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PSYCHOLOGICAL CLINICS FOR CHILDREN.
1046 anaesthetists in this country would probably agree problem when the anaesthetic is considered from start that the very much greater certainty of results to finish as a general whole. I a.m. Sir. vonrs fa,ithfullv. obtained either by some form of premedication, or of ether small A. H. MACKLIN. the addition of (and they quantities by are small), to the gas-oxygen greatly outweighs any minor disadvantages of doing so. DOUGLAS BELFRAGE.
DERMATITIS FROM ORANGES AND LEMONS ’I’o the Editor of TilE LANCET.
SiR,-Referring to To the Editor
of
THE LANCET.
the useful paper
by
Dr.
Sibyl
G.
Horner, it is interesting to note that her conclusions are
supported by previous experimenters. Muller, "
SIR, With regard your comments (p. 921) in 1926, noted that the " essential oil in the rind of the orange alone provoked a dermatitis. The on my paper, may I say that to a certain extent I heartily agree. I was however more concerned with subject was discussed, in 1930, in persons handling justifying the asphyxial element than with a discussion lemons, by Shapiro.2 This year Fanburg and of the practical problem of securing relaxation in Kaufmansatisfactorily show that the juice of the operations on the upper abdomen. The latter, in flesh is comparatively harmless; on the contrary the my opinion, is a problem of the highest importance essential oil of lemons readily brings out eruptions, which might form a useful subject for discussion at particularly in susceptible individuals. Dr. Horner combined meetings of surgeons and anaesthetists. has advanced our knowledge by showing the close With regard to the use of local agents, as I said in relationship between the irritants of the citrus and my paper, " the anoci-association methods have much pinus group of plants. I am. Sir. vours faithfullv. to recommend them, but certainly have not found I R. PROSSER WHITE. universal favour with surgeons in this country." I have for a long time insisted that to poison every cell of the body cannot be regarded as the ideal way PSYCHOLOGICAL CLINICS FOR CHILDREN. to secure anaesthesia of a localised area, and I should To the Editor of THE LANCET. like to see local anaesthetics much more freely used. SiR,-The annotation under the above heading in As to basal narcotics, it must be remembered that issue of Sept. 24th is an admirable and timely your are which are effective because they poisons only not merely of the interest that the medical they have a depressant action on cell activity, and example takes in the progress of medicine in this country, this action is apt to be prolonged much more than is press and ward it keeps over the developbut of the watch necessary or desirable. Certainly an anaesthetist must be able to give the surgeon sufficient relaxation ment of new trends. All too little is known by medical to enable him to perform the operation with the men and women as a whole of the work that is being not only by the Child Guidance Clinic, the greatest speed and the least amount of trauma, but done Health Organisation’s Clinic, and the National Jewish in my judgment, having regard to the patient’s of Child Psychology, but also by the InstiInstitute ultimate welfare (the only thing that matters), he must aim to do this with the least anaesthetic effect, tute of Psychological Medicine (formerly the Tavistock departments established to deal with limiting as much as possible both depth and duration. Clinic), and thechildren at Guy’s Hospital, Great I have the feeling that we all, particularly surgeons, maladjusted Ormond-street Hospital, University College Hospital, are apt to concentrate too much on how to secure the maximum relaxation at the time of operation, the Maudsley Hospital, and elsewhere, which are unenumerated in your note. Until, indeed, the and not enough on end-results. nature and the differences of this work are familiar as all in abdominal with cases, Personally, upper to medical the profession, misconceptions must other cases, I like to see the patient come out of arise. the anaesthetic as quickly as possible. I know then that inevitably Of this fact there could perhaps be no better cells and tissues are recovering their tone, and that defensive and repair processes will rapidly come into example than your appreciative and yet chastening action just when the patient, shocked and cooled, note. We kiss the rod with the better grace because most requires them to prevent respiratory complica- the