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Greetings.-"1924" is welcome, largely because of an optimism that believes that each year lived thru represents some gain to humanity, regardless of its record of crises or catastrophes. "1923" has departed, leaving the world somewhat better than when it came upon the calendar of life. True, the affairs of the world are by no means settled. Doubt, pessimism, famine, disease, and oppression still have a foothold in many sections of the world. The world, however, is looking upward and forward, America especially.

Revolt in Mexico, economic tottering in Germany, religious dissensions, the falling franc, income taxes, and the loosening up of numerous foundations of social organization, all presage developments whose meaning and results are scarcely predictable. The growth of education, the strengthening of some internal ties, the liberalizing of viewpoints, the increasing interest of all people in world politics, and a widening concept of brotherly relations suggest that constructive ideas are gaining force to rebuild the world and to straighten out the rocky paths of existence for many. National hatreds are less acute-national welfare is more pronounced. And in all the world no country appears to be in a position of greater service to humanity than the United States. It is an envied nation, whose position is unenviable!

It may be said that it is not the function of a medical journal to dwell upon politics or religion, but in the broadening field of

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medicine, these have been shown to bear a closer relation to the health and welfare of the people than was believed even a few years ago. Therefore, we shall not hesitate to discuss any topic that may touch in any way the needs of our people or humanity in general, during the months ahead. What 1924 is to yield to our own and those of other countries is problematic. But the greeting, "A Happy New Year," indicates our earnest wish for a period fraught with greater economic benefit, more social grace, better physical welfare, and for every one who has a duty or obligation in life, more genuine spiritual enlightenment.

AMERICAN MEDICINE extends to its sub

scribers, and the profession at large, such wishes for 1924. It congratulates the medical profession upon its ever-widening range of usefulness. The most hopeful element today lies in the scientific trends of the times. Peace and progress depend upon the health of individuals. Happiness is within the grasp of mankind, if they would but seize it.

"Reason's whole pleasure, all the joys of

sense,

Lie in three words-health, peace, competence."

These be our New Year's greeting.

War and Health.-More than twentytwo thousand plans were submitted in response to Edward W. Bok's stimulating

offer for "the best practical plan by which the United States may cooperate with other nations to achieve and preserve the peace of the world.”

Regardless whether the plan proposed, on which a referendum is being held, constitutes the most desirable method of achieving a permanent peace, it is undeniable that there is a world interest in the general idea involved. While the individual winner, at the time of this writing unnamed, achieves a rich cash prize, the nation realizes an invaluable prize in the arousing of public interest and in the free discussion of the elements involved in overcoming a chaotic international state, which is prejudicial to all people.

The horrors of war require no discussion; the benefits of peace are accepted. The mode of abolishing one and establishing the other on a permanent basis challenges man's intelligence and his humanity.

The destructiveness of war today is limited to the brutality martial instruments. There was a time, however, when disease as a war product was more fruitful than high explosives, artillery, and bayonets. The modern instruments of destruction have increased the hazards of fighters and, possibly, have served to decrease the likelihood of some measure of death from disease, owing to the greater number of fatalities directly due to military methods. It is proper, however, to contrast war as the direct cause of death and disease as its usual accomplice.

In The American Journal of Public Health, January, 1924, A. W. Ferrin indicates, "Some elements of modern war, a healthy business." His discussion is based mainly upon the official figures relating to German soldiers; but the facts that he adduces are applicable to armies of other lands.

Germany had mobilized 13,350,000 men, of whom 1,711,154 met death from all causes. Of this number only 182,554 men died from definite diseases not growing out of battle wounds. This was a remarkable achievement for the doctors and hygienists in grappling with the health of military forces.

Despite the fact that the army was constituted of a selected group of the community, chosen because of physical fitness, the German mobilization, as that of other warring nations, with the exception of the United States, included large groups of men who under ordinary conditions of war would have been excluded from military service. During the latter part of the war period, influenza became epidemic and its ravages helped to raise the death rate beyond ordinary levels. About 23 per cent. of all the deaths in the German army were due to inflammation of the lungs, to tuberculosis, to influenza, and to typhoid fever. Dysentery and other gastrointestinal disturbances, which in former wars had played such havoc, were responsible for approximately 13,000 deaths. The old ravages of malaria were reduced to 703 fatalities, while appendicitis carried off almost 2,000 men. Cancer was responsible for 2,286 deaths, while erysipelas removed only 706 from active service. Most striking of all was the occurrence of only 22 deaths from smallpox.

By way of contrast with this significant achievement in protecting the health of soldiers, which resulted in only 91⁄2 per cent. of the total deaths of soldiers from disease, one needs but recall that during the Crimean War 76 per cent. of the total deaths among the English soldiery, and 79 per cent. of the French total losses were occasioned by sickness. During the FrancoPrussian War, the Germans lost by sickness

30 per cent. of their total fatalities. The American army in Cuba in 1898 suffered the death of seven times as many men by disease as by military casualties, and in the South African War the British loss from disease was one and three-quarter times that from strictly military injuries.

