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CONFERENCES ON THERAPY
1109 The presidentialaddress-as would be expected by those who know Dr. Evang and his record-was an inspiring appeal for the Common Man, and included a call to the U.S.S.R. to renew collaboration. The general speeches that followed, on the reports of the directorgeneral and the executive board, included attacks on the policy of W.H.O.-and on the U.S.A. in particular-by Czechoslovakia, Hungary, Bulgaria, and Poland, who complained of discrimination in the supply of medical equipment, notably the American refusal to give export licences for Podbielniak extractors for the production of penicillin. Although these attacks contained language unusual at health congresses, and veiled threats of withdrawal, the general implication seemed to be that not only was non-cooperation not contemplated but the door was not necessarily closed even on U.S.S.R. collaboration. The complaints heard previously from the same quarter, of swollen staff, excessive salaries, and unsound geographical distribution of staff, were reiterated but without any detailed or constructive suggestions : somewhat better founded was the charge. that these countries had not received what they had most wanted from W.H.O., because of the system of priorities : no doubt the assembly will take this into consideration in adopting the programme for 1950. Other noteworthy speeches included that of Rajkumari Amrit Kaur, minister of health for India, whose sincerity and evident wish to use W.H.O.’s deeply impressed the assembly. Dr. Melville Mackenzie (U.K.) struck a note of caution based on the approach of " suitability for international action." This approach is the.best means of reconciling the divergent tendencies of so many delegations, which are apt to praise concentration of effort and then propose a variety of new special projects. Dr. Stampar (Yugoslavia) steered an adroit course between the scylla of Western deviation and the charybdis of Cominform conformity, and SurgeonGeneral Leonard Scheele made a but firm repudiation of discrimination by the U.S.A. and a declaration that his country was wholeheartedly behind W.H.O. in its programme. Three weeks have been allotted to the assembly.
help
temperate
CLOSURE OF THE LOCK HOSPITAL THE North-West Metropolitan regional hospital board decided on June 13 that the London Lock Hospital, Dean Street, should no longer be used for the treatment of venereal diseases and that its premises should become the nucleus of the West End Hospital for NervousDiseases, which was severely damaged in the war. This decision, reached after the proposal had been referred for reconsideration, affects both the wards of the Lock Hospital, which were shortly to be reopened, and its outpatient clinic, which in 1948 dealt with 2433 new cases and total attendances of 24;800. The board have satisfied themselves that other hospitals within easy reach of Dean Street—notably St. Paul’s, University College, and the Middlesex Hospitals--can cover the needs of the Lock’s clientele more than twice over, whereas the West End Hospital’s service is not adequately covered elsewhere. The prevention of wasteful overlapping of hospital services is one of the main functions of the regional boards ; and, though in the 200 years since its foundation at Hyde Park Corner the Lock Hospital has built up a valuable local reputation for wisdom and kindliness, it is for the board to decide whether its work can be as effectively and more economically done by sharing it among other hospitals. Teaching, however, is outside and it remains questiona regional board’s purview ; able whether the teaching of venereology in London would not have benefited by the retention and renovation of the Lock Hospital as a centre for postgraduate training.
N.H.S. AND E.C.A. Mr. W. A.
Richardson, editor of Medical Economic,
to the United States after examining the National Health Service, is reported1 as saying that
returning
programme of socialised medicine could given under the Marshall plan. There is of course a sense in which all our activities depend on the generous effort of the American people to set the European economy again on its feet ; for without that effort the whole pattern of our, lives would probably have changed to something far simpler and uglier. If Mr. Richardson merely means that without E.C.A. we should have had no National Health Service, perhaps he is right. But if he is suggesting that the service is conducted at the expense of our American friends, that is quite another matter. V4hether we choose to pay for medical care by private fees and charitable benefactions on- the one hand, or by compulsory contributions and taxes on the other, is entirely an internal affair : we are simply redistributing the burden among ourselves as we think best. The Americans can be supposed to pay for the N.H.S. only in so far as its establishment has increased this country’s difficulty in earning dollars and has thus made us more If the N.H.S. has diverted labour or on Marshall aid. materials from the dollar-earning industries, or has appreciably raised costs in those industries, the criticism can be maintained ; but not otherwise. We were glad to hear of this - week’s denial from Mr. Finletter, E.C.A. minister here, that the idea has any substance.
this
country’s
not be carried out without American dollars
dependent
_
CONFERENCES ON THERAPY THE technique of teaching by - recorded expositions and the subsequent cross-examination of teacher by student was probably begun by Sir Byrom Bramwell in Edinburgh at the end of last century, when he published his famous Clinical Studies. Thetechnique of the
recorded clinicopathologicalconference was developed by Cabot in Boston, and the Cabot cases became renowned and valuable factual records. The success of the method has now led to further growth and development, and clinicopathological conferences form a focusing point of medical educational activity in most of the American schools. Other conferences are now being developed on clinical and research problems, and Cornell Medical School makes a special point of arranging conferences on therapy. The conversational reporting makes the published volumes interesting and easy to read. Cross-examination of the opening speakers by other,members of the staff helps to clarify uncertain points, and also to reveal those on which knowledge is uncertain or lacking. In the latest volume,2 discussions on the management of congestive heart-failure, streptomycin, protein
hydrolysates, pneumonia, BAL, hepatic insufficiency, and thrombophlebitis are to be found among others. The speakers often take a novel line which sometimes leads them into deep water, and a good many contrary opinions are expressed. But that is partly where the value of the method comes in. The only question is whether so lavish a method of reporting lends itself to publication in book form. Perhaps the best place for recording these discussions is thejournals, and in fact most of them are already in print in the Arzerica7z Jau.za1 of JMetHctMe and- elsewhere. The demand for the collected/ reports, however, seems to be high in the United States, and there Cornell.
