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QUIS CUSTODIET ipsos custodes? Who will guard the guards themselves? queried Juvenal, the Roman poet and satirist, many centuries ago.Juvenal's remark was aimed at the dilemma of ensuring the chastity of women. But his query seems fitting for an embryonic field of study that has gained momentum during the last dozen years or so: an effort to investigate how those who oversee peer review, the evaluative action at the heart of the biomedical literature, can themselves assure that the process itself is sound.To this end, more than 300 participants from 46 countries recently gathered at the International Congress on Biomedical Peer Review and Global Communications in Prague, Czech Republic, organized by JAMA, BMJ (British Medical Journal), and Project Hope. They came to the meeting, the third such congress since 1989, to hear the latest research aimed at answering such questions as whether the process allots credit where (and

DESPITE ever more sophisticated strategies for treating human immunodeficiency virus (HIV) disease, researchers are finding that many patients suffer needlessly because physicians fail to recognize and alleviate AIDS-related pain. Studies show that although people with HIV infection and AIDS suffer pain comparable to that experienced by cancer patients, their pain is "dramatically undertreated, even in academic centers with a focus on HIV care," said William Breitbart, MD, at a recent international congress on pain held in Vancouver, British Columbia. "The story of pain in AIDS has been a story of neglect," noted Breitbart, of Memorial Sloan-Kettering Cancer Center, New York, NY. And the problem may be exacerbated by pressures of managed care that result in greater numbers of people with HIV and AIDS being cared for by primary care physicians, many of whom have little training or experience in managing chronic pain. "Most physicians haven't been trained in

In this issue ofThe Journal, we publish 26 of the papers presented at the Second International Congress on Peer Review in Biomedical Publication, held in Chicago, Ill, September 9-11, 1993. Of these 26 papers, two, those by Kassirer and Campion1and Judson,2were invited. The others were submitted in response to a concerted effort we have made during the past 8 years to stimulate research into editorial peer review.3,4 Given the subject, it is appropriate to comment on the review process used to help select these papers. We received 110 abstracts describing work to be presented at the congress. These were sent to seven independent reviewers (from the United States, Canada, and the United Kingdom) who allotted scores to each abstract; selection was made according to these scores. Thirty-three abstracts (30%) were selected for oral presentation, and 21 abstracts (19%) were presented as posters. Subsequently, the

RESEARCH is revealing much room for improvement in the long-concealed world of medical journal peer review. A host of shortcomings, from bias and error to poor readability and a lack of clear standards, were documented in studies presented at the Second International Congress on Peer Review in Biomedical Publication, held in Chicago, Ill. See also p 2856. The meeting, sponsored by the American Medical Association, was designed "to stimulate research, not rehash editorial opinion," says congress director Drummond Rennie, MD, Deputy Editor (West), JAMA , Chicago, Ill. "We are looking closely for information we can put into practice" to improve "and, if necessary, reinvent" medical journals, says George D. Lundberg, MD, Editor, JAMA . Need for Standards Despite Rennie's call to focus on research, calls for establishing standards peppered the meeting. Speakers cited a need for clear statements of the types of reasons papers are rejected, what is expected from reviewers, how

IN RECENT years, scientists and editors of scientific journals have often noted how few hard data exist on the workings of editorial peer review. Although pressures from inside and out increasingly encourage journals to be more explicit about their practices and more inclined to question their own habits, there is still a good deal of truth in the sardonic observation made 5 years ago that "the arbiters of rigor, quality, and innovativeness in publishing scientific work do not apply to their own work the standards they apply in judging the work of others." 1 This paradox inspired The First International Congress on Peer Review in Biomedical Publication, with its goal of encouraging the systematic and empirical study of journals. Of course, data and rigorous methods are not enough to make a science. The systematic study of peer review is even more deficient in theory than it is in data. Some

The First Annual International Congress for Interferon Research, held in Washington, DC, during the fall of 1980, left the impression that interferon as an anticancer drug was intriguing but unproved (JAMA [MEDICAL NEWS] 1981;245:109-116).The second congress, held recently in San Francisco and, like the first congress, well attended by scientists, the business community, and the press, left much the same impression. However, some new questions, for example, those concerning interferon's possible role in disease induction, came to light.At the time of the first congress, the results of the American Cancer Society-sponsored phase I trials of interferon in cancer patients were known. They were highly variable—reported tumor regression ranged from 0% to 40%—and raised several questions, such as these: Was the variability of response due to the kind of interferon used for treatment (there are three major groups of interferons that include a minimum of 20 distinct entities)? Was

