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POLITICS IN THE HOSPITAL
1217
CORRESPONDENCE NATIONAL PHYSICAL TRAINING
To the Editor
of
Tfm LANCET
SIR,-In the account in your last issue (p. 1140) of a discussion on this subject Sir Joseph Barcroft is reported to have said that he merely desired to ask a few questions. It does not appear that he, received any" reply. Might the apostles of the gospel be asked to reply in your columns‘ of "fitness When politics and propaganda combine questions are apt to be regarded as treasonable, but perhaps, Sir, in a medical journal a spirit of criticism may be allowed to survive without calling down too much calumny. Would the protagonists of more gymnastics (who now have designs on the leisure of the medical Is it fitness for war student) define " fitness " against a human enemy or against disease’? Is there evidence that the " fit " are less likely to contract pulmonary tuberculosis than the " unfit " 1 Are the men in the fighting services, who enjoy compulsory games under medical supervision, more resistant to disease than a corresponding age-group who take no -exercise ? Do life insurance companies find that those who have kept " fit " by regular exercise are better risks than those who have enjoyed a more sedentary existence Information on points such as these and many others might be considered before the medical profession is stampeded into giving its blessing to a scheme which may be desirable on political grounds and even on medical grounds, and questions like those of Sir Joseph Barcroft deserve an answer. I am, Sir, yours faithfully, CECIL FLEMMING. Upper Wimpole-street, W., Nov. 15th.
POLITICS IN THE HOSPITAL
To the Editor
of
THE LANCET
SiR,-I, too, have read with interest your leading article of Oct. 9th. It is all to the good that medical students should concern themselves with public health in the widest sense, but one may be allowed to point out that many problems which have recently been given a political flavour are essentially technical problems. Their solution has often been hindered by the introduction of party feeling into their discussion. In my view our medical students can best contribute to the well-being of the State by first learning to be good doctors. The academic atmosphere of a hospital or university is likely to produce academic politics, whereas, if those interested would reserve their considered opinions for the time when they have already held resident appointments, travelled, and read more, they would be more likely to be realistic. They would then be able to decide whether .a man works better,for a salary plus a pension than he might as a free lance. They would know whether it is agreeable to be employed by an authority controlled by politicians. They could possibly judge whether these politicians are as sensitive to the complaint of the voter-patient as they are loyal to the doctors who serve them. They might discover many doctors in public services who are sickened by the manoeuvres of those set in authority over them. It might even occur to them that the doctor’s ego is a potent healing agent and that any encroachment upon it reduces his power for good. They might decide whether a hospital authority should pay
attention to anonymous letters. They might learn Andre Siegfried rote 11 England’s Crisis." Let us suppose that one of the elect tells us " it is the policy of my party to stamp out boils." Are we then to suppose that the other side are pro-boilt This sort of thing is as dishonest by insinuation as it is surgically unsound. In fact, taking public health in the widest sense, we may suggest that many emotional and intellectual disordeisof the body politic are caused by political claptrap. An intelligent health authority would use a carbolic spray at many political meetings. I am, Sir, yours faithfully, G. C. PETHER. Buxton, Nov. 9th.
why
ASSESSMENT OF PSYCHIATRIC TREATMENT
of THE LANCET SiB,—I have read with deep interest the letter in which Dr. Mary Luff first raises the question whether there are two rival schools of thought in psychotherapeutic treatment, the one addicted to prolonged or intensive," the other pinning its faith on shorter methods. She makes the suggestion that this deplorable divergence may be dependent upon the possibility that the adherents of these rival faiths tend only to see the failures achieved by the other faction ; and invites me to join in the task of constructive To the Editor
"
"
reconciliation. It would seem equally probable, however, that fallacies might arise owing to the possibility that the rival factions-if such there be-do not tend to see each other’s successes. Taking as a theoretical illustration an institution dedicated solely to the method of prolonged treatment for any and every patient (there can be no institution of this kind, for surely we are not so ignorant and silly as all that), it would be easy to understand how workers in such an institution might tend to over-estimate the efficacy of, or necessity for, the method of prolonged treatment they employed ; for if the patients they treated were comparable to the ones I saw at St. George’s, certain of the good results that might be attributed by them to their prolonged method of treatment would have been obtained in patients who would have improved without it ; but who would also (unless we were very cynical) have improved with it. But in treating psychiatric patients, as Dr. Luff rightly points out, the issue is not that of prolonged versus shorter methods of psychotherapy. Nor do I believe should the issue be put forward as consisting solely in the correct choice between these alternative (or at least contrasted) methods. Such a view would come perilously near to the fallacious assumption that psychiatric treatment and psychotherapy are synonymous. Yet it may well be that I have derived an erroneous impression from the fact that Dr. Luff concentrates upon the above issue, and only alludes to other forms of treatment (such as "environmental" and " physical ") when discussing " psychoses." It would, I hope, be wrong to infer that Dr. Luff regards other forms of psychiatric treatment as second bests, or wishes to imply that they may not be necessary, and indeed essential, for treating " neuroses " as well. But if considered important, why were they left out The problem as I see it is not only what form of psychotherapy but also what other forms of psychiatric treatment should be employed ; and in order
.
