commands, is the importance of nutrition and hygiene concomitant with physical development. A large part of the minor morbidity of camps, predisposing also to serious infections, especially with pneumonia and influenza, has been ascribed by military critics to chill following the inevitable perspiration of drills, especially when the routine prevented bathing and change of clothing for the major part of the day or when the soldier was, on account of fatigue and lack of time that could be spared from sleep, tempted to sleep in damp underwear.

We venture to predict that the health and resistance of our troops, even without attention to these details, will be much better for the second winter, even for the first winter in service of men trained during the whole summer and fall, and that the routine of the front, when exercise is mostly combined with the psychic stimulation of actual fighting and when periods of service alternate with those of rest and attention to hygienic details, will result in less morbidity than cantonment life. Thus the general prediction may be made that the transformation of a civilian young male adult population into soldiers, will result in very little loss, after that incident to the weeding out of genuine defectives, though most of these are not defectives according to the demands of the ordinary vocations to which they have been adapted. Even this is not a military loss of serious moment, since it is not at all likely that we shall be required to raise even half of the theoretic "militia" of 10% of the total population and since a large percentage of the adult population must, by any country that does not rely to an undue degree upon the labor of women and children or of enslaved aliens, be retained in civil occupations, even if we look no farther ahead than military necessity.

In civil practice and undoubtedly military-physiologic hypertrophy of the heart is not merely a theory nor even a demonstration from the standpoint of general pathology. It is something readily detected by clinical methods-perhaps most convincingly by the X-ray, but also by percussion, either ordinary or auscultatory. In particular the left border of the heart of an athlete or of one who has done much muscular work, is 1-2 c.m. outside the line established by one who has not used his muscles to any degree. This difference can even be noted in the same individual after a few months, perhaps a few weeks, of exercise. The pathologic principle (pathologic only in the sense that the matter is usually included in the teaching of pathology) that the heart readily hypertrophies in response to stimuli has an unfortunate

corollary, that the hypertrophied heart does not so readily atrophy, without actual degenerative changes, when the continued stimulus is withdrawn. Moreover, we must reckon with a general hypertrophy of the vascular apparatus, not so easily demonstrated even histologically except for the larger trunks and almost undemonstrable clinically. Even if it were conceded that the vessels participated only functionally in the increased circulatory response, we should still have to consider that the viscera and other organs have adapted themselves to a greater circulatory activity, including all that this implies from the standpoint of respiration, and that the reflex response of all organs, especially those of nutrition and elimination, have become attuned to grosser excito-reflex impressions, and that the regulation of the physical apparatuses in general has been effected by innervational discharges from which comparatively little has been subtracted for intellectual work.

The actual lesions and functional disturbances to which ex-athletes and those who have changed from muscular to bráin work, or from active to sedentary occupations, are liable, have been described in many articles though the profession and hygienists generally do not yet seem to realize fully the importance of this subject. It would be out of place in an editorial article, to enter into details, but it is important that the general subject should receive due attention in advance of the immediate need of considering the personal health of the two or three million men who will be restored to civil life in what we hope will be the comparatively near future. This subject should also receive attention from the standpoint of the discussion as to universal military training, for it is something more than an aggregation of personal needs for guidance. It involves sociologic problems that tend to ramify. Off-hand, we are inclined to believe that the only solution of the problem, whether for the athlete, the muscle worker who retires or who changes his vocation at an early age, or for the soldier adjusting himself to civil life, is a moderate continuance of physical work and an avoidance of the toxaemias of alcohol, tobacco, and of preventable diseases and unhygienic modes of living. The first factor is more important than it seems. It is easy to advise, but difficult to carry out without involving a large amount of wasted. efficiency unless the physical work can be rendered of practical value in some way and right here, the problem begins to ramify along all sorts of industrial, sociologic and almost political lines. But it, as well as the other factors, must be made operative, or else great harm will result to many individuals and a not negligible amount to posterity.

Post Bellum Problems.

for war,

it

If, in time of peace, a country should prepare is equally important, in time of war, to prepare for peace. Such preparation by no means implies an excess of optimism as to the date when the war will end, though it may be said that it is scarcely conceivable that it will last too long to allow delay in beginning the discussion of the major problems of readjustment to peace conditions.

SHALL STANDARDS OF MEDICAL EDUCATION BE REDUCED? This is not an academic question but one which has been seriously raised. According to standards of graduation long in vogue among our Allies, the war almost immediately reduced the supply of physicians to a minimum for the civil population and has already left even the armies with a relative shortage, though this has been compensated by various means, including a supply from our own formerly redundant profession. Even in our own country, the supply of military medical men by volunteering has just about reached the limit of purely voluntary action, concomitant with the raising of the force at first announced (2 million) and the additional contingent already provided for.

