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THE LANCET.

LONDON: SATURDAY, AUGUST 6, 1927.

THE BRITISH-AMERICAN NEUROLOGICALMEETING.

LAST week the American Neurological Associationand the Section of Neurology of the Royal Society ofMedicine held a joint meeting in London, and theevent deserves notice even in these days of worldtravel and of congress multiplicity. For this was thefirst occasion on which a British-American gatheringof neurologists has taken place, and it becomes us toput on record our appreciation of the compliment ourAmerican confreres paid us in coming so far (many ofthem having travelled long distances before reachingthe Atlantic) and with such a comprehensive repre-sentation of American neurology, to attend a three-daymeeting. From the very beginning, the reception bySir JAMES and Lady BERRY at the house of the RoyalSociety of Medicine, a note of cordiality was struck,and as the congress proceeded it deepened into oneof mutual regard and of personal good-fellowship.While some of the older neurologists of the UnitedStates were missed, they were nevertheless worthilyrepresented by the veteran Dr. CHARLES DANA, towhom was given the honour of delivering the HughlingsJackson lecture, and who performed his task withdistinction. An abstract of this lecture and of thediscussions as a whole will be found on a later page.The contributions from the younger members of theAmerican Neurological Association were remarkablefor the high general level of knowledge and researchwhich they revealed, and they furnished impressiveevidence of the standard of attainment whichAmerican neurologists have set themselves. Of theexistence of this scientific spirit of inquiry and studythe chance visitor to American schools of medicineand to American medical conferences has long beenaware, but when one of their medical societies (withlimited membership, it is true) comes over to offer itscontributions to an audience the major portion ofwhich is English, and when one presentation afteranother forms a fine addition to neurological theoryor practice, the effect is undoubtedly highly impressive.Who knows whether the tide of research will not setwestwards more strongly than ever, as a sequel to thisboldly conceived and admirably executed idea of

showing an assembly of our English neurologists whatAmerican neurology is doing ? "

Naturally, we shall not with false modesty under-rate the value of the contributions of the former tothis successful joint meeting, the more so as in manyinstances they were of outstanding merit, and weregenerously pronounced to be so by our Americanvisitors. The truth is that contact of mind with mindarouses emulation and yet leads to the cultivation ofdeference, and in this respect the discussions of lastweek must prove eminently fruitful. Criticisms werefriendly and controversies were eschewed, as befitteda meeting of two English-speaking races. At thebanquet which was the official close of the conferencethe toast of " Cooperation in English and AmericanMedicine " was surely honoured not only by outwardsigns, but by mental resolve on the part of guests andhosts that it should stand for a reality to-day.Possibly one of the greatest delights in a joint gatheringof this kind resides in the opportunity it affords of 1

seeing and hearing men whose names have beenfamiliar, through the medium of printed contributions,to neurological doctrine. Alany of those visitors whocrossed the sea to meet us were known by reputation,and it is a charming experience to come into personalcontact with medical confreres animated with thesame ideals as ourselves and interested in the samesubjects ; even if imaginary impressions are correctedthe end-result is never a loss. Beyond the manifestsignificance of these gatherings lies a latent and deepermeaning. It is embodied in the idea that this is the

only kind of interracial rivalry a war-sick world canbring itself to tolerate-in the case of medical men, anamicable struggle to attain the end of perfect know-ledge of the ills of the flesh and to achieve the con-summation of the art of healing. In the realm ofmedical science racial isolation is more than ever animpossibility. Any steps which are taken from timeto time to impress this fact on collective medicalconsciousness will always be welcome. A naturaloutcome of the British-American Neurological Congressis the hope, publicly expressed by our visitors, that intwo or three years a return meeting may be organisedon the other side of the Atlantic. A precedent isestablished with conspicuous success, and it may findan echo in other similar conferences of English-speaking specialists. This would indeed be the bestcompliment that could be paid to the organisers ofthe neurological meeting that has now become a

pleasing memory.

MEDICAL OFFICERS AND PUBLIC SCHOOLS.IN April last a memorandum, with a series of

recommendations, was published in the Supplementof the British Medical Journal dealing with theconditions under which the work of a medical officerof a public school is carried on, and enumerating thecircumstances in which the duties and responsibilitiesdiffer from those of the general practitioner. The

origin of the memorandum lay in the fact that theMedical Officers of Public Schools Association hadsought the assistance of the B.M.A. with a view tosecure improved conditions in their employment andremuneration, feeling that their status requireddefinition and that their prospects called for improve-ment. The memorandum was a very detailed pieceof work, as all will see who refer to it/ for theparagraphs nearly exhaust the alphabet, and theseare followed by 19 recommendations, 13 havingreference to the work of the whole-time medicalofficers of public schools and the remainder dealingwith the part-time officers. It can be said that thematter has been looked at from every side in theinterests of the doctors.At the recent Representative Meeting a report

with this series of recommendations was introducedfor adoption by Dr. J. W. BoNE, Chairman of theMedico-Political Committee, who admitted that theAssociation was leaving its ordinary routine in itsproposed action, opening up a whole new class ofwork; but he urged that this was being done at theinstance of representations from the whole-time medicalofficers of public schools, and in the event it was seenthat the Representative Body declared themselvesready to deal with the matter. A preliminary debatetook place as to the advisability of any such discussionamong the Representatives before an arrangement orapproach for a preliminary understanding had beenarrived at with the governing bodies and headmastersof public schools, and, moreover, it was evident that