REPORTS of the current status of marijuana research were presented at a symposium on marijuana held in July 1978 in Reims, France, under the aegis of the Seventh International Congress of Pharmacology.1-2More than 100 scientists from 14 countries attended the meeting sponsored by the National Institute on Drug Abuse (NIDA), The French Ministry of Health, the French National Institute for Health and Research (INSERM), and the International Medical Council on Drug Use. Organizers of the symposium were Gabriel G. Nahas (Columbia University), W. D. M. Paton (Department of Pharmacology, Oxford University), and Monique Braude (NIDA). Analysis, metabolism, cellular responses, and effects on reproduction and on the brain were the topics discussed during the two-day meeting. Pharmacokinetics The pharmacokinetics (absorption, distribution, biotransformation, and elimination) of the psychoactive substance of marijuana—Δ9-tetrahydrocannabinol, or THC—and of its byproducts (metabolites) were described by E. R. Garrett (University of Florida). Unlike water-soluble

A new class of antiulcer drugs—it is hoped—may be as effective as the histamine receptor antagonists (H2 blockers) in inhibiting gastric acid secretion.However, the activity of this new class may go beyond that, according to a series of clinical trials presented at two medical conferences in Portugal— the XII International Congress of Gastroenterology in Lisbon, and a symposium on prostaglandins in the Algarve.The new drugs are laboratory devised derivatives of naturally occurring prostaglandins. Preliminary indications are that, in addition to inhibiting gastric acid secretions and helping to heal ulcers, they may protect the gastroduodenal mucosa against potential damage from aspirin, alcohol, and other agents. As such, they might be particularly useful in patients with rheumatoid arthritis and for other persons who routinely ingest large amounts of nonsteroidal anti-inflammatory agents, some of the conference reports suggest. However, larger clinical trials remain to be done, and questions about factors

Barely 13 years after its initial discovery, the hypothalamic luteinizing-hormone releasing hormone (LHRH) appears to be claiming a large territory in clinical medicine. "There's almost no subspecialty of medicine that will be left untouched by the [research] advances associated with LHRH or its analogues," predicts William F. Crowley, MD, associate professor of medicine at Harvard University Medical School, Boston. He points out that this polypeptide hormone (also known as gonadotropin-releasing hormone or GnRH) is already providing new treatments for several human diseases and "represents one of the examples where an investment in basic science has profound clinical applications." Crowley, who is also chief of reproductive endocrinology at the Massachusetts General Hospital in Boston, discussed the therapeutic implications of LHRH and its analogues at the Seventh International Congress of Endocrinology in Quebec City. So far, he says, the ability of LHRH to either stimulate or suppress reproductive processes has been applied

REPAIRING GENES by taking advantage of chromosomal recombination is emerging as a promising new approach to gene therapy, according to speakers at the recent 16th International Congress of Genetics in Toronto. Although gene therapy was once thought to be nearing clinical trials, numerous technical problems have kept it in the laboratory. One principal stumbling block has been an inability to get inserted genes to express proteins at useful levels in animal models. The difficulty, many investigators say, arises from the vehicles used to transport genes into the cell. The most widely used vehicles, modified retroviruses, are essentially unguided missiles that deposit their cargo randomly about the genome. The transported genes, out of their customary positions, are usually only temporarily activated, if at all. One solution may be to repair the defective gene in place, suggests Paul Berg, PhD, director of the Beckman Center for Molecular and Genetic Medicine, Stanford (Calif)

Interferon was celebrated at the first annual International Congress for Interferon Research in Washington, DC. The conference, organized by the Journal of Interferon Research and Scherago Associates, Inc, an advertising and marketing company in New York City, had an air of upstage scientific excitement and backstage financial intrigue. With some of the biggest stars of the interferon research and business worlds crowded together in one hotel, it was difficult to mask the conflict with smiles and diplomacy. Real and potential interferon producers and brokerage companies were gleaning information instead of selling or exhibiting products. There were even stories of black market interferon and of a wealthy cancer patient offering half a million dollars to researchers for interferon therapy. On the second day of the conference, clinicians from Europe and the United States reported on the results of several clinical trials of interferon in cancer and antiviral therapy. The results were

A book of 63 headings in only 329 pages can hardly be said to have chapters. Indeed the text comprises the papers from an International Congress on the Knee Joint held in Rotterdam in September 1973. The material covered is divided into six sections: I. Biomechanics of the Knee Joint, II. Degenerative Joint Disease, III. Trauma of the Knee Joint, IV. Congenital and Postural Deformities, V. Transplantation of Cartilage and Bone, and VI. Arthroplasty of the Knee Joint. Each section contains both short research reports and clinical material. In general, the research material is interesting and may be worth inspection by those actively engaged in the particular areas involved. This is particularly true of the biomechanics and transplantation sections, where some new and interesting material appears. Even here, however, much of the material appears to be either so preliminary as to be unsupported by data, or a rehash of the