genuflexion offers us the opportunity to remove tions and persisting acidosis, with those distressing more than one misconception as to the aims and objects of the National Institute of Child Psychology. symptoms, cough and vomiting. In my series of upper abdominal cases I think I (1) No proposal has ever been made by the institute could claim that the results in one-third were excellent, to establish any course of instruction for social in another third satisfactory ; but I must admit workers ; (2) the institute does not intend to issue that in the final third the relaxation secured at the certificates of proficiency either to doctors or to time of operation was by no means perfect. There social workers ; (3) no claim has ever been made were however two factors other than the inadequacy by the institute-nor will it ever be-to decide who. of the agent which entered into these results : shall and who shall not be competent to direct work first, I was buying my experience ; and, secondly, in child psychology. It is true that medicine is already I was experimenting with apparatus. With greater overburdened with degrees and diplomas. Far be it, experience, an effective apparatus that does not unduly from us to add to their number. Some recognition distract attention from the patient, and reliable gas- of satisfactory study is, however, the due of any cylinders (which the makers have not yet given us), serious student attending a 12 months’ course of I am quite sure that much more consistent results instruction ; and the certificate which the instituteat the time of operation could be secured with proposes to give is designed to afford this recognition gas-oxygen, especially if combined, as you suggest, and, at the same time, as is expressly stated in the with effective local injections. syllabus, to form an entrance qualification. 1 Finger Dermatitis from Peeling Oranges, Münch. med. Light preliminary medication is undoubtedly of Wochenschr., May 21st, 1926, p. 804. or but I do that not think value, profound prolonged 2 Vrach. Dielo, Sept. 1st, 1930, p. 1240. 3 basal narcosis forms any part of the solution of the Jour. Amer. Med. Assoc., August 8th, 1931, p. 390. to
1047 interested in your limitation of the field of psychological medicine in its relation to children to behaviour disorders and juvenile delinquency. This is in line with the. view of the Child Guidance Council as expressed in their official pamphlet but not of the institute. In the field covered by the work of the institute are included many forms of minor physical ailment, the psychoneuroses of childhood, and any form of difficulty experienced by children in their adjustment to life or to their own emotional states, for which adequate provision is not already successfully made by ordinary hospital treatment or social agencies. I am, Sir, yours faithfully, MARGARET LOWENFELD,
We
are
Hon. Medical Director, National Institute of Child Psychology.
POST-WAR NEURASTHENIA AND ABREACTION. To the Editor of THE LANCET.
SiR,-In to-day’s issue of THE LANCET I followed with interest and pleasure Dr. Eric Coplan’s description of the post-war neurasthenic and shell-shock cases he dealt with at the ex-Services Welfare Society; but I found it difficult to agree with his remarks on the treatment of these cases. I am tempted to ask if he has witnessed-as I have-the dramatic effect of a typical abreaction when such a psychopathic case relives the trauma which has caused these symptoms ; and if he has watched the after-effects of this abreaction, when the patient regains quietness and stability, and pursues his daily business to his own his employer’s satisfaction. I am, Sir, yours faithfully, M. L. DOBBIE-BATEMAN.
and
1 Child Guidance by Team Work. By William Moodie, M.D. M.R.C.P., D.P.M. The Child Guidance Council.
OBITUARY ROBERT GORDON CRAIG, M.B., Ch.M. F.R.A.C.S.
Syd.,
Dr. Gordon Craig, news of whose death has reached this country, was a noted figure in Australian surgery, which he did much to advance. Robert Gordon Craig was the eldest son of Capt. Robert Craig, and a nephew of Dr. John Macmillan Brown, Chancellor of the Senate of the University of New Zealand. Born in Ayrshire in 1870, he was taken to Australia at the age of 8 years and received his early education at Sydney Grammar School. Returning to George Watson’s College, Edinburgh, in his teens, he
matriculated in Edinburgh before entering Sydney LTni-
versity
as
a
medical1 student, where he qualified in 1894, being awarded the
University gold medal at graduation.