The tide turned in favor of the hygienists during the Russo-Japanese War, when the Japanese loss by disease was one-half that due to field casualties or or from battle wounds.

It is patent that nations were mightily concerned in conserving the physical wellbeing of their warriors. It is not that war is "a healthy business," but that the conditions of war demand a superior attack and war against disease. The soldier is an instrument to be guarded and protected, as a business man would safeguard some vital machinery in his plant against unnecessary injury or breakdown. If under the conditions of war such excellent results are obtainable, how much greater should be the hygienic advances achievable during conditions of peace.

One can understand The International Health Organization formed under Article 23 of the regulations of the League of Nations. The jurisdiction of this health organization involves fighting disease on an international scale, by the conference of health authorities, the interchange of health information, the establishment of international health agencies, the publication of health information, and active cooperation with the international Red Cross Society. The utilization of this international health committee should go far in promoting international health, but it is not sufficient to serve a wide function within any specific country.

All types of hygienic machinery and all health agencies that were found useful for

conserving the physical welfare of soldiers should be even more useful in advancing conditions of health for Civil soldiers who are constantly fighting conditions of life in the interests of national advancement and prosperity. Health is no less an asset during times of peace than in times of war. Teaching people how to live for their country is as valuable and necessary as to protect them, so that, if necessary, they may die for their country.

From present indications, the death rate. for the United States during 1923 was slightly higher than that for 1922. While the peak of fatality would appear to have occurred during the first three months of the year, the mortality rate for all months, thus far statistically compiled, indicates an elevation of fatality rate above that established in 1922. At the present time it is impossible to comment upon the causes of death responsible for the higher death rate during 1923, but it would appear imperative that such an analysis be made, to cast light upon those types of morbidity responsible for the conditions.

The business side of war did concern itself with the conservation of the vital assets of the fighting forces. The economic phase of modern medicine is concerned with the preservation of the health of all. Wars are conditioned by birth rates and death rates, by over-population and under-population, by health and by disease, no less than by specific quasi-political occurrences, of which advantage may be taken to promote selfish nationalistic developments. While sick nations cannot fight, healthy nations should not fight. There is a paradox in international health organizations striving to promote national health, while other forces in the community are promoting schemes that will lead to terrific casualties among those who have been taught how to

achieve and maintain reasonable conditions of health. The business side of war is its abolition.

Trauma and Nervous Disorders.-The rôle of "Trauma in Etiology of Organic and Functional Nervous Diseases," as discussed by S. A. Kinnier Wilson, of London, England, in The Journal of the American Medical Association, December 29, 1923, presents some valuable medico-legal questions. A tremendous amount of litigation annually attests the importance of the subject. The problems of compensation costs, the expense of litigious controversies, the unwarranted exploitation of industry, and the speculative nature of many legal actions make the actual effects of trauma worthy of thoughtful evaluation.

Starting with the principle, "It may be taken as a good general rule that the more apparent causes for a disease, the less likely is any one of them to be specific," one is forced to ask whether the rôle alleged to be played by trauma has not been exaggerated. Is there not possibly an essential cause for tumors and degenerations, as there is for infections? Is the nervous system liable to a different set of causative factors than any other of the somatic systems? Why is the nervous system the main one alleged to be modified by a morbid neural process initiated by trauma?

It has been stated that trauma may originate cerebral tumors, but the thousands of head injuries resultant from the recent war have not given rise to intracranial neoplasms. It is difficult to believe that similar injuries in civil occupations should be responsible for tumors, when war injuries are not thus productive. Disseminated sclerosis, tabes, and general paralysis are essentially infective in character, insofar as our present knowledge

teaches, and it is doubtful whether a traumatism is to be held as a causative factor. Certainly the injury may light up a morbid process, or direct attention to symptoms that previously had escaped notice, or may modify in some way the course of the disease. For the most part, symptoms arise immediately following a trauma and the time element between the accident and the appearance of specific symptoms calls for consideration.

There has been a general belief that trauma may cause epilepsy. Of 18,000 cases of gunshot wounds or injuries of the head occurring in warfare in England, less than 5 per cent. have developed epilepsy. Wilson accepts Turner's statement: "It is difficult to avoid the conclusion that something more than local tissue alterations is requisite for the production of the seizures of traumatic epilepsy, and the determining agent, in my opinion, is an inherited or inborn constitutional predisposition to nervous instability and epilepsy." In justification, he remarks that in an investigation of the family history and individual make-up of soldiers who have suffered traumatic epilepsy as a result of war injuries, he has obtained evidence of a neuropathic predisposition among 80 per cent. of these patients. He believes, therefore, that the most that one is justified in admitting is that in a small minority of war cases of traumatic epilepsy the injury seems to have initiated the disorder in individuals previously healthy and unimpaired by heredity. He attaches, therefore, more importance to the constitutional make-up of individuals. than to the injury as a factor in causing epilepsy.

There is adequate recognition as to the great difficulty in approaching the problem of neuroses. It is well known that in a large proportion of instances symptoms re

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