The published reports of proceedings of conferences are a difficult problem for a reviewer. These reports have the inherent problem of containing a large number of papers (in this case, more than 100) that are usually short and can vary in quality and in interest. The major advantages of this format are the timely nature of much of the material, often its diversity, and the fact that less-relevant portions of the volume can be ignored without significant loss of continuity to the reader. This volume represents the proceedings of the eighth international congress on Sarcoidosis and Other Granulomatous Diseases, convened in Cardiff, Wales, in 1978. It contains broad coverage of all the aspects of this fascinating disorder, including its pathology, etiology, immunologic aspects, diagnosis, and therapy. There is a complete chapter on the angiotensin-converting enzyme and its relevance to sarcoidosis and usefulness in the diagnosis. Since the papers included are

A wide therapeutic range, low toxicity, and strong clinical efficacy against previously hard-to-treat, antibiotic-resistant infections are the main advantages of what is now being called the "third generation" of cephalosporin antibiotics. Scores of papers covering the drugs' microbiologic, pharmacologic, and clinical performance were presented at the 12th International Congress of Chemotherapy in Florence, Italy. What is intriguing about these relatively new cephalosporins and their relatives is that they are able to destroy many of the Gram-negative microorganisms that are not affected by or have become resistant to the first-generation cephalosporins. In addition, through chemical modification of the basic cephalosporin molecular structure, the third-generation drugs are able to sidestep most of the β lactamase enzymes, which have allowed microorganisms to neutralize the effects of many of the first- and second-generation agents. Currently, the only member of the new cephalosporin family on the American market is cefotaxime, developed by Hoechst-Roussel Pharmaceuticals, Inc

Once upon a time there were hyperthyroidism and hypothyroidism. Therapy for the first aimed at diminishing excess hormone production, while therapy for the second aimed at replacing it. But now research from a variety of laboratories suggests that in certain conditions these therapeutic approaches, however logical on the surface, may be unnecessary and even dangerous. Some of these relatively rare conditions were discussed at the Seventh International Congress of Endocrinology in Quebec City and at the annual meeting of the American Thyroid Association in New York City. The recurrent message was: Hyperthyroidism is not always hyperthyroidism. And the same holds true for hypothyroidism. For example, at the endocrinology meeting, held last summer, Thomas F. Nikolai, MD, discussed a condition noticed at the Marshfield (Wis) Clinic and regarded as a clinically new form of hyperthyroidism not recognized before 1970. Called "silent thyroiditis" (or lymphocytic thyroiditis with spontaneously resolving hyperthyroidism), this disease

LAST YEAR, Sydney J. Peerless, MD, was among the first to learn the results of an eight-year international surgical study. "My jaw dropped. I couldn't believe what I found," he said. "What the data were telling me was that with 95% confidence we can rule out a 5% benefit from extracranial/intracranial [EC/IC] bypass surgery." Peerless, who is professor of neurosurgery at Canada's University of Western Ontario, London, was principal neurosurgical investigator in the 71-center study. His incredulity was mirrored 500-fold when the study was presented at the International Congress of Neurosurgery in Toronto a month later. And, when he reprised the study's findings at a special symposium at the American Association of Neurological Surgeons in Denver this spring, it was apparent that many of his colleagues still refused to believe what they were hearing. Yet the message was straightforward. The neurosurgeons were told that the intricate microsurgical procedure—the anastamosis of

Much has been said and written about the peer review process for scientific journals. A simple search of the MEDIS database reveals 435 articles that contain the term "peer review." The first International Congress on Peer Review in Biomedical Publication, sponsored by the American Medical Association and to be held in 1989 in Chicago, 1 will delve into the effectiveness of this process extensively. But there is another side to the peer review process. The administration of a peer review file and its daily use for reviewing manuscripts is complicated. 2 Management of such a large body of data has been made somewhat easier through computerization. Our peer reviewer file and manuscript processing procedures were converted from paper to electronics in 1988 through a difficult and tedious process. The file of nearly 6000 reviewer names, addresses, and relevant information is now available on a computer database. When a manuscript arrives

Proceedings of international congresses can only be announced rather than reviewed. Nephrologists hold theirs every three years, and these volumes are from the proceedings in Mexico City in 1972. The proceedings furnish the reader with a series of brief and interesting papers arranged in three volumes. Taken together, the volumes provide a convenient and rapid overview of current nephrological interests. The first (Morphology and Pathology) deals mainly with glomerular diseases and it is clear that the 20th century French have inherited the 19th century German passion for nosology as a thing of beauty. Volume two (Physiology) reviews sodium transport, including the related problems of energy needs. Volume three (Clinic) deals with various aspects of proteinuria, uremia, hypertension, and therapeutics. The Australians have an unquenchable enthusiasm for heparin, but there is some difficulty in transporting their good results safely across the ocean.Finally, I am once again puzzled by the absence

