EDUCATION IN WAR AND PEACE STEWART PATON, M. D. Ex Libris C. K. OGDEN THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES EDUCATION IN WAR AND PEACE EDUCATION IN WAR AND PEACE BY STEWART PATON, M.D. LECTURER IN NEUROBIOLOGY, PRINCETON UNIVERSITY, LECTURER IN PSYCHIATRY, COLUMBIA UNIVERSITY; PRESIDENT EUGENICS RESEARCH ASSOCIATION NEW YORK PAUL B. HOEBER 1920 COPYRIGHT, 1920, BT PAUL B. HOEBER Published January, 1920 Printed in the United States of America TO WILLIAM DAVID BOOKER, M.D. CLINICAL PROFESSOR EMERITUS OF PEDIATRICS JOHNS HOPKINS UNIVERSITY BALTIMORE 1C19413 PREFACE During the War the public developed an interest in cases of so-called "shell- shock." Patients with these symptoms were nervously unfit for active military service. Peace no less than War produces "shell-shock." The symptoms interfere with individual efficiency, happiness and social progress. Many of those who are emotionally unfit for active service in life are found in the almshouses, reforma- tories, juvenile and criminal courts, hos- pitals for the insane, sanatoriums for the treatment of nervous cases, and the vari- ous institutions for the care of "social mis- fits," or are making an effort to compen- sate for personal inadequacy in facing the [vii] PREFACE real problems of life by what amounts to whistling to keep up their courage; an- nouncing their faith in the efficacy of pat- ent medicines, Christian Science, thought transference, radical socialism or other forms of diversion suggested by wishful- thinking. In the following pages attention is called to the urgent necessity of making adequate provision in our universities for training investigators competent to un- dertake the solution of the vitally impor- tant educational problems now confront- ing civilization. I desire to thank the officers of the Harvey Society, New England Head- masters' Association, and the Editor of Science for permission to reprint these papers. STEWAET PATON. Oct. 1, 1919 IvifiJ CONTENTS CHAPTER PAGE I. HUMAN BEHAVIOR IN WAR AND PEACE . 1 II. WAR AND EDUCATION 63 III. THE PSYCHIATRIC CLINIC AND THE COM- MUNITY . 94 [ix] EDUCATIONS WAR AND PEACE CHAPTER I HUMAN BEHAVIOR IN WAR AND PEACE * IN August, 1914, we were suddenly and tragically reminded of our igno- rance of what constitutes the foundations of temperament and character. A dem- onstration on a scale of exceptional mag- nitude alarmed us by showing that it was * Harvey Lecture, New York Academy of Medicine, April 12th, 1919. EDUCATION IN WAR AND PEACE possible for civilized man to revert within a few hours to primitive man. Evidences of the advance of a people to the period of national development were then re- placed by signs indicating the return to tribalism. The change at first startled and then depressed us ; and the depression deepened as the consciousness of our igno- rance of human nature and consequent inability to forecast behavior was im- pressed upon us. Indeed there have been times during the past four years when those who did not have some rational philosophy to sustain them were almost ready to blame Prometheus "for fashion- ing such animals as men." One striking evidence that already we are becoming indifferent to the study of the emotional and mental forces that [2] HUMAN BEHAVIOR resulted in Germany's aggressions, is re- flected in our failure to realize, with the historian Lecky, that a "study of predis- positions is much more important than the study of arguments." At the present time when the world has been turned topsy-turvy and disorganizing influences are operating in society, it is very desirous that we should make every effort to find out the causes that predispose men to be peaceful or warlike, to be impulsive or deliberate, to be quick to resent a sup- posed injury or to be cautious in forming an opinion and slow to anger ; and, finally, what peculiar combination of circum- stances has resulted in the over-valuation of ideas expressed in such beliefs as are entertained by persons who are obsessed with the notion of having found the only [3] EDUCATION IN WAR AND PEACE road to ethical, cultural or political salva- tion. If we are intelligent in making preparations for peace, then we should be fully alive to the danger threatening civilization whenever and wherever ego- tism, belief in the infallibility of any sys- tem, and efficiency of organization are combined. We should not judge Prus- sianism, Bolshevism or Pacifism by the arguments presented, but should go deeper to study the predispositions of those professing these doctrines, which will be found to be the product of minds hav- ing many traits in common. Predisposi- tions and not the arguments of those who plead, either the cause of Democracy or Autocracy, are the potent influences in the development of our civilization. Already there are signs that there is a [4] HUMAN BEHAVIOR return of the old spirit of indifference to finding solutions for the problems of hu- man behavior and to the state of unpre- paredness for either peace or war; and if it renders us insensitive to our present responsibility and opportunity, we shall drift along as we did before the war, until some catastrophe brings us once again to our senses. II The greatest foe of civilization to-day is nervousness. We do not now refer to the great number of well recognized types of nervous and mental diseases, but to the nervousness of many persons of unstable emotional equilibrium possessing unusual intellectual capacity. No adequate pro- vision is being made to study these super- [5] idealists, fanatics, and visionaries. The menace of these wishful thinkers is far greater than that caused by tuberculosis or any of the contagious or infectious dis- eases; and yet our medical schools, the Army Medical Corps and the Red Cross do not seem to appreciate the urgent need of attempting to increase the supply of psychiatrists able to cope successfully with the dangerous malady rapidly spreading by suggestion, and even now threatening the foundations of society. The civilized world is asking for peace, and the adoption of every reasonable pre- caution that will diminish the possibility of another war. At the Peace Confer- ence many "arguments" have been pre- sented but we have heard very little of any inquiry into those "predispositions" which [6] HUMAN BEHAVIOR incline people either to make peace or drive them into war. Under the influence of wish-directed thoughts, and without any deep and comprehensive knowledge of the forces shaping character, we have begun to build up a social structure on the shift- ing sands of conjectural opinion as to what we imagine man to be. Only when we are surrounded by instances of man's inability to control his passions do we un- derstand that "Le genie n'est probable- ment pas le resultat de la connaissance de la matiere, mais de la connaissance de l'homme." Nevertheless, in spite of the storm clouds there is more reason to be optimis- tic in regard to the future of civilization than there was four years ago. Society has not only survived a capital operation [7] EDUCATION IN WAR AND PEACE but it has been driven literally at the point of the bayonet to take a more rational in- terest in human behavior. Of course there are dark spots on the horizon, but to-day, in contrast to the condition four years ago, the problem we have to solve is taking definite shape. Although organized fury no longer menaces civilization, through- out the world morbid instability, quarrel- someness, extravagances of all kinds, and the neurotic tendency of blaming every- body except ourselves for our misfortunes make difficult sometimes the realization that man is a rational being. We are like children crying aloud for peace, promis- ing ourselves only good things, dreaming of Utopias, formulating schemes for the reorganization of society, planning new republics, and advertising our faith in the [8] HUMAN BEHAVIOR efficacy of "isms" to take the place of that accurate knowledge we should be inter- ested in securing about the genesis and nature of the impulses, motives, senti- ments and trains of thought which either drive people into war or inspire them to make and preserve peace. We draw up schemes for redeeming society much faster than we take steps to add to our knowl- edge of man. So many successive plans having as their object the redemption of Society are proposed that one is tempted to ask, "Which way go the physiogno- mists, metoscopists and chiromantists to work?" in The members of the medical profession have a magnificent opportunity to assist in [9] EDUCATION IN WAR AND PEACE developing the mental preparedness essen- tial either for maintaining peace or for prompt prosecution of war, if this is again necessary to overthrow unjust aggressors. The physician should be well qualified to undertake the study of human charac- ter. Unlike the psychologist, the physi- cian does not have to be reminded of the very close interaction of mind and body. Even before the days of Aristotle he had approached the study of the mind from the side of the body. Long ago he recog- nized the necessity of understanding some- thing about the structure and the relation of the various organs as preliminary to the study of the machine in action. The medical man while only vaguely appreciat- ing the value of functions like feeling and [10] HUMAN BEHAVIOR thinking as processes assisting in the ad- justment of life, recognized that although there was a close connection between mental phenomena and those related to the circulation, respiration and secretion of the internal glands, analysis was so difficult that little attention was given to exploring emotional and mental adjust- ments. Even if he has not been able to explain the connection, intimate as it is between body and mind, his line of ap- proach to the ancient problem has at least made it easier for him than for other in- vestigators since he should see the body- mind problem in its proper biologic set- ting. The physician should be ready by reason of his medical training to grasp the significance of the recent rediscovery of a very old truth, namely, the doctrine of EDUCATION IN WAR AND PEACE biologic unity. This doctrine when stated in practical terms stresses the impossibil- ity of dissociating mind and body and em- phasizes the importance of considering as a whole what for so many centuries by some observers have been considered as two entirely separately systems working independently of each other. The body-mind problem as it was once formulated appealed only to the specula- tive philosopher, but as recast in the world's laboratory of life it has acquired an immediate and tragic interest for every thinking person. "Life" and "living" have forced these questions into the center of the field of interest. Doubtless we shall soon visualize correctly the present opportunity, see the problems in their right perspective and make provision for [12] DIAGRAMMATIC REPRESENTATION OF FACTORS CONCERNED IN ADJUSTMENTS OF HUMAN MACHINE Organs governing intake (I), assimilation (A), stor- ing (S), and elimination (E), of energy, and processes of reproduction and growth (R & G), controlling mech- anism, brain and nervous system, B, N. S.), Motor apparatus, (M). Environmental contacts, sense organs, (S). In health the human organism is capable of shifting gears from reflex to automatic, emotional or intellectual levels to effect the adjustment of internal conditions to external conditions essential for efficiency and the main- tenance of a well-balanced personality. [13] EDUCATION IN WAR AND PEACE teaching mental hygiene in connection with departments of hygiene. As a mat- ter of fact many physicians do not yet recognize the importance of considering these two departments, Physical and Mental Hygiene, as inseparable and as representing two phases of one great prob- lem. Will it be necessary for an intelligent lay public to lead the medical profession to appreciate its present opportunity and responsibility in this particular field? The war has served to remind medical men of the fact that there was one side of the great human problem to which they have unfortunately given comparatively little attention. They have been occupied in getting the human machine in order to run, but have given little or no attention [14] HUMAN BEHAVIOR to the amount of strain it would stand, the distance it would go without repairs, and took little notice of the kind of work it is best fitted to perform. Every day the physician has been accustomed