PSYCHO-SOMATIC PROBLEMS IN GYNAECOLOGICAL AND OBSTETRICAL PRACTICE* BY...
PSYCHO-SOMATIC PROBLEMS IN GYNAECOLOGICAL AND
BY M. D. ADATIA
T h e study of the personality of the patient is essential for a medical practitioner
because personality of an individual is the sum-total of all the reactions in an individual" says
Dr. M. D. Adatia and emphasises in the following article the need for adoption of psycho-
therapeutic procedures in the treatment of patients, especially women suffering from
gynaecological and obstetric troubles. T h e author, in support of his arguments, cites several
examples from his case records.
Dr. Adatia is a Medical Practitioner and Member of the Obstetric and Gynaecological
Recently great interest has been taken by guard and should make him watch for a
the medical profession in psychosomatic background of emotional disturbance, which
problems. Psychiatry may be called the may be producing disordered physiology and
youngest branch of medicine but by no means acute distress in the pelvic region." (Miller
it is of less importance than any other domain and Weaver).
of this science. Every disease has a psychic
and somatic component; and the symptoms
The precise figures concerning the in-
which appear to be due to organic diseases cidence are difficult to obtain, because in a
may be only the result of emotional and large group of patients the psychic and
psychological disturbances. Cooke goes so somatic conditions overlap making accurate
far as to say that 90% of the severity of differentiation extremely difficult. Yet on
human suffering is mental.
the whole the incidence of psychosomatic
disorders in the obstetric and gynaecological
A great deal of Symptomatology encounter-
patients has been estimated to vary from
ed in everyday gynaecological practice is of 30% to 70%.
purely mental origin. Most alert observers
recognise that a large proportion of women
It will be indeed distressing to the patient
seeking aid for "female trouble" are, instead, if every now and then she is to be referred
"troubled females". It is a well-recognised to a psychiatrist for her functional ailments
fact—even by women—that they are more and minor psychiatric problems. Frequent
apt to undergo psychological disturbances. reference will upset her mind and will make
The word "hysteria" which is almost asso-
her emotionally antagonistic to any of the
ciated with "women" has an interesting approaches of the psychiatrist. A little
philological origin in as much as that the practice, a little elementary instruction and
word in Greek means "Uterus". The kinship some interest in psychiatry could enable a
between disorders of genital tract in women gynaecologist to handle the psychosomatic
and psychological disturbances has been re-
aspect of his patients far more competently
cognised since long.
and with much less psychic trauma to the
patients than by referring them to a psychi-
"A great number of pelvic operations atrist.
unnecessarily performed and the large quan-
tities of hormones irrationally employed
Many of our consulting room patients are
should put a conscientious worker on his suffering from emotional reactions and fear.
Paper read before the Bombay Obst. & Gyn. Soc.
1 8 3
The confidence that a doctor is able to inspire productive system is often the channel of ex-
in the patient should be enough to break pression of psychosomatic tension.
down this distressing barrier between the
doctor and the patient. The patient should
Mind divides itself into two parts, sub-
be entirely at her ease with maximum of conscious and conscious. Mostly the conver-
opportunity of self-expression and with all sion of psychological conflict into a somatic
possible attention from the doctor. A
disorder is not direct or conscious. The
thorough history taken personally is an patient is not aware of the state of tension
essential part of any gynaecological consulta-
existing within herself. Generally, when a
tion. A rapid examination carried out with conflict cannot be freely expressed, it is
the help of assistants may often mislead us. suppressed beyond conscious recognition.
We may perform a miracle of diagnosis and These repressed conflicts express themselves
of operative cure in a case of pathological in the form of a functional disturbance of an
state; and yet leave the patient a hopeless, individual or of a particular system of a
life-long invalid because we have failed to body like genito-urinary system. These
employ appropriate prophylactic and curative symptoms are the expression of underlying
psychotherapy of a very simple type.
