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PUBLIC COMPETITION IN THE SERVICE OF HUMANITY.
1736
paved with the north of the Great Wall. These and other consideracement or concrete ; (4) the absence of sanitary fittings tions render the immunity enjoyed by Shanghai difficult to inside the houses, so that it is impossible for the Ohinese be accounted for in any sanitary conclusions. We are daily to interfere with the working of the drains ; (5) an ample getting additional proofs that the presence of plague in supply of water ; (6) the removal of the whole of the epidemic form is dependent upon the infection of the night soil and kitchen refuse by the bucket system ; and domestic animals of the district. Cases of plague occurring (7) the flushing of the drains by tidal water and the amongst men arriving from infected areas are little likely to consequent destruction of rats. According to this show- lead to a local outbreak of the disease. It seems to be ing Shanghai would appear to be a hygienic paradise and a fact that if the animals do not suffer from plague the immunity from epidemics of all sorts practically to be disease will not spread amongst men. By animals it is not only rats that are meant for almost all domestic animals guaranteed. Those who know Shanghai will be astonished to hear the are known to acquire plague and it may be safely said sanitary arrangements of the city so highly spoken of. It that if these animals do not develop plague the disease is a fact that typhoid fever is present in Shanghai to a in man will not continue in any particular district. We degree unparalleled in any other of the coast ports of China- rejoice to know that Shanghai has escaped plague so at any rate, so far as Europeans are concerned. Dysentery is far ; we are willing to admit that careful precautions have a disease of common occurrence, diphtheria claims its victims, been taken by the municipal authorities ; we admire the and cholera is not unknown during the autumn. The water- sanitary improvements which have been accomplished by the supply of the city is, moreover, not above suspicion. Water untiring efforts of the medical officer of health, the sanitary there is, no doubt, in plenty but the quality of the water was engineers, and by those responsible for the health of the recently the subject of serious alarm. The claims made for great city, of which the foreign community has every reason the bucket system being efficacious in the prevention of to be proud ; but we are sure that they will pardon us if we plague cannot be seriously considered, for the bucket refuse to recognise as a scientifically proved fact that these system is in force in all treaty ports in China. It would measures have succeeded in protecting Shanghai from an appear, therefore, that there must be other causes at work to epidemic of plague, seeing that other cities and districts account for the immunity enjoyed by Shanghai but we are with far fewer hygienic advantages have also shown an not prepared to say what these are. In many other parts extraordinary immunity to the same disease. each house has
a
small
yard
at the back
of the world we find isolated towns and districts with a similar and a still more extraordinary immunity. No better example can be quoted than that of the city of Madras. Plague has not visited Madras city although in the Madras Presidency right up to the very outskirts of the city itself plague has prevailed in epidemic form for several years. Anyone who has visited Madras is ready to believe that all the elements, as we at present understand
them, calculated
to harbour
plague
exist there, and
yet,
of the disease have actually been although imported into the town and died there, the disease has not spread. Why this should be is not understood. Calcutta, again, has not suffered so severely as Bombay, although the conditions would appear to be even more favourable for the spread of plague in the former than in the latter city. There are other etiological factors at work that are not readily ascertainable and the immunity of Shanghai is not to be understood by any sanitary consideration which we know of. In Hong-Kong we have the example of a city visited again and again by plague, a city in which the quality of the water supplied for consumption is amongst the purest in the world. The bucket system is in force there, the sewerage is excellent, and yet Hong-Kong suffers to as great an extent as Canton where all the sanitary conditions are bad. The fact is that plague exists nowhere along the valley of the Yang-tse-Kiang and although Shanghai stands at the mouth of the river and is liable to infection from the seaboard we know that, in China at any rate, the infection has come for the most part overland. Canton was infected from Yunnan and from Canton plague reached Hong-Kong. The disease travelled along the Chinese littoral to Swatow andfurther north. The infection of Niu-Chwang and parts of Manchuria was possibly from up country, for CLEMpw has shown that a distinct centre of plague exists to some
cases
Annotations. "Ne
quid nimis."