to ask his patients "how they felt," "whether they were worrying about anything," or "whether it was not possible for them to take a more rational view of living," but little time and attention have been de- voted to investigating emotional disorders, the causes of worry, and the reasons for the psycho-neurotic's general feeling of dissat- isfaction with life, all of which have such an important bearing upon the present complex of symptoms of social unrest. To some persons the analysis of "sensations," "sentiments," "instincts," "feelings" and "ideas," seems to be outside the ordinary [15] EDUCATION IN WAR AND PEACE field of exploration reserved for the physi- cian. But on the contrary, the rapid growth of functional nervous and mental diseases, more general belief in the effi- ciency of "isms/* and the spread of the Christian Science Pacifistic and Bol- shevist psychoses are decidedly within the field of the medical investigator. IV At every turn there are signs that many people have strayed into a special field of investigation representing the study of mind, in which they should be guided by medical men trained in the art of studying the human personality. A visit to almost any book shop in order to count the number of books in which such subjects as "Thought Trans- [16] HUMAN BEHAVIOR ference," "Speaking with the Dead," "Theosophy," "Christian Science," "The Search for the Philosopher's Stone," and various other forms of mysticism are dis- cussed, is sufficient to indicate the vaga- ries of wish-directed thinking which rep- resent unsuccessful attempts to satisfy deep-seated needs. It is very unfortunate that the members of the medical profes- sion have not been more active in direct- ing these currents of thought into proper channels. They have waited until the public has begun to be impatient at its failure to secure reliable information in regard to the problems of human be- havior. Already many intelligent peo- ple are showing signs of uneasiness be- cause they cannot receive intelligent as- sistance from members of the medical [17] EDUCATION IN WAR AND PEACE profession in securing satisfactory ad- justments in their emotional and intel- lectual life. The assumption is often made by a group of investigators who, it may be said, have never had time or opportunity to study the problems of human behavior, that a great deal is known about this sub- ject. This belief is current among scien- tific men engaged in studying the be- havior of the lower organisms, as well as among persons who have approached this special field from the academic point of view. A few hours in a psychiatric clinic where one is compelled to explore the per- sonality of patients should be sufficient to convince any rational person that we have only just begun the study of human ac- tivities. Possibly it is advisable to re- [18] HUMAN BEHAVIOR mind those critics who affirm that very lit- tle more information is to be obtained in regard to the behavior of the human ani- mal that a distinguished surgeon in the sixteenth century declared little re- mained to be done in advancing surgical knowledge ! Before the outbreak of the war there were evidences of increasing popular in- terest being taken in the causes and meth- ods of preventing nervous and mental dis- eases. The war directed the attention of the intelligent public to special phases of the problem; to the war psychoses or to the search for some rational explanation for the Prussian psychosis, Bolshevist mania, and the emotional instability which results in criminal acts and general unrest. It is indeed unfortunate that the physician [19] EDUCATION IN WAR AND PEACE has waited until he is compelled by force of circumstances to take cognizance of his present opportunity for directing so much of the energy now dissipated to strengthen the constructive forces in civilization. It is not creditable to the medical profession that largely as the result of its indifference to a very important subject it has now be- come much easier to secure large endow- ments for Christian Science temples than it is to find the funds for institutions for the study of human behavior. The physician has interested himself in examining different parts of the human machine, and has imitated the example of the mechanician who remains in the work- shop cleaning out cylinders and grinding valves but taking little interest in finding [20] HUMAN BEHAVIOR out how the motor runs while climbing hills or crossing rough roads. If the average physician were asked why he has neglected to analyze the soul life of his patients, he would doubtless re- ply that he had been so preoccupied in ministering to their physical needs that practically no time remained for the study of mental processes. This reply is only partially true. In the minds of a great many doctors there exists a prejudice as old as the Lucretian philosophy that makes it extremely difficult for them to consider the study of psychological phe- nomena as a legitimate field for scientific exploration. Physicians have been among the most consistent and persistent oppo- nents of mysticism, and yet curiously enough they have tacitly accepted the [21] EDUCATION IN WAR AND PEACE naive mysticism with which the radical materialist covers up some of the defects in his logic. Science is pictured as hav- ing a certain set of symbols, microscope, balance, and test tube, and it is assumed that mental phenomena which can be neither seen, weighed nor dissolved should be immediately rejected as unworthy of scientific investigation. As a rule the average medical man takes cognizance only of those facts in individual experi- ence which fit into his rough and ready philosophy of life, and discards those which cannot be quickly analyzed and ar- bitrarily adapted to suit conventionalized lines of thought. There is another factor which has had a very decided influence in preventing the physician from developing an intelligent [22] HUMAN BEHAVIOR interest in the study of mental processes. There is nothing particularly dramatic in exploring the personality of the average patient and only the occurrence of some tragic event seems to arouse his interest in the drama of life. The character of the methods used and the nature of the in- struments employed in making a physical examination are always suggestive of the possibility of the introduction of some un- expected element to stimulate the interest of the examiner. On the other hand, in analyzing emotional reactions or intellec- tual adjustments the examiner is thrown back upon his own intellectual resources and there is little opportunity to manipu- late apparatus and stimulate the flagging imagination by the suggestion of reality associated with purely objective signs. [23] EDUCATION IN WAR AND PEACE While physicians appreciate that the circulatory and respiratory functions rep- resent mechanisms essential for the suc- cessful adjustment of life, they seldom stop to consider that feeling and thinking are also equally important in securing the adaptation of human beings to the envir- onment in which they live. Having reviewed some of the sins of omission of the medical man we shall prob- ably not be considered prejudiced if ref- erence is made to the sins of commission of psychologists. If the physician stopped short of the goal he might have reached had he extended his field of exploration to include the study of the personality, the psychologist has been guilty of trying [24] HUMAN BEHAVIOR to build a house without paying very much attention to the foundations. The latter in practice has followed the lead of Des- cartes and has discussed the "res cogitans" as separate and distinct from the "res ex- tensa." Emotions and mental processes are described as if they were not directly modified by physiological processes. The phenomena of intelligence have often been referred to without any suggestion of the relation of these very complicated adjust- ments to mouth breathing, visual, or lung capacity, or to the supply of hemoglobin and other physiological functions. It is unfortunate that more psycholo- gists do not take time to equip themselves to carry on work in fields into which they have been drawn by their enthusiasm. Al- though excellent work has been done by [25] EDUCATION IN WAR AND PEACE the psychologists in determining the men- tal fitness of individuals for their task, there is no doubt that many of the results should be accepted only after they have been carefully criticized by members of the medical profession who possess a prac- tical knowledge of the different parts of the human machine and their reciprocal activities. Once the decision has been made by the physician to explore a personality, he should not allow himself to be coerced by any fear of being thought unscientific into submissively abandoning terms whi^h are of value in recording the data col- lected. The mystics of a certain school of materialists object to the use of the word "consciousness," and state that the word [26] HUMAN BEHAVIOR behavior is sufficiently comprehensive to describe the highest as well as the lowest forms of adjustment. There has been, as Kempf* has pointed out, "a sleight of hand movement in psychology to drop the term consciousness." If I slip on an orange peel, bump my head on the side- walk, and remain unaware of what has happened, common sense will confirm the diagnosis that self -consciousness and not behavior was lost. A reference is permissible to the use of the word behavior in this paper to include conduct. The word behavior is often used to describe those higher forms of response conduct in which some guiding motive is * Kempf, E. J. The Autonomic Functions and the Personality, Nerv. and Ment. Dis., Monogr., Series No. 28, 1918, p. zi. [27] EDUCATION IN WAR AND PEACE present. The retention of the word con- duct in our vocabulary is desirable. There can be no doubt that we convey a better idea of the functions of the conductor of an orchestra by the use of this word than we should do if he were described as the leading behaviorist. It seems to be the general consensus of opinion that during the period of the war many new facts of fundamental impor- tance for the study of human behavior were not discovered. We have, however, acquired considerable skill in spreading out in a very thin layer the small stock of knowledge we possess. The neurologists who have had active service in the army know to what good use this information has been put in improving treatment as well as in preventing the occurrence of [28] HUMAN BEHAVIOR the symptoms of mental disorders. Prog- ress has also been made in securing in- creased industrial efficiency, and last but not least, in assisting us to acquire a new and broader outlook upon life in general. After reading the clinical histories of per- sons suffering from nervous or mental dis- eases, the scientist with a reflective turn of mind is ready to sympathize with the French philosopher's lament that there are not more intelligent doubters in the world. "Sensations," "instincts," "con- flicts," and "compensatory mental reac- tions" are discussed in many of these rec- ords with a degree of assurance which sug- gests a great deal of attention has been given to analyzing these phenomena; an inference, however, which is not justified. [29] EDUCATION IN WAR AND PEACE One example may be cited of the desir- ibility of extending our knowledge beyond the present stage in which vague concep- tions and approximate definitions form the basis from which most of our investiga- tions start. We often hear it said that in soldiers under fire for the first time, the old instinct to preserve life gets the better of the recently acquired central reactions as- sociated with a special sense of cluty and an understanding of the desirability of facing the enemy, with the result that an unfortunate conflict is precipitated. At once the question is suggested what phe- nomena should be included under the term instinct and what is the nature of the con- flict. [30] HUMAN BEHAVIOR At present we have only the vaguest sort of notions in regard to the synthesis of reactions described collectively as an instinctive response and we are also very much in the dark as to just what mechan- isms are involved in the conflict. In a very general way we are correct in saying that the instinct activities may be referred to mechanisms in the cord, medulla, and mid-brain. Ontogenetically as well as phylogenetically these nerve tracts are known