are
now
three volumes in this series from
1. Daily Telegraph, June 17. 2. Cornell Conferences on Therapy : vol.III. Edited by HARRY GOLD, M.D. New York and London: Macmillan. 1948. Pp. 337. 17s. 6d.
help
temperate
CLOSURE OF THE LOCK HOSPITAL THE North-West Metropolitan regional hospital board decided on June 13 that the London Lock Hospital, Dean Street, should no longer be used for the treatment of venereal diseases and that its premises should become the nucleus of the West End Hospital for NervousDiseases, which was severely damaged in the war. This decision, reached after the proposal had been referred for reconsideration, affects both the wards of the Lock Hospital, which were shortly to be reopened, and its outpatient clinic, which in 1948 dealt with 2433 new cases and total attendances of 24;800. The board have satisfied themselves that other hospitals within easy reach of Dean Street—notably St. Paul’s, University College, and the Middlesex Hospitals--can cover the needs of the Lock’s clientele more than twice over, whereas the West End Hospital’s service is not adequately covered elsewhere. The prevention of wasteful overlapping of hospital services is one of the main functions of the regional boards ; and, though in the 200 years since its foundation at Hyde Park Corner the Lock Hospital has built up a valuable local reputation for wisdom and kindliness, it is for the board to decide whether its work can be as effectively and more economically done by sharing it among other hospitals. Teaching, however, is outside and it remains questiona regional board’s purview ; able whether the teaching of venereology in London would not have benefited by the retention and renovation of the Lock Hospital as a centre for postgraduate training.
N.H.S. AND E.C.A. Mr. W. A.
Richardson, editor of Medical Economic,
to the United States after examining the National Health Service, is reported1 as saying that
returning
programme of socialised medicine could given under the Marshall plan. There is of course a sense in which all our activities depend on the generous effort of the American people to set the European economy again on its feet ; for without that effort the whole pattern of our, lives would probably have changed to something far simpler and uglier. If Mr. Richardson merely means that without E.C.A. we should have had no National Health Service, perhaps he is right. But if he is suggesting that the service is conducted at the expense of our American friends, that is quite another matter. V4hether we choose to pay for medical care by private fees and charitable benefactions on- the one hand, or by compulsory contributions and taxes on the other, is entirely an internal affair : we are simply redistributing the burden among ourselves as we think best. The Americans can be supposed to pay for the N.H.S. only in so far as its establishment has increased this country’s difficulty in earning dollars and has thus made us more If the N.H.S. has diverted labour or on Marshall aid. materials from the dollar-earning industries, or has appreciably raised costs in those industries, the criticism can be maintained ; but not otherwise. We were glad to hear of this - week’s denial from Mr. Finletter, E.C.A. minister here, that the idea has any substance.
this
country’s
not be carried out without American dollars
dependent
_
CONFERENCES ON THERAPY THE technique of teaching by - recorded expositions and the subsequent cross-examination of teacher by student was probably begun by Sir Byrom Bramwell in Edinburgh at the end of last century, when he published his famous Clinical Studies. Thetechnique of the
recorded clinicopathologicalconference was developed by Cabot in Boston, and the Cabot cases became renowned and valuable factual records. The success of the method has now led to further growth and development, and clinicopathological conferences form a focusing point of medical educational activity in most of the American schools. Other conferences are now being developed on clinical and research problems, and Cornell Medical School makes a special point of arranging conferences on therapy. The conversational reporting makes the published volumes interesting and easy to read. Cross-examination of the opening speakers by other,members of the staff helps to clarify uncertain points, and also to reveal those on which knowledge is uncertain or lacking. In the latest volume,2 discussions on the management of congestive heart-failure, streptomycin, protein
hydrolysates, pneumonia, BAL, hepatic insufficiency, and thrombophlebitis are to be found among others. The speakers often take a novel line which sometimes leads them into deep water, and a good many contrary opinions are expressed. But that is partly where the value of the method comes in. The only question is whether so lavish a method of reporting lends itself to publication in book form. Perhaps the best place for recording these discussions is thejournals, and in fact most of them are already in print in the Arzerica7z Jau.za1 of JMetHctMe and- elsewhere. The demand for the collected/ reports, however, seems to be high in the United States, and there Cornell.
are
now
three volumes in this series from
1. Daily Telegraph, June 17. 2. Cornell Conferences on Therapy : vol.III. Edited by HARRY GOLD, M.D. New York and London: Macmillan. 1948. Pp. 337. 17s. 6d.