168

field Drinker also offers an explanation of the changesfound in pulmonary silicosis. The fibrosis in the lungsdevelops as a result of chronic lymph stagnation and theaccumulation of protein-rich fluid. This is brought aboutby the fibrotic stricture of the lymphatic vessels roundthe silica particles carried to them from the pulmonaryalveoli.

There remain a number of unsolved problems in thisfield. For instance, why does the flow of lymph from thesame organ vary widely from one animal to another ofthe same species ? The quantities of lymph obtained bearno relation to the weight of the animal, but may con-ceivably reflect some difference in its nutritional state.The function of the intestinal lymphatics is not clear.It has yet to be shown experimentally what proportionof the fat ingested by a mammal leaves the gut by wayof the lacteals. At the same time the thoracic duct

provides a bypass enabling certain products of digestionto reach the blood without first having to pass through.the liver. The answer to these and similar questions ismost likely to come from the application of the carefulexperimental methods well illustrated by the work ofDrinker and his colleagues.

PROFESSIONAL FREEDOM AND THE LCC

LAST week opened well for lovers of liberty ; and on

Tuesday the London County Council carried on the goodwork. The first of two significant decisions affecting itsmedical staff concerns the censorship of scientific booksor articles by administrative superiors. Doctors

employed by the LCC have been perfectly free to publishbooks and papers so long as they did not refer to theirconnexion with the council; but if they wanted to men-tion their appointment they were obliged to show theirdraft to the head of their department so that he couldsatisfy himself " that no question of policy likely toimplicate the Council is involved." In its report pre-sented on Tuesday the general purposes committee sug-gested that officers should be encouraged to write ontheir own technical or scièntific subjects, and that it cansafely be left to their discretion not to publish any bookor article in their official capacity which will seriouslyimplicate or embarrass the Council in regard to its policy.Accepting this view, the LCC has decided that, in writingon purely technical or scientific subjects, medical andother officers may state their LCC appointment withoutasking leave of their departmental chief. This

enlightened ruling is, we suspect, not altogether unrelatedto the call for " scientific freedom" raised by Dr.

Geoffrey Bourne and others in the British Jledical Journalduring the past few months ; and the second decisionreached at the same meeting also betokens a welcomesensitiveness to medical public opinion. An experi-ment, it was agreed, is now to be made at St. James’

Hospital, Balham, by which the medical superintendentwill devote himself entirely to administration, and thecomplete clinical charge of patients will be dividedbetween the heads of the medical, surgical, and obstetricaldepartments. This is another step towards liquidatingthe hierarchical system which has been one of the majorflies in the ointment. of municipal service.

ARTIFICIAL INSEMINATION

THE House of Lords, as reported on page 176, has beendebating artificial insemination. In the USSR andUSA especially, this practice is now widely employedby stockbreeders, who benefit greatly by a method whichallows one bull to sire as many as 1000 calves in a breedingseason. The rapid development of artificial insemina-tion of animals is no doubt responsible for the newinterest in its application to human beings, either as aeugenic measure or as a means of relieving the unhappi-ness of involuntary sterility. In the United States itsuse for this last purpose has evidently been makingheadway. A survey sponsored by the National Research

Foundation for Eugenic Alleviation of Sterility providedparticulars of 9489 women who had achieved at leastone pregnancy by artificial insemination, and in 3649of these the semen came from a donor other than thehusband.l More than 97% of these pregnancies are

said to have yielded normal babies.Guttmacher 2 classifies the indications in three main

groups. In the first of these, intravaginal coitus betweenhusband and wife is impossible because of mechanicalfactors, among which he includes impotence, hypospadias,vaginismus, and excessive obesity. Probably all doctorswill agree with John Hunter that in such circumstancesartificial insemination is right and proper. There isneither moral nor legal objection ; the child will no

‘

doubt be accepted at law as the true offspring and heirof the parents concerned. Guttmacher’s second groupcomprises a miscellaneous collection of conditionsincluding (in the woman) genital hypoplasia, cervicalstenosis, uterine malpositions, and (in the man) sub-normal semen. In such cases the indications are, to

say the least, less definite ; for these conditions aremostly amenable to treatment and should be treatedaccordingly. The third group-the controversial one-is that in which semen has to be provided from anoutside donor, either because the husband is sterile orbecause he carries hereditable characters that make itinadvisable for him to beget children. The husbandwho discovers that he must not or cannot have a childof his own may share his wife’s wish that she should beenabled to bear healthy offspring.

There is, as we have said, no legal or moral problemwhen the husband provides the semen ; but bothlawyers and moralists are profoundly concerned wheninsemination is performed out of wedlock. As the lawstands, the child conceived in this way is a child ofuncertain parentage ; and Guttmacher, writing forAmericans, recommends that, to avoid litigation later,it should always be adopted by its mother and nominalfather.

_____

Sir BECKWITH WHITEHOUSE, professor of midwiferyand diseases of women in the University of Birmingham,died suddenly in London on July 28. He had just beennominated president of the British Medical Associationfor a second year. He was in his 61st year.We also regret to announce the death on July 27 of

Dr. JOHN GILMOUR, for many years senior regionalmedical officer to the Scottish Department of Health.

1. Seymour, F. I. and Koerner, A. Ibid, 1941, 116, 2747.2. Guttmacher, A. F. J. Amer. med. Ass. 1942, 120, 442.

PORTABLE X-RAY UNITS.—In. response to an appeal byMr. Derek McCulloch for :i1500 to provide a mobile X-rayunit listeners to the Children’s Hour have contributed tentimes this amount and E300 has been spent on a mobile X-rayunit which was presented on their behalf to Sir Ernest Clarke,chairman of the home service ambulance t5mmittee of theJoint Red Cross. The unit, which has been constructed underthe direction of Mr. H. T. Ferrier, FSR., carries a team ofthree-senior radiographer, dark-room assistant, and driver-mechanic-and is self-contained with its own generatingequipment, a high-power X-ray unit, spare X-ray tubes, anda dark room. It can be adapted for different kinds of work.In its simplest form a single transformer tank, easily carriedby two men, can be set up at the patient’s bedside with thecontrol table to produce 125 mA at the usual kV values forrapid bedside chest work. For routine chest work at a clinictwo small valve tanks, each handled by one man, can be joinedup as a four-valve set producing 250-300 mA. The exposureof 2’Br-l(} sec. at the usual teleradiographic distances is thefastest yet obtainable under mobile conditions. The controltable and the other parts of the apparatus may be switchedand connected to allow mass miniature radiography. Cameraand identification system are automatic. A system oflagging, reverse action fans and thermostat keep the insideof the car and the processing units at an even temperature.Eleven portable X-ray units are also being supplied tochildren’s hospitals in this country and 6000 has been sentto buy X-ray equipment for the benefit of children in Russia.