1390 free heparin (1000 units per ml.) and diluted tenfold in culture-medium RPMI 1640 containing 100 units of penicillin and 50 (1.g. of streptomycin per ml., and tritiated leucine (specific activity 54 Ci per mmol) at a concentration of 0-5 mCi per ml. This suspension was dispensed in triplicate 3 ml. aliquots to upright tissue-culture tubes 16 x 125 mm. containing various dilutions of purified P.H.A. The tubes were cultured with and without autologous serum, or calf serum, for 22 hours. Then the cells were centrifuged and washed twice with 3% acetic acid, bleached with one drop of 30% hydrogen peroxide, heated at 85 °C for 20 minutes, and dissolved in 0-6 ml. of NCS solubiliser, resuspended in scintillation fluid, and counted for 10 minutes on a Hewlett Packard scintillation counter. The results (figs. 1 and 2) confirm that there is a conspicuous depression of cell-mediated immunity in disseminated neoplasia and show a definite, though less striking, depression in patients with glioma. The apparent depression of cell-mediated immunity in patients with benign intracranial tumour is not significant. In our preliminary study the effect of autologous serum on protein synthesis was not clearly and defined, a more detailed analysis with a larger group of patients would be necessary to elucidate this point. These results show that there is a definite impairment Of P.H.A. responsiveness in lymphocytes of patients with malignant glioma. The impairment of protein synthesis in these lymphocytes may be due to an intrinsic abnormality or to a humoral inhibiting factor in the serum. Further work on analysing this immune defect is in progress and may have important implications for management of intracranial tumour. We gratefully acknowledge the support of the Peel Medical Trust in performing this study. Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF.
D. G. T. THOMAS CATHERINE B. LANNIGAN P. O. BEHAN.
APHTHOUS ULCERATION, CROMOGLYCIC ACID, AND CELLULAR IMMUNE RESPONSE
SIR,-It has been reported that disodium cromoglycate (D.S.C.G.), a known inhibitor of IgE-mediated release of histamine1 and other substances in type-i immune reactions, conveyed in toothpaste, reduces the incidence of recurrent aphthous ulceration.’ In a double-blind trial of cromoglycic acid, the acid form of D.s.c.G., in topical tablet form, we found a significant reduction in the symptoms but not the incidence of recurrent aphthous ulcers.3 In view of the proposal that cell-mediated reactions may play a part in the pathogenesis of aphthous ulceration4 and of the effects of levamisole (a drug thought to modify the cellular immune response) upon aphthous ulceration,5 we determined the effect of D.S.C.G. upon in-vitro lymphocyte responsiveness.6 D.S.C.G. at 100 and 1000 µg. per ml. did not alter the in-vitro lymphocyte response of 6 individuals to a mitogen, P.H.A., and an antigen, P.P.D., as measured by lymphocyte transformation, production of -macrophage migration inhibitory factor, and lymphotoxin production. Both of these concentrations of D.S.C.G. were apparently non-toxic for the lymphocytes in culture. It seems possible that the c.G.A. in the trial was acting upon a second immune component of the ulceration, one giving rise to the pain in the middle of the ulcer life. This second immune phase may be associated with the reduction in the demonstrable 1. Assem, E. S. K., McAllen, M. M. Br. med. J. 1970, ii, 504. 2. Frost, M. Lancet, 1973, ii, 389. 3. Dolby, A. E., Walker, D. M. Br. J. oral Surg. (in the press). 4. Lehner, T. Oral Surg. 1972, 33, 80. 5. Symoens, J., Brugmans, J. Br. med. J. 1974, iv, 592. 6. Walker, D. M., Dolby, A. E. Int. Archs Allergy appl. Immun.
(in the press).
mast-cell content of the ulcers which occurs a few days after onset.’ It is not certain whether the two immune components are related, but if our hypothesis is correct new inhibitory compounds which both inhibit lymphocyte transformation as well as mast-cell degranulation8 are indicated in the treatment of aphthas. We are grateful to Fisons Ltd., Pharmaceutical Division, for financial support for the investigations. Welsh National School of Medicine, Dental School, Heath Park, Cardiff CF4 4XY.
D. M. WALKER A. E. DOLBY.
7. Dolby, A. E., Allison, R. J. J. dent. Res. 1969, 48, 901. 8. Assem, E. S. K. Int. Archs Allergy appl. Immun. 1973, 45, 708.
Obituary HERBERT VICTOR MORLOCK
M.C., M.D.Lond., F.R.C.P.