to be much older than those con- cerned in voluntary responses. Here within a very small area we see the con- nections between the circulation, respira- tion, internal secretion, movement and the general sensibility, which all play a part in the instinctive reactions. The majority of physicians adhere conservatively to [81] EDUCATION IN WAR AND PEACE their determination to study only the ob- jective reactions connected with the ac- tivities of the lower brain centers. A glance at any diagram illustrating the re- lation of parts in the mid-brain and me- dulla is sufficient to refresh our minds in regard to the proximity of all the great nerve tracts radiating from these centers to higher ones and suggests the need of more active cooperation in research be- tween psychiatrist and internist who have arbitrarily separated functions which na- ture has united. Think of what valuable information could be obtained by intelligent coopera- tion between the psychiatrist and internist intent upon studying together the physi- cal and mental symptoms associated with the vagaries of feeling, thinking and act- [32] HUMAN BEHAVIOR ing occurring in every patient admitted to the wards of a general hospital. This entente would be of assistance, not only in laying the foundations of an exact knowl- edge of the psycho-neuroses, but as an aid in understanding human nature. A pool- ing of clinical interests is needed in order to conduct a successful attack upon the problem of the psycho-neuroses which are probably a greater menace to civilization than are all the hostile military forces in the world. In the vertebrate embryo there is an excellent opportunity of tracing the de- velopment of the different nervous tracts in relation to the rapid elaboration taking place in responses as higher cen- ters modify and inhibit more primitive im- pulses; an important relation to under- [33] EDUCATION IN WAR AND PEACE stand in its bearing on the psycho-neu- roses. We are accustomed to talk quite glibly without possessing any definite knowledge of the subject about the rebel- lion of these lower centers in "shell- shock" against the control imposed by the autocracy assumed by the new brain. Professor H. H. Lane, at my sugges- tion, studied some of the earliest reactions in the embryos of guinea-pigs with a view of correlating as far as possible the pro- gressive changes taking place in the nerv- ous system during growth with the in- creasing complexity of reaction and the assumption of control by the new brain. He demonstrated that "avoiding reac- tions" took place in response to olfactory stimulation before the olfactory lobe was connected by differentiated nerve tracts [84] HUMAN BEHAVIOR with the cerebral cortex. The fact that an "avoiding reaction" does occur without the intervention of the cerebral cortex sug- gests the interesting question as to what extent in fear the subsequent responses take place without the participation of the higher centers. An interesting study could be made to determine in what man- ner these primitive responses are modified as the cortex gradually assumes control. A number of years ago I suggested that light would be thrown upon this problem by correlating the earliest reactions of the human embryo and the progressive struc- tural changes taking place in the nervous system ; and pointed out the excellent op- portunity there is in the obstetrical wards of a hospital for extending these observa- tions to the human subject. Studies of [35] ' EDUCATION IN WAR AND PEACE this character are needed to assist in deter- mining what factors are introduced as the higher begin to dominate the lower cen- ters, and when this is known then the way is open to analyze the conditions respon- sible for "a conflict." Hughlings Jackson * in a remarkable series of lectures, called attention to the control exercised by the "higher nervous arrangement" over the lower forms from which they had been evolved, and com- pared it to the action of a government di- recting the nation from which the govern- ment had been evolved. When any dis- turbance in the coordination of function in the higher and lower centers take place we have to consider not only the effect of "the taking off" of the control, but also *Croonian Lectures, 1884. [36] HUMAN BEHAVIOR the "letting go" of the lower functions. The sudden removal of the governing body of any country gives reason for la- menting, "(1) the loss of service of emi- nent men, and (2) the anarchy of uncon- trolled people." This distinguished rep- resentative of the medical profession rec- ognized the value of that fundamental knowledge of man which it is not incon- ceivable that some day we shall require our statesmen to possess. When we come to consider the question of how instincts are inherited, we begin to be confronted with serious difficulties. The physician is too much inclined to assume that biological inheritances are transmitted in the same way that psycho- logical inheritances are passed on from one generation to another. There are two [37] EDUCATION IN WAR AND PEACE forms of heredity, says Professor Ward; "the one with which the biologist deals and this which he leaves to the psychologist who usually leaves it alone." VII Reference to the methods used in the Air Service for studying the personality of the aviator * indicates the possibility of utilizing even our very limited store of knowledge for conserving both energy and life. These examinations are conducted with a view to determining the emotional and mental fitness of an aviator to fly. It is also interesting to note that far more attention is paid to-day in analyzing the predisposition of an aviator and determin- ing his fitness for his task than in select- * Manual of Medical Research Laboratory, U. S. War Department, Air Service, 1918, pp. 200-212. [38] HUMAN BEHAVIOR ing a President. Is it unreasonable to believe that some day we shall judge our rulers by their "predispositions," and not by their arguments ? The efforts made to safeguard the mental hygiene of the avia- tor unquestionably prevented many acci- dents. MEDICAL RESEARCH LABORATORY Hazelhurst Field, Mineola, L. I., N. Y. Examined date Name Rank Organization Residence I. Aviation: Enlistment date, place, sworn in, Assigned to (branch of service) Active Service Entrance or Transfer to Air Service. Avia- tion School work Repeats. Aviation active service date of commission, dates and places of training. Hours of flying. Maximum Al- titude. Duration. Accidents. Reasons for selecting aviation. [39] EDUCATION IN WAR AND PEACE II. Personal History : Age S. M. W. Diseases (children's and adult). Injuries, operations. Education, School and College. Athletic training. Occupation of Civil Life Success. Tobacco Alcohol Sleep Family. III. Physical Examination: Ht. Wt. Gain or Loss Pupils Reaction to light and accommodation, Secondary dilatation Knee Jerks Psycho-motor Tension. Tic Tremor. Extension in fingers and hands Tongue Drawing parallel lines Writing slowly Dermagraphia before and after rebreathing Appearance Tired Evidence of anxiety or of stress. IV. Personality study: Observation, good or bad Resourcefulness Forcefulness Frankness (Does he seems to be genuine?) Spontaneity Emotivity Temperament (mood), even, lively, dull, un- steady, tendency to unburden, stable Contentment [40] HUMAN BEHAVIOR Alertness Aggressiveness Mental Reactions, quick, slow, deliberate, de- gree of mental energy, dull, well balanced, high tension Cooperation Sportsmanship Self-possession Remarks : Rating: This study of the aviator's personality judged from the medical standpoint alone is not sufficiently comprehensive for all purposes, but the lines of inquiry followed were suggested by the experience gained from examinations made on the field. The initial mental symptoms of fatigue have a special interest. MENTAL SIGNS OF STALENESS 1. Lack of pleasure in the work. 2. Lack of confidence. 3. Disgust at the whole business. [41] EDUCATION IN WAR AND PEACE 4. Nervousness in attacking the task; technique goes to pieces; he analyzes every part of it and sees his task too minutely. When these are present the aviator should not be allowed to fly. Personality studies properly made could be used to great advantage in laying the foundations for a rational education. The Qualification Card * for use in schools and colleges was suggested to me as the result of examining students, and trying to as- sist them in some of their difficulties in adjusting life. The need for this kind of work both in schools and universities is far greater than had been imagined. The information asked for can be obtained by any intelligent teacher, and it is of such * See page 89. [42] HUMAN BEHAVIOR a character that special technical knowl- edge on the part of the examiner is not necessary in gathering the data. Impor- tant results have followed the introduc- tion of even such brief personality studies and already have led to more frequent and sympathetic cooperation between parents, teachers and physicians. A number of years ago we suggested that a training in pedagogics should aim to give teachers some practical insight into the methods of exploring a personality ; in order that they might appreciate the beginning of the pathological tendencies which are respon- sible for so many failures in life.* The present alarming incidence of nervous and mental diseases calls for more active ef- * Paton, S. Psychiatry, 1905. J. B. Lippincott Com- pany, p. 197. [43] EDUCATION IN WAR AND PEACE forts on our part to secure reliable infor- mation in regard to the genesis of these disorders and the methods of preventing their development. VIII The problem of human behavior cannot be discussed without some reference being made to the emotional and mental symp- toms indicative of the unrest which is appearing in all parts of the world. These disorders are part of the price man is paying to-day for his neglect in mak- ing adequate provision for the study of human nature. Various epidemics of bodily disease during the middle ages se- riously menaced the progress of civiliza- tion. Since that time the progress in medical science has lessened this danger; [44] HUMAN BEHAVIOR but unfortunately relatively little at- tention has been given to limiting the spread of mental disorders. As the result of the greatest war in history and the pres- ent unsettled social conditions, our atten- tion is now being forcibly directed to the urgent need to remedy this defect. While we are waiting as patiently as possible for additional information in regard to the fundamental qualities of human nature, we should let our statesmen realize that the data already in our possession could be used to advantage in assisting to restore the emotional and mental balance essential to the establishment of peace and order. The emotional disorders sweeping over the world to-day seem to have a common basis; although the symptoms are modi- fied by the local conditions existing in the [45] EDUCATION IN WAR AND PEACE different countries. There is no more room for believing that the emotional in- stability appearing in Russia, France, or the United States is traceable in each country to independent causes than there was for believing that the extraordinary action of the flagellants, the dancing ma- nias, and various forms of psychotic dis- turbances appearing in the middle ages were the result of diseases differing spe- cifically from each other. Dr. Johnson in defining the word in- sanity anticipated some of our modern psychiatric conceptions when he stated that "all power of fancy over reason is a degree of insanity." Just as soon as fancy begins to supply the data upon which we base our plan for the conduct of life, the condition we call insanity is present. This [46] HUMAN BEHAVIOR is the biologic conception of insanity and not the one generally given in the court room. The sane man faces squarely the plain facts connected with living and does so under all ordinary circumstances with- out developing a feeling of insecurity or inadequacy. He reviews calmly the fact that life is a struggle for existence and the progress of civilization is necessarily very slow. Having faced these facts, rea- son, not fancy, then prepares and elab- orates his program for living. The psy- cho-neurotic, driven by a sense of inade- quacy and insecurity, dodges the main issues. To him the idea of struggle and the slowness of progress are harrowing thoughts. Concrete, well-defined situa- tions are extremely