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Twenty-First Anniversary Dinner
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TWENTY-FIRST
ANNIVERSARY
DINNER.
The first meeting of the " Society of Tropical Medicine and Hygiene " took place on 26th June, 1907, under the Presidency of Sir PATRICKMANSO~, and a Dinner to celebrate the 21st anniversary of this event was held at the Caf6 Royal, Regent Street, London, on Wednesday, 20th June, 1928. Professor J. W. W. STEPHENS, M.D., F.R.S., President of the Royal Society of Tropical Medicine and Hygiene was in the Chair, and there were present as guests of the Society : the Right Honourable L. S. AMERY, P.C., M.P., Secretary of State for Dominions and for the Colonies ; Sir JAMES BERRY, F.R.C.S., President of the Royal Society of Medicine ; E. BRUMPT, M.D., Professor o f Parasitology, Paris ; HERBERT W. CARSON, F.R.C.S., President of the Medical Society of L o n d o n ; Lieut.-General Sir MATTHEW FELL, K.C.B., C.M.G., DirectorGeneral of the Army Medical Service ; Sir WALTER FLETCHER, K.B.E., Secretary, Medical Research Council ; Surgeon-Vice-Admiral ARTHURGASKELL,C.B., Director-General of the Medical Department of the Royal Navy; Sir JAMES MICHELLI, C.M.G., Treasurer of the Seamen's Hospital Society; Air ViceMarshal DAVID MUNRo, C.B., C.I.E., Director-General of the Medical Department of the Royal Air Force ; Sir GEORGEMAXWELL,K.B.E., C.M.G., DeputyChairman, Colonial Medical Research Committee ; Colonel T. R. ST. JOHNSTON, Administrator of St. Kitts, Leeward Islands ; Sir SQUIRESPRmGE, M.D., Editor of the Lancet; W. H. WELSH, LL.D., Professor of the History of Medicine, Johns Hopkins University, U.S.A. The dinner which all have agreed was a distinct success was attended by 126 Fellows and their guests. The number would have been greater were it not that at least three other similar functions had been independently arranged for the same evening. The Chairman read a cablegram from Dr. WILLIAM JAMES, of Panama, which ran as follows :" Congratulations on birthday and best wishes for deserved and continuous success." He then asked Mr. AMERY to propose the toast of the Royal Society of Tropical Medicine and Hygiene. Referring to his activities as a soldier, a sailor, a linguist, an historian, a minister, and an administrator of a great Department of State, Professor STEPHENSpreferred to address Mr. AM~RY as a student Of tropical medicine, as we all were, and to welcome him as one directing his great abilities to a fundamental aspect of the administration of our vast tropical countries, the health of their populations. The bonds forged by Mr. Joseph Chamberlain, over a quarter of a century ago,
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between the Colonial Office and tropical medicine, resulting in the foundation of two great Schools of tropical medicine, were being in no way relaxed by Mr. AMERY, whose recent foundation of the Colonial Medical Research Committee constituted recognition of a vital matter. Research was the perennial spring of medicine, without it there could be no advance ; it was one of the main objects of this Society, whose pleasure and duty it would always be to give Mr. AM~RY all possible assistance in combating the scourge of tropical disease. " The Royal Society of Tropical Medicine and Hygiene."
The Right Honourable L. S. Amery, P.O., M.P. (Secretary of State for Dominions and for the Colonies), dealing with the reference to his being a student of health, suggested that he had had to be sufficiently a student of his own health to survive the life of a Member of Parliament. He must be, too, a student of tropical medicine and tropical hygiene in so far that no one could hold the position he held without recognising their immense importance and value to the tropical Colonial Empire, whose political and economic importance as constituent elements of the British Commonwealth was becoming so increasingly recognised. None of the many functions of the Colonial Office was more important than that of Ministry of Health in the tropics. Disraeli's saying of nearly 50 years ago, Sanitas sanitatum, omnia sanitas, was at least as true today over vast areas where every prospect pleased, but where man lived in constant fear of death and disease and in chronic physical and therefore moral depression. During the last generation we had learned that disease was no more inevitable in the tropics than in our own country. When the fact clearly emerged that the tropics could be made healthyfor European merchants and administrators, and also for their native inhabitants, a new light was cast on the possibility of and responsibility for our tropical Empire. Mr. AMERY then referred to Mr. Joseph Chamberlain's dispatch of 25th November, !898, informing all Colonial Governments that he had decided upon two main lines of action in dealing with the important question of reducing the mortality amongst European residents in tropical climates. The first was the establishment of schools of tropical medicine where medical officers would be given special instruction in tropical diseases--in Liverpool soon constituted thanks to the generosity of Sir ALFRED JONES, and in London ; the second,the encouragement by every means in his power of scientific research into the causes of tropical diseases. Of this dispatch, Mr. AMERY continued, it has been truly said that it may well be doubted if one of greater import was ever penned by a Secretary of State for the Colonies. Mr. Chamberlain was more directly concerned with the problem of the health of the white administrators and traders, who
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were in his immediate charge, but we have gradually come to realise that the problems of white and native health in the Empire are in fact inseparable. The mosquito and the tsetse fly link them together, and while segregation may be a useful initial step in the main centres, it cannot help us in the outlying districts or form a permanent final solution of our difficulties. More than that, our conscience and our interest in life are steadily bringing us to the belief that in the health of the native peoples must be sought the master key for their happiness and prosperity. We are beginning to realise that there is no form of native education more calculated to civilise or strengthen the sense of personal responsibility than education in health, no field for mutual co-operation between Government and governed more fruitful of good, political as well as physical, than co-operation in the field of hygiene and sanitation. The education of the natives in this matter is certainly not the least of the objects which statesmanship in the Colonial Empire must place before it. This new outlook had led to great expansion of the personnel of the Colonial Medical Services, some figures of the cadre of medical officers, comparing 1895 with today, being ; for the Gold Coast 21 and 100, for Nigeria 7 and 161, for Ceylon 34 and 363, for Fiji 8 and 68. Today the Colonial Medical Services contained 1,700 officers and were growing yearly, while individual salaries had been increased about 50 per cent. The creation, continued Mr. AMERY, of larger organisations, like the West African Medical Service, means a greater opening for able men to get the best paid posts. I hope with confidence that we may before many years are out create something even more, something of the nature of a single Colonial Medical Service giving not only the individual the widest range of opportunity, but enabling the best brains in the service to be available for the Colonies that need the work most, irrespective of their actual reckoning of what they could afford to pay. Anyhow, I think I can claim today that the general level of medical work never stood so high in the Colonial Empire. Moreover, the increased number of officers available has enabled us to pay more attention to research and to prevention, and not to leave our officers struggling continuously with the problem of overtaking a thing after it has occurred. Moreover there were hospitals available for purposes of study, and greater facilities for officers to visit other countries in order to improve their knowledge. Another matter, owing its initiation to Joseph Chamberlain, was nursing, and congratulation was due to the Colonial Nursing Association for their work in supplying the Colonial Empire with a sufficiency of qualified, keen nurses and for their efforts to improve nursing and hospital conditions throughout it. He referred to the great new hospitals at Singapore, at Accra on the Gold Coast covering an area as large as that of the Wembley Exhibition, and at Mulago, Uganda, so important as the centre for training a native medical staff. The creation of an effective medical school for the training of qualified medical men was in prospect in West Africa. Special campaigns and investigations
