1081

lines, every inmate helping in the work of the house.A weekly fee of J62 12s. includes residence and treat-ment at the clinic, as well as the benefit of occupa-tional classes twice weekly. The clinic has workedduring the past year in cooperation with the NationalCouncil for Mental Hygiene, as well as with otherkindred organisations, and combined efforts havedone much to help the financial situation. Never-theless, there is a deficit of nearly £500 on the year’saccounts, and an additional £1000 in annual sub-

scriptions is needed to place the work on a satisfactorybasis. That it is a work appreciated and neededis shown by the fact that the waiting-list has had tobe closed owing to the number of applicants, andthat there is at the present time an unofficial list ofsome 250 people waiting to be put on the waiting-list as soon as it is reopened.

FLUCTUATIONS IN VENEREAL DISEASE.

IN this self-satisfied age we may think that suchphrases as " genius epidemicus " are an anachronism,but it seems doubtful whether the factors governingthe rise and fall of the venereal diseases can even nowbe given any more accurate description than " mys-terious." The encouraging reports quoted in our

issue of April 26th (p. 927) are somewhat discountedby the story of the behaviour of these diseases inHelsingfors and in all Finland, which Dr. N. E. Wilencontributes to the February number of FinskaLakaresallskapets Handlingar. The curves for syphilis,gonorrhoea, and ulcus molle during the last two decadeshave been on the whole parallel, he says, and thus farit is evident that they have followed some commonlaw. But while measures directly devised for com-bating these -diseases seem to have influenced thembut little, social upheavals of various kinds apparentlyplayed a comparatively important part. The years1900, 1912, and 1923 showed the lowest dips in theincidence of the venereal diseases grouped as a whole ;they amounted to 7-2 per thousand inhabitants inthe first year, to 12-2 in 1912, and to 14-6 in 1923.The highest peaks were observed in 1905, 1917, and1927, the corresponding figures being 23-3, 27’8 and26-7 respectively. The Russianising of the Finnishpolice force in the period 1900—05, and the greatstrike of 1905 corresponded with high rates. Theregulation of prostitution was abolished on May 16th,1907, but the marked decline in the incidence of allthe venereal diseases about this time was demonstrablefrom 1905 to 1910-i.e., it occurred before as well as ’’

after this event. With regard to the possibility ofsalvarsan and allied drugs influencing the syphilisrate, it should be noted that it was not till after thelate war that these drugs were extensively used inHelsingfors. In 1910, the year when salvarsan wasintroduced, there were 12 new cases of syphilis per10,000 inhabitants in the capital. This figure roseconsiderably during the following years, attaininga peak of 54 in 1919. From this year till 1923 therewas a remarkable decline, the number of new casesbeing reduced in the last-named year to 16. Sincethen, however, there has been an almost unbrokenrise, the corresponding figure for 1929 being 29.Hence Dr. Wilen’s conclusion that " it would thereforeseem that salvarsan treatment is unable to counteractthe periodic increase in the incidence of this diseaseto the extent hoped for." His study of the incidenceof syphilis in Stockholm before and after the Swedishlaw (Jan. 1st, 1919) against venereal disease showsthat while there were only 32 new cases of syphilisfor every 10,000 inhabitants in 1918, this figure roseto 40 for 1919. It is true that the following yearsshowed a marked decline, and in 1925 there wereonly five new cases in Stockholm per 10,000 inhabi-tants. In 1927, however, this figure jumped to 12.What is still more remarkable is that, during thesepost-war years, the syphilis curves of Helsingfors andStockholm ran parallel to a striking degree, althoughthe venereal disease legislation of Sweden was notparalleled in Finland. Dr. Wilen concludes that

his Scandinavian studies give a certain degree ofsupport to the thesis of Buschke, Gumpert, andLanger, who in 1927 in the Miinchener medizinischeWochenschrift expressed doubts about the moderntreatment of syphilis being the chief factor in itsperiodic decline. These writers consider that theincidence of the venereal diseases is mainly deter-mined by economic and social factors, and that theexplanation for the fluctuations in their frequencyis to be found (or hidden) in the term " geniusepidemicus."

---

THE PSYCHOLOGY OF THE BLIND.

