are neglected, and
the patient, betrayed by a dangerous knowledge of the drug and the
dose by which he may relieve not only physical pain, but also mental
depression, and tempted by the facility with which the coveted
narcotic may be obtained, falls an easy victim to habitual excesses.
The lowered moral tone of convalescence from severe illness and of
habitual invalidism increases these dangers. Yet more reprehensible
than the neglect of many physicians in these matters is the folly of
the few who do not hesitate to fully inform the patient in regard to the
medicines given to relieve pain or induce sleep, and to place in his
hands designedly the means of procuring them without restriction for
an indefinite period of time. Almost criminal is the course of those
who entrust to the patient himself or to those in attendance upon him
the hypodermic syringe. No trouble or inconvenience on the part of
the physician, no reasonable expense in procuring continuous
medical attendance on the part of the patient for the sake of relief
from pain, can ever offset, save in cases of the final stages of
hopelessly incurable painful affections, the dangers which attend
self-administered hypodermic injections.
The uniform and efficient regulation of the sale of narcotic drugs by
law would constitute an important prophylaxis against habitual
narcotism. Unfortunately, the existing laws relating to this subject are
a dead letter. They are neither adequate to control the evil nor is
their enforcement practicable. Nostrums containing narcotics, and
particularly opium and morphine, in proportions that occasionally
produce fatal results are freely dispensed at the shops to all comers.
Prescriptions calling for large amounts of opium, morphine, codeia,
chloral, cannabis indica, etc. are dispensed to the same individuals
at short intervals over the counters of apothecaries for months or
years after the illness in which they were originally prescribed is
over. Yet more, occasional cases come to light which serve to
indicate the appalling frequency with which opium, its tincture,
morphine, and solutions of chloral are directly sold to unauthorized
individuals. If the evil thus accomplished were better understood, the
paltry profit realized from such nefarious trading would rarely tempt
men to the commission of the crime which these practices constitute.
Finally, the dissemination of a wholesome knowledge of the methods

by which the opium habit and kindred affections are induced, of the
serious character of these affections, and of the dangers attendant
upon an ignorant and careless employment of narcotics, would
constitute an important measure of prophylaxis. I am fully aware of
the evils resulting from the publication of sensational writings relating
to this subject. Notwithstanding these dangers, I am convinced that a
reasonable and temperate presentation of the facts in the popular
works upon hygiene used in schools and in the family would exercise
a wholesome influence in restraining or curing the tendency to the
practice of these vices.
Where these habits have resulted in consequence of the medicinal

abuse of narcotics in acute cases from which the patient has long
recovered, a determined effort to break them up should at once be
instituted.
b. The Curative Treatment.—The responsibility assumed by the

physician in attempting to cure patients suffering from the confirmed
abuse of narcotics is often a serious one. Much judgment must be
exercised in the selection of cases. The responsibility of the
physician, beginning as it does with the judicious selection of the
cases, does not cease with the active management of the patient
until the habit has been completely broken up, but involves for a
considerable period of time such continued personal influence and
supervision as is needed to avert relapse. It is needless to say that
such supervision and influence must, after a more or less extended
period, in nearly every case come to an end, but the important fact is
to be borne in mind that the danger of relapse becomes less and
less with the progress of time; therefore, the more extended the
period during which the personal control of the physician may act as
a safeguard to his patient the better.
The question as to whether the cure should be attempted in the

