THE INFLUENCE OF MIND AS A THERAPEUTIC AGENT

1775

healthy women to wear corsets habitually for the pur- i’eport of the College at page 9. Your report states that the driving stagnant blood from the abdominal viscera lPresident replied that "the body corporate"consisted of As I seems to me to be an advantage entirely outweighed by the t- he past, present, and future Fellows and Members. disadvantages of impeded respiration and restricted move-‘was present I can vouch that what the President actually ment ; and I cannot but think that the support of naturalssaid was the body corporate consists of the past, present, muscles, aided, if necessary, by suitable exercises, attainsand tuture Members of the College." This is the reply also in this end quite sufficiently. That a corset, however well- at areported in your medical and lay contemporaries. There is fitting, does impede breathing can be easily tested. Let any vital difference between your report of what the President woman attempt to fasten her corset in its usual dimensionssaid and his real reply.-I am, Sir, yours faithfully, while holding her chedt in a position of deep or even SIDNEY C. LAWRENCE, M.B., D.P.H., M.R.C.S., moderate inspiration and she will usually fail to do so. If Honorary Secretary, Society of Members of the Royal College of Surgeons of England. England. she can do so, which is unlikely, the corset is useless for the Lower Edmonton, N., Dec. 7th, 1909. abdominal of increasing pressure. purpose In conclusion, I would ask at what age Mr. Bigg considers it advisable to begin wearing a corset. If the erect posture THE HARD CASE OF THE LONDON demands it, then we should be wise to put our babies into STUDENT. stays as soon as they begin to toddle. God forbid t To the the Editor Edit or of THE THE LANCET. LANCET . To of I am, Sir, yours faithfully, CECIL E. FISH, SIR,--After reading your excellent articles on medical FisH, M.B. Cantab., For

pose of

one feels that, indeed, the medical world is "out of joint." Main issues are so often missed, and as regards the question of "degrees for London students"the main SACCULI NOT DIVERTICULA. issue is usually passed over. To the Editorr of THE LANCET. The M.D. degree of most universities involves only a SIR,-It was my good fortune to be present at a demon- medical training. The degree is considered academic because stration by Dr. W. H. Maxwell Telling on the disease of the it is conferred by a university. The arts and science training colon with which you have associated his name in are practically the same as for a licence. No degree required THE LANCET of Nov. 27th. After his demonstration I in arts is taken in most instances, and excepting for preexplained my views of the condition, and I believe that they liminary work the whole training is technically medical. met with his acceptance. They were expressed in the "There’s the rub." With similar conditions of curriculum " Medical Annual " (Wright), 1909, p. 210, as follows:and examination there is a difference in title and in name Diverticula" of the colon, especially of the sigmoid, have been long which leads to jealousy and confusion. I place our great known to pathologists. Only recently has their surgical importance London medical schools on an equality with the medical been recognised, and chiefly as a cause of left-sided intra-abdominal suppuration or as tumours of the sigmoid which have been mistaken departments of most universities, and I hold that those of for cancer. More obscurity than probably belongs to the subject has us who took respectable positions in the class-work and arisen from the use of the term diverticulum as applied to these pro- examinations of those schools, and also took our licences to trusions from the bowel, and small consideration shows that between them and the recognised diverticula there are many points of difference. practise, are in no sense the inferiors, either in training or posiIt seems probable that all diverticula are of congenital origin. All coats tion, to the graduates of medical departments of universities. of the intestine enter into their composition. All have a special vascular That the examinations of some universities go beyond the supply of their own. They are seldom if ever multiple, and are found at any age. The vermiform appendix is representative of this type in ordinary grade is true, and men holding those degrees are the normal subject. Meckel’s diverticulum, due to arrested involution credited with the position their work has gained, but that of the omphalomesenteric duct, has long been recognised as of surgical invidious distinction should be made in title or otherimportance, and the existence of diverticula at different portions of any wise between the graduates and diplomates of approximately the gastro-intestinal tract associated with small pancreatic outgrowths has been recently added to our knowledge of these interesting condi- equal standing is absurd and unreasonable. The question tions. Of the traction diverticula due to the drag of a limited adhesion, stands thus. Is it just that London students who have more needs to be said than to be that they ought classed nothing passed through the training and examinations of a medical separately from any other form. The swellings observed on the colon do not answer to our description college equal in every respect to the constituent medical of a diverticulum at all ; indeed, their origin is so different that the of most universities, who have also passed examinaconfusion caused by calling them diverticula should cease. They differ colleges from diverticula in that they are never of congenital origin, and have; tions for qualifying diplomas recognised by the General consequent]_V notbeen found inyouth; are multiple; thin-walled, because Medical Council as sufficient to ensure registration on equal the muscular coat of the intestine is usually absent in them ; they are terms, shall be allowed to suffer under a technical disability rounded in shape, do not attain to large size, and are practically limited There can be no to advanced life. In the urinarv bladder, other parts of the gastro- in the eye of the public ? It is not just I intestinal tract, the gall-bladder, the vermiform appendix, and Fallopian other answer. tubes, similar swellings have been described; indeed, it is safe to say The remedy is not far to seek. All that is required is the that they will be found if sought for in any of the hollow muscularwill to remove the evident injustice, and a disposition to I coated viscera. The cause in all is obscure, but in the colon as elsewhere, it is probable that chronic obstruction to the escape of thee sink small jealousies and petty self-seekings. contents (constipation) and weakening of the wall are the determining I am, Sir, yours faithfully, factors. The suggestion that they are due to traction from little J. B. PIKE. 1909. Dec. 4th, Loughborough, with for it is a curious fact that masses of fat must be received caution,