BEFORE the nineteenth century the blind in allcountries necessarily led isolated lives, and onlythose specially favoured by circumstances couldmanage by prodigious efforts to develop their faculties.Most people still find it hard to realise that a personblind from infancy, if only he is given the opportunityto develop those other senses which are relativelyunimportant to the sighted, can acquire a conscious-ness of the world in which he lives very little inferiorto that of the sighted person. This result, however,can only be attained by appropriate training, whichcan be bestowed on blind pupils collected in a school,but hardly on the isolated blind child. The movementfor the amelioration of the condition of the blindreally started in 1784, with the establishment in Parisof the first school ever known for blind children byValentin Hauy. The movement has continued togain momentum up to our own day, when the State- more especially in England-has taken the blindunder its special protection. Of this movement theBlind Persons Act of 1920, a measure aiming atthe organisation of voluntary effort throughout thecountry and its supplement by monetary aid from theState, probably marks the climax. Two booksrecently published give a clear account of the problemsinvolved in the care and education of the blind andof the psychological aspects of their development.Mr. Ritchie, who gives his principal attention to thehistory of the movement for the betterment of theblind, is also concerned with their mental processes.His last three chapters provide an excellent summaryof the consequences involved by the absence of thesense of sight on the mental content, behaviour, andcharacter. Prof. Villey, who provides a psycho-logical study of great value, complains that the blindare still victims of the ignorance of the public con-cerning their real position in the community.An excuse for this ignorance is that in some casesblindness is only part of a diseased condition of thebody that involves mental defect, but mostly this isnot so. The deprivation of a single sense, even themost important one, need not, by itself, render theblind man either intellectually or morally inferiorto his sighted neighbours. In reading the historyof the educational facilities offered to the blind theparamount importance of the invention of the Braillealphabet becomes obvious. Mr. Ritchie describesits struggle and final victory over competing systems,practically the only other survivor of these being theMoon system, which, being easier to learn, is moreadapted to the use of those who become blind latein life. The Braille alphabet, unlike its predecessors,abandoned any pretence of making the embossedletters adapted to the sense of touch resemble theletters adapted to the sense of sight. Full advantageis taken of the extreme sensitiveness of the finger-tips,and its success is largely due to this fact. The NationalLibrary is now a varied collection, showing not onlywise discrimination but a wide catholicity of choice,In the year ended in March, 1929, the number of

1 The World of the Blind. A psychological study by Pierre Villey, Professor of Literature, Caen University. Translatedby Alys Hallard. London : G. Duckworth and Co., Ltd. 1930.Pp. 403. 7s. 6d.—Concerning the Blind. Being a historicalsketch of organised effort on behalf of the blind of Great Britain,and some thoughts concerning the mental life of a person bornblind. By J. M. Ritchie, M.A., Ph.D. London: Oliver andBoyd. 1930. Pp. 235. 7s. 6d.

1082

volumes circulated reached the huge total of231,000.To account for the great facility with which many

of the educated blind go about their ordinary workor play many people, including even psychologists,have supposed that their surviving senses are moreacute than those of other people ; this explanationhas been applied especially to the deaf-blind. Moderninvestigations, however, disprove the assumption onwhich it rests. The minimum excitation necessaryfor provoking a tactile or auditive sensation is notless for a blind person than for one who sees. It isin the way that these sensations are interpreted by theblind that the superiority of the latter consists.Similarly, the shepherd and the townsman may eachpossess normal sight, but while the shepherd candistinguish each of his sheep individually, to thetownsman they appear all alike. Both books dealwith the various implications of the substitutionof one sense for another. The " sense of obstacles,"a faculty possessed by many of the blind which makesthem conscious of obstacles in their path, has been thesubject of much controversy. Monsieur Villey attri-butes it to the sense of hearing, whereas Mr. Ritchieholds that although the ear may take a leading partin this appreciation of obstacles, it acts rather as anorgan for the detection of pressure than as a vehiclefor sound. An interesting psychological problemdiscussed in both books concerns the conception ofspace possessed by the blind. To the ordinary manit is difficult to understand how a person born blindcan have mental images of objects at all resemblingthose of the sighted person. The fact is that theirimages are not unlike, but are reached by a differentmethod of interpretation. Visual images withoutmental analysis do not tell one much, as is illustratedby the mistakes made at first by a patient with con-genital cataract who obtains sight by operation inadult life. The sense of touch is an alternative channelto that of sight, and when interpreted by mentalprocesses may result in conception of the outsideworld, not perhaps as complete as that of the sighted,but still of the same order. All this is worked outat considerable length by Monsieur Villey, and moretersely by Mr. Ritchie, who discusses the extent towhich the limitations of the blind in this connexionaffect character. These considerations have a mostpractical bearing on the education of the blind, inwhich Mr. Ritchie has himself been engaged for manyyears. His final chapter in his book should appealto all who have to do with the blind in any capacity,even those who would use them as characters in fiction.

