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not at hand, good use can be made of gramophonerecords such as those demonstrated on Dec. 1 to the

Physiological Society.*

Group TherapyTHE first really bright spot in The Messiah is the

chorus " All we like sheep have gone astray." Theaudience smiles happily ; gaiety seizes the orchestra ;and the choir thoroughly enjoys its group-confessionof naughtiness. The sinner is a man cut off from hisfellows ; and atonement is sweet benison-as hasbeen known throughout the ages. There is in fact

nothing new about group therapy: ÆSCULAPIUS

practised it, and there are instances of it in both Oldand New Testaments. Nevertheless it is a far cryfrom Jacques’s " Ducdame " to BION’s 2 " leaderlessgroup " ; and certain differences exist between theBrick Lane branch of the United Grand JunctionEbenezer Temperance Association 3 and the war-time*’

psychoneurotic therapy groups " described in this

issue by Major FOULKES as an extension of the workdone in pre-war days by FouLKES and LEWIS.4 No

longer does the group conductor, for instance, rely oncommunity singing, vicarious testimony, perspiration,sex-appeal, and all the other weapons employed byBrother Humm : his r6le nowadays demands a

treading delicately rather than a rushing in.The neurotic, like the sinner, is an isolate. In

group therapy the patient, in addition to individualattention from his trusted doctor who " thoroughlyunderstands his case," is drawn out of his isolationinto a social situation in which, like the repentantsheep, he feels at home. He is a fellow-being, onequal terms with the others. Furthermore, his dis-covery that his morbid ideas, anxieties, and impulsesare not unique but are experienced by others makeshim feel less of an outcast and diminishes his feelingsof anxiety and guilt. Particularly is this broughtabout when he finds that the super-ego of the groupis more benign and tolerant than his own tyrannicalconscience. The obsessional patient may then, bymeans of identification and contrast, reshape his ownsuper-ego into a more realistic ideal-in other words,he may unconsciously lower his standards to a morepracticable and attainable level. Beyond and beneaththe mere words and ideas exchanged in discussion,however, changes are wrought on a deeper plane.The collective unconscious of the group is meanwhilemaking itself felt. It supplies a super-ego which isits own inherent property and not merely an averagedrawn from those of its individual members. Dreamsand symbols have a wider and deeper significancewhen their associations are " pooled " by the group.Explanations and interpretations which spring fromthe group have the power to strike home more

forcibly than those supplied on demand by the

psychiatrist. Even though the actual discussion mayfail to show the feeblest glimmer of pentecostal fire,the psychiatrist is not discouraged. His role is thatof the angel who troubles the waters, from the depthsof which comes wisdom. And deep calleth to deep.As any Service medical officer will confirm, the

morale of a unit can be measured by the smallnessof its sick-parades. Ills of the flesh do not assail a

1. As You Like It. Act II, scene 5.2. Bion, W. R. Lancet, 1943, ii, 678.3. Pickwick Papers, chap. xxxiii.4. Foulkes, S. H., Lewis, Eve. Brit. J. med. Psychol. 1944, 20, 175.

keen and happy unit to anything like the extent thatthey bother a unit which is " browned off." In hisletter on another page Captain DAY suggests likewisethat remarkably good all-round health will be main-tained by a civilian group if it is engaged in a

progressive and creative enterprise. Mens sana in

corpore sano—or Corpus sanum in mente sana ?Assuredly neither one nor the other, but both

indivisibly.

Annotations

STANDARDISING NUTRITIONAL SURVEYS

TOWARDS the end of 1944 the advisory committeeon nutrition surveys which had been set up by theNutrition- Society called together’a number of Englishand foreign experts, who happened to be in this countryat that time, and established a standing advisory com-mittee for coordination of methods of survey in liberatedterritories. This body appointed three panels, the firstto investigate laboratory methods and the secondclinical ones, and the third to study methods by whichactual food surveys might be carried out. The firstand third panels have now issued their reports (on type-written duplicated sheets), which can be obtained fromProf. J. R. Marrack, London Hospital, E.I.The first report, of 67 pages, contains a great deal of

critical information about the estimation of plasmaproteins and hæmoglobin, and some limited adviceabout the value of vitamin assays and saturation tests.A long table shows the values obtained for haemoglobinand plasma proteins in men, women, and children byvarious investigators using various methods. Many ofthe technical methods are explained in appendices, andthere is a bibliography of 200-250 references. The reporton the methods for dietary surveys is shorter and containsadvice about the persons one should aim at studying,how the samples of the population may be selected,and how the results can be presented, as well as a descrip-tion of various methods of collecting the informationdesired about the food eaten. There is a section also

containing hints on how to interview subjects. This

report has no bibliography. It includes some data on

European food-supplies : these are essentially tables offood composition, with a few suggestions about the

applicability of some of the data to the various Europeancountries.

It is evident that a great deal of work has been putinto the preparation of these reports, but they are

difficult to follow in their present form, and if they areto be of wide use the " liberated territories " will haveto be taken off their title-page and they will have to beprinted. It must be admitted, however, that most ofthe information is already accessible in printed form, andnot all will agree with the desirability of standardisingmethods. The history of international research and

investigation, moreover, does not suggest that Europeancountries will readily adopt recommendations, comingfrom outside, which they did not help to prepare.

RELIEF AND PREVENTION OF ACUTE MASTITIS

AcuTE puerperal mastitis is an unpleasantly frequentcomplication among women delivered in hospitals andmaternity institutions, and Fulton 1 suggests that theincidence among women delivered in their own homes,although lower than in hospital, is by no means negligible.Apart from protracted maternal distress and discomfortthe most serious consequence of this condition is theeffect on the infant of the abrupt. termination of breast-feeding which nearly always results. Bacteriologicalinvestigation usually discloses a coagulase-positive strain

1. Fulton, A. A. Brit. med. J. 1945, i, 693.