714 WHAT CONSTITUTES A CURE IN PSYCHOTHERAPY?

by toxin-antitoxin should be discontinued. Prof.Pirquet’s proposal was adopted by the AustrianMinistry of Health, and the performance of activeimmunisation is now forbidden in Austria. Unfor-tunately we are still in the dark as to origin of theVienna tragedy, which has had no parallel in othercountries where the use of toxin-antitoxin mixtureas a prophylactic is on the increase. We hope thatthe Austrian authorities will insist on tracing theaccident to its source with a view to its avoidance infuture rather than simply prohibit one of the mostpromising avenues of preventive medicine.

WHAT CONSTITUTES A CURE IN PSYCHO-

THERAPY?

THERE is an urgent need for some definite standardof " cure " in psychotherapy, if this form of treatmentis to take its place with the established therapeuticprocedures. Psychotherapists are divided into severalschools and the symptoms grouped under the vagueterm " neurosis " are very elusive, so that thecriterion of cure is much more difficult to determinethan in organic disease. Dr. Otto Veraguth hascollected 1 definitions of cure from a number ofleading psychotherapists. Freud says briefly, " acure is the restoration of productive ability and thecapacity for enjoyment." Stekel defines it as, " theconquest by the neurotic of his tendency to isolation,a regained capacity for work and sexual activity,and abandonment of phantasy in favour of reality."Jung claims that his method produces " a maturityof character, due to conscious understanding andassimilation of the undeveloped parts of the personalityenabling the patient to adapt himself to the claims oflife which he had hitherto-wittingly or unwittingly-failed to face." Frank distinguishes between a" scientific " cure and a " practical and social "cure. In practice, a cure is claimed when pathologicalsymptoms are no longer seen, although this may beonly the result of improved environmental conditions.Bezzola regards a cure as the removal of the badsuggestions induced by education, environment, andpsychic trauma, so that the individual is free toeducate himself. Maeder distinguishes between thestrictly medical and the pedagogic attitude towardsthe patient. The latter includes, as well as removalof symptoms and restoration of ability, the synthesisof the personality and the integration of the individualas a member of the cosmos. Dr. Veraguth pointsout that the drive of life may be divided into fourmain branches from a common stem : The preserva-tion and development, respectively, of the individualand of the species. The drive towards individualevolution, towards differentiation and progress, hasreceived inadequate recognition, but its existence isself-evident. When its activity is limited to somaticprocesses the individual is an uneducable idiot, butits presence in normal men is reflected in the peculiarplasticity of the human brain; such characters as

Faust or the hermit show instances of men whoseflow of life energy is disproportionately strong alongthis channel. The drive towards development ofthe species expresses itself psychically in the higherforms of affectivity ; the man in whom it is excessively ienergised is the prophet. In the healthy man thefour principles should be evenly balanced within thelimits of individual and age variation ; in the neuroticthere is, or has been in the past, a lack of this balance.Dr. Veraguth’s definition of psychotherapeutic cureis the restoration of the balance, and he goes on todiscuss how it is manifested. The objective signs arethe permanence of the result achieved and the freeingof the patient from dependence on his doctor. Hequotes a number of cases to show the caution thatmust be exercised in estimating these signs. " Per-manence

" must take into consideration the cyclicalfluctuation of manic-depressive types ; the passagefrom one psychic phase to another may easily give

1 Schweizerische Medizinische Wcchenschrift, August 27th.

a false impression of cure. Renewed ability to workmust only be taken as a criterion of cure when judgedboth qualitatively and quantitatively. Renewedcapacity for enjoyment must include all aspects oflife ; the preponderance of sexual difficulties amongpsychotherapeutic patients has misled some practi-tioners into regarding restored enjoyment of thisfunction as a sign of cure. Freedom from the doctor’sinfluence must not be confused with a negativetransference which is a sign that cure has not beeneffected. More important, however, than these,in Dr. Veraguth’s opinion, is the subjective convictionof the erstwhile patient that his personality hasgrown, a feeling not of ability to work, but of self-application to work; not of capacity for enjoyment, butof determination to enjoy; not of adaptation to thedemands of life, but of a personal choice betweenadaptation and resistance. A further and peculiarsign of cure is the sense of gratitude for his formersymptoms. The patient finds that he has been curedof so much more than he originally complained ofthat he can rejoice in his former tribulations, sincethey led him to the treatment that opened up to himnew fields of life. Dr. Veraguth ends with a plea,which we cordially endorse, for the publication byexperienced psychotherapists of quantitative statistics.

FOULING OF FOOTWAYS BY DOGS.

