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impossible to predict that in Britain ten years later itwould be possible to control all tuberculosis by meansof chemotherapy. But in spite of the efficacy of

treatment, there are still arguments in favour of routineB.C.G. vaccination: it takes time to discover patients withactive tuberculosis and during this time the disease canbe spread to others or, after diagnosis, patients maydefault from treatment. Even if routine vaccination ofschoolchildren is abandoned, it will still be essential toprotect selected groups, such as medical students, otherhospital workers, and contacts of patients with tubercu-losis.

Progress at SouthamptonDISCUSSING the prospects for new medical schools in

Britain, the Royal Commission on Medical Educationdeclared: " Of those cities and towns without medicalschools already, Southampton undoubtedly offers themost adequate facilities. The University has already atotal of 4000 students and has staff and departments,including a well established Department of Physiologyand Biochemistry, which can constitute a strong nucleusfor a medical school. There are strong links between the

University and the Wessex Regional Hospital Board,which serves a growing population already amountingto two millions (half of whom are concentrated in

Southampton, Portsmouth and Bournemouth and thesurrounding areas). The Board is rebuilding the mainSouthampton hospitals on lines which are readilyadaptable to meet the needs of undergraduate clinicalteaching ". Thus, the case for Southampton was sostrong that the Commission had earlier urged theGovernment to go ahead without waiting for its finalrecommendations.

How is Southampton progressing ? The first phase ofthe preclinical building will, it is hoped, be ready inJune, 1971: and the plan is to begin with an intake of65 students in October, 1971, rising to the full quota of130 a year later. The development of SouthamptonGeneral Hospital (financed jointly by the Departmentof Health and the University Grants Committee) is dueto start in 1969 and the capital expenditure will be someEl 6 million. The General Hospital will provide thecentre-of-gravity of a teaching-hospital group in whichother hospitals in the region will figure: it is a mile fromthe preclinical sciences building (which adjoins the

university campus)-not an ideal arrangement but aworkable one. A broad outline of the undergraduatecurriculum was prepared by a working party and it willbe worked out in detail as senior staff are appointed tothe medical school. Prof. E. D. ACHESON became thenew dean last July; an announcement will shortly bemade inviting applications for chairs in the fields ofhuman anatomy, medicine, surgery, and obstetrics.Obstetrics will come under the novel title, for this

country, of human reproduction, which will include notonly clinical obstetrics and gynaecology but also major

responsibility in the early part of the course for theteaching of the applied physiology of reproduction.A feature of the draft curriculum is a year’s study in

depth in the fourth year, after the student has beenintroduced to clinical work (in contrast to the orthodoxB.SC. course taken immediately after 2nd M.B.). Duringthis year all students will follow a course of honoursstandard in subjects studied singly or in groups of up tothree. Some of the subjects which have been suggestedare: cell biology, biochemistry and physiology, includingclinical aspects, genetics, pathology, pharmacology,psychology and sociology; but it should also be possibleto take advantage of other already thriving researchinterests in Southampton University in medical aspectsof physics and engineering. The expectation is that anhonours course, placed in the fourth year, will encouragestudents to choose as their subjects clinical and socialaspects of medicine. The structure for clinical teachingwill, it is envisaged, include units where physicians andsurgeons share beds and facilities. High on the list ofpriorities will be the teaching of medicine in the com-munity and efforts will be made to introduce the studentto the practice of medicine outside the hospital as wellas within it from the beginning. Professor ACHESONand his colleagues will strive to draw the whole of theWessex region into the affairs of the medical school.Fears have occasionally been expressed in the region thatPortsmouth, Bournemouth, and other centres would berelegated to a sort of second division; but one influencethat makes that prospect unlikely is the splendid post-graduate training network that already exists in Wessex,giving it a unity that many regions envy. The aim is tooffer many of the senior hospital staff both a teachingand research commitment and a service commitment,obviously in differing proportions. Throughout all theplans for this new school, Professor ACHESON sees it as apartnership between the University and the NationalHealth Service in which teaching, research, and serviceare inseparable, and must develop together.

Annotations

CBW

DURING the 1914-18 war chemical warfare underwenta steady escalation from tear-gas to chlorine to phosgeneand finally to its most lethal-mustard gas. Deathsattributed to these chemicals totalled 91,000. Publicrevulsion against " poison gas " led in 1925 to the signingof the Geneva Protocol which banned the use of bothchemical and bacteriological weapons. The United Statesdid not ratify the agreement. In 1936 Italy, which did,used mustard gas against the Ethiopians. In the 1939-45war, chemical weapons were not used, though both sidespossessed large stocks and the Germans had evolved newand deadly nerve gases (tabun, sarin, and soman) capableof inflicting immense casualties, particularly amongcivilian populations. This restraint was again observedduring the Korean war, but it seems to have been brokenin 1967 by the Egyptians in the Yemen and by the

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Americans in Vietnam, though this is disputed on theground that the agents employed are not lethal. As forbiological agents, there is no firm proof that they haveever been used.

Though the 1925 Geneva Protocol banned the first useof both chemical and bacteriological weapons, it did notforbid retaliatory use nor did it preclude research or actualproduction. In the past decade in some fifteen or morecountries much research has been done; and in a fewproduction has risen steeply. Details of the known agentsand their application in war are given in two recent books-one British,! one American.2 Neither makes comfortable

reading. Among the new generation of chemical weaponsis a nerve gas reputed to be 2000 times as toxic by cutaneousabsorption as mustard gas; a dose so small (2-10 mg.) asto be invisible on the skin would be fatal. Deliverysystems have also been improved, and aerosol sprays,bomb clusters, and guided missiles are among the meansnow available for disseminating both chemical and

biological agents. Nerve agents are said to be stored atthe Rocky Mountain Arsenal in Denver in quantitiescapable of killing hundreds of millions of people. Theurge to stockpile biological weapons is less keen,but preparations for large-scale rapid production are

known to have been made, for example, at Pine BluffArsenal in Arkansas. Little is known about the

position in Communist countries, but it is probablysimilar.