harassing as the possi- bility always exists of being forced to meet [47] EDUCATION IN WAR AND PEACE an unwelcome intruder in the guise of some unsolved personal question. General theories and abstractions take the place of facts, and if the truth cannot be avoided, to quote from Huxley, "its fair face is varnished with the pestilent cosmetic rhet- oric." Just as soon as confidence in self is shaken various ruses are adopted to re- store the emotional equilibrium. Differ- ent degrees of egotism may represent the compensatory efforts to effect a satisfac- tory readjustment. The aggressive forms of egotism are protective reactions useful in keeping intruders off the premises; thus reducing the danger of the sudden exposure of the real personality. In pre- paring these defenses the power of fancy over reason is often clearly in evidence. Society has unconsciously made it in- [48] HUMAN BEHAVIOR creasingly difficult for the psycho-neurotic to face his own problems. We have been socialized in thought to the extent of avoiding a great many personal questions, and the word individual has almost been dropped from our vocabulary. Feelings and thoughts as well as our living quarters are shared with our friends and acquaintances. Such a very keen interest has been developed in what other people are doing there is seldom time to put our own house in order. It is a great comfort to the psycho-neurotic in- tellectual to forget temporarily the diffi- culties of the individual citizen and to dis- cuss class privileges, class distinctions, class rivalries and class judgments. He is also enthusiastic in discussing general so- cial conditions, a method of diverting at- [49] EDUCATION IN WAR AND PEACE tention from the galling recollections of personal defeat and personal disappoint- ment. A form of competitive notoriety in championing the cause of the people serves to divert attention from personal failure. Any suggestion in regard to making the facts derived from the study of individual cases of human behavior the hasis for a science of character is received with scant consideration. The psycho-neurotic dreads to be left alone with himself but loves to pose in public as a martyr. He runs away from unsolved personal problems and de- velops fanatical enthusiasms in studying general social questions; and tries to put democracy on the patent-medicine shelf as a universal remedy, hoping thereby to avoid the irritation and mortification as- [50] HUMAN BEHAVIOR sociated with the recollection of personal insufficiency. Numerous illustrations selected from actual life could be cited as evidence of the skill acquired in camouflaging the bitterness of personal defeat and disap- pointment by resorting to semi-rational- ization. There is the familiar case of the neu- rotic mother exhibiting such an abnormal degree of solicitude in reforming the en- tire educational system, while subjecting her own children to such distracting influ- ences in the home that the natural diffi- culties of acquiring good mental habits are immeasurably increased. Then there are the men and women who are continu- ally declaring their interest in the "broth- erhood of man" or in the "cause of the [51] EDUCATION IN WAR AND PEACE common people" who in the inner circle of the home exhibit peculiarly exasperat- ing qualities of both temperament and character. An interesting illustration of the sub- stitution of general terms to describe a concrete situation is exemplified by the person who is afraid to apply the tests suggested by reason to determine whether his own life has been a success, and suddenly surprises his friends by an- nouncing his conviction that there is a great deal of good in the present Bolshe- vist movement. This statement, which at first may be as much of a surprise to the person making it as to his friends, exposes a side of the personality which was care- fully hidden from the public view until the cat jumped out of the bag. Such a [52] HUMAN BEHAVIOR person does not think pertinently nor through any of the real issues in his own life. Extreme solicitude in concealing personal defects generally results in the exposure of the real personality. The present widespread emotional in- stability gives rise to many and strange repugnances. In one class of persons where there is little intellectual capacity to eff ect a partial compensation, the symp- toms of ennui and boredom express the general dissatisfaction with self. If there is sufficient mentality to effect a compen- sation of even temporary value there is apt to be a rapid multiplication of wish- directed thoughts diverting attention away from the skeleton in the closet. The ineffectual character of the compensation may be indicated by attacks of mental [53] EDUCATION IN WAR AND PEACE depression and these are followed by a period in which great zeal is shown in elaborating plans for the general improve- ment, not of the individual, but of so- ciety. The various plans proposed run fche gamut from parlor socialism to Bolshe- vism. We need to be reminded constantly of the fact, and reminded by a psychiatrist too, that we can remain sane only if we begin by setting our own house in order before starting out to reform the world. And the first step in this direction is to learn to face life as it is, and not as we should prefer or wish to have it. "Better the sight of the eyes than the wandering of desire" is an old Hebrew maxim based on the recognition of a very sound princi- ple of mental hygiene which was formu- lated a great many centuries before Freud [54] HUMAN BEHAVIOR redirected attention to the danger of un- controlled wishing. IX It is fortunate for Society that the phy- sician is still interested in individual cases, and has not yet shown any indication of studying disease or treating his patients as the average social reformer attempts to do, en masse. His work compels him to attempt to make a diagnosis of each person's malady, and his generalizations as a rule summarize the definite findings of specific cases. His practice is based on at least the tacit recognition of the prin- ciple that human beings are independent autonomous organisms, each requiring special study and no two are exactly alike. The average American could profit a [55] EDUCATION IN WAR AND PEACE great deal by taking lessons in the art of balancing his personal accounts, emotional as well as mental, and adopting a rational plan for finding out whether the debit and credit columns tally. There is sufficient evidence to show that as a nation we are untrained in this art. Our personal feel- ing of insecurity, our fear of finding su- periors is revealed in the emphasis placed on the word "equality" while relatively little is said about justice. We are driven to take this position by prompt- ings from the subconscious field remind- ing us continually of our inadequacy and unfulfilled ambitions. It would be a great comfort to many to feel that there were no physical or mental or social inequalities. Marked solicitation characterizes our plans for developing [56] HUMAN BEHAVIOR some form of government in which the biological inequalities of individual citi- zens will be carefully concealed. As a people we are always afraid of finding superiors, and this unfortunate national characteristic is one result of the failure to cultivate an intelligent critical spirit. If we were satisfied that Democracy had accomplished all we claim for it, there would be less inclination to parade its vir- tues upon every occasion. The man who is honest at heart seldom makes any per- sonal reference to his own particular vir- tues, and advertised virtues are rarely to be considered as pledges of good conduct. We have just begun to realize the dan- ger of wishful thinking. Most of our wishes are artfully concealed, not only from public inspection, but as a result of [57] EDUCATION IN WAR AND PEACE skillful self-deception even from our own recognition. As a wish from the biological standpoint is nothing more or less than an indication of the "motor set" determining the direction of all our activities, the ele- ments composing it are found largely in our subconscious life. This is a fact of which we need to be constantly reminded as the wish when translated into overt ac- tion may be so easily reinforced by emo- tion that its genesis is soon hidden beneath a very complex series of compensatory responses. Let us hope that the physician to-day will make the best use of the opportunity which the war has brought to him to ac- quire for himself and to assist others to acquire the art of intelligent self-criticism which is so essential in protecting indi- [58] HUMAN BEHAVIOR viduals against the incidence of nervous and mental disorders as well as in com- pensating for a pronounced defect in our national life. Intelligent self-criticism is needed in this country in order to assist in repelling those disorganizing forces which now dissipate individual as well as national energy. The physician, as has been indicated, should be better qualified than the mem- ber of any other profession to undertake the study of body-mind problems, and im- mediate action should be taken to provide adequate opportunities in our medical schools for studying the problems of hu- man behavior. The future of our civili- zation depends first upon the realization of the need for training investigators com- petent to explore these special problems. [59] EDUCATION IN WAR AND PEACE A neuro-psychiatric institute is the logical center for this work. The insti- tute should be in close and sympathetic connection with other clinics and labora- tories, and also with other scientific de- partments in a university in order that there may be collaboration between in- vestigators in related fields of study. When once these centers have been estab- lished then we may know that an intelli- gent effort is being made to go to the root of many of our social troubles. At the present time money and energy are wasted in the treatment of the last stage of dis- orders of adjustment found in work- houses, asylums, prisons, reformatories and various other institutions. The "down and outs" bear witness to our unprepared- ness to attack directly the real enemies of [60] HUMAN BEHAVIOR Mental Hygiene Social Service Criminal Juvenile Court Court Medical Clinic Pediatric Clinic Surgical Clinic CLINICAL RELATIONS For Study of Human Behavior NEURO-PSYCHIATRIC INSTITUTE Hospital and Laboratories LABORATORY RELATIONS Physical & Chemical Laboratories Physiological Laboratory Anatomical Laboratory Anthropological Laboratory Institute for Study of Genetics [61] EDUCATION IN WAR AND PEACE our civilization. It is singularly unfor- tunate that in a republic it has never been possible, until very recently, to organize a center well equipped for carrying on ex- plorations in the field of human behavior. In Newark, N. J., under the direction of Dr. C. C. Beling,* a Bureau of Mental Hygiene is now being organized as one of the divisions of the Department of Pub- lic Affairs. The physician realizes probably to a greater degree than the members of any other profession that present social dis- orders as well as other diseases can be most effectively studied by beginning with the consideration of the facts in individual cases. His training as well as his prac- * Health Bulletin, May, 1919. Issued monthly by the Department of Health, Newark, New Jersey. [62] HUMAN BEHAVIOR tical philosophy of life should make it easy for him to appreciate the value of Socra- tes' advice, "Know thyself." Upon the success attained in assisting people to practice the precept which for so many centuries has been repeated automatically with academic precision, depends the sta- bility and development of human institu- tions. [63] CHAPTER II WAE AND EDUCATION* r I iHE war has not taught us much that A is new in regard to the foundations of character, but it has reminded us in a tragic way of the importance of a good many old truths. The revisions of the cur- ricula, either already undertaken or being discussed, in educational institutions, civil as well as military, are the results of some of the useful lessons learned during our * Address delivered at the Annual Meeting, Head- masters' Association of the New England Schools, New Haven, February 14, 1919. [64] WAR AND EDUCATION efforts to make adequate preparation for waging a successful war. Let us thank Heaven that at last the words "life" and "living" have been writ- ten in capitals in the educational