surgeon for that of order to take charge had created and to which he contributed in all about 20,000, together with his own fully equipped private laboratory. He also made substantial gifts for research work and for a post-graduate fellowship course in urology. Gordon Craig’s name will, however, chiefly be associated with the Royal Australasian College of Surgeons, of which he was a foundation fellow, and in the creation of which he took a very active part. In 1917 he was president of the British Medical Association in New South Wales, and in 1924 he was elected a fellow of the American College of Surgeons. A great traveller, he used to make periodic trips to England, America, and the Continent, mainly for the purpose of study whilst abroad, and to keep himself in touch with the latest developments in surgery. A versatile man, with a wide general knowledge of medicine, he had an unusual gift for friendship, while his enthusiasm for all kinds of altruistic work was infectious. Much of his leisure time he gave to golf, and for many years he was a prominent yachtsman, owning and racing successfully many different crafts as a member of the R.S.Y.S. Dr. Craig is survived by his widow, who before her marriage was Miss Connon of New Zealand, and by
quished the post of honorary honorary urological surgeon, in of the department which he
In 1901 he was elected to the two daughters. honorary staff SHOLTO DOUGLAS, M.D.Oxf., M.Sc.Birm., of the Royal PROFESSOR OF PATHOLOGY, UNIVERSITY OF SHEFFIELD. Prince Alfred THE news of the sudden death at Llandudno, in Hospital on Oct. 30th, of Prof. Sholto Douglas came as a on Sydney, which he painful shock to his colleagues in Sheffield. Although served for he had been laid up for some weeks, the latest news nearly 30 was that he was progressing favourably, and it was years. During expected that he would soon be back at work. James Sholto Cameron Douglas was born at the war he was colonel in Leicester in 1879, being elder son of Mr. Claude charge of the first Australian hospital ship Karoola, Douglas, F.R.C.S., consulting surgeon to the Leicester which was organised and fitted in England under his Infirmary, and brother of Dr. C. G. Douglas, F.R.S., supervision. He took part in the operations around Fellow and tutor in natural science at St. John’s Gallipoli, and made numerous trips between Egypt College, Oxford. Sholto went to Wyggeston’s and Australia. After the war his interest began Grammar School, and from there to Haileybury to focus specially on genito-urinary surgery, and College, from which he gained an open science exhibiit was due to his efforts that a department of uro- tion to Christ Church, Oxford. Graduating in 1902, genital surgery was established at the Prince Alfred he entered St. George’s Hospital for his clinical Hospital. In 1926, on his own suggestion, he relin- study, becoming Webb scholar in bacteriology, and
DERMATITIS FROM ORANGES AND LEMONS ’I’o the Editor of TilE LANCET.
SiR,-Referring to To the Editor
of
THE LANCET.
the useful paper
by
Dr.
Sibyl
G.
Horner, it is interesting to note that her conclusions are
supported by previous experimenters. Muller, "
SIR, With regard your comments (p. 921) in 1926, noted that the " essential oil in the rind of the orange alone provoked a dermatitis. The on my paper, may I say that to a certain extent I heartily agree. I was however more concerned with subject was discussed, in 1930, in persons handling justifying the asphyxial element than with a discussion lemons, by Shapiro.2 This year Fanburg and of the practical problem of securing relaxation in Kaufmansatisfactorily show that the juice of the operations on the upper abdomen. The latter, in flesh is comparatively harmless; on the contrary the my opinion, is a problem of the highest importance essential oil of lemons readily brings out eruptions, which might form a useful subject for discussion at particularly in susceptible individuals. Dr. Horner combined meetings of surgeons and anaesthetists. has advanced our knowledge by showing the close With regard to the use of local agents, as I said in relationship between the irritants of the citrus and my paper, " the anoci-association methods have much pinus group of plants. I am. Sir. vours faithfullv. to recommend them, but certainly have not found I R. PROSSER WHITE. universal favour with surgeons in this country." I have for a long time insisted that to poison every cell of the body cannot be regarded as the ideal way PSYCHOLOGICAL CLINICS FOR CHILDREN. to secure anaesthesia of a localised area, and I should To the Editor of THE LANCET. like to see local anaesthetics much more freely used. SiR,-The annotation under the above heading in As to basal narcotics, it must be remembered that issue of Sept. 24th is an admirable and timely your are which are effective because they poisons only not merely of the interest that the medical they have a depressant action on cell activity, and example takes