815

SPECIAL ARTICLESTHE

CONSULTANT SERVICE OF THE L.C.C.

A FURTHER MEETING OF LONDON CONSULTANTS

AT a general meeting of consultants and specialistscalled at B.M.A. House on March 28th by a Con-sultants’ Committee consisting of Dr. J. P. Martin,Dr. W. J. O’Donovan, Dr. Percy Spurgin, Mr. R.Davies-Colley, Mr. J. D. M. Cadell, Mr. F. CourtenayMason, Dr. W. Howard Jones, Dr. M. Donaldson,Dr. J. W. McNee, Mr. Aleck Bourne, Mr. P. H.

Mitchiner, and Dr. A. A. Moncrieff, the action of theLondon County Council in formulating a scheme ofconsultant service, without affording the consultantsan opportunity of discussing the proposals before

adoption, was deplored, and the consultants and

specialists of London were advised not to make

application for posts in this service or, if applicationhad been made or was contemplated, to place noticesof withdrawal in the hands of the Medical Secretaryof the British Medical Association.A further meeting was held on April llth, when

the chairman, Mr. H. S. Souttar, outlined the positionreached and Dr. O’Donovan moved :

" That this general meeting of consultants, realising thefar-reaching importance of the principle in dispute betweenthe consultants and the London County Council, requeststhe Council of the British Medical Association to takeaction on behalf of the consultants, particularly in viewof the offer of the Voluntary Hospitals Committee forLondon to act as mediator, and instructs the committeenot to proceed at present with the plan of withdrawal."

This resolution was approved with only twodissentients, and Dr. C. 0. Hawthorne then movedtwo other resolutions which were carried unanimously :

" That this meeting of medical and surgical consultantsand specialists practising in London, having received thereport of the committee relative to the medical services ofthe L.C.C., expresses its appreciation of the activities ofthe committee recorded therein, and thanks in particularthe chairman (Dr. O’Donovan) and the medical secretary(Dr. C. G. Anderson)."

" That the meeting, in reappointing the committee,repeats its regret that representatives of the consultantsand specialists were not afforded an opportunity, prior toits adoption, of considering the scheme recently approvedby the L.C.C. ; for, had this course been followed, themeeting is convinced that in several respects modificationsadvisable in the public interest and necessary to engage thegoodwill of the medical profession could have been secured."

The matter now comes before the meeting of theB.M.A. Council on April 12th.

LISTER AND HIS TIME *

BY SIR CHARLES BALLANCE, F.R.C.S., K.C.M.G.CONSULTING SURGEON, ST. THOMAS’S HOSPITAL

Sir Charles Ballance began by quoting the lines :" To those who knew thee not, no words can paint;And those who knew thee know all words are faint."

The whole life of Joseph Lister, he said, all his physicalstrength, all the high attainments of his mind, hadbeen consecrated to winning control over the septicdiseases which are so fatal to the life of man. Lister

* Abstract of the Lister Memorial Lecture delivered at theRoyal College of Surgeons of England, on April 5th, 1933.

had had no other ambition but to serve, and thiscontinuing devotion to a noble purpose had provedin him the source of an ever-widening river of happi-ness. "The strongest personalities are the outcome,not so much of striving for personal honour andfame, as of never-ceasing unobtrusive and faithfulendeavour in the path of daily duty and of faith inan ideal " : these words exactly expressed the reasonfor the influence and attraction which the lives ofLister and Pasteur exerted on the mind of the averageEnglishman. The lecturer said that, whether he wasvisiting a surgical operating theatre in a lonelyPacific island or in some great city, he always sensedin it the living spirit of Lister, whose labours hadransomed countless numbers of our race from pain,from illness, and from death, and the lapse of timewas powerless to dim their lustre. History haddeliberately pronounced that amongst eminent mennone had left a more stainless and none a moresplendid name. The whole earth was the sepulchreof Lister.The lecturer then sketched Lister’s early profes-

sional life and the influence of Pasteur on it, andrecalled his own personal contacts with him at King’sCollege Hospital, including the meeting of the MedicalSociety of London in 1877, when Lister had describedthe first open operation for transverse fracture ofthe patella. He recalled that when he had visitedLister in Park-crescent after a period of study inGermany, the great master seemed to have been

endeavouring to learn something from the strugglingyoung surgeon-a great encouragement.

Sir Charles Ballance thought that Lister wouldhave taken much interest in certain recent investiga-tions, particularly the following :

1. The regressive changes in the cells of the facial areaof the left Rolandic cortex following experimental inter-ference with the right facial nerve.

2. The contractile tissue of the iris.3. The culture of the cells of the embryo sciatic nerve

(a) in the egg ; (b) in the subdural space ; (c) by the ordinarymethod of tissue culture.

4. The ligation of arteries and the intimate process ofthe absorption of ligatures.

5. Double lateral implantation of the ends of a damagednerve into the side of an intact neighbouring nerve.

6. The histology of incubated carcinomatous and normaltissues.

SOME NEUROLOGICAL INVESTIGATIONS

Recent work had shown that there was a muchmore rapid return of function in the facial muscleswhen a cut facial nerve was substituted by a nerve-grafting operation in the aqueduct of Fallopius thanwhen it was anastomosed to another nerve. Aftersection of this nerve the large pyramid cells hadshown disappearance of the Nissl granules, exceptat the base of the axon ; diminution and alterationof the shape of the body of the cell; loss of the cellprocesses; and an eccentric position of the nucleus.

Lister’s first contribution to the literature of science,in 1853, had been entitled " Observations on theContractile Tissue of the Iris." The lecturer showedslides illustrating his own confirmation of Lister’s.statement that the dilator fibres of the iris consist ofmany narrow bundles running inwards separatelybetween the vessels and being inserted into theborder of the sphincter.Attempts to cultivate the cells of the embryo

sciatic nerves in the egg had failed, but transplantsinto brain tissue had been more successful. Therewas no evidence that the brain tissue itself actedotherwise than as a culture medium. Kanji Arai hadfound that axis cylinders persisted for two or three