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had been begun under the auspices of the Colonial ONce : the Sleeping Sickness Investigation by t h e League of Nations under LYNDItURST DUKE, malaria work, particularly in Ceylon, Malaya, and Palestine and on the Singapore Base, a great and increasing volume of work of all kinds. Regarding results in West Africa the invaliding and death rates per thousand of oNcials at this Society's inauguration were 67.2 and 27.3 ; today they were 19-2 and 8-6. In East Africa these rates, in 1910, were 24.5 and 14.9 and, in 1926, 5.6 and 4.4. Few places had a lower invaliding rate. For the natives, figures were not available, but health had steadily improved and confidence and interest had been established. This was indicated by the increase in three years of new cases treated by the Uganda Medical Service from 62,000 to 380,000 and by an expenditure grown from £61,000 to £128,000. Coupled with steady training of a subordinate staff, this promised great achievement in tropical Africa in the next ten years. I appointed two years ago, added Mr. AMERY, what I considered a very necessary essential to the work of any Colonial Secretary, namely, a Medical Adviser at the Colonial ONce itself, one who would hold the importance of the subject steadily before him and remain in touch with the Medical Services throughout the Colonial Empire, keeping an eye on good men, keeping one man informed of what others are doing, and helping to strengthen the corporate spirit in the Services and to link his work with all the outside field of scientific knowledge and personal ability which this country affords, a wonderful reservoir. We have three organisations. We have the ordinary administrative routine work; for this we have the Colonial Medical and Sanitary Advisory Committee--a body to which the Colonial ONce has been greatly indebted for many years not only for advice but for all the help they have given in the selection of medical oNcers. Last year we added a re-organised Colonial Medical Research Committee. We have established latterly a Bureau of Hygiene and Tropical Diseases in order to keep all the information resulting from research throughout the world in an accessible form and available for distribution where it is needed. As an outer periphery to this inner central organisation at the Colonial ONce, we have the Committee of Civil Research which links us to all the other research activities of the Government. We have great Schools of Tropical Hygiene and Medicine in London and Liverpool, and last, but by no means of least importance in its contribution to research, we have your Society, the toast of whose health and good work I have the honour of proposing this evening. I am specially glad that it has been my privilege to attend here tonight on the evening of your coming of age. Your Society was founded by Sir JAMESCANTLIE, Sir PATRICK MANSON and others, in the early days of the extension of tropical research that I have spoken of, and it has enjoyed since then the support of all the best brains in the Colonial, Army, a n d Civil Medical Services, and the Presidency of many distinguished men like Sir RONALD ROSS, Sir DAVID BRUCE
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and others whose names I need not mention, and not the least distinguished amongst them is the one with whom I am coupling the toast tonight, Dr. ANDREW BALFOUR.
I well remember my first introduction to the problems of tropical health and tropicalmedicine more than twenty years ago, and there are two names I remember in that connection because I met them both within a few weeks of each other. One was travelling up the coast of Africa from Mombasa to the Suez Canal, a man who may still be remembered by some in the Army Medical Service, Dr. LAMBKIN, who rendered great service in dealing with the problem of venereal disease in the early days, and the other was Dr. BALFOUR, whom I remember visiting in his laboratory at the Gordon College, and learning from him something about the variety and interest of the problems to which he was then devoting himself and to which he has devoted himself with increasing success during the intervening years. I realise how much the British Empire, and in the larger sense the Empire, owes to all those who worked in the field of research in tropica ! medicine, and I beg to propose in all sincerity the health and success of the Royal Society of Tropical Medicine. Dr. Andrew Balfour noted that there was a measure of reasonableness in the request to him to reply to this toast since he had been rather closely associated with this great Society from its very inception : as Original Fellow-and most of these were now verging on, or had reached, the sere and yellow leaf; as Local Secretary--and he paid a tribute to the yeoman service which Local Secretaries were doing for this Society all over the world ; as Treasurer in the difficult period following the close of the W a r - - a post now in the more capable hands of Dr. BAGSHAWE; as Vice-President; and as President. He would refer to three Presidents who had passed into the shades--JAMES CANTLIE, irrepressible, kindly, genial, shrewd, and wise; WILLIAM LEISHMAN, careful, accurate, thoughtful and helpful, whose influence still remained with us; and our first President, PATRICK MANSON, that great man, facile princeps amongst us all, in whose memory our new home was to be named. The Society had succeeded, by hard work, in raising £3,324, with some outside help, among which he was glad to mention the Anglo-Dutch Plantations L t d , which had contributed £100 through Dr. DAUKES. He would say to other companies " go thou and do likewise," for it was necessary that a fitting memorial should be raised to that great man Sir PATRICK MANSON. He liked to think of these three men, and others who had passed from our ken, looking down from some Olympus, proud that the Society had reached its 21st birthday, and gratified that Mr. AM~RY had voiced the sentiments of all present. Not since the days of Joseph Chamberlain had a Colonial Secretary been so interested in tropical medicine and hygiene. He had breathed a new spirit into Colonial Office affairs. Dr. BALFOUR added a fourth to the three important things which Mr, AMERY had mentioned as happening during his r6gime, namely that this
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Society had been recognised during Mr. AMERY'8term of office as one to which the Colonial Office might appeal in difficulty, just as the kindred society in France was approached by the French Government, an important development for which we were grateful. We all know, continued Dr~ BALFOUR, that Mr. AMERY and his able co-adjutor Mr. ORMSBY-GORE are believers in the personal touch. Mr. AMERY has familiarised himself with the conditions prevailing in many of our tropical possessions, and I venture to think and to hope that perhaps he may extend that personal touch in another direction, in the way of appointing those medical liaison officers who will come and go, not as inquisitors but as helpers and. advisers. These men were pleaded for years ago, and I hope the day will soon come when we may see them going hither and thither, helping and advising, and bringing glad tidings to those working far away from centres of light and learning. I remember, long ago, when I was at Khartoum, how greatly we appreciated the visit of BRUCE and others, with whom we could talk over the various problems that perplexed us so in that out of the way part of the world. If these liaison officers are appointed I am sure the Society will be very glad to supply them. It is most gratifying that Mr. AMERY recognises the importance of the work that this Society is doing, and I must thank him very much for what he so kindly said about it and also what he said as regards myself. The next important function of this kind which the Society will hold will presumably be its Jubilee Dinner nine and =twenty years he/ice. Let us hope that on that occasion it may be possible to entrust the toast of the evening to a Colonial Secretary as far-seeing,, as sympathetic, and as influential, as the distinguished servant of the Empir e who has tonight honoured us by proposing in so gracious and encouraging a manner the health of the Royal Society of Tropical Medicine and Hygiene. " The
Guests."