program. The educational system, according to the pronouncements before the war, pre- pared pupils in schools for college and those in colleges for business or profes- sions ; but remained silent in regard to any thoroughgoing preparation for life and living. After the bitter experiences of the last four years the discovery has been made that in exploring life and in direct- ing the activities of human beings, it is essential to enlist the interest and serv- ices of persons who understand something about the running capacity of the human machine. We know now that a knowl- [65] EDUCATION IN WAR AND PEACE edge of mathematics, Greek, or chemistry does not imply the possession of the ex- perience essential for the intelligent di- rection of the emotional life, for cultivat- ing good mental habits, for the adoption of precautions necessary in protecting the soldier against symptoms of shell-shock or the civilian against nervousness, for increasing military or industrial efficiency, for avoiding the emotional conflicts result- ing in egotism, and for keeping the mind free of the obsessions, over-valued ideas, and irrational fears which seriously inter- fere, either with military preparedness, or the kind of mental preparedness requisite for a true and durable peace, and last but not least, for success in living. Some persons realize that education should be considered as the process of [66] WAR AND EDUCATION assisting human beings, first to measure their own physical, emotional, and intel- lectual capacities, and, second, to adjust their lives so as to give free expression to their natural, and not as is so often the case to thwarted or distorted propensities. It is no exaggeration to say that already the more general and intelligent interest taken in the study of the foundations of character promises to repay a thousand- fold all the cost of war, measured either by money expended, suffering endured or life lost. For a good many centuries pupils have written with automatic precision in their copy-books, "Know thyself," but they have had little instruction in the difficult art of acquiring reliable self-knowledge. Unfortunately a war seems to have been [67] EDUCATION IN WAR AND PEACE necessary to give to the academic mind a definite interest and reason for translat- ing the Socratic precept into action. If professors had taken a more practical in- terest in assisting students to realize in their own lives some of the Greek ideals Greek would still be one of the required studies. School and college records usually con- tain conventional references to a stu- dent's acquisitive, but unfortunately none to his inquisitive capacity, and as a rule omit altogether any allusion to the strength and set of the deep emotional under-currents shaping his personality. If we were accustomed to going below the surface of a personality and to studying its composition, we should not be so aston- ished to learn that the very ancient in- [68] WAR AND EDUCATION stinct of self-preservation could gain such domineering control of the conduct of an intelligent man as happened to an officer who, while waiting under heavy shell fire for orders, experienced great relief from nervous tension as soon as he covered his head with a blanket. Nor would we be nonplussed in the search for a satisfactory explanation of the behavior of the avia- tor possessing an excellent record as a pilot, who suddenly lost his nerve and flatly refused to go up in a plane, regard- less of the consequences of disobedience. Here the attempt to turn the back upon and forget an extremely annoying un- solved personal problem precipitated a conflict by trying to force unwelcome in- truding thoughts out of consciousness. The struggle ended in temporary but com- [69] EDUCATION IN WAR AND PEACE plete loss of courage. Some advice and as- sistance led to a complete readjustment, including the return of self-confidence, and to the enjoyment of the satisfaction of again making good as a flier. In schools and colleges we pay a great deal of attention to training the lately ac- quired conscious processes but do not de- vote much time to exploring the basic in- stincts forming the foundation of char- acter. War in many instances has torn off the outside covering of the personality and exposed the real driving forces in the human personality. Time and again it has been shown that a nervous breakdown either in civil life or on the battlefield is due to the disorganization following a poorly assimilated instinctive life. [70] WAR AND EDUCATION II While the Army is beginning to appre- ciate the necessity for protecting the sol- dier against shell-shock, but very little is being done by the schools and colleges to protect the civilian in times of peace, by giving him the right kind of education to withstand the strain and stress of mod- ern life. During the school period much could be accomplished in detecting and then correcting the presence of the disruptive forces which later in life might tend to disorganize the entire personality. It is well for the educator to understand the fact that a nervous or mental breakdown is one of Nature's methods of protesting against the attempt to live in a manner [71] EDUCATION IN WAR AND PEACE which makes an entente between instinct and reason either difficult or impossible, or, as Emerson said, "puts a man out of connection with his reason." All intelligent schoolmasters thorough- ly appreciate the responsibility for taking adequate measures to protect the physical health of the pupil, but the case is differ- ent when it comes to the mental life. To- day there is no question where the blame should be placed for the tragic ending of the following case : A boy while in boarding school begins to cough and expectorate and at the same time rapidly loses in weight. Weeks later, after the symptoms have developed to an alarming extent, and after other boys have been infected, the schoolmaster seeks the advice of a consulting physician who [72] WAR AND EDUCATION at once makes a diagnosis of tuberculosis. In this case the public rightly places the blame on the schoolmaster. Here is the record of another boy, and in the minds of the laity there may be doubt, but the psychiatrist has none, as to the degree of direct responsibility the schoolmaster has in averting an equally tragic ending. During his school days the second boy gave much evidence of the existence of cross purposes existing be- tween his instinctive life and the so-called mental processes. There were periods of moodiness, and distinct attacks of the "blues." At other times there was a de- cided tendency to hyperactivity and an unusual buoyancy of spirit. The school records show that the school requirements were satisfied and the results of examina- [73] EDUCATION IN WAR AND PEACE tioris were excellent. Several years after leaving college there was a complete ner- vous breakdown followed by a partial readjustment. In the subsequent effort to obliterate all traces of inadequacy the young man over-compensated in his search for peace, becoming a pacifist and radical socialist. His interest in univer- sal peace and in the brotherhood of man- kind represents an effort to attain per- sonal peace and to satisfy an ungratified desire of being a good mixer. The educator should be familiar with the effort so often made by those possess- ing a weakened sense of personality to compensate for this defect by arbitrarily dividing society into two rival classes and then by assuming membership in the group which has been selected as the only one [7*] WAR AND EDUCATION entitled to salvation. Time and circum- stances change the names of the group, but this method of securing personal sal- vation is as old as the human race. The "sheep and goats," "saints and sinners," "capitalists and laborers" represent the elect or the damned, depending upon the point of view adopted. Here is an example of the futile attempt often made under trying circumstances to compensate for a weakened sense of personality. A young person brought up in conventional surroundings, but suffer- ing from the effect of emotional instabil- ity, mental repressions, and the lack of opportunities to give adequate expression to the drive of the instinctive life and wish- directed thoughts, suddenly develops an intense interest in a number of social [75] EDUCATION IN WAR AND PEACE movements having as their object the radi- cal and immediate reorganization of pres- ent customs and modes of thought. It does not require any one with a very pro- found knowledge of human nature to ap- preciate the source of the motives and the reason for the development of these very radical opinions. The following case illustrates the great difficulty of discovering the real cause of maladjustment and the difficulties in remedying a difficult situation. A lad ahout sixteen years of age was unable to adjust his life satisfactorily to the environment of a boarding school. Although he did reasonably well in his book work, he was subject to marked emo- tional disturbances which were partly con- cealed by a series of compensatory defense [76] WAR AND EDUCATION reactions. The boy could not be relied upon for persistent efforts, and unless he received a great deal of praise his work rapidly deteriorated. At times he was possessed of unusual determination and would do a great deal of work in spurts along lines in which he had some special interest, and showed considerable strength in resisting distracting influences. One of the symptoms which first attracted the attention of his teachers was the tendency to do and say things that brought him into unusual notice, while among his companions he was boastful and his actions often were decidedly dra- matic. At times he was a "good mixer" and at others, if his luck was against him, seclusive and occasionally extremely reti- cent. The periods of reticence seemed to [77] EDUCATION IN WAR AND PEACE be followed by outbreaks of unusually good fellowship, and these were accom- panied by amusing eccentricities and man- nerisms. His honesty in regard to money matters and his sense of responsibility were strangely defective. Although not actually caught in any dishonest practices, he gave the impression at times of not hav- ing a very clear conception of the embar- rassing position in which he placed him- self nor of his pecuniary obligations. He was not noted either in sport or in class room work for any ability or inclination to stand alone, and was quick and ingeni- ous in offering explanations whenever, as is so often the case, he was thrown on his own resources or compelled to explain some statement he had made. The ex- cuses offered in explanation of his per- [78] WAR AND EDUCATION sonal defects were often exceedingly elab- orate. If forced by circumstances into a position where the inconsistencies of his statements were apparent, he never ad- mitted the real difficulty and made haste to prepare a new set of defenses. For the present purpose it is not neces- sary to give any more details, as sufficient has been said to indicate how poorly the majority of parents as well as teachers are equipped to deal satisfactorily with such a complex of symptoms. The con- ditions in the home life, as is so often the case, were unfavorable for the boy. The father was unusually stern and subject to sudden impulses, and the mother present- ed the emotional instability so often asso- cited with the so-called artistic or psycho- neurotic temperament. [79] EDUCATION IN WAR AND PEACE If the proper environment is supplied at the right time in cases of this character, and sympathy and intelligent assistance given in solving the personal problems, it would often be possible to direct the ac- tivities along lines which would not termi- nate in a tragedy. The real difficulties in the case were probably of an elementary character but should be sought for below the conscious level. There can be little doubt that this particular boy, who may be taken as representing a large class, had started off in life without an opportunity to appreciate and to prepare to meet the difficulties connected with living which he would undoubtedly be called upon to face. It is interesting to compare with this type of case another one where apparently the mechanism of adjusting life is not one [80] WAR AND EDUCATION whit more effective than in the first in- stance; but the boy has grown up in an environment where plain facts are not varnished by rhetoric and the habit is formed of