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ASTHMA RESEARCH.
209
by the phraseology being that the reporter does not appreciate possibilities. Would he recognise (or stigmatise) as neurotic " the hardworking and overscrupulous type described in the leading article in the same issue ? This protest concerns the nervous patient generally. With regard to the main question,
Correspondence. " Audi alteram
"
partem."
it is not too much to say that any worker upon asthma who pushes aside the help offered by psychopathology deprives himself of an essential weapon.
ASTHMA RESEARCH. To the Editor
of
THE LANCET.
T
SIR,—Perhaps Mr. Frank Coke will forgive
me if as a text
I take his letter in your issue of Jan. 19th from which to plead for the serious consideration of the psychological aspect of asthma. He writes : " In the past those unfortunate people, the asthmatics, have been treated as neurotics, and their
symptoms stigmatised as and they were told they
Sir.
vours
faithfully. MILLAIS CULPIN.
Queen Anne-street, W. Jan. 21st, 1929.
THE TREATMENT OF HÆMORRHOIDS BY
INJECTION.
manifestations,
nervous were incurable." such a state of affairs once treated as neurotics " and "
It is to me that existed, but the phrases " stigmatised as nervous manifestations," suggest that he refers to an era before the development of modern psychopathology. He justifiably holds out hope ,of cure from the study of biochemical processes and his list of methods of cure-so divergent that it is difficult to conceive a theory of pathology common to all-is far from complete. From my own knowledge I can add cauterising the nasal septum, avoiding feather pillows, Christian Science, psychotherapy, and a visit to the battlefields of France-vagaries sufficient to suggest some factor not to be elucidated by research limited to biochemical phenomena. Psychopathologists have of necessity received sufficient training to follow the work of Mr. Coke and his colleagues with reasonably intelligent interest. They have, in addition, the advantage of practical experience of the influence of mental processes, often unsuspected by the ordinary clinician, in producing emotional states which, in turn, find expression by alterations of physiological function. Some of them have recorded cases of asthma in which the sequence of pathological events was of this nature and, in spite of Mr. Coke’s pessimism, they even hold out hopes of cure by psychological means. I myselff am acquainted with people who actually claim to have been cured of asthma by some kind of psychoanalysis. Yet psychopathologists find no difficulty in reconciling their views with biochemical theory ; some theory of the kind is necessary, for by their own hypothesis a physiological process is set in motion, and it must follow a biochemical path. They will even admit that to direct our therapy towards the physiological process is often justified by news
H.Tn
To the Editor
of THE LANCET. SIR,-I note with surprise the renewed advocacy of the submucous injection treatment of haemorrhoids. I recall a joint meeting of the American Proctological Society and’ the corresponding subsection of the Royal Society of Medicine, held in London on July 9th, 1924, when, following a very able paper by the late Mr. Græme Anderson, and after a full discussion, the general opinion was that the method was only of use in simple uncomplicated cases,
and that recurrence followed in some 50 per cent. of these. How is it possible for such a method to deal with those cases, very common, in which there is a large protruding oedematous mass of rectal tissue, showing bleeding ulcerative piles higher up ? I feel certain that if Mr. Christopher Howard ind Mr. A. S. Morley will try the treatment by galvanopuncture into the vein itself, described by me before the Harveian Society in October, 1925, and afterwards published,2 they will never use any other Harley-street, W., Jan. 21st, 1929. W. S. WHITCOMBE.
MYOFIBROSITIS. To the Editor
of THE LANCET. SIR,—In his address on Myofibrositis as a Simulator of Other Maladies, published in your issue of Jan. 19th, Prof. G. R. Murray is highly interesting and informative, but he does not give any evidence of the symptoms mentioned being caused by fibrositis. However tempted one may be to agree with himand it would be impossible to prove that they were not so caused-Prof. Murray’s readers would be grateful for.definite evidence of fibrositis being the
results.
fiend that causes all this trouble. Positive evidence is much more satisfactory than reasoning by exclusion.