PUBLIC COMPETITION IN THE SERVICE OF HUMANITY. ANY plan which iscalculated to develop inventive capacity and to direct it towards the attainment of humane ends is worthy of the highest encouragement. The, great masses of people must include not a few individuals possessing originality of purpose, thought, and practical application to a special degree which lie dormant for the want of a stimulus or for lack of opportunity of developing these attributes. There is no doubt that if many of the difficult problems which frequently confront us could be forced upon the serious attention of the public at large there probably would be found some individuals to whom a satisfactory way out would readily suggest itself. Amongst the methods of drawing upon the talent that may otherwise lie hidden in a community is that of offering prizes of a substantial and honour-giving character. The method is commendable so long as the reward, is ample to the originator of the design and consistent with what may prove to be its practical value to humanity. There are several instances on record in which by opening a public competition and offering substantial money prizes valuable results in the interests of humanity have been gained. We need refer only to two-viz., the King’s Prize Essay for the best design of a sanatorium for the treatment of consumption and the Nobel prize for the best essay on the steps to be taken calculated best to secure the peace of the world. The latest example of inventive capacity being invited and encouraged to work in the interests of humanity was the offer of the Transvaal Chamber of Mines at Johannesburg in 1902 of three prizes-the first of 500, with a gold medal ; the second of &250; and the third of £ 100-for the three
1737 ascending- order of frequency followed morphinomania, (three cases), hypochondriasis (five cases), paranoial forms of insanity (seven cases), and melancholia with depression (17 cases). The cases of melancholia were sufficiently severe to warrant the diagnosis. The psychoses which follow were in higher proportion—viz., 28 cases of climacteric psychoses or mental disturbances in women occurring at the menopause and sufficiently grave to cause anxiety to themselves or their friends, 26 cases of general made in vain but rather to add very substantially to our paralysis of the insane, all in males, and 40 cases of knowledge of the difficulties presented and of means by chronic alcoholism of which 39 were males. Probably, which they may ultimately be overcome. In the competition says Dr. Jelliffe, these alcoholic casesrepresent but at Johannesburg the judges expressed the opinion that the a small portion of those addicted to excessive drinking. best means of suppressing the evil of miners’ phthisis would On the borderland between the psychoses proper, as menbe the adoption of a perfect water drill combined with the tioned before, and the neuroses a number of cases variously use of an atomiser. The first prize was awarded to Mr. called neurasthenia and phrenasthenia were treated at the Thomas J. Britten for an atomiser which was found to lay clinic. Whether the "neurastheniacs"that present them’75 per cent. of the dust and the second prize was awarded selves at the clinic for diseases of the nervous system are in for a water drill which, however, still left something to be reality cases of psychasthenia or neurasthenia it was difficult desired but it is confidently hoped that the partial success of to decide, Dr. Jelliffe’s opinion being that most of the cases the drill will lead inventors to improve further upon it until were " individuals of weak mental capacity and, properly’ absolute success is attained. speaking, psychasthenias rather than neurasthenias of the strictly nerve-fatigue type. Neurasthenias of defective [cerebral] evolution perhaps they may be but neurasthenias THE MINOR NEUROSES AND PSYCHOSES AS of overwork they rarely are." They comprised 364 patients, SEEN IN THE DISPENSARY PRACTICE of whom 211 were men and 152 were women. No etiological OF A GREAT CITY. factors are mentioned for nearly the whole number, except IT is seldom possible to obtain accurate data and trust- that syphilis is put down as an exciting cause in aig, .trauma worthy figures with regard to the distribution of the minor in two, and sexual excesses in 45. It appeared that psychoses’ and neuroses in any community, though the most of them were of congenitally abnormal nervous con-; inquiry might be well undertaken by philanthropic bodies stitution. The -group of "neuroses"proper which follow such as the charity organisation societies of’ great cities. comprised varying forms of neuralgia and neuritis, of periIn the Journal of Nervous and Mental Disease for May Dr. pheral palsies, tabes dorsalis, and other diseases of the, Smith Ely Jelliffe of New York gives an interesting account nervous