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Special Articles

AMERICAN MEDICAL ASSOCIATION

CENTENNIAL MEETING

FROM A CORRESPONDENT

THE venue of this meeting, from June 9 to 13, wasAtlantic City. Imagine Brighton or Blackpool, buton a larger scale ; take away the promenade and substi-tute a wooden broadwalk of great width and enormouslength devoted solely to pedestrians and those morejaded who prefer to be wheeled slowly in well-sprung,pneumatic-tyred, upholstered chairs ; flank this broad-walk on one side with a perfect sandy beach, largeAtlantic rollers breaking in a froth of spindrift, tents,bathers, and all the paraphernalia of the seaside includingthree mammoth piers, and on the other side with aseries of low-built shops containing anything from themost expensive mink coats and jewellery to the apparatusof the practical joker; intersperse these shops withnumerous luxury hotels, more reminiscent of Le Touquetor Juan les Pins than our native hostelries; add a con-vention hall which appears to be larger than Olympia orthe White City ; back the whole with a large andapparently prosperous town with good shops, banks,and boarding-houses ; and you may get some idea of theatmosphere of the place.

Atlantic City was chosen because at least 15,000 doctors,most of them accompanied by their wives, and someby their families also, were to attend the meeting ;a town used to accommodating a very large number oftransient guests was the only possible location.The convention hall was not much used for meetings ;

here were housed the exhibits of instrument manu-facturers, publishers, and drug houses, in a displayreminiscent of the exhibitions seen at home. Herealso was the scientific exhibit, where by means of charts,coloured transparencies, and other devices includinganatomical preparations some 1300 items were cleverlyand succinctly shown.The American Medical Association had invited a large

number of distinguished guests, representing othermedical associations and governments, to attend the

meeting. The British Medical Association was repre-sented by Dr. Guy Dain, Dr. Charles Hill, Dr.

Hugh Clegg, and Dr. J. A. Pridham. Representativescame from as far away as Syria, Saudi Arabia, andSiam ; and distinguished clinicians and scientists frommany countries were to be seen wearing on their lapelsthe golden medallion of the A.M.A. with the words" Invited Guest " printed in gold on a green ribbonbelow the medallion.The programme- of the section meetings covers some

190 closely printed pages in the official manual; and itis impossible to do more than outline some of the titlesof the more important contributions, in full awarenessthat the selection may do less than justice to the effortsof many men.

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In the section on internal medicine, the chairman,J. T. Wearn, delivered a paper on the challenge offunctional disease ; R. Fitz gave the centennial addresson the history of the specialty of internal medicine in theUnited States; whilst H. D. Claro, of Chile, the section’sforeign guest, spoke on the contribution of the laboratoryto the differential diagnosis of jaundice.

In the section on surgery, Sir Heneage Ogilvie,-theforeign guest, opened the proceedings with a paperentitled gastric surgery after one hundred years ; hewas followed by the chairman, A. Ochsner, who spokeon carcinoma of the lung ; and the centennial addresswas given by E. A. Graham, whose subject was a centuryof American surgery. (In each section the centennialaddress concerned American work in the section’s

specialty during the past hundred years.) After someeight other papers authorities from the surgical sectionand the section on gastro-enterology combined to give awide-ranging symposium on peptic ulcer.

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In the section on obstetrics and gynecology, .T. E. Eyre,of Montreal, spoke on cervical cytology in the diagnosisof early cancer ; E. A. Schumann delivered the centennialaddress ; Alice F. Maxwell, the chairman, gave a paperentitled a medical inventory ; the foreign guest,J. Heyman, of Stockholm, spoke on the comparabilityof material in evaluating results of radiotherapy ofcancer of the uterine cervix.

The section on ophthalmology heard an address bySir Stewart Duke-Elder, the foreign guest, witnessed ademonstration of new instruments, and among othermatters received a communication from J. G. Bellows andC. J. Farmer on streptomycin in ocular infections.The section on laryngology, otology, and rhinology were

addressed bv G. Ewart Martin, of Edinburgh, the foreignguest, on the present position of bronchcesophagologyin Great Britain ; they met under the chairmanship ofJ. Mackenzie Brown, who spoke on the future of oto-laryngology, and their centennial address was deliveredby R. A. Fenton.

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R. Debre, of Paris, lectured to the pediatric section onthe deleterious results of overdosage of vitamin D2during infancy ; E. P. Copeland gave the centennialaddress; and other subjects ranged from the manage-ment of tick typhus in childhood to rheumatic fever.

