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THE PROPHYLAXIS OF VENEREAL DISEASE.
471 THE PROPHYLAXIS OF VENEREAL DISEASE.
Correspondence. "
Audi alteram
partem."
HYPNOSIS IN HYSTERIA. To the Editor of THE LANCET.
Brown and Captain J. R. O’Brien in discussing the rôle of hypnosis in hysterical people, the former when he states that "only hysterical patients can be hypnotised,"and the latter when he takes exception to this on the ground that ’’80 per cent. of The essential point all mankind can be hypnotised." to be realised is, that the factor in hysteria that lends itself to hypnotism is suggestibility, and this factor is present in all mankind, though in varying degrees. Given a defective environment during upbringing-defective as far as the environment in which the child when grown up will have to live and work-then there is liable to be a lack of emotional control and an associated high degree of suggestibility which in the course of time is likely In to give rise to obtrusive hysterical symptoms. the educated adult who has been correctly orientated there is a considerable degree of emotional control, and suggestibility, though present, is of low intensity. But it is present, and in that such a man is emotional and is suggestible at all he has the factors of hysteria present. In otner words, all human beings are hysterical to a certain extent, in that they are human. But in only a few people, comparatively speaking, do the emotions through Jack of control, and suggestibility through its intensity, manifest symptoms in a manner necessitating medical treatment, and in such people no new factors are being encountered, but factors which, present in all, are intense in some only. So that it is not that only hysterical patients can be hypnotised so much as that hysterical patients are easily hypnotised ; people who have not manifested hysterical symptoms, being less suggestible, are less easily hypnotised. But, as Captain O’Brien’s statistics go to show. the great majority of men can be hypnotised in some way or another. If Major Brown had said only hysterical people can be hypnotised"" there would have been no incompatibility between his statement and Captain O’Brien’s; the majority of mankind, though having all the factors of hysteria, go through their lives without showing obtrusive symptoms, and so without their coming under medical treatment. The value of hypnotism in hysterical patients is, in my opinion, open to doubt, for in such cases there is a degree of suggestibility that has proved itself to be morbid, and in playing on this suggestibility there is a possible risk of increasing its intensity ; by so doing the patient, though relieved of his symptoms, may be left more hysterical at the end of treatment than at its inception. The rational method is surely not the empirical method of suggestion from without, which in addition to the above objection has the further drawback of the liability to relapse, but the resolution of the symptoms through the patient’s own consciousness, a very much harder method but one which is more liable to be permanent as far as those particular symptoms are concerned. In his letter in THE LANCET of Sept. 28th Major Brown admits the risk of making a hysterical patient more hysterical as a result of hypnosis, and the methods of hypnotism that he himself employs are undoubtedly directed towards a lessening of this risk. But still the essential fact is unaltered ; in any case that has been hypnotised the suggestibility previously possessed by the patient, and active in the genesis of his hysterical symptoms, has been picked out and utilised by this method, and however carefully the operator may have brought the patient out of the hypnotic state the very fact that the morbid dissociation has been resynthesised at all indicates a reactivation of this already morbid degree of suggestibility, and is therefore to be deprecated. It is noticeable that the modifications used by Major Brown in the process of hypnosis are directed to the end of an appeal to the patient’s own consciousness and a lessening of the purely hypnotic suggestion. The more successfully this is carried out the more satisfactory will be the result, until the ideal will be attained and the hypnotic element completely eliminated.-I am, Sir, yours faithfully, DONALD E. CORE, Manchester, Oct. 1st. 1918. Captain, R.A.M.C. (T.F.).
SIR,-Both Major W. raise an interesting point
To sice Editor of
THE LANCET.