The 27th International Congress of the History of Medicine held in Barcelona, Spain, in 1980 provided an opportunity to examine the effects of medicine in the old world on medicine in the new world. The four authors originally presented summaries of their work; in this volume they have greatly expanded these into full-fledged essays. In his introduction, Numbers contrasts the environmentalist approaches of Daniel Boorstin and Bernard Bailyn, who held that the primitive conditions in America brought about a completely new way of thinking and doing, with the opposing views of Michael Kammen and Richard Harrison Shryock, who saw and demonstrated much closer relationships between the old and the new worlds. This book gives many examples of such relationships in the theory, practice, and control of medicine. Guenter Risse, Toby Gelfand, and Eric Christianson, respectively, have written the essays on New Spain, New France, and New England. They compare new

In Reply.— I am sorry that the editors have obtained the impression that the article was a duplicate publication of an earlier article in the New EnglandJournal of Medicine. I am surprised by this editorial decision, because my coauthor and I believe that both in purpose and content the two articles are significantly different from each other.The material in the recent JAMA article was first prepared for presentation by one of us at a meeting of the Fourth International Congress of the World Federation of Public Health Associations, whose theme was "Lessons Learned in Primary Care." A review of the literature led us to conclude that the effects of a glut of specialists on primary care, and the organization of care, had received insufficient attention, and we decided to develop a more detailed discussion of these issues.To be sure, these manuscripts contain some common material, in terms

"Peer review" has a variety of meanings for physicians. All physicians are accustomed to surveillance of their use of hospital beds or of the records they keep about the patients in those beds by utilization review and quality assurance committees made up of their peers. Physicians face yet more peer review when they double as investigators, put their proposals before institutional review boards, and have their grant applications assessed by expert panels of their peers. Finally, the product of all this—the manuscript that embodies their scientific brainchild and carries their hopes of fame and promotion—is subjected by journal editors to yet another round of peer review. Understandably, it is this last version that tends to interest journal editors the most. However, the workings of the editorial peer review system are of vital concern to every scientist and ultimately to all physicians and patients because all the important advances in science

The modern concept of sports medicine originated with the first international congress of sports medicine at the Olympic Games in 1928 in Amsterdam. The purpose of that congress was to exchange experiences and scientific observations on the treatment of injuries and the medical care of athletes. In the years to come, the field widened to include almost all biomedical sciences related to sports and physical activity.This wide-ranging interdisciplinary coverage of clinical knowledge and experimental research is embodied in the table of contents of The Year Book of Sports Medicine 1979. The editors screened 3,000 international journals and selected articles that had appeared in 1978 for brief review. These articles cover a great variety of subjects, such as diagnosis and treatment of sports trauma, preventive aspects of physical activity, exercise physiology and psychology, training for general fitness or competitive performance, selective criteria for special sports, exercise testing and prescription, the

The word is out in Britain and spreading elsewhere: Bromocriptine reduces jumbo prolactinomas to manageable size.In the United States, the Food and Drug Administration still recommends use of the synthetic ergot alkaloid, a dopamine agonist, only for lowering serum prolactin levels in hyperprolactinemic patients with no demonstrable prolactinomas (JAMA [MEDICAL NEWS] 242:401, 402, 407-409, 1979). American clinicians generally have used the agent only as a last resort in treating large pituitary tumors, after surgical debulking and external megavoltage irradiation (both notoriously noncurative) have failed. But, like British endocrinologists, American physicians may gradually be coming to regard bromocriptine as the treatment of choice for some of these hardy neoplasms.The most recent British research was reported at a satellite meeting of the Sixth International Congress of Endocrinology in Adelaide, Australia, last February. At that meeting, Alan M. McGregor, MB, MRCP, of Cardiff, Wales, reported tumor regression in 12 of

This well-edited volume makes available the symposiums and workshops of the First International Congress of Child Neurology. The major headings are "Neonatal Neurology," "Temporal Lobe Seizures," "Learning Disabilities," and "Behavior Disorders in Childhood." In addition, an introductory article by Sven Brandt on "The Parentage of Child Neurology" and an article by Gastaux on the Lennox-Gastaux syndrome are included. With few exceptions, the individual contributions are excellent statements of the state of the art. As such, they are valuable and usually critical reviews. In a problem such as the predictive, or lack of predictive, value of neonatal behavioral and neurological assessment, an article by Graziani and associates is an especially thoughtful and careful appraisal of a difficult topic. Discussions of the importance of pharmacokinetics in the neonatal period, the management of neonatal seizures, and the topic of temporal lobe seizures are good reviews. The remaining articles address themselves to the most