Lieut.-Colonel W. P. Mac Arthur, in proposing the Toast of " The Guests," said: Her late Majesty Queen Elizabeth while on a royal progress through her kingdom arrived at a small town where, to her intense indignation, she was not greeted with the customary salvo of artillery. The mayor of the town was haled before the irate monarch to account for this outrageous, even treasonable, omission. The trembling man, producing a long document from his pocket, explained that there were 20 reasons why the Queen's highness had not been received with a royal salute, the first of these being that they had no guns. Whereupon the Queen said that she would not trouble him to read the other 19. When Dr. WE~YON informed me that I had been selected for the honour of proposing this Toast, following my exemplar, the Elizabethan mayor, I explained to him that there were 20 reasons why I should not make a speech, the first being that I had nothing to say. Dr. WENYON, less amenable than his
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prototype, the Virgin Queen, replied by reciting a list of the guests, and when I had heard that long beadroll of fame I then protested that I had so much to say that I could not possibly find the time to say it. We have with us here tonight as our chief guest, H.M. Secretary of State for the Dominions and Colonies, most appropriately, for, as he himself had indicated, of all the King's Ministers, he is the most concerned with tropical medicine and hygiene, and, moreover, on his recent tour, as he has told us, he has had ample visual evidence of the miracles wrought by medical science in the tropics. Ministers of State were not always at such pains to acquire exact knowledge of the countries under their jurisdiction. The Islands of Mauritius and Bourbon lie close together in tile line of the old trade route to India round the Cape. After the Napoleonic Wars the British Government retained the island of Mauritius, and handed Bourbon back to tile French. I often puzzled over this astounding procedure. Clearly the wise course would have been for the British to have held both islands, and so protected their trade route. It might even be comprehensible if they had handed both back to the French, in some outburst of Christian benevolence ; but to keep one and hand back the other was a course not to be explained even by tile English love of compromise gone mad. It appears, however, that the island of Bourbon was returned to the French because the responsible minister thought that it was in the West Indies ! Mr. AMERY has completed his tour of the Colonies and Dominions with benefit to the Empire and satisfaction to himself ; he has accomplished another task, infinitely more exacting though less spectacular, for he has composed ancient animosities in Ireland, and has gained the affection and esteem of those on both sides of the border. It is possible, however, that during the next few months be may find more diverse duties--possibly even distasteful duties-thrust upon him. In accordance with an ancient precedent of Henry VIII, should any person contumaciously refuse to accept the doctrines of the Prayer Book, and in consequence be put to the torture, Mr. AMER¥ may be required to attend at the Tower of London and himself twist the handle of the rack, to ensure that it is well and truly done. I am sure that this office would be equally distasteful to his genial nature whether the offender were some recalcitrant Anglo-Catholic on the one hand, or on the other, a contumacious Evangelical, perhaps in the person of his own colleague, the Home Secretary. If the malefactor should prove to be any friend of mine, I sincerely hope Mr. AMERY will be selected to preside at the wheel, for standing here and looking at him I cannot imagine that he would twist the handle very tight. As a possible alternative, imagine being racked by somebody from the IncomeTax Department ! We extend a hearty welcome tonight to Professor BRUMPT,who has journeyed from Paris to be with us here, and tomorrow will honour the Society with a discourse. Professor BRUMPTdoes not need any introduction to this assemblage, for there is no branch of medical parasitology that he has not touched, and
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he touched none that he did not adorn. Another visitor from a far country is the veteran Professor WELSH. His tireless energy has now found a new outlet, for he has recently accepted the Chair of the History of Hygiene in Johns Hopkins University, and who more fitted to teach history than one who has spent his life in making it. Others who grace the guests' table are Sir JAMES BERRY,holder of the coveted Presidentship of the Royal Society of Medicine--the President of the ancient Medical Society of London--Sir WALTER FLETCHER who is so prominently engaged in organising and correlating official medical research in this country--Sir JOHN MAXWELL, charged with a like responsibility in colonial affairs--Colonel JOHNSTON, administrator of the romantic island of St. Kitts, which really is in the West Indies !--Sir JAMES MICHELLI,life-long benefactor of the merchant seamen--the Directors of the Medical Services of the Armed Forces of the Crown, Services which deserve well of the nation, for through their ceaseless vigilance in China the dire epidemics, confidently prognosticated, have not come to pass. " Sir," said Dr. Johnson on one occasion, " in lapidary inscriptions a man is not upon oath." I have sometimes felt that the sage might have enlarged his dictum to include not only writers of epitaphs but proposers of votes of thanks and speakers to toasts ; but tonight I have no such feeling. This Toast calls neither for verbal subterfuge nor logod~edaly. The reputation of each of our guests stands secure on some solid rock of achievement. Their very presence here testifies that each of them is, in his own kind, inter ignes luna minores. This Toast is to be responded to by Sir SQVlRE SPRIGGE,whose easy and graceful literary style has long been at once both the envy and the despair of those of us whom duty forces to take pen in hand with no natural aptitude for the task. Possibly some of us have even had the salutary experience of re-reading some effusion of our own with its rough-hewn sentences smoothed down, and a final touch of academic polish applied by his skilled hand. Sir SQUIRESPRIGGE will doubtless demonsstrate that his tongue is no less mighty than his pen, and if any prolixity of mine were to cut short his discourse by a single word, I feel sure that I should fall under your just condemnation. And so I give you the Toast of " Our Guests " coupled with the name of Sir SQUIRESPRIGGE. Sir Squire Sprigge, in responding said : You will admit that my task is not made easier by the introductory words, and by the mention of a long series of distinguished guests present enumerated by the proposer of the Toast, any one of whom clearly ought to be making this speech instead of me. I only wish that our Toast-master had read out to you in detail their qualifications for doing the job that I am about to do. The compliment paid to the branch of medicine to which I belong as the editor of a medical journal, in being asked to reply, embarrasses me, for the fact, of course, is that medical journals only exist through the kindness and by the co-operation of yourselves ; if it were not for you who supply us with material, with arguments, with the information
