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A PROPOSAL FOR DEVOLUTION.
945 but that interrupting pregnancy is a remedy of Another German authority, very doubtful value.
Modern Technique in Treatment.
in the same views of Dr. A Series of Special Articles, contributed by Scherer, and in Germany as well as in France the invitation, on the Treatment of Medical movement would seem to be gaining ground which and Surgical Conditions. favours the careful supervision of pregnant women in a sanatorium or other institution during and ; XLII.-THE TREATMENT OF THE NEUROTIC. immediately after pregnancy. SOME 40 articles have appeared in this series so far, each and all-with one exception, and that only A PROPOSAL FOR DEVOLUTION. either with a definite type of THE rapid development of our knowledge in apparent--dealing or a definite objective symptom. The more disease has had and is having a profound preventive medicine the simpler is and the condition, objective impersonal effect on the administrative side of the public health its therapeutic consideration ; specific ailments evoke service, as Sir George Newman has pointed out on specific treatment. Nothing could be more objective many occasions. For example, the reduction of than club-foot, nothing more impersonal than scabies enteric fever can be attributed to improvement in or pediculosis. By comparison, the physician called water-supply, drainage, sewerage, and refuse disposal, on to discuss the treatment of the neurotic and and the control of food, including shell-fish. Still is neurasthenic doubly handicapped ; he is not sure undefeated enemies from the preventive standpoint whether he is dealing with " disease " in the accepted .are heart and respiratory diseases, circulatory word, and as a clinician he is frequently in troubles, nervous diseases, and cancer. These must sense of thedoubt as to the of the symptoms he justifiable be from the attacked mainly necessarily personal may be invited to dispel. reality He labours, however, under aspects, and it is these a.spects which have been raised by Lieut.-Colonel F. E. Fremantle, M.P., in no misapprehension as to the commonness of nervous symptoms called neurotic or neurasthenic ; were he a letter to the Prime Minister published recently. Colonel Fremantle thinks that the time has come for a prone to minimise their significance or ignore their reconsideration of health administration, which will universality, the rush of patients to the latest purlead to the crystallisation of the views of many veyor of mysterious panaceas, duly chronicled in the press, would remind him of his error. Whatever people. He makes concrete proposals for changes in daily central administration which are revolutionary in else is the matter is uncertain, this is clear, that there amount of nervous ailment, real, character, being no less than the abolition of the exists an immense or feigned, with which the practitioner of exaggerated, Ministry of Health and the transfer of its powers to medicine should be able to cope, and for the conthe Office of Works as to housing, Home Office as to tinuance of he cannot which escape a modicum of local government (presumably including Poor-law responsibility. as and the Board of Education to its health work), It is unnecessary to indicate with greater particufunctions. Colonel Fremantle’s suggestion, broadly the nervous symptoms included under neurosis larity our is that the of knowwith development speaking, and and it would be endless were it neurasthenia, ledge sanitary works of the character of water-supply and sewerage have no longer the importance which necessary. There is no kind or degree of ache or pain, of or other paraesthesia, of fear or depression, they had in the past, and that future progress is to be of numbness fatigue or ennui, of sensitiveness or apathy, of found in " research (under the Privy Council) and or moodiness, which cannot be set down to " public enlightenment, which surely should come anxiety the nerves " and for which relief will not be sought. -Linder the Board of Education." In considering his here made to define the landmarks or to No is pretence be the gathered from proposals some guidance can their relative importance ; no description can lost opportunities of the past. In 1871 Sir John specify that be be will universally applicable ; but the given that of :Simon po’ntecl out the opportunity placing in soon learns to separate the practice physician a new branch of work-sanitary administration-cases from the " functional," though here, as organic it on on a sound basis was spoilt by grafting of therapeutic to an existing department which was bound to will be indicated later, lies a source be to its detriment, and it has been abundantly trouble. The Element of Fear. shown that the association of health work with Poor-law administration was a mistake. For the successful treatment of the neurotic it is Colonel Fremantle refers to the need of intelligent use incumbent on the practitioner to realise in every of the human factor in every department of local instance that there may exist in the patient’s mind an He has not the or national government, as well as in what, because