meeting difficulties as they arise and of dealing with concrete situations. In the second case the danger of sudden col- lapse is much less than in the first boy where an artificial series of reactions has been built up and the security of these defenses depends merely upon the strength in resisting sudden impulses without the ability to enlist the full power of rational control. Before passing on to the consideration of another phase of the question I think it may be said that within a few years public opinion will hold educators as strictly to account for the tragic failures [81] EDUCATION IN WAR AND PEACE of students beginning with marked disor- ders of the emotional life as it does now for the unfortunate ending of a case show- ing marked pulmonary symptoms and left so long without proper medical attention. in The results of the war experiences have indicated the reasons for emphasizing the value that in any rational scheme of edu- cation should be placed upon "doing things." Again and again we have been reminded of the fact that the sense of ac- complishment, associated with movement, is essential for sane thinking and the de- velopment of real, stimulating, perma- nent intellectual interests. The people who have found the daily struggle of life [82] ' WAR AND EDUCATION a little bit more than they could endure with equanimity and have resorted to petty intellectualisms in order to restore their own lost balance, have assumed that doing is an inferior function to thinking. Our national failing of being hypnotized by the sound of words is one result of such academic conceptions of education as those to which reference has been made. One of the extraordinary fallacies in the present system of education is the assump- tion that the emotional and mental char- acteristics of the cultured person may be developed in students merely by instruc- tion in the Classics. The ridiculousness of this position is apparent as soon as we begin to analyze the characteristics of a cultured mind. Considered from the psychologic point of view, the ability to [83] EDUCATION IN WAR AND PEACE select the best that has been thought and said in literature is a special capacity de- pending principally upon certain emo- tional, not intellectual, qualities which pre- serve a balance by preventing the forma- tion of obsessions and over-valued ideas. This discriminating capacity is developed as the result of the proper adjustment maintained between feeling, thinking and action. The reason our schools and uni- versities have not been more successful in fostering the spread of culture is that so much emphasis has been devoted to selecting subjects of thought that prac- tically little attention has been given to improving methods of thinking. Every college graduate should be familiar with the conditions essential for the preserva- tion of sanity and understand what pre- [84] WAR AND EDUCATION cautions should be observed as necessary to cultivate intelligent intellectual in- terests. He should also know what could be done to keep the mind free from the distorting influences of a poorly regu- lated emotional life. Action, Professor G. H. Parker of Harvard has reminded us, is one of the oldest and most ingrained of our func- tions. The muscular system is probably millions of years older than the nervous system, and we now know that this mus- cular system gives the set to all activities finding their ultimate expression in wish- es, in desires and in the whole current of the emotional and intellectual life. It is interesting to speculate as to whether the Gettysburg speech would ever have been written if Lincoln had not been [85] EDUCATION IN WAR AND PEACE able to chop wood; if the frescoes of the Sistine Chapel would ever have been con- ceived if the brain of the artist had not also been capable of formulating plans and assisting in the construction of the scaffolding upon which he worked ; or whether Newton would ever have discov- ered in the fall of the apple the universal law if he had not been familiar with the sense of accomplishment associated with doing. Functions described as feeling may be classified with doing as primordial. The academic bias in favor of thinking has made us forget how much more funda- mental feeling and doing are. Thinking is only the surface current in the stream. The direction of both desire and the [86] WAR AND EDUCATION thought processes are determined by the emotional set. The war has taught us a great deal about the danger of irrationally directed feeling. Do we need now any reminder of the fact that feeling should be linked up early in life with rational as well as permanent motives and ideals, and, as of equal importance, with action? Perverted feeling, a feeling of imag- inary superiority, was the high explosive in the German character. Half a cen- tury ago even thoughtful people did not appreciate the danger lurking in the Teu- tonic complex of symptoms in which ego- tism, sentimentality and wishful thinking were the dangerous elements. It was not the militarist who lighted the torch that [87] EDUCATION IN WAR AND PEACE set the world in a blaze, but the super- idealist dreaming of Teutonic supremacy. If Germany's emotions were too often suppressed ours find expression too easily. We are conducting a very doubtful ex- periment when we permit such emotional storms to break as are seen in connection with American athletic contests. Organ- ized cheering and other manifestations of hysteria have no connection with the nor- mal idea of sport, and these emotional storms are doing a great deal to check the development of intellectual interests in schools and colleges by giving the student a false set of values as well as tending to foster the spirit of Chauvinism and boast- fulness which at times assume such ridicu- lous proportions in our national life. [88] WAR AND EDUCATION IV The following suggestions are made be- cause they have a direct bearing upon the whole educational problem. The informa- tion asked for on the Qualification Card should be readily obtained by any intelli- gent teacher who has not had any special training in the art of exploring the per- sonality. These cards could be used to great advantage in both schools and col- leges. If records of this kind were kept we should accumulate a great deal of val- uable information bearing upon the real problems of education, in most of which, at the present, we seem to have only an academic interest. QUALIFICATION CARD Birthplace of father of mother Father's profession Number of brothers Number of sisters [89] EDUCATION IN WAR AND PEACE . Professional and intellectual interests of parents refer to musical and artistic abilities of members of family Chief characteristics of home environment Brief description of physical defects Height Weight note any recent changes. . . Indicate special aptitudes shown at play or work Record specifically character and degree of coordination of movements Manual dex- terity Note emotional balance Is it easily disturbed? Is there any tendency to seclusiveness ? To aggressive sociability? What are the chief characteristics in facing any critical situation? Is there a frank and open attitude? Note any strong or unusual prejudice What evidence is there of intelligent curiosity?. Does the attention easily lapse? What is the capacity for concentrated effort? What opportunity has been given to sense feeling of achievement [3 any special interest developing? [90] WAR AND EDUCATION (1) Notes should be made of the per- sonality of each pupil. The effort should be made to find out what he is fitted for emotionally as well as intellectually before attempting to "fit him" either for college or any other field of activity. (2) Each student before he leaves school should experience a definite sense of achievement in connection with his work. If he does not have this satisfac- tion an intelligent effort should be made to find out what it was that prevented. (3) Fewer subjects should be taught and those which are taught should be bet- ter taught. The fact that we expect pu- pils to study so many different subjects leaves no time for the learning spirit to develop, creates and fixes bad mental hab- its and induces a series of reactions which [91] EDUCATION IN WAR AND PEACE later in life predisposes the pupil to func- tional nervous disease. (4) The boy should be helped to real- ize the Greek ideal of becoming a good companion for himself. A great many Americans are afraid of themselves, and this is because they have no intelligent in- terest either in the immediate environment or immediate present. A boy who while walking in the country takes an intelli- gent interest in what he sees, such as plants, insects, etc., other things being equal, has acquired a series of "feeling" and "thinking" reactions which will serve later in life as an excellent protection against the development of nervous mal- adjustments. It is most unfortunate that so little at- tention is given in schools to old-fashioned [92] WAR AND EDUCATION Nature study, which could be taught to great advantage if combined with sketch- ing. The individual student as well as the cause of science would both be benefited if the colleges and universities required from all applicants for admission to un- dergraduate courses proof that they had acquired an intelligent interest in nature studies. A struggle of far greater importance and intensity than the war has begun. It is our duty to try to make democracy safe for the world; and not follow the Prus- sian's example of assuming that the world should be made safe either for democracy or autocracy. The only hope of accom- plishing this depends upon our abil- ity to regulate human behavior intelli- gently. Surely those who call themselves [93] EDUCATION IN WAR AND PEACE educators should realize that this cannot be done unless we study the human ma- chine and explore the genesis of impulses, the development of the personality and add some understanding of the method of regulating intelligently the forces ex- pressed in human behavior. [94] CHAPTER III THE PSYCHIATEIC CLINIC AND THE COM- MUNITY * increasing interest shown in the i study of human activities is one of the most significant and hopeful signs of our times. Momentous as was the im- pulse given to science by Copernicus, Gali- leo and Newton one result of their inves- tigations was to direct attention to a uni- verse in which human beings were con- sidered to be merely passive observers of Address delivered at the opening exercises of the Henry Phipps Psychiatric Clinic, The Johns Hopkins Hospital, Baltimore, Md. [95] EDUCATION IN WAR AND PEACE natural phenomena. So absorbed did man become in formulating hypotheses to explain a theoretical universe of which he did not form a part, and in delving into the records of his own past history, that he neglected the study of present activities. At last the course of events warned him that the lessons of remembrance or the hypertrophied historical sense had become "a malady from which men suffer." The dedication of a psychiatric clinic is an event of more than ordinary impor- tance to a community, since it marks the awakening of intelligent interest in man as an active thinking being. Having striven for centuries to improve the meth- ods for recording his fanaticisms, super- stitions, sins of omission and of commis- sion, and failures to adjust life to meet [96] THE PSYCHIATRIC CLINIC new conditions, he has begun at last to take rational measures to improve his lot, and to acquaint himself with the laws on which the social organism rests. Because the value of this benefaction to the com- munity will depend directly upon the in- telligent use of resources and energy made available for rendering more eff ective serv- ice to humanity, may we not profitably de- vote a few moments in attempting to formulate some of the problems to the solution of which this clinic is dedicated? Errors in judgment committed now, in estimating the scope and the character of the investigations to be carried on in this building, might defeat the efforts of those upon whom the responsibility of equaliz- ing opportunity and achievement must fall. [97] EDUCATION IN WAR AND PEACE This clinic, in a peculiarly distinctive manner, typifies the human as well as the humane spirit of the twentieth century. During the seventeenth and eighteenth centuries the physical sciences had suc- ceeded in breaking away from the tra- ditions and superstitions which had ham- pered their