Dr H. V. Morlock, consulting physician to the London Chest Hospital and the Miller and Hampstead General Hospitals, died on May 18 at the age of 76. In the 1914-18 war, immediately after leaving school, he joined the Rifle Brigade, saw service in France, and was decorated with the M.c. on the field at the age of 19. He qualified M.B. from St. Bartholomew’s Hospital in 1924, and was elected to the staff of the first of his three hospitals at the age of 28. With the late Dr A. J. Scott Pinchin he spent some months in Vienna and on his return started the bronchoscopy clinic at the London Chest Hospital, using an instrument of his own design with a telescope for direct vision. This pioneer work, in which he was later joined by E. H. Hudson, established diagnostic bronchoscopy firmly in the hands of chest physicians and thoracic surgeons and was complementary to the work of H. P. Nelson on postural drainage for bronchiectasis. Some found his dynamic personality a little forbidding, but those who accepted this soon developed for him an admiration coupled with affection. There was about him an endearing streak of eccentricity. He habitually wore the old-fashioned style of dress of a consultant after most others had abandoned it, entirely in keeping with his basic philosophy that whatever you set out to do should be done properly. A story runs that at the beginning of the 1939-45 war patriotism impelled him to give up his Rolls and take to an Austin Seven, only to find that he could not sit in it with his top hat on unless the sunshine roof was open. The war affected him keenly; the arrival of the N.H.S. in 1948 even more so. Feeling that his initiative would be cramped, he withdrew to some extent. When he retired he transferred his boundless energy to riding and the hunting field. We shall cherish the memory of a man of character, a generous, warm-hearted colleague. He is survived by his wife, a son, and a daughter who is herself a doctor.
N. L. R. ANGUS NORMAN MacPHAIL M.C., M.D.Glasg., D.P.H.
Dr A. N.
MacPhail, formerly senior lecturer in medicine and general practice in the community of died on June 1 at the age of 60. University Leeds, He had retired last year owing to ill-health. Angus MacPhail qualified M.B. at Glasgow in 1937, subsequently graduating M.D. with commendation in 1951.
1391 In the 1939-45
war
he served in the R.A.M.C. In the Nor-
mandy campaign his stretcher-bearers refused to go out for casualties. He later had them court-martialled; meanwhile he himself went out to the wounded, and was awarded the M.c. Before coming to Leeds in 1959 he had been professor of public health in the University of Khartoum, where he instituted a scheme whereby students were taken on tours of several thousand miles to see for themselves the medical His teaching, and social conditions in outlying areas. which was marked by forthright exposition, was particularly popular with students from developing countries, whose needs he understood so well. Like many Celts, Angus MacPhail had a deep interest in languages, adding to Scottish Gaelic a working knowledge of Classical Greek. He is survived by his wife and daughter.
D. B. B.
JOHN
SETON MICHAEL PRINGLE
M.B.Cantab. and Dubl., F.R.C.S.I., F.R.C.S.
Mr J. S. M. the age of 65.
Pringle died in Dublin
on
May
22 at
His early surgical career was interrupted by service with the R.A.M.C. in the 1939-45 war; he landed in Normandy on D + and was involved in the Arnhem campaign. In civilian life, some years as consulting surgeon to Mercer’s Hospital were followed by appointment to the staff of the Royal City of Dublin Hospital and of the Rotunda and Drumcondra Hospitals. He held the chair of surgery at the Royal College of Surgeons of Ireland and later became regius professor of surgery at Trinity College, Dublin. Failing health led to his retirement in 1972. He was a skilful, dedicated surgeon and teacher who will be deeply mourned by friends, colleagues, and patients throughout Ireland. His first wife died in 1950, leaving him with two daughters and a son. He is survived by his second wife, whom he married in 1959.
B. P.
Diary of the Week JUNE 22
To
28
Monday, 23rd INSTITUTE OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London WC2 4.30 P.M. Mr M. F. Stranc: Principles and Methods in Plastic
Surgery.
Tuesday,
24th
INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, London WCIN 3BG 5.30 P.M. Prof. Fred Plum (New York): Experimental and Clinical Studies in Anoxic-ischsEmic Brain Disease.
Wednesday,
25th ROYAL POSTGRADUATE MEDICAL SCHOOL, Hammersmith Hospital, London W12 OHS 2 P.M. Dr C. L. Berry: The Development of Vessels and Degenerative Disease. INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Prof. J. M. P. Clark: Surgical Management of Paralytic Poliomyelitis-Upper Limb. 8.15 P.M. Professor Clark: Surgical Management of Paralytic Poliomyelitis-Lower Limb.
Thursday, UNIVERSITY 5 P.M.
