General Medicine

MEDICINE, GENERAL. Since 1910 the progress of medi cine has been much influenced by the four years of the war, which, while interfering with steady research, brought with it urgent prob lems, caused diseases previously rare or unrecognised to become matters of common knowledge, and produced epidemics on an enormous scale, thereby calling forth much investigation and new knowledge.

Influence of the World War.

Trench fever and a special form of kidney affection, called trench nephritis, were practically new diseases; and the serious condition of epidemic (lethargic) encephalitis (q.v.), though it may have existed previously, for the first time became common and was recognised during the war. Certain industrial forms of poisoning, namely of trinitrotoluene among munition workers, and of tetrachlorethane among aero plane makers, were temporarily in evidence, and an impetus was given to research into the conditions modifying efficient perform ance of labour. Deficient diet caused scurvy, especially in 'Iraq, and other "deficiency diseases" came into evidence, especially in central Europe. Cerebrospinal ("spotted") fever became for the first time epidemic in Great Britain (see SPINAL MENINGITIS) ; as a result of the depressing conditions and the lowered bodily resist ance, influenza (q.v.) became pandemic all over the world in 1918 19 and a fatal form of infective heart disease (endocarditis lenta) became much more frequent in discharged soldiers. A form of infective jaundice (spirochaetosis icterohaemorrhagica), formerly known as Weil's disease, became prevalent in Flanders, and its true nature, namely, an infection with an animal microbe, akin to that of yellow fever (q.v.) (Leptospira icteroides), was found in Europe to be identical with that described in Japan in 1914. Para

typhoid fevers (see PARATYPHOID FEVERS) A and B, though of course known before, became much more familiar during and after the war, and it may be noted that the distinction between the forms of enteric fever known as typhoid and paratyphoid was not recognised in the Boer War (1899-1902), when the disease exacted a relatively heavier toll than in the World War, when the troops were eventually extensively protected by T.A.B. vaccination. Dys entery (q.v.), as in past wars, became prominent, as did malaria (q.v.) in the eastern areas of the campaign. The influence of a Sanitary Corps in the prevention of disease among the Allied Armies was a noticeable feature (see MEDICAL SERVICE, ARMY). Much progress has also been made in the prevention of tropical diseases. (See THERAPEUTICS and TROPICAL MEDICINE.) Mental Diseases.—The war provided a tremendous field for the observation of the mental perturbations commonly designated as "shell shock," due to the physical effects of long-continued born bardment, mental strain and anxiety, repression or the active for getting of terrifying experiences, and of fear. Incidentally it gave an opportunity for testing the opinion of the more advanced fol lowers of Sigmund Freud of Vienna, who, on the assumption that the sexual instinct is stronger than those of self-preservation and of the herd, have increasingly tended to refer mental symptoms akin to those of shell shock to the conflict resulting when some sexual experience had, in obedience to the conventional influences, been repressed and thus removed out of the zone of consciousness.

The value of Freud's contribution to morbid psychology (see