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SOME BIOLOGICAL ASPECTS OF DISEASE.
155
Notes, Short Comments, and Answers to Correspondents. SOME BIOLOGICAL ASPECTS OF DISEASE. An Abstract of a Lecture delivered under the auspices the Chadwick Trust, on Nov. 25th, 1920, by Professor J. B. FARMER, F.R.S.
of
is known, is responsible for the incidence of cancerous development; probably various stimuli are able to effect that wonderful change. The result, however, was always
the same-freedom from that control which is essential for the maintenance of an organised cell community. The tissue often exhibited rapid cell multiplication, which accompanied the newly acquired independence, and might lead to transplantations or metastases of cells which had been derived from the original cancer This occurred in varied degrees, and the cells cells. themselves might still retain, to some extent, the form and qualities of the typical tissue cells in which the change first appeared. The characteristic effect, however, always seemed to be to produce a more generalised type, recalling in some measure that of the lower organisms. An essential fact was that these transplanted cancerous units did not infect the tissues in which they came to lie, though they might, and often did, produce changes in the growth of the tissues, leading to the formation of the stroma. The circumstance that this kind of tissue could rise from once normal cells, as the indirect result of stimuli of various kinds-e.g., continuous irritation and inflammation, the effects of lesion or of other less clearly ascertained precursory conditions-served to emphasise the need of a much more thorough biological examination than had hitherto been made. A suggestive example which showed how the protoplasm could change its behaviour under certain conditions was furnished by the events in the life-history of a myxomycete. These small organisms started life as a number of independent amoebiform cells, each with its own power of movement and growth. By-and-by a number of these fused to form a protoplasmic living mass of slime, which then behaved as a lowly but really organised entity, capable of feeding upon various nutritive substances. The coalescence of the individual amœbæ to form the plasmodium was followed immediately by the fusion, in pairs, of nuclei. As soon as this had taken place no more amoabae were admitted as partners into the new cell republic, but any that approached sufficiently near it were drawn in and devoured.
introductory remarks the lecturer said that he to dwell on certain peculiarities or properties of the higher organisms with which healthy and normal discharge of function is intimately connected. The illustrations of the points raised in the lecture were largely chosen from examples drawn from the plant kingdom, partly because from an experimental point of view plants were more readily accessible than animals, and also partly because the things of most fundamental importance were those which are i common alike to animals and plants. Interaction of Parts of an Orharcistn. Although our knowledge as yet was but relatively small, an outstanding fact was that one part of the organism could, and habitually did, influence other parts, limiting and directing their possibilities of growth and determining the particular mode of development which would be actually followed in any given individual. It was shown by means of a number of examples drawn from the study of plants, and supplemented by others from animal life, how the organisation of an individual depended on the mutual influence of its constituent .cells one upon another. The coordinated growth which led to the development of a particular form depended on the serial (or sequential) nature of the reactions which went on in the cells and tissues of the organism. An intelligent recognition of this fact and of its consequences was essential Survey of the Present Position. to a proper appreciation of the larger problems both of the cancer problem still remained for the most .health and disease; for anything which could modify the Although " chemical changes concerned in the production of a " normal" part (and from the point of view of its victims entirely) .organ or tissue was reflected in a departure, to a greater or an unsolved one, it could nevertheless be attacked less extent, from the particular form or structure normal with a fair chance of success; but failure seemed to be inevitable, unless the right measures were adopted in for that organ or tissue. attacking it. Surveying the present position we might well I,:eterrtal Conditions. Modification of Organisms by ask how much have we actually found out, how much The lecturer then went on to show, by consideration of a nearer we were to the understanding of the causes which number of selected examples, how differences in chemical bring about these far-reaching changes in previously normal or physical environment might produce definite changes body cells-changes which endowed them with such appalling in the organism subjected to them. He further insisted qualities. It had been discovered that the cell nuclei that it must not therefore be concluded that only the exhibited remarkable modifications ; that those wonderful external conditions mattered ; a closer analysis of the facts structures the chromosomes had undergone suggestive emphasised the essential point that only when the environ- alterations both in number and in form. This in itself ment was able to interfere at all, so to speak, with the protowas a step in the right direction, and the lecturer believed plasm itself could a response of the kind indicated be we were justified in correlating the nuclear changes with obtained. In other words, the course of development in any the new properties acquired by the cells individually-in given cell, or in any given individual, was only subject to other words, that there was a causal nexus between modification by external conditions in so far as it was itself nuclear change and functional disturbance. But if we susceptible