We must biochemical
accept as facts of observation both the phenomena and the disappearance of asthma after psychological treatment, treatment which is not haphazard but which often throws light upon the why of the situations that have called up the attack, and it is probable that the correlation of these two groups of facts may furnish the key to the whole problem. Instead of a collection of abnormalities to be interpreted only as freakish mani-
T
am
Sir
vours faithfully
SHEFFIELD NEAVE. 1929. Ingatestone, Essex., Jan. 21st, 1929 TEACHING OF
MEDICAL HYDROLOGY.
To the Editor
festations of a biochemical Puck, we have now a’ reasonable assumption of cause and effect that may be made a basis of research. As a point of attack we might start on the relation between hysterical dermatographia-a physiological sign of pathological anxiety-and the urticaria group or the dermal reactions of the asthmatic, not omitting a psychological study of the sufferers. Those who regard an asthma patient as something more than a collection of test-tube reactions and conditioned reflexes will, in the interests of coöperation protest against the point of view and understanding, implicit in Mr. Coke’s words as quoted above. I may be doing him an injustice, but I read into them that he uses " neurotic " as a term of reproach and regards any psychological approach to a disorder as an attack upon the moral integrity of the sufferer. This mental attitude still survives, and we often read in case reports such phrases as " the patient was in no way neurotic," the only information given ‘
of THE LANCET. SIR,—Owing to the proposal to make spa treatment available for insured patients suffering from rheumatism and kindred ailments, it is probable that many medical men in this country would be glad of the opportunity of learning something of a method of
treatment which is more familiar to the medical profession on the Continent than in Great Britain. Until quite recently the only means of obtaining information on these subjects was to visit one of the spa hospitals, but in 1923 a Committee was formed, composed of representatives of the chief spas of Great Britain, and from London, for the purpose of giving instruction in medical hydrology in the universities and medical schools of Great Britain. This function the Committee still performs, but it is thought that some medical societies not connected with teaching centres might care to hear lectures 1 See THE LANCET, 1924, ii., 117. 2 Brit. Med. Jour., 1925, ii., 992.
by the phraseology being that the reporter does not appreciate possibilities. Would he recognise (or stigmatise) as neurotic " the hardworking and overscrupulous type described in the leading article in the same issue ? This protest concerns the nervous patient generally. With regard to the main question,
Correspondence. " Audi alteram
"
partem."
it is not too much to say that any worker upon asthma who pushes aside the help offered by psychopathology deprives himself of an essential weapon.
ASTHMA RESEARCH. To the Editor
of
THE LANCET.
T
SIR,—Perhaps Mr. Frank Coke will forgive
me if as a text
I take his letter in your issue of Jan. 19th from which to plead for the serious consideration of the psychological aspect of asthma. He writes : " In the past those unfortunate people, the asthmatics, have been treated as neurotics, and their
symptoms stigmatised as and they were told they
Sir.
vours
faithfully. MILLAIS CULPIN.
Queen Anne-street, W. Jan. 21st, 1929.
THE TREATMENT OF HÆMORRHOIDS BY
INJECTION.
