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THE CAUSATION AND TREATMENT OF STATES OF MENTAL ANXIETY AND ALLIED CONDITIONS.
1566 borne out by practice. In a dislocation, however, the In all complete disare by no means identical.
fully
IS FISH-CURING A
DANGEROUS TRADE?
at home to show that when the Scotswomen Iwith the evil There not in better be little doubt are
they
are
a
place.
can
time goes on the fish-curing industry will be brought more directly under the supervision of the inspectors of factories and workshops, and it seems probable that t. accomplish this end Section 41 of the Workshop Act, 1901 (1 Edward VII. cap. 22), may be of use, but it is perhaps uncertain whether the Secretary of State is empowered under this clause to make regulations by special order in the case of fbh- as well as of fruit-preserving. Should he be empowered to do so it seems possible that changes for the better might be rapidly effected in the sanitary state of the factories. As matters stand at present the local authorities occasionally display a lack of activity, as in a case which lately occurred of a corporation which owned the site on the beach which was used for cleaning the fish. A sudden revolution in the working of a large industry is not to be expected, nor could it be brought about without causing great suffering which would inevitably fall chiefly on those least able to protect themselves—in this case the fbh cleaners and the poor for whom bloaters are a staple article of food. Local sanitary authorities will do well in the interests not only of the health of the workers but also of the pockets of manufacturers if they will carry out to the full the provisions of the Publie Health Act. they fail to do so without delay there is no doubt that a serious attempt will be made to prove that fish-curing is a dangerous trade. Not a little has indeed already been written to that end. that
as
VERY large catches of herrings have lately been made off eastern coast of England. Great Yarmouth, as everyone knows, is one of the chief towns in which this fish is cured, but few people are acquainted with the details of the work or have any conception of the way in which it is carried out. Women are largely employed and a great proportion of them ’It has been computed that of 90,000 come from Scotland. THE CAUSATION AND TREATMENT OF STATES Scots who are engaged in the fishing industry about a OF MENTAL ANXIETY AND ALLIED .quarter are women who spend some part of their time in CONDITIONS. he curing of fish. This estimate is a very rough one and THE study of phenomena formerly regarded as purely shoald not be taken as anything more than conjecture and it is only necessary to insist that there is no doubt that the psychological but considered now as legitimate objects of Scottish women engaged in the trade are to be reckoned by clinical and neurological investigation has served during the thousand. Some of these women and girls go south with recent years to throw a flood of light on many nervous and the fishing boats and follow the herrings round the coast. mental conditions which occupy the borderland between During the present year the heavy catches have occurred health and disease. For some of the most fruitful achieve rather late in the season and large numbers of the women ments in this direction we have been indebted to Charcot have been glad to start at once for a place at which work and the school of neurology which he founded at the At the recent Annual Congress of French - can readily be obtained. The work is hard, the hours are Salpebriere. Alienists and Neurologists held at Grenoble Dr. G. Lalanne and in cases conditions of the the sanitary curinglong, many The women coming from of Bordeaux presented a paper on States of Anxiety and ’houses are extremely defective. Allied Troubles in which an attempt was made to define and - a. distance have to find lodgings for themselves and it is to classify such conditions in the light of recent clinical and not a matter for surprise that the sudden inrush of many ’hundreds of women into a town like Great Yarmouth has pathological observation. The condition of anxiety, said In dealing with this Dr. Lalanne, was a malady in which circulatory and respiraa tendency to cause overcrowding. problem alone the local sanitary authorities must have their tory disturbances played a prominent part. It presented The processes of fish-curing, whether various degrees of intensity, from a condition of simple resources sorely tried. considered in the interests of the community at large or from apprehensiveness and restlessness to one of pain and prasthe point of view of the health of the