To the Editor.— The article entitled "Genetic Damage From Diagnostic Radiation" (237:2399-2401, 1977) makes interesting reading. The authors (Bross and Natarajan) attack "a dogma that is often cited by radiologists who claim that diagnostic radiation is harmless" and imply that an attitude of "out of sight, out of mind" is a radiological precept. I for one was not taught that diagnostic radiation is harmless and have not taught it myself. Most of my radiologic colleagues and many of our predecessors would make the same claim. As long ago as 1928, the second International Congress of Radiology at Stockholm adopted recommendations made by the British x-ray and radium protection committee ( Acta Radiol , suppl 3, part 1, 1928, pp 62-73). "The suggestions are now to form the basis by which doctors and engineers will be guided in making their departments safe for patients and staff." 1 Note that it is not staff

THE SIXTH International Congress of the Transplantation Society was characterized by a recrudescence of interest in the various aspects of transplantation biology and medicine, and particularly in cell-to-cell interaction. The general consensus at the close of the meeting was that a firm basis had been established for the acquisition of new biological facts of direct relevance, not only to transplantation, but also in the understanding of a wide variety of disease processes in man. CLINICAL AND EXPERIMENTAL ORGAN TRANSPLANTATION The 13th (and final) report of the International Human Renal Transplant Registry of The American College of Surgeons, National Institutes of Health, was one of the highlights of the Congress. This report detailed the experience with 24,193 kidney transplants performed at 301 institutions, including 165 in the United States, since 1963. Six institutions performed more than 51 transplants per year in each of the five years ending in June 1976; eight

No. V. THE INTERNATIONAL MEDICAL CONGRESS AT ROME. Rome, Italy, April 7, 1894. Dear Dr. Senn: —When I promised you a letter from Rome, relating to the International Medical Congress, I did not realize the import of the promise. I had been at the International Congress at Copenhagen and found there no difficulty in following the work of one or two Sections; at least, made notes as the papers were read, and elaborated them at night, so that at the end of the Congress I had a fairly full report of the general sessions and of at least one Section ready for the press. I found matters quite different here, and have been obliged to postpone this letter to the end of the Congress in order to arrange my notes and collect material, when I could not be present in person. I find that my account of this Congress can

Washington, D. C., Aug. 26, 1904. To Members of the Medical Profession: —The organizers of the International Congress of Arts and Science, to be held at the Universal Exposition, St. Louis, Sept. 19 to 25, 1904, desire to invite the, special attention of your profession to the unexampled opportunity which it offers to meet and hear a great number of eminent men of learning. It is expected that more than three hundred eminent scholars of Europe and America will deliver discourses in the various departments and sections of the congress, and that several hundred shorter communications will be made by those present. Among the foreign members of the profession who have accepted invitations to speak are Profs. Brunton, Semon, Ross, Celli, Orth, Liebreich, Allbutt, Kitasato and Escherich. Dr. William Osler is chairman of the department. It is the desire of the directors of the fair and of all concerned in

1230Olive St., St. Louis, Dec. 26,1893. To the Editor: —Referring to the item in theJournalof December 23, regarding the International Congress,can you tell what arrangements for transportation and otherwise have been made as to visitors from this country? Yours fraternally, Ans: —Address Dr. A. Jacobi, 110 W.Thirty-Fourth Street, New York.

To the Editor: —The fifth congress to be held on the history of medicine since the foundation of the society in 1920 took place at the Athenee in Geneva, July 20 to 25, under the presidency of Dr. Charles Greene Cumston, formerly of Boston, and now instructor in medical history in the University of Geneva. Eleven nations were represented (Belgium, Denmark, France, Great Britain, Holland, Italy, Morocco, Poland, Spain, Switzerland and the United States) and although the number of those registered was not as great as at the previous congress (influenced largely by the unfavorable rate of exchange), the percentage attending the various seances was considerably higher. Five national sections (Egypt, Greece, Portugal, Roumania and Sweden) were not represented. Each session was presided over by the representative of one of the countries participating. In opening the congress Monday afternoon, Dr. Cumston gave an interesting talk on several men prominent in

To the Editor: —I am requested by the Honorary Secretaries of the Committee of Organization of the Seventh International Congress of Hygiene and Demography, to call attention to the fact that this Congress will be held in London during the week beginning August 10, 1891. The Governments of all countries, and municipalities, and all public health authorities, universities, colleges and societies occupied in the study of the sciences more or less immediately connected with hygiene, are invited to cooperate and appoint delegates to represent them at the Congress. The Prince of Wales will preside. A Committee of Organization has been formed of which Sir Douglas Galton is Chairman, and Prof. W. H. Corfield and Mr. Shirley F. Murphy are Honorary Secretaries. An exhibition of articles of hygienic interest will be held in connection with the Congress. The last of these Congresses was held in Vienna in 1887, and was attended