to influence by those conditions. For, on the were asked what started these complex changes in the one hand, the effects of temporary isolation of parts of the cell nuclei, we should have to answer that as yet we body from the material influences exerted by adjacent parts did not know. The older assertions as to the existence might result in a:permanent loosening of those ties which pre- of specific parasites, whether bacteria, yeasts, protozoa, viously served to knit the constituent cells into a coherent or even helminthines, had not stood the test of closer organism. On the other hand, union of parts hitherto separate examination. The more hopeful line of investigation seemed might result in the formation of a synthetic new organism, to point in the direction of chemical or phvsico-chemical different from those from which it-the new organism- disturbances, which might act in various ways and themhad been built up. Lichens afforded a striking illustration selves be traceable to more than one source; but the result of this fact. Other illustrations were provided in the new was clear, so far as it is known up to the present time. The relations that are so commonly established between fungi cells so affected passed through certain definite changes, and roots or other parts of the higher plants. Further and became freed from those coordinating influences by aspects of the matter were opened up by a consideration of which their chemical processes were previously regulated, the various abnormal growths which could definitely be and by which their multiplication had previously been held traced to the substances injected by parasitic animals, and a in check. study of the formation of vegetable galls afforded a suggestive Such a complex problem as that of, cancer was not likely outlook on the consequences of the mutual relations here to yield up its secrets till it had been broken down into the established between parasite and host. smaller components of which it constituted the formidable From the foregoing considerations and conclusions, the sum’. The smaller problems must then be systematically lecturer passed on to a brief discussion of those various attacked, and upon their solution the issue of the whole abnormal growths, or neoplasms, which originate as the matter would finally depend. It appeared to be clear that result of obscure changes taking place within the cells success could only be reasonably looked for if the new themselves. investigations were planned from the first on sound general Cancer. lines and placed in the hands of the very ablest men who The normal course of events which produced and main- could be found for the purpose. In spite of the dangers and tained what is called organisation could he upset in various difficulties lying in the way of organising research, the latter ways. How did this circumstance affect our outlook on the could be organised if wisdom, and not merely administration, mysterious disease which we called cancer ?-? The funda- ruled. Indeed, it had already been found practicable in mental fact was that certain body cells broke away fromdealing with other scientific problems or groups of problems, that coördinating elusive influence which controls normal though on a relatively smaller scale. development. The change is accompanied by cellular and General Nature of Required Research. nuclear modification, some of which had already been for example, need to know far more than was We others not as As Sir W. Collins should, recognised, perhaps yet. ] had long maintained, no specific causal organism, so far asknown at present as to the precise nature of those influences IN his
proposed
156 which, by controlling individual cellular activities, made possible the existence of an organism. In certain directions actual progress had already been made-for example,
in the case of some internal secretions. Tasks such as these would fall naturally within the province of the physiologist and of the bio-chemist, both on the plant and on the animal side. Extensions into the region of comparative experimental research on the physiology and bio-chemistry of the lower organisms were also clearly indicated. Far more must be known, also, of the minute cellular changes which were involved; this would fall within the scope of the cytologist. Furthermore, all that assistance which the medical profession alone was in a position to render would be required, inasmuch as cancer was most common in the human species, and from a practical point of view it was really to this circumstance that the real urgency of concerted action was mainly to be attributed. In order that such research, based on, concentrated and cooperative action, might be carried on with a prospect of fruitful results, it was essential to attract and retain the best men. Ample The task means must be forthcoming for this purpose. itself was so big that unless we were prepared to see it through on a liberal scale it seemed hardly worth while to proceed with it at all, for judging by past experience, little was to be expected from isolated efforts or from half-measures. The question was, were we prepared to go on watching the daily ravages of an unsparing foe in our midst, which continued still to strike, even as other diseases struck, till they were brought under reasonable control by means of scientific discovery, first as to their real nature and immediate cause, and thence by rationally devised checks on their onslaught. It was true that so far as we could judge, this problem was far more complex than they have proved to be. It might well be that a long time would elapse before malignant disease could be brought under effective control; we should do well not to be too sanguine or too impatient. The lecturer here emphatically stated that he was far from undervaluing the work now going on at various institutions in this and other countries; but it seemed to him that the full magnitude of the task had not been sufficiently realised, and hence that the means which were essential to success had hitherto been lacking.
