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In a letter to local health authorities the Minister says theseextensions are based on the advice of the Joint Committee onPoliomyelitis Vaccine. At the same time the committeerecommend that efforts should continue to be directed to thevaccination of as many as possible in the existing prioritygroups. " Thus, although the acceptance rate among childrenborn since 1943 is generally high, special efforts are still

required in those areas where the rate is below the nationalaverage; and the need for raising the rate among expectantmothers continues in most areas. Authorities have, with theco-operation of general practitioners, and by hard work andimaginative publicity measures, to a large degree surmountedthe difficulties encountered in obtaining a satisfactory responsefrom the group born between 1933 and 1942." Executivecouncils are also sending a letter to all family doctors about theextension of the programme.By the end of last year registrations for vaccination passed

the 13 million mark. Nearly all of those registered had had atleast two doses of vaccine and over 7-3 million had receivedthree. In the 16-26 age-group, a total of about 2-7 million, or46% of those eligible, had registered, and almost all had hadat least two injections. For children (1943-59 age-group) theacceptance rate rose to 75 4%, and 9-5 million had receivedtwo or more doses.The provisional number of cases of paralytic poliomyelitis

last year fell below 1000 for the first time for 13 years: the totalwas 914. The provisional number of both paralytic and non-paralytic cases was 1345, which was also the lowest since 1947.It compared with 2370 in 1958. The previous lowest totalwas 2177 in 1948. The highest number of cases notified inany one week during 1959 was 58 for the week ended Aug. 22.The lowest figure was two cases during the week endedDec. 26. This is the lowest number for any week since the lastweek in 1946 when only one case was notified.

1. Department of Health for Scotland. Scottish Health Statistics 1958.H.M. Stationery Office. Pp. 205. 12s. 6d.

1959Provisional figures for England and Wales in 1959 were

published on Jan. 23 by the Registrar General in his weeklyreturn.

The number of live births was 750,170-i.e., 16-5 per 1000 popula-tion, which is the highest rate since 1949. Infant mortality was22-0 per 1000 live births (22-6 in 1958, 23-1 in 1957, 23-7 in 1956, and32-4 in 1949). The death-rate was 11-6 per 1000 population (11-7 in1958 and 11-5 in 1957). The excess of births over deaths registered in1959 was 222,596, the biggest since 1948, when it was 307,072.15,009 stillbirths were registered in the year, giving a rate of 207per 1000 live and still births (21-6 in 1958 and 22-5 in 1957).

Health Statistics for ScotlandThe Department of Health for Scotland has published

the first 1 of a new series of annual reports giving detailedstatistics about health and health services in Scotland. It dealswith 1958 and gives more detailed figures over a wider rangethan have so far appeared in Scotland in a single volume.

Until 1958, the annual reports of the Department of Healthincluded statistical information about health services. It was decidedthat the ordinary departmental report for 1958 (already published)should include only limited statistical material, and that a separatemore detailed volume of health statistics should be published. Itincludes population and other vital statistics and figures showingcauses of death and illness in Scotland in 1958. Under some headsit covers a number of years before 1958. In the section on the

hospital and specialist services, comprehensive figures are givenshowing the number of beds used for various types of illness in theregions, and the number of staff of different types employed in thehospitals. There are also sections on the maternity services, infantand child health, and general medical, dental, and ophthalmicservices. Another section gives figures showing the cost of thehealth service under various heads.

Conference

RADIATION PROTECTION AND MARROW

TRANSPLANTATION

AT a conference held at the Oak Ridge National

Laboratory, Tennessee, on Jan. 8-9, progress in protectionagainst radiation was reported by various groups in theUnited States.

D. G. DOHERTY (Oak Ridge) said that no recently syn-thesised compounds tested had been superior to aminoethylisothiourea (A.E.T.), for which maximum protective effect inmice gave an LDso of 1100-1200r. D. P. JACOBUS (WalterReed) had obtained good results with mercapto propyl- andethyl-amines, and with 5-hydroxytryptamine there was signifi-cant protection in mice and rats, but not in dogs, apart fromslight delay in fall of white-blood counts. J. MAISIN (ArmedForces Institute) had used tritium-labelled A.E.T. to determineits distribution in the mouse after intraperitoneal injection.Autoradiographs appeared to show widespread uptake in liver,spleen, brain, kidney, lung, and pancreas, and also in spon-taneous tumours such as ovarian adenocarcinoma, hepatoma,angiosarcoma, and reticulosarcoma; but it was not clearwhether the material was intracellular or not.

