A CONGRESS OF PUBLIC HEALTH
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1139 .earnest and scrupulous regard for others-qualities estimable in their proper place, but in these cases recognisable as indications of one type of " nervous " .disorder and suggesting to the psychopathologist other and deeper emotional stresses. This boy was .described as capable, hard-working, and brave, the only evidence of emotional stress being a casual observation that he was subject to notable phases of silence. It is possible that the matter of fagging served as a point of fixation of troubles dependent upon deeper emotional difficulties, just as in the other cases we hear that the victim persistently worried over matters that others regarded as trivial or non-existent. It is the essence of some disorders that the patient suffers from anxiety of unconscious origin ; this ..anxiety must be transferred to something in the world outside, and it may then appear as irrational and .absurd. Perhaps the day will come when we shall be able to recognise temperamental difficulties in young people and give timely aid, just as we have already learnt to watch over the physical well-being of the child without waiting for the development of disease. INFECTION IN ST, KILDA. ST. KILDAlies 40 miles west of Northern Uist, and is the most isolated of the British Isles. This spring the relief ship sent out by the Scottish Health Department only effected a landing with difficulty at the second attempt, and informer times the island was regarded as almost inaccessible during eight months of the year. These circumstances have long deserved the attention of epidemiologists, and the name of St. Kilda has, in fact, become familiar to the profession in more than one connexion. It is well known, for instance, that formerly more than half the children born on the island died of tetanus neonatorum-a state of affairs which lasted as late as 1890, when Nurse Chisnell began her ministrations. This peculiar mortality had been variously explained before its cause was discovered, and there have been at least as many .explanations of the strange way in which the St. Kildeans take cold on the arrival of the first boat - of the season. In his " Life of Johnson," Boswell relates that when Macaulay wrote his account of the island, " he was advised to leave out of his book the ’Wondl3rful story that upon the approach of a stranger -all the inhabitants catch cold." To which Johnson replied, "Sir, to leave things out of a book, ’-merely because people tell you they will not be believed, is meanness." Dr. John Campbell, it appears, took -a great deal of pains to ascertain the facts, and attempted to account for them " on physical principles, from the effect of effluvia from human bodies." But a lady of Norfolk wrote to Boswell to say that the 44 explication of this seeming mystery " was so very obvious as to have escaped attention. " Reading the book," she said, " with my ingenious Mend, the late Reverend Mr. Christian of Docking-after ruminating a little, The cause, (says he,) is a natural one. The situation of St. Kilda renders a north-east wind indis- pensably necessary before a stranger can land ; the wind, not the stranger, occasions an epidemick cold." As in the time of Mr. Christian, the need of ’epidemiology to-day is for accurate data, and St. Kilda might still provide some. A few years ago almost every inhabitant took whooping-cough, but unfor- tunately this incidence of infection on the virgin soil of an adult population could not be studied -as it deserved. The opportunity for medical research on the island still exists, but it is rapidly passing. The native population-109 in 1852-is now only 38, to whom should be added the missionary and his family, and the nurse provided by the Highlands and Islands Medical Service. Attempts have often been made to get the inhabitants to leave their home, for it has not fully supported them within living memory. Soon, moreover, there may not be enough men to take boats across to the - neighbouring islands where they keep sheep. The -captain of the relief trawler says that all save two old men would now be willing to leave, but our Scottish correspondent thinks this is " too good to be true." It does not allow, he says, for the nostalgia of the islander, and he doubts whether the main- tenance of the remnant would be any less expensive on the mainland. Meanwhile we learn that a geologist lately spent a long period in verifying the structure of the island, and it seems likely that a