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Hong Kong Med J 2006;12:456-9

Cases of 'hidden aconite poisoning' have been detected in Hong Kong. Doctors from the Hospital Authority Toxicology Reference Laboratory present the first series of instances of hidden aconite poisoning reported in the medical literature.

Aconite herbs are a common cause of severe herbal poisoning but they are also used therapeutically in traditional Chinese medicine. Two aconite-containing herbs, Radix Aconiti and Radix Aconiti Kusnezoffii, have long been used in Oriental materia medica for the treatment of various musculoskeletal disorders.

During the period from March 2004 to May 2006, the Toxicology Reference Laboratory confirmed 10 cases of acute aconite poisoning. In four of these 10 cases, no aconite herb was listed in the written prescription but aconitum alkaloids were detected in the herbal broth and patient's urine samples. Inadvertent contamination with aconite containing herbs is a possible explanation as inadvertent mixing of aconite herbs with other herbs could occur during harvesting, processing, transportation and storage.

Symptoms of aconite poisoning include paraesthesia (tingling), numbness in the mouth and limbs, weakness, and bradycardia (slow heart beat). Severe poisoning can lead to abnormal heart rhythms and cardiac collapse, thus, recognising the symptoms and starting treatment early is crucial. This report also highlights the importance of quality assurance for medicinal herbs.

Hong Kong Med J 2006;12:463-6

An 11-year-old girl was admitted to a Hong Kong hospital with multiple injuries including fractures, burns and bruising, after working, unpaid, as a domestic servant for one year. She was acquired from her parents in Mainland China by a relative in Hong Kong.

The child�s parents received a sum of money that the child had to repay with work. Her hardship was characterised by long hours of incessant labour and physical torture when she failed to meet the demands of her mistress or her mistress� children.

Her circumstances were only discovered because shop assistants in the local supermarket, concerned about the girl�s obvious injuries and emotional distress, alerted the authorities.

This case resembles Mui Tsai, a form of child slavery and exploitative domestic labour that was rife in Hong Kong a century ago but outlawed in the late 1920�s after much conflict between the wealthy elite who wished to preserve the system and middle-class social activists.

Poor Mainland Chinese parents were paid a lump sum to relinquish all rights to their young daughters who joined a Hong Kong household and worked as an unpaid maidservant until the age of 18. The last recorded case occurred in 1956 when a farmer was prosecuted for importing a Mui Tsai from Mainland China.

It also illustrates new challenges to child rights and protection posed by the increasing social and economic integration between the Hong Kong Special Administrative Region and Mainland China. This child had overstayed her visa so was repatriated to mainland China where Hong Kong social workers and doctors could not follow up her case. The child�s parents were not available for investigation as the procedure was beyond the jurisdiction of the Hong Kong police.