All properly organized and directed movements and efforts that have for their object the saving of sight are to be approved and should have the support of ophthalmologists. While, generally speaking, therefore, an international congress for the consideration of the subject of conservation of vision, so called, is to be commended and should receive the approval of the section, it is the opinion of your committee that the time is not yet ripe for such an undertaking. The conservation of vision movement, embracing, as it does, not only all that is included in the science of ophthalmology but also all that relates to the subject in an educational, commercial and broadly social sense as well, has not yet been developed and crystallized in this country, at least, into a position where international cooperation could be successfully accomplished. As a first step toward the holding of such a congress, your committee

"Approximately one-third of the communications given at the Fourth International Congress of Neuropathology have dealt with histochemistry or have identified histochemical techniques." This statement, with corresponding warnings about misuse and misinterpretations of these new techniques, was made by the Chairmen of the Official Themes, Pearse, Shimizu, and Wolman, in the summary of the proceedings at the end of this magnificently presented volume. Indeed, the extraordinarily rapid progress of histochemical and biochemical approaches to the problems concerning the central nervous system made it necessary for the Editorial Committee to limit the length of each communication to 5 to 8 pages and 2 to 3 illustrations. However, this synoptic panorama of new fields in the study of structure and function of the central nervous system gives insight into new perspectives and possibilities for future research. The volume opens with reproductions of the various opening speeches of the Congress. President Haymaker, in his

In the Diario de Noticias, of October 23, published iu Bahia, Brazil, there appears an article touching inoculation as a prophylactic against yellow fever. I have made a literal translation of it, and present it for the consideration of the medical profession in this country, without note or comment, as follows:"In the International Congress of Hygiene and Demography, of Buda-Pesth, assembled inl ast September, the question of yellow fever was discussed and Dr. Miranda de Azevedo, a delegate from our government, presented to the distinguished assembly the report of our illustrious citizen, Dr. Domingos Freire, whose investigations upon the etiology and prophylaxis of this disease are well known."The Congress formed in this respect, the following conclusions:"1. It is a fact attained for science, thanks to the labors of Prof. Domingos Freire, supported by many physicians of Brazil and by observers of other countries, that a microbe (cryptococcus

To the Editor: —The third international congress on the history of medicine was held at the Royal Society of Medicine in London, July 17 to 22, under the honorary presidency of Sir Norman Moore and the acting presidency of Dr. Charles Singer, two of the leading medical historians of the English-speaking world. Distinguished representatives from every country of Europe, except Germany, Austria, Russia and one or two of the Balkan states, attended the scientific meetings. At the Royal College of Physicians, its president, Sir Humphry Rolleston, gave a most entertaining discourse on the history of the institution, and its splendid historical library and portrait gallery of distinguished members was exhibited. The scientific program was chiefly devoted to medieval epidemics and to the history of anatomy. In the former topic, important papers were given by Tricot-Royer, a former president of the association, Professor Simpson, Wickersheimer, Mrs. Singer and others. The subjects

This volume, reporting a symposium of the 1963 International Congress of Zoology, outlines well many contemporary ideas in biology and illustrates the increasing unity of the biological, physical, and behavioral sciences. Eighteen essays, written by specialists, fall into six different categories, ranging from genetic continuity to behavior. Thus, the opening articles define modern ideas of the duplication and recombination of genes and gene action. These chapters provide a base for the succeeding series, dedicated to the modern understanding of cell structure and function. Careful reading of these articles will provide considerable insight into the relation of ultrastructural elements and the synthetic and energetic activities of cells. Ample electronmicrographs of good quality aid the reader in achieving such insight. Next described, in fine detail and clarity, are the prevailing ideas regarding those critical events in embryogenesis defined as cellular differentiation and cellular interactions during development. Mid-20th-century ideas of evolution and phylogeny

Baltimore, March 1, 1906. To the Editor: —Having received numerous letters of inquiry regarding Lisbon and its people I take this opportunity to give a few facts to those who are to attend the congress. Being well acquainted with the people of Portugal, I regret that I can not do them greater justice, but material for a medical journal has its limits. Contrary to the general opinion, Portugal differs sensibly from Spain in its social, intellectual and moral life. Ethnographically the inhabitants of the two countries are the same race, but apart from this there is a great difference between the two races. The primitive traits of the Portuguese have been changed by long series of mixtures between the original inhabitants and foreigners. This amalgam, which was produced during and directly after Portugal's great geographical discoveries, has brought about a physiognomic difference which is noticeable the moment the traveler reaches