PORTEOUS ’ MAZES." To the Editor of THE LANCET. SIR,-In reference to your answer to °° S. M. 0." in your issue of to-day’s date may I say that the Porteous " mazes" can be obtained from the C. H. Stoelting Company, 3037-3047, Carroll-avenue, Chicago, Illinois, U.S.A. Almost any kind of psychological apparatus can be got from this firm. And it is not creditable to British enterprise that, so far as I know, there is no firm in this country which acts as agent for this form of scientific goods. Apart from the trouble of ordering from, and remitting to, America, a British depot would have the great advantage of enabling one to inspect some particular form of apparatus before purchasing it. It is annoying to purchase some form of test and then to find it unsuited for the particular purpose for which I am, Sir, yours faithfully, one wanted it. M. HAMBLIN SMITH. H.M. Prison, Birmingham, Jan. 8th, 1921. DISABLED officers and nurses who served during the war, with the widows and dependants of deceased officers, can obtain advice and information regarding their rights under the regulations of the Ministry of Pensions by applying to the Officers’ Friend," Ministry of Pensions, Cromwell House, London, S.W. 1, or to the " Officers’ Friend " at any of the regional offices of the Ministry-viz., Burton Court, Chelsea, S.W. 1., Newcastle-on-Tyne,
along
Manchester, Bristol, Leeds, Nottingham, Birmingham, Edinburgh, Dublin, Belfast, or Cardiff.
Letters, &c., Communications, been received
Outline of a Scheme. he continued, it was obviously neither practical nor useful then and there to attempt to formulate a detailed scheme, he would venture to outline the principles which he believed should be kept in mind. About a dozen first-rate men attached to research in the different relevant branches of science should be working in collaboration, and they ought to be provided with the means of attracting to their laboratories a number of able research students. Of course, there would be difficulties, but he did not think they were insuperable. In order that such men might be attracted and retained, they should be really well paid and their future secured to them. The funds should be provided by the State, for the work would be for the benefit of the whole community. A large sum would be needed; the interest on one million sterling would not be too much to cover the annual expenditure required by the scheme as the’ lecturer visualised it. But not much could be hoped for unless the country was prepared to shoulder the expense and provide for something much better than had heretofore existed.
Although,
THE DOCTOR’S FREEDOM OF SERVICE : THE AMERICAN VIEW. A RECENT issue of the Jozernat of the American Medical Association devoted a long leading to Mr. Ernest Hutchinson’s play, The Right to Strike, drawn from the annotation columns of THE LANCET and from the letters of Dr. A. Cox and Dr. A. Welply, from which it is concluded that it was not a strike which was proposed but a " measure of reprisal." We mention the article here in orderto call attention to an interesting ethical statement on the physician’s freedom of service issued by the American Medical Association. It runs as follows :-
article
.