SLEEPING IN UNDERGROUND ROOMS.

THE use of underground rooms for sleeping purposesin London is subject to compliance with the provisionsof the Public Health (London) Act, 1891, the HousingAct, 1925, and especially the regulations made bylocal authorities under the latter Act. In Holbornthere recently has been occasion to consider questionsrelating to the construction of underground rooms.Plans for new buildings have to be submitted to theLondon County Council for approval under theLondon Building Act and to the local authority forapproval so far as drainage work is concerned.For the latter purpose plans were submitted inconnexion with a block of flats proposed to beconstructed in the borough. The plans disclosedan intention to construct underground sleepingrooms. It appeared that the rooms if constructedas shown on the plans would not comply with theregulations, and use of these for sleeping would havecalled for action to prevent illegal occupation. Itseems a weakness in public health law that nomunicipal authority has power to prevent the con-struction of underground rooms which would notbe in compliance with the regulations when usedas sleeping rooms. It is true that on occupationof the rooms the local authority could take steps todeal with the matter by way of closing order, but

such a course in the case of newly erected dwellingswould, to say the least of it, be inconvenient for thetenant who had moved in in all good faith, unecono-mical for the owner who might be faced with theloss of rent or considerable outlay for reconstruction,and harsh on the part of the local authority makinga closing order for part of newly erected premises.In the particular case in question after correspondenceand interviews the plans were amended and theunderground rooms brought into conformity withthe requirements. The absence, however, of anystatutory power to prevent such rooms being newlyconstructed led the borough housing committee toexpress the view that architects and others proposingto construct basement rooms in connexion withnew buildings should be required to submit for theapproval of the local authority complete plans withappropriate specification and a declaration that theunderground rooms proposed to be built would complywith all enactments dealing with the use of basementrooms. If the construction of such rooms cannot beentirely prevented it is not unreasonable to seekpowers to ensure that when completed they willcomply with the minimum requirements for livingpurposes. The borough council agreed with theviews expressed by their housing committee andadopted a resolution, copies of which were sent tothe Minister of Health and to the larger boroughcouncils asking them to take similar action. Up tothe present replies have been received, we understand,from 31 authorities; 25 supported the Holbornresolution, 6 disagreed or decided to take no action.

THE SURGICAL TREATMENT OF

HYPERINSULINISM.HYPERiNSULlNiSM is now recognised in America

as a definite clinical entity, the antithesis to diabetes,as hyperthyroidism is to myxoedema, gigantism topituitary ateliosis, and osteitis fibrosa diffusa toparathyroid tetany. Clinically the symptoms are

those of an overdose of insulin, notably intensemuscular weakness and exhaustion, which can onlybe controlled by repeated resort to carbohydratefood. In extreme cases there may be convulsiveseizures and the patient may die in hypoglycaemiccoma. In this country no such fatal cases of whatmay be termed idiopathic hypoglycaemia have so

far been recorded ; yet they must occur from timeto time, and are probably erroneously regarded asepilepsy. Pathologically an adenomatous or carcino-matous hyperplasia of the islets of Langerhans is

usually found, either in the form of a localisedtumour, or more commonly diffused throughoutthe’ pancreas. The possibility of treating the condi-tion by resection of portions of the pancreas hasalready been explored by American surgeons, andtheir results up to date have been reviewed byF. N. Allan, W. C. Boeck, and E. S. Judd.l Inthose cases in which the hyperplastic tissue is in theform of a localised tumour the operation is.relativelysimple, and in the only case of hyperinsulinismwhich has so far been completely cured by operationsuch a tumour was found and excised. The morecommon type of diffuse hyperplasia, however, isless easy to deal with, for, as in the surgical treat-ment of exophthalmic goitre, the operator can onlyguess how much tissue should be removed. If acomparatively small portion of pancreatic tissueis excised the patient’s symptoms will not be relieved,while, on the other hand, too radical resection maycause diabetes. Up to the present, the surgeonhas erred on the side of conservatism and the results,from the point of view of the patient, have not beenstrikingly successful. The operative difficulties are

considerable. It is necessary to remove the tail ofthe pancreas completely, since it contains the bulk ofthe islet tissue, and in this region haemorrhage,especially from the splenic vessels, may be dinicult

1 Jour. Amer. Med. Assoc., April 12th, p. 1116.