430 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1954 



published later in the same year/ makes it clear that Mitchell was the 

 dynamic force behind the study. His analysis of the problem illus- 

 trates his powers of observation and his genius for making sound 

 physiological deductions. Among other things, Mitchell and his col- 

 leagues discovered that in certain cases following severance of an 

 important nerve, especially when the nerve's disruption was associated 

 with infection, there were abnormal sensory manifestations, i. e., hy- 

 peresthesia in the extremity affected, a syndrome that Mitchell named 

 causalgia. The problem of causalgia has been studied for nearly a 

 hundred years in both civilian and wartime cases of nerve injury, 

 and it came to be most actively studied during World War II, when 

 its incidence was frequent. 



In retrospect, an even more important contribution of Mitchell and 

 his collaborators lies in the clear-cut description of "primary" and 

 "secondary" shock. Thus, in discussing the various types of shock, 

 one reads in the circular on reflex paralysis (see footnote 6) : 



The majority of physicians will no doubt be disposed to attribute the chief 

 share in the phenomena of shock ... to the indirect influence exerted upon and 

 through the heart. There are, however, certain facts, which duly considered, 

 will, we think, lead us to suppose that in many cases the phenomena in ques- 

 tion may be due to a temporary paralysis of the whole range of nerve centres, 

 and that among these phenomena the cardiac feebleness may play a large part, 

 and be itself induced by the state of the regulating nerve centres of the great 

 circulatory organs. . . . But there do exist certain cases, more rare it is true, 

 in which singular affections of the nerve centres, other than those of the heart, 

 occur as a consequence of wounds. 



WORLD WAR I 



During World War I there were many medical advances stimulated 

 by the war itself, particularly in the sphere of prevention of infectious 

 disease. It is said that when the Austrians attempted to invade the 

 Balkans, the front was held not by guns but by the louse and the dev- 

 astating epidemics of typhus caused by the jumping creatures. It is 

 estimated that nearly a million Austrian soldiers poised on the Balkan 

 border perished from epidemic typhus. The Russian armies had much 

 the same difficulty and so did those of other countries of western 

 Europe. Our soldiers were similarly troubled in the trenches on the 

 western front, but through use of hygienic methods there was far less 

 devastation. 



On the basis of the experience of World War I, every effort was made 

 in World War II to protect our troops from typhus, especially in the 

 Mediterranean theater. Meanwhile, DDT, the most effective insecti- 



' Gunshot wounds and other injuries of nerves, Philadelphia, 1864; see also 

 Fulton, J. F., Neurology and war (Vlllth Weir Mitchell Oration), Trans, and 

 Stud. Coll. Phys., Philadelphia, vol. 8, p. 157, 1940. 