A physician is free to choose whom he will serve. He should, however, always respond to any request for his assistance in an emergency or whenever temperate public opinion expects the service. Once having undertaken a case a physician should not abandon or neglect the patient because the disease is deemed incurable; nor should he withdraw from the case for any reason until a sufficient notice of a desire to be released has been given the patient or his friends to make it possible for them to secure another medical attendant. This question must be determined between the individuals who are primarily interested. It cannot be settled on the basis of principles governing the ethical relationships of
Prof. J. A. Lindsay, Belfast; A.-Association of Public Vaccinators of England and Wales; Dr. N. C. Lake, Lond. Capt. H. St. A. Agate, Ports- M.-Manchester Royal Infirmary; mouth.
Mr.
M.
S.
Monier-Williams,
B.-Dr. J. Blomfield, Lond.; Dr. Lond.; Sir P. J. Michelli, Lond.; H. C. Brown, Lond.; Mr. H. W. Maudsley Hospital PatholoDr. D. A. gical Laboratory, Lond., DirecBarwell, Lond.; Bigtor of; Dr. J. W. MeNee, land, Wengen ; Dr. H. C. Bazett, Oxford; Dr. W. Brown, Lond.; Lond.; Dr. E. Morton, Lond.; Mr. J. Morgan, Cardiff. Dr. G. Blacker, Lond.; Mrs. C. Brereton, Lond.; Prof. A. E. N.-National Hospital for Diseases of the Heart, Lond., See. Boycott, Radlett, C.-Canadian United Manufacof; Dr. J. T. C. Nash, Norwich. turers’ Agency, Lond.; Chelsea O.-Oxford Medical Publications, Lond. Hospital for Women, Lond.; Messrs. J. and A. Churchill, P.-Dr. R. H. A. Plimmer, AberProf. E. L. Lond.; Collis, deen ; Dr. H. R. Prentice, Cardiff ; Mrs. A. CunningLond.; Dr. M. Ponzio, Turin. ham, Macclesfield ; Dr. C. Q.-Queensland, Inspector of Hospitals for the Insane of, Coombs, Bristol; Dr. F. G. Brisbane. Clemow, Constantinople: Miss G. Cowlin, Lond.; Dr. H. M. R.-Royal Institution of Great Britain, Lond.; Royal Chest Cade, Ipswich. D.-Dr. H. A. Des Voeux, Lond.; Hospital, Lond.; Dr. J. ReyLt.-Col. A. M. Davies, R.A.M.C.; nolds, Lond.; Royal Society of Dr. W. F. Dearden, ManchesArts, Lond.; Research Defence ter ; Dr. C. Daniel, Bucarest; Society, Lond.; Dr. D. G. RiceDr. J. Donald, Leicester. Oxley, Lond.; Dr. J. D. RollesE.-Dr. C. L. Evans, Lond.; Mr. ton, Lond. S.-Prof. W. Stirling, ManchesJ. T. Edwards, Lond. F.-Sir J. K. Fowler, Lond.; Mr. ter ; Dr. H. Sainsbury, Lond.; H. A. T. Fairbank, Lond. I Scottish Board of Health, EdinJ. Dr. G.-Sir burgh ; The Statesman, CalGalloway, Lond.; R. P. Garrow, Lond. cutta, Assistant Editor of; Sir H.-Dr. D. C. Hare, Lond.; Mr. C. J. Symonds, Lond. ; St. C. A. Hill, Lond.; Home Office, Marylebone General Dispendes Societe sary, Lond.; Mr. J. T. Henderson, Lond.; ’
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be
THE LANCET : SUBSCRIPTION RATES. Year 0 Y,220 OneMonths 1 1 Six (Three Months ............ 010 6 ............
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In passing we remark on a curious inability to quote eorrectly. The "personal service" of our annotation is rendered quite inappropriately professional services."