The section on experimental medicine and therapeuticsreceived contributions which may eventually affect thepractice of medicine in many specialties. R. A. Wood-bury and his colleagues discussed asymatrine hydro.bromide in the treatment of gastro-enteric hypermotility,and L. 0. Jacobson the use of nitrogen mustards in thetreatment of disease. Jacobson has found that thecourse of acute leukaemia and multiple myeloma isunaffected by these drugs, but that significant clinicalremissions are produced in Hodgkin’s disease, lympho-sarcoma, chronic lymphatic and myelogenous leukaemia,and polycythsemia rubra vera. I. Snapper, in a paperon stilbamidine in the treatment of multiple myeloma,reported that whilst the drug might relieve pain it didnot cure the disease.. T. Luetscher and W. T. Longcopediscussed B.A.L. therapy in arsenic and mercury poisoning,and F. M. Rackemann the use of anti-histamine drugs.C. Heymans, of Ghent, the foreign guest, contributed apaper on blood-pressure homeostasis and circulatoryfailure. The chairman, C. A. Dragstedt, spoke on

idiosyncrasy to drugs. -

In the section on pathology and physiology, besides asymposium on the present status of cancer research,papers were contributed by J. J. Moore, the chairman,on the practice of pathology ; G. Liljestrand, of Stock-holm, on regulation of the arterial pulmonary pressure ;H. T. Karsner (centennial address) ; E. W. Schultz onviruses and virus diseases ; and H. J. Corper andM. L. Cohn on various phases of the use of streptomycinin tuberculosis.

T. Alajouanine, of Paris, was the foreign guest in thesection on nervous and mental diseases. S. Cobb gave thecentennial address, and R. P. Mackay, the chairman,spoke on the Neurologist Looks at Discipline.

0. S. Ormsby delivered the centennial address to thesection on dermatology and syphilology, and was followedby the foreign guest, R. M. B. MacKenna, who spoke onthe international outlook in dermatology. The chairman,N. P. Anderson, in a paper on cysts, sinuses, and fistulas,did much to make simple a subject which is complicatedin many books by traditional beliefs and muddled think-ing. H. E. Michelson spoke on sarcoidosis, and amongstmany other papers that by H. J. Templeton, C. J.Lunsford, and H. V. Allington on autosensitisationdermatitis may be referred to as confirming views firstsuggested by Whitfield in England.The work of the section on preventive and industrial

medicine and public health was made particularly interestingby a paper from S. Forssman, of Sweden, on comparativepractices in industrial medicine in Sweden and in theUnited States, and by a symposium on the question of

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how scientific proof could be attained in workmen’scompensation controversy.

In the urological section W. J. Kolff, of Holland, spokeon the artificial kidney (his apparatus was demonstratedin the scientific exhibition) ; G. Carroll, the chairman,discussed Ps. aeruginosa (pyocyanea) and related bacillaryinfections of the urinary tract; and F. S. Patch, ofMontreal, the foreign guest, read a paper on epithelialmetaplasia of the urinary tract.The section on orthopedics was addressed by J. Valls,

of Buenos Aires, on aspiration biopsy in the diagnosisof lesions of the vertebral bodies ; by L. F. Bush andC. Z. Garber, who discussed storage in the bone-banksby " deep freeze " methods ; and by E. W. Ryerson, whogave the centennial address. H. J. Seddon, of Oxford,contributed a paper on nerve lesions complicatingcertain closed bone injuries.The section on gastro-enterology and proctology held a

symposium on the pancreas, another on ulcerativecolitis, and a third on gastritis and gastric neoplasms.The chairman, M. S. Kleckner, spoke on proctologicsurgery of the large bowel; J. A. Bargen gave thecentennial address ; and J. McMichael, of London,the foreign guest, reviewed clinical and biochemicalproblems of liver disease as revealed by systematicbiopsy studies.

G. 4V. Holmes gave the centennial address to the sectionon radiology G. E. Gomez, of Colombia, South America,was the foreign guest and spoke on cardiac hypertrophyin residents of high altitudes.The section on anesthesiology, under the chairmanship

of C. F. McCuskey, considered many topics, and wereaddressed by A. R. Hunter, of Manchester, the foreignguest, on anaesthesia for operations within the vertebralcanal.

E. Ashworth Underwood, of London, addressed thesection on miscellaneous topics on the spread of thepublic-health movement, 1847-1947 ; and D. Y. Solandt,of Toronto, spoke on the relationship of physicalmedicine to industrial medicine ; both were foreignguests.