26th
OF
LONDON
(St. Mary’s Hospital Medical School, Paddington W2.) Prof. J. Loewenthal (Sydney): The Australasian Renal Transplant Experience. ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, Manson House, 26 Portland Place, London WIN 4EY 6 P.M. Dr D. A. Warrell: Snake-bite in Nigeria.
Notes and News THE LANCET
The Lancet’s lateness and underweightness this week is caused by the continuing printing dispute in Britain. BIRTHDAY HONOURS
THE honours awarded to members of the medical sion in the list published on June 14 include:
profes-
K.C.B.
(Civil) Henry Yellowlees, chief medical officer, Department of Health and Social Security. D.B.E. (Civil) Joyce Margaretta Daws, honorary surgeon, Queen Victoria Memorial Hospital, Melbourne, Australia; Frances Violet Gardner, dean, Royal Free Hospital School of Medicine, London. Knights Bachelor John Halliday Croom, chairman, Scottish Council for Postgraduate Medical Education; Daniel Thomson, Civil Service medical adviser. C.B. (Military) Surgeon Rear-Admiral George Augustus Binns. C.B.E. (Civil) Arnold Steadman Aldis; Eric Anthony Barker; Frederic Stanley William Brimblecombe; John Campbell McClure Browne; Patrick Sarsfield Byrne; William Guy Daynes; Brian Oliver Lyndhurst Duke; Priscilla Sheath Fairley; Jean Littlejohn; Andrew Sinclair McLean; Richard Selwyn Francis Schilling.
Honours awarded sion include:
to
people outside
the medical
profes-
G.C.B. (Civil) Sir Philip Rogers, permanent secretary, Department of Health and Social Security. Knight Bachelor Rodney Geoffrey Swiss, president, General Dental Council. C.B. (Civil) Wulf Rudoe, under-secretary. Department of Health and Social
Security. (Civil)
C.B.E.
Mary Frances Appleby, formerly director of MIND (National Association for Mental Health). DISCOVERING SOCIAL PATHOLOGY
WHEN Dr Tonge and his colleagues1 began to look at problem families in Sheffield they were interested in the psychiatric aspects. However, their experiences forced on them a broader outlook: " We became more interested in the social pathology which could not be ascribed to psychiatric disorder ... " Thirty-three families living in Corporation housing in south-east Sheffield were selected from the lists held by various social agencies such as the children’s department and the family service unit; all the families were in touch with three or more agencies or with two agencies one of which was engaged in intensive casework. Neighbouring families matched for maternal age served as controls. A lot of the detail in the ensuing thorough study is unsurprising: the problem families, by definition, had many problems. As a social study the material is rather too selective; the families in question constituted only 0-17% of those in a working-class area and almost certainly represented the extreme end of a broad spectrum of families in difficulty. The problems, in the words of Tonge and his colleagues, form an " interlocking mosaic ", but the remedies, they believe, must be
piecemeal. 1. Families without Hope: A Controlled Study of 33 Problem Families. By W. L. TONGE, D. S. JAMES, and SUSAN M. HILLAM. Published for the Royal College of Psychiatrists by Hedley Brothers Ltd, Invicta Press, Ashford, Kent TN24 8HH. £4; $12.
D. G. T. THOMAS CATHERINE B. LANNIGAN P. O. BEHAN.
APHTHOUS ULCERATION, CROMOGLYCIC ACID, AND CELLULAR IMMUNE RESPONSE
SIR,-It has been reported that disodium cromoglycate (D.S.C.G.), a known inhibitor of IgE-mediated release of histamine1 and other substances in type-i immune reactions, conveyed in toothpaste, reduces the incidence of recurrent aphthous ulceration.’ In a double-blind trial of cromoglycic acid, the acid form of D.s.c.G., in topical tablet form, we found a significant reduction in the symptoms but not the incidence of recurrent aphthous ulcers.3 In view of the proposal that cell-mediated reactions may play a part in the pathogenesis of aphthous ulceration4 and of the effects of levamisole (a drug thought to modify the cellular immune response) upon aphthous ulceration,5 we determined the effect of D.S.C.G. upon in-vitro lymphocyte responsiveness.6 D.S.C.G. at 100 and 1000 µg. per ml. did not alter the in-vitro lymphocyte response of 6 individuals to a mitogen, P.H.A., and an antigen, P.P.D., as measured by lymphocyte transformation, production of -macrophage migration inhibitory factor, and lymphotoxin production. Both of these concentrations of D.S.C.G. were apparently non-toxic for the lymphocytes in culture. It seems possible that the c.G.A. in the trial was acting upon a second immune component of the ulceration, one giving rise to the pain in the middle of the ulcer life. This second immune phase may be associated with the reduction in the demonstrable 1. Assem, E. S. K., McAllen, M. M. Br. med. J. 1970, ii, 504. 2. Frost, M. Lancet, 1973, ii, 389. 3. Dolby, A. E., Walker, D. M. Br. J. oral Surg. (in the press). 4. Lehner, T. Oral Surg. 1972, 33, 80. 5. Symoens, J., Brugmans, J. Br. med. J. 1974, iv, 592. 6. Walker, D. M., Dolby, A. E. Int. Archs Allergy appl. Immun.
