FEAR, SHOCK, AND PANIC.•
Tatmn are many who believe that the war will do great things for the advancement of medicine and of surgery. This belief is not likely to be fulfilled. Our present knowledge will be widened out we shall learn much about the geographical distribution tu,d incidence of fevers, the ways of their transmission, time relation of surface.aoil to diseases, and so forth we shell establiah or P;..sibador. rif,lirwrgildinie ELediotp:,11c1Fmeziej trar July, sit /flan
extend or correct our present lines of diagnosis and of treatment : our younger physicians and surgeons on active service will come back with increased experience, insight, and dexterity. But we may doubt whether any discoveries of the first magnitude will be brought to light by the war. Anaestheties, antiseptics, localization of the motor-areas of the brain, interpretation of the action of the ductless glands, diphtheria antitoxin, tetanus antitoxin, protective vaccines—these discoveries, of the first magnitude, same not from the dealing with millions of men, but (turn long years of uneventful work in laboratories and in civil practice. War takes such median' and surgical facts as we already possess, and uses thent for all they are worth, and teats them, and adds soinothing to them, a bit here and a bit, there ; but he who wants to make the really groat discoveries had better atop at home, and work in our labora- tories and our civil hospitals, and be master of his own time and his own theories.
As it is with wounds and fevers, so it is with " nu:Mal cases." Nothing, in all the miseries of the present war, is more pitiful, snore tragical, than the legions of men broken in nerve, stint home as cams of exhaustion or of shock it is downright horrible. Even though we follow the wise rule—that we must not add.up tmhappi- :testes, that no man beats or fools more than his own individual pain or distress—still, it is grievous to think of the multitude of these - nerve cases." And we keep hoping that some groat dis- covery will come out of the more multitude of them. We ale hoping against hope. The war will extend our observations and our experiences of these cases : it will test our present methods of diagnosis and of treatment : it will strengthen our insight, and our power to judge whether this or that patient is or is not exag- gerating the filets of his case ; but it will not bring us any discovery of the first magnitude, any new drug or operation to " raze out the written troubles of the brain." Still, the investigation of these cases, these wounds of the mind, has not been without value. An immense literature has already since 1914 been accumulated over them. Among these hundreds of monographs, there is a paper by Sir Robert Armstrong-Jones on Fear and Panic in War Time' it first appeared in the Jeanie/ of Mental Science, July, 1917: it is a good summary of our present knowledge, and he ha; had very long and wide experience in the study and the treatment of "mental diseases."
Thanks to our physiologists and physician., we now are acquaints.' with; the chemistry of the body under conditions of fear. Our psychologists, it seems, have not given us much to be thankful for they never do. They are not yet agreed among themselves, and perhaps they never will be, whether we cry because we are frightened, or aro frightened because we find ourselves crying. They must be left to solve this and other problems of life. With our pliyeiologiat and our physicians, we are on surer ground. Fear, they toll us—aid they have proved it—acts not only in our braille, but also, through our lower nervous centres, in our livers, thyroid glands, suprarenal glands, &o. these organs accrete more actively : there is more sugar, more thyroid ferment, more adrenalin, in our blood, that we have in it when our minds are at rest. The primal object of these chemical workings in us is self.proteetion : the adrenalin and the sugar are intended to restore our muscular activity, to stimulate our hearts, to raise our blood pressure, and to give tone to our viscera. " The emotion of fear is a protective reflex, inasmuch: ae those physiological effects are precisely those that prepare the body for n strenuous effort ; snob an effort expressing itself in active combat, conflict, or flight, the latter being asentially a struggle to be free." Here is a good sound bit of positive fact it would have delighted Darwin. But it was discovered before the war.
Cases of " " may exhibit these signs of chemical and organic changes in the thyroid, supraronals, and liver : we cannot draw a hard-and-fast lino between ahell.ahoek and fearsbock But the speoial interest of shell-shock is in the question whether the derangements of the functions of the brain and spinal cord are merely "functional " or are due to actual physical concussion of these delicate tissues. The evidence is in favour of the latter view :—
" One of the results of high explosives bursting with a sudden pressure of about 7,000 Idlogrammes to the square centimetre, must inevitably be a perenasionahook, which would he conveyed, with an intense mechanical force, through the corebro.spinal fluid and the injury in eholl.shook eases must be a defin ire molecular phyeical injury to the brain and cord, an injury which is super-added to that caused by the sudden emotional strain. . . . To 11B at home, it is unimaginable and inconceivable what proximity to the continued stress of high explosives must mean."
Hero, on a colossal settle, we have the old question that woe raised, some forty yeas ago, over " railway spine. "—i.e., caws of per.
sietent loss of muscular power after the sudden shook of a railway accident. There was a memorable controversy between two well- known surgeons, whether these derangements of the °entrel nervous system were merely " functional " or wore due to " definite mole- cular physical injury" to the spinal cord.
From the consideration of fear and of shook, Sir Robert goes on to the consideration of panics. He has diligently collected
many historical accounts of notable panics, and he sets them forth in a very interesting way. 131.1t, of courts, there is no salaam of
panics, nor ever will be. Such phrases as "infectious feeling of fear " and "dominant thought-wave " and collective will-power " and " psychologie do Is foule," are mere words, for the psychologists to play with. Absolute individualism is the first principle of psychology : one might as well talk of a dominant adrenalin-wave as of a dominant thought -wave ; one might as well talk of collective sugar-power as of collective will.power. [N.B.—This last sentence has been written just after an air raid r the basement has released its five occupants. All of them experienced fear, all of them behaved nicely ; but they hesitate to bow the knee to any psychological explanation of their good behaviour.]
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