medical research student of suitable gifts could make some- thing equally important out of its unusual human material. INSULIN BY NOSE AND MOUTH. I MANY attempts have been made to devise means of administering insulin which will be free from the inconvenience of daily hypodermic injections. Recently H. Wassermeyer and A. Schiiferl have recorded observations on absorption of the hormone from the nasal mucous membrane, when applied either on tampons or in the form of snuff. They find definite evidence that some degree of absorption occurs, the blood-sugar-both in the diabetic and in the normal subject-falling appreciably during three hours fol- lowing the application. Unfortunately, the fall in the blood-sugar is not proportional to the dose of insulin employed. 100 units have no greater effect than 20 units, and it is apparently impossible to reduce the blood- sugar sufficiently to evoke hypoglycaemic symptoms. Since the successful management of diabetes entails a nice adaptation of the dose of insulin to the varying tolerance of the patient, and since any chance catarrhal inflammation of the absorbing surface must adversely influence absorption, it is evident that the scope of intranasal insulin therapy is severely limited. Another and more ambitious attempt to solve the same problem has been even less successful. It has been claimed that insulin, when mixed with desoxycholin, is rendered immune to the destructive action of the digestive ferments and can thus be administered by the mouth. D. Kwilecki and K. Silberstein,2 however, have failed to find any evidence that this preparation (Cholosulin) is of value in diabetes, and they observed dyspeptic symptoms in several patients to whom it was given. Cholosulin, even in such heroic doses as 200 units, does not depress the fasting blood-sugar. If it is given several hours before a meal it certainly tends to lessen the subsequent rise in ’blood-sugar, but this may well be due to the nausea which it undoubtedly provokes. The hypodermic syringe remains indispensable to the diabetic requiring insulin. A CONGRESS OF PUBLIC HEALTH. Major-General J. E. B. Seely, as Lord Lieutenant of Hampshire, will preside over the annual congress of the Royal Institute of Public Health which meets at Portsmouth at Whitsuntide. After an inaugural session on the morning of Wednesday, June 4th, at which he will give an address on Health and Courage, the congress will adjourn until the following day, when the sectional meetings begin at the Guildhall. The two principal discussions in the Section of State Medicine will be on National Health and the Local Government Act, and on the Slum Problem. Prof. H. R. Kenwood’s presidential address will be on the Reduction of Preventable Disease, and among the papers contributed will be one by Dr. C. 0. Stally- brass on Variations in Virulence during the Course of Epidemics. Prof. Rene Cruchet, of Bordeaux, will address the Services Section on Post-encephalitic Parkinsonism and Military Pensions, and Dr. J. B. Christopherson will speak on the R61e of Dress in the Tropics in Relation to Health and Disease. The chief subjects before the Section of Industrial Hygiene-as is suitable for a Portsmouth meeting- are Health in Seafaring Occupations and the Health of Dockyard Workers ; while the section 1 Med. Klin,, March 28th, p. 474. Ibid., April 4th, p. 513.
Transcript of A CONGRESS OF PUBLIC HEALTH
1139
.earnest and scrupulous regard for others-qualitiesestimable in their proper place, but in these casesrecognisable as indications of one type of
" nervous ".disorder and suggesting to the psychopathologistother and deeper emotional stresses. This boy was.described as capable, hard-working, and brave, theonly evidence of emotional stress being a casualobservation that he was subject to notable phases ofsilence. It is possible that the matter of faggingserved as a point of fixation of troubles dependentupon deeper emotional difficulties, just as in the othercases we hear that the victim persistently worried overmatters that others regarded as trivial or non-existent.It is the essence of some disorders that the patientsuffers from anxiety of unconscious origin ; this
..anxiety must be transferred to something in the worldoutside, and it may then appear as irrational and.absurd. Perhaps the day will come when we shall be ableto recognise temperamental difficulties in young peopleand give timely aid, just as we have already learnt towatch over the physical well-being of the child withoutwaiting for the development of disease.