An attempt is made here to briefly
For example, the sexual impulse is a natural
epitomise the salient features and basic and harmless one, yet it must be admitted
principles of psychopathology.
that there is a great deal of social condemna-
tion of a genital functioning as a whole. The
The study of the personality of the patient lack of intelligent consideration on the part
is a great asset to the observer, because of the parents and teachers is really deplor-
personality of an individual is a sum total able and as a result the genital tract as a
of all the reactions in an individual. Persona-
body system has fallen in the path of deluge
lity is dynamic from birth to death. Its of human emotions of most unfortunate
development begins from infancy. In the character. For example, we will take a
course of the development there is a constant very common illustration. The monthly flow
struggle between the inborn tendencies on the of blood or menstruation is looked upon by
one hand and the demands of the outside so many educated and even cultured people
world. Most of our instinctual cravings, our as something that is unholy enough to make
likes and dislikes, our love and hatred have the menstruating women sit in seclusion.
to be inhibited to make ourselves acceptable
to the society in which we live. The social
The correlation of personality changes and
conventions and the ethical code of the physiological changes in the normal sex cycle
society force us to modify our desires to suit of a woman has been studied and there is a
the requirements of the community of which general agreement about the findings. As
we constitute a part. The repressed ideas observed by Malleson, Nail Burgler and
always play upon one's mind and produce Ribmiller: —
a state of psychological tension. This tension
may ultimately express itself in the form of
"The preovulative phase of the cycle is
psychological disturbance like anxiety state, accompanied by a mood of elation and strong
hysteria, etc. or may express itself in the form hetero-sexual interests. The tension is dis-
of somatic disturbance, In women the re-
pelled with sexual gratification or with the
1 8 4
M. D. ADATIA
rupture of the follicle. The phase of the attached to the memories by intellectual
progesterone increase is accompanied by discussions.
passivity, a desire to be loved affectionately
and protected. This gives place to a phase
It was explained to the
in which fantasies related to pregnancy can patient how faulty intellectual and emotional
be revealed by exploratory techniques. The attitudes on her part were reactions to certain
immediately premenstrual phase is accompa-
difficulties, also how such tendencies led to
nied by emotional tension in a setting of undesirable habits and unhealthy emotional
depression and irritability.
and mental conditions. By reasoned argu-
ment it was implanted in the patient's mind
The repeated preparation for child bearing the conviction that her symptoms will dis-
is apparent even in the psychological study. appear.
The patient was help-
Principles of Psychotherapy.
—Rationale of ed by subtly, often indirectly, implanting or
psychotherapy in these psychosomatic dis-
inducing the idea or belief that unpleasant
orders is that these disturbances are brought disabling symptoms are being relieved.
about as a result of repression of psychologi-
cal conflicts; and if the conflicts themselves
(vi) Mental Catharsis.
are brought to the conscious awareness of listened, without criticism, while the patient
the individual, the need for its disguised and related emotionally troublesome mental con-
vicarious expression in the form of a bodily tent, recounted traumatic events that were
disease would not exist. If the conflict is painful to her and sometimes disclosed
resolved at conscious level by finding a suit-
socially condemned motivations and feelings
able way out of it, the symptoms would dis-
which she had entertained.
appear through sheer lack of need for them.
Interview was usu-
It has been attempted to give a short ally conducted with the patient lying on a
sketch of various psychiatric methods attem-
couch while the therapist sat beside her.
pted by me during the treatment of various All efforts were made to give a maximum
degree of comfort and relaxation. A cheer-
ful and quiet atmosphere of the room was
A confidential relationship indispensable. A presence of a nurse was
between the physician and a patient was allowed in the room to prevent undue em-
established whereby the latter gained confi-
barrassment on the part of female patients.
dence and respect for the therapist, and a By no means any of the relatives or strangers
desire to co-operate with him despite precon-
were allowed in to watch the procedure.
ceived notions of the origin of her symptoms.
(ii) Ventilation and Aeration.
Patient was encouraged to express herself
consisted in bringing into conscious attention and to say everything that came to her
in specific details wholesome attitude and mind, regardless of how inappropriate, irrele-
reactions, which were usually associated with vant or personal it may seem to be. She was
asked to relax and sleep if possible. At this
junction i. V. injection of Pentothal Sodium
This consisted in was started and was continued slowly, drop
removing the unpleasant emotional tone by drop. All the time the patient was allowed
1 8 5
to talk. Maximum of 10 c.c. of Pentothal So-
ready to control her if any untoward accident
dium (2.5%) was administered in some cases; happened. Mouth gags were used to prevent
but cases respond to much smaller doses. In injury to the tongue. Injection was given
a matter of seconds or minutes the patient en-
rapidly and within a fraction of a minute
tered a trance-like state of varying depth.
