Billings Lecturer

(See front cover)

Next week the American Medical Association will hold its 86th annual convention at Atlantic City. At the same time and place the Canadian Medical Association will hold its 66th annual session. It will be the first time in history that organized U. S. Medicine (99,532 members) and organized Canadian Medicine (2,652 members) have held such a joint session. About 8,000 doctors from south of the Border, about 2,000 from north of the Border are expected to attend.

They will see portly Dr. Jonathan Campbell Meakins, 53, of Montreal, who last month ended a year's service as president of the American College of Physicians, installed as president of the Canadian Medical Association. They will hear him talk exaltingly on "The Breath of Life."

They will also see slim Dean John Howell Janeway Upham of Ohio State University, functioning as chairman of the board of trustees of the American Medical Association, suspend a gold medal by a green ribbon from the neck of portly Dr. Walter Lawrence Bierring, 67, of Des Moines, retiring president of A. M. A.

And they will see portly Dr. James Somerville McLester, 58, of Birmingham and Tuscaloosa, Ala. installed as president of A. M. A. Like Dr. Bierring and other American doctors of their age, Dr. McLester, when a medical student the last decade of last century, was excited by the flood of bacteriological discoveries then pouring from the laboratories of Germany. With a medical degree from University of Virginia, he spent a year abroad, returned to become professor of pathology, then professor of medicine in Birmingham Medical College. After that College had become the postgraduate department of the University of Alabama, Dr. McLester became professor of medicine there. In passing he investigated and became a foremost authority on nutrition and diet in health and disease. "Nutrition and the Future of Man" is the subject of his presidential address next week.

The most disturbing question which the A. M. A. House of Delegates and the C. M. A. Council must face in their separate, secret sessions is, as in the past, that of their respective dollars. The average doctor on either side of the Border is barely making a living. Compulsory sickness insurance and state employment of doctors are the biggest solutions thus far offered. Both put the doctor under lay administrators, cramp the traditional practice of his profession. Organized Canadian and U. S. Medicine thus far have stubbornly fought all such lay control.

Birth control is another problem, posed by instructed delegates from Arkansas, California and New York, which the A. M. A. meeting must handle.

As for the science of Medicine, in which the 10,000 are more immediately interested, they will see four special exhibits: Diabetes, supervised by Dr. Elliott Proctor Joslin of Boston and Dr. Frederick Grant Banting of Toronto, Nobel Prizeman, co-discoverer of insulin; Nutrition, supervised by Dr. Reginald Fitz of Boston; Prevention of Asphyxial Deaths, supervised by Dr. Chevalier Lawrence Jackson (son) of Philadelphia; Vaccines & Serums (measles, rabies, typhoid fever, diphtheria, smallpox, scarlet fever, tetanus), supervised by Dr. Ralph Chester Williams of Washington. In addition there will be some 200 less extensive scientific exhibits illustrating Medicine's progress. Among the 200 will be Dr. Allan Roy Dafoe's "Chart Life'' of the Dionne Quintuplets.*

Some 350 doctors will report on significant medical studies which they accomplished during the past year--from Philadelphia's Louis Manuel Lieberman & Simon Stein Leopold's "Further Data on Artificial Pneumothorax in Experimental Lobar Pneumonia" to Philadelphia's Charles Harrison Frazier's "The Modern Treatment of Surgical Shock." These papers will keep the A. M. A.'s Journal in ample copy for six months or more.

Special Salutes-Through all bustle of such ceremonies, special and ordinary lectures, special and ordinary demonstrations, doctors who spend their hard-earned dollars attending an A. M. A. convention keep their ears and minds open for two extraordinary orations which not only are of decidedly practical value but also represent special salutes by organized Medicine to the men who deliver them.

Those are the Osler Oration and the Frank Billings Lecture. Older of the two is the Osler Oration, named after the late Sir William Osler (1849-1919), great practitioner and teacher of medicine. Osler Orator this year is Dr. Lewellys Franklin Barker, 67, Canadian-born successor to Osler as physician-in-chief at Johns Hopkins Hospital.

The Billings Lecture was established to honor Chicago's late great Dr. Frank Billings (1854-1932) who made the medical departments of Northwestern University and the University of Chicago largely what they are today; who, with Dr. George Henry Simmons, editor and general manager-emeritus of the A. M. A., made the A. M. A. a great, potent organization; who, most of all, promulgated the doctrine of focal infection. More than any other physician, he traced human ailments to their remote and often obscure causes. definitely establishing that infected tonsils may cause blood poisoning, that gonorrhea may produce rheumatism, that a bad tooth may result in heart disease.

With focal infection as his theme the Billings Lecturer must be an eminent clinician, a topnotch diagnostician, a wise interpreter of the symptoms which a patient brings to his examination room. Billings Lecturers in the past have included such front-rank men as Dr. Joseph Leggett Miller, professor of clinical medicine at the University of Chicago, specialist in vaccine therapy and rheumatism; Dr. Lewis Atterbury Conner, Cornell professor of medicine, editor of the American Heart Journal; Dr. James Bryan Herrick of Chicago, specialist in diseases of the heart and blood vessels; the late William Sydney Thayer (1864-1932), 1928 president of the A. M. A., longtime professor of clinical medicine at Johns Hopkins.

Next week's Billings Lecturer is Dr. Emanuel Libman, 62, professor of clinical medicine at Columbia University, consultant physician to Manhattan's Mount Sinai Hospital, heart specialist, and philosopher on human pain.

Mount Sinai's Scholar. Dr. Libman was born in Manhattan, son of a prosperous picture-frame dealer. A quick-witted, slightly-built young man, he went to the College of the City of New York, where he won Phi Beta Kappa, and to Columbia's College of Physicians & Surgeons.

