- Email: [email protected]
HOSPITAL DOCTORS
1231
with preoperative mental disease this seemed to have arisen in previously disturbed personalities. This might suggest an early cerebral injury of rheumatic type predisposing to mental disease, or a joint predisposition to mental and cardiac disease. SVEN J. DENCKER Department of Neurology, Department of Psychiatry, University of Lund, Sweden.
ARNE SANDAHL.
HOSPITAL DOCTORS
SIR,-Iwelcome the proposals of the Platt Working Party to create the post of medical assistant ". Most of my experience in England was in the casualty and accident service, which work I thoroughly enjoyed, although the premises and consultant supervision left much to be desired. In view of the recent report of the Nuffield Trust it might be asked why I left the accident service, and England. I could see "
future for myse f in the National Health Service in its existing framework. Firstly, the road to a consultant appointment appeared too formidable, I have never found examinations easy, and the primary F.R.C.S. had to be abandoned for several reasons. Secondly, I did not have a teaching-hospital registrar appointment, nor was I likely to get one. The apparent future offered nothing but a series of seniorregistrar appointments with all their frustrations and uncerno
protein is difficult. Filtration is tedious, and may seem superfluous to a receptionist undertaking routine testing. Another relevant test consists in adding about a third of its volume of 10% potassium-hydroxide solution to about an inch and a half of urine in a boiling tube. Purulent urine then becomes viscous, which may be demonstrated by pouring it out, or more readily by shaking it and observing how slowly the bubbles rise. This test is helpful, but may inexplicably not reveal severe pyuria; the results of testing 87 samples on which leucocyte-counts were made are shown in the accompanying figure. A neat biochemical test for peroxidase in urine has been described 1; but it is positive in the presence of either red or white cells, and is relatively time-consuming.
Microscopy can usually be very speedily carried out if equipment is to hand-about as quickly as testing for protein by boiling-and is particularly useful for diagnosing urinary infections in young children, in whom the illness may be acute, the history non-specific, and the the
of urine obtainable very small. I wish to thank Dr. Rosemary Biggs for some of the leucocyte-counts, and Dr. Ian Skinner, who taught me the potassium-hydroxide test. amount
Calverton, Nottingham.
Calverton,
tainties.
J.
M. FORRESTER. M Nj, F JJ.M. J,
PAVLOV OR FREUD?
Not all registrars wish to become consultants and many would welcome the opportunity of carrying on their work provided they were given security of tenure. I came abroad, while several of my colleagues have drifted into other permanent
appointments. I believe that the standard of the Hospital Service would be improved by creating " medical assistants ". Medical Department,
Gombe, Nigeria.
EDWIN
Northern
J. WRIGLEY.
DETECTING PYURIA IN GENERAL PRACTICE SIR,ŃIn this country nowadays many of us in general practice enjoy access to prompt and effective laboratory facilities. Yet there is still a rich harvest of immediate diagnostic in-
formation to be reaped by microscopy of
the urine, for there satisalterfactory native. A drop from an
which is no
ordinary
specimen is sufficient; it is placed on a
LEUCOCYTES per c.mm.oF urine
Leucocyte-counts of urine. In 100 consecutive
as
passed
slide and examined unstained under the 2/a in. and 1/6 in. objectives without a
coverslip.
specimens examined thus in ordinary practice, pyuria was by far the commonest abnormal finding, and was noted in 27. On testing by boiling and acidification protein was found in only 16 of these 27; it is especially in the somewhat turbid pyuric urines that detecting small traces of
SIR,-It seems necessary to point out to those among correspondents who plead for a rapprochement between psychotherapy and behaviour therapy (Dr. Bower, April 1; Dr. MacDonald, April 22) that they misunderstand the position taken up by the proponents of the latter. Not only has behaviour therapy been invented with the aim to supersede psychotherapy but the two also lack common ground. your
Psychotherapy recognises mind as an entity, behaviour therapy does not. Where there is no room for mind there can, of course, be no question of diseases of the mind, and, consequently, no psychopathology. Inquiries addressed to learning theorists about psychopathological issues involved in their cases (Dr. Bower, April 1; Dr. Edelston, May 6) are therefore out of place. Professor Eysenck is quite explicit on these points. In a paper dealing with neuroses and their treatment2 he says: Throughout this paper I have stressed entirely the treatment of symptoms without alluding to any underlying complex or illness. The reason is that as far as learning theory is concerned there is no illness and there is no complex. We are dealing entirely and exclusively with maladapted habits formed through a process of conditioning ..." (Professor Eysenck’s italics.) In another place 3 Professor Eysenck commits himself If the physical causation of G.P.I. and to the following view: similar diseases had been known from the beginning, it is doubtful if these would have been classified as psychiatric disorders." Although this view removes insanity from the scope of the psychiatrist the underlying thinking is logical, coming from one for whom mind is non-existent. As far as I can follow Professor Eysenck’s basic thinking, he makes use, on the one hand, of the concept of neural properties "
"
inherent in the autonomic and other parts of the nervous sysand, on the other, of the concept of outer stimuli or patterns of stimuli impinging upon it. There is nothing else. The interaction of the two brings about the conditioned responses or, in behavioural terms, the habits. I do not see how this theoretical outlook can invoke Pavlov’s work for its basis. If we take the classical salivation experiments, neither the conditioned nor the unconditioned stimuli can be said to have brought about the salivation. The salivation was brought about by hunger, in animals kept without food and made to expect nourishment in certain experimentally defined circumstances. tem
1. 2. 3.
Jarvinen, K. A. J. Brit. med. J. 1958, i, 379. Eysenck, H. J. Proc. R. Soc. Med. 1960, 53, 507. Eysenck, H. J. Handbook of Abnormal Psychology; p. 4. 1961.