worker, deserve greater cordial distress, attended with feelings of suffocatioa attention than they have yet received. The preliminary pro-’ and of impending death. From an etiological standpoint there was often no apparent external cause for such manicess of cleansing the fish and removing the intestines is festations. The patient was anxious in spite of himself and not infrequently performed in places which are neither prowithout knowing why. It was only recently that the clinical perly drained nor paved, a fact to which attention has 1 " had been separated from the general group state "anxiety" THE of LANCET. The preparation already been directed in the fish for kippering is done under cover, but the buildingsIof emotions. The exciting causes were sometimes physical sometimes psychical. The following somatic disturb.are often defective in regard to the flooring, the irregu-and were found to accompany such anxiety "--viz., ances rarities of which make it practically impossible to prevent and paraesthesias of the organs of sense, retracansesthesias ,the accumulation of decomposing organic matter. It has 1tion and feelings of cold " of the skin, horripilation, been suggested that fish-curing is unsuitable for ’women. To such a sweeping assertion exception must be vertigo, a tendency to muscular tremor, and loss of coördiJ of fine movements. Prasoordial distress and oppression taken. The conditions under which the work is now carriednation 1 also felt in varying degrees, from slight distress to severe were on should be altered, but it would be a cruel hardship on ‘and death-like agony. Coldness of the extremities, pallor of n industrious class if they were to be deprived of their t and sweats were generally present. These the cold face, principal means of livelihood. Nothing can justify a conand of vaso-motor were cardiac disturbmainly symptoms ’tincance of the present conditions of some of the workplaces, and although it may be true it does not do awayance. Respiration was also modified, inspiration being jerky (saooadée) and accompanied with sighs. Gastro.intestinal dis1 THE turbance was present and diarrhoea was one of the symptoms. 1060. LANCET, Oct. 19th, 1901, p.
Should
>the
young
1567 as a rule. The salivary änd gastric upon his resignation he was elected consulting surgeon to the" usually deticient and digestion was retarded, hospital and also a governor, while the school committeeAmong the psychical disturbances were vague fears and recommended to the governors that he should be asked to mental obsessions, slight confusion of thought, and some de- deliver a course of lectures on clinical surgery. We are g}ad’ fect of the power of attention and of recollection. There was, to learn that Mr. Butlin’s teaching connexion with Stsaid Dr. Lalanne, an intermediate condition between simple Bartholomew’s Hospital is not completely severed by his. anxiety with depression and the "anxious melancholia"of withdrawal from the active surgical staff. the alienist. This transition was furnished by "melancholia with prasoordial anguish"" (Krafft Ebing). Attacks of prsoON St. Andrew’s Eve (Nov. 29th) the Commendator?cordial pain and distress of paroxysmal character marked Dr. Lapponi, body-physician to Leo XIII., made his first, the last named and were especially liable to occur in the appearance at the Vatican after the serious operation which morning. In the classical forms of established and chronic he recently underwent at the hands of his colleague, Dy. anxious melancholia the following stages could usually be Guido Mazzoni, surgeon to His Holiness. Fully re-established traced-viz., first a stage of simple melancholic depre-sion : in health Dr. Lapponi thanked the Pope for his affectiomatesecondly, a period of doubt and mental perplexity in which solicitude in his behalf and received, in reply, the cordial the patient showed a tendency to brooding and seclusion ; congratulations of His Holiness on his resumption of the thirdly, a delusional stage in which were developed delusionsduties he so ably discharges as Archiatro Pontificio. " of ruin, damnation, possession by malign agencies, and the like ; and, lastly, a stage of chronicity in which Hrs MAJESTY THE KixG, patron of the Middlesex the above forms of delusions were succeeded by a trans- Hospital, has been graciously pleased to send the sum of formation of - the ego or sense of personal identity. E100 as an annual subscription to the hospital. The subIn this last stage a phase of megalomania of a special scription is in continuance of the contribution which haskind, described by Cotard as 11 d6tire d’enormite," was been made by reigning sovereigns during