patient's own home or away from it does not appear to the writer to
admit of discussion. Some trustworthy observers12 have reported
successful cases not only of the home-treatment of opium-addiction,
but even under circumstances in which the patients have been
permitted to go at large. Many physicians do not hesitate to
undertake the treatment with certain precautions at the home of the
patient. On the other hand, those whose experience in the
management of these cases is most extended look upon attempts of
this kind as likely to be unsuccessful in the great majority of the
cases of the opium or morphine habit. In cases of chloralism and the
abuse of less formidable narcotics, as cannabis indica, paraldehyde,
etc., the home-treatment, if judiciously carried out, usually succeeds,
but the cases in which the home-treatment proves successful in
curing the confirmed addiction to opium or morphine must be looked
upon as exceptional. The reasons for this are obvious. They relate to
a variety of circumstances which tend to weaken the mutual relations
of control and dependence between the physician and his patient.
The doubts, criticisms, remonstrances, even the active interference,
of the patient's friends tend to weaken the authority of the physician
and to hamper him in the management of the case; the discipline of
the sick-room is maintained with greater difficulty; the absolute
seclusion of the attendant with his patient is a practical impossibility.
Affectionate but foolish friends come with sympathy at once
disturbing and dangerous. Some devoted and trusty servant
cunningly conveys from time to time new supplies of the coveted
drug, or, if these accidents be averted, the very consciousness of the
separation which amounts to a few feet of hall-way only is in itself a
source of distress to the patient and his friends alike. Furthermore,
the period of convalescence following the treatment is attended with
the greatest danger of relapse—a danger which is much increased
by the facility of procuring narcotics enjoyed by the patient in his own
home as contrasted with the difficulties attending it away from home
under the care of a watchful attendant. The desirability of
undertaking the treatment away from the patient's home can
therefore scarcely be questioned. That this plan is more expensive,
and that it involves a radical derangement of the ordinary relations of
the patient's life, are apparent rather than real objections to it. The
very expense of the cure within the limits of the patient's ability to
pay, and the mortification and annoyance of temporary absence from
usual occupations and seclusion from friends, are in themselves
hardships that enhance the value of the cure when achieved, and
constitute, to a certain extent, safeguards against relapse. Whether
the treatment can be more advantageously carried out in a private
asylum designed for the reception of several such cases, or in a
private boarding-house, or at the home of the physician himself, is a
question to be determined by circumstances. The writer is of the
opinion that with well-trained and experienced attendants, well-
lighted, airy rooms in the upper part of a private house are to be
preferred on account of the seclusion thus secured.
12 See, for example, Waugh, “A Confirmed Case of Opium-addiction treated
Successfully at the Patient's Home, with Remarks upon the Treatment, etc.,”
Philadelphia Medical Times, vol. xvi., March 20, 1886.
In general, two methods are recognized: (a) that of the abrupt

suppression of the drug, and (b) that of the gradual diminution of the
dose. Both of these methods demand the isolation of the patient, and
to some extent at least the substitution of other narcotics. The
isolation of the patient under the care of skilled and experienced
attendants may be secured in a suitable private boarding-house, in
the home of a physician, or in a private room of a well-appointed
general or special hospital. Favorable opportunities are also afforded
in private institutions devoted to this purpose. The apartment
occupied by the patient should be so arranged as to guard against
attempts at suicide, and the furniture should be of the simplest
character. The heating and lighting arrangements must be such as to
render any accidental injury to the patient during paroxysms of
sudden maniacal excitement quite impossible. From the beginning of
the treatment the patient must under no circumstances be left alone.
Two attendants are required, one for the day and one for the night.
They should be not only skilful and experienced, but also patient and
firm; and, as a considerable proportion of the patients are persons of
education and refinement, intelligence and good manners are
desirable on the part of those who must be for a length of time not
only the nurses, but also the companions, of the sufferer. It is
desirable that the separation of the patient from his family and
friends should be made as complete as possible. During the
continuance of the active treatment no one should be admitted to the
patient except his physician and regular attendants. Communication
with his friends by letter should be interdicted. The enforcement of
this rule must be insisted upon. So soon as the acute symptoms
caused by the withdrawal of the drug subside and convalescence is
fairly established, brief visits from judicious members of the family in
the presence of the nurse may be permitted. At the earliest possible
moment open-air exercise by walking or driving must be insisted
upon, and change of scene, such as may be secured by short
journeys or by visits to the seashore, is useful. These outings require
the constant presence of a conscientious attendant.
The Treatment of the Opium and Morphine Habit.—a. The Abrupt

