TRAINING FOR PSYCHIATRY1

581

7 tons of morphine, as such, are needed annually tomeet the world’s legitimate requirements. Thisreduction in the manufacture of morphine is greatestin the older producing countries such as Germany,France, Switzerland, and the United States, while atendency in the opposite direction is evident in Statessuch as Belgium, Hungary, Poland, Sweden, andCzechoslovakia which have only lately embarked onthe manufacture of morphine. The legitimate pro-duction of heroin to meet world requirements hasfallen from 4 tons in 1930 to 1 ton in 1934, and ofcocaine from just under 6 tons in 1930 to 3 in 1934.The United States is the largest producer of morphineamong the countries of the world, while Japan is

responsible for the largest output of heroin andcocaine. Having regard to the statistics furnishedto the League, the Secretariat feels justified in con-cluding that the world production of heroin andcocaine now approximates to what may be consideredthe amount necessary for legitimate consumption,and that in the case of morphine it is possible thatlast year the amount manufactured may even havebeen less than that legitimately required. TheSecretariat accordingly claims that the work of theLeague in controlling the traffic in dangerous drugshas been amply justified, while in no way minimisingthe menace of clandestine manufactories and thealarming amount of illicit production and trafficthat still continue.

TRAINING FOR PSYCHIATRY1

THE series of articles on the training of neuro-logists and psychiatrists, which has been noticedin THE LANCET 2 while in course of publication, hasnow been collected into a brochure. In these ninestatements of representative opinion, the pre-occupation of most of the writers has been to definewidely the limits of his own specialty. Eachconcedes the debatable ground where neurosurgeonmeets neurologist, paediatrician meets psychiatrist, orpsychotherapist meets neurologist; and each holdsthat the other must not encroach further and claimtoo much. In spite of such opinions, which mightbe expected to lead to divergent conclusions as totraining, there is a large measure of agreement betweenthe contributors--of whom five are neurologists(Walshe, Brouwer, Riley, Lhermitte, Ramsay Hunt),two are psychiatrists (Strecker, Meyer), one apaediatrician (Veeder), and one a neurosurgeon(Penfield). They recognise for the most part thatthe neurologist cannot give wholly adequate treat-ment to patients with mild mental disorders, especiallypsychoneuroses, unless he has had some soundpsychiatric training, and that such patients will

inevitably form an important part of his practice ;they recognise that the psychiatrist is handicappedunless he has had an adequate training in neurologyas well as in medicine generally, and they are unani-mous in denouncing the doctrine, widespread amongthose who practise psychotherapy, that for this

popular branch of medical practice a thoroughgrounding in neurology and psychiatry is superfluousor harmful. This question of the treatment of thepsychoneuroses bulks largely in the various essays.As the editorial summing up puts it-

" When one reads the articles of this series it is all toopatent that the main bone of contention is the large groupof the psychoneuroses.... Besides the neurologist andthe psychiatrist, many others with less training than they

1The Training of the Neurologist and the Psychiatrist.Reprinted from the Archives of Neurology and Psychiatry.New York. 1934-35.

2 THE LANCET, 1934, i., 31.

have entered into the competition for practice in thepsychoneuroses. Psycho-analysts, some of them withouteither neurologic or psychiatric training, mental hygienists,child guidance specialists, clinical psychologists, cultistsand quacks—’ the seven and twenty warring sects ofpsychotherapy ’ (Walshe)-now take their place in thefront line with the trained physician."

Indeed, Dr. Walshe’s allusion, made in the firstarticle of the series, is frequently quoted by othercontributors ; in the last article in the book,Dr. Ramsay Hunt repeats it in the following passage:

" One may feel certain also that three years devoted tothe private practice of psychiatry alone is entirelyinsufficient to enter that great field envisaged by AdolfMeyer. Such a requirement would open the door to oneof the greatest dangers to modern psychiatry to-day,the poorly trained psychotherapeutist who ekes out acareer on a flimsy structure of one or the other of whatWalshe has aptly termed the seven and twenty warringsects of psychotherapy. ’

"

Other special topics, such as training for research,are given provident consideration by the writers,who are clearly aware of the complexity of issuesthat are too often lightly dismissed. They do not,as one may see especially in the articles by Prof.Adolf Meyer and Prof. Strecker, regard psychiatryas mainly a matter for psychological and social

study along lines remote from general medicineand biology, nor do they expect neurology, as we

know it, to provide the means of treating, or indeedinvestigating mental illness, which transcends thelimited range of part-functions with which neurologydeals. Dr. Walshe, however, thinks that it mayfall to the neurologist " in the future to importreason and the scientific outlook into a field (thepsychoneuroses) that has for too long been the happyhunting ground of the half-trained enthusiast."For the special cases of the neurosurgeon, and of thephysician engaged in child guidance, it is agreed thatthe latter must be thoroughly grounded in paediatricsand that the former should have a good neurologicaltraining unless he works in close association with acompetent neurologist.

CLINICAL RECORDS OF INFLUENZA

IN the earlier part of last year Laidlaw pled for"a more refined and intensive clinical analysis ofcases of the influenza type." The clinician knowsas well as the pathologist that the word" influenza"as he uses it covers a collection of different illnessesvarying from pandemics to feverish colds, and hemust admit that his unaided study of them hasfailed to isolate clear-cut groups clinically distin-

guishable. The pathologists, led by Laidlaw and hiscolleagues, have now discovered an influenza virus,which they can obtain from the human patient,propagate by passage in ferrets and mice (from which,- upon occasion, they may apparently reinfectthem-selves),2 and identify with considerable precision byprotection experiments using immune horse serum.They have found this virus in some recent minorepidemics of "influenza" but not in others, andthey have found its first cousin in

" swine influenza,"a disease which affects the pigs of America and seemsto date from 1918. The importance of assessing theresponsibility of this virus for various minor influenzaepidemics, and its possible relation to pandemics, isobvious. To this end search for the virus must gohand in hand with accurate clinical observation and

1 Laidlaw, P. P. : THE LANCET, 1935, i., 1118.2 Smith, W., and Stuart-Harris, C. H. : Ibid., July 18th,

1936, p. 121.