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shapes and sizes firmly rooted in the soil of pathology, but the Institute more closely resembles the tropical house at Kew where luxuriant growth may be seen at unexpected places and where the brightest flowers spring from stock which has no apparent roots. Few psychologists are pathoTHE LANCET logically minded, whether by temperament or education, and whatever development may take place there will never be lacking that need for LONDON:SATURDAY, MAY 9, 1936 experience in interpretation of pathological findings which is a conspicuous gift of the hospital clinicians of our own time. One of the greatest EXPANDING PSYCHOTHERAPY gains from the new spaciousness should be to give of THE Institute Medical Psychology, which opportunity for work done on pathological lines, moved only five years ago from its dignified house as much for the education of the psychologist as in Tavistock-square into more commodious premises for the investigation of the patient. Indeed the in Malet-place, is now developing a large extension development of the educational side is the most scheme. A site of 31,400 square feet has been hopeful feature of the programme. It is hardly acquired facing Store-street, within a stone’s more than a year since the Institute achieved throw of the London School of Hygiene and academic status in its recognition by London Tropical Medicine, and on this site it is hoped to University for clinical work in the D.P.M. syllabus. build at once a new hostel of 21 beds to take the The training course for doctors proposing to take place of the small in-patients’ hostel in Endsleigh- up psychotherapy has now been extended from street, the lease of which falls in next year. If one to two years. And finally the research side all goes well, this will be the first instalment of of the work has been recognised by the Halley Stewart Trust and the Rockefeller Foundation, a scheme for a large educational centre of psychoboth of which have established fellowships at the to the shadow of within medicine, logical grow up the new central buildings of London University. Institute. In one other respect the fabric of the Institute The extension scheme, which has the blessing of differs Edward’s Fund and the interest fundamentally from that of most other King Hospital of the Rockefeller Fo.undation, will provide equip- medical bodies in this country. During the period ment for laboratory investigation and research, of development the Institute was largely under the adequate lecture-rooms, facilities and space for direction and guidance of an individual mind, and occupational treatment, and the greatly increased to that fact is due a degree of conscious planning number of consulting-rooms in which out-patient which has delivered the goods although quite and psychotherapist may be brought together alien to any therapeutic system hitherto known. without the delay of a long waiting-list. Over In Dr. REES the founder of the clinic has had a hours treatment Whether centrifugal direction of were last 25,000 year ; worthy successor. given there are nearly 500 patients, adults and children, can safely be maintained is a question which will have to be carefully weighed. The growth of a now under treatment, and the Institute is open from 9 A.M. until 10.30 P.M. And yet it was only medical advisory board may indicate that it is possible to open the waiting-list for six weeks in likely to give place more and more to the collective 1935, and the evening waiting-list which had been responsibility in medical matters which is prevalent closed for two years was opened only for three elsewhere. But the pioneer work already done by weeks. Both are now closed indefinitely. This the Institute in its education of social workers, is a plain statement of the facts behind a state of qualified nurses, general practitioners, and wouldaffairs which is tragic. be psychologists is beyond all praise, and the The development of medical psychology in our extension of its usefulness in this direction can time has been meteoric and, to paraphrase have no limit. SCHOPENHAUER’S words, if there were no Tavistock Clinic it would be necessary to invent one. Over 80 medical men and women are working at the Institute and a study of the list of names on pages 2 to 5 of the report suggests that it has included most of the well-known names of those who have devoted their lives to this aspect of medicine. There were not many trained psychologists in London when Dr. CRICHTON-MILLER’S brave scheme first began to take shape, and they were of all grades-Freudian, Jungian, Adlerian, and what not. It was hardly to be expected, or indeed to be desired, that the organisation of the new faculty should follow closely that of the more corporeal form of medical practice. The hospital clinical system can be fairly compared to a herbaceous border, with all the plants of various

THE LAW OF ABORTION PROFESSIONAL, even apart from public, interests the clarification of the law concerning abortion. On this subject the recently issued report1 of the special committee appointed by the council of the British Medical Association deserves attention. Laws ought to be clear ; the law about abortion is obscure. It is not enough to say that in practice the registered medical practitioner is not exposed to prosecution for bona-fide treatment of his patients. Surgeon and physician do not know where they stand. Our judges, who could have given public and authoritative guidance, have added to the confusion. Many distinguished

require

1 Brit. Med. Jour., April 25th, Suppl.,

p. 230.