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Notes, Short Comments, and Answers to Correspondents. SOME BIOLOGICAL ASPECTS OF DISEASE. An Abstract of a Lecture delivered under the auspices the Chadwick Trust, on Nov. 25th, 1920, by Professor J. B. FARMER, F.R.S.
of
is known, is responsible for the incidence of cancerous development; probably various stimuli are able to effect that wonderful change. The result, however, was always
the same-freedom from that control which is essential for the maintenance of an organised cell community. The tissue often exhibited rapid cell multiplication, which accompanied the newly acquired independence, and might lead to transplantations or metastases of cells which had been derived from the original cancer This occurred in varied degrees, and the cells cells. themselves might still retain, to some extent, the form and qualities of the typical tissue cells in which the change first appeared. The characteristic effect, however, always seemed to be to produce a more generalised type, recalling in some measure that of the lower organisms. An essential fact was that these transplanted cancerous units did not infect the tissues in which they came to lie, though they might, and often did, produce changes in the growth of the tissues, leading to the formation of the stroma. The circumstance that this kind of tissue could rise from once normal cells, as the indirect result of stimuli of various kinds-e.g., continuous irritation and inflammation, the effects of lesion or of other less clearly ascertained precursory conditions-served to emphasise the need of a much more thorough biological examination than had hitherto been made. A suggestive example which showed how the protoplasm could change its behaviour under certain conditions was furnished by the events in the life-history of a myxomycete. These small organisms started life as a number of independent amoebiform cells, each with its own power of movement and growth. By-and-by a number of these fused to form a protoplasmic living mass of slime, which then behaved as a lowly but really organised entity, capable of feeding upon various nutritive substances. The coalescence of the individual amœbæ to form the plasmodium was followed immediately by the fusion, in pairs, of nuclei. As soon as this had taken place no more amoabae were admitted as partners into the new cell republic, but any that approached sufficiently near it were drawn in and devoured.
introductory remarks the lecturer said that he to dwell on certain peculiarities or properties of the higher organisms with which healthy and normal discharge of function is intimately connected. The illustrations of the points raised in the lecture were largely chosen from examples drawn from the plant kingdom, partly because from an experimental point of view plants were more readily accessible than animals, and also partly because the things of most fundamental importance were those which are i common alike to animals and plants. Interaction of Parts of an Orharcistn. Although our knowledge as yet was but relatively small, an outstanding fact was that one part of the organism could, and habitually did, influence other parts, limiting and directing their possibilities of growth and determining the particular mode of development which would be actually followed in any given individual. It was shown by means of a number of examples drawn from the study of plants, and supplemented by others from animal life, how the organisation of an individual depended on the mutual influence of its constituent .cells one upon another. The coordinated growth which led to the development of a particular form depended on the serial (or sequential) nature of the reactions which went on in the cells and tissues of the organism. An intelligent recognition of this fact and of its consequences was essential Survey of the Present Position. to a proper appreciation of the larger problems both of the cancer problem still remained for the most .health and disease; for anything which could modify the Although " chemical changes concerned in the production of a " normal" part (and from the point of view of its victims entirely) .organ or tissue was reflected in a departure, to a greater or an unsolved one, it could nevertheless be attacked less extent, from the particular form or structure normal with a fair chance of success; but failure seemed to be inevitable, unless the right measures were adopted in for that organ or tissue. attacking it. Surveying the present position we might well I,:eterrtal Conditions. Modification of Organisms by ask how much have we actually found out, how much The lecturer then went on to show, by consideration of a nearer we were to the understanding of the causes which number of selected examples, how differences in chemical bring about these far-reaching changes in previously normal or physical environment might produce definite changes body cells-changes which endowed them with such appalling in the organism subjected to them. He further insisted qualities. It had been discovered that the cell nuclei that it must not therefore be concluded that only the exhibited remarkable modifications ; that those wonderful external conditions mattered ; a closer analysis of the facts structures the chromosomes had undergone suggestive emphasised the essential point that only when the environ- alterations both in number and in form. This in itself ment was able to interfere at all, so to speak, with the protowas a step in the right direction, and the lecturer believed plasm itself could a response of the kind indicated be we were justified in correlating the nuclear changes with obtained. In other words, the course of development in any the new properties acquired by the cells individually-in given cell, or in any given individual, was only subject to other words, that there was a causal nexus between modification by external conditions in so far as it was itself nuclear change and functional disturbance. But if we susceptible to influence by