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181 BRITISH MEDICAL ASSOCIATION AT the official religious service, held in Liverpool Cathedral on July 18, a large congregation heard the BISHOP OF BIRMINGHAM declare that, after four centuries, the post-Renaissance era was drawing to a close. In the phase that was now opening, the outlook would be humanist, and would be profoundly influenced by the growth in scientific knowledge. As to progress in medicine : " It is already clear that possibly the most important medical’ research of the future will be con- cerned with the elimination from human stocks of genetic defects, and with the production of human types finer than any that have hitherto appeared. It is among such human types that the finer kinds of religion and ethics will, in ages to come, show themselves." The increasing importance of medical science was already evident. " New knowledge is likely to bring ethical and religious changes which will be more significant than material progress. Among the consequences of an over- populated world are starvation and warfare. Medical science, in many ways so valuable to humanity, is not without some responsibility for both calamities." The Bishop went on to express his disbelief in material matter. The two fundamentals, he said, were not mind and matter but mind and conduct. At the annual dinner on July 20, attended by some 550 people, Lord HORDER spoke of Liverpool as the gateway of the west, the focal point of the Battle of the Atlantic, and a city unique in having two cathedrals built in the 20th century. In medicine it had taken a lead especially in public health, in tropical medicine, and in orthopaedics. Responding, the LORD MAYOR (the Rev. H. D. Longbottom) said that, for all its slums and dark patches, Liverpool was a city of variety and charm ; and the VICE-CHANCELLOR (Mr. J. F. Mountford) mentioned that among the university’s priorities the new medical school had almost the highest place. Prof. D. R. SEABORNE DAVIES, proposing The B.M.A., said that justice was the supreme good ; and justice for the patient was unattainable without justice for the doctor. Replying as chairman of council, Dr. E. A. GREGG said that though the B.M.A. existed partly to advance the interests of those who practised medicine, a great proportion of its energies was devoted to improving the practice of medicine. It would have preferred to see the National Health Service introduced in stages ; but, now that the service was here, members of the profession must do nothing that would enable anyone to point a finger of scorn at them. All must realise, however, that warfare for health against disease was, like other warfare, expensive ; and there must be no stinting of resources : he spoke particularly of the needs of the public-health service. Sir HARTLEY SHAWCROSS, M.P., pro- posing The President, referred to Sir Henry Cohen’s accession to the chair of medicine at 34 and of his long and untiring public service : all three political parties had sought his advice and it had been given objectively. In his reply Sir HENRY COHEN took the opportunity to pay tribute to all those who had made the meeting a success. In dealing with the toast of The Guests, on which he had produced a 93-page preliminary memorandum, Mr. BRYAN McFARLAND said there were those who thought that a dead hand had been laid on medicine and that its spirit was like to die. But the profession had remained free and faithful through worse trials than the present’and its voice would rise again triumphant and clear. Lieut.-Colonel R. FLEETWOOD-HESKETH (mayor of Southport), Dr. A. J. ORENSTEIN (South Africa), and Dr. DAG KNUTSON (Sweden) responded. Among the films shown at the meeting were the following : Treatment of Infections of the Hand.-This new film, illustrat- ing the practice at the hand clinic of the surgical unit, University College Hospital, London, was sponsored by Glaxo Laboratories Ltd., and produced by the Realist Film Unit Ltd., under the auspices of the British Medical Associa- tion. In sound and colour, it depicts clearly treatment that can be carried out single-handed ; and the need for choosing the right moment for surgical intervention is properly emphasised. The value of the film is enhanced by the summary with which it ends. (116 mm. ; running-time 28 minutes.) Total Sympathectomy for Hyperten,sioz.-In sympathectom3r operations, few onlookers can hope to see what the surgeon is about, because of the depth at which he is working. Thus this film, by Mr. A. Dickson Wright, which illustrates the procedure by the retropleural approach, should prove very popular ; for, thanks to efficient illumination, even the deepest planes are clearly shown. (16 mm., silent and colour ; running-time 15 minutes.) In his public lecture at the close of the meeting, Dr. C. 0. STALLYBRASS called for a national effort to eradicate tuberculosis. "And in this I know,’’ he added, " that 1 represent the views of many, heavily disheartened and overworked, of those engaged in tuberculosis preventive work." Scientific Sections MEDICINE President : Prof. E. N. CHAMBERLAIN Modern Oonceptions and Therapeuties of Cardiac Failure Prof. E. P. SHABpEY-ScnAFER spoke of the need for a satisfactory definition of heart-failure. To define it as failure of the heart to pump in a proper manner would embrace other conditions not commonly accepted as heart-failure, and it overlooked complex alterations in the pressure/flow relations occurring in the peripheral vessels. The vascular response of the normal subject on changing from the recumbent to the erect posture consisted in vasoconstriction, elevation of the arterial blood-pressure, and diminished peripheral blood-flow. By contrast the patient with cardiac failure developed these changes when he passed in the reverse direction from the semi-erect to the recumbent position. Elevation of the venous pressure was the important factor precipi- tating an attack of acute left ventricular failure, which was associated with intense vasoconstriction, raised arterial pressure, greater cardiac work, and dyspnoea. Vasoconstriction and dyspnoea produced further venons- pressure rise, completing a vicious circle which could be broken by treatment designed to lower the venous pressure. It was tentatively suggested that these changes resulted from modification of the normal postural or haemorrhagic reactions. DR. RICHARD BAYLISS said that pulmonary hyper- tension occurred in less than half the cases of emphysema, and mitral stenosis. In the patient with emphysema, pulmonary hypertension, and right ventricular failure, oxygen therapy would lower the pulmonary arterial pressure : it was not yet determined whether this effect was due to vasodilatation or to a fall in the cardiac output. It was uncertain what part pulmonary arterio- sclerosis played in the maintenance of raised pulmonary arterial pressure in patients with a severe degree of mitral stenosis. The answer could only be obtained by observing the results in patients with this condition who underwent valvulotomy. Dr. PAUL WOOD was provocative in his remarks on raised venous pressure, which, he said, could and did exist without precipitating cardiac failure. He instanced, among other examples, the " high-output states " associated with anaemia and thyrotoxicosis, in which it was often difficult to tell when patients passed into cardiac failure. He denied emphatically that digitalis exerted its effects by lowering venous pressure, and he illustrated absence of this action in a series of patients with raised venous pressure and high cardiac output but without heart-failure. Postural treatment was vital and many more cardiac beds should be available. A low- sodium diet had been devised containing less than 1 g.