SIR,-Long discussion following Sir Bryan Donkin’s letters early last year showed that there are now a number of medical men who have the courage to advocate the abandonment of the neglect of this the most potent weapon against the spread of venereal diseases ; but it is not clear that any very active steps have yet been taken by the medical profession in this direction. Unless the present golden opportunity is utilised of making these simple antiseptic methods generally known, the end of the war is certain to cause venereal diseases to be more widespread than ever, as after many previous wars. On the other hand, if all the Army could be instructed regarding the prophylaxis against venereal diseases this life- and health-saving knowledge will become widely diffused among the general population on demobilisation, and a great reduction, instead of an increase, of the scourge will be effected. Really the case for adopting these prophylactic measures may be briefly summarised in the following propositions: 1. Venereal diseases are causing a most serious loss of manpower at a crisis in our national history, as shown by the statement of the Under Secretary for War that no less than 54,884 soldiers were admitted to hospital for these diseases in 1917 alone, while many innocent women and children will certainly be infected after the war. 2. The use of Metchnikoff’s 30 per cent. calomel ointment before and after exposure to infection and of a 1 in 2000 solution of permanganate of potash for washing after exposure have been proved to greatly reduce venereal infection by the experience of the United States Navy and that recorded by Dr. G. Archdall Reid in THE LANCET of Nov. 3rd, 1917. The recent figures of Rigg relating to several thousand exposures showed that only 0-08 per cent. of infections occurred after disinfection within one hour, 0-65 per cent. after from two to four hours, but 7 80 per cent. after over ten hours, or a reduction of nearly 99 per cent. by very early disinfection. 3. The question is essentially a medical one, and the fact that a single innocent child can be saved from suffering from the most serious and deadly of these diseases to my mind far outweighs any moral arguments against placing prophylaxis against these affections on the same footing as those against all other infectious diseases, while the following plain statement regarding syphilis of Professor Sir William Osler,Get people to realise that it is a great communicable disease, two-thirds of the victims of which are innocent, and much will be done to break down the present barrier of ignorance and false sentiment, "is, I think, unanswerable. I therefore strongly urge that the greatest national service the medical profession can render at the present time is to form an active society (unless such already exists) to adopt the plan of the committee of medical men in Victoriawhen the Victorian Government hesitated in the matter-namely, to publish and distribute widely a pamphlet, in which it is first clearly set forth that sexual incontinence is totally unnecessary and best avoided altogether; but that in the case of everyone who fails to be continent it is their duty to the nation, to themselves, and to possible future innocent victims of their errors immediately to use the simple means of disinfection set forth in the pamphlet to diminish the chances of their becoming infected, although they must remember that it is not an absolute preventive and will not make them completely safe against the penalties of their offences against morality. If every soldier returning to Great Britain, either on leave or eventually on demobilisation, is given such a pamphlet an immense amount of disease, and subsequent infection of innocent women and children, will be avoided, and the reproach recently levelled by certain colonial troops against London as the plague spot of the worldmay be partially removed. As action rather than discussion is now urgently needed, and the writer is not in a position to take an active part in such a crusade, I shall be glad to contribute through you, Sir, to any society or body of medical men who will undertake early action, beginning in London, on some such lines as the above, the sum of .S100 towards the expenses of the propaganda. To show that I have some qualifications for expressing an opinion on the matter, I subscribe myself M.D., F.R.C.P., F.R S. Sept. 28th, 1918. 1
See THE LANCET, March 17th. 1917, p. 424.
Correspondence. "
Audi alteram
partem."
HYPNOSIS IN HYSTERIA. To the Editor of THE LANCET.
Brown and Captain J. R. O’Brien in discussing the rôle of hypnosis in hysterical people, the former when he states that "only hysterical patients can be hypnotised,"and the latter when he takes exception to this on the ground that ’’80 per cent. of The essential point all mankind can be hypnotised." to be realised is, that the factor in hysteria that lends itself to hypnotism is suggestibility, and this factor is present in all mankind, though in varying degrees. Given a defective environment during upbringing-defective as far as the environment in which the child when grown up will have to live and work-then there is liable to be a lack of emotional control and an associated high degree of suggestibility which in the course of time is likely In to give rise to obtrusive hysterical symptoms. the educated adult who has been correctly orientated there is a considerable degree of emotional control, and suggestibility, though present, is of low intensity. But it is present, and in that such a man is emotional and is suggestible at all he has the factors of hysteria present. In otner words, all human beings are hysterical to a certain extent, in that they are human. But in only a few people, comparatively speaking, do the emotions through Jack of control, and suggestibility through its intensity, manifest symptoms in a manner necessitating medical treatment, and in such people no new factors are being encountered, but factors which, present in all, are intense in some only. So that it is not that only hysterical patients can be hypnotised so much as that hysterical patients are easily hypnotised ; people who have not manifested hysterical symptoms, being less suggestible, are less easily hypnotised. But, as Captain O’Brien’s statistics go to show. the great majority of men can be hypnotised in some way or another. If Major Brown had said only hysterical people can be hypnotised"" there would have been no incompatibility between his statement and Captain O’Brien’s; the majority of mankind, though having all the factors of hysteria, go through their lives without showing obtrusive symptoms, and so without their coming under medical treatment. The value of hypnotism in hysterical patients is, in my opinion, open to doubt, for in such cases there is a degree of suggestibility that has proved itself to be morbid, and in playing on this suggestibility there is a possible risk of increasing its intensity ; by so doing the patient, though relieved of his symptoms, may be left more hysterical at the end of treatment than at its inception. The rational method is surely not the empirical method of suggestion from without, which in addition to the above objection has the further drawback of the liability to relapse, but the resolution of the symptoms through the patient’s own consciousness, a very much harder method but one which is more liable to be permanent as far as those particular symptoms are concerned. In his letter in THE LANCET of Sept. 28th Major Brown admits the risk of making a hysterical patient more hysterical as a result of hypnosis, and the methods of hypnotism that he himself employs are undoubtedly directed towards a lessening of this risk. But still the essential fact is unaltered ; in any case that has been hypnotised the suggestibility previously possessed by the patient, and active in the genesis of his hysterical symptoms, has been picked out and utilised by this method, and however carefully the operator may have brought the patient out of the hypnotic state the very fact that the morbid dissociation has been resynthesised at all indicates a reactivation of this already morbid degree of suggestibility, and is therefore to be deprecated. It is noticeable that the modifications used by Major Brown in the process of hypnosis are directed to the end of an appeal to the patient’s own consciousness and a lessening of the purely hypnotic suggestion. The more successfully this is carried out the more satisfactory will be the result, until the ideal will be attained and the hypnotic element completely eliminated.-I am, Sir, yours faithfully, DONALD E. CORE, Manchester, Oct. 1st. 1918. Captain, R.A.M.C. (T.F.).