the past 100 years. often observed. In persons with a hereditary tendency His Majesty has also sent ten brace of pheasants for the’ to insanity the occurrence of states of anxiety should give benefit of the patients. cause for serious thought. Such states might be the prelude THE council of King’sCollege has made the foHowmg to an attack of mania, melancholia, or circular insanity, or they might herald an outbreak of dangerous frenzy with appointments at King’s College Hospital in consequence of suicidal or destructive and murderous impulses. Such the resignation of the chair of clinical surgery by Mr-results were seen in both sexes and more frequently in the W. Rose :-Mr. W. Watson Cheyne, C.B., F.R.8., to be female sex, the affection occurring most often between the professor of clinical surgery ; Mr. A. Carless to be professor ages of 20 and 30 years. In children the malady showed of surgery ; and Mr. F. F. Burghard to be teacher of operativeitself in the form of morbid fears ; in adolescents and young surgery. adults it led to attacks and dangerous impulses of the Dr. A. E. Wright is resigning his appointment as professor form above mentioned ; and in the middle-aged and elderly of pathology at the Army Medical School and has accepted} it developed into persistent and refractory melancholia. As the Lalanne advocates post of pathologist and bacteriologist to St. Mary’sDr. systematic hydroregards treatment, therapy to overcome the circulatory and physical weakness, Hospital. gymnastics or muscular exercise in moderation, rest in bed Sir Michael Foster is understood to be about to resign during the stages of mental confusion and acute melancholy, his seat as member of Parliament for the University of the administration of morphia, codeine, bromides, and London. chloral to secure sleep, and the use of nitro-glycerine and amyl nitrite to relieve attacks of prascordial spasm and anguish. Cold baths were, he considered, bad. as they tended REPORT ON AN OUTBREAK OF TYPHOIDto increase vaso- constriction and cardiac distress and thereFEVER AND OTHER ILLNESS fore preference should be given to tepid baths. DUE TO OYSTERS.
Polyuria
was
secretions
present
were
’’
"
I
-
-
-
THE
PREVALENCE
BY JOHN C.
OF SMALL-POX
Wednesday, Dec. 3rd, there was 1 fresh case of small-pox admitted to the hospitals of the Metropolitan Asylums Board. The Local Government Board for Scotland intimates that during the period from Nov. 16th to 30th 8 cases of small-pox have been notified to them-viz., 1 case in the Ayr district, 1 case in the Dundee district, 1 case in the Burgh of Arbroath, and 5 cases in the Burgh of Dundee.
THRESH, M.D. VICT., D.SC. LOND., &C.,
MEDICAL OFFICER OF HEALTH TO THE ESSEX COUNTY COUNCIL LECTURER ON PUBLIC HEALTH, LONDON HOSPITAL MEDICAL COLLEGE ;
ON
;
AND
F. L. WOOD, M.B. VICT., D.P.H. R.C.P.S. LOND., ASSISTANT TO THE MEDICAL OFFICER OF HEALTH TO THE ESSEX COUNTY COUNCIL.
!
TowARDS the end of the past summer numerous cases of fever occurred in the county of Essex which were THE council of the Clinical Society of London desires to attributed by the medical officers of health who investigated make it. known that a considerable number of copies of their origin to the eating of cockles or oysters. A number volumes of the Transactions of the society have accu- of these cases have recently been reported upon by Drmulated in past years and that it proposes to distribute J. T. C. Nash, the medical officer of health of the borough of them to such members of the profession as may wish to have Southend. Apart from the cases at Southe:.d no connected’ them, in order of application and free of all cost except that series of heard of until Sept. 29th, when attention.. of packing and carriage. Applications for volumes will be was arrested by an alarming newspaper report of an outreceived until Jan. lst, 1903. They should be addressed to break of typhoid fever or other illness alleged to havethe.Secretary of the Clinical Society, 20, Hanover-square, occurred at Mistley aud Bradfield, parishes on the extreme noithern boundary of the county. Dr J. W. Cook, the; London, W. The volumes required should be specified. medical officer of health of the iural district in which these are situated, had previously reported upon Mr. H. T. Butlin, through pressure of private engage- severalparishes cases of, typhoid fever which had occurred in various ments, has been reluctantly compelled to resign his appoint- parts of the district and which were appanntly due to ment as surgeon to St. Bartholomew’s Hospital. Immediately eating oysters derived from what is known as the St. Oyttt
typhoid
cases were
fully
IS FISH-CURING A
DANGEROUS TRADE?