IN the Royal Borough of Kensington there are

many flats and maisonettes to which no gardens areattached, with the result that dogs are exercised onthe footways. Owing to the fouling of the footwaysas a result of this practice, the borough council in1921 obtained the sanction of the Home Secretary tothe following by-law:-"No person being in charge of a dog in any street or

public place and having the dog on a lead shall allow orpermit the dog to deposit its excrement upon the publicfootway.

’ " Any person offending against this by-law shall be liableto a penalty not exceeding 40s."The by-law was made in pursuance of Section 23

of the Municipal Corporations Act, 1882, Section 16of the Local Government Act, 1888, and Section 5of the Local Government Act, 1899, for the good ruleand government of the Royal borough. Two officersof the public health department report breaches ofthe by-law detected by them to the Health Com-mittee. These officers are engaged on other outdoorduties and make their observations whilst passingfrom place to place in the borough. A leaflet callingattention to the requirements of the by-law has beendelivered to a large number of dog owners, a posterin similar terms has been exhibited in the borough,and a printed slip has been attached to the ratedemand notices. During 1922 two offences were

reported to the Public Health Committee and a warn-ing was issued in each case. In 1923 two warningswere issued and in the case of a third offence a summonswas taken out, the defendant being fined 5s. In 1924a conviction was obtained in each of the foursummonses issued ; in one case the fine was 5s. and ineach of the other three 10s. Dr. James Fenton,borough medical officer of health, tells us that thecondition of the footways in the borough has improvedvery considerably since the by-law came into opera-tion, and that several other boroughs have adopteda similar measure. As Dr. Andrew Balfour haspointed out,! the traffic in London streets is now suchthat the dog can no longer use the roadway for hiscalls of nature and is obliged for purposes of safetyand comfort to resort to the sidewalk. Mr. T. W. M.Cameron, M.R.C.V.S., of Edinburgh, has discussed 2 thedog as a carrier of disease to man, mentioning severalroundworms and cestodes which might come intoquestion apart from the dangerous hydatid. TheWellcome Bureau of Scientific Research examinednumerous samples of excreta, presumed to be thoseof the dog, on London pavements in the neighbourhood

1 THE LANCET, 1922, ii., 1165.2 THE LANCET, 1922, i., 564.

715THE MOTOR EXHIBITION, 1925.

of Gordon-square. Eggs of helminths were found ina small proportion of cases, the type being that ofascaris in 3 per cent., of Tcenia serrata in 2, and ofankylostoma in 1. In nearly 5 per cent. cysts ofgiardia were found and a new coccidium of the dogwas discovered. The inquiry revealed no evidence ofhydatid disease, and Dr. Balfour then expressed theopinion that the presence of dog excrement, howeveroffensive on aesthetic grounds, was not to be regardedas disquieting from the point of view of public health.He admitted, however, that apart from the work ofthe Wellcome Bureau little, if anything, seemed tobe known as to the dangers which might lurk in thefaeces of dogs. ____

A CHANCE FOR THE AMATEUR

PHILOSOPHER.

IT is supposed that philosophers can retire at willto some higher world where the air is so rarefied thatthey are undisturbed by the presence of the populaceand where everything is so vague that it cannot beoffensive. There are none who would find the giftof voluntary translation more useful or more enjoyablethan members of the medical profession ; but withoutlong practice it is impossible to live in the atmosphericconditions of the abstract world. The novice onlytoo frequently can be heard puffing and blowing inthe air just above our heads, and though he may seemore than the rest he appears uncomfortable andinadequately balanced. There is, however, a certainnumber of professionals (so to speak) who are willingto descend from their pinnacles and prescribe suitableexercises which are helpful without being ridiculous.Though nobody imbued with the scientific spiritwillingly believes authorities, they can at least showthe way by which they got to where they are ; andno man can do more. The British Institute of Philo-sophical Studies is willing to arrange such assistance,and it suggests that certain courses of lectures wouldbe particularly helpful to the medical man whocomes back perforce to his material patients fromtime to time. During the next sessions there will belectures by Prof. T. H. Pear on Psychology, by Prof.James Johnstone on Life and Mind, and by Prof.Leonard Russell on the Conception of Matter, andeach of these is calculated to be of great interest todoctors. The Institute, which is under the presidencyof Lord Balfour, will provide courses of lectures onthe more important subjects coming within the

scope of philosophy ; will arrange classes undertutorial guidance ; will give assistance to individuals

I

in their reading and encourage research in philosophy,and will form a library. The temporary office is at88, Kingsway, London, W.C., and it is to be hoped -that members of the profession will avail themselves ifreely of the admirable facilities provided by theInstitute. Details of the times and places of the r

lectures will be found on reference to our advertisementcolumns.

