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to drop as the week passes, whereas the skilled operative,employed on congenial work, shows a curve approachingmore nearly to the ideal of a rise throughout the week.The importance of this conclusion to methods of workis considerable, for it suggests that the most rapidworker is the steady worker, and not the one whoproceeds by irregular spurts; it confirms what mighthave been anticipated from athletics, where the bestlong-distance runners cover lap after lap at the samerapid rate, in contrast to the performance of lessefficient runners who vary their pace. The last sectionof the report records a short experiment with rest-pauses, in which two of a team of three womenoperatives employed in the press-room worked 40minutes, while one rested 20 minutes and then

replaced one of the workers. Thus each operativewas only actively employed for about 30 hours a weekinstead of 46. A considerable increase of outputwas obtained, the increase resulting more from thecomparatively unskilled and less robust workers, whowould naturally be more liable to fatigue, than fromthose whose output was high before the rest-pauseswere -instituted. Although, the report concludes, theduration of the experiment was not very long, itcovered a sufficient period of time to render the resultsvaluable and suggestive. It proved to the advantageboth of employers and employed. The employersincreased the output per machine by roughly 50 percent., and if one girl of a team was absent from anycause the press could still be worked; the number ofaccidents was sensibly reduced, and the employees werecontented, and said that they were less tired and inbetter health. _

"PSYCHOLOGY AND PSYCHOTHERAPY."IN his inaugural address, with this title, to the Cardiff

Medical Students’ Club Scientific Society on Nov. 9th,Dr. William Brown, Reader in Psychology at King’sCollege, London, laid especial stress upon the followingpoints :-

(1) There should be no divorce between psychotherapy,with its psychological methods and principles, and neurology.All who study the subject should be trained in neurology.To say that it deals with "functional nervous disease ismisleading. All nervous diseases are functional in theirmanifestations. And yet to say that any disturbance ofnervous function over and above that which is the directoutcome of organic change, if demonstrable organic changethere be, is due to suggestion, is a most inadequate explana-tion, and in many cases is demonstrably wrong.

(2) Psychotherapy is applicable mainly to the so-calledpsychoneuroses, in which the factors of causation and cureare mainly, though not always exclusively, psychological innature. Suggestion is, indeed, one such factor, of greatprevalence and potency, but there are many others. Thequestion of diagnosis is of the utmost importance to successin treatment. The psychoneuroses comprise neurasthenia,hysteria (of conversion and anxiety types), compulsionneurosis (obsessions), and also hypochondria and mytho-mania. The causation and therapeutic requirements ofthese different diseases are themselves different. Muchconfusion, for example, is caused by identifying hypo-chondria with hysteria, and again by putting anxietyhysteria and compulsion neurosis into one class and callingthem psychasthenia.

(3) Hysteria of the so-called conversion type correspondsto a crude dissociation of the psychophysical functions,brought about by mental conflict and repression, or bysudden shock. A large proportion of the shell-shock cases

. of the war corresponded to this type. They were easilyhypnotised. Indeed, the greater the degree of dissociationthe more hypnotisable were the cases. This is in harmonywith Charcot’s view that hypnosis is an artificial hysteria.It is most important to realise this, although many scientists,confusing hypnosis with suggestion, still deny it. Hypnosisis useful in a small percentage of cases, to clear up amnesiasand work off bottled-up emotion (abreaction or psycho-catharsis), but, like an anaesthetic, is in itself not beneficialand may be harmful. Repeated hypnosis of the same patientis undoubtedly bad. Dr. Brown sketched his own theory ofshell-shock hysteria in terms of a double dissociation, andshowed how the practically proved beneficial effect ofabreaction of repressed fear could be theoretically justified.

(4) Many of the mental mechanisms discovered by Freudare verifiable, and psycho-analysis as a method (" free asso-ciation) is of the greatest value, but the general theory ofpsycho-analysis, especially that part referring to infantile

sexuality, is of more than doubtful truth. The phenomenonof "transference" that occurs in the course of psycho-analysis is akin to suggestion, and is an essential elementin cure.

,

(5) Another important factor of psychotherapy is the self-knowledge that comes from psychological analysis, anddiscussion of the earlier memories, strivings, hopes, fears, &c.,that led up to the outbreak of symptoms. This is anintellectual factor, but one which takes full account of theemotional substratum of all mental illness. It is notidentical with psycho-analysis, and it deserves a special name.It might be called autognosis.Dr. Brown concluded with the caution that there

is no panacea in psychotherapy. The chief factorsinvolved in successful treatment are reassociation, psy-chocatharsis (abreaction), autognosis, and the personalinfluence of the physician, including " transference "and suggestion. Of these four factors the physician’spersonal influence is of the chiefest importance, sinceit is a determining condition of the effective working ofthe other three factors.

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PENSIONERS’ RECORDS.

IN an annotation entitled " Temporary or PermanentPension?" which appeared in THE LANCET for Oct. 23rd,we set out briefly the arguments against any extensiveaward of permanent pensions at the present time. Solong as the disability is liable to change a carefulmedical record of the pensioner’s condition is unavoid-able. More than a year ago the Ministry of Pensionsinstituted a uniform system of records-medical recordcards-and there is now in existence in duplicate fornearly every pensioner a medical record card on whichis briefly but comprehensively recorded the completemedical history of the pensioner as known to theMinistry. This medical abstract is obtained in thefirst place from a study of the army documents andmedical board papers; after the card has been madeout, the finding of each successive board, the result ofeach period of treatment, and the opinion of each doctorwho deals with the case are entered thereon in chrono-logical order. In this way, at any given time, it ispossible by reference to the record card to obtaina complete summary of the man’s medical history upto date. The cards are kept in duplicate, one copyremaining with the pensioner’s documents, the otherbeing in the custody of the deputy commissioner ofmedical services (D.C.M.S.) of the area in which thepensioner resides. Arrangements are made to ensurethat an entry made on one card is duly recorded on theother also. The card kept by the D.C.M.S. is, so tospeak, the active and travelling card, and is sent byhim to any medical officer, medical referee, or otherdoctor who may be called upon to treat or examine thecase in order that the latter may make an appropriateadditional entry on it.When the doctor to whom the card is sent for

such entries is an official of the Ministry thereis naturally no difficulty in obtaining his entry on thecard. But we are informed that only in comparativelyfew instances is the Ministry able to obtain from theconsultant staff of a civilian hospital any entry onthe pensioner’s record card. This may be due in somecases to a natural dislike to the filling up of forms, butthe roots of the difficulty lie much deeper in the multi-farious claims upon the time and energy of the voluntaryconsultant which are subject to physical limitations.The Ministry of Pensions desires to obtain the opinionof these experts, but obviously the successful working ofthe scheme rests on a voluntary basis and stands or fallsby the good will or otherwise of those who take part in it.The Medical Services Division of the Ministry of Pensionslays the greatest stress on the necessity for the efficientworking of the record card system amongst its ownofficials, and regards the scheme as the basis uponwhich the medical work of the Ministry must rely.The scheme is also greatly to the advantage of theprofession as a whole, for nothing is more desirablethan a comprehensive and accessible system of medicalrecords in regard to all patients in this country, whetherpensioners or not. Skilled time and labour should notbe expended in eliciting clinical data which have alreadybeen found out, although in fairness to the patient his