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need, not of lack of means. By the application of theseprinciples TITMUSS believes that it will be possible toachieve " equity, adequacy and administrative effici-

ency ".

After EssexTHE disturbances at the University of Essex are

remarkable in several ways. They originated in concernover a large issue which most people have preferred toignore; the participants consisted, not of a small dis-affected rump, but of a sizeable proportion of studentsand some staff; and the setting was a university whosehighly democratic constitution might have been expectedto ensure that differences were settled before reachingflash-point. Those wishing no truck with insurgency canshut their eyes, block their ears, and proclaim thetheme of ungrateful, undisciplined youth whose bad wayshave been aggravated by a small gang of itinerant activistssome of whom are not even British. It is of more than

passing interest to establish how accurate this picture is,and in particular to identify the roots of the trouble andwhy this trouble burgeoned so alarmingly, because whathas happened at Colchester can happen in other universi-ties ; and it is precisely because the Essex constitution isrelatively liberal that the episode there may turn out tohave been the warning marker of disaffection in other,more restricted university societies. Before reconcilingourselves to constant distrust and occasional openhostility between much of the general population and asegment of the country’s future leaders, we should try tounderstand how these emotions have developed. Itwould be sensible to undertake a formal inquiry into thecauses of recent events at Colchester and elsewhere.This inquiry should be impartial, and it should be seento be impartial; and the first evidence should be collectedquickly before any of those concerned graduate andscatter. The inquiry might suitably be sponsored by anindependent agency-perhaps one of the charitablefoundations-and the report could prove both ofimmediate practical importance and of lasting socialsignificance. The views of one student are expressed byMr. Triesman on p.1145.)Meanwhile the constructive purpose behind the Essex

students’ demonstration should not be forgotten. TheUnited Kingdom signed the Geneva Protocol of 1925under which the use of chemical and biological agents inwar is prohibited.2 What the Essex students were, andare, concerned about is the irreconcilability of this pro-hibition with some activities of the Chemical Defence

Experimental Establishment at Porton. In a letter on

p. 1148 Dr. NORMAN MACDONALp underlines this questionand calls for the establishment of a medical ethical bodyto help counter the continuing erosion of publicstandards, besides dealing with more strictly professionaltopics. On public issues the American organisation,Physicians for Social Responsibility,3 and in Britain theMedical Association for the Prevention of War are both

doing valuable work-and if any suppose that the truths1. See Lancet, May 18, 1968, p. 1085.2. ibid. May 4, 1968, p. 974.3. See Sidel, V. W. ibid. p. 966.

underlying this work are self-evident they should turn toDr. CROSBY’S letter on p. 1148. Neither of these organisa-tions will resent argument: what is hard to bear is the

complacent indifference with which the medical pro-fessional often regards issues, including issues of warand peace, which are beyond its immediate purview. Itis nonsense that doctors, whose professional concern iswith preserving life, should not be personally committedto preserving peace; and in this task the proposed ethicalbody might act as a channel of communication and amouthpiece. No doubt much of this organisation’s workwould be concerned with professional issues., The

Hippocratic Oath and its modern counterparts are nocomplete guide to current practice. Several bodies-

notably the Medical Research Council 4 and the RoyalCollege of Physicians 5-have sought to make good thisdeficiency; but the truth is that in present-day circum-stances principles can often be interpreted, not by once-for-all reports, but only by steady consideration ofindividual circumstances. All members of the suggestedorganisation should be medical, though they would befree to co-opt non-medical people for specific purposes;and the organisation should be small enough to workcoherently-perhaps ten is about the right number.Besides answering questions, this body should considerevidence and viewpoints submitted by organisations andindividuals; and it should itself initiate studies-for

example, of secrecy in medical research,6 and of how tofill the gaps in the patchy teaching of ethics to medicalstudents. In its dual role such an organisation could beof real help both to society and to the profession.

Annotations

DISEASES OF WILD ANIMALS

IN the rooms of the Zoological Society of London onMay 9 and 10, 23 contributors, enlisted by Dr. A.McDiarmid, of the Agricultural Research CouncilInstitute for Research on Animal Diseases, gathered for asymposium on the diseases of free-living wild animals.Three sessions concerned the important parasite groups-viruses, bacteria, and protozoa-and a fourth covered amiscellany of ectoparasites, fungi, and neoplasms.

It was clear that man’s interest in these diseases was

rarely separable from his egocentric purpose of ensuringhis own survival and that of his domestic stock, protectinghis crops, or preserving the wild animals he hunts forsport. Thus, there is a temptation to discuss the threepapers concerned with foot-and-mouth disease of cattle

(J. B. Brooksby), salmon disease (J. T. Carbery), andmyxomatosis of rabbits (Helen E. N. Vaughan and J. A.Vaughan), to the exclusion of others. Beyond noting thatthese papers brought a refreshing rationality into the

appreciation of diseases which are often subject to

emotional distortion, we will resist this temptation.The priorities of human interest were inevitably mani-

fest also in the balance of many of the papers. It was oftenplain that the mechanisms of transmission of disease

4. See ibid. 1964, ii, 139.5. See ibid. 1967, ii, 357.6. See ibid. 1952, i, 258.7 See Macdonald, J. B. ibid. 1967, i, 563.