INFECTION IN ST, KILDA.ST. KILDAlies 40 miles west of Northern Uist, and is
the most isolated of the British Isles. This spring therelief ship sent out by the Scottish Health Departmentonly effected a landing with difficulty at the secondattempt, and informer times the island was regarded asalmost inaccessible during eight months of the year.These circumstances have long deserved the attentionof epidemiologists, and the name of St. Kilda has, infact, become familiar to the profession in more thanone connexion. It is well known, for instance, thatformerly more than half the children born on theisland died of tetanus neonatorum-a state of affairswhich lasted as late as 1890, when Nurse Chisnellbegan her ministrations. This peculiar mortalityhad been variously explained before its cause wasdiscovered, and there have been at least as many.explanations of the strange way in which theSt. Kildeans take cold on the arrival of the first boat- of the season. In his " Life of Johnson," Boswellrelates that when Macaulay wrote his account of theisland, " he was advised to leave out of his book the’Wondl3rful story that upon the approach of a stranger-all the inhabitants catch cold." To which Johnsonreplied, "Sir, to leave things out of a book,’-merely because people tell you they will not be believed,is meanness." Dr. John Campbell, it appears, took-a great deal of pains to ascertain the facts, andattempted to account for them " on physical principles,from the effect of effluvia from human bodies." Buta lady of Norfolk wrote to Boswell to say that the44 explication of this seeming mystery " was so veryobvious as to have escaped attention.
" Reading the book," she said, " with my ingeniousMend, the late Reverend Mr. Christian of Docking-afterruminating a little, The cause, (says he,) is a natural one.The situation of St. Kilda renders a north-east wind indis-pensably necessary before a stranger can land ; the wind,not the stranger, occasions an epidemick cold."
As in the time of Mr. Christian, the need of’epidemiology to-day is for accurate data, and St. Kildamight still provide some. A few years ago almostevery inhabitant took whooping-cough, but unfor-tunately this incidence of infection on the virginsoil of an adult population could not be studied-as it deserved. The opportunity for medicalresearch on the island still exists, but it israpidly passing. The native population-109 in1852-is now only 38, to whom should be added themissionary and his family, and the nurse providedby the Highlands and Islands Medical Service.Attempts have often been made to get the inhabitantsto leave their home, for it has not fully supportedthem within living memory. Soon, moreover, theremay not be enough men to take boats across to the- neighbouring islands where they keep sheep. The-captain of the relief trawler says that all save two
old men would now be willing to leave, but ourScottish correspondent thinks this is
" too good to betrue." It does not allow, he says, for the nostalgiaof the islander, and he doubts whether the main-tenance of the remnant would be any less expensiveon the mainland. Meanwhile we learn that a geologistlately spent a long period in verifying the structureof the island, and it seems likely that a medicalresearch student of suitable gifts could make some-thing equally important out of its unusual human
material. ____
INSULIN BY NOSE AND MOUTH.
I MANY attempts have been made to devise meansof administering insulin which will be free fromthe inconvenience of daily hypodermic injections.Recently H. Wassermeyer and A. Schiiferl haverecorded observations on absorption of the hormonefrom the nasal mucous membrane, when applied eitheron tampons or in the form of snuff. They find definiteevidence that some degree of absorption occurs, theblood-sugar-both in the diabetic and in the normalsubject-falling appreciably during three hours fol-lowing the application. Unfortunately, the fall in theblood-sugar is not proportional to the dose of insulinemployed. 100 units have no greater effect than 20 units,and it is apparently impossible to reduce the blood-sugar sufficiently to evoke hypoglycaemic symptoms.
Since the successful management of diabetes entailsa nice adaptation of the dose of insulin to the varyingtolerance of the patient, and since any chance catarrhalinflammation of the absorbing surface must adverselyinfluence absorption, it is evident that the scope ofintranasal insulin therapy is severely limited. Anotherand more ambitious attempt to solve the same problemhas been even less successful. It has been claimedthat insulin, when mixed with desoxycholin, isrendered immune to the destructive action of thedigestive ferments and can thus be administered bythe mouth. D. Kwilecki and K. Silberstein,2 however,have failed to find any evidence that this preparation(Cholosulin) is of value in diabetes, and they observeddyspeptic symptoms in several patients to whom itwas given. Cholosulin, even in such heroic doses as200 units, does not depress the fasting blood-sugar. Ifit is given several hours before a meal it certainlytends to lessen the subsequent rise in ’blood-sugar,but this may well be due to the nausea which itundoubtedly provokes.The hypodermic syringe remains indispensable to
the diabetic requiring insulin.