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THE MOTOR EXHIBITION, 1925.

’THE annual motor exhibition at Olympia, organisedby the Society of Motor Manufacturers and Traders,Ltd., in connexion with the Royal Automobile Club,will be held from Oct. 9th to 17th. This great exhibi-tion, which has always been international in character,promises this year to be one of the largest assembliesof everything pertaining to motor-cars that has everbeen gathered under one roof, and additional impor-tance attaches to the show as the Paris motor exhibitionwill not be held this autumn. Whatever gloomyviews may be taken of certain British trades andindustries, one can hardly feel despondent about themanufacture of motor-cars and their accessories, andin the last four years the number of motor vehiclesregistered in this country has increased by over

100,OOO.annually. On the one hand, the market forcars has greatly widened its boundaries, the difficultiesattending mass production methods have been largelyeliminated, and improved plant has increased output;on the other hand, labour is more costly, taxation

heavier, and expenses higher, but nevertheless thebalance is on the right side and car value to-day hasnever been approached at any period of the industry.The car that appeals to the average medical man maybe said to be that of the E300 to E400 class, and it isin this class that the keenest competition on the partof the manufacturers has resulted in the maximumadvantage to the purchaser. Although no revolutionin price, design, or construction is foreshadowed, theprocess of evolution will be in evidence, not the leastin these apparently minor details the perfection ofwhich makes for the difference between owning a carand being owned by it. The exhibition will remain opendaily from 10 A.M. to 10 P.M.

SuMMEB-TiMB in Great Britain ends at 3 A.M. onSunday, Oct. 4th, when the clock will be put back to2 A.M. In France the return to normal time takes placeon Oct. 4th at midnight (zero hour), the changetherefore being practically simultaneous on the twosides of the Channel. Belgium follows the Frenchpractice.

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SOME idea of the admirable work done in Iraqduring the past two years may be gained from theabstract of the report of the Director-General ofHealth Services, which appears on p. 733. Reversionto the " simplified " hygiene of purely Easterngovernment would be especially disastrous sincerailways and motors have opened up the country tothe ravages of epidemics. It would be most regret-table if the British officers in the service should haveto cease work before they can build up a local organisa-tion whose members are ready and willing to do thepersonal work amongst the tribes which is so urgentlyneeded in this disease-ridden country.

THE first social evening of the new session of theRoyal Society of Medicine will be held on Tuesday,Oct. 27th, at 8.30 P.M., when Fellows and their guestswill be received by the President, Sir StClair Thomson,who, at 9.30 P.M. will give a short address on " Shake-speare as a Guide in the Art and Practice of Medicine. "The library will be open, and there will be an exhibitionf the drugs which are mentioned in Shakespeare’splays ; the display will be lent by the WellcomeElistorical Medical Museum and arranged by Mr.J. S. Thompson, the curator.

SOCIETY OF SUPERINTENDENTS OF TUBERCULOSISINSTITUTIONS.-It has been impossible to arrange to holdthe proposed Provincial Meeting of this Society at Leeds.The ordinary meeting will be held in London in October.The exact.date will be announced later.

FELLOWSHIP OF MEDICINE AND POST-GRADUATEMEDICAL ASSOCIATION.-A series of lectures on Tuberculosiswill be held in the Lecture-room of the Medical Society,11, Chandos-street, during October, November, andDecember. The first lecture will be given on Oct. 12th at5.30 P.M. by Dr. L. S. Burrell, on Tuberculosis from thePhysician’s Viewpoint. There is no fee for attendanceat this series, and all members of the medical profession willbe welcomed. On Monday, Oct. 5th, the Central LondonThroat, Nose and Ear Hospital will begin a three weeks’course in Laryngology, Rhinology, and Otology. The clinicalcourse will be from about 9 A.M. to 5 P.M. daily, and anoperative surgery class will also be held. The operative

surgery and the clinical classes may be taken together orsingly. The London School of Hygiene and TropicalMedicine have the first two of their series of eight clinicaldemonstrations on Tuesday, Oct. 6th, and Thursday,Oct. 8th, at 2 P.M. Dr. G. C. Low and Dr. P. Manson-Bahrwill consider the more important diseases of tropical countries.Other courses in October will commence as follows :Oct. 12th, a combined course in Children’s Diseases at thePaddington Green Hospital, Victoria Hospital for Children,and Children’s Clinic ; Oct. 19th, a course in Urology atSt. Peter’s Hospital ; Oct. 26th, a course in Dermatologyat St. John’s Hospital. Copies of any syllabus, togetherwith the Fellowship programme, may be obtained from theSecretary, 1, Wimpole-street, London, W. 1.