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JAMES MACKENZIE INSTITUTE FOR CLINICAL RESEARCH.
186 be paid to the opinions of those in touch with the living being. The fact that for thefirst time ? history research had figured in the agenda of the Imperial Conference which had been held during the Cirsoid Aneurysm. autumn marked a distinct stage in the attitude of The second case was a cirsoid aneurysm of the our administration to it. But there was a danger right suprascapular artery in a man of (3() who first that too much reliance was being placed upon the The pulsating word noticed a lump six months ago. research " and that anyone getting into and bleeding was stopped by the diathermal cautery. The wound healed well and the patient was now able to walk, but still dragged his left leg.
"
swelling lay below and slightly outside a congenital and measured about 3 inches. Running nævus down and slightly outwards from this was a dilated, tortuous. thickened vein. There was marked pulsation and thrill and a diastolic bruit all over the swelling. These were eliminated by pressure on the subclavian artery, and removal after temporary ligature of this vessel was the treatment proposed. *
The PRESIDENT and Mr. OGILVIE concurred as to the importance of temporary ligature, as the bleeding from this type of tumour might be appalling.
Paget’s Disease with Nephrolithiasis. The third case was one of Paget’s disease with renal calculus in a man of 07.
dift1culties had only to pronounce the magicword to have these difficulties overcome. There was also the danger of clinical research coming to be looked upon as something apart from the practice of medicine. whereas it should grow out of the daily work of It required observation. intuition. practitioners. and imagination, just as much in the clinician in his daily round as in the laboratory worker. In the relationship of clinical research to the public services there was the danger that the enormous machine of administration might prove of more injury than service to the work of people who were so to speak, on their own and uncoördinated. One way to avoid this danger was to imbue the rminds of the administrator and the clinician witha proper conception of the work and difficulties of The administrative worker must coxnc research. in contact with the growing process which research
health
of the head had been noticed six years the legs four years ago. Twenty-six years ago some renal calculi had been removed from the )eft kidney and for ten years the patient had had periodical represented. Thesum of £2,860,000, said Major Elliot, had been attacks of Last November pain in the left loin. he had a typical renal colic followed by sweiting,’ spent in Scotland on feeding at the public expense of the right testicle. Radiography showed four large stones during 1926, and the State had been devoting parin the left kidney and cystoscopy revealed a cystitis and ticular attention to the problems of nutrition as a little pus exuding from the left ureter. The urea conaffecting child welfare, particularly with regard t() centration of the right kidney was 2’7 I. per cent., so nephrectomy was performed. Owing to the kypbosis the rickets. Public authorities were beginning to spend last rib almost met the iliac crest, and made the operation ’, large sums on irradiation. Expenditure on treatment difficult, but recovery was uneventful. by cod-liver oil, however, might be counted im pence
Enlargement bowing of
and
In reply to a question Mr. WAKELEY said that he did not mean to suggest any connexion between the two conditions, but Dr. E. I. SPRIGGS remarked that recently an attempt had been made to ascribe all these conditions to an infective origin, and quoted a case of a patient under his care in whom the bone disease had distinctly improved after the removal of a chronically infiamed appendix.
against shillings for treatment by li ght ,an d authoritative scientific opinion might thus be of immediate tinancial importance. The problem was fully discussed in the Scottish Board of Health Report for 1925 and a Conference had been called in Edinburgh in July, 192(), by the Board of Health with the object of enlisting the physiologist and biochemist to serve the clinical
man
who had for many years worked at the
problem. The idea was to give the clinician the actual work of the scientist and not the published living Mr. OUI1.YIE showed a case of results alone. This was an attempt to yoke the Tumour of the Calf. science and art of medicine together to this practical At the age of 19 (40 years ago) the man had twisted problem in Scotland and it was an example only. his right leg and been three months in hospital ; The general questions involved were of great interest there had been no fracture. During the next 12 and importance. months a lump slowly appeared in the left calf and The relationship of research and administration since then had given no trouble. The swelling was had been considered at the Imperial Conference, large, rounded, placed deeply in the gastrocnemius, and Lord Balfour had made a preliminary survey elastic but not fluctuating, and not tender. It was of the problem, which though it dealt with industry probably a thick-walled cyst of traumatic origin. and agriculture rather than medicine, was largely lVIr. Ogilvie compared it with the cysts due to rupture applicable to the question under discussion. of the rectus in typhoid, and pointed out that it must ’’ Can we suppose," said Lord Balfour, *’ that either be a real tumour, as inflammatory fibrosis would have or organisation can increase the supply of money original diminished in size after all that time.