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BRITISH MEDICAL ASSOCIATION

AT the official religious service, held in LiverpoolCathedral on July 18, a large congregation heard theBISHOP OF BIRMINGHAM declare that, after four centuries,the post-Renaissance era was drawing to a close. Inthe phase that was now opening, the outlook would behumanist, and would be profoundly influenced by thegrowth in scientific knowledge. As to progress in

medicine : " It is already clear that possibly the mostimportant medical’ research of the future will be con-cerned with the elimination from human stocks of

genetic defects, and with the production of human

types finer than any that have hitherto appeared. It is

among such human types that the finer kinds of religionand ethics will, in ages to come, show themselves." The

increasing importance of medical science was alreadyevident. " New knowledge is likely to bring ethical andreligious changes which will be more significant thanmaterial progress. Among the consequences of an over-populated world are starvation and warfare. Medicalscience, in many ways so valuable to humanity, is notwithout some responsibility for both calamities." TheBishop went on to express his disbelief in materialmatter. The two fundamentals, he said, were notmind and matter but mind and conduct.

At the annual dinner on July 20, attended by some 550people, Lord HORDER spoke of Liverpool as the gateway ofthe west, the focal point of the Battle of the Atlantic, anda city unique in having two cathedrals built in the 20th

century. In medicine it had taken a lead especially in

public health, in tropical medicine, and in orthopaedics.Responding, the LORD MAYOR (the Rev. H. D. Longbottom)said that, for all its slums and dark patches, Liverpool wasa city of variety and charm ; and the VICE-CHANCELLOR

(Mr. J. F. Mountford) mentioned that among the university’spriorities the new medical school had almost the highestplace. Prof. D. R. SEABORNE DAVIES, proposing The B.M.A.,said that justice was the supreme good ; and justice for thepatient was unattainable without justice for the doctor.

