1 entailed in its production. It demonstrates not alone scholarship and learning, but a grasp of life and living that bespeaks many years of intelligent systematic observation. Better than any other book thus far written it exemplifies all that we have claimed about the widening sphere of medicine. We only mention it at this time (a full review will appear shortly) because it shows so well that modern medical science touches humanity at every point. With infinite skill and the deepest learning Dr. Woodruff has woven his facts together to form a book that will live for many a day. Not the least of its many features is the way that the author brings us face to face with the fundamentals of life and their bearing on the problems of race and human progress. One type of journalism seems to exist simply to stir up ill feeling, to cast the foulest aspersions and to do all the harm possible. It never creates anything but always tears down. It points no morals, serves no honorable purpose and seems to have no other aim than to work all the injury it can. Neither logic nor common sense enter into its fabric and its warp and woof are all too plainly hatred, jealousy and malice. Fortunately, medical journalism has been pretty free from this type of literary depravity and medical editors with the rarest exceptions are clean, decent men. The literary attainments of most of us may be ordinary and the products of our pens may never rise above mediocrity, but few of us ever go out of our way to attack and injure our fellows or use what little power we may have to belittle some colleague and his work. Most of us respect our opportunities too sincerely to prostitute them in any such way. There are a few editors of medical journals, however, whose chief delight is in insulting, slandering, or traducing every one whom they do not fear, or do not want something from. No one is exempt from their venomous attacks. If a man attends to his own business-he is slurred, if he tries to make the most of his opportunities, however humble-he is belittled, if he tries to be kind and friendly and show his love for mankind-he is ridiculed. "Write something" against him, "knock" him, hurt him all that is possible in his pride, pocketbook or ambition—that is their creed and that is the standard under which they offer their bastard journals to the medical world. What must be the psychology of men who so delight in putting their hatreds and ill feeling into "imperishable print?" Most American medical journals are free from this taint of personal animus. In this country and Canada there are said to be nearly three hundred medical journals. It is a mighty fine thing to be able further to say that less than ten of these are ever guilty of traducing or wilfully injuring individuals. That so little of the vicious kind of material previously mentioned ever appears in these many journals is a splendid testimonial to the clean, kindly minds of the "men behind." It is good to stop and think that there is so much simon pure decency, peculiar to no locality nor section, but just common to the class of medical editors. When one comes to look at the fine good things that the decent journals. of this country are doing, somehow or other the yelping and snarling of the jackals grow very insignificant and harmless. "Stir up the fire, and if they come too close a good swift kick is always effective. They will slink away when the daylight comes, so what's the use of worrying?" And with this the old hunter rolled over with his blanket around him and went to sleep." Sounds kind of sensible, now don't it? , 1909 , Vol. IV ORIGINAL ARTICLES. THE DANGERS OF TENT SHELTERS FOR CONSUMPTIVES IN SUMMER. BY MAJOR CHAS. E. WOODRUFF, U. S. Army Med. Dept. as can The benefits of open air are so phenomenally great that our endeavors to obtain it are liable to lead us into other dangers which will prevent the best results. This is illustrated by the mania for putting consumptives into tents in the hot and light months, a mania so pronounced that every tuberculosis exhibit includes many models of shacks, tents, sheds, &c., and never a word is said as to their summer dangers. Cases which have recovered in spite of the harm are held up proof that no possible damage ensue from living in a hot glary tent in the summer time. The experience of tent hospitals in the civil war is also quoted as proof, and in our medical schools. it is still taught that hospital gangrene so fatal in houses was apt to recover promptly if put out doors into tents. The overflow from the dirty, septic hospitals got well. Those retained indoors perished. It is now believed that the good results of out door treatment were mostly found in cool weather, because we have suddenly realized that all kinds of cases do badly in tents in our field hospitals in the hottest weather. Two years ago at the Jamestown Exposition camp we found that in every fever, the temperature was abnormally high in tents but when the case was transferred to the comfortable hospital at Fort Monroe the temperature would fall two to four degrees. This corresponds We with the observations of White of Colorado Springs and others who found in consumptives