convulsions appeared. Accurate dose for a
particular patient was determined after
Out of the irrelevant and incoherent mass careful observations and trials. Respiratory
of details that the patient brought out, certain or other embarrassments were not seen. No
trends of thoughts were gradually manifested. fracture was recorded. Within a few minutes
It was observed that most of my cases were the patient used to come round; some
either illiterate or lacking in a good educa-
remained dizzy for several hours, while some
tional background. Their thoughts and complained of pain and backache for
words were not trained to express themselves several days. About 12 injections were re-
well. Patient had to be guided at times by quired in average patients. They were given
various suggestions and reassurances.
everyday till the quiescent stage was reached,
then on alternate days and sometimes even
A good knowledge of the emotional once a week.
background of the patient's symptoms could
(x) Insulin Shock Therapy.
be obtained in one or more interviews. During insulin was given early in the morning and
further interviews attention was given to an assistant was kept near the patient to
amelioration of the patient's symptoms.
watch for the coma. Dosage was decided
upon by careful observations and trials. It
Talking to the therapist about their varied from 30 to 400 units. Onset of coma
troubles made the patient feel better. was noticed within 3 to 7 hours. Coma was
Reassurance, environmental manipulation never allowed to continue for more than
and understanding of the meaning of her 45 minutes. Progress of coma was carefully
own symptoms were further steps in relieving watched. Injection of glucose was given to
the patient of her symptoms.
bring the patient out of coma. She was,
then adequately fed. Incomplete coma was
(viii) Continuous Narcosis.
—Few patients an indication to increase the dose.
were given this therapy which lasted for 48
to 96 hours. Pentothal Sodium dissolved in
(xi) Retraining, Re-education and Stabi~
1000 c.c. of Glucose Saline was given by lisation.
—This consisted in. guiding the
drip method continuously day and night. patient to react more or less automatically
When the patient woke out of this artificial in a symptomless, efficient and wholesome
sleep, often the previous complexes were manner to various stresses in life.
forgotten. Record of pulse and temperature
was quite essential. Bladder and bowels were
Several times I had to prescribe and work
out regimen at home, hospitalisation, occu-
pational and physical therapy.
(ix) Cardiozol Convulsive Therapy.
Attention to nutritional and hygienic
injections of Cartazol in doses varying (from needs of the patient was given.
5 to 20 c.c.) with the individual were given.
Patient was made to lie down comfortably
Selection of Cases.
—Cases for psycholo-
in bed, Two to three assistants were kept gical approach were selected usually at the
1 8 6
M. D. ADATIA
first interview. Some cases were given this
2. A Christian lady, name M.C.T. age
treatment when they failed to respond to 38 years, wife of an insane husband, had
sex relations with her boarder without
contraceptive on the 28th day of her cycle.
These cases could be divided mainly into She developed pregnophobia which could
three groups: —
be relieved by hypno-analysis.
(i) Patients came with all symptoms only
3. An unmarried lady, name S.K.M. of
and no signs.
28 years had amenorrhea for three
(ii) Patients came with definite signs, but consecutive periods after the death of her
symptoms were out of proportion to brother who was the sole earning member
of the household.
(iii) There were definite signs and Sympathy, explanations and settling her
proportionate symptoms but the in some decent job started the normal
background was psychogenic or pro-
duced by psychogenic factors.
—Psychic magnification of
The following is the record of cases that basic pain was found to a variable degree
have been treated by me: —
an element in practically every case of long
standing dysmenorrhoea. An attempt was
Menstrual Disorders: Amenorrhoea.
—4 made to evaluate and to reduce or eliminate
Cases. Mental shock often brought about this this element in every case.
complaint in several women.
I have about 7 cases on record, two of
1. A young girl, name C.J.T., age 19 which are more interesting to narrate.
years, was brought to me for amenorrhea
two months after her marriage. On physical
1. A young married lady name Mrs.
examination there was no evidence of K.D.T. of 22 was referred to for severely
pregnancy, or of any other apparent cause painful periods. The symptoms originated
of this complaint. Patient had two leuco¬ after her marriage and had lasted for about
derma patches on the waist; and on further 12 months. The pain used to be relieved by
questioning very interesting history was Morphine or Pethidine only. Hormones,
elicited. The husband of the girl had diathermy, infra-rays, aspirin all were tried
threatened never to take her back to his but in vain. No somatic cause for the pain
home because of those small whitish spots. was elicited.