Other workers in the Armed Forces Institute had shownmarked protective synergism in mice, using A.E.T. and 5-hy-droxytryptamine. At 2500r there was only a 25% mortality.V. DI STAFANO (Rochester) had found A.E.T. to have acetyl-choline-like effects on the gut, which were blocked by atropineboth in vivo and in vitro.

A.E.T. had been used clinically by J. V. SCHLOSSER (NewOrleans) in more patients. There was no evidence of tumour

protection, but so far there were too few controls to assess thedegree of protection of the patient. M. KELLY (NationalCancer Institute) presented good evidence from controlledexperiments in dogs that A.E.T. did not protect tumours, butdid protect the animals against radiation. J. A. CoHEN (Nether-lands) reported that the effect of A.E.T. on thymocyte protection

in vitro correlated inversely with oxygen consumption andsuggested that A.E.T. exerted its effect in vivo in this way.

BONE-MARROW TRANSPLANTATION

N. GENGOZIAN (Oak Ridge) reported his findings of differ-ences in the antigen recognition mechanisms in mice, using redcells of different species. Sublethal irradiation lengthened theinduction period following red-cell injection. The more closelyrelated the donor species, the greater the lengthening. Youngmice had longer induction periods than older mice and gavelower antibody titres. For effective heterologous marrow trans-plants in irradiated mice, larger quantities of cells were neededfor the rabbit than the rat, the hamster being intermediate.W. DAMESHEK (Boston) had shown inhibition of antibodyformation to soluble antigens by rabbits treated with 6-mercap-topurine in doses of 3-6 mg. per kg. Such failure of responsepersisted for about six months, as judged by response to furtherchallenges with the same antigen, but there was no failure ofimmunisation to other soluble antigens. However, such pre-vention of acquired immunity could not be demonstrated withskin grafts, though with big doses of 6-mercaptopurine somedelay of graft rejection was demonstrable. E. SIMMONS (Uni-versity of Chicago) reported similar experimental results inrabbits using sublethal irradiation instead of 6-mercaptopurine.

J. W. GooDMAN (Oak Ridge) had shown that when isologousheparinised whole blood was injected into irradiated mice,together with homologous marrow, there was an increasedmortality, which did not occur if the blood was irradiated with75r first. In discussion many made the point that lymphocyteswere possibly responsible. G. Popp (Oak Ridge) had showngraded survival of irradiated mice given different amounts ofparental marrow, and on the basis of these results suggestedthat in human subjects too few marrow cells were being given.On a weight-for-weight basis a 70 kg. man should receiveabout 1-05 x 1011 cells-far more than is being given at present.Dr. COHEN showed that the interval between sublethal irradia-tion and time of injection of heterologous bone-marrow wasextremely important in determining survival and incidence ofsecondary disease. If bone-marrow transfusion was delayeduntil twenty-four hours after irradiation, survival was much

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increased. The possibility was raised that some cells responsiblefor " recognition " might persist in the host for some hoursafter irradiation.

J. ANDERSON (Texas) reported rapid hxmatological recoveryin monkeys given 2-5-3.5 x 1012 bone-marrow cells (isologous)three days after irradiation with 900r.

Dr. SIMMONS and others agreed that the chances of treatingsystemic tumours successfully by irradiation were poor at

present. In rats and mice sterilisation of solid tumours andleukxmic tissue required about 4000r, whereas the presentsublethal working limit, except possibly in animals treated withA.E.T. and 5-hydroxytryptamine, was about 1500r, using A.E.T.or marrow transfusion alone. There was still a wide gap to be

spanned.

Medicine and the Law

Drink and Diminished ResponsibilityDESCRIBED by the prison doctor as a psychopathic

personality, a 19-year-old soldier has been found not

guilty of murder on the ground of diminished responsi-bility. He was convicted of manslaughter under theHomicide Act 1957, and sentenced to life imprisonment.The prisoner was charged with the murder in December,

1958, of a woman whose mutilated body was found in bed.The murder remained unsolved until last November when the

police took his fingerprints in connection with another charge.After his arrest, the prisoner made a statement in which hedescribed how he killed the woman; he also referred to attackson two other women.

Dr. Francis Brisby, principal medical officer at Brixton

prison, said that, in his view, the prisoner had a psychopathicpersonality, which expressed itself in aggressiveness withoutsufficient cause and in criminal acts which induced no remorseor shame. When he was 15 his headmaster had described himas difficult and precocious. Two years ago he had tried to hanghimself. For a year he had been drinking heavily. He hadclaimed that he never committed any offence except when indrink. The encephalograph findings were abnormal.