at home to show that when the Scotswomen Iwith the evil There not in better be little doubt are
they
are
a
place.
can
time goes on the fish-curing industry will be brought more directly under the supervision of the inspectors of factories and workshops, and it seems probable that t. accomplish this end Section 41 of the Workshop Act, 1901 (1 Edward VII. cap. 22), may be of use, but it is perhaps uncertain whether the Secretary of State is empowered under this clause to make regulations by special order in the case of fbh- as well as of fruit-preserving. Should he be empowered to do so it seems possible that changes for the better might be rapidly effected in the sanitary state of the factories. As matters stand at present the local authorities occasionally display a lack of activity, as in a case which lately occurred of a corporation which owned the site on the beach which was used for cleaning the fish. A sudden revolution in the working of a large industry is not to be expected, nor could it be brought about without causing great suffering which would inevitably fall chiefly on those least able to protect themselves—in this case the fbh cleaners and the poor for whom bloaters are a staple article of food. Local sanitary authorities will do well in the interests not only of the health of the workers but also of the pockets of manufacturers if they will carry out to the full the provisions of the Publie Health Act. they fail to do so without delay there is no doubt that a serious attempt will be made to prove that fish-curing is a dangerous trade. Not a little has indeed already been written to that end. that
as
VERY large catches of herrings have lately been made off eastern coast of England. Great Yarmouth, as everyone knows, is one of the chief towns in which this fish is cured, but few people are acquainted with the details of the work or have any conception of the way in which it is carried out. Women are largely employed and a great proportion of them ’It has been computed that of 90,000 come from Scotland. THE CAUSATION AND TREATMENT OF STATES Scots who are engaged in the fishing industry about a OF MENTAL ANXIETY AND ALLIED .quarter are women who spend some part of their time in CONDITIONS. he curing of fish. This estimate is a very rough one and THE study of phenomena formerly regarded as purely shoald not be taken as anything more than conjecture and it is only necessary to insist that there is no doubt that the psychological but considered now as legitimate objects of Scottish women engaged in the trade are to be reckoned by clinical and neurological investigation has served during the thousand. Some of these women and girls go south with recent years to throw a flood of light on many nervous and the fishing boats and follow the herrings round the coast. mental conditions which occupy the borderland between During the present year the heavy catches have occurred health and disease. For some of the most fruitful achieve rather late in the season and large numbers of the women ments in this direction we have been indebted to Charcot have been glad to start at once for a place at which work and the school of neurology which he founded at the At the recent Annual Congress of French - can readily be obtained. The work is hard, the hours are Salpebriere. Alienists and Neurologists held at Grenoble Dr. G. Lalanne and in cases conditions of the the sanitary curinglong, many The women coming from of Bordeaux presented a paper on States of Anxiety and ’houses are extremely defective. Allied Troubles in which an attempt was made to define and - a. distance have to find lodgings for themselves and it is to classify such conditions in the light of recent clinical and not a matter for surprise that the sudden inrush of many ’hundreds of women into a town like Great Yarmouth has pathological observation. The condition of anxiety, said In dealing with this Dr. Lalanne, was a malady in which circulatory and respiraa tendency to cause overcrowding. problem alone the local sanitary authorities must have their tory disturbances played a prominent part. It presented The processes of fish-curing, whether various degrees of intensity, from a condition of simple resources sorely tried. considered in the interests of the community at large or from apprehensiveness and restlessness to one of pain and prasthe point of view of the health of the worker, deserve greater cordial distress, attended with feelings of suffocatioa attention than they have yet received. The preliminary pro-’ and of impending death. From