system. Cases of neuralgia were common, there being of the cases of minor neuroses and psychoses at the 114 cases, including 49 males and 65 females. The neuralgic Vanderbilt Clinic of New York since its opening in 1888, attacks were nearly always local, affecting the following and ’adds full details of the special kinds and classes of regions-viz , facial (40 cases), occipital (five cases), sciatic patients treated during the past year. The conclusions (36 cases), supraorbital (nine cases), dental (16 cases), drawn, .based as they are on the material of a vast and brachial (nine cases), arthritic (ten cases), and lumbar representative practice of the dispensary class, are of both region (four cases), while a few are not specified. Neuritis, medical and social interest. During the early years of the affected 61 patients-viz., 35 males and 26 females. All period-viz., from 1888 to 1892-the cases of all diseases were mild cases unassociated with peripheral palsy or treated in the clinic averaged from 30, 000 to 35, 000 a year, thewasting of muscles. They comprised three cases of occipital proportion of nervous diseases among these being between 4 neuritis, four due to lead poisoning, eight of multiple and 5 per cent. This proportion has been maintained through- (peripheral) distribution and of obscure causation, and ten out the period under review. During the past five years theof alcoholic neuritis. The peripheral palsies and organic included the following classes cases of all diseases treated in the clinic averaged from diseases of the nervous system of "progressive muscular cases. Three were cases 46,000 to 48,000 per annum, the proportion of nervous diseasesof of the lower lumbar cord) type, there were four (or remaining practically as before-viz., between 4’2 and 4.88; atrophy" of tumour of the six of lateral sclerosis (all cord, spinal per cent. " So far as the Vanderbilt Clinic is concerned," sayscases of disseminated 20 of Erb’s paralysis, 21 16 sclerosis, males), Dr. Jelliffe, the ratio of sickness referable to the nervous acute anterior 31 of traumatic children), poliomyelitis (of of of the entire sick system varies from 4 to 5 .per cent. nerves (21 being of the musculo-spiral of various with i palsy the illnesses into those clinic population." Dividing mental ’symptoms (psychoses) and those unattended withl nerve), 31 were cases of facial paralysis, and 35 of tabes important mental disturbance (neuroses) it is found that inIdorsalis. the years 1902 and 1903 for one case of psychosis there were
praotical suggestions ;and devices for obviating or minimising the occurrence of miners’ phthisis. The awards. have been made recently and no fewer than 229 competitors entered into the practical consideration of a remedy for this fearful scourge and great good has come out of the scheme. Even assuming that an entirely satisfactory.. method does not prove to be the outcome of a competition organised on the lines indicated, yet the efforts made towards securing a desirable end are not likely to be best
.
Then in
‘
I
-
THE LIVERPOOL SCHOOL OF TROPICAL of neuroses. The total number of cases of both MEDICINE AND TRYPANOSOMIASIS. psychoses and neuroses for the year 1903 was 1860. The b IN a letter published in the Times on June 14th an. psychoses"" comprised all conditions varying from idiocy and the degenerative forms of insanity to melancholia, appeal is made for funds to continue the important insanity of the menopause, and general paralysis. The researches on trypanosomiasis which are now, being convarious grades of idiocy and mental deficiency were repre- ducted by the Liverpool School of Tropical Medicine. Iii the sented by a total of 75 patients out of 1860. This proportion appeal, which is signed by Sir Alfred L. Jones as chairman,’ (4 per cent.) " is 1 per cent. higher than the incidence noted by the Duke of Northumberland as vice-.chairman, and- by, in 1902, and emphasises with even greater force," adds Dr. Professor Ronald Ross, the cost of the investigation is shown Jelliffe, I I that the city [of New York] is greatly in need of to be very heavy. The school has already disbursed the sum supplementary training schools for defective children." The of 3000 and will require to expend at least £2000 a year if experience of the Vanderbilt Clinic shows that there is a the work on this subject is to be continued. The importance large number of such defectives. The other psychoses,were the investigation of the relation of the trypanosomes to nine
cases
of
in very .widely varying proportions. Cases of simple mania and of obsessions were very rare (three casea in all). and "
sickness in man, which now claims so manyvictims, sleeping to tsetse- fly disease and in animals is surra
very
