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who do are probably examples of relapse of an initialpsychosis, after an intervening period of remission.

Many of these psychotic defectives have higher intelli-gence quotients than ordinary defectives, but they areless educable because they are less in touch with theirenvironment. Some of them have isolated areas ofintellectual preservation ; he mentioned a child who

- though he could not read-after several years in amental-defective colony could still play the piano,which he had learnt before the onset of his psychosis.Dr. D. W. Winnicott remarked that some phases innormal development can properly be termed psychotic.The young child lives in a mad world and only graduallylearns to relate himself to reality : even in adults, hesuggested, a retreat from the hard tasks of everydayreality-testing is allowed in the spheres of religion andart. The child analyst has to be able to enter a madworld where reality is dealt with by means of magicalthinking. It may be questioned whether " psychotic "is the right term to use in discussing the phases of

development ; being equated with " madness " byparents and lay people, it is apt, as Dr. K. Cameronpointed out, to cause alarm and misapprehension.Speakers had very little to offer on the subject of

treatment for these serious illnesses of childhood. Goodresults were claimed from loving and patient parentalcare of a difficult and apparently unrewarding child,psychotherapy (sometimes more efficacious after electro-convulsive therapy), and long-continued psycho-analysis ;but only in cases recognised early enough and treatedwith sufficient perseverance and intensity. Insulin,though it may improve the physical condition and sohelp the task of the psychotherapist, does not seem tohave yielded results comparable to those seen in adultpsychotics. All agreed that we must learn to recognisethese cases earlier. -

VIRUS VARIATION

VIRUSES are well known to vary in virulence. At a

meeting of the comparative medicine section of the

Royal Society of Medicine on Feb. 20, Mr. J. R. Hudsonpointed out that African natives recognise mild andsevere forms of rinderpest, and in protecting theiranimals from the severe form by exposing them to themild they practise something approaching Jennerianmethods. Similarly, as Mr. I. A. Galloway, D.sc., pointedout, the virulence of different strains of the foot-and-mouth disease viruses varies widely, and many antigenicsubtypes have been uncovered. Viruses may vary, asMr. Hudson remarked, not only in antigenic charactersand virulence but in host range, tissue affinities, andphysical properties ; and with regard to the influenzaviruses Professor Wilson Smith, F.R.S., made a plea forless preoccupation with the antigenic variations and

greater attention to the other characters that mightaccount for virulence. He described a variant ofinfluenza virus which had been found in his laboratory,and which showed changes in its surface configurationwithout antigenic or other changes. Dr. D. J. Trevanand Mr. A. B. Maclntyre made it clear that the virusesof the dog distemper complex, though antigenicallyrelated, produce different clinical syndromes-notablythe classical catarrhal distemper and the non-catarrhal"hard pad." The latter is essentially the distemper ofrecent times. This strain of virus gives rise to lesions instratified squamous epithelium, and sometimes in thebrain, which differ from those associated with thedistemper virus as known to Laidlaw and Dunkin ; andtypical catarrhal distemper does not follow injection ofit into dogs.

It is, of course, not easy to dissociate the virulenceof a virus from the susceptibility of its host -; there aremany well-known examples of a single virus strain causingmild disease in a partially immune population and

extremely severe disease in a susceptible population

entering the area. When the behaviour of a virus

changes on passage in a new-host, it is tempting todiagnose virus variation. Other possibilities, however,must be taken into account. One is that contamination

by a laboratory strain has taken place ; a second is thata mixture of two agents was originally present, one ofwhich has been selected by the new host ; and a thirdis that inoculation with foreign material has activated alatent virus in the new host-workers with respiratoryviruses and the virus of lymphocytic choriomeningitisare familiar with this difficulty. Very rigid criteriamust be satisfied before altered behaviour of a viruscan be ascribed to variation.At the meeting one further type of virus variation was

mentioned : Mr. Hudson suggested that the three typesof equine encephalomyelitis virus-Eastern, Western,and Venezuelan-may be variants derived originallyfrom a common ancestor. But here we are leavingthe virus world for the metaphysical. M. Jourdainwas delighted to learn that he had been talking prose allhis life ; perhaps the virologist will one day find thathe has been talking metaphysics.

1. Bull. postgrad. Comm. Med., Unir. Sydney, 1951, 7, 111.

THE AUSTRALIAN RESIDENTTHE newly qualified medical graduate in Australia

often finds it impossible to get a resident hospital appoint-ment. This difficulty is not confined to Australia, but areport 1 by Mr. V. M. Coppleson, director of postgraduatestudies in the University of Sydney, shows how acute itis in that realm. The number of doctors qualifying eachyear from the university is now double the pre-war figure,and the increase in internships has been quite insufficientto meet the demand. Moreover, Mr. Coppleson thinksthat such vacancies as there are do not always measureup to the standard of training he would like to see in thevital first year after qualification. ’" No matter how goodthe undergraduate couse he has attended, the type ofhospital in which he trains after graduation will deter-mine the standard of medicine a medical graduate willpractise for the rest of his life." The report goes on tosay that in Australia today " the young graduate whohas not the ability and good fortune to obtain an intern-ship at one of the larger teaching hospitals is likely toreceive a poor and inadequate training in what is

undoubtedly the most important year of his career."Newly qualified doctors, as yet too inexperienced to

begin the practice of medicine, are left largely to theirown resources. There is no compulsory intern year afterqualification in New South Wales, though legislation tointroduce one was passed as long ago as 1938 ; its enforce-ment was postponed first because of war and then becauseof shortage of jobs. Those who can, usually do fourappointments of three months each. Mr. Coppleson saysthat internships should be more closely supervised andpostgraduate teaching more widely planned by theAustralian universities than at present.The standard that he would establish is undoubtedly

a high one, compounded from the best that he has seenduring a long tour last year of teaching centres in thiscountry and the United States: The report is calledTrends in Modern Medical Education, and it interpretsthe results of his investigations into every part of thesubject in relation to,Australian conditions in generaland those of Sydney and New South Wales in particular.But some judgments might find wider application. Forinstance : " In graduate medical education a false scentis being followed. The acquisition of diplomas hasbecome the highest goal, and instead of through thehospital, the university and the research laboratory, thepath of higher medical education is being blazed throughthe classroom and the examination hall." No systemyet devised for the specialised training of physicians andsurgeons can entirely escape this recurrent criticism, butundue emphasis on academic achievement can only be