Pentothal interview correlated the above
On direct persuasion under hypno-analysis
findings. The husband happened to look the patient showed hostility to mother-in-law,
upon the patches on the very first night father-in-law, husband and needed urgent
after marriage. Early next morning he took change of environment.
her back to her father's place, and raised
a big quarrel about his being deceived about
By psychotherapy, the pain threshold was
his wife's appearance.
raised and deep psychogenic factors were
Treatment of leucoderma and appearance
of the pigment brought back the normal
2. In the case of an unmarried girl name
M.B.H, of about 25 years, dysmenorrhea
1 8 7
developing late in life was the expression of
—Eight cases are on record.
frustration, inferiority and mal-adjustment. Most of them were of unmarried girls.
Leucorrhoea is like a headache of the lower
Very significant facts were brought out abdomen, and were very resistant to treat-
on hypno-analysis. She had secret love ment in most of these cases. Unconscious
relation. Her great depth of the feeling for sexual ideas led to hyperaemia and hyperse-
the man could not be adequately dealt with cretion in the genital region with a decrease
in various contacts which she had with him. of tonus of the smooth musculature. Follow-
She felt tremendously guilty of her emotions ing marriage and satisfactory sexual adjust-
about him. The closer she came in contact ment and the living out of the sexual fantasies
with him, more and more psychic and physi-
and erotic desires, the leucorrhoea also
cal pain was evoked. The ordinary expres-
sions of love, such as kissing and other
physical contact, gave rise to marked conflict
The case of a Parsi woman, name K.N.T.
in her. Her body felt tense and dysmenor-
age 27, having severe diarrhoea and marked
r h e a began. She was unable to relax and white discharge per vaginam is very interest-
become care-free in the presence of the ing. The symptoms had appeared six
opposite sex. She knew that she needed months after her marriage and the patient
them greatly but did not know how to deal was brought to me by her husband.
with them in a way that left her physically
No somatic cause was detected to account
for the severe and irritating leucorrhoea.
At college she could not concentrate on
One significant fact stood out of all un-
consequential details. The discharge was
Loving a man conflicted with her ideals. more in the presence of the husband and
In her own words, "It makes me tense and had appeared only lately before 6 months
intolerable, I cannot stand it. It has come soon after a plane accident in which her
to the point where I have the same tension husband was involved. The accident had
in my insides and in my head. I guess that's greatly mutilated the face of her husband
why I can't study."
and he had undergone various plastic
Faulty sex education and sex prejudices operations.
harboured by the orthodox parents were also
suggested. After hypnosuggestion she res-
The wife showed a repulsion and hostility
ponded with these beautiful words: "I am towards the husband. Her repressed feelings
tired of binding myself to social conventions, about him were expressed in this unpleasant
I am going to feel like a free human being symptom of vaginal discharge.
and enjoy life." On further education and
Divorce relieved her of the complaint.
instruction she was far better. "When I
relaxed emotionally I relaxed down there
—Two cases had
(meaning her pelvis). Everything about been noted.
me flows easily now. I feel free to be a
woman in every way. Menstruation flows
1. I was called upon for consultation in a
more easily; my emotions of sex and love very aristocratic family to examine an un-
are easy and free and no longer associated married girl name S.S.R.E. of 26 years.
Her complaint was that of frequency of
1 8 8
M. D. ADATIA
micturition, lack of control and sometimes can be shared, so much of emotional and
incontinence. No organic cause could be spiritual value given to each other as in the
sexual relationship, if the attitude towards
each other as man and wife is normal.
On hypno-analysis, following revealments
were obtained. A strict, orthodox father
Pregnophobia, conscious or subconscious,
resented the idea of her freely mixing with was found to be the common cause of any
the opposite sex. Prohibition of society degree of frigidity.
resulted in suppression of emotions which
led to frustration of her sexual activi-
Abuse of Surgery.
—Two of my cases are
ties. Urinary symptoms represented at a good illustrations how surgery in vogue is
conscious level the substitute for normal sex fruitlessly attempted without any considera-
activity. Frequency of micturition was far tion of the psychosomatic aspect of the
more marked in the presence of opposit sex. patient.
Re-education in thinking and feeling rightly
1. A lady, Mrs. M.C. aged 39, complained
to sex resulted in removal of frequency and of pain in the abdomen, backache, nervous-
urgency of urination.
ness and fatigue. She was operated twice
for the relief of similar complaints and was
—In the presence of a complete even ready for a third operation.
physiological normality the frigidity was in
most of the cases the result of an abnormal
On rapport and ventilation she seemed to
resent her normal environment and enjoyed
hospitalisation and being attended to and
Five cases were noted in this respect.
