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32 to psycho-analysis (in the strict sense) a weight to which no other system of mental analysis is prima facie entitled. Psycho-analysis, both as a theory of psychology and as a therapeutic technique (the word covers both senses), deserves to be treated with the greatest respect. And though the Committee are non-committal about the most important issues, they pronounce quite definitely on some of the criticisms to which psycho-analysis has been subjected. They reply to the suggestion that " psycho-analysis applied as medical treatment may cause insanity in the patient" with the categorical " No proof of this charge has been discoverad by the Committee." They refute the suggestions that psycho-analysis ignores the relation of the body to the mind, that it is materialistic and that it is inordinately expensive. They are satisfied that it is impossible to make a verbal record of an actual psycho-analysis in order to present it to a sceptical public. On all these points the contentions of the psycho-analysts are upheld. The summary of " modern psycho-analytical methods and teaching," which the Committee " has reason to believe " to be " correct as far as it goes," lays great stress on the resistances which prevent the emergence into consciousness of parts of the unconscious mind, and describes the aim of a psycho-analysis as the overcoming of these resistances. In the replies to criticisms of psycho- analysis, which replies (provided by the President of the British Psycho-Analytical Society) and criticisms the Committee " leaves to the judgment of the reader," the element of resistance in the attacks of critics is emphasised. Thus the Committee, while declining to commit itself upon the truth or value of Freudian psycho-analysis, may fairly be said both to treat it with respect and to recognise that the charge of emotional prejudice which psycho- analysts make against their critics may have some I foundation. NEOSALVARSAN AS A PULMONARY ANTISEPTIC. INTEREST in chronic lung diseases and the applications of surgery to their treatment has been greatly stimulated by Dr. R. A. Young’s masterly review of this subject in his Lumleian Lectures delivered in London in March of this year.l Of such conditions there are few that demand greater care and judgment on the part of the physician than that of empyema, particularly when streptococcal in origin, and of chronic bronchiectasis. In the former there is general agreement that too early operation may and in fact usually does lead to that troublesome condition, chronic empyema. This result of treatment by open operation has led many workers to treat such cases by continuous aspiration, with or without irrigation of the cavity with some form of antiseptic solution. That most usually employed has been Dakin’s solution-neutral 0-5 per cent. solution of sodium hypochlorite—though others have also found their advocates. Recently Dr Hans Edel2 has recorded a few cases which he has treated with intrapleural injection of neosalvarsan. His treatment has been to aspirate the pus through a needle of moderate size, using the same needle to inject at once a solution of neosalvarsan. Edel has found that the pleura is able to withstand large doses of this solution without undue reaction ; thus his usual initial dose has been 0-45 g. dissolved in 10 c.cm. distilled water, which is gradually increased up to 0-6 g. according to the general reaction and the degree of refilling of the empyema. The surprising tolerance shown by the pleura to such high dosage suggests to Edel that considerable local thrombosis occurs round the site of the injection. It is, of course, well known that neosalvarsan even in far weaker 1 THE LANCET, 1929, i., 593, 697, and 805. 2 Die Lokalbehandlung eitriger Lungenprozesse mit intra- horakalen Neosalvarsan-injektionen, Med. Klin., April 26th, 929. solutions is a powerful antiseptic, especially against streptococci, and it is natural that the attempt should be made to utilise it at the site of infection instead of in the blood stream alone. Edel has gone further and has injected solutions of similar strength (from 0-15 to 0-6 g. dissolved in 10 c.cm. of water) into the bronchial tree in cases of bronchiectasis. His method has been similar to that used for the introduction of lipiodol into the lung, namely, cocainisation of the trachea and direct injection through a laryngeal catheter. In the few patients he has so far treated Edel reports considerable success, the total quantity of neosalvarsan used being in one case as much as 5-25 g. Another patient suffering from ri;ht-sided pulmonary gangrene and empyema received in all 0-9 g. into the pleura and 2-7 g. into the lung, a total of 3-6 g. The patient became afebrile two days after the first injection and in 12 days the empyema had disappeared, " cure " resulting in seven weeks, though the X ray still showed some thickening of the pleura. The local application of arsenical bactericides in pulmonary conditions is a method to be watched with interest, although clinicians may hesitate to copy the high dosage employed by Dr. Edel until.: further results have been reported. LOSS OF APPETITE IN CHILDHOOD. THE literature of anorexia in children is voluminous. and the underlying causes sponsored by individual writers innumerable. Some fresh light has, however, been recently thrown on the subject by a stimulating article from the pen of Dr. Joseph Garland,l who attributes the trouble essentially to a failure of’ management in the earliest weeks of life and con- firmed in childhood by improper training and discipline. Thus he suggests that the initial loss of weight that occurs before the establishment of’ complete lactation is in itself an advantage to the baby, as during these first few days the sensation of appetite has time to develop, a sensation that the baby is never likely to lose subsequently. Once breast feeding has been established a transient loss of appetite is a usual occurrence during acute febrile disturbances, and may in fact be interpreted as a protective mechanism since the gastro-intestinal tract, under the circumstances, is not commonly prepared for the reception and utilisation of food. It is frequently found that the mother’s greatest source of anxiety during the illness of a child is the failure to take nutriment, and it may require con- siderable patience to explain the situation to her. In many cases it should be realised that the appetite- difficulty is not a real one at all, but exists only in the fertile imagination of the over-anxious parent. This is often the case with infants at the breast who take their feeds so rapidly that the mother becomes obsessed with the idea that little or no milk has been taken; weighing the baby before and after feeds will generally banish this illusion. Sometimes an artificially fed infant will fail to finish its carefully calculated allowance but con- tinues to gain at a satisfactory rate. This baby does not require as much food as another infant of’ the same age and weight. One of the greatest boons that could be granted mankind would be an appre- ciation of the fact that all human beings are individuals with varying digestive capacities with varying temperatures, levels of activity, and caloric require- ments. The period of starting new foods, which includes very definitely the weaning period, presents often the first great obstacle to the continuation of a, normal appetite. Habits of feeding have become firmly fixed, and infants, like their elders, resent, change. Where such difficulties arise it is absolutely essential to ensure firmness in management on the part of mother and nurse, even if this entails two or three days’ misery for all concerned. The physical 1 Garland, J.: New Eng. Jour. of Med., 1929, cc., 1135.