A CONGRESS OF PUBLIC HEALTH.
Major-General J. E. B. Seely, as Lord Lieutenantof Hampshire, will preside over the annual congress ofthe Royal Institute of Public Health which meets atPortsmouth at Whitsuntide. After an inauguralsession on the morning of Wednesday, June 4th, atwhich he will give an address on Health and Courage,the congress will adjourn until the following day,when the sectional meetings begin at the Guildhall.The two principal discussions in the Section of StateMedicine will be on National Health and the LocalGovernment Act, and on the Slum Problem. Prof.H. R. Kenwood’s presidential address will be on theReduction of Preventable Disease, and among thepapers contributed will be one by Dr. C. 0. Stally-brass on Variations in Virulence during the Course ofEpidemics. Prof. Rene Cruchet, of Bordeaux, willaddress the Services Section on Post-encephaliticParkinsonism and Military Pensions, and Dr. J. B.Christopherson will speak on the R61e of Dress in theTropics in Relation to Health and Disease. Thechief subjects before the Section of IndustrialHygiene-as is suitable for a Portsmouth meeting-are Health in Seafaring Occupations and theHealth of Dockyard Workers ; while the section
1 Med. Klin,, March 28th, p. 474.Ibid., April 4th, p. 513.
1140
concerned with women and children will have dis-cussions on the Slum Child, and on the Prevention ofSickness and Death in Motherhood. Before thissection Dr. Doris Odlum will speak on Home and theAdolescent, Mr. W. Clarke Hall on the Problem of theDelinquent Child, and Lieut.-Colonel R. KuperWhite on Post-puerperal Disabilities in Women.Sir Henry Gauvain’s presidential address to theSection of Tuberculosis will deal with Sun Treatmentin England, and Mr. H. Morriston Davies will open adiscussion on the Present Position of Surgical Treat-ment of Pulmonary Tuberculosis.Each of the sections has arranged visits to centres
of interest in the locality, and there are, as usual,various excursions and functions for the congress asa whole. Application for membership may be madeto the hon. secretaries of the Institute, 37, Russell-square, London, W.C.1.
MENTAL HYGIENE IN PUBLIC HEALTH.
A NEW conception of preventive medicine andpublic health work was outlined by Prof. HavenEmerson in his address to the First InternationalCongress on Mental Hygiene held in Washingtonearly this month. He spoke of mental hygiene as apublic health problem and gave convincing argumentsin support of his thesis that the public health servicein its present form is inadequate to th needs of thecommunity. The control of communicable diseases,the protection of maternity and infancy, the detectionof physical defects or even of feeble-mindedness inchildren, and so forth, can no longer be considered the Iwhole duty of the health officer. In the future Ihe may be called upon to account to his con-
stituency for the incidence of suicides, showingcorrelations perhaps with unemployment, the preva-lence of divorce, heredity, sex, and occupation.The fact that the diabetes death-rate in America hasrisen in the last 70 years from approximately5 to 20 per hundred thousand is important enoughbut is of less real moment to the community than thatthe suicide-rate has risen in the same proportion.It is questionable, he continued, whether investigationof the reasons for a rising death-rate from appendicitisis any more necessary than the analysis, with a viewto prevention, of the conditions which have broughtabout a rise in the divorce-rate from 26. to 68 perhundred thousand in less than 50 years. He didnot minimise the importance of diphtheria swabs andtyphoid inoculations, but urged that the psychologicalwelfare of the community should also receive attention.According to experienced child-guidance workers,in any unselected group of children of four years ofage, considered by their parents to be normal, morethan one-third are found on investigation to havecharacteristic behaviour problems which are likely todevelop into personal or family embarrassments. Itis not a matter of intelligence, to be dismissed as aproblem that the proper ascertainment of defectiveswould solve. These ill-adjusted children are foundamong the dull, the average, and the precocious.Evidence of deviation from good mental health mayinclude extreme shyness, severe speech, defects,and themore precise phenomena of tantrums, interferencewith appetite for and use of food, and enuresis. Theproblem of public health, according to Prof. Emerson,is to include in the plan of service to parents suchpersonnel as can be trusted to notice aberrations ofconduct in the home, to advise parents to seekprofessional guidance when necessary, and to dealwith early and mild disturbances in this field in thesame way as health visitors deal with physiologicalerrors in the field of growth, nutrition, and infection.The community should see that the psychiatrist getsto the mean lazy ne’er-do-well before the policemandoes, and that the bully, the fearful cnild, and themiserable man meets a wise social worker before he isforced into an institution.