West

Vale of

Worthing.

education

Clwyd Sanatorium, N. Wales.

"

"

"

,

.

I

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many pathological conditions of the colon-even cancer and tubercleIn the are associated with localised deposits of fat in the bowel wall. urinary bladder, where they have been known longest, they have always been called sacculi, and this would appear to be the most suitable name for them elsewhere. In their pathology, however, they closely resemble the diverticula of which the vermiform appendix may be taken as a type. Like this, they may harbour faecal concretions, and inflammation in them leads to the same results. It is therefore possible to find, as a consequence of sacculitis of the sigmoid. gangrenous perforation with peritonitis, ulceration, and perforation with left iliac abscess, or inflammatory thickening and fibrosis closely resembling a malignant growth of the affected bowel.

I am,

Sir, yours faithfully,

Newcastle-on-Tyne, Nov. 29th, 1909.

RUTHERFORD MORISON.

ANNUAL MEETING AT THE ROYAL COLLEGE OF SURGEONS OF ENGLAND. 10 U fJlUJ

SIR,-In your report

UJ

of this

THE

LANCET

meetingan inaccuracy

so

serious appears that I am sure you will correct it in your next issue either by inserting a correcting paragraph or this letter, as you may think the better thing to do. I refer to the following : Dr. W. G. Dickinson asked the President who were "the body corporate" referred to in the annual

THE INFLUENCE OF MIND AS A THERAPEUTIC

AGENT

To the Editor ofTHE LANCET. SIR,-In his remarks on Dr. Morison’s views concerning the influence of mind as a therapeutic agent Mr. J. Foster Palmer would seem to condemn hypnotism entirely. The sentence,"when hypnotic suggestion takes the form of inducing the patient to believe what sound reason tells him to be impossible," might be taken as an admission that this is not always the case, but other passages, in which hypnotic suggestion is termed °induced insanity,""criminal offence," "the more execrable"because enfeebling the already feeble-minded, leave no doubt that the condemnation is intended to be absolute. I will not enter into doctrinal considerations, but it may be pointed out that hypnotism does not always mean enfeeblement of will. A patient may, with the sane part of his mind, desire a healthy ideal, but may be kept, nevertheless, in hopeless degradation by a morbid obsessive idea. In such a case-chronic alcoholism, for example-rational persuasion, as we all know, may fail utterly, whereas the intermental influence of hypnotic suggestion may strengthen the

