In some instances these factors have been taken cognizance of in the selection of the type of vocational training adapted to certain cases of "shell shock." In other instances, especially in the early days of this work, all these factors were ignored, and we have succeeded in untraining good carpenters to make pseudo stenographers and vice versa.

It is my belief that careful and well supervised physical training will do very much to overcome these tendencies. I am much in favor of encouraging dancing, such games of skill as golf, supervised calisthenics and other forms of physical training. Nothing, however, which implies abnormal heart strain or over muscular exhaustion should be permitted. There can be no question but that the class training most happily worked out by the British in the rehabilitation of these cases, even after man-grown, did very much toward bringing them back to a relatively normal standard. If this is possible, as has been shown to be the case, with young adults, then it is quite certain that if these methods are established in the early teens that we shall prevent many cases developing. I have seen some particularly brilliant results, especially as regards the elevation of cardiac and skeletal muscle reserve follow supervised training and education in mild outdoor sports and the like. Over physical stress must never be permitted. Some successful college athletes who break in early after life are doubtless of this type.

I do not feel myself competent to discuss adequately the mental and emotional training which these individuals should receive. I know

however, that wise teachers and parents and that experienced neurologists and psychiatrists do a great deal with these patients. Certain it is that self-control, emotional curbing and the cultivation of normal reactions to normal environments should be encouraged. Results of a most beneficial nature may be achieved along these lines, and age is often an adjuvant of great value.

I know from experience also, that the physician can do a great deal along established and well accredited lines of treatment, the correction of anemia by diet with iron and arsenic, sunlight and open air, the correction of constipation by diet, exercise, and if need be by the added use of proper drugs. The mere confidence inspired in the emotional and receptive patient by the supervision of a respected practitioner has in itself much of therapeutic good in so far as instilling self-confidence and poise into these patients. When it is possible the patient's studies, work and notably his recreations should receive the attention of the physician. Diversion selection is perhaps of secondary importance, only to the selection of an occupation for the patient suffering from this complex.

I believe that the symptomatic use of drugs is very beneficial. When a tendency to heart dilatation is shown, rest and digitalis act beneficially, especially the rest, for digitalis often fails in these cases as it does in instances of hyperthyroidism. The bromides sometimes combined with cannabis indica are very helpful in many cases. Of course one will avoid in as far as possible the use of the opiates and of the other habit form

ing drugs, particularly because of a definite tendency on the part of these patients to take on drug habituation.

In my experience an attempt to reduce muscle exhaustion by the use of strychnine, caffeine and similar preparations is unwise and inadvised, much as one may be tempted to try them out, because of their symptomatic indication. Carefully adjusted physical training is far more certain of result.

Here would seem to be a condition in which the use of the endocrines might work marvels. Perhaps they sometimes do. Theoretically the use of the sexual gland specific to either sex would seem to be a direct indication. My experience is as yet too short to permit me to say more than that I believe that good results along these lines are being reached. I find it very hard, however, to convince myself entirely of the certainty of results achieved along this line in a disease condition in which the confidence and hope of a trusting

patient with an abnormally exaggerated emotional status emotional status may lead him to deceive the physician, as well as himself. Thyroid has been recommended by some, particularly in the fat cases. I feel that I have done more harm by the use of thyroid than I have achieved benefit-perhaps you see that I have not entirely divested my mind of the feeling that a hyperthyroidism has something to do with the production of the condition. Be that as it may, I advise against experimentation with thyroid, and my use of drugs and endocrines has been determined by individualistic and symptomatic indications for the greater part. My great reliance is placed on the elevation of muscle reserve by diet, rest and carefully supervised training. The emotional aspects of the condition have been most improved under my observation by intelligent attempts at mental and emotional control, not repression, and by education and adjustment of emotional output along normal channels.

I

T IS perhaps not unfitting at a gathering of such distinction, that a historical digression be offered instead of a technical paper, more especially when the occasion is one of academic as well as of scientific interest. For this reason I have chosen as my subject certain great explorers in scientific medicine. It is of peculiar interest in this connection that many of these outstanding figures have played important rôles in the domain of preventive medicine, and in no direction have their discoveries been more fruitful than in the development of protective inoculation or vaccination.

The early progress of this branch of science is inseparably linked with the names of three remarkable men: van Leeuwenhoek, who discovered the bacteria; Jenner, who introduced vaccination against smallpox; and Pasteur, who placed vaccination on a scientific basis and materially altered the whole outlook in medical science.

The first important figure is undoubtedly van Leeuwenhoek, who lived in what was perhaps the Golden Age of the Dutch Republic. In all the arts and sciences the fame of Holland at that time reached its highest point. Rembrandt and a host of other artists had raised

1 Fellowship address before American College of Physicians, St. Louis, February 21, 1924.

ANNALS OF CLINICAL MEDICINE, VOL. III. NO. 1

should have sufficed for the first accurate description of the capillaries, of many animal parasites, and also for the discovery of the bacteria.

but

Leeuwenhoek wrote no connected account of his observations, his findings were communicated to various societies in the form of letters, and many of these are still extant in the archives of the Royal Society in London. In a review Dobell de

of the allegorical style affected by the medical illustrators of his day (fig. 3). The engraving represents the Spirit of Enquiry, whose width and consequent wisdom will appeal to all admirers of Dickens, using the microscope to study the secrets of nature, which are being displayed by Philosophy, the Queen of Science. Grouped around the dais are figures representing Diligence leading Error, the latter being blindfolded, halt,

FIG 3. FRONTISPIECE-Arcana Naturae, 1695 scribes them as being written in a very crabbed hand, and in colloquial Dutch. They are rambling and diffuse, gossipy in character, frequently passing beyond the verge of coarseness, and show the author as a man who saw life from many points of view, and with a distinctly "charitable" eye. A Latin translation of many of his letters was published in his lifetime under the general title Arcana Naturae. The frontispiece of one of these volumes offers a good example

FIG. 4. MICROORGANISMS FROM THE MOUTH First description of bacteria in human body leaning on a cane, and decorated with the ears of an ass. The next three figures represent the superstitions of the past and present, the Jewish, Theological and Greek Schools of Philosophy, while the "unadorned" figure of Truth is spurning with her feet the haggard form of Envy.

In this volume is a letter to the Royal Society dated 1681 with the accompanying figure (fig. 4). In this letter he gives the first description. of the bacteria, and a portion of the text may be freely translated as follows: