and urine, to sexual perversions, to respiratory restraint and strain, the misuse of the organs of special sense, are examples of the extent to which prophylaxis is easily under voluntary control, while cure, by this or other means, is difficult or impossible. Similarly, it may be laid down as an axiom that a definite chemic or permanent mechanic state is not amenable to psychotherapy. Various extreme schools of psychotherapy, especially of charlatans, argue that, if a disease is caused by a mental factor, it may also be relieved by mental force. To this claim, there is no better answer than the exquisite irony of the old rhyme: There was a man in our town And when he saw his eyes were out Functional Disturbances Amenable to On the other hand, it may be contended with equal propriety that any function, whether essentially chemic, motor or otherwise (if there be any otherwise), which is due to the maintenance of nervous stimulus or any lack of function due merely to the lack of such a stimulus may be modified therapeutically by securing the proper nervous effect, positive or negative, through psychotherapy. This dictum is, however, subject to numerous practical qualifications, which it is extremely difficult to codify. One would be tempted to lay down the rule that a function normally under direct control of volition could be directly controlled by psychotherapy, and that a function controlled by involuntary centers could not be thus ameliorated. But such a rule does not stand the test of experience. For instance, psychotherapy cannot be directly invoked to influence, except very transiently, abnormal respiratory rhythm and frequency, urinary irritability, tremors and paralyses of the voluntary muscles. On the other hand, it can, to a large degree, though indirectly, influence cardiac rhythm and frequency, and even the state of the vessels, as manifested in blushing, syncope, and the condition of the cerebral vessels required for sleep. Classification of Psychotherapy Psychotherapy may be classified, according to the method of application, somewhat as follows: 1. A command, more or less emphatic, with more or less emotional appeal, threat, etc. 2. Explanation of the relation of extrinsic factors, state of mind, etc., to function. 3. Autosuggestion: (1) induced by ordinary suasion; (2) induced by hypnotism; (3) induced by permanent domination by some sort of religious or superstitious influence. It Let it be repeated that none of these forms of psychotherapy can directly modify an organic lesion, a permanent mechanic condition, or a chemic condition of relatively stable nature, especially if essentially extrinsic. All that can be expected is the control of a function of a labile nature. is not impossible that such control may be obtained in spite of the persistence of an ineradicable lesion-much work may be got out of a partially disabled engineand it is by no means strange that the subjective suffering of a perversion of function may be caused to be forgotten. Genuine relief may be expected only in cases in which the disturbance, traced to its ultimate organ, is functional throughout. Genuine cure may be expected only in accordance with ordinary operation of the vis medicatrix naturæ or of artificial therapeutic measures of other kind, favored by the functional relief or ignoring of subjective effects, and, so far as ultimate cure is concerned, psychotherapy can obviously act only as the symptomatic treatment of details by other means. It is likewise obvious that simple command is not widely available as a therapeutic agent. It is available only for immediate effect-save as it involves the principle of autosuggestion by suasion-and mainly for the control of habit-spasms, to en force general emotional control, although syncope can often be prevented in this way. Attacks of aerophagia, gagging, psychic vomiting, some forms of irritative cough, or sphincteric weakness may be thus treated. The second heading, psychotherapy by explanation of the relation of extrinsic factors, state of mind, etc., may require an apology. In a sense, the intelligent control of reflexes, by avoiding or purposely introducing exciting causes, is far removed from the ordinary conception of psychotherapy. Forgetting, for the moment, problems of disease, we know that there are everyday acts so simple and generally understood that it is necessary to say only "Do," or "Don't," while others, more complicated, require also an explanation. An analogous relation exists between the simple disease phenomena just mentioned with rega which one may say, "Do," or the outside, the term auto signifying merely the ultimate object of producing a habitual discharge of nervous energy along certain channels. Of the three forms of autosuggestion, that by simple suasion is the most generally available and the least objectionable. Just how the establishment of autosuggestion by suasion is brought about, must depend on circumstances and to a large degree on individual tact, also on the personal equation of the physician. -Speaking personally, the writer would express a preference for a progressive suggestion, in keeping with the rationally expected progress of relief, rather than the immediate forcible impression on the patient's mind that such and such. a symptom must disappear. Nine times. out of ten, it will not disappear immediately or for several days and, not to mention the discounting of the physician's reliability, bed discount a symptom does not disap 667 't," pear, after the patient has been told and tell himself that it will and and gastric secretion, cardiac pabitationSE Past culcate the opposite auto certain states of high arterial asion must, liable to cause apoplexy, etc. To con siderable degree, such conditions may IBRARY ha, if the initial suggestion is of prevented or, in so far as they remain The Term "Autosuggestion" Not A The term autosuggestion is not entirely beyond criticism. Many deny that one mind can influence another. Indeed, from the materialistic standpoint, such influence is an absurdity and, as language has developed everywhere as an expression of thought based on the opposite conception of mind, it is difficult to give verbal expression to our meaning without employing contradictory terms. Without going to the opposite extreme from materialism, and viewing mental phenomena in a superstitious light, it is still in keeping with ordinary experience to hold that, in some way, one mind does