that the temperature invariably rose upon exposure to the sun. Two years ago in the epidemic of typhoid in our Cuban Army, the cases treated in the modern hospital near Havana suffered no mortality, but those in distant stations, where there were only improvised hospitals some in tents and no arrangements for protecting cases from heat or light there was a mortality of nearly seventeen percent. now teach that in the field it is safer to send a typhoid a long distance over rough roads in a springless wagon, if it will only get him to a cool shaded hospital where modern treatment is possible. It is also a matter of military regulation to get all cases out of the field hospital into the semi-permanent or fixed hospitals on the lines of communication or at the base. This is mostly to remove infections from healthy troops but also to give better prospects for recovery. Our tent hospitals are now only receiving and detention wards where cases are held long enough to make a diagnosis and arrange for their transfer to the rear. It is the only kind of hospital whose usefulness depends upon its being kept empty, ready to move with the mobile army. Thus it happens that while military practitioners are abandoning tents, civilians are taking them up more and more. I have no doubt that much of the bad result of summer treatment is due to exposure in tents, where the patients cannot be kept cool or shaded. Even in houses in summer, we find infinitely better results by the constant use of an electric fan, playing day and night gently upon the bed in such a way that the body is protected from the direct draft. In one case during last summer I was amazed at the increased comfort of a typhoid patient from the use of the electric fan. In the tropics, there should be one for each bed or group of beds. It is doubly necessary to protect from tent glare. Last summer we gave a trial to a tent I had devised with a blue roof, to keep out the glare, and it was remarkable how much more comfortable it was. Not only must we warn against the use of tents in the hot light months, but I beg all those having opportunities, to compare the results of treatment in tents with those carefully shaded and kept cool. I have been recently informed that when the civil war closed and the sick were being shifted north, it was found that they improved as soon as they reached cooler latitudes, and that they could not be unloaded even as far north as Washington or Baltimore without extreme danger. There is no doubt that the tuberculosis mortality in summer, particularly in the south, is unduly large and avoidable if we will only avoid tents and keep the patients cool and shaded. TIMIDITY AND INSANITY.* BY MARY K. ISHAM, M. D. Columbus, O. A hospital for the insane offers a splendid chance for the observation of psychic processes in their making and unmaking. Here is a vast psychological laboratory, where the experiments are already prepared. Here we have human characteristics concentrated, disintegrated, perverted, exaggerated, diminished, or abolished. *Read before the Academy of Medicine of Cincinnati on April 19, 1909. , 1909 , Vol. IV Fear in its various forms is the cause of SO much human misery, that the psychiatrist is naturally attracted to a study of it. The relation which timidity bears to fear may perhaps be made a little more clear, if I were to repeat a few thoughts from a former paper. Timidity is hardly a pure and well defined emotion. It involves more or less all the forms of fear. It is rather a mental attitude of shrinking from one's environment on any given occasion. It has many modifications and disguises. In the presence of persons, the sufferer exhibits bashfulness, shyness, or backwardness; in the presence of an event plus persons, embarrassment, lack of self confidence; and in the presence of an event alone, worry. The unpleasant experiences due to timidity can be traced directly to a survival of the old instinct of flight in the presence of possible danger. The desire to be somewhere else is counteracted by the demands of custom to remain present; and when thus forced to stay, one desires to appear as well as possible. The inhibitory stress of the transaction creates the disagreeable feelings of timidity. The inhibitory processes are allowed to attack a tendency to flight because one wishes to do the proper thing. Close upon the struggle presses an anxious sense of impending failure. Out of over seventeen hundred patients at the Columbus State Hospital, only forty were found who were able and willing to answer intelligently a list of questions relating to timidity. Of these forty, twentyfive were directly under my care. Answers from the other fifteen were obtained through their ward physicians. As the entire number of patients under my charge represents approximately one-fourth the , 1909 , Vol. IV Of patients of the institution, it is fair to con- Out of the forty, twenty-two stated that they were timid. What the intellectually submerged are feeling, has not yet been determined. It will be easier to examine each of these cases separately and draw general conclusions later. let the nervousness take care of itself." What the nerves