development. Astronomy had been divorced from astrology, chem- istry from alchemy, and the foundations of geology had actually been laid. In the nineteenth century the renaissance of the biological sciences was accompanied by the formulation and expression of a ra- tional idea of man's position in cosmos. Towards the close of the eighteenth and the beginning of the nineteenth century a few investigators had already called at- tention to the importance of studying the [98] THE PSYCHIATRIC CLINIC activities of human beings; but not until the second half of the last century was there any realization of the fact that the most interesting phenomena of the uni- verse for human beings to study were their own activities. How do we live, move and have our being? To the lay mind the term psychiatry often suggests a very limited field in med- ical science, but those who take an active part in the work of this clinic will easily appreciate that they are engaged in at- tempting to find the solution of problems of far greater importance than any re- lating merely to the care of patients suf- fering from mental and nervous disorder. Anomalies of thought and conduct are studied in order that the knowledge ac- quired may be applied directly to making [99] EDUCATION IN WAR AND PEACE life for the majority of persons pleasanter and more effective. Institutions of this character are intended primarily for the study of human nature along broad bio- logical lines. We are justified in considering disease as an analytical process which reduces to a comprehensive form the complex activi- ties we designate collectively as health. An intimate knowledge of abnormal states of mind and body is, as Pinel affirmed, a key that unlocks the secrets of human his- tory. By making use of nature's contrast of functions we may also gain an insight into that continuous process of adjust- ment we call life. From the study of disease the facts have been gathered for the foundations upon which modern pre- ventive medicine has been established, and [100] THE PSYCHIATRIC CLINIC through it a new meaning has been given to life and greater efficiency in thought and action to those who profit by the les- sons of science. For centuries the differ- ent parts of the body have been studied by physicians, and a knowledge of the structure and function of the separate parts has been attained. It is essential, if we are to comprehend the fundamental mechanisms of response of the organism, that we familiarize ourselves with the laws which govern the relationship of all these organs as they are expressed in each indi- vidual, and we must accustom ourselves to study man as a living organism. Living beings have the capacity of ex- pressing their integral unity as individu- als, and in the case of man there are spe- cial mechanisms of adjustment, collec- [101] EDUCATION IN WAR AND PEACE tively designated as the personality. The complex adjustments synthesized in the personality may easily be deranged by in- terference with the activities of organs or by disturbing the capacity for adaptation, the chief function of sense organs, brain and nervous system. We all know how intimately dependent human beings are upon their environment. Changes in the latter call for delicate and immediate adaptation, and it may be said the prob- lems of psychiatry relate to the determina- tion of the causes which give rise to im- perfect adjustments. A great blessing was conferred by sci- ence upon humanity when the problems of psychiatry were re-stated in biological terms. Life was recognized as a process of adjustment, relatively perfect in health [102] THE PSYCHIATRIC CLINIC and imperfect in disease ; while that meta- physical term insanity, arbitrarily reserved to designate certain forms of unsuccessful adjustment, was cast into the rubbish- heap, together with the chains, strait- jackets and hand-cuffs which had long tortured the lives of patients. Out of hazy mystical conceptions entertained in regard to the nature and genesis of activities de- scribed as thought and conduct sprang new ideas potent to inspire the minds of investigators, capable not only of bring- ing about great practical reforms in the care of the insane, but also in improving the methods for attacking the problems relating to human thought and conduct. As the ultimate success of the work to be carried on in this clinic, more than in any other department of the hospital, will [103] EDUCATION IN WAR AND PEACE depend upon cooperative endeavor, I may be permitted to emphasize what seems to me to be an important factor in organiza- tion and administration. The patients presenting themselves for treatment are subjects of imperfect adjustments in the life process. The time during which they remain under observation in these wards will represent relatively brief epochs of life, and the records of cases will often give but cursory glimpses into the gene- sis, duration and progress of imperfect life adaptations. In order to serve the high purpose for which it is planned and dedicated this clinic should be regarded as an important link in a chain of agencies, home, school, college, other hospitals and institutions ; in fact of the entire social or- ganization with which it is essential con- [104] THE PSYCHIATRIC CLINIC stant sympathetic contact should be main- tained. Only by the establishment of such relationships can progress in the study of life processes be made. May we express the hope that in at- tempting to estimate the value of the work accomplished in this clinic the public ex- pression of opinion should be tempered by charity and patience? Although the field of investigation, which includes the consideration of the factors determining human thought and conduct, is the most interesting one in modern medicine, let us not forget that it is the last one to be thrown open to investigators. The methods of investigation necessa- rily employed will not appeal to the imag- ination of the public. The inspiration nec- essary to solve the problems of modern [105] EDUCATION IN WAR AND PEACE psychiatry will probably not flash into consciousness as did the visions that guided the observer watching the lamps swing in the cathedral or the apple fall from the tree, but it will come gradually only after patient quiet effort, similar to that which finally rewarded the author of "The Origin of Species," and gave a new meaning to life. The realization of the ideals to which we do homage to-day will mark the time when, in Goethe's words, "Reason begins again to speak, And hope again to blossom." PAUL B. HOEBER, 67-71 E. S9TH ST., NEW YORK HOEBER'S MEDICAL MONOGRAPHS MEDICAL MONOGRAPHS Published by PAUL B. HOEBER i East 59th St., New York This catalogue comprises only our own publications. It will be noticed that particular care has been exercised in the selec- tion of Monographs of timely interest. We are always glad to consider the publication of new and original medical works. Correspondence with authors is in- vited. Owing to the constant changes in manufacturing costs, prices in this catalogue are subject to change without notice. ADAM: Asthma and Its Radical Treatment. By JAMES ADAM, M.A., M.D., F.R.C.P.S. Hamilton. Dispensary Aural Sur- geon, Glasgow Royal Infirmary. 8vo. Cloth, viii+184 pages, Illust ................... net $1.75 ADLER: Compendium of Histo-Pathological Technic. By EMMA H. ADLER. Formerly Technician Pathological Labora- tory, Presbyterian Hospital, New York. 12mo. Cloth ....................................... net $1.25 ADLER: Primary Malignant Growths of the Lungs and Bronchi. By I. ADLER, A.M., M.D., Prof. Emeritus New York Polyclinic, Consulting Physician, German, Beth-Israel, Har Moriah, People's and Montefiore Hospitals. 8vo. Cloth, xii+325 Pgs. 16 Halftone PL, 1 Colored. net $2.50 AMERICAN JOURNAL OF ROENTGENOLOGY, THE. Official Organ of the American Roentgen Ray Society. Edited by H. M. IMBODEN, M.D., New York. Published monthly. Vol. VI, No. 1, Jan., 1919. . .$6.00 per year. ANATOMICAL CHARTS. (See ELAINE.) ANNALS OF MEDICAL HISTORY. Edited by FRANCIS R. PACKARD, M.D. Associate Editors : Drs. Harvey Gushing, George Dock, Fielding H. Garrison, Howard A. Kelly, Sir William Osier, William Pepper, Lewis S. Pilcher, David Ries- man, Charles Singer and Edward C. Streeter. Volume I (1917-1918) 441 pages, well indexed, in parts as published, $6.00; Bound in cloth, net $8.50; Bound in Half Mo- rocco, net $10.00; Bound in Morocco, net $12.00. Volume II (in course of publication) $6.00. Subscription, per year ................................. $6.00 ARMSTRONG: I. K. Therapy, with Special Reference to Tuberculosis. By W. E. M. ARMSTRONG, M.A., M.D., Dublin. Bacteriologist to Cent. Lond. Ophthalmic Hosp., Late Asst. a HOEBER'S MEDICAL MONOGRAPHS in Inoculation Dept., St. Mary's Hosp., Paddington, W. 8vo. Cloth, x+93 pages, Illust net $1.50 BACH: Ultra-Violet Light by Means of the Alpine Sun Lamp. By HUGO BACH, M.D., Bad Elster, Germany. Author- ized Transl. from German. 12mo. Cloth, 114 pages, Illust net $1.00 BARRINGER, JANE WAY AND FAILLA: Radium Ther- apy in Cancer at the Memorial Hospital. (See Janeway, Barringer and Failla.) BIGG: Indigestion, Constipation and Liver Disorder. By G. SHERMAN BIGG, Fellow of the Royal College of Surgeons; Fellow of the Royal Institute of Public Health; Late Surgeon Captain, Army Medical Staff; Surgeon Allahabad, India. 12 mo. Cloth, viii-j-168 pages net $1.50 ELAINE: Anatomical Charts, especially arranged by ED- WARD S. ELAINE, M.D., for the graphic recording of roentgen or surgical findings. These show (a) complete skeleton, dorsal, ventral and left and right side views also with outline of internal organs in color, if desired; (b) skeleton of head, dorsal, ventral, left and right side, and top views, enlarged; (c) Torso, dorsal, ventral, left and right side views, enlarged also with outline of internal organs in color; (d) upper ex- tremities, enlarged view; (e) lower extremities, enlarged view. These charts will be made up to meet the individual needs of the specialist or general practitioner. BLAND-SUTTON: Tumours: Innocent and Malignant. Their Clinical Characters and Appropriate Treatment. By SIR JOHN BLAND-SUTTON, LL.D., F.R.C.S., Surgeon to, and Chair- man of the Cancer Investigation Committee of the Middlesex Hospital, Sixth edition. 8vo. Cloth, ix+790 pages, with 338 Illust net $7.50 BRAUN AND FRIESNER: Cerebellar Abscess: Its Eti- ology, Pathology, Diagnosis & Treatment. (See Friesner & Braun.) BRpCKBANK: The Diagnosis and Treatment of Heart Disease. Practical Points for Students and Practitioners. By E. M. BROCKBANK, M.D., (Viet.), F.R.C.P., Hon. Phys. Royal Infirmary, Manchester, Gin. Lecturer Diseases of the Heart, Dean of Clin. Instruction, University of Manchester. 12mo. Cloth, 3d Edition, 148 pages, Illust net $2.00 BRUCE: Lectures on Tuberculosis to Nurses. Based on a course delivered to the Queen Victoria Jubilee Nurses. By OLIVER BRUCE, Joint Tuberculosis Officer, County of Essex. 12 mo. Cloth, 124 pages, Illust net $1.00 BRUNTON: Therapeutics of the Circulation. By SIR LAU- DER BRUNTON, M.D., D.SC., LL.D. Edin., LL.D., Aberd., F.R.C.P., F.R.S. Consulting Physician to St. Bartholomew's Hospital. Second Edition, Entirely Revised. Cloth, xxiv+536 pages, 110 Illust net $2.50 HOEBER'S MEDICAL MONOGRAPHS 3 BULKLEY: Cancer: Its Cause and Treatment, Volume I. By L. DUNCAN BULKLEY. 8vo. Cloth, 272 pages net $1.50 BULKLEY: Cancer: Its Cause and Treatment, Volume II. By L. DUNCAN BULKLEY. 8vo. Cloth, 272 pages net $1.50 BULKLEY: Compendium of Diseases of the Skin. Based on an analysis of thirty thousand consecutive cases. With a Therapeutic Formulary, by L. DUNCAN BULKLEY, A.M., M.D. Physician to the New York Skin and Cancer Hospital; Con- sulting Physician to the New York Hospital. 8vo. Cloth, xviii+286 pages net $2.00 BULKLEY: Diet and Hygiene in Diseases of the Skin. By L. DUNCAN BULKLEY. 8vo. Cloth, xvi+194 pages :..net $2.00 BULLETIN: See Neurological Bulletin. CARLETON: The Seriousness of Venereal Disease. By SPRAGUE CARLETON, M.D., F.A.C.S., Special Publication. Second Edition. 12mo. 67 pages, 26 Illust. Boards net 75c Flexible cloth net 50c CARREL AND DEHELLY: The Treatment of Infected Wounds. By A. CARREL and G. DEHELLY. Authorized Trans- lation from the French by Herbert Child, M. D., Formerly Sur- geon, French Red Cross, Capt. R.A.M.C. (Ty.) with an Intro- duction by Sir Anthony A. Bowlby, F.R.C.S., Temporary Sur- geon General, Army Medical Service. Adopted by U. S. Army. Second Edition. 