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agents were much better appreciated for man and domesticanimals than for wild animals. As instances, the signi-ficance of many of the wild animals which are foundinfected by foot-and-mouth virus (J. B. Brooksby), bysalmonella (Joan Taylor), by trypanosomes (E. A. Wellsand W. H. R. Lumsden; J. R. Baker), or by piroplasms(S. F. Barnett and D. W. Brocklesby) is often uncertain.This situation arises partly from the greater difficulty ofsampling wild animal populations; but it is often due todeficiencies in available methods for recognising infectedanimals or for recognising in wild animal hosts the" strains " of parasites which are pathogenic to man.Purely parasitological diagnostic methods are often infirm,since parasites may be present in very low concentrationor only intermittently, and " strains " of different patho-genic effect may be morphologically indistinguishable.Immunological identification of infected hosts or of par-ticular " strains " is much more advanced in some fields,such as salmonellosis and leptospirosis (G. I. Twigg),than in trypanosomiasis or theileriosis.

Concerning liability to infection, emphasis was laid onstudy of the habits of the hosts concerned (C. L. Oakley,Joan Taylor). Rats which frequent abattoirs are moreoften infected by salmonella than rats in other environ-ments, as are fish from polluted waters. In Apodemus(field mouse) both sexes are about equally infected byleptospira while in Clethrionymus and Microtus (voles) themales are more often infected than the females, indicatingsome sexually different behaviour. Moreover, incidenceof infection increases with the wetness of the habitat.Predators may be more liable to infection than herbivores;high incidences of trypanosome infection were found inlions and hyaenas and of leptospirosis in foxes. Catswhich are ferocious hunters tend to have a higher inci-dence of Pasteurella pseudotuberculosis than cats which donot have an opportunity to hunt (N. S. Mair). Afterthese revelations about the dangers of ingestion, it was

reassuring to learn that no isolation of Salmonella typhifrom a wild oyster had yet been made.

Many infections, such as trypanosomiasis and thei-leriosis, are usually regarded as " non-pathogenic " inwild animals on the evidence that many apparently healthywild animals may be found infected. But it is, in fact,uncertain whether these balanced associations of a hostand its parasites are acquired without some expense in theform of prenatal, neonatal, or juvenile mortality or mor-bidity. Evidence that parasite infections cause disease inwild animals derives mostly from situations in which oneor other component of the complex is in the process ofinvading. Thus, forest monkeys die of yellow fever inSouth America but not in Africa, whence the virus is pre-sumed to have been derived; and Indian monkeys die ofKyasanur Forest disease when cattle with their ticksinvade the forest environment (D. I. H. Simpson).Fluctuations of the populations of red squirrel are per-haps related to the introduction of viral agents, maybe ingrey squirrel (A. D. Vizoso). Since the introduction of

mosquitoes, and with them blood protozoa, to Hawaiiabout 1880, certain species of bird have been extinguishedat low altitudes and now survive only at higher altitudesor on other islands (C. M. Herman). New situations maybe very highly lethal to the host, as was the introductionof myxomatosis virus into European rabbit populations,but modification of both parasite and host may take placetowards attenuation of the agent and genetic selection of aless susceptible host population. Regarding established

transmission patterns, overt disease may sometimes arise,but several speakers held the simple state of infection tobe of incomplete significance: stress, of one sort or

another, was necessary in addition before pathogeniceffects appeared. Salmonella infections tend to be patho-genic to greenfinches and sparrows in winter conditions;Pasteurella pseudotuberculosis infections behave similarly;ulcerative dermal necrosis of salmon is perhaps associatedwith cold or with the stress of transition from salt to freshwater; interference with food-supply by rough weathermay exalt the activity of an intestinal worm of the Canadagoose, thus causing erosion of the intestinal lining.The welter of infections described at the symposium

left the feeling that wild animals led a precarious life,exposed continually to a host of menacing infections.This picture was difficult to reconcile with the com-

parative rarity with which disease in wild animals seemsto be recognised. But that these infections are importantinfluences on wild animal populations is probably the trueinterpretation. Diseases of wild animals are no esoteric

study but a subject of immediate interest and importancefor our own health and for that of our domestic animals.

ÆTIOLOGY OF REGIONAL ENTERITIS

WHEN, in 1932, Crohn and others 1 described a non-specific granulomatous inflammatory process affecting theterminal ileum, the disease was virtually a new entity.Though it is now recognised that any part of the alimentarytract may be affected, its cause remains unknown and nospecific treatment has been developed. The inflammationbegins with lymphadenoid hyperplasia in the submucosa,and mucosal ulceration follows as a result of oedemacaused by lymphatic obstruction. Giant cells are found

early, not only in the diseased intestine but also in theregional lymph-nodes, and their presence inevitablysuggested that the condition was a manifestation of

tuberculosis, though tubercle bacilli have never beenisolated and the disease does not respond to anti-tuberculous treatment. On p. 1144 Dr. Golde suggeststhat regional enteritis is caused by an organism related tothe mycobacteria, and he provides some attractive answersto the argument that the continuing inability to identifyan organism, the poor response to antibiotics, and anepidemiological pattern which implicates genetic andenvironmental factors are strongly opposed to theinfection hypothesis.

In one of the early accounts of the disease Dalziel 2

compared the lesions with those found in Johne’s diseaseof cattle, which causes changes in the bowel similar tothose of regional enteritis but where acid-fast bacilliabound. Golde argues that a better parallel is provided bythe tuberculoid forms of leprosy and other mycobacterialskin lesions, where organisms are rarely demonstrated andthe pathological picture is equally varied. Though nocontrolled therapeutic trial has yet been undertaken inregional enteritis, there is an impression that both cortico-steroids and sulphasalazine are beneficial. Golde pointsout that the 5-aminosalicylic acid component of the lattercompound is similar to the tuberculostatic drug, p-amino-salicylic acid, and that corticosteroids might act byfavourably influencing the complex immunologicalresponses that accompany mycobacterial disease. Max-

1. Crohn, B. B., Ginzburg, L., Oppenheimer, G. D. J. Am. med. Ass.1932, 99, 1323.

2. Dalziel, T. K. Br. med. J. 1913, ii, 1068.