Loss of memory, loss of muscular strength, increasing presbyopia (old-sight), and all other signs of exhaustion are very common. "Punjab head" or "Burma head" is a cerebral asthenia due to exhaustion well known in the Indian army. It sometimes completely prostrates because loss of memory is very marked. Cases generally recover when they go home, only to relapse upon return. We have had many similar cases, though, but few are permanent.

The following table from Lombroso shows the month in which insanity begins, and illustrates the effects of heat and light:

January................... 1,476

February.................. 1,420

March..................... 1,829

April...................... 2,237

May...................... 2,642

June...................... 2,701

July....................... 2,614

August.................... 2,261

September................. 1,604

October................... 1,637

November................. 1,452

December.................. 1,529

Overwork in the tropics seems to be a very potent cause of exhaustion. Vigorous Americans invariably fall into this error, as they cannot understand why they should do less than at home. In time one learns to take things easy. A high civil official who had an intense interest in his work, informed me what a sad mistake he had made by working to his limit the first year. He soon found himself exhausted and unable to render correct legal decisions unless he limited his work. To be just, then, a judge should keep his mind active by the greatest conservatism of his mental powers. The same applies to clerks. The government gets more out of them in the tropics if there are only four and one-half hours of work, than if it exacts eight.

"The average native born (Australian) is taller and paler than his British forbear. The hot, dry climate induces a nervous temperament, also unlike the British stolidity. Girls develop rapidly, have a tendency to anaemia, and age earlier than is usual with English women." The nerves and physique "are further exhausted by the busy life" they lead.* The New York Medical Record of February 2, 1901, published a letter calling attention to the rapid degeneration of Anglo-Saxons in New Zealand, and enumerated the prevailing conditions - loss of teeth, cessation of lactation in nineteen-twentieths of mothers, neurasthenia, chlorosis, sexual and nervous disorders.

There is a peculiar stimulation during the first few months of residence in the tropics just as the heat of hot mineral baths stimulate chemical changes when sluggish, such as in gout and rheumatism. Manson mentions it (page 369), and Dr. James Cantlie, in the International Textbook of Surgery, mentions the stimulating effects of the heat on newcomers to the tropics with the subsequent ansemia, exhaustion, lower vitality, feebleness and irritability. He also states that no natives have any physical or moral stamina.

There being increased tissue change of newcomers in the tropics, there must be a feeling of well-being with better and freer thoughts. It makes newcomers enthusiastic about the climate and they invariably say that it is far better than they were told. One high-ranking naval officer cabled home that the climate was perfect, and three months later he was carried home collapsed and ruined in health. I know of another officer who wrote his wife to come and bring the children, as the climate was perfect; before she could get on the boat she was cabled that he had died of disease due to his contempt for sanitary measures.

A chaplain, who came over with the volunteers and who, upon his return, published roseate views of the climate as fit for colonization, was killed in three years by the climate which had so basely deceived him by its early stimulation. While under this preliminary stimulation Wm. E. Curtis, the correspondent, actually wrote home that white men could labor in the fields, but Dr. Louis H. Fales, formerly of the Civil Service in the Philippines, shows that * the tropic neurasthenia is common among white people in the tropics, particularly the women.

*Colquhoun, "The Mastery of the Pacific." * American Medicine, April 1, 1905.

Tropical Neurasthenia. Suicide

As previously explained, there is no evidence that any civilized man in modern times ever commits suicide if he is mentally healthy. In more than half of the cases there is proof of marked insanity, and in the rest it is sure that there is a mental depression due to an incurable neurasthenia or a temporary exhaustion. The Chief Surgeon in the Philippines, Colonel Greenleaf, reported that most of the suicides are from this latter class. Of course, men who come from neurotic families, will suffer more than normal men. These facts are confirmed by the investigations of Prof. E. G. Dexter, University of Illinois,* of the suicides at home. He finds that like insanity * there is a marked increase in warm weather, April to August, inclusive, then gradually diminishing to a minimum in February. There is a remarkable increase on very hot days when the temperature is over eighty-five degrees. Humidity is also a powerful factor, and there is a gradual rise in suicides as the air becomes damper, a remarkable rise taking place in the days when the temperature is over ninety and the air saturated. These two facts at home explain the increase in suicides in the tropics among those who have been there long enough to be exhausted by the heat and moisture.

That suicides are more frequent in the light months than in the dark ones is also shown in the following table of Petit:*

Paris

Italy

January....

862

1,025

February...

887

1,109

March...

1,017

1,294

April...

1,136

1,527

May...

1,193

1,651

June...

1,311

1,718

Paris

Italy

July..............

1,231

1,625

August............

1,029

1,309

September....

926

1,021

October...........

917

1,049

November.........

773

942

December.........

724

891