paved with the north of the Great Wall. These and other consideracement or concrete ; (4) the absence of sanitary fittings tions render the immunity enjoyed by Shanghai difficult to inside the houses, so that it is impossible for the Ohinese be accounted for in any sanitary conclusions. We are daily to interfere with the working of the drains ; (5) an ample getting additional proofs that the presence of plague in supply of water ; (6) the removal of the whole of the epidemic form is dependent upon the infection of the night soil and kitchen refuse by the bucket system ; and domestic animals of the district. Cases of plague occurring (7) the flushing of the drains by tidal water and the amongst men arriving from infected areas are little likely to consequent destruction of rats. According to this show- lead to a local outbreak of the disease. It seems to be ing Shanghai would appear to be a hygienic paradise and a fact that if the animals do not suffer from plague the immunity from epidemics of all sorts practically to be disease will not spread amongst men. By animals it is not only rats that are meant for almost all domestic animals guaranteed. Those who know Shanghai will be astonished to hear the are known to acquire plague and it may be safely said sanitary arrangements of the city so highly spoken of. It that if these animals do not develop plague the disease is a fact that typhoid fever is present in Shanghai to a in man will not continue in any particular district. We degree unparalleled in any other of the coast ports of China- rejoice to know that Shanghai has escaped plague so at any rate, so far as Europeans are concerned. Dysentery is far ; we are willing to admit that careful precautions have a disease of common occurrence, diphtheria claims its victims, been taken by the municipal authorities ; we admire the and cholera is not unknown during the autumn. The water- sanitary improvements which have been accomplished by the supply of the city is, moreover, not above suspicion. Water untiring efforts of the medical officer of health, the sanitary there is, no doubt, in plenty but the quality of the water was engineers, and by those responsible for the health of the recently the subject of serious alarm. The claims made for great city, of which the foreign community has every reason the bucket system being efficacious in the prevention of to be proud ; but we are sure that they will pardon us if we plague cannot be seriously considered, for the bucket refuse to recognise as a scientifically proved fact that these system is in force in all treaty ports in China. It would measures have succeeded in protecting Shanghai from an appear, therefore, that there must be other causes at work to epidemic of plague, seeing that other cities and districts account for the immunity enjoyed by Shanghai but we are with far fewer hygienic advantages have also shown an not prepared to say what these are. In many other parts extraordinary immunity to the same disease. each house has
a
small
yard
at the back
of the world we find isolated towns and districts with a similar and a still more extraordinary immunity. No better example can be quoted than that of the city of Madras. Plague has not visited Madras city although in the Madras Presidency right up to the very outskirts of the city itself plague has prevailed in epidemic form for several years. Anyone who has visited Madras is ready to believe that all the elements, as we at present understand
them, calculated
to harbour
plague
exist there, and
yet,
of the disease have actually been although imported into the town and died there, the disease has not spread. Why this should be is not understood. Calcutta, again, has not suffered so severely as Bombay, although the conditions would appear to be even more favourable for the spread of plague in the former than in the latter city. There are other etiological factors at work that are not readily ascertainable and the immunity of Shanghai is not to be understood by any sanitary consideration which we know of. In Hong-Kong we have the example of a city visited again and again by plague, a city in which the quality of the water supplied for consumption is amongst the purest in the world. The bucket system is in force there, the sewerage is excellent, and yet Hong-Kong suffers to as great an extent as Canton where all the sanitary conditions are bad. The fact is that plague exists nowhere along the valley of the Yang-tse-Kiang and although Shanghai stands at the mouth of the river and is liable to infection from the seaboard we know that, in China at any rate, the infection has come for the most part overland. Canton was infected from Yunnan and from Canton plague reached Hong-Kong. The disease travelled along the Chinese littoral to Swatow andfurther north. The infection of Niu-Chwang and parts of Manchuria was possibly from up country, for CLEMpw has shown that a distinct centre of plague exists to some
cases
Annotations. "Ne
quid nimis."