element of fear or apprehension. of former deficiencies, have been looked on as knowledge that the practitioner has ; he is incapable works of sanitation-water-supply, sewerage-or of interpreting aright the symptoms that have begun housing or hospitals. His use of the word " former " to obtrude themselves into conscious notice ; uneasy suggests that there is no need for further activity in and concerned, a prey to too facile an imagination, these matters. Happy would be the area of which especially if he is, as almost all of this class are, this could be said, but even if it were true of the constitutionally sensitive, he seeks advice because he is large towns, there is much to be done in the vast dominated to some extent by foreboding. He may be tracts of county areas before even modest ambitions afraid of having to relinquish his work, of having with respect to water-supply, sewerage, refuse brought the trouble . on by previous indiscretions, of disposal, and isolation hospitals would be satisfied. failure on the part of the practitioner to diagnose his These are hardly cognate to the work of the Board of condition accurately, of insufficiency in respect of the Education. We agree with Colonel Fremantle-that treatment that will be suggested-in a word, he longs knowledge of prevention of illness and disease has to be reassured about himself and his symptoms. reached the stage when public enlightenment iR an The physician’s aim, therefore, must be to show by even more important factor than it has been at any his investigation and his demeanour that he recognises previous time, and for this the community requires a the symptoms for what they are, that he is familiar central department which has preventive measures as with the course taken by such morbid conditions, and its chief function. But the Ministry of Health has that he is confident a cure’is practicable. He must since its inception behaved as though prevention were never allow the patient to leave his room on the first its prime object, and though the Ministry might well visit without having taken definite steps to dispel be relieved of certain extraneous duties it must remain apprehension. In this respect he might take a leaf the central department for all health matters. Decen- out of the book of the " faith healer " ; if he is true to tralisation of some of the functions of the Ministry can his own intellect he cannot, like the latter, facilely only be recommended with stringent safeguards for deny the reality of disease, yet his optimistic outlook, and his willingness to take the burden of the patient’s efficiency and economy.
Schellenberg, has published journal statistics supporting the Dr.
Modern Technique in Treatment.
in the same views of Dr. A Series of Special Articles, contributed by Scherer, and in Germany as well as in France the invitation, on the Treatment of Medical movement would seem to be gaining ground which and Surgical Conditions. favours the careful supervision of pregnant women in a sanatorium or other institution during and ; XLII.-THE TREATMENT OF THE NEUROTIC. immediately after pregnancy. SOME 40 articles have appeared in this series so far, each and all-with one exception, and that only A PROPOSAL FOR DEVOLUTION. either with a definite type of THE rapid development of our knowledge in apparent--dealing or a definite objective symptom. The more disease has had and is having a profound preventive medicine the simpler is and the condition, objective impersonal effect on the administrative side of the public health its therapeutic consideration ; specific ailments evoke service, as Sir George Newman has pointed out on specific treatment. Nothing could be more objective many occasions. For example, the reduction of than club-foot, nothing more impersonal than scabies enteric fever can be attributed to improvement in or pediculosis. By comparison, the physician called water-supply, drainage, sewerage, and refuse disposal, on to discuss the treatment of the neurotic and and the control of food, including shell-fish. Still is neurasthenic doubly handicapped ; he is not sure undefeated enemies from the preventive standpoint whether he is dealing with " disease " in the accepted .are heart and respiratory diseases, circulatory word, and as a clinician he is frequently in troubles, nervous diseases, and cancer. These must sense of thedoubt as to the of the symptoms he justifiable be from the attacked mainly necessarily personal may be invited to dispel. reality He labours, however, under aspects, and it is these a.spects which have been raised by Lieut.