those conditions. For, on the were asked what started these complex changes in the one hand, the effects of temporary isolation of parts of the cell nuclei, we should have to answer that as yet we body from the material influences exerted by adjacent parts did not know. The older assertions as to the existence might result in a:permanent loosening of those ties which pre- of specific parasites, whether bacteria, yeasts, protozoa, viously served to knit the constituent cells into a coherent or even helminthines, had not stood the test of closer organism. On the other hand, union of parts hitherto separate examination. The more hopeful line of investigation seemed might result in the formation of a synthetic new organism, to point in the direction of chemical or phvsico-chemical different from those from which it-the new organism- disturbances, which might act in various ways and themhad been built up. Lichens afforded a striking illustration selves be traceable to more than one source; but the result of this fact. Other illustrations were provided in the new was clear, so far as it is known up to the present time. The relations that are so commonly established between fungi cells so affected passed through certain definite changes, and roots or other parts of the higher plants. Further and became freed from those coordinating influences by aspects of the matter were opened up by a consideration of which their chemical processes were previously regulated, the various abnormal growths which could definitely be and by which their multiplication had previously been held traced to the substances injected by parasitic animals, and a in check. study of the formation of vegetable galls afforded a suggestive Such a complex problem as that of, cancer was not likely outlook on the consequences of the mutual relations here to yield up its secrets till it had been broken down into the established between parasite and host. smaller components of which it constituted the formidable From the foregoing considerations and conclusions, the sum’. The smaller problems must then be systematically lecturer passed on to a brief discussion of those various attacked, and upon their solution the issue of the whole abnormal growths, or neoplasms, which originate as the matter would finally depend. It appeared to be clear that result of obscure changes taking place within the cells success could only be reasonably looked for if the new themselves. investigations were planned from the first on sound general Cancer. lines and placed in the hands of the very ablest men who The normal course of events which produced and main- could be found for the purpose. In spite of the dangers and tained what is called organisation could he upset in various difficulties lying in the way of organising research, the latter ways. How did this circumstance affect our outlook on the could be organised if wisdom, and not merely administration, mysterious disease which we called cancer ?-? The funda- ruled. Indeed, it had already been found practicable in mental fact was that certain body cells broke away fromdealing with other scientific problems or groups of problems, that coördinating elusive influence which controls normal though on a relatively smaller scale. development. The change is accompanied by cellular and General Nature of Required Research. nuclear modification, some of which had already been for example, need to know far more than was We others not as As Sir W. Collins should, recognised, perhaps yet. ] had long maintained, no specific causal organism, so far asknown at present as to the precise nature of those influences IN his
proposed
156 which, by controlling individual cellular activities, made possible the existence of an organism. In certain directions actual progress had already been made-for example,
in the case of some internal secretions. Tasks such as these would fall naturally within the province of the physiologist and of the bio-chemist, both on the plant and on the animal side. Extensions into the region of comparative experimental research on the physiology and bio-chemistry of the lower organisms were also clearly indicated. Far more must be known, also, of the minute cellular changes which were involved; this would fall within the scope of the cytologist. Furthermore, all that assistance which the medical profession alone was in a position to render would be required, inasmuch as cancer was most common in the human species, and from a practical point of view it was really to this circumstance that the real urgency of concerted action was mainly to be attributed. In order that such research, based on, concentrated and cooperative action, might be carried on with a prospect of fruitful results, it was essential to attract and retain the best men. Ample The task means must be forthcoming for this purpose. itself was so big that unless we were prepared to see it through on a liberal scale it seemed hardly worth while to proceed with it at all, for judging by past experience, little was to be expected from isolated efforts or from half-measures. The question was, were we prepared to go on watching the daily ravages of an unsparing foe in our midst, which continued still to strike, even as other diseases struck, till they were brought under reasonable control by means of scientific discovery, first as to their real nature and immediate cause, and thence by rationally devised checks on their onslaught. It was true that so far as we could judge, this problem was far more complex than they have proved to be. It might well be that a long time would elapse before malignant disease could be brought under effective control; we should do well not to be too sanguine or too impatient. The lecturer here emphatically stated that he was far from undervaluing the work now going on at various institutions in this and other countries; but it seemed to him that the full magnitude of the task had not been sufficiently realised, and hence that the means which were essential to success had hitherto been lacking.
