1484 MEDICAL SOCIETY OF INDIVIDUAL PSYCHOLOGY

and a few other drugs, and referred briefly to thetreatment of acute oedema of the lungs, cardiacasthma, and coronary thrombosis. Rest in thetreatment of heart disease implied mental as well asphysical rest ; mental strain must always be relievedif in any way possible.

Miss D. W. HALL pointed out that the portal ofentry of the haemolytic streptococcus might be

through the nasal mucous membrane as well as

through the tonsils.Dr. DORIS ODLUM maintained the importance of

treating the psychogenic factor in thyrotoxicosis ;she believed that there were two types of cases, inone of which the psychic trauma was predominant.

Dr. D. C. HARE pointed out the danger of delayedoperation in certain cases in which the nervous

manifestations were alleviated by medical treatment,but the cardiac damage was progressive. She sug-gested that too large doses of iodine were often given ;she had had good results from 1 minim of Lugol’siodine three times a day.

In reply, Dr. AITKEN agreed that the neglect of anunhealthy nasal condition might account for someof the disappointing results from tonsillectomy.Psychic trauma was an important setiological factorin thyrotoxicosis, but once the thyroid secretion hadbeen altered, psychotherapy was not likely to effecta cure. She rarely gave iodine herself in the earlystages, in order to reserve its beneficial action for theperiod before operation.

MEDICAL SOCIETY OF INDIVIDUAL

PSYCHOLOGY

AT a meeting of this society held in London onDec. 14th Dr. JAMES YouNG took the chair, and apaper entitled

Purpose and Some Neuroses

was read by Dr. F. G. LAYTON. It is the job of theunconscious mind, he said, to keep its host going,and upon this text he built his thesis that, all neurosesbeing purposeful, they are in essence protective.This characteristic of neuroses was demonstratedparticularly in unravelling the twisted threads ofindustrial accident when, after the effects of physicaltrauma had passed, there remained the effects ofthe mental trauma. If this was unrecognised muchinjustice was likely to be done, and not infrequentlywas done. Those to whom the dogma of purposein neurosis was distasteful preferred to regard thepost-accident neurotic as often a malingerer, andtalked of "compensation neurosis." Such talk was

dangerous, and should be regarded with suspicion.The task of the physician was constantly to ask

why; to seek the purpose underlying the trainof symptoms presented. Thus would he learn

something of the patient as a whole and get nearerto being able to help him.

The Tyranny of the Invalid

Dr. 0. H. WOODCOCK followed with a paperpointing out that the discomfort and suffering ofillness are rarely confined to the patient, and thatthere is no surer method of dominating a sympathetichousehold than by the exhibition of disease. Notonly the neuroses but also the attacks and exacerba-tions of disease with discoverable pathological changesoccurred opportunely when the patient craved extraattention, wished to evade a duty or to excuse

faulty performance or failure. Even infants soon

learned to play upon the fears of an anxious motherby sudden variations of the action of the bowels orthe development of convulsions when thwarted.At the school age colds and fever might be opportunefor escaping examinations and difficult menstruationmight be an excuse for neglect to take a share inhousework. Even normal pregnancy was a usefullever to secure the dominance of a husband and theills of the puerperium could be exploited to maintainit. Men could and did advertise headaches andexhaustion so that they might be petted and comfortedat the end of a business day or to explain a lack ofsuccess in it. Lastly, old age all too frequentlyimposed on the next generation a yoke by virtue ofits decrepitude, and many a devoted son and daughterhad declined into soured middle age, too pre-occupiedwith the care of the parent to take his or her rightfulplace among contemporaries. The demand of theinvalid for attention rarely allowed solitary suffering-there must be an audience to suffer too. So tenaciouswas his hold on his imagined rights, that sometimeshe would die rather than surrender them.

In every case of illness, Dr. Woodcock concluded,we are justified in asking ourselves : What is the

patient gaining by this

LIVERPOOL MEDICAL INSTITUTION

AT a pathological meeting of this institution onDec. 7th, with Dr. H. R. HURTER, the president, inthe chair, a paper on

Urochrome in Health and Disease

was read by Dr. C. L. G. PRATT. After summarisingpresent knowledge of the chemical composition of thepigment, he presented evidence to show that theamount excreted per day was fairly constant andindependent of the diet. In considering its possibleprecursors in the body, he maintained that its originfrom hsemoglobin was improbable. There was reasonto suppose that the suprarenal gland, and possiblythe liver, were concerned in the metabolism of thepigment. In general, the daily output rose with anyphysiological or pathological increase in metabolism.Dr. Pratt regretted the lack of attention paid to aproblem which was easily susceptible of approachfrom a clinical standpoint.

In the discussion which followed, Prof. J. H. DIBLEsuggested a possible relationship between fat pigmentand urochrome, pointing out that Dr. Pratt hadreferred to cyclical vomiting and other conditionsinvolving starvation as being associated with an

increased urochrome excretion. Since increasedbreaking-down of fat was also common to theseconditions, Prof. Dible asked whether Dr. Pratthad considered the possibility of urochrome havingsuch an origin.

METROPOLITAN HOSPITAL APPEAL.—At a meetingat the Mansion House last week the Lord Mayor ofLondon launched an appeal for this hospital, ofwhich he is president. Mr. Lionel de Rothschild, thetreasurer, explained that the hospital had usually beenable to balance its accounts by local support, butnow that it is situated in Kingsland-road, where theinhabitants are extremely poor, that help is lacking. The

recently built nurses’ hostel and many unexpected expenseshad caused a heavy debt, and 30,000 is required at once.A committee was formed to consider the best means ofraising the money.