MENTAL OVER-WORK AMONG PUBLIC MEN. 27 



ally assigned as causes were good, but both were hard intellectual 

 workers. Temporary albuminuria was present in two othSr cases. 

 Examinations of the urine were not made in many of the cases. 

 In this connection, the report made by Dr. Andrew Clarke,^ a phy- 

 sician connected with the Indian Civil Service, to Dr. Hack Tuke 

 is interesting. He wrote that he was a witness to the grave, and 

 sometimes irreparable, mischief done at schools and in working for 

 competitive examinations. Of the young men passing the Civil 

 Service examination for the Indian service, and afterwards sent to 

 him for health certificates, ten per cent, had temporary albuminu- 

 ria. Professor Tyson' says that it is certain that interstitial ne- 

 phritis often exists for a long time undiscerned in business men who ■ 

 have lived under a state of constant mental tension. He quotes 

 Dr Clifford (from an article by Dr. Edes), who attributed twenty- 

 four out of thirty-two cases iu private practice to some long-con- 

 tinued anxiety oi* grief. When interstitial nephritis or some other 

 form of chronic Bright's disease is in existence, but practically dor- 

 mant, mental strain may spur it into dangerous activity and thus lead 

 to premature death. One case of this kind has already been detailed, 

 and reference has already been made to another in wdiich long- 

 standing disease of the kidneys was not discovered until after 

 death. 



In the case of bulbar paralysis and of angina pectoris post mor- 

 tem examinations showed degenerative disease of the blood vessels ; 

 and in four cases — the diagnosis in two confirmed by autopsy — 

 cerebral haemorrhage resulted from a combination of excessive 

 mental work and great responsibility. Two of these patients, how- 

 ever, were between sixty and seventy, and two between fifty and 

 sixty, but in all, a life and usefulness might have been prolonged 

 if mental strain had been avoided. On the one hand, arterial 

 degeneration may occur as tlie result of continued cerebral over-work 

 and emotional strain, and on the other, such strain and over-work 



1 The .Journal of Mental Science, January, 1880. 

 '^Op. cH. 