He interned two years (1894-96) at Mount Sinai Hospital, at that time a grubby little institution where the late great Dr. Edward Gamaliel Janeway (1841-1911) inducted him into habits of sharp observation of the patients' symptoms and quick deduction as to ailment. Then, like ambitious contemporaries, Dr. Libman proceeded to the famed clinics in Berlin, Vienna, Munich, studied bacteriology and pathology, identified a germ (Streptococcus enteritis, subsequently called Streptococcus Libman) which causes focal infection of the intestines and, he later discovered, destructive inflammation of the lining of the heart (subacute bacterial endocarditis).

Back in Manhattan, assistant pathologist in Mount Sinai Hospital's new department of pathology, he prosecuted in every conceivable aspect blood, heart and arterial diseases. He grew to understand the dynamic interrelation of the heart which pumps the blood, the liver which strains the blood, the lungs which refresh the blood, the stomach and intestines which nourish the blood.

Adolph Lewisohn, philanthropic mining tycoon, gave Mount Sinai a special pathology building whose museum. Dr. Libman stocked. He helped persuade other rich Manhattan Jews to endow Mount Sinai Hospital. Today Mount Sinai can bed 780 patients at a time. Its buildings and equipment cost $22,500,000. Its total endowment amounts to $2,000,000. That Mount Sinai is today the No. 1 Jewish Hospital in the U. S. is due in no small part to the tireless efforts of Dr. Libman.

Around zealous Dr. Libman developed the Mount Sinai "School of Cardiologists." He and his assistants studied the focal infections from which germs get into the blood stream, found out how germs grow in circulating blood, how certain germs destroy blood cells, how certain others fasten to the valves and inner walls of the heart and create warty excrescences which cause the heart to fail.

One of his pupils, Dr. Leo Buerger, discovered the mechanism of the disease called thromboangiitis obliterans, during which arteries of the legs close up. In extreme cases the limbs must be amputated, else they grow ulcerous and gangrenous. Smokers, especially, must beware of Buerger's Disease.

Another pupil, Dr. Alfred Einstein Cohn, became head of the Cardiac Department of the Rockefeller Institute (TIME, June 3). Another, Dr. Moses Swick, invented an iodine compound which when injected into the veins makes the kidneys visible to x-rays (TIME, Aug. 24, 1931). Still another, Dr. Reuben Ottenberg, who showed how blood tests could determine paternity, in the "Convention Number" of the A. M. A. Journal gave doctors explicit instructions about deciding whether an adult patient suffering from jaundice needs medicine or an operation.

Such pupils remain gratefully loyal to Dr. Libman. Generous and modest, he finances able youngsters in medical schools, in research laboratories. He gets them paying fellowships, good hospital appointments. To celebrate his 60th birthday in 1932, former pupils wrote special scientific articles for a homage volume. They got learned colleagues and friends to contribute: Nobel Prizemen Alexis Carrel and Albert Einstein, Dr. George Richards Minot (who later received a Nobel Prize), the late great Dr. William Henry Welch (1849-1934). The salutes to Dr. Libman filled three Libman Anniversary Volumes. Dr. Welch, who wrote the introduction, needed ten epithets for his hero: "Teacher, investigator, writer, skilled physician, exemplar and promoter of scientific research, generous helper of fellow-workers and pupils, guide, leader and friend of a devoted band of disciples."

Pain. Long a doctors' doctor, Dr. Libman now accepts only rare cases which other doctors refer to him. Some of his old patients, however, still climb the high stoop of his brownstone house in Manhattan's East 64th Street. Up that stoop, as patient or friend, have gone Adolph Lewisohn, Samuel Untermyer, Albert Einstein, Alexis Carrel, Sarah Bernhardt.

Dr. Libman's present preoccupation, and probably his most important contribution to the science and practice of Medicine, concerns Pain. Chiefly by evidence of pain can a doctor tell what ails his patient. Diagnostician Libman has discovered that people are either sensitive (i. e. normal) or hyposensitive (i. e. subnormal) to pain and that the sensitives and the hyposensitives show systematically different symptoms when suffering from the same disease.

Instead of pain normally caused by a disease, a hyposensitive person may feel only pressure, burning sensations, numbness, prickling, tingling. "Such symptoms as pruritus and ticklishness need special study in this connection," says Dr. Libman. "That ticklishness may represent pain is suggested by the observation that pressure over a diseased organ may elicit laughter in a hyposensitive patient instead of pain."

A hyposensitive may feel no normal symptoms of a disease until accidental conditions build up his sensitivity. Sensitizers: "worry, fear, anger, sorrow, fatigue, diversion of attention, joy, focal infections, and endocrine influences (especially the menopause), trauma, meteorological changes." As an example Dr. Libman cites the case of a Viennese doctor who, when a soprano took a B note a quarter of a tone too high, suffered a severe attack of pain in a tooth that had never before been painful. On the following day that doctor's dentist found the tooth decayed.

Dr. Libman's method of detecting a patient's degree of sensitivity: he gets up, walks around the room, accosts the patient. "What seems to be the matter with you?" The patient tries to explain. Dr. Libman apparently pays little heed. He pats the patient's head, glides his right palm down the patient's neck, slyly presses his thumb, first against the tip of the mastoid bone ("Do you feel any pain? Does it hurt you when I press?"), then against the styloid process just below the ear, "Do you feel any pain? Does it hurt you when I press?" With a sensitive person, sick or well, pressure on the styloid process will hurt keenly, whereas the hyposensitive will suffer not at all. Having thus fundamentally classified his patient, the diagnostician can then proceed to string symptoms on one of two lines of medical logic.

*Last week Dr. Dafoe became an officer of the British Empire.

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