affect another. At any rate, autosuggestion, from the practical standpoint, implies a preliminary influence from suggestion, t it can not disappear. On is of relief in degree, lessened frequence of recurrence and gradual improvement, this reversal of autosuggestion is not likely to be brought about in a patient at all receptive, even if no noticeable amelioration occurs for some time. The Limitations of Psychotherapy Another important point to be considered is the limitation of the possibilities of psychotherapy in general. It is useless to suggest the impossible. A rather amusing illustration of this point has lately come to the attention of the writer. A Christian scientist was suffering the agonies of an ulcerated tooth. Her little boy, bred in the tenets of that cult, talked to her against yielding to error and enjoined her to think of God, with the result that the good lady became so angry that she renounced Christian science. Hypnotic Suggestion Is Dangerous Hypnotic suggestion is something with which the writer has had very little experience, from the conviction that it is rarely justifiable, on the ground that it virtually enslaves the individual and ultimately weakens the factors of self-control necessary to the cure. Another point to be considered is this: relief by hypnotism is the relief of a detail, and the very means employed tend to convince the patient of the reality and nonfunctional nature of the symptom. Hence, he is extremely liable to a recurrence of any hysteric tendencies in some other direction and with firmer conviction of the existence of an essential disease. For example, a clergyman, a man of high scholastic as well as medical education, was "cured" of hysteric aphonia by hypnotism. In spite of his medical training, he was firmly convinced that hypnotism had cured him of a definite disease, instead of a purely functional manifestation, and he gave public expression to his gratitude, partly to the doctors, partly to Providence. Imagine the further course of such a case-any kind of ache or pain or neurotic manifestation would be magnified and relief would become increasingly difficult. Without going so far as to hold that in every case the physician should brutally tell the patient that his hysteric symptom is (qualified) nonsense, the writer feels that in no case is the cure complete until the patient is, somehow and sometime made aware of the essential nature of his complaint and of the importance of control by himself. Autosuggestion and Christian Science Autosuggestion by some sort of permanent domination of a religious or superstitious nature is, at present, best exemplified by Christian science, although it should be recognized that very similar results have been achieved for centuries in various countries, under religious influences of various types. So far as Christian science is concerned, it should be remembered that its numeric strength consists largely of persons who have had no occasion to make any serious therapeutic test, but who are more or less formally affiliated because the general social and religious atmosphere is pleasant. So far as therapeutic tests are concerned, Christian science succeeds in three groups of cases: (1) imaginary ailments; (2) ordinary functional disturbances, amenable to any kind of psychotherapy; (3) organic diseases, usually of mild and very chronic type, in which symptoms may be ignored, as arteriosclerosis, interstitial nephritis, mild diabetes, moderate ocular deformities in which eyestrain is not great and in which the patient may readily persuade himself that he can see without lenses. A little consideration will show that, in psychotherapy as in business, a systematized big undertaking has a specious advantage. Moreover, Christian science, unlike the private physician, is irresponsible at law. The writer, as probably many another physician, has been amazed at the number of Christian scientists who have recourse to ordinary medicinal as well as surgical treatment. This inconsistency can often be blamed on be blamed on a meddling relative or friend, or it simply is not explained at all. From the lay standpoint, it is not surprising, nor even unreasonable, that medical relief of, say, a mastoid abscess, or a pneumonia, or an attack of jaundice is regarded as of minor importance, as compared with insomnia due to no particular cause other than the establishment of a bad habit, or the annoyance of wearing glasses for astigmatism, or headaches due largely to habits of worry and bad temper, which cannot be cured by occasional visits to a physician. Neither is it at all surprising that the actual subjective benefit secured from an association which holds frequent meetings, which includes a large social element and which acts almost continuously by the repeated suggestion of a large number of individuals, each forming a different contact, yet all with the same ultimate tendency, should be superior, in certain cases, to the effect of psychotherapy by a single individual, seen briefly and occasionally, in whose case the business element and the normal standard of objective, material methods is constantly before the mind of the patient. Or Practical Helps for July Diseases By GEORGE L. SERVOSS, M. D., Fallon, Nevada ITH the advent of the heated term, we come in contact with maladies peculiar to the season. Owing to the extreme heat or humidity, many of the functions are interfered with. Early in the season the majority of us are prone to consume large quantities of new vegetables and fruits, in many instances a month or more prior to the time when they are really seasonable in the climate where we happen to reside. The eating of such food interferes to a greater or less extent with the functions of digestion and there is very liable to follow an irritation of the gastrointestinal tract. In some instances the fruits so taken are not as sound as they might be, and not infrequently do we eat fruits that may be infested with the microorganisms of putrefaction. The latter often set up an irritation of the bowels which may persist throughout the heated term, in many instances being followed by attacks of acute inflammation accompanied by diarrhea and other undesirable conditions. Iced Foods and Cold Drinks Early in the spring the sale of ice-cream is inaugurated, and, then, as a rule, we are all eager to eat large quantities of this dainty. It is now the vogue to add to the ice-cream either carbonated water or to