(in the press).
mast-cell content of the ulcers which occurs a few days after onset.’ It is not certain whether the two immune components are related, but if our hypothesis is correct new inhibitory compounds which both inhibit lymphocyte transformation as well as mast-cell degranulation8 are indicated in the treatment of aphthas. We are grateful to Fisons Ltd., Pharmaceutical Division, for financial support for the investigations. Welsh National School of Medicine, Dental School, Heath Park, Cardiff CF4 4XY.
D. M. WALKER A. E. DOLBY.
7. Dolby, A. E., Allison, R. J. J. dent. Res. 1969, 48, 901. 8. Assem, E. S. K. Int. Archs Allergy appl. Immun. 1973, 45, 708.
Obituary HERBERT VICTOR MORLOCK
M.C., M.D.Lond., F.R.C.P.
Dr H. V. Morlock, consulting physician to the London Chest Hospital and the Miller and Hampstead General Hospitals, died on May 18 at the age of 76. In the 1914-18 war, immediately after leaving school, he joined the Rifle Brigade, saw service in France, and was decorated with the M.c. on the field at the age of 19. He qualified M.B. from St. Bartholomew’s Hospital in 1924, and was elected to the staff of the first of his three hospitals at the age of 28. With the late Dr A. J. Scott Pinchin he spent some months in Vienna and on his return started the bronchoscopy clinic at the London Chest Hospital, using an instrument of his own design with a telescope for direct vision. This pioneer work, in which he was later joined by E. H. Hudson, established diagnostic bronchoscopy firmly in the hands of chest physicians and thoracic surgeons and was complementary to the work of H. P. Nelson on postural drainage for bronchiectasis. Some found his dynamic personality a little forbidding, but those who accepted this soon developed for him an admiration coupled with affection. There was about him an endearing streak of eccentricity. He habitually wore the old-fashioned style of dress of a consultant after most others had abandoned it, entirely in keeping with his basic philosophy that whatever you set out to do should be done properly. A story runs that at the beginning of the 1939-45 war patriotism impelled him to give up his Rolls and take to an Austin Seven, only to find that he could not sit in it with his top hat on unless the sunshine roof was open. The war affected him keenly; the arrival of the N.H.S. in 1948 even more so. Feeling that his initiative would be cramped, he withdrew to some extent. When he retired he transferred his boundless energy to riding and the hunting field. We shall cherish the memory of a man of character, a generous, warm-hearted colleague. He is survived by his wife, a son, and a daughter who is herself a doctor.
N. L. R. ANGUS NORMAN MacPHAIL M.C., M.D.Glasg., D.P.H.
Dr A. N.
MacPhail, formerly senior lecturer in medicine and general practice in the community of died on June 1 at the age of 60. University Leeds, He had retired last year owing to ill-health. Angus MacPhail qualified M.B. at Glasgow in 1937, subsequently graduating M.D. with commendation in 1951.
1391 In the 1939-45
war
he served in the R.A.M.C. In the Nor-
mandy campaign his stretcher-bearers refused to go out for casualties. He later had them court-martialled; meanwhile he himself went out to the wounded, and was awarded the M.c. Before coming to Leeds in 1959 he had been professor of public health in the University of Khartoum, where he instituted a scheme whereby students were taken on tours of several thousand miles to see for themselves the medical His teaching, and social conditions in outlying areas. which was marked by forthright exposition, was particularly popular with students from developing countries, whose needs he understood so well. Like many Celts, Angus MacPhail had a deep interest in languages, adding to Scottish Gaelic a working knowledge of Classical Greek. He is survived by his wife and daughter.
D. B. B.
JOHN
SETON MICHAEL PRINGLE
M.B.Cantab. and Dubl., F.R.C.S.I., F.R.C.S.
Mr J. S. M. the age of 65.
