779

completing the course ". In return, the doctor will be

paid El 425 a year from the date of contract (within thesix months before registration) until a new contract is

signed for his overseas post.The Ministry’s statement clearly recognises that the

postgraduate course offered must be flexible. " On theone hand, it is necessary to offer a course of post-registra-tion training sufficiently comprehensive and thoroughboth to fit the young doctor for service abroad and toenhance his chance of re-entry at an acceptable levelinto the profession on his return home; and on the other,any such course must be readily adaptable to the needsof individual candidates. For example, some doctors

may have obtained the necessary experience in obstetricsand gynxcology before registration; studies in medicineor surgery could therefore be regarded as an alternative.For others the full Diploma Course in Tropical Medicineand Hygiene might be more appropriate."Young doctors would be invited, primarily through

the medical Press, to volunteer within the six monthsbefore registration. On accepting his first contract thedoctor would be required to take up hospital appoint-ments in appropriate subjects over a period of twelvemonths and to complete such other training as mightbe considered necessary by the Ministry of OverseasDevelopment.A doctor signing a first contract would be committing

himself to serve anywhere in the world. Some, the

Ministry realise, would be reluctant to do this, sincesalaries and social and political conditions vary con-

siderably in overseas territories. Personal preferences havenot, however, proved a serious difficulty in recruitinggraduate volunteers from other professions in another

context; and the Ministry hope that the scheme willoffer enough advantages to attract sufficient young doctorsby providing them with additional and valuable post-qualification experience and supervision, at above-averageremuneration. In its first year, the scheme will probablybe limited to 50 places.

RESERPINE IN HUNTINGTON’S CHOREA

IT is now ten years since the introduction of reserpinefor the treatment of Huntington’s chorea ’1 and thereseems little doubt that it may encourage motor improve-ment and reduce choreiform movements in some patientsif given in a dose sufficient to evoke signs of parkinsonism.Similar improvement may also be produced by certainphenothiazines.3-5 The way reserpine acts is obscure.On the assumption that it might be able to deplete cerebralamines, Sourkes and his colleagues 6 treated 3 patientswith cx-methyldopa, and they found that there were notonly objective changes of improvement in the electro-encephalogram but also none of the mental depressionwhich may appear with reserpine. Markham et al.,7 onthe other hand, observed improvement in only 1 out of10 cases treated with a-methyldopa.Mackiewicz and Reid now produce evidence of

cellular damage in the reticular formation of brains from1. Chandler, J. H. Univ. Mich. med. Bull. 1955, 21, 952. Lazarette, J. A., Baers, C. W., Pearson, J. S. Proc. Staff Meet. Mayo

Clin. 1955, 30, 358.3. Pakenham-Walsh, R. Lancet, 1960, ii, 767.4. Lyon, R. L. Br. med. J. 1962, i, 1308.5. Merskey, H. ibid. 1962, ii, 549.6. Sourkes. T. L. Br. med. Bull. 1965, 21, 66.7. Markham, C. H., Clark, W. G., Winters, W. D. Life Sci. 1963, p. 6978. Mackiewicz, J., Reid, A. A. Med. J. Aust. 1965, i, 833.

4 patients with Huntington’s chorea treated for longperiods with large doses of reserpine. Changes typical ofthis condition were found in the basal ganglia, but inaddition foci of destruction in the reticular formation and

pathological changes in fibre tracts and vessels of this areawere present which were not found in the brains of 9

patients untreated by reserpine. Whether or not all theneuronal changes were secondary to local vascular

damage is uncertain.2 of the 4 patients died during a heat-wave, and the

authors suggest that reserpine, which is known to reducebody temperature, interfered in some way with theirhomceostatic mechanism of temperature control. The

experiments of Feldberg and his colleagues, usingregional perfusion of the cerebral ventricles of labora-

tory animals, have suggested that noradrenaline,adrenaline, and serotonin may be of importance in

temperature regulation, and it is tempting to postulatethat a change in cerebral amines produced by reserpinemight be responsible for its effect on body temperature.

In a disease such as this, any treatment which reducesdiscomfort and disability must be welcomed, even ifit may have certain undesirable effects, as seems

probable with reserpine. Where phenothiazine derivativesare effective, they are preferable to reserpine; but in thosepatients for whom reserpine alone produces improvement,special care may be needed when they are exposed toextremes of temperature.

AGRICULTURAL SPRAYS AND CANCER

IT is the custom of Mr. Jack Brocklebank, NorthYorkshire organiser of the National Union of AgriculturalWorkers, to circulate a monthly newsletter to his mem-bers, and to send copies of it to the local Press. In his

September newsletter he drew attention to the fact that,over a period of two years or so, several N.U.A.W. mem-bers in the area had died of cancer. 4 out of the 6 mostrecent deaths had been attributed to this cause, and 2 or3 of them to cancer of the " stomach ". The ages ofthese men ranged from 45 to 62. Mr. Brocklebank’s

comments, particularly in relation to a possible cancerhazard from agricultural sprays, were intended not as anindictment but merely as a suggestion that a close lookat the situation was desirable.When the local Press, and then the national Press,

seized on Mr. Brocklebank’s observations, it became hardto keep them in perspective. To complicate matters

further, Mr. Fred Peart, the Minister of Agriculture, is

expected to attend the North and East Yorkshire countyconference of the N.U.A.W. on Oct. 30, and some of theresolutions to be put before the conference relate to

possible dangers to health from agricultural sprays.These resolutions, however, were prepared before Mr.Brocklebank wrote his newsletter and do not refer

directly to it.At present we have no exact information about the

causes of death of any of the patients referred to by Mr.Brocklebank. It is not certain whether those who diedhad ever been exposed to agricultural sprays, and if sowhen or for how long. No particular type of spray hasbeen mentioned. If cancer was the correct diagnosis, theexact site of its origin in each case is not clear, since theterm " stomach cancer " may refer to any malignant

9. Feldberg, W., Fleischhauer, K. Br. med. Bull. 1965, 21, 36.