Introduction

In a survey published on the British Journal of Medicine in November 1913, G. Price used missionary statistics to determine the major reasons for why Western residents in the tropics and sub-tropics became invalids. The most common tropical diseases among Westerners in India, Ceylon, China and Japan were neurasthenia and mental disorders. Japan had the worst scenario, with 81.25% of the white invalids diagnosed with neurasthenics. In comparison, the leading illness caught by Westerners in Africa was malaria, and neurasthenia ranked second. Among the 203 cases in China, 25% were affected by neurasthenia and 8.8% by mental diseases. In September 1915, the China Medical Journal used Price's data to emphasize the arduous life of the missionaries stationed in the country. The high prevalence of neurasthenia was mostly attributed to their tremendous responsibility and heavy workload. Similarly, Frank Oldt, an American medical missionary in Canton, stated in 1919 that nervous disorder posed the greatest health risk among foreign populations in China. In 1920, William Lennox of the Peking Union Medical College conducted a statistical study on the health of missionary families in the country and showed that nervous breakdown ranked fourth among the most frequently occurring illnesses, and nervousness was a key cause of miscarriages.

Since the early 1900s, tropical neurasthenia and other related disorders have been a focus of attention in the field of tropical medicine.