in the progress of medicine in this country, this action is apt to be prolonged much more than is press and ward it keeps over the developbut of the watch necessary or desirable. Certainly an anaesthetist must be able to give the surgeon sufficient relaxation ment of new trends. All too little is known by medical to enable him to perform the operation with the men and women as a whole of the work that is being not only by the Child Guidance Clinic, the greatest speed and the least amount of trauma, but done Health Organisation’s Clinic, and the National Jewish in my judgment, having regard to the patient’s of Child Psychology, but also by the InstiInstitute ultimate welfare (the only thing that matters), he must aim to do this with the least anaesthetic effect, tute of Psychological Medicine (formerly the Tavistock departments established to deal with limiting as much as possible both depth and duration. Clinic), and thechildren at Guy’s Hospital, Great I have the feeling that we all, particularly surgeons, maladjusted Ormond-street Hospital, University College Hospital, are apt to concentrate too much on how to secure the maximum relaxation at the time of operation, the Maudsley Hospital, and elsewhere, which are unenumerated in your note. Until, indeed, the and not enough on end-results. nature and the differences of this work are familiar as all in abdominal with cases, Personally, upper to medical the profession, misconceptions must other cases, I like to see the patient come out of arise. the anaesthetic as quickly as possible. I know then that inevitably Of this fact there could perhaps be no better cells and tissues are recovering their tone, and that defensive and repair processes will rapidly come into example than your appreciative and yet chastening action just when the patient, shocked and cooled, note. We kiss the rod with the better grace because most requires them to prevent respiratory complica- the genuflexion offers us the opportunity to remove tions and persisting acidosis, with those distressing more than one misconception as to the aims and objects of the National Institute of Child Psychology. symptoms, cough and vomiting. In my series of upper abdominal cases I think I (1) No proposal has ever been made by the institute could claim that the results in one-third were excellent, to establish any course of instruction for social in another third satisfactory ; but I must admit workers ; (2) the institute does not intend to issue that in the final third the relaxation secured at the certificates of proficiency either to doctors or to time of operation was by no means perfect. There social workers ; (3) no claim has ever been made were however two factors other than the inadequacy by the institute-nor will it ever be-to decide who. of the agent which entered into these results : shall and who shall not be competent to direct work first, I was buying my experience ; and, secondly, in child psychology. It is true that medicine is already I was experimenting with apparatus. With greater overburdened with degrees and diplomas. Far be it, experience, an effective apparatus that does not unduly from us to add to their number. Some recognition distract attention from the patient, and reliable gas- of satisfactory study is, however, the due of any cylinders (which the makers have not yet given us), serious student attending a 12 months’ course of I am quite sure that much more consistent results instruction ; and the certificate which the instituteat the time of operation could be secured with proposes to give is designed to afford this recognition gas-oxygen, especially if combined, as you suggest, and, at the same time, as is expressly stated in the with effective local injections. syllabus, to form an entrance qualification. 1 Finger Dermatitis from Peeling Oranges, Münch. med. Light preliminary medication is undoubtedly of Wochenschr., May 21st, 1926, p. 804. or but I do that not think value, profound prolonged 2 Vrach. Dielo, Sept. 1st, 1930, p. 1240. 3 basal narcosis forms any part of the solution of the Jour. Amer. Med. Assoc., August 8th, 1931, p. 390. to
1047 interested in your limitation of the field of psychological medicine in its relation to children to behaviour disorders and juvenile delinquency. This is in line with the. view of the Child Guidance Council as expressed in their official pamphlet but not of the institute. In the field covered by the work of the institute are included many forms of minor physical ailment, the psychoneuroses of childhood, and any form of difficulty experienced by children in their adjustment to life or to their own emotional states, for which adequate provision is not already successfully made by ordinary hospital treatment or social agencies. I am, Sir, yours faithfully, MARGARET LOWENFELD,
We
are
Hon. Medical Director, National Institute of Child Psychology.
POST-WAR NEURASTHENIA AND ABREACTION. To the Editor of THE LANCET.