To the Editor: —D. A. Emanuel, MD, and F. J. Wenzel, BS, describe in their clinical note "Erythrocytosis Associated with the Nephrotic Syndrome" ( JAMA 181 :788 [Sept 1] 1962) an interesting example of a nephrotic state accompanied by erythrocytosis. They state, "The association of erythrocytosis and the nephrotic syndrome has not been previously described." We would take issue with this statement and refer the reader to the Proceedings of the First International Congress of Nephrology , Sept 1-4, 1960, G. Richet, Editor, S. Karger, Basel, 1961, p. 560, in which the nephrotic syndrome occurring in three patients was reported, erythrocyte volume having been measured by Cr 51 red-blood-cell (RBC) tag. These patients together with patients having other renal lesions seen since 1960 will soon be the subject of a more complete report. The cases include three of chronic glomerular nephritis proven by renal biopsy. In nephrotic states, both plasma and red-blood-cell

I wish in this paper, based on the study of several epidemics of yellow fever in Charleston, to make three points which are of the first importance; also to give some of the results of my experience as regards treatment and pathology, which I do not think have attracted the attention they deserve: 1. That this fever in Charleston has always been accompanied by what is known as "breakbone fever;" this, though extremely mild, is not distinguishable, but being counted in with cases of true yellow fever, prevents all accuracy in the mortality reports, 2. That yellow fever is fully susceptible of successful management in fair cases, seen early, 3. That life is compromised in the first six to ten hours of the disease; so that it is essential that treatment should be begun early. Co-existence of Yellow and Breakbone Fever .—Invariably two forms of fever existed together, namely, yellow fever

New York, May 27, 1896. To the Editor: —Regarding an International Congress for the prevention of leprosy, as proposed by Dr. Goldschmidt, I have the honor to transmit the following letter: "Honolulu, Hawaiian Islands, April 28, 1896. " Dear Dr. Ashmead :—At a meeting of the Board of Health held on the 22d inst., I presented your correspondence with Dr. Goldschmidt in regard to the International Medical Congress for the discussion of leprosy. It was decided to inform you that the Hawaiian Government takes deep interest in the efforts of Dr. Goldschmidt to hold a congress and that the sending of a delegate will be considered, if an invitation is received. "Sincerely yours,L. F. Alvarez, M.D. "Bacteriologist to the Hawaiian Board of Health." Very truly yours

ACNE RUBRA SEBORRHEICA. At the third International Congress of Dermatology and Syphilography, Petrini described two cases of a disease of the skin of the face in middle-aged women, which appeared in the form of small red papules, especially about the nose. He recognized from the color and clinical features of this affection that it was a distinct and characteristic condition. To this affection he applied the term acne rubra seborrheica. In 1903 Pringle undoubtedly described the same condition in an article 1 to which he gave the title, "A Rare Seborrheid of the Face." Since that time we have carefully watched the literature for further contributions on this condition, but after a rather thorough search no further data could be obtained. One of us had for years been in the habit of classing the affection above named under the term "seborrheic acne." It seems strange that more attention has not

To the Editor: —I have received the following letter from Professor Virchow, the President-elect of the next Medical Congress. Very truly yours, Treasury Department, U. S. Marine-Hospital Bureau, Washington, D. C., October 30, 1889. Berlin, October 1, 1889. Dear Sir: —The Organizing Committee of the Tenth International Medical Congress is now constituted. I myself am elected President, and Dr. Lassar (Karlstrasse 19, N.W.) Secretary-General. We will be very happy to receive the Transactions of the Ninth International Congress, and we hope to see you and many of your countrymen at the new session. I am, sir, very sincerely your obedient servant, Professor Rud. Virchow.

In a discussion before the Fifteenth International Congress on Hygiene and Demography, Sept. 26, 1912, Rosenau 1 reported that he had been able to transmit a disease in all essential respects like poliomyelitis, through the agency of the biting stable-fly, from monkeys purposely infected with poliomyelitis to six out of twelve well monkeys used in his experiment. At the time of this announcement parts of California were passing through a severe epidemic of poliomyelitis, 2 and the problem of preventing the spread of the disease was of especial concern to the State Board of Health. If the stable-fly was the chief disseminator of poliomyelitis, very important steps were not being taken, while unnecessary preventive measures, some of them very burdensome, were being enforced. The State Board of Health at once laid plans for an investigation to determine the extent to which it should consider the stable-fly in measures for preventing

It is the purpose of this address to contribute to your knowledge of transatlantic medicine and medical men. That is why I have to ask the pardon both of my countrymen and of all of you, but mainly of the French gentlemen here assembled, for using—or, perhaps, misusing —a language not my own, but better known to most of you than mine. In this way I hope to serve the ideal of the International Congress, which admits the delegates of medicine from all over the globe, recognize three languages as equivalent, listen to contributions on all possible topics connected with medicine and its numerous tributaries that are offered by the glory-crowned heads of the profession and by those on whose shoulders, now young, will rest the future of medical science and practice, and thus give an example of cosmopolitanism, the universal realization of which must be left to the coming