scientific genius, or direct it, when found, into utilitarian It is plainly impossible. Genius cannot be The CHAIRMAN remarked on the size of the lesion channels ?a The best we can do and said he had a strong suspicion that these lesions made to order nor discovered by rule. is to provide fitting opportunities for its exercise when we wereall really sarcomata. Cysts about the knee are fortunate enough to find it,.... Yet I am convinced that were liable to travel down the calf, and this might much may be accomplished if we are not too ambitious.... be an example. How, then, is it possible for the Conference to assist ? It
Mr. OGILVIE agreed that it of a Baker’s cyst.
JAMES
might be
in the nature
MACKENZIE INSTITUTE CLINICAL RESEARCH.
FOR
meeting of this Institute held on Dec. 21st last WALTER ELLIOT gave an address on CLINICAL RESEARCH IN ITS RELATION TO THH PUBLIC HEALTH SERVICES. Expressing his conviction of the valuable results which must accrue from the meeting of public health administration and general practitioners, he laid it down as a fundamental rule that every respect must AT
a
Major
give money ; it cannot impose a policy... let us cultivate easy intercourse and full cooperation will follow. Investigators in the same intellectual field though far separated in space will work as partners. Overlapping, and all the intellectual waste that accompanies overlapping, will be greatly diminished ; and considered judgments about the gaps in our knowledge which most urgently require to be filled will follow as of course." cannot
In conclusion, Major Mlliot said that public health work would increasingly concern itself with research ; that control, especially superimposed control, would of necessity fail, and opportunities for work were the most that organisations could hope to offer; and that the independence of scientific institutions ought to be jealously guarded so as to provide the necessary check on the rapidly increasing undertakings of State research.
"
swelling lay below and slightly outside a congenital and measured about 3 inches. Running nævus down and slightly outwards from this was a dilated, tortuous. thickened vein. There was marked pulsation and thrill and a diastolic bruit all over the swelling. These were eliminated by pressure on the subclavian artery, and removal after temporary ligature of this vessel was the treatment proposed. *
The PRESIDENT and Mr. OGILVIE concurred as to the importance of temporary ligature, as the bleeding from this type of tumour might be appalling.
Paget’s Disease with Nephrolithiasis. The third case was one of Paget’s disease with renal calculus in a man of 07.
dift1culties had only to pronounce the magicword to have these difficulties overcome. There was also the danger of clinical research coming to be looked upon as something apart from the practice of medicine. whereas it should grow out of the daily work of It required observation. intuition. practitioners. and imagination, just as much in the clinician in his daily round as in the laboratory worker. In the relationship of clinical research to the public services there was the danger that the enormous machine of administration might prove of more injury than service to the work of people who were so to speak, on their own and uncoördinated. One way to avoid this danger was to imbue the rminds of the administrator and the clinician witha proper conception of the work and difficulties of The administrative worker must coxnc research. in contact with the growing process which research
health
of the head had been noticed six years the legs four years ago. Twenty-six years ago some renal calculi had been removed from the )eft kidney and for ten years the patient had had periodical represented. Thesum of £2,860,000, said Major Elliot, had been attacks of Last November pain in the left loin. he had a typical renal colic followed by sweiting,’ spent in Scotland on feeding at the public expense of the right testicle. Radiography showed four large stones during 1926, and the State had been devoting parin the left kidney and cystoscopy revealed a cystitis and ticular attention to the problems of nutrition as a little pus exuding from the left ureter. The urea conaffecting child welfare, particularly with regard t() centration of the right kidney was 2’7 I. per cent., so nephrectomy was performed. Owing to the kypbosis the rickets. Public authorities were beginning to spend last rib almost met the iliac crest, and made the operation ’, large sums on irradiation. Expenditure on treatment difficult, but recovery was uneventful. by cod-liver oil, however, might be counted im pence
Enlargement bowing of
and
In reply to a question Mr. WAKELEY said that he did not mean to suggest any connexion between the two conditions, but Dr. E. I. SPRIGGS remarked that recently an attempt had been made to ascribe all these conditions to an infective origin, and quoted a case of a patient under his care in whom the bone disease had distinctly improved after the removal of a chronically infiamed appendix.