12mo. Cloth, 265 pages, 114 Illust net $2.50 CARREL AND DUMAS: Technic of the Irrigation Treat- ment of Wounds by the Carrel Method. By J. DUMAS, and ANNE CARREL. Authorized translation by Adrian V. S. Lam- bert, M.D., Acting Professor of Surgery, College of Physicians and Surgeons (Columbia University), New York City. In- troduction by W. W. Keen, M.D., LL.D., F.R.C.S. (Hon.) 12mo. Cloth, 90 pages, 11 pi net $1.25 CAUTLEY: The Diseases of Infants and Children. By EDMUND CAUTLEY, M.D., Cantab., F.R.C.P., Lond. Senior Physi- cian to the Belgrave Hospital for Children, etc, Large 8vo. Cloth, 1042 pages net $8.00 CHARAKA: Proceedings of the Charaka Club. Vols. III. IV, V. Vol. V containing twelve selections relating to ancient, medieval and modern phases of medicine and surgery. 8vo. Boards, 101 pages, 16 Illust., per volume net $4.00 COLLINS: Neurological Clinics. Exercises in the Diagno- sis of Mental Diseases of the Nervous System as discussed at the Neurological Institute, New York City. Edited by Joseph Collins, M.D. 8vo. Cloth. About 240 pages, with Illust net $3.00 4 HOEBER'S MEDICAL MONOGRAPHS CONTRIBUTIONS TO MEDICAL AND BIOLOGICAL RESEARCH: Dedicated to SIR WILLIAM OSLER, in honor of his seventieth birthday, July 12, 1919, by his pupils and co- workers. Special publication under the auspices of the Osier Anniversary Volume Committee. Two volumes; 1300 pages, 125 Illust., including one steel en- graving of Sir William Osier, and 5 colored pi. Sold only by subscription. COOKE: The Position of the X-Rays in the Diagnosis and Prognosis of Pulmonary Tuberculosis. By W. E. COOKE, M.B., M.R.C.P.E., D.P.H. (Lond.). 8vo. Cloth, Illust net $1.75 COOPER: Pathological Inebriety. Its Causation and Treatment. By J. W. ASTLEY COOPER. Medical Superintend- ent and Licensee of Ghyllwood Sanatorium. With Introduc- tion by Sir David Ferrier, M.D., F.R.S. 12mo. Cloth, xvi+151 pages net $1.75 COOPER: The Sexual Disabilities of Man, and Their Treatment. By ARTHUR COOPER. Consulting Surgeon to the Westminster General Dispensary, London. 3rd Edition. 12mo. Cloth, viii+227 pages net $2.50 COPESTAKE: The Theory and Practice of Massage. By BEATRICE M. GOODALL-COPESTAKE, Examiner to the Incorpor- ated Society of Trained Masseuses ; Teacher of Massage and Swedish Remedial Exercises to the Nursing Staff of the Lon- don Hospital. 8vo. Cloth, 284 pages, Illust net $3.00 CORBETT-SMITH: The Problem of the Nations. A Study in the Causes, Symptoms and Effects of Sexual Disease, and the Education of the Individual Therein. By A. CORBETT- SMITH, Editor of The Journal of State Medicine; Lecturer in Public Health Law at the Royal Institute of Public Health. Large 8vo. Cloth, xii+107 pages net $1.00 CORNET: Acute General Miliary Tuberculosis. By PROF. DR. G. CORNET, Berlin. Transl. by F. S. Tinker, B.A., M.B. 8vo. Cloth, viii+107 pages net $1.75 CROOKSHANK: Flatulence and Shock. By F. G. CROOK- SHANK, M.D., Lond., M.R.C.P. Physician (Out Patients) Hamp- stead General and N. W. Lond. Hospital. 8vo. Cloth, iv+47 pages net $1.00 DAVIDSON: Localization by X-Rays and Stereoscopy. By SIR JAMES MACKENZIE DAVIDSON, M.B., C.M., Aberd. Con- sulting Medical Officer, Roentgen Ray Department, Royal London Ophthalmic Hospital. 8vo. Cloth, 72 pages, PI. and 58 Stereo. Figures net $3.00 DAWSON: The Causation of Sex in Man. By E. RUMLEY DAWSON, L.R.C.P. Lond., M.R.C.S. England. 8vo. Cloth, 240 pages, with 21 Illust net $3.00 HOEBER'S MEDICAL MONOGRAPHS 5 DUMAS AND CARREL: Technic of the Irrigation Treat- ment of Wounds by the Carrel Method. (See Carrel and Dumas.) ED RIDGE-GREEN: The Hunterian Lectures on Colour- Vision and Colour Blindness. Delivered before the Royal College of Surgeons of England on February 1st and 3rd, 1911. By PROFESSOR F. W. EDRIDGE-GREEN, M.D., F.R.C.S. 8vo. Goth, x+76 pages net $1.75 EHRLICH: Experimental Researches on Specific Thera- peutics. By PROF. PAUL EHRLICH, MJX, D.SC. Oxon. The Harben Lectures for 1907 of Royal Institute of Public Health. 16mo. Cloth, x+95 pages net $1.00 EINHORN: Lectures on Dietetics. By MAX EINHORN, Pro- fessor of Medicine at N. Y. Post-Graduate Med. School and Hospital, Visit. Phys. German Hospital, N. Y. 12mo. Cloth, xvi+156 pages net $125 ELLIOT: Glaucoma. By COL. ROBERT HENRY ELLIOT, M.D., F R.C S. 8vo. Cloth, 60 pages, with 23 Illust net $1.50 ELLIOT: Glaucoma. A Text Book for the Student of Oph- thalmology. By COL. ROBERT HENRY ELLIOT, M.D., F.R.C.S. 8vo. Cloth, 546 pages, 156 Illust net $7.50 ELLIOT: The Indian Operation of Couching for Cata- ract. Incorporating the Hunterian Lectures delivered before the Royal College of Surgeons of England on February 19 and 21, 1917. By ROBERT HENRY ELLIOT, M.D., B.S., Lond., SC.B-., Edin., F.R.C.S., Eng., etc. 8vo. Cloth, 94 pages, 45 Illust net $3.50 ELWOT: Sclero-Corneal Trephining in the Operative Treatment of Glaucoma. By ROBERT HENRY ELLIOT, M.D., B.S. Lond., D.SC. Edin., F.R.C.S. Eng. Lieut. Colonel I.M.S. 2d Edition. 8vo. Cloth, 135 pages, 33 Illust net $3.00 EMERY: Immunity and Specific Therapy. By WM. D'EsTE EMERY, M.D., B.SC. Lond. Clinical Pathologist to King's Col- lege Hospital and Pathologist to the Children's Hospital. Adopted by the U. S. Army. 8vo. Cloth, 448 pages, with 2 Illust net $3.50 EMERY: Tumors, Their Nature and Causation. By WM. D'EsTE EMERY, M.D., B.SC., Lond. Director of Laboratories, King's College Hospital, Captain R.A.M.C (T. F.). 12mo. Cloth, 146 pages net $1.75 FAILLA, JANEWAY AND BARRINGER: Radium Ther- apy in Cancer at the Memorial Hospital. (See Janeway, Barringer and Failla.) FISHBERG: The Internal Secretions. (See Gley.) 6 HOEBER'S MEDICAL MONOGRAPHS FRIESNER AND BRAUN: Cerebellar Abscess; Its Eti- ology, Pathology, Diagnosis and Treatment. By ISIDORE FRIES- NEE, M.D., F.A.C.S., Adjunct Professor of Otology and Assistant Aural Surgeon, Manhattan Eye, Ear and Throat Hospital and Post-Graduate Medical School, and Alfred Braun, M.D., F.A.C.S., Assistant Aural Surgeon, Manhattan Eye, Ear and Throat Hospital, Adjunct Professor of Laryngology, New York Poly- clinic Hospital and Medical School and Adjunct Otologist, Mt. Sinai Hospital. 8vo. Cloth, 186 pages, 10 pi., 16 Illust net $3.00 GERSTER: Recollections of a New York Surgeon. By ARPAD G. GERSTER, M.D. 8vo. Cloth, 347 pages, 18 Illust net $3.50 GHON: The Primary Lung Focus of Tuberculosis in Chil- dren. By ANTON GHON, M.D., English Translation by D. Barty King, M.A., M.D. Edin., M.C.R.P. Large 8vo. Cloth, 196 pages, 72 Illust., 2 pi net $3.75 GILES : Anatomy and Physiology of the Female Generative Organs and of Pregnancy. By ^ARTHUR E. GILES, M.D., B.SC. Lond., M.R.C.P. Lond. ; F.R.C.S. Ed. Gynecologist to the Prince of Wales General Hospital. Large 8vo. 24 pages, with Mannikin net $2.00 GLEY: The Internal Secretions. By E. GLEY, M.D. Mem- ber of the Academy of Medicine of Paris, Professor of Physiology in the College of France, etc. Authorized Trans- lation. Translated and Edited by Maurice Fishberg, M.D. 8vo. Cloth 241 pages net $2.50 GREEFF: Guide to the Microscopic Examination of the Eye. By PROFESSOR R. GREEFF. Director of the University Ophthalmic Clinique in the Royal Charity Hospital, Berlin. With the co-operation of Professor Stock and Professor Win- tersteiner. Translated from the third German Edition by Hugh Walker, M.D., M.B., c.M. Large 8vo. Cloth, 86 pages, Illust. net $2.00 GREEN, EDRIDGE-: The Hunterian Lectures on Colour Vision and Colour Blindness. (See Edridge-Green.) HARRIS: Lectures on Medical Electricity to Nurses. An Illustrated Manual by J. DELPRATT HARRIS, M.D., M.R.C.S. 12mo. Cloth, 88 pages, Illust net $1.00 HELL MAN: Amnesia and Analgesia in Parturition Twi- light Sleep. By ALFRED M. HELLMAN, B.A., M.D., F.A.C.S. 8vo. Cloth, with charts, 200 pages net $1.50 HEW ATT: The Examination of the Urine, and Other Clinical Side Room Methods. By ANDREW FERGUS HEWATT, M.B., CH.B., M.R,C.P. Edin. lomo. 5th Edition, numerous Illust net $1.00 HOEBER'S MEDICAL MONOGRAPHS 7 HOFMANN-GARSON: Remedial Gymnastics for Heart Affections. Used at Bad-Nauheim. Being a Translation of "Die Gymnastik der Herzleidenden" von Dr. Med. Julius Hofmann und Dr. Med. Ludwig Pohlman. Berlin and Bad- Nauheim. By JOHN GEORGE GARSON, M.D. Edin., etc. Physi- cian to the Sanatoria and Bad-Nauheim, Eversley, Hants. Large 8vo. Cloth, 144 pages, 51 full-page Illust net $2.50 HOWARD: The Therapeutic Value of the Potato. By HEATON C. HOWARD, L.R.C.P. Lond., M.R.C.S. Eng. 8vo. Paper, vi-}-31 pages, Illust net 50c JANE WAY, BARRINGER AND FAILLA: Radium Ther- apy in Cancer at the Memorial Hospital, Report of 1915- 1916. By HENRY H. JANEWAY, M.D., with the Discussion of the Treatment of Cancer of the Prostate and Bladder by Ben- jamin S. Barringer, M.D., and an Introduction upon the Physics of Radium by G. Failla. 8vo. Cloth, 242 pages, 16 IllusL net $2.25 JELLETT: A Short Practice of Midwifery for Nurses. Embodying the treatment adopted in the Rotunda Hospital, Dublin. By HENRY JELLETT, B.A., M.D. (Dublin University), F.R.C.P.I., Master Rotunda Hospital. With Six Plates and 169 Illustrations in the Text, also an Appendix, a Glossary of Medical Terms, and the Regulations of the Central Midwives Board. 12mo. Cloth, xvi-1-508 pages net $2.50 JONES: Notes on Military Orthopaedics. By COL. ROBERT JONES, C.B., Inspector of Military Orthopaedics, Army Medical Service. 8vo. Cloth, 132 pages, 95 Illust net $1.75 KENWOOD: Public Health Laboratory Work. By HENRY R. KENWOOD, M.B., F.R.S. Edin., P.P.H., F.C.S., Chadwick Profes- sor of Hygiene and Public Health, University of London. 6th Edition. 8vo. Cloth, 418 pages, Illust net $4.00 KERLEY: What Every Mother Should Know About Her Infants and Young Children. By CHARLES GILMORE KERLEY, M.D. Professor of Diseases of Children, N. Y. Polyclinic Med- ical School and Hospital. 8vo. Paper, 107 pages net 35c KETTLE: The Pathology of Tumors. By E. H. KETTLE, M.D., B.S., Assistant Pathologist, St. Mary's Hospital, and As- sistant Lecturer on Pathology', St. Mary's Hospital. 8vo. Cloth, 242 pages, 126 Illust net $3.00 LAMBERT: A Terminology of Disease. To facilitate the Classification of Histories in Hospitals. By ADRIAN V. G. LAMBERT, M.D., Associate Professor of Surgery, Columbia Uni- versity; Director Surgical Research Service, Presbyterian Hos- pital, N. Y. 12mo. Cloth, 176 pages net $225 8 HOEBER'S MEDICAL MONOGRAPHS LEWERS: A Practical Textbook of the Diseases of Women. By ARTHUR H. N. LEWERS, M.D. Lond. Senior Obstetric Physician, London Hospital. With 258 Illustrations, 13 Colored Plates, 5 Plates in Black and White. 7th Edition. 8vo. Cloth, xii+540 pages net $4.00 LEWIS: Clinical Disorders of the Heart Beat. A Hand- book for Practitioners and Students. By THOMAS LEWIS, M.D., D.SC., F.R.C.P. Assistant Physician and Lecturer in Car- diac Pathology, University College Hospital Medical School. 4th Edition. 8vo. Cloth, 120 pages, 54 Illust net $2.50 LEWIS: Lectures on the Heart. Comprising the Herter Lectures (Baltimore), a Harvey Lecture (New York), and an Address to the Faculty of Medicine at McGill University (Montreal). By THOMAS LEWIS. 124 pages, with 83 Illust net $2.50 LEWIS: Clinical Electrocardiography. By THOMAS LEWIS. 8vo. Cloth, 2nd Edition, 120 pages, with charts net $2.50 LEWIS: The Mechanism of the Heart Beat. With Special Reference to Its Clinical Pathology. By THOMAS LEWIS. Large 8vo. Cloth, 295 pages, 227 Illust. New Edition in prep- aration. LEWIS: The Soldier's Heart and the Effort Syndrome. By THOMAS LEWIS. 8vo. Cloth, 156 pages net $2.50 McCLURE: A Handbook of Fevers. By J. CAMPBELL Mc- CLURE, M.D., Glasgow. Physician to Out-Patients, The French Hospital, and Physician to the Margaret Street Hospital for Consumption and Diseases of the Chest, London. 8vo. Cloth, 470 pages, with charts riet $3.50 McCRUDDEN: The Chemistry, Physiology and Pathol- ogy of Uric Acid, and the Physiologically Important Purin Bodies. With a Discussion of the Metabolism in Gout. By FRANCIS H. MCCRUDDEN. 12mo. Paper, 318 pages net $2.00 McKISACK: Systematic Case Taking. A Practical Guide to the Examination and Recording of Medical Cases. By HENRY LAWRENCE MCKISACK, M.D., M.R.C.P. Lond. 12mo. Cloth, 166 pages net $1.75 MACKENZIE: Symptoms and Their Interpretation. By JAMES MACKENZIE, M.D., LL.D. Aber. and Edin. Third Edition. 8vo. Cloth, Illust. xxii+318 pages net $4.00 MACKENZIE: The Action of Muscles. By WILLIAM COLIN MACKENZIE, M.D., F.R.C.S., F.R.S. (Edin.) 8vo. Goth, 267 pages, 99 Illust. 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