have a liberal amount of fruits or fruit syrups added to it. Taken occasionally, such a dish undoubtedly is but little harmful, but if, as is so frequently the case, either ice-cream or ice-cream sodas or sundaes are eaten or drunk to excess, we find a toxic condition of the bowel to follow, and finally a general toxemia, due to absorption from that organ. In many parts of the country, especially those where a high degree of humidity accompanies the summer heat, insolation is not uncommon. In many cases this condition follows that of autotoxemia, due largely to the causes outlined above. We rarely see a case of heat-prostration occurring in those who are careful regarding their diet and who see to it that their bowels are kept clear and clean at all times of the year. Young children, especially those who are nursing and depending largely upon cow's milk or one of the manufactured foods, are very prone to bowel and stomach troubles during the summer months. Cholera infantum is common at such times, its etiologic factors being improper feeding combined either with extreme heat or a high degree of humidity. The Value of Preventive Measures Among the specific conditions, or diseases, we find that malaria prevails to a very considerable extent in the newer portions of the country or in those portions adjacent to marshes or undrained spots where the mosquito breeds. Typhoid fever likewise prevails in those portions where the water supply becomes infested with the specific organism, due to faulty hygiene. In the southern countries we find more or less prevalent diseases peculiar to such localities, including typhus, yellow-fever, cholera, dysentery, and other gastrointestinal maladies, their frequency being governed by the local sanitary conditions. In all of the pathologic conditions peculiar to the heated term we find that preventive measures, if properly carried out, overcome a tendency to their occurrence. If possible, prior to the arrival of the hot months, the practician should encourage his patrons to clear out their bowels, and keep them clean at all times during the heated term. He should offer counsel as to diet and recommend conservatism at all times. He should advise that at the least sign of any irritation of the gastrointestinal tract his patron should come to him for consultation and treatment. Personal hygiene undoubtedly is of greater importance during the summer months than at any other time of the year. At this time the skin is very active, as a rule, and after the least exertion is covered with excretory material which should be removed at frequent intervals, that it may not undergo decomposition, thereby favoring an irritation of the cuticle and the possible interference with the functions of that organ. The First Point of Therapeutic Attack When we find instances of gastrointestinal disturbances during the summer months, our first effort should be to clear the stomach and bowels of their contents, thoroughly and completely. In order to accomplish this, it is probable that calomel and podophyllin, followed by a laxative saline, are our best agents. I prefer administering calomel in 1-6 grain doses, every half hour until a total of 2 grains has been taken. To every other dose of the calomel, I add 1-6 grain of podophyllin. Following the last dose of the cholagog, at an interval of from two to four hours, an effervescent laxative saline, preferably one carrying 60 percent of purified magnesium sulphate, is administered, at half-hourly intervals, in teaspoonful doses until such time as the discharges from the bowels are absolutely free from all solid material. If the flow of bile is deficient and the liver inactive, I find that the addition of 1-8 grain of bilein to each dose of calomel overcomes this deficiency and stimulates the action of the bowels. Following the clearing out of the bowels, they should be kept clean by the use of the sulphocarbolates to effect or until such time as the feces are of normal consistency and odorless. If there is an apathetic condition of the bowel, juglandin, in dosage of from 1-2 to 1 grain three times a day, acts to stimulate the bowel function. Look Out for the Eliminants If such cases as a general toxemia are encountered, in addition to the local intestinal conditions, the eliminating functions should all be stimulated. That the liver may be stimulated to increased action, the administration of emetin and colchi cine, either or both, is indicated. Xanthoxylin favors elimination by the kidneys, and in that manner removes many of the toxic substances. If there is an excess of acidity, as shown by the condition of the urine, the alkaline treatment is indicated, and here we find the sodium and xanthoxylin compound of avail. The bowels should be kept relaxed at all times, during the course of treatment, by laxative morning doses of the effervescent saline. Insolation is, as a rule, treated symptomatically. If there is a pronounced congestion of the internal tissues, we find glonoin, which dilates the peripheral vessels, one of our best primary remedies. In order that the excess of blood may be held to the surface, the subsequent use of atropine is indicated. If there is a high degree of fever, aconitine and veratrine are indicated, to be employed to effect. In hyperpyrexia, cold applications or cold baths are to be employed in connection with the internal antipyretics. In all cases the bowels should have attention, being cleared out and kept clean. The Folly of Opiates In the past, under the older systems of treatment, the mortality in cholera infantum has been appalling. Opiates were employed, and thereby, instead of ridding the stomach and bowels of the irritative substances, they were locked up therein, to become too active again with the subsequent loss of opiate effect. Under the newer plan of treatment, elimination is favored. Initially the bowels are cleared out with calomel, followed either by a saline laxative or castor oil. If the temperature is high, cool enemas are given, the water being from 5 to 10 degrees below the normal body-heat. If there is pronounced diarrhea, zinc sulphocarbolate should be pushed to effect, otherwise the combined sulphocarbolates, to effect. Copper arsenate is of great value, both as an astringent and intestinal antiseptic in such cases. It may be combined with hydrastin and strychnine. If the condition of the skin is cold and clammy with pallor of the patient, and there are symptoms of |