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members of the bench have maintained the traditional legal position that illicit abortion is a grave offence against society as well as, in view of the furtive, unskilled, and insanitary methods of the usual criminal abortionist, a terrible menace to the life and health of the women concerned. Yet

much-respected judge, the late Sir Henry McCardie, seemed often ready to treat an indictment for unlawful abortion as a venial matter hardly distinguishable from birth control and to apply all his judicial authority to hamper the success of a prosecution. Along with this apparent licence to criminal abortionists, there has been an uncomfortable apprehension on the part of the registered practitioner because the law gives him one

definite security in the termination of a pregnancy for sound and genuine therapeutic reasons. The profession is aware that bona-fide decisions in the general conduct of medical and surgical practice can lead to exaggerated claims for damages and that, in respect of abortion, If criminal prosecution is at any rate a risk. death follows an operation for the termination of pregnancy, a charge of murder is possible and an inquest may be the opportunity for unwelcome questions and suggestions. Such proceedings may be disastrous to a professional career even if the victim, as the phrase goes, leaves the court without a stain upon his character. The topic of abortion has important religious, economic, and eugenic implications. To the profession it is of immediate no

personal concern. The law is to be found in Sections 58 and 59 of the Offences against the Person Act, 1861. There is no need now to go back into the ancient history of ecclesiastical offences. In 1828 Parliament imposed the death penalty for unlawfully and maliciously administering poison or any other noxious thing, or using an instrument or any other means, with intent to procure the miscarriage of a woman quick with child. If the woman was not with the child, quick punishment could be 14 years’ a public whipping. In the and transportation law in these of the criminal 1861 revision general unlawful administerwere the provisions replaced ; ing of poison or other noxious things, and the unlawful use of instruments or other means, with intent to procure abortion, is now punishable with three years’ penal servitude. Commenting on this enactment some years ago,2we suggested that, if the statute were nowadays re-enacted, one might expect that an express proviso would be inserted to exempt from criminal liability the fully qualified practitioner who terminated a pregnancy for the bona-fide purpose of preserving the mother from special danger to life or health. The suggestion was justified soon afterwards when the Infant Life (Preservation) Act of 1929, while punishing the wilful destruction of a child capable of being born alive, added a proviso to exempt acts " done in good faith for the purpose only of preserving the life of the mother." It is arguable that this exemption would give like protection against the penalties of the Act of 2 THE LANCET, 1927, i., 237.

The professional man is entitled to some definition of what is " unlawful " in that If his honest efforts to save the life or health mother are (as they surely must be) lawful, those who frame and administer our laws should make the position plain. Of the moral and religious aspects of the matter there is here no need to speak. Exact statistics of the prevalence and danger of illicit interference with pregnancy may be lacking, but clinical experience in hospitals has its own knowledge of sepsis as a contributory cause of mortality. Public views may vary between that of Tsarist Russia where abortion was punished by solitary confinement and of the Soviet’s modern legislation which makes abortion free and permissible in public hospitals while forbidding it to unqualified practitioners. If there is to be any revolutionary change in the law of our own country, feminine opinion, never so well organised or so articulate as to-day, will no doubt be heard. The problem to which we draw attention is a limited one-how is the doctor to be given confidence that the termination of pregnancy on solid bona-fide grounds of therapeutic urgency shall not expose him to the risk 1861. closer Act. of the

of prosecution ? Compulsory notification, though it might go far to abolish the grave public dangers of unskilled secret abortion, may be ruled out as impracticable. The confirmation of professional decisions by a second opinion is worth consideration. The recent report of the special committee suggests that a doctor contemplating therapeutic abortion might be obliged to obtain the sanction of a professional colleague of recognised status, " on the analogy of approved " practitioners under the Mental Treatment Act. This specific safeguard should, we think, be thoroughly examined. It would at least enable the doctor to concentrate upon his proper duty to his patient without distracting visions of judges and juries reviewing his decision at the assizes.

HUMAN ENDURANCE a rule human beings employ only a small of the resources-physical certainly, less part obviously mental-which they in fact possess and which can be mobilised for emergency. We live in a state of inhibition or control, a state which is usually identified by the evidence of its removal in so-called superhuman efforts, though exemplified in its extreme or pathological form by the hysteric or the victim of neurosis afflicted with abulia or a sense of chronic fatigue. In certain circumstances the limits of human endurance appear to be amenable to exact measurement or estimation. Thus, no athlete has as yet succeeded with certainty in running twelve miles within the hour, although a bare half-dozen figure in the records with performances a couple of hundred yards or so short of this distance. In a " go as you please " contest over six days, 624 miles have been covered. Unsuited as he is for an amphibian existence, man has swum for over 27 hours in a successful crossing of the Channel. Two teams once contested a tug-of-war pull for

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