Abnormal mental attitude towards sex
Psychoanalysis suggested that she had no
relations covered tremendous range of satisfaction from the husband and that is
patients; and in most of the cases the causes why she wanted to change her environment.
were the inhibitory factors which affected Education of the husband and assurances and
adjustments of her emotions brought much-
needed relief to her.
Physically and emotionally healthly women
did not have a capacity to indulge in marital
2. A young girl, name S.M.J. age 18, had
relationships of sexual function with pleasure. to postpone her marriage date four times
The ideas and the emotions with respect because of severe right sided abdominal pain.
to this function were not rational and well She was operated and appendicectomy and
D & C were done. But still on the next
wedding date her complaints reappeared.
Even the husband never thought of On psychic examination she was found to be
woman's satisfaction in his act. He had emotionally immature to face the sexual
some fancy notions that women were not relationships.
probably meant to feel the same way in
—Too much eagerness to get a
sexual relations as men.
child was seen to bring premature ejaculation
It was explained to him then that there of ova, and the fertilisation was then never
is no human relationship in which so much fruitful.
1 8 9
Adoption of a child and dissipation of
4. A primipara, name M.M.S., age 48 was
worries was of help in starting the normal diagnosed to be pregnant. During consulta-
tion with some other gynaecologist she was
told to the contrary. She never brought her-
1. A rich lady, Mrs. M.M.S. age 48 self to believe the truth about her condition
years, had been to almost each and every until all possible confirmations were tried.
gynaecologist of repute in Bombay for her Hypno-analysis and suggestions at the end
sterility. In despair, she adopted a child satisfied her.
and sought consolation for her troubled
mind. Her emotional tension was relieved,
5. A patient, name R.M.A., age 32 who
the injurious influence on the follicular had a deformed child in the previous labour,
apparatus disappeared and she was able to suspected that similar fate will befall her
conceive at the age of 48, exactly 32 years again. By psycho-suggestions, proper con-
solations she was taken out of this phobia
and carried to the last days of pregnancy.
—True hyperemesis was always
a magnification of the basic nausea of
—The condition was pre-
pregnancy. Abortion and premature labour cipitated by either pregnophobia or intense
were seen to be precipitated by profound desire to become pregnant.
emotional shock alone.
1. The patient, M.R.R. age 36, believed
I have 5 cases on record.
to be pregnant was supposed to be in labour
pains, but I was able to relieve her pains by
1. The patient's name K..S.P. age 18; did injection of moryl and by passing a flatus
not want a child, as she was far more devoted tube.
to music and art. As soon as the knowledge
that she was pregnant dawned upon her she
2. According to her own calculation a
started vomiting, believing that through vo-
patient, name Z.H.S. age 40, was in the
miting she may be able to do away with eighth month of pregnancy, she had also
registered herself at a well known hospital,
on examination she showed sings of conges-
2. A multipara name S.J.M. age 36, tive cardiac failure and ascites. She also
suspected that her husband was too busy and reported having felt the foetal movements.
was not paying proper attention to her. She
started vomiting as soon as she was known
3. A patient, name T.L.Z., age 32, had
to be pregnant. Her symptoms were pro-
undergone D & C by me twelve years after
jected in the hope that her husband would her marriage. She missed her period and
stay at home and look after her.
became suspicious, at the end of four months,
the breasts showed fairly large enlargement
3. A patient, name L.S.P., age 39 who and also some milky discharge, the uterus
had her previous delivery by caesarean section showed doubtful enlargement. I called her
always worried that her present labour would after a fortnight for further check up with
terminate in the same manner. Her fear a word of hope that she might be pregnant.
and doubts were removed by sympathetic Overjoyed as she was she spent a lavish sum
on some religious ceremony. On subsequent
1 9 0
M. D. ADATIA
examination, I was of the opinion that she
was not carrying. Her condition became
critical and she had to be brought round by
gradual and careful psychosuggestion.
Gradually the enlargement of the beast,
milk discharge, slight distention of the abdo-
All cases improved with heavy sedatives and
men and vague feeling of foetal movements cartazol shocks. Tuinal and paraldehyde
were the drugs of choice for sedation. I have
given more than six capsules of tuinal gr.