New
York,
with preoperative mental disease this seemed to have arisen in previously disturbed personalities. This might suggest an early cerebral injury of rheumatic type predisposing to mental disease, or a joint predisposition to mental and cardiac disease. SVEN J. DENCKER Department of Neurology, Department of Psychiatry, University of Lund, Sweden.
ARNE SANDAHL.
HOSPITAL DOCTORS
SIR,-Iwelcome the proposals of the Platt Working Party to create the post of medical assistant ". Most of my experience in England was in the casualty and accident service, which work I thoroughly enjoyed, although the premises and consultant supervision left much to be desired. In view of the recent report of the Nuffield Trust it might be asked why I left the accident service, and England. I could see "
future for myse f in the National Health Service in its existing framework. Firstly, the road to a consultant appointment appeared too formidable, I have never found examinations easy, and the primary F.R.C.S. had to be abandoned for several reasons. Secondly, I did not have a teaching-hospital registrar appointment, nor was I likely to get one. The apparent future offered nothing but a series of seniorregistrar appointments with all their frustrations and uncerno
protein is difficult. Filtration is tedious, and may seem superfluous to a receptionist undertaking routine testing. Another relevant test consists in adding about a third of its volume of 10% potassium-hydroxide solution to about an inch and a half of urine in a boiling tube. Purulent urine then becomes viscous, which may be demonstrated by pouring it out, or more readily by shaking it and observing how slowly the bubbles rise. This test is helpful, but may inexplicably not reveal severe pyuria; the results of testing 87 samples on which leucocyte-counts were made are shown in the accompanying figure. A neat biochemical test for peroxidase in urine has been described 1; but it is positive in the presence of either red or white cells, and is relatively time-consuming.
Microscopy can usually be very speedily carried out if equipment is to hand-about as quickly as testing for protein by boiling-and is particularly useful for diagnosing urinary infections in young children, in whom the illness may be acute, the history non-specific, and the the
of urine obtainable very small. I wish to thank Dr. Rosemary Biggs for some of the leucocyte-counts, and Dr. Ian Skinner, who taught me the potassium-hydroxide test. amount
Calverton, Nottingham.
Calverton,
tainties.
J.
M. FORRESTER. M Nj, F JJ.M. J,
PAVLOV OR FREUD?
Not all registrars wish to become consultants and many would welcome the opportunity of carrying on their work provided they were given security of tenure. I came abroad, while several of my colleagues have drifted into other permanent
appointments. I believe that the standard of the Hospital Service would be improved by creating " medical assistants ". Medical Department,
Gombe, Nigeria.
EDWIN
Northern
J. WRIGLEY.
DETECTING PYURIA IN GENERAL PRACTICE SIR,ŃIn this country nowadays many of us in general practice enjoy access to prompt and effective laboratory facilities. Yet there is still a rich harvest of immediate diagnostic in-
formation to be reaped by microscopy of
the urine, for there satisalterfactory native. A drop from an
which is no
ordinary
specimen is sufficient; it is placed on a
LEUCOCYTES per c.mm.oF urine
Leucocyte-counts of urine. In 100 consecutive
as
passed
slide and examined unstained under the 2/a in. and 1/6 in. objectives without a
coverslip.
specimens examined thus in ordinary practice, pyuria was by far the commonest abnormal finding, and was noted in 27. On testing by boiling and acidification protein was found in only 16 of these 27; it is especially in the somewhat turbid pyuric urines that detecting small traces of
SIR,-It seems necessary to point out to those among correspondents who plead for a rapprochement between psychotherapy and behaviour therapy (Dr. Bower, April 1; Dr. MacDonald, April 22) that they misunderstand the position taken up by the proponents of the latter. Not only has behaviour therapy been invented with the aim to supersede psychotherapy but the two also lack common ground. your
Psychotherapy recognises mind as an entity, behaviour therapy does not. Where there is no room for mind there can, of course, be no question of diseases of the mind, and, consequently, no psychopathology. Inquiries addressed to learning theorists about psychopathological issues involved in their cases (Dr. Bower, April 1; Dr. Edelston, May 6) are therefore out of place. Professor Eysenck is quite explicit on these points. In a paper dealing with neuroses and their treatment2 he says: Throughout this paper I have stressed entirely the treatment of symptoms without alluding to any underlying complex or illness. The reason is that as far as learning theory is concerned there is no illness and there is no complex. We are dealing entirely and exclusively with maladapted habits formed through a process of conditioning ..." (Professor Eysenck’s italics.) In another place 3 Professor Eysenck commits himself If the physical causation of G.P.I. and to the following view: similar diseases had been known from the beginning, it is doubtful if these would have been classified as psychiatric disorders." Although this view removes insanity from the scope of the psychiatrist the underlying thinking is logical, coming from one for whom mind is non-existent. As far as I can follow Professor Eysenck’s basic thinking, he makes use, on the one hand, of the concept of neural properties "
"
inherent in the autonomic and other parts of the nervous sysand, on the other, of the concept of outer stimuli or patterns of stimuli impinging upon it. There is nothing else. The interaction of the two brings about the conditioned responses or, in behavioural terms, the habits. I do not see how this theoretical outlook can invoke Pavlov’s work for its basis. If we take the classical salivation experiments, neither the conditioned nor the unconditioned stimuli can be said to have brought about the salivation. The salivation was brought about by hunger, in animals kept without food and made to expect nourishment in certain experimentally defined circumstances. tem
1. 2. 3.
Jarvinen, K. A. J. Brit. med. J. 1958, i, 379. Eysenck, H. J. Proc. R. Soc. Med. 1960, 53, 507. Eysenck, H. J. Handbook of Abnormal Psychology; p. 4. 1961.
New
York,