CZECHO-SLOVAKIA.

660 Increase of Venereal Disease in Austria. Venereal disease has long been much commoner in (FROM OUR Austria than in Western countries. If the incidence in the armies in peace time be taken as an indication Medical Permission for Marriages. be found that of THE chief Board of Health of Vienna, which super- of the general distribution, it will were the annual vises the health of about 40 per cent. of the entire each 1000 soldiers the following of men reported as suffering from venereal population of the republic, has come to an important figures decision concerning the institution of a form of diseases : Prussia, 18 ; Bavaria, 20 ; France, 27; the former Austria, 61. This high rate medical licence for couples desiring to marry. Last Belgium, 28 ; was chiefly due to the Balkan and Magyar elements year, at the suggestion of Prof. Tandler-then of the population, but even the Tyrol had a rate of Minister for Public Health-steps were taken to 1000. The war resulted, as was to be expected, 39 per ascertain the attitude of the bodies concerned towards of sexual disease. More the idea of certification of health before marriage. in a very marked increase 12 per cent. of the rank and file at the front were than Compulsory certification had to be abandoned for suffering from venereal disease. Up to August 1st, numerous reasons ; it was finally decided that the 1917, 1,275,855 soldiers were reported as infected, municipal board of health should appoint a specially and this figure must be regarded as a minimum. At medical man to act as examiner of qualified persons the end of the war at least 33 per cent. more must be of both sexes, to certify their mental and physical as diseased. Of these soldiers, 59 per cent. counted fitness for marriage. The likelihood of healthy were single, 41 per cent. married ; 15 per cent. came offspring is considered, and also any signs of tuber- from cities, 31 per cent. from small towns, 54 per cent. culosis, neurosis, general debility, or cardio-vascular from rural districts ; when the war was over they disease in the applicant. The chief idea is, of course, home with their diseases. But behind the returned to prevent persons suffering from syphilis, epilepsy, and especially in Vienna, a marked increase mental disease, and chronic alcoholism from marry- front, also, of sexual was observed the war, chiefly disease ing. If the examiner thinks fit, he will send the amongst juveniles ; the figures during went up from 42 per at a to a the latter will clinic ; applicant specialist 1000 to 111 1000 for males, from 129 per report not to the patient, but to the examiner, who 1000 to 213 per per 1000 for females. Amongst will then be able to give his authoritative advice and married women the number of infected persons went a licence to be issue marry. Examination will free, for the first year or two at least, and it is hoped that up from 10 per cent. in 1913 to 23 per cent. in 1918. demoralisation, infection by the returning many young people will avail themselves of the Increasingand social husband, changes are responsible for this opportunity. Women in particular are expected to insist on the production of certificates by their deplorable state of affairs, against which an energetic intended husbands. If many women apply for warfare is now being waged under the leadership of examination a woman doctor will be appointed too. Prof. Finger, who compiled the statistics given above. In order to popularise the institution, no compulsion The revolution occasioned a further rise in the figures ; whatever will be applied ; reliance is placed solely the demoralisation among young girls assumed alarming proportions. Police raids on the type of hotel on moral influence, by which in time it is hoped that where prostitutes are most frequently found, showed the public will be educated up to the full significance of a contract of marriage. Absolute profes- only 33 per cent. of the juvenile offenders to be sional secrecy is, of course, guaranteed ; no one but infected in 1918 ; in 1919 and 1920 the figures were the applicant will be informed of the result of the 46 per cent. and 48 per cent. respectively. Under conditions these diseases are no longer merely examination. Advice as to treatment will be given such " sexual " ; they are " infectious," threatening the if necessary. The official examiner has now been population like small-pox, cholera, or influenza. appointed at a salary of about 25,000 kroner a month. whole Prof. Finger justly points out that both, first, the The Status of the General Practitioner. present means of detaining the manifestly diseased In a recent communication to the Wiener Medi- prostitutes in hospitals, and, secondly, the regular zinische Wochenschrift the attention of the public is control of those not in hospital, by weekly or more called to the necessity of ensuring for the general frequent examination, are rendered worse than useless practitioner a standard of income sufficiently high to unless the infected men are also rendered innocuous. relieve him of constant financial worry. The writer He insists on the necessity of legislation in this conof the communication argues that practitioners should nexion. An example has been set in this respect by be evenly distributed throughout the country, and the Scandinavian countries, where the effect is said to not permitted to group themselves too much in one be most encouraging. A Bill will be shortly brought place ; he also emphasises the need for a distinct before the Austrian National Assembly, whereby separation of the general practitioner from the police control of prostitutes will be suspended, but medical administrator, public health official, or whereby persons found infected will have to submit teacher. He therefore demands that whole-time to treatment. The Bill will not be limited as to sex, appointments be made by local authorities ; the class, or occupation. If passed, this law, it is hoped, holders of those appointments should not be allowed will act not only as a sanitary measure, but will to participate in private practice, but should be paid provide for the establishment of care centres and for on a scale admitting of a decent standard of comfort. the spread of a sense of moral responsibility. He also suggests that the titles " professor," " privatMarch 14th. " be abolished by law in docent," councillor," &c., private practice. At present a medical man holding a professorship in some purely theoretical subject CZECHO-SLOVAKIA. (e.g., medical history or forensic medicine) may use (FROM OUR OWN CORRESPONDENT.) his title in general or special practice and charge is It that all internes accordingly. suggested hospital and assistants, all whole-time teachers and demonSanitary Conditions in Greater Pra,gue. strators, should also be debarred from private pracof the contributor to Dr. Ladislav Prochazka, chief health officer of the tice ; only then, in the opinion the Wochenschrift, will professional competition be city of Prague, has reported to the city council the established on an ethical basis, whilst the population results of his recently completed sanitary survey will be better served by medical men devoted wholly of Greater Prague, which came into existence on to private practice. At present, he observes, practi- Jan. lst, 1922, and now forms a city of approxitioners " hold " many appointments (e.g., as phy- mately 700,000 inhabitants. The centre of the city sicians to the Krankenkassa, to the police force, to theas it now exists is well equipped with the prime " railway companies, &c.), but cannot be said to fillnecessities for a modern city, including good water; and sewage disposal; but in a number of them. supply