PUBLIC COMPETITION IN THE SERVICE OF HUMANITY. ANY plan which iscalculated to develop inventive capacity and to direct it towards the attainment of humane ends is worthy of the highest encouragement. The, great masses of people must include not a few individuals possessing originality of purpose, thought, and practical application to a special degree which lie dormant for the want of a stimulus or for lack of opportunity of developing these attributes. There is no doubt that if many of the difficult problems which frequently confront us could be forced upon the serious attention of the public at large there probably would be found some individuals to whom a satisfactory way out would readily suggest itself. Amongst the methods of drawing upon the talent that may otherwise lie hidden in a community is that of offering prizes of a substantial and honour-giving character. The method is commendable so long as the reward, is ample to the originator of the design and consistent with what may prove to be its practical value to humanity. There are several instances on record in which by opening a public competition and offering substantial money prizes valuable results in the interests of humanity have been gained. We need refer only to two-viz., the King’s Prize Essay for the best design of a sanatorium for the treatment of consumption and the Nobel prize for the best essay on the steps to be taken calculated best to secure the peace of the world. The latest example of inventive capacity being invited and encouraged to work in the interests of humanity was the offer of the Transvaal Chamber of Mines at Johannesburg in 1902 of three prizes-the first of 500, with a gold medal ; the second of &250; and the third of £ 100-for the three
1737 ascending- order of frequency followed morphinomania, (three cases), hypochondriasis (five cases), paranoial forms of insanity (seven cases), and melancholia with depression (17 cases). The cases of melancholia were sufficiently severe to warrant the diagnosis. The psychoses which follow were in higher proportion—viz., 28 cases of climacteric psychoses or mental disturbances in women occurring at the menopause and sufficiently grave to cause anxiety to themselves or their friends, 26 cases of general made in vain but rather to add very substantially to our paralysis of the insane, all in males, and 40 cases of knowledge of the difficulties presented and of means by chronic alcoholism of which 39 were males. Probably, which they may ultimately be overcome. In the competition says Dr. Jelliffe, these alcoholic casesrepresent but at Johannesburg the judges expressed the opinion that the a small portion of those addicted to excessive drinking. best means of suppressing the evil of miners’ phthisis would On the borderland between the psychoses proper, as menbe the adoption of a perfect water drill combined with the tioned before, and the neuroses a number of cases variously use of an atomiser. The first prize was awarded to Mr. called neurasthenia and phrenasthenia were treated at the Thomas J. Britten for an atomiser which was found to lay clinic. Whether the "neurastheniacs"that present them’75 per cent. of the dust and the second prize was awarded selves at the clinic for diseases of the nervous system are in for a water drill which, however, still left something to be reality cases of psychasthenia or neurasthenia it was difficult desired but it is confidently hoped that the partial success of to decide, Dr. Jelliffe’s opinion being that most of the cases the drill will lead inventors to improve further upon it until were " individuals of weak mental capacity and, properly’ absolute success is attained. speaking, psychasthenias rather than neurasthenias of the strictly nerve-fatigue type. Neurasthenias of defective [cerebral] evolution perhaps they may be but neurasthenias THE MINOR NEUROSES AND PSYCHOSES AS of overwork they rarely are." They comprised 364 patients, SEEN IN THE DISPENSARY PRACTICE of whom 211 were men and 152 were women. No etiological OF A GREAT CITY. factors are mentioned for nearly the whole number, except IT is seldom possible to obtain accurate data and trust- that syphilis is put down as an exciting cause in aig, .trauma worthy figures with regard to the distribution of the minor in two, and sexual excesses in 45. It appeared that psychoses’ and neuroses in any community, though the most of them were of congenitally abnormal nervous con-; inquiry might be well undertaken by philanthropic bodies stitution. The -group of "neuroses"proper which follow such as the charity organisation societies of’ great cities. comprised varying forms of neuralgia and neuritis, of periIn the Journal of Nervous and Mental Disease for May Dr. pheral palsies, tabes dorsalis, and other diseases of the, Smith Ely