THE PSYCHOLOGICAL APPROACH 1332 JUNE 26, 1937 MEDICALICAHEBRITISNAJOURNAL into encouragement and discouragement ; each had its THE PSYCHOLOGICAL APPROACH place. There was one pitfall and one only, about en- At a meeting of the Medical Society of Individual Psycho- couragement: it might be the last thing the patient sought logy on June 10 Dr. T. A. Ross read a paper entitled or desired ; in which case it might make him worse. "The Psychological Approach." The good doctor must believe in his treatment. No one Dr. Ross said there were two aspects presented by such could give encouragement, unless he were a rogue, about an approach-namely, the understanding by the physician something in which he had no faith. The analytic of his patient's illness and the understanding by the patient approach was of value in the psychoneuroses and in every of the origins and causes of his illness in so far as these kind of chronic illness. The analytic approach did not were psychogenic. From the standpoint of the physician necessarily mean deep analysis, and many psychoneurotics two views might be contrasted. According to one there could be got to remain well for years without any know- was no psychological approach. In the absence of ledge of their infancy or young childhood. Deep analysis physical signs people who said they were suffering quite had its uses; but every abdominal pain did not call for clearly were not, and in an ideal society would have been a laparotomy. handed to the policeman or the priest but for the fact that in the world as it is neither of these functionaries would do their duty in this matter. According to the second view, as expressed, for example, by Groddeck, Local News psychogeny embraced the whole of medicine and was the key to the understanding of every patient. Whether an illness was traumatic or microbic the patient came by his catastrophe because he wished it, the catastrophe IRELAND being preferable to something which it averted. For An Outbreak of Puerperal Fever Groddeck intention was the key to everything. But this view was unprovable. Anxiety could be found in any The report of the Rotunda Hospital, Dublin, which case if it were looked for industriously enough, and-there covers the twelve months to October 31, 1936, states were many who " wished " for an illness but did not get it. that there has been a considerable advance in the pro- Indeed many obviously refused the advantage which their gramme of reconstruction under the auspices of the Irish physical illness might confer on them, and went about Hospitals Sweepstakes Fund. During the six months courageously when they might well be, and could be, at following the opening of the new out-patient department rest. Illness, even if not psychogenic in origin, must soon an increase of 30 per cent. in the number of patients be complicated by events. The average man did not want attending is reported. An account is given of a serious to be ill ; he wanted to do a lot of things which illness outbreak of haemolytic streptococcal sepsis in March and prevented: to play or watch football, to play golf, or go April, following a smaller epidemic in the two preceding to the cinema. Illness brought fear, anxiety, loss of months. Fourteen patients were affected and there were confidence in the doctor, resentment against employers, four deaths, a mortality of 28 per cent. The report points hope of unearned increment, and other factors inimical out that extensive building and alterations were taking to recovery. place in the hospital at that time, and that it was there- fore difficult to maintain general cleanliness. The out- The truth was intermediate between the doctrine of break also coincided with a severe epidemic of strepto- physical causation and that of pure psychogenic causa- coccal throats in both the hospital and in the city. The tion. It seemed obvious that every patient presented both sequence of events is frankly described. On January 3 a mental and a physical problem. For this reason, among labour was induced in a primipara, Mrs. A. A normal others, medical psychologists of all people had much need puerperium followed until the eighth day, when, the to look more at patients and less at books. Medical patient complaining of sore throat, a throat swab was psychology had suffered of late from having one clinical taken, from which grew a pure culture of haemolytic observer of outstanding genius, with no one quite com- streptococci. The two nurses attending this case sub- petent to criticize him effectually, who was surrounded sequently attended Mrs. B., who also developed a strepto- by a cohort of praetorians ready to slay any outside critic. coccal throat. Mrs. B. elected to leave hospital with a Dr. Ross said that when he began to study the effect temperature against the advice of the staff. Throat swabs of mind on bodily symptoms he was living and working were then taken from the two nurses, and both grew in the Isle of Wight, in isolation from others interested haemolytic streptococci; the two nurses were sent home. in the subject. There were disadvantages in this; there Meanwhile Mrs. C., delivered by forceps on February 1, were also considerable advantages. There were advan- had been nursed in the bed beside Mrs. B. by these same tages in having a director to supervise one's earlier cases; nurses before their throat condition was recognized. but the pupil tended to become subservient to the teacher, Mrs. C. developed a rigor on the fourteenth day, a blood to lose his critical faculties, to depend less on the picture culture was positive for haemolytic streptococci, and she provided by the patient and more and more on the master's died twelve days later. The next case recorded was in ideas. With the regulation that every would-be therapist a Mrs. D., who had a spontaneous delivery on February must himself be analysed before he started treating others 15, followed by a rise of temperature on the second there was an end to originality. No one ever quite re- evening. A cervical swab produced haemolytic strepto- covered from an analysis. The patient might lose his cocci. The patient recovered. In this case no contact illness ; but every successful analysis, whether of patient with infection could be traced. An interval of calm or of pupil, must result in the more or less permanent now supervened until Mrs. E., delivered on March 25 adoption of the analyst's views. One might hope to get and attended by a nurse subsequently found to have a number of people well without making them subjects of streptococci in her throat, developed a puerperal infec- transference neurosis, which might sometimes be an in- tion of haemolytic streptococci. Some ten days later curable neurosis, meaning that the doctor shared the ill- several cases appeared in rapid succession. Of these one ness with the patient instead of some member of the patient was delivered on April 5s two on April 7, two latter's family doing so. on April 8; the remaining cases were delivered on There were two possible strategic methods for the April 11, 14, and 21, and May 8. It is noted that in psychological approach: one was analysis and the other seven of these fourteen cases there was no vaginal inter- persuasion. Whenever a history was taken an interpreta- ference of any kind. Six of them started in the same tion was probably made: there was little difference puerperal ward, and eight were in direct contact with between this and analysis. Whenever a prognosis was droplet or spray infection from a positive streptococcal given, persuasion was used. Persuasion might be divided throat. The repolt describes the thorough precautionary JUNE 1937 THE BRrrIs 1333 26,- SCOTLAND JUNE 26, 1937 MEDICAL JOURNAL measures taken, and it is stated that following this married and reproduced more C3 people. In other words, epidemic all those conducting cases in the labour ward civilization was slowly but surely producing race suicide. and all nurses washing up puerperal cases in the lying-in There had been great civilizations in the past, and one wards have been ordered to wear masks. It is further might speculate what had destroyed them. Clinics were suggested that the question of spray and droplet infec- palliative not preventive, although child welfare clinics tion is not sufficiently stressed in the rules of the Central might in time prove preventive by educating future Midwives Board, and that under Rule 9a the infective mothers. The question of sterilization was being con- danger of sore throats and colds should be clearly stated. stantly discussed, but this would not affect the class from which the mental defective was largely recruited, for not many people were willing to admit that they were of C3 calibre. The public must be educated to a knowledge that like produced like. Medicine had made great strides SCOTLAND in the prevention of infectious diseases, and the deaths University of Glasgow from tuberculosis had been reduced by 25 per cent. in the last twenty-five years. Why should the increase of At the graduation ceremony of the University of mental deficiency not also be reduced by research and Glasgow on June 16 Sir Daniel M. Stevenson, Chancellor the constant teaching of the laws of health? Dr. W. D. of the University, presiding, doctorates in law were con- Chambers said that it was essential that the physical defects ferred upon thirteen persons, of whom six were members and disorders concealed behind more striking psychological of the medical profession. Professor Gibb, in presenting disorders should not be overlooked, for at least 25 per these graduands in law, said that Professor Boeke, who is cent.