SIR,-Both Major W. raise an interesting point
To sice Editor of
THE LANCET.
SIR,-Long discussion following Sir Bryan Donkin’s letters early last year showed that there are now a number of medical men who have the courage to advocate the abandonment of the neglect of this the most potent weapon against the spread of venereal diseases ; but it is not clear that any very active steps have yet been taken by the medical profession in this direction. Unless the present golden opportunity is utilised of making these simple antiseptic methods generally known, the end of the war is certain to cause venereal diseases to be more widespread than ever, as after many previous wars. On the other hand, if all the Army could be instructed regarding the prophylaxis against venereal diseases this life- and health-saving knowledge will become widely diffused among the general population on demobilisation, and a great reduction, instead of an increase, of the scourge will be effected. Really the case for adopting these prophylactic measures may be briefly summarised in the following propositions: 1. Venereal diseases are causing a most serious loss of manpower at a crisis in our national history, as shown by the statement of the Under Secretary for War that no less than 54,884 soldiers were admitted to hospital for these diseases in 1917 alone, while many innocent women and children will certainly be infected after the war. 2. The use of Metchnikoff’s 30 per cent. calomel ointment before and after exposure to infection and of a 1 in 2000 solution of permanganate of potash for washing after exposure have been proved to greatly reduce venereal infection by the experience of the United States Navy and that recorded by Dr. G. Archdall Reid in THE LANCET of Nov. 3rd, 1917. The recent figures of Rigg relating to several thousand exposures showed that only 0-08 per cent. of infections occurred after disinfection within one hour, 0-65 per cent. after from two to four hours, but 7 80 per cent. after over ten hours, or a reduction of nearly 99 per cent. by very early disinfection. 3. The question is essentially a medical one, and the fact that a single innocent child can be saved from suffering from the most serious and deadly of these diseases to my mind far outweighs any moral arguments against placing prophylaxis against these affections on the same footing as those against all other infectious diseases, while the following plain statement regarding syphilis of Professor Sir William Osler,Get people to realise that it is a great communicable disease, two-thirds of the victims of which are innocent, and much will be done to break down the present barrier of ignorance and false sentiment, "is, I think, unanswerable. I therefore strongly urge that the greatest national service the medical profession can render at the present time is to form an active society (unless such already exists) to adopt the plan of the committee of medical men in Victoriawhen the Victorian Government hesitated in the matter-namely, to publish and distribute widely a pamphlet, in which it is first clearly set forth that sexual incontinence is totally unnecessary and best avoided altogether; but that in the case of everyone who fails to be continent it is their duty to the nation, to themselves, and to possible future innocent victims of their errors immediately to use the simple means of disinfection set forth in the pamphlet to diminish the chances of their becoming infected, although they must remember that it is not an absolute preventive and will not make them completely safe against the penalties of their offences against morality. If every soldier returning to Great Britain, either on leave or eventually on demobilisation, is given such a pamphlet an immense amount of disease, and subsequent infection of innocent women and children, will be avoided, and the reproach recently levelled by certain colonial troops against London as the plague spot of the worldmay be partially removed. As action rather than discussion is now urgently needed, and the writer is not in a position to take an active part in such a crusade, I shall be glad to contribute through you, Sir, to any society or body of medical men who will undertake early action, beginning in London, on some such lines as the above, the sum of .S100 towards the expenses of the propaganda. To show that I have some qualifications for expressing an opinion on the matter, I subscribe myself M.D., F.R.C.P., F.R S. Sept. 28th, 1918. 1
See THE LANCET, March 17th. 1917, p. 424.