an etiological standpoint there was often no apparent external cause for such manicess of cleansing the fish and removing the intestines is festations. The patient was anxious in spite of himself and not infrequently performed in places which are neither prowithout knowing why. It was only recently that the clinical perly drained nor paved, a fact to which attention has 1 " had been separated from the general group state "anxiety" THE of LANCET. The preparation already been directed in the fish for kippering is done under cover, but the buildingsIof emotions. The exciting causes were sometimes physical sometimes psychical. The following somatic disturb.are often defective in regard to the flooring, the irregu-and were found to accompany such anxiety "--viz., ances rarities of which make it practically impossible to prevent and paraesthesias of the organs of sense, retracansesthesias ,the accumulation of decomposing organic matter. It has 1tion and feelings of cold " of the skin, horripilation, been suggested that fish-curing is unsuitable for ’women. To such a sweeping assertion exception must be vertigo, a tendency to muscular tremor, and loss of coördiJ of fine movements. Prasoordial distress and oppression taken. The conditions under which the work is now carriednation 1 also felt in varying degrees, from slight distress to severe were on should be altered, but it would be a cruel hardship on ‘and death-like agony. Coldness of the extremities, pallor of n industrious class if they were to be deprived of their t and sweats were generally present. These the cold face, principal means of livelihood. Nothing can justify a conand of vaso-motor were cardiac disturbmainly symptoms ’tincance of the present conditions of some of the workplaces, and although it may be true it does not do awayance. Respiration was also modified, inspiration being jerky (saooadée) and accompanied with sighs. Gastro.intestinal dis1 THE turbance was present and diarrhoea was one of the symptoms. 1060. LANCET, Oct. 19th, 1901, p.
Should
>the
young
1567 as a rule. The salivary änd gastric upon his resignation he was elected consulting surgeon to the" usually deticient and digestion was retarded, hospital and also a governor, while the school committeeAmong the psychical disturbances were vague fears and recommended to the governors that he should be asked to mental obsessions, slight confusion of thought, and some de- deliver a course of lectures on clinical surgery. We are g}ad’ fect of the power of attention and of recollection. There was, to learn that Mr. Butlin’s teaching connexion with Stsaid Dr. Lalanne, an intermediate condition between simple Bartholomew’s Hospital is not completely severed by his. anxiety with depression and the "anxious melancholia"of withdrawal from the active surgical staff. the alienist. This transition was furnished by "melancholia with prasoordial anguish"" (Krafft Ebing). Attacks of prsoON St. Andrew’s Eve (Nov. 29th) the Commendator?cordial pain and distress of paroxysmal character marked Dr. Lapponi, body-physician to Leo XIII., made his first, the last named and were especially liable to occur in the appearance at the Vatican after the serious operation which morning. In the classical forms of established and chronic he recently underwent at the hands of his colleague, Dy. anxious melancholia the following stages could usually be Guido Mazzoni, surgeon to His Holiness. Fully re-established traced-viz., first a stage of simple melancholic depre-sion : in health Dr. Lapponi thanked the Pope for his affectiomatesecondly, a period of doubt and mental perplexity in which solicitude in his behalf and received, in reply, the cordial the patient showed a tendency to brooding and seclusion ; congratulations of His Holiness on his resumption of the thirdly, a delusional stage in which were developed delusionsduties he so ably discharges as Archiatro Pontificio. " of ruin, damnation, possession by malign agencies, and the like ; and, lastly, a stage of chronicity in which Hrs MAJESTY THE KixG, patron of the Middlesex the above forms of delusions were succeeded by a trans- Hospital, has been graciously pleased to send the sum of formation of - the ego or sense of personal identity. E100 as an annual subscription to the hospital. The subIn this last stage a phase of megalomania of a special scription is in continuance of the contribution which haskind, described by Cotard as 11 d6tire d’enormite," was been made by reigning sovereigns during the past 100 years. often observed. In persons with a hereditary