SiR,-In to-day’s issue of THE LANCET I followed with interest and pleasure Dr. Eric Coplan’s description of the post-war neurasthenic and shell-shock cases he dealt with at the ex-Services Welfare Society; but I found it difficult to agree with his remarks on the treatment of these cases. I am tempted to ask if he has witnessed-as I have-the dramatic effect of a typical abreaction when such a psychopathic case relives the trauma which has caused these symptoms ; and if he has watched the after-effects of this abreaction, when the patient regains quietness and stability, and pursues his daily business to his own his employer’s satisfaction. I am, Sir, yours faithfully, M. L. DOBBIE-BATEMAN.
and
1 Child Guidance by Team Work. By William Moodie, M.D. M.R.C.P., D.P.M. The Child Guidance Council.
OBITUARY ROBERT GORDON CRAIG, M.B., Ch.M. F.R.A.C.S.
Syd.,
Dr. Gordon Craig, news of whose death has reached this country, was a noted figure in Australian surgery, which he did much to advance. Robert Gordon Craig was the eldest son of Capt. Robert Craig, and a nephew of Dr. John Macmillan Brown, Chancellor of the Senate of the University of New Zealand. Born in Ayrshire in 1870, he was taken to Australia at the age of 8 years and received his early education at Sydney Grammar School. Returning to George Watson’s College, Edinburgh, in his teens, he
matriculated in Edinburgh before entering Sydney LTni-
versity
as
a
medical1 student, where he qualified in 1894, being awarded the
University gold medal at graduation.
surgeon for that of order to take charge had created and to which he contributed in all about 20,000, together with his own fully equipped private laboratory. He also made substantial gifts for research work and for a post-graduate fellowship course in urology. Gordon Craig’s name will, however, chiefly be associated with the Royal Australasian College of Surgeons, of which he was a foundation fellow, and in the creation of which he took a very active part. In 1917 he was president of the British Medical Association in New South Wales, and in 1924 he was elected a fellow of the American College of Surgeons. A great traveller, he used to make periodic trips to England, America, and the Continent, mainly for the purpose of study whilst abroad, and to keep himself in touch with the latest developments in surgery. A versatile man, with a wide general knowledge of medicine, he had an unusual gift for friendship, while his enthusiasm for all kinds of altruistic work was infectious. Much of his leisure time he gave to golf, and for many years he was a prominent yachtsman, owning and racing successfully many different crafts as a member of the R.S.Y.S. Dr. Craig is survived by his widow, who before her marriage was Miss Connon of New Zealand, and by
quished the post of honorary honorary urological surgeon, in of the department which he
In 1901 he was elected to the two daughters. honorary staff SHOLTO DOUGLAS, M.D.Oxf., M.Sc.Birm., of the Royal PROFESSOR OF PATHOLOGY, UNIVERSITY OF SHEFFIELD. Prince Alfred THE news of the sudden death at Llandudno, in Hospital on Oct. 30th, of Prof. Sholto Douglas came as a on Sydney, which he painful shock to his colleagues in Sheffield. Although served for he had been laid up for some weeks, the latest news nearly 30 was that he was progressing favourably, and it was years. During expected that he would soon be back at work. James Sholto Cameron Douglas was born at the war he was colonel in Leicester in 1879, being elder son of Mr. Claude charge of the first Australian hospital ship Karoola, Douglas, F.R.C.S., consulting surgeon to the Leicester which was organised and fitted in England under his Infirmary, and brother of Dr. C. G. Douglas, F.R.S., supervision. He took part in the operations around Fellow and tutor in natural science at St. John’s Gallipoli, and made numerous trips between Egypt College, Oxford. Sholto went to Wyggeston’s and Australia. After the war his interest began Grammar School, and from there to Haileybury to focus specially on genito-urinary surgery, and College, from which he gained an open science exhibiit was due to his efforts that a department of uro- tion to Christ Church, Oxford. Graduating in 1902, genital surgery was established at the Prince Alfred he entered St. George’s Hospital for his clinical Hospital. In 1926, on his own suggestion, he relin- study, becoming Webb scholar in bacteriology, and