Jelliffe of New York gives an interesting account nervous system. Cases of neuralgia were common, there being of the cases of minor neuroses and psychoses at the 114 cases, including 49 males and 65 females. The neuralgic Vanderbilt Clinic of New York since its opening in 1888, attacks were nearly always local, affecting the following and ’adds full details of the special kinds and classes of regions-viz , facial (40 cases), occipital (five cases), sciatic patients treated during the past year. The conclusions (36 cases), supraorbital (nine cases), dental (16 cases), drawn, .based as they are on the material of a vast and brachial (nine cases), arthritic (ten cases), and lumbar representative practice of the dispensary class, are of both region (four cases), while a few are not specified. Neuritis, medical and social interest. During the early years of the affected 61 patients-viz., 35 males and 26 females. All period-viz., from 1888 to 1892-the cases of all diseases were mild cases unassociated with peripheral palsy or treated in the clinic averaged from 30, 000 to 35, 000 a year, thewasting of muscles. They comprised three cases of occipital proportion of nervous diseases among these being between 4 neuritis, four due to lead poisoning, eight of multiple and 5 per cent. This proportion has been maintained through- (peripheral) distribution and of obscure causation, and ten out the period under review. During the past five years theof alcoholic neuritis. The peripheral palsies and organic included the following classes cases of all diseases treated in the clinic averaged from diseases of the nervous system of "progressive muscular cases. Three were cases 46,000 to 48,000 per annum, the proportion of nervous diseasesof of the lower lumbar cord) type, there were four (or remaining practically as before-viz., between 4’2 and 4.88; atrophy" of tumour of the six of lateral sclerosis (all cord, spinal per cent. " So far as the Vanderbilt Clinic is concerned," sayscases of disseminated 20 of Erb’s paralysis, 21 16 sclerosis, males), Dr. Jelliffe, the ratio of sickness referable to the nervous acute anterior 31 of traumatic children), poliomyelitis (of of of the entire sick system varies from 4 to 5 .per cent. nerves (21 being of the musculo-spiral of various with i palsy the illnesses into those clinic population." Dividing mental ’symptoms (psychoses) and those unattended withl nerve), 31 were cases of facial paralysis, and 35 of tabes important mental disturbance (neuroses) it is found that inIdorsalis. the years 1902 and 1903 for one case of psychosis there were
praotical suggestions ;and devices for obviating or minimising the occurrence of miners’ phthisis. The awards. have been made recently and no fewer than 229 competitors entered into the practical consideration of a remedy for this fearful scourge and great good has come out of the scheme. Even assuming that an entirely satisfactory.. method does not prove to be the outcome of a competition organised on the lines indicated, yet the efforts made towards securing a desirable end are not likely to be best
.
Then in
‘
I
-
THE LIVERPOOL SCHOOL OF TROPICAL of neuroses. The total number of cases of both MEDICINE AND TRYPANOSOMIASIS. psychoses and neuroses for the year 1903 was 1860. The b IN a letter published in the Times on June 14th an. psychoses"" comprised all conditions varying from idiocy and the degenerative forms of insanity to melancholia, appeal is made for funds to continue the important insanity of the menopause, and general paralysis. The researches on trypanosomiasis which are now, being convarious grades of idiocy and mental deficiency were repre- ducted by the Liverpool School of Tropical Medicine. Iii the sented by a total of 75 patients out of 1860. This proportion appeal, which is signed by Sir Alfred L. Jones as chairman,’ (4 per cent.) " is 1 per cent. higher than the incidence noted by the Duke of Northumberland as vice-.chairman, and- by, in 1902, and emphasises with even greater force," adds Dr. Professor Ronald Ross, the cost of the investigation is shown Jelliffe, I I that the city [of New York] is greatly in need of to be very heavy. The school has already disbursed the sum supplementary training schools for defective children." The of 3000 and will require to expend at least £2000 a year if experience of the Vanderbilt Clinic shows that there is a the work on this subject is to be continued. The importance large number of such defectives. The other psychoses,were the investigation of the relation of the trypanosomes to nine
cases
of
in very .widely varying proportions. Cases of simple mania and of obsessions were very rare (three casea in all). and "
sickness in man, which now claims so manyvictims, sleeping to tsetse- fly disease and in animals is surra
very