"I can assure you that rarely in my life have I felt greater joy than during those days, weeks and months when I recognized with ever-growing clearness the essential causal relation between inoculation and immunity." These enthusiastic words were uttered by von Behring at the closing session of the International Congress of Tuberculosis October 7, of this year, before an assembly of lay and medical members and their guests. They served as an introduction to the revelation of this remedy of tuberculosis, of which we, who were in Paris at the time, had seen the most wonderful accounts on the preceding days in the sensational press of the French metropolis. It seems to be the specialty of international congresses to bring forth some sensational revelations. In 1890 Koch's announcement of his tuberculin and later in 1901 of his unbelief in the identity of the human and bovine type of the

Preface—Upon the suggestion of the secretaries of the International Safety Committee, Dr. G. W. C. Kaye and Dr. Stanley Melville, the Advisory Committee on X-ray and Radium Protection was formed in the United States for the purpose of preparing a unified set of safety recommendations. In order to have a committee not too cumbersome and yet thoroughly representative of the several phases of the art, two members were appointed by each radiological society, two by the manufacturers of X-ray equipment, and one by the American Medical Association. The presidents of the radiological societies were each asked to appoint one physicist and one radiologist. The members representing the manufacturers were selected by the manufacturers through nomination and ballot. The following members compose the Committee: Lauriston S. Taylor, representing the International Safety Committee and National Bureau of Standards. Henry K. Pancoast, M.D., University of Pennsylvania Hospital, and J. L. Weatherwax, M.A., Physicist, Philad...

The Eighth International Congress of Hygiene and Demography, held at Buda-Pesth September 2 to 8, 1894, can be considered as one of the most remarkable and important reunions of representatives of the medical sciences from all countries during the latest times. This can be judged from the reports so far published. One of the most important proceedings of the Congress was the discussion on the etiology and prophylaxis of diphtheria, which may be shortly related in the following: Loffler, from Greifswald in Germany, says that diphtheria is produced by a specific bacillus, whose importance is not doubted any more by anybody. As diphtheria we can consider that affection only which is produced by the Loffler bacillus, excluding all similar affections which are caused by other microorganisms. In fact, we often find diseases of the upper air passages, which give the same picture as genuine diphtheria, but which are caused by

Moscow, Russia, Oct. 10, 1896. To the Editor: —Will you kindly insert in an early issue of your esteemed journal the following notice: From the Surgical Section of the Twelfth International Medical Congress in Moscow. —Acting upon the advice of Dr. E. Browitz (Konigsberg), the Surgical Section of the Twelfth International Medical Congress has decided, in view of the approaching Congress, to collect international statistics on narcotizations for the current year (1896). For this purpose the managers of the said Section apply to all their colleagues and earnestly request them to give answers to the following questions: Number of narcoses from Jan. 1, 1896, to Jan. 1, 1897? What narcotics were administered? Number of fatal cases? The Secretary of the Surgical Section, F. Rein, Malaja Dmitrowka, house Scheschkov, Moscow, Russia, will be glad to receive such information, and, if possible, not later than July 1, 1897.

I saw the capital city of Imperial Germany in the early morning from an elevated railroad depot, on Friedrich-Strasse. After having washed the dust from my eyes, and given twenty-five cents for so doing, I took a look at my strange surroundings. To see this city had been a dream of childhood. The roofs decorated with statuary and symbols, the clean asphalt pavement, the peculiar architecture of the buildings, the silent way of doing the city work, and the subdued, even tread of companies of soldiers going to morning parade, keenly excited my curiosity. I was satisfied even to look over the city which held the greatest ruler and the grandest man—Virchow—the father of cellular pathology. The unexpected greetings of long ago friends, known as college chums, and the reminiscences of college life, made me feel kindly towards the whole German nation and at home at once. The friendly reception

Dr. John A. Wyeth, New York City, has sent us a letter which he has received from Prof. Miguel Bombarda, secretary-general of the International Congress of Medicine to be held at Lisbon in 1906. Dr. Wyeth expresses the hope that the unpleasant experiences of our delegates at Madrid will not deter us from taking an interest in the Lisbon congress. He suggests that it would be well for The Journal of the Association to inaugurate this movement by printing at this time this invitation. A translation of the letter referred to is as follows: Lisbon, Dec. 22, 1903. Sir and most honored confrere: —At the last international congress at Madrid, Lisbon was designated as the place of meeting of the Fifteenth International Congress of Medicine, and the medical profession of Portugal, appreciating the great honor conferred on it, accepted with pleasure the decision of the representatives of the various countries