This stimulating address was a fitting introductionto the deliberations of a congress so important that
53 countries were represented and so interesting to theAmerican people that an audience of over 3000
persons attended the inaugural session. Some of thescientific communications made to the congress werereported in THE LANCET of last week, and anothErgroup will be found on p. 1148. The history of themental hygiene movement, from its inception in 1908,has been one of almost miraculously rapid develop-ment. The source of the movement, as Dr. WilliamWhite pointed out in his presidential address, was thevision and zeal of one man. When he was a student atYale, Mr. Clifford Beers had a mental breakdownfrom which he completely recovered. He returned tothe community inspired with the purpose of savingothers from the sufferings which he himself hadundergone and the first committee on mental hygienewas formed in Connecticut with the single object ofimproving the conditions in mental hospitals. Thegrowth of the organisation was speedy, accelerated bythe strong public opinion created by Mr. Beer’s book"A Mind that Found Itself," and the concept ofdefinite curative treatment of the insane and of theprevention of insanity began to take shape. It wassoon felt that this aim, valuable as it was, constitutedonly one aspect of’mental hygiene, what might betermed the negative aspect. The positive aspect-the guidance of children, adolescents, and employees,which involves the education of parents, teachers, andemployers to the knowledge that abnormalities ofbehaviour at all ages are influenced less by reason thanby emotional undercurrents, is even moie important.The communications to the congress show how muchprogress has already been made by Americans and howgenerous has been their endeavour to stimulate actionin other countries. Partly through the good offices ofthe Commonwealth Fund, London is now equippedwith at least three child-guidance clinics and morewill come. The spirit of a few enthusiasts has flamedso brightly that it has compelled the attention of thewhole world.
___
RETIREMENT OF MR. HAYWARD PINCH.
THE retirement of Mr. A. E. Hayward Pinch,F.R.C.S., after 21 years’ work as medicalsuperintendent and director of the Radium Institute,is announced to take place in June next. Thereorganisation of the work of the institute, consequenton its affiliation with the Mount Vernon Hospital,and the setting up of the new Post-Graduate School ofRadiotherapy, is in progress, and Mr. Pinch’s stateof health prevents him from undertaking new andmore onerous duties. The committee of the RadiumInstitute, in announcing Mr. Pinch’s impendingretirement, put on record their appreciation of theservice he has given during his long tenureof office, and have elected him a member of the
honorary consulting staff.
THE sixth annual meeting of the National Institutefor the Deaf will be held at Church House,Westminster, on Friday next, May 30th, at 3 P.M.Lord Charnwood, the President of the Institute, willpreside, and Mr. Stanley Baldwin will address themeeting.
ROYAL INSTITUTION.-The Rockefeller Foundationhas offered .620,000 for endowment of research in the Davy-Faraday Laboratory on condition that z60,000 is raisedfrom other sources. This offer has been accepted.
JUVENILE BLINDNESS IN SCOTLAND.-Mr. WilliamAdamson, the Secretary for Scotland, recently opened largeextensions of the workshops of the Aberdeen Asylum forthe Blind, which have cost close upon .86000. Mr. Adamsonpointed out that the statistics warranted the hope that thenewly born blind would shortly entirely disappear in Scot-land. They have already done so in the north-east of Scot-land, there no longer being a single blind child under 6 yearsof age in the county or city of Aberdeen, or in the countiesof Banff and Kincardine.
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