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which we hand on, we should have no existence. I may also say in this connection that the great State Department which watches with deep self-interest the progress of your Society is also a source of perpetual assistance and information to our service. I do not suggest by that that the Rt. Hon. Secretary of State for the Colonies writes anonymous leaders in the Lancet, and I do not suggest that Dr. A. T. STANTON is at my disposal--I wish he was. But I should like to take this opportunity of recording my thanks to the Colonial Office for the extraordinary readiness with which they answer questions and give information in places w h e r e questions can be fairly asked and the information is reMly needed ; so that one may be able on the one hand to report the progress of medicine and hygiene in far off Dependencies, and on the other hand, assist the Colonial Office in recruiting for their extremely important, hard-worked and valuable staff. At this dinner, some two years ago I think, LORD BALFOUR made an eloquent speech in which he pointed out, with the facility and grace which today is almost unusual amongst after-dinner speakers, the directions in which science in its separate branches was tending to fuse itself, the various directions in which philosophers who studied research and taught different branches of science were able to find that their discoveries, their results, their arguments, and their theories, could be applied to each other with the result of fortifying weak arguments and the production of new theories all tending to the enormous advance of science. Those who heard LoRD BALFOUR'Sspeech may remember that he indicated that medicine in itself was to a certain extent a reproduction of that general fusion of scientific knowledge, because medicine today impinges in so many ways on such varying and various departments of learning, and that of course is the case. I am old enough to remember that when we were trained in medicine the various departments of training were kept in water-tight compartments. Today it is recognised in the preliminary stages of education that ancillary scientific subjects have their bearing on direct professional scientific subjects, and that in both cases the studies have no particular meaning at all except for their ultimate bearing on clinical medicine. It seems to me that in the Royal Society of Tropical Medicine and Hygiene we have a very exact example of both the great and the lesser fusion, the great fusion being that our knowledge of tropical conditions, in every science which the EncyclopcediaBritannica can mention, will have some bearing upon work in the Colonies, while every piece of work that is done in the Colonies, as far as medicine is concerned, must be related to all the different sciences. The Royal Society of Tropical Medicine and Hygiene, although not working perhaps on any exact lines, must take note of discoveries in geometry, geology, gyna~cology, chemistry, and also general sociology, before it can get to work on its more particular objectives. As far as the Colonies are concerned, its task, of course, is to assist what is now the programme of the Colonial Office, to improve our various Dependencies and possessions for the benefit of the natives who reside in them. The officers of the Colonial Office have to live in close contact with
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the races in environmental circumstances, which in days gone by would have been an extremely perilous task; but owing to the good offices of scientific medicine and the support which in recent days the Colonial Office has brought to the efforts of tropical medicine, many of the places to which those officers were summoned to discharge their duty not so very long ago, and had the certain knowledge that the actuarial risk of life w.as an extremely bad one, now are places which are little less than health resorts. That is extremely practical evidence of the value of the work which has been done by the Royal Society of Tropical Medicine and Hygiene. In conclusion I should like to say--only I feel apologetic for talking about personal work--that a medical journal having these general large questions to think of, as well as more intimate questions relating to the progress and work of the profession in its day to day character, can necessarily only touch upon salient points. It is quite impossible to do more than look forward to such leading things as seem in some way or other to have their general influence in the first instance on the profession, and in the second, on the progress of the world. In an attempt to do that sort of work I must again put on record the obvious fact that one can only attempt it with the extremely generous co-operation of those who really know what they are talking about. " The Chairman." Dr. P. H. Manson-Bahr, in proposing the toast o f " T h e Chairman," proclaimed himself an inefficient substitute for Sir WILLIAM PROUT, prevented from attendance by illness regarding which all present extended to him sympathy and hope of speedy recovery. Our distinguished PR~SlI)ENT belonged to the old brigade of pioneers in tropical medicine. Educated at King's College, Cambridge, and St. Bartholomew's Hospital, he became President of the Abernethian Society of that Hospital in 1896, and scholar in pathology and bacteriology. He was appointed bacteriologist to the Government of India in 1897, but actually became a member of the Royal Society's Malaria Commission under CHRISTOPItERS with whom he worked for four years till 1902. These researches, a model for all subsequent work on malaria and blackwater fever, were embodied in a joint book which remained a classic to the present day. In 1903 he was called to join the Liverpool School of Tropical Medicine and became the Walter Myers Lecturer on Tropical Medicine and shortly the Alfred Jones Professor of Tropical Medicine in the Liverpool University. He invented a special malaria parasite Plasmodium tenue, and assisted at the birth of Trypanosoma rhodesiense. Amongst other activities he was known for the part he played in the recognition of the tapeworm-like elements in bananas. During the War he contributed thirty-one monumental papers on malaria to the Annals of Tropical Medicine and Parasitology and embodied them in a r4sum6 in 1923. To
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all his work he applied a cold and critical philosophy and an admirable exactness. Last year Professor J. W. W. STEPHENS had been elected President of this Society, a wise choice, and one under which the Society had enjoyed unprecedented prosperity, but it was on his part a selGsacrificing one, involving much expenditure of time in travelling betv?een Liverpool and London. Professor STEP,InNS was a noted archaeologist and ornithologist; and indeed at the moment it appeared that a training in the latter pastime was essential for success in tropical medicine ! Professor STEPHENS was, in a word, a man of distinction who had conferred honour on the Society by becoming its President. The Chairman, in reply, said : I hardly thought tonight I should have had laid bare all the iniquities of my past career. I have a troubled conscience. As the boy who said to his father " Dad, what are public schools for," so I imagine the newly-appointed medical officer going to Mr. AMERY and saying " Mr. Secretary, what are professors of tropical medicine for ?" and his replying " My boy, they are not for anything, but you have got to go to one." When I stand before you here tonight, especially after the remarks of the various speakers, I am reminded of an incident that I read a little time ago in a charming book entitled " Small talk at Wreyland," in which the author relates how he took a distinguished foreigner for a walk in the country. After a little time they came to a sign-post on which was written " Chagford, 1½- miles," and after proceeding a little further they came to another sign-post on which was written " Chagford, 2 miles." The foreigner said " We advance 100 metres and retreat half a mile. How then shall we arrive ?" The author answered " Ah, we muddle through." When I think of the distinguished Presidents you have had in the past and I see you regarding the dilapidated sign-post before you tonight, I cannot help thinking that I hear you say " How shall we arrive ?" I hope the answer may be that " we muddle through."