-Colonel F. E. Fremantle, M.P., in no misapprehension as to the commonness of nervous symptoms called neurotic or neurasthenic ; were he a letter to the Prime Minister published recently. Colonel Fremantle thinks that the time has come for a prone to minimise their significance or ignore their reconsideration of health administration, which will universality, the rush of patients to the latest purlead to the crystallisation of the views of many veyor of mysterious panaceas, duly chronicled in the press, would remind him of his error. Whatever people. He makes concrete proposals for changes in daily central administration which are revolutionary in else is the matter is uncertain, this is clear, that there amount of nervous ailment, real, character, being no less than the abolition of the exists an immense or feigned, with which the practitioner of exaggerated, Ministry of Health and the transfer of its powers to medicine should be able to cope, and for the conthe Office of Works as to housing, Home Office as to tinuance of he cannot which escape a modicum of local government (presumably including Poor-law responsibility. as and the Board of Education to its health work), It is unnecessary to indicate with greater particufunctions. Colonel Fremantle’s suggestion, broadly the nervous symptoms included under neurosis larity our is that the of knowwith development speaking, and and it would be endless were it neurasthenia, ledge sanitary works of the character of water-supply and sewerage have no longer the importance which necessary. There is no kind or degree of ache or pain, of or other paraesthesia, of fear or depression, they had in the past, and that future progress is to be of numbness fatigue or ennui, of sensitiveness or apathy, of found in " research (under the Privy Council) and or moodiness, which cannot be set down to " public enlightenment, which surely should come anxiety the nerves " and for which relief will not be sought. -Linder the Board of Education." In considering his here made to define the landmarks or to No is pretence be the gathered from proposals some guidance can their relative importance ; no description can lost opportunities of the past. In 1871 Sir John specify that be be will universally applicable ; but the given that of :Simon po’ntecl out the opportunity placing in soon learns to separate the practice physician a new branch of work-sanitary administration-cases from the " functional," though here, as organic it on on a sound basis was spoilt by grafting of therapeutic to an existing department which was bound to will be indicated later, lies a source be to its detriment, and it has been abundantly trouble. The Element of Fear. shown that the association of health work with Poor-law administration was a mistake. For the successful treatment of the neurotic it is Colonel Fremantle refers to the need of intelligent use incumbent on the practitioner to realise in every of the human factor in every department of local instance that there may exist in the patient’s mind an He has not the or national government, as well as in what, because element of fear or apprehension. of former deficiencies, have been looked on as knowledge that the practitioner has ; he is incapable works of sanitation-water-supply, sewerage-or of interpreting aright the symptoms that have begun housing or hospitals. His use of the word " former " to obtrude themselves into conscious notice ; uneasy suggests that there is no need for further activity in and concerned, a prey to too facile an imagination, these matters. Happy would be the area of which especially if he is, as almost all of this class are, this could be said, but even if it were true of the constitutionally sensitive, he seeks advice because he is large towns, there is much to be done in the vast dominated to some extent by foreboding. He may be tracts of county areas before even modest ambitions afraid of having to relinquish his work, of having with respect to water-supply, sewerage, refuse brought the trouble . on by previous indiscretions, of disposal, and isolation hospitals would be satisfied. failure on the part of the practitioner to diagnose his These are hardly cognate to the work of the Board of condition accurately, of insufficiency in respect of the Education. We agree with Colonel Fremantle-that treatment that will be suggested-in a word, he longs knowledge of prevention of illness and disease has to be reassured about himself and his symptoms. reached the stage when public enlightenment iR an The physician’s aim, therefore, must be to show by even more important factor than it has been at any his investigation and his demeanour that he recognises previous time, and for this the community requires a the symptoms for what they are, that he is familiar central department which has preventive measures as with the course taken by such morbid conditions, and its chief function. But the Ministry of Health has that he is confident a cure’is practicable. He must since its inception behaved as though prevention were never allow the patient to leave his room on the first its prime object, and though the Ministry might well visit without having taken definite steps to dispel be relieved of certain extraneous duties it must remain apprehension. In this respect he might take a leaf the central department for all health matters. Decen- out of the book of the " faith healer " ; if he is true to tralisation of some of the functions of the Ministry can his own intellect he cannot, like the latter, facilely only be recommended with stringent safeguards for deny the reality of disease, yet his optimistic outlook, and his willingness to take the burden of the patient’s efficiency and economy.
Schellenberg, has published journal statistics supporting the Dr.