Pringle died in Dublin
on
May
22 at
His early surgical career was interrupted by service with the R.A.M.C. in the 1939-45 war; he landed in Normandy on D + and was involved in the Arnhem campaign. In civilian life, some years as consulting surgeon to Mercer’s Hospital were followed by appointment to the staff of the Royal City of Dublin Hospital and of the Rotunda and Drumcondra Hospitals. He held the chair of surgery at the Royal College of Surgeons of Ireland and later became regius professor of surgery at Trinity College, Dublin. Failing health led to his retirement in 1972. He was a skilful, dedicated surgeon and teacher who will be deeply mourned by friends, colleagues, and patients throughout Ireland. His first wife died in 1950, leaving him with two daughters and a son. He is survived by his second wife, whom he married in 1959.
B. P.
Diary of the Week JUNE 22
To
28
Monday, 23rd INSTITUTE OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London WC2 4.30 P.M. Mr M. F. Stranc: Principles and Methods in Plastic
Surgery.
Tuesday,
24th
INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, London WCIN 3BG 5.30 P.M. Prof. Fred Plum (New York): Experimental and Clinical Studies in Anoxic-ischsEmic Brain Disease.
Wednesday,
25th ROYAL POSTGRADUATE MEDICAL SCHOOL, Hammersmith Hospital, London W12 OHS 2 P.M. Dr C. L. Berry: The Development of Vessels and Degenerative Disease. INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Prof. J. M. P. Clark: Surgical Management of Paralytic Poliomyelitis-Upper Limb. 8.15 P.M. Professor Clark: Surgical Management of Paralytic Poliomyelitis-Lower Limb.
Thursday, UNIVERSITY 5 P.M.
26th
OF
LONDON
(St. Mary’s Hospital Medical School, Paddington W2.) Prof. J. Loewenthal (Sydney): The Australasian Renal Transplant Experience. ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, Manson House, 26 Portland Place, London WIN 4EY 6 P.M. Dr D. A. Warrell: Snake-bite in Nigeria.
Notes and News THE LANCET
The Lancet’s lateness and underweightness this week is caused by the continuing printing dispute in Britain. BIRTHDAY HONOURS
THE honours awarded to members of the medical sion in the list published on June 14 include:
profes-
K.C.B.
(Civil) Henry Yellowlees, chief medical officer, Department of Health and Social Security. D.B.E. (Civil) Joyce Margaretta Daws, honorary surgeon, Queen Victoria Memorial Hospital, Melbourne, Australia; Frances Violet Gardner, dean, Royal Free Hospital School of Medicine, London. Knights Bachelor John Halliday Croom, chairman, Scottish Council for Postgraduate Medical Education; Daniel Thomson, Civil Service medical adviser. C.B. (Military) Surgeon Rear-Admiral George Augustus Binns. C.B.E. (Civil) Arnold Steadman Aldis; Eric Anthony Barker; Frederic Stanley William Brimblecombe; John Campbell McClure Browne; Patrick Sarsfield Byrne; William Guy Daynes; Brian Oliver Lyndhurst Duke; Priscilla Sheath Fairley; Jean Littlejohn; Andrew Sinclair McLean; Richard Selwyn Francis Schilling.
Honours awarded sion include:
to
people outside
the medical
profes-
G.C.B. (Civil) Sir Philip Rogers, permanent secretary, Department of Health and Social Security. Knight Bachelor Rodney Geoffrey Swiss, president, General Dental Council. C.B. (Civil) Wulf Rudoe, under-secretary. Department of Health and Social
Security. (Civil)
C.B.E.
Mary Frances Appleby, formerly director of MIND (National Association for Mental Health). DISCOVERING SOCIAL PATHOLOGY
WHEN Dr Tonge and his colleagues1 began to look at problem families in Sheffield they were interested in the psychiatric aspects. However, their experiences forced on them a broader outlook: " We became more interested in the social pathology which could not be ascribed to psychiatric disorder ... " Thirty-three families living in Corporation housing in south-east Sheffield were selected from the lists held by various social agencies such as the children’s department and the family service unit; all the families were in touch with three or more agencies or with two agencies one of which was engaged in intensive casework. Neighbouring families matched for maternal age served as controls. A lot of the detail in the ensuing thorough study is unsurprising: the problem families, by definition, had many problems. As a social study the material is rather too selective; the families in question constituted only 0-17% of those in a working-class area and almost certainly represented the extreme end of a broad spectrum of families in difficulty. The problems, in the words of Tonge and his colleagues, form an " interlocking mosaic ", but the remedies, they believe, must be
piecemeal. 1. Families without Hope: A Controlled Study of 33 Problem Families. By W. L. TONGE, D. S. JAMES, and SUSAN M. HILLAM. Published for the Royal College of Psychiatrists by Hedley Brothers Ltd, Invicta Press, Ashford, Kent TN24 8HH. £4; $12.