tendency His Majesty has also sent ten brace of pheasants for the’ to insanity the occurrence of states of anxiety should give benefit of the patients. cause for serious thought. Such states might be the prelude THE council of King’sCollege has made the foHowmg to an attack of mania, melancholia, or circular insanity, or they might herald an outbreak of dangerous frenzy with appointments at King’s College Hospital in consequence of suicidal or destructive and murderous impulses. Such the resignation of the chair of clinical surgery by Mr-results were seen in both sexes and more frequently in the W. Rose :-Mr. W. Watson Cheyne, C.B., F.R.8., to be female sex, the affection occurring most often between the professor of clinical surgery ; Mr. A. Carless to be professor ages of 20 and 30 years. In children the malady showed of surgery ; and Mr. F. F. Burghard to be teacher of operativeitself in the form of morbid fears ; in adolescents and young surgery. adults it led to attacks and dangerous impulses of the Dr. A. E. Wright is resigning his appointment as professor form above mentioned ; and in the middle-aged and elderly of pathology at the Army Medical School and has accepted} it developed into persistent and refractory melancholia. As the Lalanne advocates post of pathologist and bacteriologist to St. Mary’sDr. systematic hydroregards treatment, therapy to overcome the circulatory and physical weakness, Hospital. gymnastics or muscular exercise in moderation, rest in bed Sir Michael Foster is understood to be about to resign during the stages of mental confusion and acute melancholy, his seat as member of Parliament for the University of the administration of morphia, codeine, bromides, and London. chloral to secure sleep, and the use of nitro-glycerine and amyl nitrite to relieve attacks of prascordial spasm and anguish. Cold baths were, he considered, bad. as they tended REPORT ON AN OUTBREAK OF TYPHOIDto increase vaso- constriction and cardiac distress and thereFEVER AND OTHER ILLNESS fore preference should be given to tepid baths. DUE TO OYSTERS.
Polyuria
was
secretions
present
were
’’
"
I
-
-
-
THE
PREVALENCE
BY JOHN C.
OF SMALL-POX
Wednesday, Dec. 3rd, there was 1 fresh case of small-pox admitted to the hospitals of the Metropolitan Asylums Board. The Local Government Board for Scotland intimates that during the period from Nov. 16th to 30th 8 cases of small-pox have been notified to them-viz., 1 case in the Ayr district, 1 case in the Dundee district, 1 case in the Burgh of Arbroath, and 5 cases in the Burgh of Dundee.
THRESH, M.D. VICT., D.SC. LOND., &C.,
MEDICAL OFFICER OF HEALTH TO THE ESSEX COUNTY COUNCIL LECTURER ON PUBLIC HEALTH, LONDON HOSPITAL MEDICAL COLLEGE ;
ON
;
AND
F. L. WOOD, M.B. VICT., D.P.H. R.C.P.S. LOND., ASSISTANT TO THE MEDICAL OFFICER OF HEALTH TO THE ESSEX COUNTY COUNCIL.
!
TowARDS the end of the past summer numerous cases of fever occurred in the county of Essex which were THE council of the Clinical Society of London desires to attributed by the medical officers of health who investigated make it. known that a considerable number of copies of their origin to the eating of cockles or oysters. A number volumes of the Transactions of the society have accu- of these cases have recently been reported upon by Drmulated in past years and that it proposes to distribute J. T. C. Nash, the medical officer of health of the borough of them to such members of the profession as may wish to have Southend. Apart from the cases at Southe:.d no connected’ them, in order of application and free of all cost except that series of heard of until Sept. 29th, when attention.. of packing and carriage. Applications for volumes will be was arrested by an alarming newspaper report of an outreceived until Jan. lst, 1903. They should be addressed to break of typhoid fever or other illness alleged to havethe.Secretary of the Clinical Society, 20, Hanover-square, occurred at Mistley aud Bradfield, parishes on the extreme noithern boundary of the county. Dr J. W. Cook, the; London, W. The volumes required should be specified. medical officer of health of the iural district in which these are situated, had previously reported upon Mr. H. T. Butlin, through pressure of private engage- severalparishes cases of, typhoid fever which had occurred in various ments, has been reluctantly compelled to resign his appoint- parts of the district and which were appanntly due to ment as surgeon to St. Bartholomew’s Hospital. Immediately eating oysters derived from what is known as the St. Oyttt
typhoid
cases were