against shillings for treatment by li ght ,an d authoritative scientific opinion might thus be of immediate tinancial importance. The problem was fully discussed in the Scottish Board of Health Report for 1925 and a Conference had been called in Edinburgh in July, 192(), by the Board of Health with the object of enlisting the physiologist and biochemist to serve the clinical
man
who had for many years worked at the
problem. The idea was to give the clinician the actual work of the scientist and not the published living Mr. OUI1.YIE showed a case of results alone. This was an attempt to yoke the Tumour of the Calf. science and art of medicine together to this practical At the age of 19 (40 years ago) the man had twisted problem in Scotland and it was an example only. his right leg and been three months in hospital ; The general questions involved were of great interest there had been no fracture. During the next 12 and importance. months a lump slowly appeared in the left calf and The relationship of research and administration since then had given no trouble. The swelling was had been considered at the Imperial Conference, large, rounded, placed deeply in the gastrocnemius, and Lord Balfour had made a preliminary survey elastic but not fluctuating, and not tender. It was of the problem, which though it dealt with industry probably a thick-walled cyst of traumatic origin. and agriculture rather than medicine, was largely lVIr. Ogilvie compared it with the cysts due to rupture applicable to the question under discussion. of the rectus in typhoid, and pointed out that it must ’’ Can we suppose," said Lord Balfour, *’ that either be a real tumour, as inflammatory fibrosis would have or organisation can increase the supply of money original diminished in size after all that time.
scientific genius, or direct it, when found, into utilitarian It is plainly impossible. Genius cannot be The CHAIRMAN remarked on the size of the lesion channels ?a The best we can do and said he had a strong suspicion that these lesions made to order nor discovered by rule. is to provide fitting opportunities for its exercise when we wereall really sarcomata. Cysts about the knee are fortunate enough to find it,.... Yet I am convinced that were liable to travel down the calf, and this might much may be accomplished if we are not too ambitious.... be an example. How, then, is it possible for the Conference to assist ? It
Mr. OGILVIE agreed that it of a Baker’s cyst.
JAMES
might be
in the nature
MACKENZIE INSTITUTE CLINICAL RESEARCH.
FOR
meeting of this Institute held on Dec. 21st last WALTER ELLIOT gave an address on CLINICAL RESEARCH IN ITS RELATION TO THH PUBLIC HEALTH SERVICES. Expressing his conviction of the valuable results which must accrue from the meeting of public health administration and general practitioners, he laid it down as a fundamental rule that every respect must AT
a
Major
give money ; it cannot impose a policy... let us cultivate easy intercourse and full cooperation will follow. Investigators in the same intellectual field though far separated in space will work as partners. Overlapping, and all the intellectual waste that accompanies overlapping, will be greatly diminished ; and considered judgments about the gaps in our knowledge which most urgently require to be filled will follow as of course." cannot
In conclusion, Major Mlliot said that public health work would increasingly concern itself with research ; that control, especially superimposed control, would of necessity fail, and opportunities for work were the most that organisations could hope to offer; and that the independence of scientific institutions ought to be jealously guarded so as to provide the necessary check on the rapidly increasing undertakings of State research.