PORTEOUS ’ MAZES." To the Editor of THE LANCET. SIR,-In reference to your answer to °° S. M. 0." in your issue of to-day’s date may I say that the Porteous " mazes" can be obtained from the C. H. Stoelting Company, 3037-3047, Carroll-avenue, Chicago, Illinois, U.S.A. Almost any kind of psychological apparatus can be got from this firm. And it is not creditable to British enterprise that, so far as I know, there is no firm in this country which acts as agent for this form of scientific goods. Apart from the trouble of ordering from, and remitting to, America, a British depot would have the great advantage of enabling one to inspect some particular form of apparatus before purchasing it. It is annoying to purchase some form of test and then to find it unsuited for the particular purpose for which I am, Sir, yours faithfully, one wanted it. M. HAMBLIN SMITH. H.M. Prison, Birmingham, Jan. 8th, 1921. DISABLED officers and nurses who served during the war, with the widows and dependants of deceased officers, can obtain advice and information regarding their rights under the regulations of the Ministry of Pensions by applying to the Officers’ Friend," Ministry of Pensions, Cromwell House, London, S.W. 1, or to the " Officers’ Friend " at any of the regional offices of the Ministry-viz., Burton Court, Chelsea, S.W. 1., Newcastle-on-Tyne,
along
Manchester, Bristol, Leeds, Nottingham, Birmingham, Edinburgh, Dublin, Belfast, or Cardiff.
Letters, &c., Communications, been received
Outline of a Scheme. he continued, it was obviously neither practical nor useful then and there to attempt to formulate a detailed scheme, he would venture to outline the principles which he believed should be kept in mind. About a dozen first-rate men attached to research in the different relevant branches of science should be working in collaboration, and they ought to be provided with the means of attracting to their laboratories a number of able research students. Of course, there would be difficulties, but he did not think they were insuperable. In order that such men might be attracted and retained, they should be really well paid and their future secured to them. The funds should be provided by the State, for the work would be for the benefit of the whole community. A large sum would be needed; the interest on one million sterling would not be too much to cover the annual expenditure required by the scheme as the’ lecturer visualised it. But not much could be hoped for unless the country was prepared to shoulder the expense and provide for something much better than had heretofore existed.
Although,
THE DOCTOR’S FREEDOM OF SERVICE : THE AMERICAN VIEW. A RECENT issue of the Jozernat of the American Medical Association devoted a long leading to Mr. Ernest Hutchinson’s play, The Right to Strike, drawn from the annotation columns of THE LANCET and from the letters of Dr. A. Cox and Dr. A. Welply, from which it is concluded that it was not a strike which was proposed but a " measure of reprisal." We mention the article here in orderto call attention to an interesting ethical statement on the physician’s freedom of service issued by the American Medical Association. It runs as follows :-
article
.
A physician is free to choose whom he will serve. He should, however, always respond to any request for his assistance in an emergency or whenever temperate public opinion expects the service. Once having undertaken a case a physician should not abandon or neglect the patient because the disease is deemed incurable; nor should he withdraw from the case for any reason until a sufficient notice of a desire to be released has been given the patient or his friends to make it possible for them to secure another medical attendant. This question must be determined between the individuals who are primarily interested. It cannot be settled on the basis of principles governing the ethical relationships of
Prof. J. A. Lindsay, Belfast; A.-Association of Public Vaccinators of England and Wales; Dr. N. C. Lake, Lond. Capt. H. St. A. Agate, Ports- M.-Manchester Royal Infirmary; mouth.
Mr.
M.
S.
Monier-Williams,
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