VIENNA. OWN CORRESPONDENT.)

661 communities now attached to the city true rural conditions still persist. The general death-rate of the whole city is not less than 20 per 1000 ; infant mortality is as high as 230. The figure for typhoid, almost nil for the central city, will be greatly increased, as this disease is endemic in some of the new suburbs. Dr. Prochazka explains these unsatisfactory conditions as follows :-The chief difficulty is that of situation, which makes Prague one of the prettiest cities in the world, but does not admit of sufficient ventilation of streets and public places. It lies in a curved valley of the Moldau, which fact accounts for the smoky appearance and atmosphere of the city. Housing conditions in the city are very unsatisfactory, largely on account of post-war conditions. Building has become very expensive, whilst great numbers of new inhabitants have flocked to Prague since it became the capital of a new State. Premises closed during and before the war on account of their unhygienic conditions are now being used, since the housing shortage has made any housing inspection illusory. As previously explained, the drainage system of the central city is good, and the watersupply admirable; but the added townships are largely supplied from wells, and only a small proportion of them have proper drainage. A lack of childwelfare activities explains the high figures of infant mortality; there is, indeed, a great need for social welfare generally, and for systematic public health education, and the general cleansing of the city must also be improved. Dr. Procházka declares that the city is now facing approximately the same problems as 30 years ago, when it was known as a focus of typhoid; at that time the authorities had courage enough to undertake the provision of good drainage and water-supply at the expense of about 70 million crowns, and the health officer hopes that the authorities of to-day will equally well interpret the needs of the city.

Correspondence. "

Audi alteram partem."

A NATIONAL COUNCIL FOR MENTAL To the

HYGIENE. Editor of THE LANCET.