will do when allowed to take care of themselves can be studied in her mannerisms. She careers around her room like a hunted animal. If in a large space she described great and intricate gyrations in her approach or more frequently her departure. She turns her head away and covers her face with her arm; and if she decides to approach will exhibit the superlative degree of coyness and shyness. But all the while one feels that she is not suffering from embarrassment as much as her actions would seem to indicate. They are too exaggerated and the great lack of control in her movements of flight shows that the mind is not undergoing much stress. One day she said to me, "Doctor, I may act very shy, but I do not feel so." This patient realizes that in an Utopian state of society fear would be unnecessary for she says in answer to the question, do you ever feel timid when alone-"I am not the Christian I once was. Perfect love casteth out all fear." She has very little endurance of either mental or physical control. In answering questions, she begins many of her answers sensibly and then trails off into nonsense, as for instance:— Question: When embarrassed how do you act? Answer: I do not have time to know how I act. When, as this expression, I would rather be good than pretty. Question: What situations with people make you feel most timid? Case 1. Melancholia, woman, age 45, Answer: *Clinical Psychiatry, pp. 354-355. When upon becoming acquainted with friends I have answered don't say appetite. (This answer has more sense than appears; for previous to commitment, she refused to eat at the table with her family on account of extreme embarrassment.) Question: Have you any characteristic. gestures or expressions due to ness? nervous I Answer: Yes ma'am, oh yes sir. laugh entirely too much for my own good. When I am asleep. Case 3. Paranoid form of dementia praecox, woman, age 54, widow. She is well educated and has well systematized, extremely fantastic delusions. She returns a very dirty and untidy paper and fills up all available space with wordy an swers. amples: The following are a few ex Question: At what period in your life were you most timid? Answer: Not timid wrongly just before some large battle or strike or national trouble, fire, or other crisis, in which I have had to take part, facing sickness or death, or as a surgeon, or any crisis. Faith in God always triumphs, yet often anxious, yet God's will be done. Question: Are you timid only in the presence of people? Answer: I look to God and read people. I am wary, alert, and either trust them to some extent or am on the defensive. None perfect except God. Question: Does timidity cause you much or any suffering? Answer: Not wrongly timid. No. God upholds and protects me. Question: Are you easily embarrassed? Answer: If I am not fully up to date upon current matters of the day, topics of conversation, current languages, or called upon publicly for public work without previous notification or preparation, sometimes it is embarrassing. Yet as far as I am competent, I am always ready. Question: When timid what is your mood-gay or otherwise? Answer: When anxious or ready for danger, cool, very cool, alert, wary, cautious, discreet, ready: as a detective, gay or quiet, firm, as necessity suits the Question: Have you any characteristic gestures or expressions due to nervousness? When Answer: No, none wrongly. anxious like to pray to God, then trust God and work it off, will go and lie down and trust God. I know God is faithful and will protect right. Reliance upon God. Question: Are you athletic? Name the outdoor sports in which you take part. Answer: Licensed in all male, also female, army drill sports, sword, horseback, theatrical, circus, menagerie, trapeze, marine ocean, license society, tennis, croquet, golf, skating, billiards, cards in all guises. Question: Have you found any way of lessening timidity? If so, how? Answer: God and brains, common sense, self respect, health, God and health gives self confidence, in soul and body strength. Question: What sort of intellectual capacity are you considered to have? Answer: Born God's begotten child. Court licensed God's begotten child. Divine birth is highest intellectual capacity. Question: What is your occupation? If you have no regular occupation, how do you spend your time? Answer: King, Queen, President. While King Queen President however, I am fully licensed also in every department of the Worlds Industrial Exposition, Combine Treasury, professional also, trades. Question: Does it seem to you that timidity hinders progress in life, intellectually or otherwise? Answer: Not in one way. Causes soul to seek study. Soul must live, often becomes expert as naturalist, geologist, astronomy, mining, unless too timid to live. Question: What in your opinion are the causes of timidity? Answer: Birth, some are not legal legitimate birth. Next unconverted by their own soul right. Self confidence is never timid. Next, not treated honestly sometimes even from childhood. Next, out of their sphere, where would be brave. Case 4. Diagnosis uncertain, woman, age 37, married. She still shows a remarkably brilliant and highly cultivated |