Similar evidence was given by Dr. Denis Leigh.Summing up, Mr. Justice Donovan said that if the jury

accepted the evidence that the prisoner was suffering from anabnormality of the mind which substantially impaired his

responsibility for the killing, they should find him guilty ofmanslaughter instead of murder. In his statement to thepolice, the prisoner had said:

" It is when I get drinking I dothese things. I am all right when I am sober." If a normal

person got drunk or drank to excess and in that condition killed

another, it would be no defence to say that he lost his self-control or that his self-control was diminished. The sectionin the Homicide Act dealing with diminished responsibilitywas not intended to be, nor was it, a charter for drunkards.

His Lordship continued that two doctors had expressed theview that even if the prisoner did not drink he would stillsuffer from an abnormality of the mind which substantiallyimpaired his responsibility. " You are not bound by what thedoctors have said. If you prefer to accept what the manhimself has said, on the grounds that probably he knows best,you are entitled to do on that basis and say guilty of murder."

After the jury had brought in a verdict of manslaughter,his Lordship said that it would be unsafe to impose a sentenceof a fixed term of years at the end of which the prisoner wouldbe set free even if he were as dangerous as he was now. Thesentence must be one which would enable the authorities todetain him until they were satisfied that he could safely minglewith his fellow creatures once again.

It has for many years been a principle of English lawthat loss of self-control through drunkenness is not adefence to a criminal charge. The summing-up in thiscase indicates that there has been no change in thisprinciple as a result of the passing of the Homicide Act.The defence of diminished responsibility under that Act

1. The chairman is Mr. Leslie Farrer-Brown and the members Prof.Melville Arnott, Prof. T. H. Davey, Prof. A. D. M. Greenfield, Prof.P. B. Medawar, Dr. Honor Smith, Prof. R. Milnes Walker, and MissGrace McDonald (secretary).

2. Cent. Afr. J. Med. June, 1958.3. ibid. March, 1959.4. Lancet, 1959, i, 929.

requires some abnormality of mind, and Mr. JusticeDonovan was surely right to tell the jury that meredrunkenness did not suffice.

Medical Education

THE NEW AFRICAN SCHOOL

THE Nuffield Foundation has offered E250.000 to theUniversity College of Rhodesia and Nyasaland towardsthe establishment of a medical school at Salisbury on thelines recommended by the Rhodesia Medical School

Planning Committee. This committee has produced tworeports, the first 2 of which proposed that a medical schoolshould be part of the University College while the second 3outlined a curriculum which has attracted much attentionand was republished at some length in our columns. 4The grant is offered on the understanding that the

teaching hospital takes the form of a new multiracial

hospital on the University College campus. The planningcommittee’s design for the medical course calls for moreintegration than is usual between the preclinical and theclinical parts of the course, and by putting the variousdepartments in close proximity the University College hasan opportunity to create a medical school which mightbecome a model.

When the new medical school is established, it will

initially be an affiliated institution of the University ofBirmingham. The planning committee thought that theschool should provide its successful students with a quali-fication which would be widely accepted, rather than witha diploma of only local value. The University of Birming-ham agreed to help over this, and the details of its relation-ship with the African college are now being worked out.While this relationship continues, students of the new

medical school will be admitted to medical degrees of theUniversity of Birmingham, and appointments to the staffof the medical school will be made only in agreement withthe university. For its part, the university will ensure thatthe shaping of the curriculum to meet local needs andopportunities does not affect the standard of the course orof the examinations required. The relationship betweenthe university and the university college will continue untilthe reputation of the new medical school is so securelyestablished that local degrees which will be widelyaccepted can be awarded. If thought desirable, theassociation of the two schools may indeed continue insome form after the university college has become a fulluniversity awarding its own degrees in faculties other thanmedicine.

It is expected that very close personal relations willdevelop between the medical school at Salisbury and themedical school and the teaching hospital in Birmingham.Staff will be exchanged and joint research undertaken. Itis being suggested, for example, that all members of thestaff of the medical school at Salisbury should also besupernumerary members of the staff of the appropriatedepartment in the Birmingham medical school. Whenfirst appointed, they would spend a period teaching atBirmingham, and at intervals thereafter they wouldrevisit Birmingham to engage, perhaps for a term, in

teaching, research, and other departmental duties.