Shell Shock Or "Shell Shy." (BY OTIPC MEDICAL CORRE:SIONDENT.) The Clinical Meeting of the British Medical Association opened yesterday at the Imperial College of Science. The first section to be con- vened was the Neurological, when Colonel Mott read a paper on " War Neuroses." Colonel Mott's views on this subject are well k-nown, as is also the research work accomplished by him. He stated that in no previous war had there been such a vast number of men disabled by lunc- tional nervous disease. The conditions of this war, on the other hand, were without precedent both as regards severity of strain and the length of time of exposure to it. According to his experience, 1915 and 1916 were the worst years, when men were un- relieved for weeks and when they were continually on the defensive, out-manned and out-gunned. Again, a conscripted army included all sorts aniL conditions of men. We had found out by the immense nunmber of soldiers discharged from the Service as permanently unfit vhat a large propor- tion of the male population of a highly civilized country possesses a neurotic predisposition. In 1917 one-third of the unwounded and one-seventh of the total discharges including the wounded were per- nanently unfit on account of functionaL nervous, or mental diseases. Colonel Mott then dealt with some of the de- batable points in the classification of war neuroses He condemned the term " shell shock," declaring that " a great many of the men who have been returned as suffering from shell shock would have been more appropriately designated " shell shy." He then ex- pounded his view that a distinct class of cases exists in which the brain itself receives injury. These may show no outward sigu of violence, but various methods existed for differentiating them from purely emo- tional shock. For example, if the cerebra-spinal fluid was examined it would be found in some of these cases to contain blood and albumen. The drum of the ear, too, might be ruptured, showving the effect of the explosion. Post mortcmn he had found micro- scopic hemorrhages in the brains of some of these people. These cases were commotional shock-, as against emotional shock. On the other hand, a soldier born with or having acquired emotivity tended sooner or later to develop one or other form of nervous com- plaint, A shell burst near him and he saw the flash and was blinded by it, and remained functionally blind; lie heard an explosion and was temporarily deafened by it and remained deaf (this being in a sense a method of defending himself against unbear- able sights and sounds). These and other conditions of the same sort vere curable by suggestions given in opposition to the emotional trend producing the phenomena. Cases might, of course, occur where both commotional and emotional shock occurrea. The war, the lecturer insisted, had produced no new nervous disease. They were dealing with the same hysteria and neurasthenia which they dealt with in peace time. " I have seen," he declared, "both hysteria and neurasthenia arise from the fear of conscription, or, having been conscribed, an hysterical crisis, con- tracture, or paralysis has occurred when it became known that the conscript would be in a draft for general service abroad." Tlough a neuropathic tendency greatly assisted the onset of shock, this might occur in sound indi- viduals. The instincts comnected with the emotions of fear and anger were all-important, but equally so wvas the herd instinct. and moral, good or bad, in a regiment was largely dependent on the instinctive suggestibility of *nan. A British general was reported to have said: " Ten per cent. of a regiment will follow you to the gates of Hell; 10 per cent, vwil fall down or run away; and the remaining So per cent, will follow either." It might, therefore, be supposed that in the 10 per cent, who folowed anywhere the primitive emotion of anger, with its instinctive reaetions, was inborni and dominant in the personality, and that to fight was the instinctive reaction of self-preserva- tion in these men. In modern trench warfare anger was impotent. The soldier could neither fight nor run away. He could only crouch nnd hide himself the instinctive attitude of the timid animal wvhen threatened with danger. . O]r r B3ATTrE DREAaxs. Now applying the view of James that we felt any cluotion because we performed the muscular move- sments associated with it, or in other words, that the bodily, changes occurring in response to a ftimulus produced feelings vvhich woere the emotion, Colonel Mott invited his audience to decide whether the bodily reactions excited by memory pictures in soldiers were the basis of their battle dreams, or whether these dreams provoked the reactions. "I explain the fact," he said, "that the neuras- thenic who so frequently suffers in the early morning with symptoms of nervous exhaustion and irritability owes this condition to the exhausting effect of dreams which he may or may not recollect," The evidence of persistent bodily changes occur- ring in soldiers suffering from shel shock was next dealt with. Of cases handled by the lecturer some 1o per cent. had conditions usually regarded as point- ing to deranged bodily function. Treatment of the body was therefore necessary in addition to treatment of the mind. COLOSEr BUZZAxD said that they must hope that the number of victims of war neuroses would gradu- ally dwindle in peace. Shell-shock would resemble a comet; it would appear and then depart again into oblivion. Sm J. PUaVES STEWARtT said he was ashamed of the term shellUshock. It was a bad 'word and un- scientific, though used by Cabinet Ministers and members of Parliament-people who did not know any better-and by medical advisors of Government Departments. It was really a sign of abnormal re- action to ordinary stimuli. He thought it a great tribute to officers and men that these conditions had not been more common. In the Section of Surgery, SIm Gaonao MIAlms, President of the Royal College of Surgeons, presided, and COLON7EL ELLIOTT dealt with gun-shot wounds of the chest. He said few observations on the pro- gressive changes in physical signs and X-ray appear- ances had been published, though abundant material must exist in the notes of medical men. He dealt with physiology of the lung at considerable length, admitting that it was not yet clearly under- stood. Knowvledge of the action of the bronchial muscles in particular was needed for general medicine. COLOSEL GAsY} said that the great lesson whieh the war had taught was a clear conception of the evolution of a wound. Nearly 100 per cent. of all wounds were contaminated. But there was a period between the receipt of a wound and the time when the germs entering it had time to flourish therein and invade the tissues. At first it was thought that chest wounds were best left alone, and that it would be dangerous to open the chest. This proved fallacioue. In the Section of Preventive Mpedidne and Patho- logy papers were read on "The Dysenteries, Bacil- lary and Aincebic.' COLONEL LEONAnD S. DunaFox stated the following conclusions:-(I) BaciUlary dysentery is most prevalent when flies are most numerous. (2) Flies after contact with food infected with dysentery bacilli are capable of carrying and disseminating these bacilli for at least 24 hours (3) Dysentery bacilli were 'isolated from wild flies cap- tured in places in which bacillary dysentery is both endemic and epideric. PrnOFESSOn WVARINGTONT Yo]R, Liverpool, gave results of laboratory work showing that dysentery carriers are indigenous to England. A number of demonstrations vere given in various hospitals during the afternoon in connexion with each section. There was an exhibition of various medical and surgical appliances and of books. In the evening the members of the British Medical Association were entertained by the President (Rear-Admiral Sir Humphrey Rolleston) and Fellows of the Royal Society of Medicine. - SHELL SHOCK OR " SHELL SHY." NERVE TROUBLES IN MODERN WARFARE. CURES BY SUGGESTION..