Replying as chairman of council, Dr. E. A. GREGG said thatthough the B.M.A. existed partly to advance the interestsof those who practised medicine, a great proportion of itsenergies was devoted to improving the practice of medicine.It would have preferred to see the National Health Serviceintroduced in stages ; but, now that the service was here,members of the profession must do nothing that would

enable anyone to point a finger of scorn at them. All must

realise, however, that warfare for health against disease was,like other warfare, expensive ; and there must be no stintingof resources : he spoke particularly of the needs of the

public-health service. Sir HARTLEY SHAWCROSS, M.P., pro-posing The President, referred to Sir Henry Cohen’s accessionto the chair of medicine at 34 and of his long and untiringpublic service : all three political parties had sought hisadvice and it had been given objectively. In his replySir HENRY COHEN took the opportunity to pay tribute to allthose who had made the meeting a success. In dealing withthe toast of The Guests, on which he had produced a 93-pagepreliminary memorandum, Mr. BRYAN McFARLAND said therewere those who thought that a dead hand had been laid onmedicine and that its spirit was like to die. But the professionhad remained free and faithful through worse trials than thepresent’and its voice would rise again triumphant and clear.Lieut.-Colonel R. FLEETWOOD-HESKETH (mayor of Southport),Dr. A. J. ORENSTEIN (South Africa), and Dr. DAG KNUTSON(Sweden) responded.Among the films shown at the meeting were the

following :Treatment of Infections of the Hand.-This new film, illustrat-

ing the practice at the hand clinic of the surgical unit,University College Hospital, London, was sponsored byGlaxo Laboratories Ltd., and produced by the Realist FilmUnit Ltd., under the auspices of the British Medical Associa-tion. In sound and colour, it depicts clearly treatment thatcan be carried out single-handed ; and the need for choosingthe right moment for surgical intervention is properlyemphasised. The value of the film is enhanced by thesummary with which it ends. (116 mm. ; running-time28 minutes.)

Total Sympathectomy for Hyperten,sioz.-In sympathectom3roperations, few onlookers can hope to see what the surgeon isabout, because of the depth at which he is working. Thusthis film, by Mr. A. Dickson Wright, which illustrates theprocedure by the retropleural approach, should prove verypopular ; for, thanks to efficient illumination, even the

deepest planes are clearly shown. (16 mm., silent and colour ;running-time 15 minutes.)

In his public lecture at the close of the meeting,Dr. C. 0. STALLYBRASS called for a national effort toeradicate tuberculosis. "And in this I know,’’ he

added, " that 1 represent the views of many, heavilydisheartened and overworked, of those engaged intuberculosis preventive work."

Scientific SectionsMEDICINE

President : Prof. E. N. CHAMBERLAIN

Modern Oonceptions and Therapeuties of Cardiac FailureProf. E. P. SHABpEY-ScnAFER spoke of the need for

a satisfactory definition of heart-failure. To define itas failure of the heart to pump in a proper mannerwould embrace other conditions not commonly acceptedas heart-failure, and it overlooked complex alterationsin the pressure/flow relations occurring in the peripheralvessels. The vascular response of the normal subjecton changing from the recumbent to the erect postureconsisted in vasoconstriction, elevation of the arterialblood-pressure, and diminished peripheral blood-flow.By contrast the patient with cardiac failure developedthese changes when he passed in the reverse directionfrom the semi-erect to the recumbent position. Elevationof the venous pressure was the important factor precipi-tating an attack of acute left ventricular failure, whichwas associated with intense vasoconstriction, raisedarterial pressure, greater cardiac work, and dyspnoea.Vasoconstriction and dyspnoea produced further venons-pressure rise, completing a vicious circle which could bebroken by treatment designed to lower the venous

pressure. It was tentatively suggested that these

changes resulted from modification of the normal posturalor haemorrhagic reactions.

DR. RICHARD BAYLISS said that pulmonary hyper-tension occurred in less than half the cases of emphysema,and mitral stenosis. In the patient with emphysema,pulmonary hypertension, and right ventricular failure,oxygen therapy would lower the pulmonary arterialpressure : it was not yet determined whether thiseffect was due to vasodilatation or to a fall in the cardiacoutput. It was uncertain what part pulmonary arterio-sclerosis played in the maintenance of raised pulmonaryarterial pressure in patients with a severe degree of mitralstenosis. The answer could only be obtained byobserving the results in patients with this conditionwho underwent valvulotomy.

Dr. PAUL WOOD was provocative in his remarks onraised venous pressure, which, he said, could and didexist without precipitating cardiac failure. He instanced,among other examples, the " high-output states "associated with anaemia and thyrotoxicosis, in whichit was often difficult to tell when patients passed intocardiac failure. He denied emphatically that digitalisexerted its effects by lowering venous pressure, and heillustrated absence of this action in a series of patientswith raised venous pressure and high cardiac output butwithout heart-failure. Postural treatment was vital andmany more cardiac beds should be available. A low-sodium diet had been devised containing less than 1 g.