_
CORRESPONDENCE NATIONAL PHYSICAL TRAINING
To the Editor
of
Tfm LANCET
SIR,-In the account in your last issue (p. 1140) of a discussion on this subject Sir Joseph Barcroft is reported to have said that he merely desired to ask a few questions. It does not appear that he, received any" reply. Might the apostles of the gospel be asked to reply in your columns‘ of "fitness When politics and propaganda combine questions are apt to be regarded as treasonable, but perhaps, Sir, in a medical journal a spirit of criticism may be allowed to survive without calling down too much calumny. Would the protagonists of more gymnastics (who now have designs on the leisure of the medical Is it fitness for war student) define " fitness " against a human enemy or against disease’? Is there evidence that the " fit " are less likely to contract pulmonary tuberculosis than the " unfit " 1 Are the men in the fighting services, who enjoy compulsory games under medical supervision, more resistant to disease than a corresponding age-group who take no -exercise ? Do life insurance companies find that those who have kept " fit " by regular exercise are better risks than those who have enjoyed a more sedentary existence Information on points such as these and many others might be considered before the medical profession is stampeded into giving its blessing to a scheme which may be desirable on political grounds and even on medical grounds, and questions like those of Sir Joseph Barcroft deserve an answer. I am, Sir, yours faithfully, CECIL FLEMMING. Upper Wimpole-street, W., Nov. 15th.
POLITICS IN THE HOSPITAL
To the Editor
of
THE LANCET
SiR,-I, too, have read with interest your leading article of Oct. 9th. It is all to the good that medical students should concern themselves with public health in the widest sense, but one may be allowed to point out that many problems which have recently been given a political flavour are essentially technical problems. Their solution has often been hindered by the introduction of party feeling into their discussion. In my view our medical students can best contribute to the well-being of the State by first learning to be good doctors. The academic atmosphere of a hospital or university is likely to produce academic politics, whereas, if those interested would reserve their considered opinions for the time when they have already held resident appointments, travelled, and read more, they would be more likely to be realistic. They would then be able to decide whether .a man works better,for a salary plus a pension than he might as a free lance. They would know whether it is agreeable to be employed by an authority controlled by politicians. They could possibly judge whether these politicians are as sensitive to the complaint of the voter-patient as they are loyal to the doctors who serve them. They might discover many doctors in public services who are sickened by the manoeuvres of those set in authority over them. It might even occur to them that the doctor’s ego is a potent healing agent and that any encroachment upon it reduces his power for good. They might decide whether a hospital authority should pay
attention to anonymous letters. They might learn Andre Siegfried rote 11 England’s Crisis." Let us suppose that one of the elect tells us " it is the policy of my party to stamp out boils." Are we then to suppose that the other side are pro-boilt This sort of thing is as dishonest by insinuation as it is surgically unsound. In fact, taking public health in the widest sense, we may suggest that many emotional and intellectual disordeisof the body politic are caused by political claptrap. An intelligent health authority would use a carbolic spray at many political meetings. I am, Sir, yours faithfully, G. C. PETHER. Buxton, Nov. 9th.
why
ASSESSMENT OF PSYCHIATRIC TREATMENT
of THE LANCET SiB,—I have read with deep interest the letter in which Dr. Mary Luff first raises the question whether there are two rival schools of thought in psychotherapeutic treatment, the one addicted to prolonged or intensive," the other pinning its faith on shorter methods. She makes the suggestion that this deplorable divergence may be dependent upon the possibility that the adherents of these rival faiths tend only to see the failures achieved by the other faction ; and invites me to join in the task of constructive To the Editor
"
"
reconciliation. It would seem equally probable, however, that fallacies might arise owing to the possibility that the rival factions-if such there be-do not tend to see each other’s successes. Taking as a theoretical illustration an institution dedicated solely to the method of prolonged treatment for any and every patient (there can be no institution of this kind, for surely we are not so ignorant and silly as all that), it would be easy to understand how workers in such an institution might tend to over-estimate the efficacy of, or necessity for, the method of prolonged treatment they employed ; for if the patients they treated were comparable to the ones I saw at St. George’s, certain of the good results that might be attributed by them to their prolonged method of treatment would have been obtained in patients who would have improved without it ; but who would also (unless we were very cynical) have improved with it. But in treating psychiatric patients, as Dr. Luff rightly points out, the issue is not that of prolonged versus shorter methods of psychotherapy. Nor do I believe should the issue be put forward as consisting solely in the correct choice between these alternative (or at least contrasted) methods. Such a view would come perilously near to the fallacious assumption that psychiatric treatment and psychotherapy are synonymous. Yet it may well be that I have derived an erroneous impression from the fact that Dr. Luff concentrates upon the above issue, and only alludes to other forms of treatment (such as "environmental" and " physical ") when discussing " psychoses." It would, I hope, be wrong to infer that Dr. Luff regards other forms of psychiatric treatment as second bests, or wishes to imply that they may not be necessary, and indeed essential, for treating " neuroses " as well. But if considered important, why were they left out The problem as I see it is not only what form of psychotherapy but also what other forms of psychiatric treatment should be employed ; and in order
.
_