TWENTY-FIRST
ANNIVERSARY
DINNER.
The first meeting of the " Society of Tropical Medicine and Hygiene " took place on 26th June, 1907, under the Presidency of Sir PATRICKMANSO~, and a Dinner to celebrate the 21st anniversary of this event was held at the Caf6 Royal, Regent Street, London, on Wednesday, 20th June, 1928. Professor J. W. W. STEPHENS, M.D., F.R.S., President of the Royal Society of Tropical Medicine and Hygiene was in the Chair, and there were present as guests of the Society : the Right Honourable L. S. AMERY, P.C., M.P., Secretary of State for Dominions and for the Colonies ; Sir JAMES BERRY, F.R.C.S., President of the Royal Society of Medicine ; E. BRUMPT, M.D., Professor o f Parasitology, Paris ; HERBERT W. CARSON, F.R.C.S., President of the Medical Society of L o n d o n ; Lieut.-General Sir MATTHEW FELL, K.C.B., C.M.G., DirectorGeneral of the Army Medical Service ; Sir WALTER FLETCHER, K.B.E., Secretary, Medical Research Council ; Surgeon-Vice-Admiral ARTHURGASKELL,C.B., Director-General of the Medical Department of the Royal Navy; Sir JAMES MICHELLI, C.M.G., Treasurer of the Seamen's Hospital Society; Air ViceMarshal DAVID MUNRo, C.B., C.I.E., Director-General of the Medical Department of the Royal Air Force ; Sir GEORGEMAXWELL,K.B.E., C.M.G., DeputyChairman, Colonial Medical Research Committee ; Colonel T. R. ST. JOHNSTON, Administrator of St. Kitts, Leeward Islands ; Sir SQUIRESPRmGE, M.D., Editor of the Lancet; W. H. WELSH, LL.D., Professor of the History of Medicine, Johns Hopkins University, U.S.A. The dinner which all have agreed was a distinct success was attended by 126 Fellows and their guests. The number would have been greater were it not that at least three other similar functions had been independently arranged for the same evening. The Chairman read a cablegram from Dr. WILLIAM JAMES, of Panama, which ran as follows :" Congratulations on birthday and best wishes for deserved and continuous success." He then asked Mr. AMERY to propose the toast of the Royal Society of Tropical Medicine and Hygiene. Referring to his activities as a soldier, a sailor, a linguist, an historian, a minister, and an administrator of a great Department of State, Professor STEPHENSpreferred to address Mr. AM~RY as a student Of tropical medicine, as we all were, and to welcome him as one directing his great abilities to a fundamental aspect of the administration of our vast tropical countries, the health of their populations. The bonds forged by Mr. Joseph Chamberlain, over a quarter of a century ago,
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between the Colonial Office and tropical medicine, resulting in the foundation of two great Schools of tropical medicine, were being in no way relaxed by Mr. AMERY, whose recent foundation of the Colonial Medical Research Committee constituted recognition of a vital matter. Research was the perennial spring of medicine, without it there could be no advance ; it was one of the main objects of this Society, whose pleasure and duty it would always be to give Mr. AM~RY all possible assistance in combating the scourge of tropical disease. " The Royal Society of Tropical Medicine and Hygiene."
The Right Honourable L. S. Amery, P.O., M.P. (Secretary of State for Dominions and for the Colonies), dealing with the reference to his being a student of health, suggested that he had had to be sufficiently a student of his own health to survive the life of a Member of Parliament. He must be, too, a student of tropical medicine and tropical hygiene in so far that no one could hold the position he held without recognising their immense importance and value to the tropical Colonial Empire, whose political and economic importance as constituent elements of the British Commonwealth was becoming so increasingly recognised. None of the many functions of the Colonial Office was more important than that of Ministry of Health in the tropics. Disraeli's saying of nearly 50 years ago, Sanitas sanitatum, omnia sanitas, was at least as true today over vast areas where every prospect pleased, but where man lived in constant fear of death and disease and in chronic physical and therefore moral depression. During the last generation we had learned that disease was no more inevitable in the tropics than in our own country. When the fact clearly emerged that the tropics could be made healthyfor European merchants and administrators, and also for their native inhabitants, a new light was cast on the possibility of and responsibility for our tropical Empire. Mr. AMERY then referred to Mr. Joseph Chamberlain's dispatch of 25th November, !898, informing all Colonial Governments that he had decided upon two main lines of action in dealing with the important question of reducing the mortality amongst European residents in tropical climates. The first was the establishment of schools of tropical medicine where medical officers would be given special instruction in tropical diseases--in Liverpool soon constituted thanks to the generosity of Sir ALFRED JONES, and in London ; the second,the encouragement by every means in his power of scientific research into the causes of tropical diseases. Of this dispatch, Mr. AMERY continued, it has been truly said that it may well be doubted if one of greater import was ever penned by a Secretary of State for the Colonies. Mr. Chamberlain was more directly concerned with the problem of the health of the white administrators and traders, who
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were in his immediate charge, but we have gradually come to realise that the problems of white and native health in the Empire are in fact inseparable. The mosquito and the tsetse fly link them together, and while segregation may be a useful initial step in the main centres, it cannot help us in the outlying districts or form a permanent final solution of our difficulties. More than that, our conscience and our interest in life are steadily bringing us to the belief that in the health of the native peoples must be sought the master key for their happiness and prosperity. We are beginning to realise that there is no form of native education more calculated to civilise or strengthen the sense of personal responsibility than education in health, no field for mutual co-operation between Government and governed more fruitful of good, political as well as physical, than co-operation in the field of hygiene and sanitation. The education of the natives in this matter is certainly not the least of the objects which statesmanship in the Colonial Empire must place before it. This new outlook had led to great expansion of the personnel of the Colonial Medical Services, some figures of the cadre of medical officers, comparing 1895 with today, being ; for the Gold Coast 21 and 100, for Nigeria 7 and 161, for Ceylon 34 and 363, for Fiji 8 and 68. Today the Colonial Medical Services contained 1,700 officers and were growing yearly, while individual salaries had been increased about 50 per cent. The creation, continued Mr. AMERY, of larger organisations, like the West African Medical Service, means a greater opening for able men to get the best paid posts. I hope with confidence that we may before many years are out create something even more, something of the nature of a single Colonial Medical Service giving not only the individual the widest range of opportunity, but enabling the best brains in the service to be available for the Colonies that need the work most, irrespective of their actual reckoning of what they could afford to pay. Anyhow, I think I can claim today that the general level of medical work never stood so high in the Colonial Empire. Moreover, the increased number of officers available has enabled us to pay more attention to research and to prevention, and not to leave our officers struggling continuously with the problem of overtaking a thing after it has occurred. Moreover there were hospitals available for purposes of study, and greater facilities for officers to visit other countries in order to improve their knowledge. Another matter, owing its initiation to Joseph Chamberlain, was nursing, and congratulation was due to the Colonial Nursing Association for their work in supplying the Colonial Empire with a sufficiency of qualified, keen nurses and for their efforts to improve nursing and hospital conditions throughout it. He referred to the great new hospitals at Singapore, at Accra on the Gold Coast covering an area as large as that of the Wembley Exhibition, and at Mulago, Uganda, so important as the centre for training a native medical staff. The creation of an effective medical school for the training of qualified medical men was in prospect in West Africa. Special campaigns and investigations