The temptation is strong, therefore, to stimulate the production of more physicians by lowering educational standards and shortening the period of medical study, even if the actual amount of work is not diminished. From the purely military standpoint, even a genuine lowering of standards of technical instruction would be justified, as a large part of the work of army surgeons could be arranged so as to assign to any individual the repetition of a comparatively simple task with ample provision not only for perfecting him in its performance but with the necessary discipline to prevent his essaying other work beyond his ability. Moreover, the military service includes both clinical and didactic instruction which would bring even an imperfectly educated physician up to the requisite standard for civil practice, in a period of a year or

two.

However, it is a safe rule always to suspect unworthy motives behind any plea for degrading medical standards and military necessity should not be conceded as a valid argument until it is presented by proper authority, in unmistakable terms. Here is one point in regard to which there should be no anticipation of necessity.

With any such duration of the war as now seems at all probable, there will be comparatively little actual wastage of physicians probably not much over 2% per annum, and indeed, not much if any more than the mortality of the older

men remaining in civil practice. Reconstruction work on returned soldiers will probably be just about balanced by the greater health of the remainder of the army and their acquired training in hygiene, immunization against typhoid, · etc. With the almost complete cessation of immigration. -representing fully half of the previous increase of our population—for a period of at least five years, the slight but still appreciable check on births, the actual loss by death in the army, and, more important than all else, the adjustment of civil practice in its various manifestations including hospital service, to a much smaller staff, the sudden return of 1 physician to about 100 men, will obviously disturb the economic relations of profession and laity. On the other hand, there will have been, according to the tendency of increasing educational requirements for the last decade or so, a gradual reduction of physicians to total population and there will probably be a greater, relatively permanent withdrawal of physicians from private to public duties than of men from civil to military professional care. Just how ratios will balance against the presumptive diminution of sickness and the increased efficiency of professional distribution, can be determined only by experience. But, unless the war is protracted far beyond the time now generally regarded as possible, it is plain that very serious economic detriment would result to the profesion from the attempt to increase medical graduation by lowering standards. In short, most of the good that has been accomplished by ten years of hard work and skillful management would be lost. It should also be considered that no hastening of graduation and increase of students that would be even tolerable from the ultimate standpoint of securing men that would deserve the title of physician, could operate immediately to relieve the necessity of still further drawing on the existing personnel of the profession to any marked degree. Such a process could not yield any appreciable increase of available surgeons for almost a year, nor reach the maximum indicated by military needs within four years and it is doubtful if it could be checked within four years more. A very slight additional pressure to secure volunteers from the extant profession would secure better results for at least two years and it is scarcely to be doubted that the war will either be over in that time or a better estimate of its duration and needs can be made than at present.

New Mercurial. Louis Bory and Albert Jacquet, Le Prog. Med., Dec. 1, 1917, report favorably on ortho-amido-benzoate of mercury, dose 4-6 c.g. a day.

BOOK REVIEWS

Books mentioned may be inspected at and ordered through this office. So far as possible, books received in any month will be reviewed in the issue of the second month following. Pamphlets, quarterly and similar periodicals, reports, transactions, etc., will, as a rule, merely be mentioned.

The Treatment of War Wounds. By W. W. Keen, M. D., L.L.D., Emeritus Professor of Surgery, Jefferson Medical College, Philadelphia. Second Edition, Reset. 12mo 276 pages, illustrated. Philadelphia and London: W. B. Saunders Company, 1918. Cloth, $2.00 net.

Within about six months after the appearance of the first edition, a new edition, largely rewritten, has been called for. Major Keen has filled his book with facts obtained by communication with surgeons engaged in actual war work. The Carrel-Dakin method is given in the minutest detail, as well as acriflavine, mercurophen, eupad, eusol, dichloramin-T, tetanus and gas gangrene prophylaxis, the use and preparation of No. 7 Paraffin for burns, the localization and removal of foreign bodies by X-rays, and the treatment of wounds in various locations. A number of personal letters from experts in the service add much to the interest and value of this most timely volume.

The Ungeared Mind. By Robert Howland Chase, A. M., M. D., Physician-in-Chief Friends Hospital (for Mental Diseases). Cloth. Price, $2.75 net. Pp. 351, with 6 illustrations. Philadelphia: F. A. Davis Company, 1918.

Under this comprehensive caption the author has gathered together a few chapters comprising "the observations and experiences of a lifetime." He writes for the general reader as well as for the physician who is interested particularly in psychology and its problems. With a genial outlook on the seamy side of life and a whimsical sympathy with minds that are out of gear, he has given us a mass of material unusual in any book and calculated to entertain as well as instruct the reader. The book is not a manual of a textbook, but he who reads it for knowledge will find unexpected supplies,--bits of wisdom not announced on the title page or noted in the index.

Emergencies of a General Practice, by Nathan Clark Morse, A. B., M. D., F. A. C. S., Surgeon to Emergency Hospital,