1 Brit. Med. Jour., April 23rd, p. 149, Sup.

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each policy, that of going forward and that of pausing,could be soundly supported. Unless the Associationhad formulated its views already there could be

nothing concrete to put before the governors and theheadmasters ; but unless the school authorities andheadmasters were invited to collaborate from thefirst they might be unwilling to join in a conferencewhose terms of reference had never been placed beforethem. The meeting in the end-and wisely, we think-decided to go into committee, with a view in this wayto get the opinion of the Representatives broadlyupon certain propositions ; after which the wholematter could be taken back to the Council of theAssociation for the conduct of further negotiations.In committee accordingly Dr. BONE moved the mostcritical of the recommendations contained in thereport-namely, that the whole-time medical officerof a public school should be appointed by, be

directly responsible to, and have direct access to, thegoverning body of the school. The recommendationwas carried unanimously, and here at any rate wemay surmise that all modern educational bodies willbe in accord. To make the man who is to beresponsible, with the cooperation of all the membersof the teaching staff, for the health of the pupils an.integral part of the organisation of the school isonly logical if-and this is provided for in theRecommendations-the method of election securesan officer whose training and experience fit him for thepost. But there will be many things to be discussedin detail, though already some of the great publicschools may be inclining towards a policy which haseverything in its favour.The duties which such an officer would have to

discharge-speaking in terms of the public school forboys-are many and different, and call for a displayof wisdom in various shapes as he comes into touchwith the head-master, the teaching staff--especiallythe house-master, and the boys. He will be responsiblefor the examination of the new pupils, and the scrutinyof these before admission should be as well organisedand as thorough as any entrance examination in

respect of educational standards ; in fact the physicaltests call for greater care as being more difficult ofapplication. At this point he will have the advantage,if and where needed, of cooperation with the pupil’sfamily doctor, but thereafter he will be solely respon-sible for the boy’s health when at school, and from thepoint of view of isolation he may be at a disadvantagein his clinical practice which is not shared to-day bymany of his colleagues in general practice. He mustbe prepared to make periodical examinations of residentpupils with as much method and particularity as theteaching staff display in their periodical stock-takings of educational progress ; it is at least as

important that at a given age a boy should havereached appropriate physical development and be

bearing the strain of growth equably, as that he shouldbe in a form with his coevals and be holding his ownamong them. How to obtain the most trustworthyresults of physical examinations will call for a realknowledge of boys and an understanding of the partwhich games play in the world of school. And whileit will be his duty to observe, in the interests of staffand pupils alike, that the general sanitation of theschool is good, he will also have to supervise andinspect the dietary, when there may be occasion forthe display of genuine tact in his relations with his

colleagues on the teaching staff. And when it isadded that much of this carefully planned work mustbe the subject of detailed note-making and writtenreports, enough has been said on general lines, withoutgoing into exact definition of clinical procedure, to

show that such an officer should be selected in the-most careful manner and on indisputable grounds forhis fitness both in character as well as in attainments.He should owe his appointment to central authorityto which he should make a regular report ; and while-thus removed from the risks of mere personal bias,he should receive suitable payment for his services.The memorandum of the Association should be-circulated to the governing bodies and teaching staffsof the public schools--to a selected group of largeinstitutions in the first place--and their criticisminvited. It is clear that all the recommendationswill not be acceptable to all the schools, but themain principles should find immediate favour becauseof their public effect. A basis would thus be obtainedupon which fruitful action could take place ; for inthe words which are the best argument for reform,." Something has got to be done."

CANCER OF THE UTERUS.To refuse to look unwelcome facts in the face,

even when knowledge may bring relief, is a deeplyingrained habit of the human mind. Its extentand its tragic consequences are illustrated by theplain tale of figures amassed by Dr. JANET LANE-CLAYPON 1 in her survey of the results of treatingcancer of the uterus. In 51 per cent. of the womenwho applied for treatment of cancer of the cervixit was no longer possible to undertake radicaloperation, and on the average, according to theirown statement, these patients had had symptomsfor six to nine months before attending hospital.Dr. LANE-CLAYPON points out that as the naturatduration of the disease from the onset of symptomsto death in untreated cases is about 21 months, thedelay of six to nine months is largely accountable forthe high proportion of inoperable cases. To thetoll of this avoidable waste must be added manyyears of life lost by an unknown number of womenwho never come for treatment.

This is only one of many points brought out bythe report. Periodical balancing of the accountsin all available records is essential for any clear

grasp of the practical results of our knowledge andtreatment of disease, and it is equally obvious thatin this particular case the mere volume of the scatteredliterature makes this balancing almost impossiblefor most medical men, particularly, perhaps, forthose specialists to whom it is most useful. The

Ministry of Health is to be congratulated in takingup this task and in having found in Dr. LANE-CLAYPON a worker able and willing to assimilatethe mass and to reproduce the essential informationin a form in which it is readily available for the useof the profession. The data are taken from 848 papersderived from 16 different countries, and cover some80,000 cases of disease. Yet the main facts have-been clearly given in 59 pages of text backed by76 of tables. To summarise such a summary woulddo the subject little justice and we recommend allwho are interested to study the report for them--selves. A few of the salient points may, however,be mentioned mainly to indicate its scope. Cancerof the cervix and of the body of the uterus are as faras possible considered separately. In cancer of the cervixthe relative advantage-as measured by the survivor-ship at the end of five years-of treatment by abdo-

1 Reports on Public Health and Medical Subjecbs. No. 40.Cancer of the Uterus: A Statistical Inquiry into the Results ofTreatment, being an Analysis of the Existing Literature. ByJanet E. Lane-Claypon, M.D., D.Sc. Ministry of Health. 1927.3s. 6d.