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had been begun under the auspices of the Colonial ONce : the Sleeping Sickness Investigation by t h e League of Nations under LYNDItURST DUKE, malaria work, particularly in Ceylon, Malaya, and Palestine and on the Singapore Base, a great and increasing volume of work of all kinds. Regarding results in West Africa the invaliding and death rates per thousand of oNcials at this Society's inauguration were 67.2 and 27.3 ; today they were 19-2 and 8-6. In East Africa these rates, in 1910, were 24.5 and 14.9 and, in 1926, 5.6 and 4.4. Few places had a lower invaliding rate. For the natives, figures were not available, but health had steadily improved and confidence and interest had been established. This was indicated by the increase in three years of new cases treated by the Uganda Medical Service from 62,000 to 380,000 and by an expenditure grown from £61,000 to £128,000. Coupled with steady training of a subordinate staff, this promised great achievement in tropical Africa in the next ten years. I appointed two years ago, added Mr. AMERY, what I considered a very necessary essential to the work of any Colonial Secretary, namely, a Medical Adviser at the Colonial ONce itself, one who would hold the importance of the subject steadily before him and remain in touch with the Medical Services throughout the Colonial Empire, keeping an eye on good men, keeping one man informed of what others are doing, and helping to strengthen the corporate spirit in the Services and to link his work with all the outside field of scientific knowledge and personal ability which this country affords, a wonderful reservoir. We have three organisations. We have the ordinary administrative routine work; for this we have the Colonial Medical and Sanitary Advisory Committee--a body to which the Colonial ONce has been greatly indebted for many years not only for advice but for all the help they have given in the selection of medical oNcers. Last year we added a re-organised Colonial Medical Research Committee. We have established latterly a Bureau of Hygiene and Tropical Diseases in order to keep all the information resulting from research throughout the world in an accessible form and available for distribution where it is needed. As an outer periphery to this inner central organisation at the Colonial ONce, we have the Committee of Civil Research which links us to all the other research activities of the Government. We have great Schools of Tropical Hygiene and Medicine in London and Liverpool, and last, but by no means of least importance in its contribution to research, we have your Society, the toast of whose health and good work I have the honour of proposing this evening. I am specially glad that it has been my privilege to attend here tonight on the evening of your coming of age. Your Society was founded by Sir JAMESCANTLIE, Sir PATRICK MANSON and others, in the early days of the extension of tropical research that I have spoken of, and it has enjoyed since then the support of all the best brains in the Colonial, Army, a n d Civil Medical Services, and the Presidency of many distinguished men like Sir RONALD ROSS, Sir DAVID BRUCE
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and others whose names I need not mention, and not the least distinguished amongst them is the one with whom I am coupling the toast tonight, Dr. ANDREW BALFOUR.
I well remember my first introduction to the problems of tropical health and tropicalmedicine more than twenty years ago, and there are two names I remember in that connection because I met them both within a few weeks of each other. One was travelling up the coast of Africa from Mombasa to the Suez Canal, a man who may still be remembered by some in the Army Medical Service, Dr. LAMBKIN, who rendered great service in dealing with the problem of venereal disease in the early days, and the other was Dr. BALFOUR, whom I remember visiting in his laboratory at the Gordon College, and learning from him something about the variety and interest of the problems to which he was then devoting himself and to which he has devoted himself with increasing success during the intervening years. I realise how much the British Empire, and in the larger sense the Empire, owes to all those who worked in the field of research in tropica ! medicine, and I beg to propose in all sincerity the health and success of the Royal Society of Tropical Medicine. Dr. Andrew Balfour noted that there was a measure of reasonableness in the request to him to reply to this toast since he had been rather closely associated with this great Society from its very inception : as Original Fellow-and most of these were now verging on, or had reached, the sere and yellow leaf; as Local Secretary--and he paid a tribute to the yeoman service which Local Secretaries were doing for this Society all over the world ; as Treasurer in the difficult period following the close of the W a r - - a post now in the more capable hands of Dr. BAGSHAWE; as Vice-President; and as President. He would refer to three Presidents who had passed into the shades--JAMES CANTLIE, irrepressible, kindly, genial, shrewd, and wise; WILLIAM LEISHMAN, careful, accurate, thoughtful and helpful, whose influence still remained with us; and our first President, PATRICK MANSON, that great man, facile princeps amongst us all, in whose memory our new home was to be named. The Society had succeeded, by hard work, in raising £3,324, with some outside help, among which he was glad to mention the Anglo-Dutch Plantations L t d , which had contributed £100 through Dr. DAUKES. He would say to other companies " go thou and do likewise," for it was necessary that a fitting memorial should be raised to that great man Sir PATRICK MANSON. He liked to think of these three men, and others who had passed from our ken, looking down from some Olympus, proud that the Society had reached its 21st birthday, and gratified that Mr. AM~RY had voiced the sentiments of all present. Not since the days of Joseph Chamberlain had a Colonial Secretary been so interested in tropical medicine and hygiene. He had breathed a new spirit into Colonial Office affairs. Dr. BALFOUR added a fourth to the three important things which Mr, AMERY had mentioned as happening during his r6gime, namely that this
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Society had been recognised during Mr. AMERY'8term of office as one to which the Colonial Office might appeal in difficulty, just as the kindred society in France was approached by the French Government, an important development for which we were grateful. We all know, continued Dr~ BALFOUR, that Mr. AMERY and his able co-adjutor Mr. ORMSBY-GORE are believers in the personal touch. Mr. AMERY has familiarised himself with the conditions prevailing in many of our tropical possessions, and I venture to think and to hope that perhaps he may extend that personal touch in another direction, in the way of appointing those medical liaison officers who will come and go, not as inquisitors but as helpers and. advisers. These men were pleaded for years ago, and I hope the day will soon come when we may see them going hither and thither, helping and advising, and bringing glad tidings to those working far away from centres of light and learning. I remember, long ago, when I was at Khartoum, how greatly we appreciated the visit of BRUCE and others, with whom we could talk over the various problems that perplexed us so in that out of the way part of the world. If these liaison officers are appointed I am sure the Society will be very glad to supply them. It is most gratifying that Mr. AMERY recognises the importance of the work that this Society is doing, and I must thank him very much for what he so kindly said about it and also what he said as regards myself. The next important function of this kind which the Society will hold will presumably be its Jubilee Dinner nine and =twenty years he/ice. Let us hope that on that occasion it may be possible to entrust the toast of the evening to a Colonial Secretary as far-seeing,, as sympathetic, and as influential, as the distinguished servant of the Empir e who has tonight honoured us by proposing in so gracious and encouraging a manner the health of the Royal Society of Tropical Medicine and Hygiene. " The
Guests."