General scientific meetings were held on June 9 and 10.G. W. Pickering, of London, addressed the first of theseon the subject of hypertensive encephalopathy, and alsotook part in a panel discussion on the modern manage-ment of heart disease. H. J. Seddon gave a paper onnerve grafting in the limbs, and took part in a paneldiscussion on emergency surgery. Sir Howard Florey,F.R.s., spoke on new antibiotic agents and laterdiscussed the development of bacterial resistance toantibiotics.

The foreign guests were royally entertained. Not

only were their creature comforts tended in the spaciousrooms of their hotels, but they were wined and dinedwith heart-warming cordiality by private groups, societies,and official bodies. On June 10, before an audiencesaid to number 6000, they heard a concert given by thePhiladelphia Festival Orchestra, in which a surpriseitem was a military march written by the new presidentof the American Medical Association, Dr. E. L. Bortz ;they also watched the installation of Dr. Bortz, whoread a most able paper on the work, aspirations, andpolicy of the association ; and they were then individuallyintroduced to the audience. The guests were awardedhonorary fellowship of the association. On June 12

they dined with the Alpha Omega Alpha Honour Society,of which they were made honorary members ; as the

society has a limited entrance this is a greatly prizeddistinction. Later in the same evening, at the president’sreception and ball, they had the pleasure of greeting thepresident’s guests, shaking hands with hundreds of

representatives of the American medical profession, theirwives, and their families.

Doubtless some other convention is now being held inAtlantic City ; doubtless the curving waves caress thevigorous bodies of other young Americans-honeymooncouples, the young, the middle-aged. The scientific

exhibits and the technical exhibits are no doubt packedaway in crates and cases. Medical controversies no

longer echo through the meeting rooms. As far as

Atlantic City is concerned, the Medical Convention isover. But in the minds of those who attended will longremain the memories of friendships made and renewed,of hospitality on a scale seldom experienced, and of

knowledge gained. -

Reconstruction

LOCAL GOVERNMENT IN TRANSITION

Sir RONALD DAVISON

OUR system of local government dates back to 1888,and everyone agrees that it is in need of a drastic over-haul. Reform has been in the air for a long time ; itshould now come down to earth. One part of the taskwas entrusted in 1945 to the Local Government BoundaryCommission which is now beginning to show its handand has published its first report.l -

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I do not envy Sir Malcolm Trustram Eve and hisfive colleagues ; they have a difficult job in recastingthe jig-saw ’of areas. Their mere existence as a com-mission has aroused the worst passions of local councillorsand their chief officers. There is apprehension andcupidity at all four levels of the hierarchy : the boroughsare preparing for war on their county councils, whileurban and rural district councils are afraid of the countyboroughs and are jealous of one another. Money is atthe root of most of this-i.e., the desire to enlargerateable values and keep rates down-but civic pridecomes in too. Most councillors at all four levels seethemselves ruling over a larger and nobler domain, andthey dislike the thought of being subordinated or reducedin area. The great county boroughs (50,000 to 500,000population) are the most aggressive ; some of themhave not even shrunk from asking that their futureboundaries should be enlarged eightfold or tenfold. Inface of all this, the commissioners are treading cautiously;for they know that as soon as they make actual alterationsof status and area they will have to face very strongobjections.

Civic patriotism is a curious emotion ; I have heardof one fervent Lancastrian who swore that he wouldquit his home and his village if it was transferred tothe Yorkshire County Council: " I couldn’t possiblystand up to the Yorkshire winters," he said. In myown district of Oxfordshire the urban district council isspending V600 on a plan for encroaching on its surround-ings, including my home, but the rural district councilis preparing to die in the last ditch rather than surrenderany territory. In my opinion it is the councillorsrather than their constituents who feel all this bitterness.One of the wise suggestions of the commission is that

we should now get rid of this complicated hierarchyfrom non-county boroughs down to rural district councils.In all of them the major functions, like education, arerun over their heads by the county councils. There isnowadays very little difference between the powers andduties and rateable values of non-county boroughs,urban districts, and rural districts. It is the ruralauthorities that have caught up on the small towns ;and henceforth, say the commissioners, all small town andcounty district councils should have the same statusand be known by a common title. Stimulated by newtasks in housing and coming duties in respect of theirlocal hospitals under the National Health Service, ourcounty councils plus district councils and their staffsare very much alive. This two-tier system of govern-ment covers 97 % of the area of England and Wales and60 % of the population. It is therefore at least as

important that any new reforms should work out wellin these sectors of Britain as that they should do so inthe great county boroughs.

THE COUNTY BOROUGHS

At present it is the big cities and conurbations thatget all the limelight; ; and they certainly get it in the

1. See Lancet, May 3, p. 617.