SIR,-There can be little doubt that the subject of mental health, using the term in its widest sense,

excites the interest both of the public and of the medical profession more now than it has ever done before. - The recent establishment of a few hospitals and clinics for the treatment of " functional nervous which might be more scientifically labelled disorders," " minor disorders of the mind," affords evidence of the fact that the early recognition and treatment of these maladies is generally regarded as a matter of importance in relation to the health of the community. There are, moreover, many societies and associations, old and young, which are engaged in promoting the study of mental disorders, the welfare of the insane, the problems of industrial psychology, and the various aspects of mental deficiency. A provisional committee of medical men, of which I have been appointed chairman, has decided to form a central organisation, a National Council for Mental Hygiene, in order that the work of these institutions and societies should be encouraged to expand and to add to their usefulness by organised cooperation. Such a National Council for Mental Hygiene will be concerned with other matters, which have not yet received sufficient attention. It will help to establish psychological clinics at general hospitals for the treatment of early mental and nervous disorders. It will endeavour to make mental hygiene a more prominent subject in the education of medical students and, by instructing the public in the prinAnnual Report of Students’ Health Centre. ciples underlying mental health and illness, gradually A year ago a health centre for students was opened diminish the enormous waste of time and energy in all in Prague, in the students’ home established by the ’, classes of society, which now results from widespread Y.M.C.A. as the gift of America to Czecho-Slovak ’, ignorance concerning these questions. students. There are 16,000 students now in Prague, The conservation of mental health is a matter of including 13 different nationalities ; the largest serious economic importance to any nation, and this numbers are of Czechs, Germans, Jugo-Slavs, and has been fully recognised in other countries, notably Russians. Of the last-named there are no less than in America, where a National Committee for Mental 1500 attending the universities at present. The Hygiene has been doing valuable work for a number of board of directors of the Students’ Health Centre years. The chief purposes of that committee are to recently held its first annual meeting, and received work for the conservation of mental health ; to its first annual report. The medical director in promote the study of mental disorders, mental defects charge of the centre is a specialist for tuberculosis; and delinquency in all their forms and relations, to there is, in addition, a part-time specialist for obtain and disseminate reliable data concerning them, venereal diseases. A public health nurse, who is also to help to raise the standard of care and treatment, and trained as a social worker, has charge of the arrange- to coordinate existing agencies-federal, state, and ments for visiting students. Treatment is free for local. These are ambitious schemes ; but even a every student ; the institution is supported partly moderate amount of success would spell happiness and by the State and partly by private gifts and collec- prosperity to many thousands of the population, tions. Of the 4052 students who applied for medical who must otherwise fail in the struggle for existence. advice at the dispensary during the past year, 228 Great Britain must not be less ambitious and must be showed definite or suspected signs of tuberculosis ; prepared to join with other nations in an International a large percentage of them were placed in sanaLeague, the objects of which will be to spread the toriums through the agency of the Anti-Tuberculosis knowledge accumulated by each of its members in all League or of the Czecho-Slovak Red Cross. Of the matters of mental hygiene. total number of patients, 1448 were of a nationality The provisional committee consists of : Sir Norman other than Czecho-Slovak. Despite the curious Moore, President of the Royal College of Physicians ; mixture of nationalities, no chauvinistic friction has Sir Charles Sherrington, President of the Royal Society ; been reported amongst the students. Sir John Goodwin, Director-General of Army Medical March 14th. Service ; Sir George Newman, Principal Medical Officer, Ministry of Health; Sir Walter Fletcher. F.R.S., Secretary of the Medical Research Council ; PRINCESS ALICE MEMORIAL HOSPITAL, EASTBOURNE. Dr. C. H. Bond, President of the British MedicoDr. Bedford Pierce, In the year 1921, despite the exercise of the greatest economy, Psychological Association ; the accounts show a deficit of £1663. At the annual meeting President of the Section of Psychiatry of the Royal of the governors on March 17th Sir Charles O’Brien Harding, Society of Medicine : Prof. George Robertson, treasurer, said it was impossible to run the hospital President-elect of the British Medico-Psychological on the amount of subscriptions received at the present Dr. C. S. Mypr-i, F.R.S., Director of the time. Patients or their relatives were therefore being Association ; of Industrial Psychology ; Dr. G. National’Institute asked to help by giving something towards the cost of their stay in the hospital, and it was hoped Ainsworth ; Dr. Helen Boyle ; Dr. Edwin Bramwell ; Lord material benefit would accrue to the hospital from the Dr. Farquhar Buzzard ;-, Sir Maurice Craig ; Dawson of Penn ; Sir Bryan Donkin ; Dr. Elliot new arrangement.