1910] on Medicine and the War 437 



in the Army Medical Corps itself medical research was appreciated. 

 I have already mentioned members of that body who stand out 

 among- the foremost pathologists and bacteriologists of our genera- 

 tion : Sir Almroth Wright, Sir David Bruce, and Sir R. Leishman. 

 And (3) a most potent influence during the war has been the whole- 

 hearted encouragement and help of the Medical Research Committee, 

 which under Mr. Lloyd George's Insurance Act was granted from 

 National Insurance moneys a sum approximating £60,000 a year, 

 which, with a wise patriotism, was with the w^ar diverted to the 

 advance of military medicine and research. Time forbids that I 

 detail the many ways in w'hich this Committee, with its energetic 

 secretary, Sir Walter Fletcher, has placed its resources at the disposal 

 of those, in and out of the army,. wishful to work out the medical 

 problems of the war. 



Shell-Shock. 



And this, let me add. not only for prevention, but for treatment. 

 Rememl)ering my title, I cannot close without calling your attention 

 to at least outstanding advance in medical treatment. I have already 

 referred to the extraordinarily good results from the development of 

 a national orthopaedic surgery under the stimulating influence of Sir 

 Robert Jones, whom we may without hesitation claim as the greatest 

 military surgeon of this war— the Ambroise Pare of the twentieth 

 century. A triumph equally great has been that over a condition so 

 uncommon in previous wars as to be scarce noted, but one which in 

 this war assumed for a time very serious proportions. I refer to the 

 loss of self-control brought about by the intensity and gravity of 

 the artillery warfare— the noise, the concussion, the f rightfulness, 

 the obvious impotency of the soldier, whether in the trenches or in 

 the open, when exposed to shells which in size, explosive power and 

 number exceeded anything even dreamt of in previous campaigns. 



In the first two years of the war little could be accomplished to 

 mitigate the profound breakdown, mental, sensory and motor, of the 

 piteous sufferers from '' shell-shock " — men rendered deaf, or dumb, 

 or blind, or unable to walk from tremors and paralysis, and suffering 

 from oft-repeated and terrifying dreams. Thanks to the studies of 

 the neurologists, cases of malingering, of mere concussion, and of 

 organic nerve diseases were distinguished from cases of shell-shock 

 proper. At first these cases were sent home to England, and here^ 

 not properly cared for and treated, they went from bad to w^orse. 

 Next, it wys noted that these cases in the male were of much the 

 same order as hysteria in the female, that they responded to sugges- 

 tion of various orders and modes of application, and this the more 

 readily the sooner after the onset of the condition of shock. And at 

 tlie beginning of the third year of the war it was found, here follow- 

 ing our allies, the French, that the best results were obtained, not 

 by posting these cases to base hospitals and over the Channel, but 