4. An old lady aged about 62 years, name 3 in one day and about sixty c.c. of
J.S.S. was referred to me by her sons. She paraldehyde intramuscularly without any
complained of severe vomiting and pain in harmful effects. Two cases were given
the lower abdomen. On examination there continuous pentothal narcosis to bring them
was slight rigidity and a lumpy feel in the under control. Supportive therapy with liver
abdomen, but there was no evidence of preg-
and vitamins and hygienic care of the
patients were carefully attended to. Nasal
Hypno-analysis and pentothal interview feeding and intravenous glucose saline were
revealed pregnophobia. A false D & C under often given. Enema and catheterization were
hypnosis relieved her of all her complaints. also necessary in some cases.
-It is the time of involutional
The cases with gynaecological complaint
epoch with all its psychological and physical were given cartazol shocks and insulin sub-
implications. In suggestions they were taught shocks on alternate days.
that there is nothing to enforce their tendency
to ascribe their condition of nervousness
A regular follow up of these cases is still
exclusively to their pelvic organs.
maintained. Some patients still need the
monthly cartazol to keep them well adapted
Four of my cases on record showed psycho-
to society. Two important obstetrical points
tic tendencies, rowdiness and disturbance to are worth mentioning. A patient having
other members of the family. Every one maniacal psychosis during her first delivery
improved with a course of six cartazol shocks. was seen to be having the same maniacal
symptoms during her next labours. On the
One of these cases was a wife of a contrary, I have had two cases with histories
Sanskrit Preacher, name M.S.S., age 42, of psychosis during previous deliveries, but
she developed hostility towards her husband under my care none of these symptoms were
during menopause, started quarrelling and seen.
finally even attempted to injure physically
her husband. She became quiet and tem-
The question of sterilisation in a psychotic
perate after a course of cartazol shocks. woman is disputable as congenital effect on
Small doses of estrogens are still being the child is still not proved by scientific
—Eleven cases are on record.
—It has been aptly observed
The following classification of these cases is by A. Mandy, T. Mandy, Farkas, Scher and
Kaiser that "The incidence of this psychoso-
1 9 1
matic illness is probably in excess of any resources that I can command at present.
estimate thus far published, since it appears My ultimate aim, is to give uptodate and
likely that nearly every woman will at satisfactory service to this group of patients,
sometime develop such disorder due to the who have wandered about from one specia-
complex disintegration of her emotions and list to the other in the hope of relief for their
sexuality. Unfortunately much more is innumerable, bizzare symptoms, and to bring
involved than a mere medical problem. them as rapidly as possible to their families
Deeply significant are the broad sociological and occupations with a better capacity for
implications underlying countless broken adaptation, before they develop deeper
houses and several divorces and the many psychosomatic disturbances.
unrecognised neglected or mishandled emo-
tional disorders. Few with a serious References.
psychosexual disturbance are capable of
providing the proper environment for either
1. Bergler E.: Psychiatric Quart.; 18,
bearing or rearing emotionally healthy
2. Cooke: 1949 Year Book of Neurology,
Psychiatry and Neurosurgery.
I have attempted here to
put before the
society my experience, and few case reports
3. Farkas Robert: Amer. J. of Obst. &
of a group of patients who obtained relief
Gyn.; 60, Sept. 1950.
with the above line of treatment. My
4. Kaiser Irvin: Amer. J. of Obst. &
collection is of only 59 cases.
Gyn.; 60, Sept. 1950.
My interest in the subject grew partly
5. Mandy Arthur: Amer. J. of Obst. &
because of my association with Dr. Vahia
Gyn.; 60, Sept. 1950.
who has been of use to me sometimes in
6. Mandy Theodore: Amer. J. of Obst.
guiding me and sometimes in directing the
&Gyn.; 60, Sept. 1950.
line of treatment for the cases. Every
gynaecologist or obstetrician is justified in
7. Miller Norman: South Surgeon; 13,
handling these patients by himself and there-
by reducing the burden of the very few and
8. Millerson Joan: British Med. Jour.;
scarce psychiatrists in our country and
2, 213, 1942.
sparing their time for deeper therapy. More
often one uses these psychotherapeutic pro-
9. Ribmiller L. F. & Nicodemus R. E.:
cedures, more successful will be his efforts
Penn. Med. J.; 49, 1214, 1946.
in eliciting proper knowledge about the
10. Scher Ernest: Amer. J. of Obst. &
patient's condition. My technique and
Gyn.; Vol. 60, Sept. 1950.
approach may still be faulty. I invite all
suggestions for improving the work that
11. Weaver John D.: South M. J.; 39,
I have been carrying on with the few