Discontinuance of the Drug: the Method of Levinstein.—This method
is thus described by the observer whose name it bears: Directly
upon admission the patient is given a warm bath, during which time
careful examination of his effects is made by a responsible person
for the purpose of securing the morphine which the patients,
notwithstanding their assertions to the contrary, frequently bring with

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DOCUMENTS XIII 8 THE UNITED STATES, CANADA, AND LATIN

II CULTURES IN COLLISION 69 13 NATIONALISM TRIUMPHANT: THE EMERGENCE OF

The Coming of War 70 Revolution in China 108

viii DETAILED CONTENTS

7 EAST AND WEST IN THE GRIP OF

Latin America Since 1945 181

The Modern Welfare State: Three European

13 N I ATIONALISM TRIUMPHANT: THE EMERGENCE

xii DETAILED CONTENTS

INDIAN IN BLOOD, ENGLISH IN TASTE AND THE TRABI LIVES! 217

PROGRAM FOR A NEW CHINA 56 GROWING UP IN JAPAN 238

THE DILEMMA OF THE INTELLECTUAL 97

FILM & HISTORY

Hulton Archive/Getty Images

The Spread of the Industrial Revolution 3

PROGNOSIS.—The prognosis is favorable as regards the

The prediction made by B. W. Richardson, within two years of

SYNONYMS.—The Chloral habit, Chloralism.

ETIOLOGY.—A. Predisposing Influences.—Age exerts but little

B. The Exciting Cause.—Chloral is a powerful hypnotic, usually

The habit has in some few instances been developed in

SYMPTOMATOLOGY.—I. Symptoms Due to Habitual Excesses.—The

Derangements of the digestive system are common, but by no

Persons not habituated to chloral usually experience a sense of

The circulation is much affected. Chloral weakens, and finally

The blood undergoes changes corresponding to the general

The respiration is not permanently affected, save in grave cases. It is

The muscular system shares in the general malnutrition. The

The kidneys show no constant derangement. In a certain proportion

Vesical and urethral irritation occurs in a small proportion of the

The skin undergoes nutritive disturbances of a marked kind. As a

The hypnotic effect is usually preserved. Hence the chloral habitué is

Headache is a frequent symptom. It is usually general, sometimes

Sensory disturbances are frequently present. They consist in local

Sensations of chilliness alternating with flashes of heat are

Tremor.—This symptom is not common. It is neither so pronounced

Palsy.—Loss of power in the lower extremities has been observed in

Impairment of Co-ordinating Power.—Ataxic phenomena are

Impairment or Abolition of the Knee-jerk.—In a man aged fifty, who

In rare cases epileptiform seizures have occurred.

Chloral produces in certain individuals, even as the result of a single

Psychical Derangements.—The mental and moral perversion caused

II. Symptoms Due to Abstinence from Chloral.—The symptoms

The more important of the symptoms induced by sudden

Irregular flushes of heat, nervousness, restlessness, inability to fix

The conjunctivitis and cutaneous eruptions usually disappear with

DIAGNOSIS.—The diagnosis of the chloral habit is attended with much

PROGNOSIS.—If the confirmed chloral habitué be left to himself, the

On the other hand, the prognosis under treatment may be said to be

The use of this hypnotic is not unattended with danger. In a single

These drugs are habitually used as narcotic stimulants by a limited

The use of ether as a narcotic stimulant is occasionally observed

The treatment of the opium habit and kindred affections is a subject

The treatment of these affections naturally arranges itself under two

a. Prophylaxis.—It is impossible to overrate the importance of a true

The second class of chronic cases includes individuals suffering

Finally, the dissemination of a wholesome knowledge of the methods

Where these habits have resulted in consequence of the medicinal

b. The Curative Treatment.—The responsibility assumed by the

The question as to whether the cure should be attempted in the