Lieut.-Colonel W. P. Mac Arthur, in proposing the Toast of " The Guests," said: Her late Majesty Queen Elizabeth while on a royal progress through her kingdom arrived at a small town where, to her intense indignation, she was not greeted with the customary salvo of artillery. The mayor of the town was haled before the irate monarch to account for this outrageous, even treasonable, omission. The trembling man, producing a long document from his pocket, explained that there were 20 reasons why the Queen's highness had not been received with a royal salute, the first of these being that they had no guns. Whereupon the Queen said that she would not trouble him to read the other 19. When Dr. WE~YON informed me that I had been selected for the honour of proposing this Toast, following my exemplar, the Elizabethan mayor, I explained to him that there were 20 reasons why I should not make a speech, the first being that I had nothing to say. Dr. WENYON, less amenable than his
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prototype, the Virgin Queen, replied by reciting a list of the guests, and when I had heard that long beadroll of fame I then protested that I had so much to say that I could not possibly find the time to say it. We have with us here tonight as our chief guest, H.M. Secretary of State for the Dominions and Colonies, most appropriately, for, as he himself had indicated, of all the King's Ministers, he is the most concerned with tropical medicine and hygiene, and, moreover, on his recent tour, as he has told us, he has had ample visual evidence of the miracles wrought by medical science in the tropics. Ministers of State were not always at such pains to acquire exact knowledge of the countries under their jurisdiction. The Islands of Mauritius and Bourbon lie close together in tile line of the old trade route to India round the Cape. After the Napoleonic Wars the British Government retained the island of Mauritius, and handed Bourbon back to tile French. I often puzzled over this astounding procedure. Clearly the wise course would have been for the British to have held both islands, and so protected their trade route. It might even be comprehensible if they had handed both back to the French, in some outburst of Christian benevolence ; but to keep one and hand back the other was a course not to be explained even by tile English love of compromise gone mad. It appears, however, that the island of Bourbon was returned to the French because the responsible minister thought that it was in the West Indies ! Mr. AMERY has completed his tour of the Colonies and Dominions with benefit to the Empire and satisfaction to himself ; he has accomplished another task, infinitely more exacting though less spectacular, for he has composed ancient animosities in Ireland, and has gained the affection and esteem of those on both sides of the border. It is possible, however, that during the next few months be may find more diverse duties--possibly even distasteful duties-thrust upon him. In accordance with an ancient precedent of Henry VIII, should any person contumaciously refuse to accept the doctrines of the Prayer Book, and in consequence be put to the torture, Mr. AMER¥ may be required to attend at the Tower of London and himself twist the handle of the rack, to ensure that it is well and truly done. I am sure that this office would be equally distasteful to his genial nature whether the offender were some recalcitrant Anglo-Catholic on the one hand, or on the other, a contumacious Evangelical, perhaps in the person of his own colleague, the Home Secretary. If the malefactor should prove to be any friend of mine, I sincerely hope Mr. AMERY will be selected to preside at the wheel, for standing here and looking at him I cannot imagine that he would twist the handle very tight. As a possible alternative, imagine being racked by somebody from the IncomeTax Department ! We extend a hearty welcome tonight to Professor BRUMPT,who has journeyed from Paris to be with us here, and tomorrow will honour the Society with a discourse. Professor BRUMPTdoes not need any introduction to this assemblage, for there is no branch of medical parasitology that he has not touched, and
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he touched none that he did not adorn. Another visitor from a far country is the veteran Professor WELSH. His tireless energy has now found a new outlet, for he has recently accepted the Chair of the History of Hygiene in Johns Hopkins University, and who more fitted to teach history than one who has spent his life in making it. Others who grace the guests' table are Sir JAMES BERRY,holder of the coveted Presidentship of the Royal Society of Medicine--the President of the ancient Medical Society of London--Sir WALTER FLETCHER who is so prominently engaged in organising and correlating official medical research in this country--Sir JOHN MAXWELL, charged with a like responsibility in colonial affairs--Colonel JOHNSTON, administrator of the romantic island of St. Kitts, which really is in the West Indies !--Sir JAMES MICHELLI,life-long benefactor of the merchant seamen--the Directors of the Medical Services of the Armed Forces of the Crown, Services which deserve well of the nation, for through their ceaseless vigilance in China the dire epidemics, confidently prognosticated, have not come to pass. " Sir," said Dr. Johnson on one occasion, " in lapidary inscriptions a man is not upon oath." I have sometimes felt that the sage might have enlarged his dictum to include not only writers of epitaphs but proposers of votes of thanks and speakers to toasts ; but tonight I have no such feeling. This Toast calls neither for verbal subterfuge nor logod~edaly. The reputation of each of our guests stands secure on some solid rock of achievement. Their very presence here testifies that each of them is, in his own kind, inter ignes luna minores. This Toast is to be responded to by Sir SQVlRE SPRIGGE,whose easy and graceful literary style has long been at once both the envy and the despair of those of us whom duty forces to take pen in hand with no natural aptitude for the task. Possibly some of us have even had the salutary experience of re-reading some effusion of our own with its rough-hewn sentences smoothed down, and a final touch of academic polish applied by his skilled hand. Sir SQUIRESPRIGGE will doubtless demonsstrate that his tongue is no less mighty than his pen, and if any prolixity of mine were to cut short his discourse by a single word, I feel sure that I should fall under your just condemnation. And so I give you the Toast of " Our Guests " coupled with the name of Sir SQUIRESPRIGGE. Sir Squire Sprigge, in responding said : You will admit that my task is not made easier by the introductory words, and by the mention of a long series of distinguished guests present enumerated by the proposer of the Toast, any one of whom clearly ought to be making this speech instead of me. I only wish that our Toast-master had read out to you in detail their qualifications for doing the job that I am about to do. The compliment paid to the branch of medicine to which I belong as the editor of a medical journal, in being asked to reply, embarrasses me, for the fact, of course, is that medical journals only exist through the kindness and by the co-operation of yourselves ; if it were not for you who supply us with material, with arguments, with the information
