SynopsisThis paper describes a study of the outcome of psychotherapy with patients disabled by chronic obstructive airways disease giving rise to dyspnoea. Forty-three men and 22 women with severe COAD were randomly allocated for 8 weeks to one of three types of psychotherapy or to an untreated control group, and were followed up six months later. The group treated by a medical nurse without training in psychotherapy experienced sustained relief of dyspnoea but tended to undergo less psychodynamic change; psychiatric symptoms were reduced in those receiving supportive, but not analytical, psychotherapy. The psychosomatic mechanisms involved and the implications for medical and nursing practice and for liaison psychotherapy are discussed.

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TETANUS CURED BY INTRATHECAL ANTITOXIN. MEDICALJOURNAL C'as 1.--A iman, aged 57, with severe aniaemia, diagnosed as pr'obably perniiicious. The blood count at the commenicemzenit of treatmenit (September 23rd, .1924) showed a mortality of 50 per centt., the common causes of death being cardiac -failui e an-id exhaustion.In considering the treatment of declared tetanul-s the pathology has to be takenl inlto ac (-ount The case about to be dcscribed illustrates the valuie of treating the various patllological plhenIomena of established tetanus by the intratlhecal adminiistration of powerful do-es of an-titoxin, by supporting the patielit's lieart and gnernrall system during the muscular spasms, and by removing promptly the site of infectioni.A Chiiiese boy, aged. 12k, liad Iiis left leg crushed in its middle third by tlhe wheel of a Chinese cart. A bad compound comminuted fracture of both tibia anid fibula was the result, and the native doctor was immediately called to attend.The child's coliditiolu becamiie progressively worse, and oni the ninth day following the accident he was brought to hospital. Below the seat of iniury absolute diry ganigrene had been established, alnd when the patieiL was lifted off the stretchier the lower part of the leg. fell off.-Tlhei'e was 11O liaemorrhage. The child had fever (1020 F.) anid a rapid pulse (120), and definite head retractioni was present, with masseteric spasm and the typical " risus sardoiiicus " of declared tetanuis.In Arguing on the principle that the lumbar enlargement of the cord was the site of attack, the lumbar puncture needle was introduced through tlhe eleventh dorsal intervertebral space, and about -15 c.cm. of cerebro-spinal fluid drained off; 20 c.cm. of standard antitoxin, representing 20,000 units, were then injected. The shoulders and pelvis of tlhe patient were raised, in order to make the site of injection the most dependent part, for fouir minutes, anid 4,000 antitoxini unitc were then administered rubcutaneously.On the next day typical opistllotonic anid pleurothotonic spasms wer-e present; the trismus was much worse, and there was considerable rigidity of the rectus abdominis muscles. Tlic temperature was 1010, and the puilse 134. The wound was slightly septic. A further intrathecal injection at the same site, of 20,000 antitoxin units. was administered, and followed by 10,000 units subcutanieously. Mouth-feeding with a tube and funnel was establislled, through the dental space previously prepared, and rectal salines (10 ounces, with 5 per cent. glucose and 30 grains of potassium bromide) were administered every four hours.On the third day the temperature was 1000, and the pulse 126; opisthotonos and trismus were present; 4,000 units were adminigtered subcutaneously, and salines and tube fecding were continued.On the fourth day the opisthotonos was very slight, but tirisoitis persist-d. The temperature was 990, and the pulse 118; 4,000 UllitS were again administered subcutaneously, and rectal anld tube feeding continued.On the fifth day opisthoton...