1776 hand is only taught one process and never learns a complete trade. The fact that general education is continued in the trade schools, so many hours per week being given to it, is Here we have somewith reason."" In Dr. Morison’s excellent letter there are, an important point in their favour. it is true, as in Mr. J. Foster Palmer’s, sentences which thing to replace the interest in the general welfare of the read separately contradict one another, but taken as a whole apprentice that was manifested by the old-time masters. If the meaning of the writer is quite clear. Rational persuasion trade schools could become a complete and full organisation is to be preferred, but for those in the portico of the I grant that the system would be ideal ; but expense alone lunatic asylum " any kind of make-believe is better than makes this impossible, and some form of apprenticeship ansanity. Delusive methods are, however, seldom necessary, must go hand-in-hand with trade schools. As an alternative for an intermediate plan which is neither simple rational to the general education in trade schools we have evening persuasion nor make-believe deception is available. This is classes, but they require cooperation on the part of the elimination of error and the credencive induction by the master, and also a great deal of care is called hetero-influence of the right and the reasonable. But I for from the parents, so that overwork may be guarded cannot see what objection there can be to inhibitingagainst. Also at these schools there is always a temptation absolutely by hypnotic cambriolage the impulses of a hopeless to work at subjects connected with the apprentices’ trade inebriate, if he cannot be reseued from slavery by any other and not at general education. Mr. Cooper, speaking from I am, Sir, yours faithfully, means the labour benches in the County Council debate on the MORAL 1909. ORTHOPEDIST. ORTHOPÆDIST. Dec. subject, urged that a larger supply of skilled labour will 5th, Paris, not create the demand seems unfortunate for two reasons. First, the foreigner is often to be found in London in positions of trust as the foreman or the skilled workAPPRENTICESHIP. man performing the more highly-finished and difficult To the Editor of THE LANCET. processes in a workshop, pointing apparently to the fact that SIR,—The discussion by the County Council of the report there does not exist a sufficient supply of Englishmen to fill of its education committee on the extent to which thE such posts. I do not know how far this is general, but two scholars at London’s elementary schools drift into unskilled trades occur to me where British workmen are found in inferior positions-viz., that of the optician and the labour, coupled with the interest of Sir John Knill, the ladies’ tailor. Second, if the young skilled workman cannot new Lord Mayor of London, in the matter of apprenticeship find work at home, surely he might seek it in many colonies. points to a serious effort being made towards the organisa- The ranks of unskilled labour may there be as overfull as tion of apprenticeship under Government auspices. As you are at home, but the master of his trade should surely they have given space to the debate at the London County Council have a better chance of finding a market. It is because I think you may be willing to publish a few words from one so many of the unemployed become a medical charge on who is interested in the movement as a practical worker. the community that I address this letter to you. There is a risk lest what is being really aimed at, which, by So many of the unemployed unfortunately become a medical should be misunderstood. ’the way, has large side, sooner or later "unemployables," filling our infirmaries The Lord Mayor seems to be in favour of a revival of and hospitals and putting a heavy burden on the shoulders apprenticeship under old conditions, when apprentices ’’ lived of the skilled and thrifty among the community. The words that these not but the does in," by public appreciate those of the Poor-law and those of the charitable authorities, the modern sense of the term ’’ living in " is not implied, and hospitals alike, which deal with such organisations under which adult shop employees are housed together on feel that every year it becomes of more importance the premises of the shop or in dormitories in neighbouring problems from the public health point of view that a greater security buildings. The revival of the old apprenticeship system of return should be enjoyed by the wage-earning classes. would make a lad a member of his master’s family, The apprenticeship movement is towards a better equipment, sharing the family life and meals. Surely a revival mentally and morally, of the youth of this country, and .of this system is impossible, and it would be a pity that medical men might well give it their support and sympathy. .anyone should confuse a very modern movement towards Both properly run trade schools and properly organised technical education with impossible mediævalism. No for apprenticing children on their leaving school machinery would in be these days either consent to or apprentice are desirable from a public health point of view. allowed to sleep under the shop counter or in any odd I am, Sir, yours faithfully, corner of the premises. Decent sleeping accommodation ON THE APPRENTICESHIP AND SKILLED A WORKER would have to be provided for him, and where the master EMPLOYMENT ASSOCIATION. 1909. Dec. 1st, lived over his place of business sufficient space would as a rule be unavailable, while where the master lived in a -suburb the whole principle of such ’living in " would be NURSING ASSOCIATIONS AND MIDWIVES.-At the altered, if only because the expense to the apprentice of annual meeting in London on Dec. lst of the Sussex County travelling to and fro would not be compensated for by his Nursing Association Mr. A. G. R. Foulerton, medical officer "living in." In the olden days of apprenticeship, the lad, of health of East Sussex, stated that instead of losing 10 ’being a veritable member of his master’s family, received infants out of 100 in East Sussex last year they had lost 6 or the same moral guardianship as the members of that family, 7, and he attributed this low mortality to the good nursing ’but this would not now be possible for numerous reasons, one of the maternity nurses from the association. Further, out being that the employer of labour often delegates his ’, of 1800 women of the working classes attended in confineresponsibility towards his own children in this direction to ment only 4 died, death being absolutely unpreventable in It is probably desirable that boys and 3 cases. These figures point to the good work of the - a schoolmaster. - girls just leaving school should continue to live with their Nursing Association, and those boards of guardians who do parents; it is wrong that they should live anywhere where not, as they are legally empowered, subscribe towards the association are to be urged to make a contribution. Boards they are not under supervision. Let us, then, leave"living in"out of the question. of guardians will probably find in the near future that it .Apprenticeship in London in the future cannot as a rule be will be far more ecomomieal to support these nursing associated with any such practice, but must be a system associations than be compelled to make provision for inunder which the boy or girl beginning business is placed numerable maternity cases, for in April next, when the Midduring working hours, with some arrangement about wives Act of 1902 comes fully into operation, no untrained premium, for a definite time with an employer. It has been women will be permitted to practise. Dr. F. H. Champneys, urged by some interested in this matter that trade schools chairman of the Midwives Board, who was present, said the are a better solution of the question how to increase the great difficulty in the question of midwives was in the rural amount of skilled labour in this country than any attempt to districts, but of the 1408 successful candidates since April revive apprenticeship, and the hygienic conditions under last 33 per cent. intended practising in the rural districts. which children are taught in these schools are certainly That showed, he added, a steady influx of the women they superior to those existing in the average factory or workshop. wanted, who were prepared to practise among the poor. There The large factory run by a limited liability company, was no reason to fear a serious shortage until April next, where no interest would, or could, be taken in individual but a redistribution might be necessary and should be

mind against unhealthy impulse, and often cures such cases .definitely, twice in my experience in the course of five minutes. Such a result can scarcely be termed parting

,apprentices,

is not under

consideration ;

at such

places

the

possible.