manifestations,
nervous were incurable." such a state of affairs once treated as neurotics " and "
It is to me that existed, but the phrases " stigmatised as nervous manifestations," suggest that he refers to an era before the development of modern psychopathology. He justifiably holds out hope ,of cure from the study of biochemical processes and his list of methods of cure-so divergent that it is difficult to conceive a theory of pathology common to all-is far from complete. From my own knowledge I can add cauterising the nasal septum, avoiding feather pillows, Christian Science, psychotherapy, and a visit to the battlefields of France-vagaries sufficient to suggest some factor not to be elucidated by research limited to biochemical phenomena. Psychopathologists have of necessity received sufficient training to follow the work of Mr. Coke and his colleagues with reasonably intelligent interest. They have, in addition, the advantage of practical experience of the influence of mental processes, often unsuspected by the ordinary clinician, in producing emotional states which, in turn, find expression by alterations of physiological function. Some of them have recorded cases of asthma in which the sequence of pathological events was of this nature and, in spite of Mr. Coke’s pessimism, they even hold out hopes of cure by psychological means. I myselff am acquainted with people who actually claim to have been cured of asthma by some kind of psychoanalysis. Yet psychopathologists find no difficulty in reconciling their views with biochemical theory ; some theory of the kind is necessary, for by their own hypothesis a physiological process is set in motion, and it must follow a biochemical path. They will even admit that to direct our therapy towards the physiological process is often justified by news
H.Tn
To the Editor
of THE LANCET. SIR,-I note with surprise the renewed advocacy of the submucous injection treatment of haemorrhoids. I recall a joint meeting of the American Proctological Society and’ the corresponding subsection of the Royal Society of Medicine, held in London on July 9th, 1924, when, following a very able paper by the late Mr. Græme Anderson, and after a full discussion, the general opinion was that the method was only of use in simple uncomplicated cases,
and that recurrence followed in some 50 per cent. of these. How is it possible for such a method to deal with those cases, very common, in which there is a large protruding oedematous mass of rectal tissue, showing bleeding ulcerative piles higher up ? I feel certain that if Mr. Christopher Howard ind Mr. A. S. Morley will try the treatment by galvanopuncture into the vein itself, described by me before the Harveian Society in October, 1925, and afterwards published,2 they will never use any other Harley-street, W., Jan. 21st, 1929. W. S. WHITCOMBE.
MYOFIBROSITIS. To the Editor
of THE LANCET. SIR,—In his address on Myofibrositis as a Simulator of Other Maladies, published in your issue of Jan. 19th, Prof. G. R. Murray is highly interesting and informative, but he does not give any evidence of the symptoms mentioned being caused by fibrositis. However tempted one may be to agree with himand it would be impossible to prove that they were not so caused-Prof. Murray’s readers would be grateful for.definite evidence of fibrositis being the
results.
fiend that causes all this trouble. Positive evidence is much more satisfactory than reasoning by exclusion.
We must biochemical
accept as facts of observation both the phenomena and the disappearance of asthma after psychological treatment, treatment which is not haphazard but which often throws light upon the why of the situations that have called up the attack, and it is probable that the correlation of these two groups of facts may furnish the key to the whole problem. Instead of a collection of abnormalities to be interpreted only as freakish mani-
T
am
Sir
vours faithfully
SHEFFIELD NEAVE. 1929. Ingatestone, Essex., Jan. 21st, 1929 TEACHING OF
MEDICAL HYDROLOGY.
To the Editor
festations of a biochemical Puck, we have now a’ reasonable assumption of cause and effect that may be made a basis of research. As a point of attack we might start on the relation between hysterical dermatographia-a physiological sign of pathological anxiety-and the urticaria group or the dermal reactions of the asthmatic, not omitting a psychological study of the sufferers. Those who regard an asthma patient as something more than a collection of test-tube reactions and conditioned reflexes will, in the interests of coöperation protest against the point of view and understanding, implicit in Mr. Coke’s words as quoted above. I may be doing him an injustice, but I read into them that he uses " neurotic " as a term of reproach and regards any psychological approach to a disorder as an attack upon the moral integrity of the sufferer. This mental attitude still survives, and we often read in case reports such phrases as " the patient was in no way neurotic," the only information given ‘
of THE LANCET. SIR,—Owing to the proposal to make spa treatment available for insured patients suffering from rheumatism and kindred ailments, it is probable that many medical men in this country would be glad of the opportunity of learning something of a method of
treatment which is more familiar to the medical profession on the Continent than in Great Britain. Until quite recently the only means of obtaining information on these subjects was to visit one of the spa hospitals, but in 1923 a Committee was formed, composed of representatives of the chief spas of Great Britain, and from London, for the purpose of giving instruction in medical hydrology in the universities and medical schools of Great Britain. This function the Committee still performs, but it is thought that some medical societies not connected with teaching centres might care to hear lectures 1 See THE LANCET, 1924, ii., 117. 2 Brit. Med. Jour., 1925, ii., 992.