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which we hand on, we should have no existence. I may also say in this connection that the great State Department which watches with deep self-interest the progress of your Society is also a source of perpetual assistance and information to our service. I do not suggest by that that the Rt. Hon. Secretary of State for the Colonies writes anonymous leaders in the Lancet, and I do not suggest that Dr. A. T. STANTON is at my disposal--I wish he was. But I should like to take this opportunity of recording my thanks to the Colonial Office for the extraordinary readiness with which they answer questions and give information in places w h e r e questions can be fairly asked and the information is reMly needed ; so that one may be able on the one hand to report the progress of medicine and hygiene in far off Dependencies, and on the other hand, assist the Colonial Office in recruiting for their extremely important, hard-worked and valuable staff. At this dinner, some two years ago I think, LORD BALFOUR made an eloquent speech in which he pointed out, with the facility and grace which today is almost unusual amongst after-dinner speakers, the directions in which science in its separate branches was tending to fuse itself, the various directions in which philosophers who studied research and taught different branches of science were able to find that their discoveries, their results, their arguments, and their theories, could be applied to each other with the result of fortifying weak arguments and the production of new theories all tending to the enormous advance of science. Those who heard LoRD BALFOUR'Sspeech may remember that he indicated that medicine in itself was to a certain extent a reproduction of that general fusion of scientific knowledge, because medicine today impinges in so many ways on such varying and various departments of learning, and that of course is the case. I am old enough to remember that when we were trained in medicine the various departments of training were kept in water-tight compartments. Today it is recognised in the preliminary stages of education that ancillary scientific subjects have their bearing on direct professional scientific subjects, and that in both cases the studies have no particular meaning at all except for their ultimate bearing on clinical medicine. It seems to me that in the Royal Society of Tropical Medicine and Hygiene we have a very exact example of both the great and the lesser fusion, the great fusion being that our knowledge of tropical conditions, in every science which the EncyclopcediaBritannica can mention, will have some bearing upon work in the Colonies, while every piece of work that is done in the Colonies, as far as medicine is concerned, must be related to all the different sciences. The Royal Society of Tropical Medicine and Hygiene, although not working perhaps on any exact lines, must take note of discoveries in geometry, geology, gyna~cology, chemistry, and also general sociology, before it can get to work on its more particular objectives. As far as the Colonies are concerned, its task, of course, is to assist what is now the programme of the Colonial Office, to improve our various Dependencies and possessions for the benefit of the natives who reside in them. The officers of the Colonial Office have to live in close contact with
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the races in environmental circumstances, which in days gone by would have been an extremely perilous task; but owing to the good offices of scientific medicine and the support which in recent days the Colonial Office has brought to the efforts of tropical medicine, many of the places to which those officers were summoned to discharge their duty not so very long ago, and had the certain knowledge that the actuarial risk of life w.as an extremely bad one, now are places which are little less than health resorts. That is extremely practical evidence of the value of the work which has been done by the Royal Society of Tropical Medicine and Hygiene. In conclusion I should like to say--only I feel apologetic for talking about personal work--that a medical journal having these general large questions to think of, as well as more intimate questions relating to the progress and work of the profession in its day to day character, can necessarily only touch upon salient points. It is quite impossible to do more than look forward to such leading things as seem in some way or other to have their general influence in the first instance on the profession, and in the second, on the progress of the world. In an attempt to do that sort of work I must again put on record the obvious fact that one can only attempt it with the extremely generous co-operation of those who really know what they are talking about. " The Chairman." Dr. P. H. Manson-Bahr, in proposing the toast o f " T h e Chairman," proclaimed himself an inefficient substitute for Sir WILLIAM PROUT, prevented from attendance by illness regarding which all present extended to him sympathy and hope of speedy recovery. Our distinguished PR~SlI)ENT belonged to the old brigade of pioneers in tropical medicine. Educated at King's College, Cambridge, and St. Bartholomew's Hospital, he became President of the Abernethian Society of that Hospital in 1896, and scholar in pathology and bacteriology. He was appointed bacteriologist to the Government of India in 1897, but actually became a member of the Royal Society's Malaria Commission under CHRISTOPItERS with whom he worked for four years till 1902. These researches, a model for all subsequent work on malaria and blackwater fever, were embodied in a joint book which remained a classic to the present day. In 1903 he was called to join the Liverpool School of Tropical Medicine and became the Walter Myers Lecturer on Tropical Medicine and shortly the Alfred Jones Professor of Tropical Medicine in the Liverpool University. He invented a special malaria parasite Plasmodium tenue, and assisted at the birth of Trypanosoma rhodesiense. Amongst other activities he was known for the part he played in the recognition of the tapeworm-like elements in bananas. During the War he contributed thirty-one monumental papers on malaria to the Annals of Tropical Medicine and Parasitology and embodied them in a r4sum6 in 1923. To
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all his work he applied a cold and critical philosophy and an admirable exactness. Last year Professor J. W. W. STEPHENS had been elected President of this Society, a wise choice, and one under which the Society had enjoyed unprecedented prosperity, but it was on his part a selGsacrificing one, involving much expenditure of time in travelling betv?een Liverpool and London. Professor STEP,InNS was a noted archaeologist and ornithologist; and indeed at the moment it appeared that a training in the latter pastime was essential for success in tropical medicine ! Professor STEPHENS was, in a word, a man of distinction who had conferred honour on the Society by becoming its President. The Chairman, in reply, said : I hardly thought tonight I should have had laid bare all the iniquities of my past career. I have a troubled conscience. As the boy who said to his father " Dad, what are public schools for," so I imagine the newly-appointed medical officer going to Mr. AMERY and saying " Mr. Secretary, what are professors of tropical medicine for ?" and his replying " My boy, they are not for anything, but you have got to go to one." When I stand before you here tonight, especially after the remarks of the various speakers, I am reminded of an incident that I read a little time ago in a charming book entitled " Small talk at Wreyland," in which the author relates how he took a distinguished foreigner for a walk in the country. After a little time they came to a sign-post on which was written " Chagford, 1½- miles," and after proceeding a little further they came to another sign-post on which was written " Chagford, 2 miles." The foreigner said " We advance 100 metres and retreat half a mile. How then shall we arrive ?" The author answered " Ah, we muddle through." When I think of the distinguished Presidents you have had in the past and I see you regarding the dilapidated sign-post before you tonight, I cannot help thinking that I hear you say " How shall we arrive ?" I hope the answer may be that " we muddle through."