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THE LANCET.

LONDON: SATURDAY, JULY 29, 1922.

The Meeting of the B.M.A.

THE MEETING OF THE B.M.A.-CEREBELLAR FUNCTION.

THE annual meeting of the British Medical Associa-tion at Glasgow is drawing to a close, and its successfrom both scientific and sociological aspects is assured.We publish elsewhere in this issue Sir WILLIAMMACEWEN’S notable Presidential -Address which wasdelivered on Tuesday evening, and its message is soclear and comprehensive that comment would be

superfluous. Sir WILLIAM MACEwEN has been and isa great surgical figure, and his leadership of theAssociation confers mutual honour on it and on

himself, a thesis which needs no support when it isput forward in his own University city.The business meetings have been infused with a z,

very proper spirit considering the times in which welive-the conclusions, so far arrived at, were concreteenough as far as existing conditions were taken intoconsideration, but there was a definite feeling that atany time circumstances might arise which wouldcompel their modification. Especially may all thisbe fairly read into the decisions which have beenarrived at in respect of the two large and vital

questions discussed on the opening days-namely, thatof professional secrecy and that of hospital organisa-tion. The attitude now adopted by the Association,in the intention to protect medical witnesses who findthemselves unable to answer inquiries in the boxwithout violating professional confidences, at first

sight may appear to have been weakened. But nobusiness man-and the Representative Body must, inthe interests of the Association, look strictly at thebusiness aspect of professional positions-can fail toendorse the wisdom of the new policy. Put briefly,last year the Association was committed to the defenceand support of any medical man who, in any circum-stances, might refuse to answer judge or counsel in alaw court, alleging that to do so would be to break thetrust reposed in him by a patient. From a business

point of view this was a dangerous position for theAssociation, which had no opportunity of judgingwhether the medical witness was wholly justified inhis conduct, absolutely well-intentioned and chivalrousas it might have been. Under the new policy of theAssociation the situation must be reviewed by theCouncil, or the Central Ethical Committee of theAssociation acting for the Council, before unqualifiedsupport will be extended to the member who hascome into collision with the Court. The policyis only reasonable, but places of course a responsibilityupon the Council of the Association to act with greatpromptitude. A further resolution of the Representa-tive Body, if it becomes operative, should tightenthis responsibility by decreasing the number ofoccasions on which it need be exercised. Thisdecision is that the proper preservation of professionalsecrecy necessitates a measure of special considerationbeing recognised for medical witnesses, an expressionof opinion with which most of our readers will bein accord. But the justification for this specialconsideration requires to be arrived at, so that thepublic may understand the justice of the generalmedical attitude. Law Courts will then follow suit.The hospital policy of the Association, as revealed

.at the meeting of the Representative Body, showed a

similar appreciation of the fact that the generalmedical attitude ought to be appreciated on twofundamental points. There may come in the nearfuture a clash of interest between medical serviceunder the Insurance Acts and the authorities of theapproved societies. A hospital policy, definite forthe time but flexible for the future, is necessary tomeet this situation, and the Representative Body ofthe Association have adopted such a policy. Secondly,the payment of medical staffs upon voluntary hospitalsis a matter on which the medical profession, whetherin general or consulting practice, are not of one accord.Now some measure of unanimity ought to be arrivedat in the medical profession upon so outstanding amatter, and the action of the Representative Bodyin adopting a report attempting-and very fairlysucceeding-to define the main issues should be

exceedingly helpful. The Representative Body mustbe congratulated upon its work.

Cerebellar Function.THE Presidential Address on Brain Surgery, to

which allusion has been made, sets forth the surgicaldifficulties in diagnosing abscess or neoplasm beneaththe tentorium cerebelli. The address should be readin conjunction with this year’s Croonian Lectures,recently delivered before the Royal College of Phy-sicians of London by Dr. GORDON HoLMES, andpublished at length in our columns. 1 Both will repaycareful study by all who are interested in the majorproblems of neurology. Of these one of the most con-troversial, as it is one of the oldest, is constituted bycerebellar function and its modus operandi, andwhile Dr. HOLMES admits that in all probability theexact nature of cerebral and cerebellar interactionwill not be settled by clinical technique alone, perusalof the Croonian Lectures will convince the reader ofthe weighty contribution the clinico-pathologicalmethod can make to the subject, even if the precisionof experimental physiology is to some extent lacking.Naturally, both in the case of gunshot wounds of thecerebellum, and tumours of the same organ, frommaterial of which types the lecturer has elaboratedhis closely reasoned argument, it is not always easy toseparate disorder of cerebellar function, sensu strictiori,from that of mechanisms united by intimateanatomical links to that mass of neural tissue ;further, Dr. HOLMES has not attempted, exceptindirectly, and as it were in passing, to differentiatebetween cortical and nuclear function in respect ofthe cerebellum. He has preferred, taking the organ asa physiological unit, to describe in admirably minuteyet logical and consecutive fashion the symptomsarising from disease of that structure and presumablyreferable directly to its involvement. Though hehimself has given us clinico-pathological studies of theprimary cerebellar atrophies he has not utilised thesein any degree, apparently, notwithstanding their valuefor the subject, the reason offered being the not

infrequent concomitant degeneration of other, non-cerebellar, structures.A unilateral lesion of the cerebellum in a general

sense gives rise to a series of motor defects in head andneck, trunk, and limbs, on the same side, the descrip-tion and interpretation of which have occupiedinnumerable observers for the better part of a century ;elaborateness and complexity have, perhaps not

unnaturally, come to take the place of the simplicity,not to say superficiality, of the earliest investigations,and it is one of the outstanding merits of Dr. HoLMES’s

1 The Clinical Symptoms of Cerebellar Disease and theirInterpretation, THE LANCET, June 17th, 24th, July 8th, 15th.