Science, medicine, and industry are becoming in-

creasingly concerned in this situation. Hersh 2 cites over50 American universities engaged in CBW projects; and,despite the fact that the information was supplied by thePentagon, " almost without exception the universities-once queried-denied they were conducting such re-

search ". Some of the heads of these institutions seemed

genuinely unsure of what was going on in this subjectwithin their own campus. U.S. contracts for work onCBW projects have also been given to a number ofuniversities in other countries, including Japan, France,West Germany, Holland, Belgium, Sweden, Ireland, andGreat Britain. Of these some are engaged in similarresearch projects for their own Governments. A list of 28CBW research contracts let to British universities was

given in Hansard on May 29, 1968. Much of the work,of course, is basic research not necessarily directly relatedto CBW. Although most is published, a small part remainssecret: at present about 80-90% of the work at the

Ministry of Defence’s Microbiological Research Establish-ment is published.3 In the U.S.A. the classified sectoris larger.The work undertaken by any one research team may

seem and indeed be innocent enough and be directed purelytowards defence. But much of the knowledge could con-ceivably be used in the reverse direction. The issues to befaced are fundamental and, for doctors in particular 4

inescapable. What is the purpose of science-and ofmedicine ? Must what the State asserts to be in thenational interest always be accepted as paramount ?Should doctors and other scientists ensase in nrenarations

1. CBW. Chemical and Biological Warfare: its scope, implicationsand future development. Report of the London Conference onCBW. Edited by STEVEN ROSE. London: George Harrap. 1968.Pp. 209. 30s.

2. Chemical and Biological Warfare. America’s Hidden Arsenal. BySEYMOUR M. HERSH. London: MacGibbon & Kee. 1968. Pp. 354.50s.

3. See Lancet, 1968, ii, 959.4. ibid. p. 391.

which could be used to spread poisons and disease ? Whateffect has secrecy on professional and on internationalrelations ? These two books on CBW may help to focusattention on the need for reappraisal of ethical values in aworld that seems increasingly to be losing its way.

HISTOCOMPATIBILITY DIFFERENCESAND CANCER

THE rapid growth of Australia’s contribution to thescience of medicine and the formation in 1956 of theCollege of Pathologists of Australia-seven years beforeits British counterpart-have led to the emergence of anew quarterly journal entitled, simply, Pathology.1 Thefirst issue is largely devoted to aspects of immunology andcancer research, but the editors indicate that papers con-cerned with all branches of clinical and experimentalpathology will be considered for publication.

Observations by Stanley and his colleagues on murineinfection with reovirus 3 culminated in 1966 in findingswhich linked the induction of runting with lymphoma.2 3After exposure to the virus during the neonatal period,only 1 % of mice of the Prince Henry (PH) strain survivedthe acute effects of the infection. In the survivors achronic progressive disease developed, the features ofwhich included lymphopenia, monocytosis, the presenceof a thermolabile antibody, and histopathological changesin the liver and other tissues suggestive of autoimmunedisease. The virus could not be recovered from animals

during the later stages of the disease. In 1 out of 26 long-term survivors malignant lymphoma (2731/L) developed.Transfer to newborn PH mice either of lymphoma cellsfrom this 1 mouse or of spleen cells from mice thatexhibited only runting gave rise first to runting (intwenty to thirty days) and later in some animals (after thethirty-first day) to massive lymphomas.

These findings were consistent with observations madein other species 4 and with previous observations inmice.5 Sinkovics 6 suggested that the association betweenrunt disease and lymphoma might come about in one ofthree different ways: (1) a passenger virus such as reovirus3 (or other microorganism) might give rise to both auto-immune disease and runting; (2) cell-induced runt

disease might escalate into malignant lymphoma; or (3) aspecific leukaemia virus carried by PH mice might cause theemergence of both autoimmune reactive and malignantlymphocytes. Sinkovics favoured the third explanation.Keast and Papadimitriou,7 however, found no evidenceof the presence of any of the common murine leukxmiaviruses in 2731/L lymphoma cells.The second of Sinkovics’ choices was originally pro-

posed by Schwartz and Beldotti,8 who reported that theinjection of parental spleen cells into Fi hybrid mice

1. The official journal of the College of Pathologists of Australia. Fourissues a year. Annual subscription A$15, U.S.$20, £8. SydneyUniversity Press, Press Building, University of Sydney, N.S.W.,Australia 2006. Manuscripts may be sent to the Editor, Prof. FrankMargarey, Department of Pathology, University of Sydney, N.S.W.,Australia 2006.

2. Joske, R. A., Leak, P. J., Papadimitriou, J. M., Stanley, N. F., Walters,M. N.-I. Br. J. exp. Path. 1966, 47, 337.

3. Stanley, N. F., Walters, M. N.-I. Lancet, 1966, i, 962.4. Dameshek, W. ibid. p. 1268.5. Sinkovics, J. G. Arch. Virusforsch. 1962, 12, 143.6. Sinkovics, J. G. Lancet, 1966, ii, 229.7. Keast, D., Papadimitriou, J. M. ibid. p. 589.8. Schwartz, R. S., Beldotti, L. Science, N.Y., 1965, 149, 1511.