- Email: [email protected]
THE U.S.S.R. RETURNS TO W.H.O.
130
ANNOTATIONS
cells.
The
retrogressive changes are but they are less obvious. It appears that all these crucial chemical and morphological comparisons have been made on long-grafted tumours, which probably means that there has been considerable selection from the original -tumour-cell population, with the result that the most rapidly growing elements have predominated. It might be valuable to know how the cells of primary malignant tumours compare with those that are conditional or dependent on the one hand, and with both normal embryonic and adult cells on the other. G. C. Easty and E. J. Ambrose have made a start, and they find that the methionine content of aestrogen-induced, dependent kidney tumours of hamsters is considerably less than that of normal kidney.
aqueous humour of non-inflamed aphakic eyes has indeed the same vitamin-C content as that of normal eyes.7 8 The reduced levels found in Boyd’s experiment may therefore be no more than an indication that the inflammation resulting from the lens extraction was more persistent than that resulting from the sham operation. It is at least as justifiable to attribute the observed delay in healing to the persistent inflammation as to the difference in ascorbic-acid levels. That is to say, delay in healing and reduction in the vitamin concentration are not necessarily causally related, as Boyd suggests, but both may be the result of the greater degree of inflammation induced by the true as compared with the sham
VITAMIN C AND HEALING Bourne1 has suggested that the formation of collagen in healing wounds is unlikely to be influenced by supplements of vitamin C if the diet is already adequate. The failure of local applications of the vitamin to increase the rate of healing in well-nourished laboratory animals accords with this view.23 . Since contrary findings have
OuR knowledge of cerebral vascular disorders is Potter 9 has broken new pathetically incomplete. in of his ground study angiomatous lesions, other than neoplasms. Perhaps his most important conclusion is that in all of these the essential abnormality is an
malignant
to be found in
same
embryonic cells,
been reported-by Saitta,4for example-the problem has been reinvestigated. In order to vary the local concentration of the vitamin in healing wounds, Boyd5 has made use of the considerable reduction in the ascorbic-acid content of the aqueous humour that follows extraction of the lens.6 In a trial series of 10 guineapigs he found that the mean concentration of ascorbic acid in the aqueous humour fell from 22-16 mg. per 100 ml. to 11-60 mg. per 100 ml.-a highly significant difference. For his main experiment he used 20 guineapigs in which the lens had been removed from the left eye, and the right eye had been subjected to a similar but sham operation. Ten days later a standard injury of each cornea was produced by an electrically heated wire loop. Healing of this injury was then assessed by watching the gradual disappearance of fluorescence from the injured site when it was viewed in ultraviolet light after the local application of fluorescein. Owing to the frequent relapses, especially on the aphakic side, healing was not regarded as complete until fluorescence was absent on four consecutive occasions. The mean of the healing time so determined was 17-3 days for the aphakic eyes and 10.8 days for the shamoperated controls. The ascorbic acid in the cornea and in the aqueous humour one week after completion of healing was significantly less in the aphakic than in the control eyes. Boyd rightly emphasises that even in the aphakic eyes the mean corneal ascorbic-acid level of 32-09 mg. per 100 g. was many times higher than in normal connective tissue ; yet healing was delayed compared with the control eyes, which had a mean corneal ascorbic-acid content of 47-29 mg. per 100 g. It is, however, questionable whether the difference in the rate of healing was in fact due to this difference in the local concentration of the vitamin. The amount of trauma suffered by the control eye was indubitably less, and probably much less, than that suffered by the eye undergoing extraction of the lens. The observed difference in the ascorbic-acid levels of aqueous humour and cornea of the two eyes was most’ probably the result of different degrees of injury. The fall in ascorbic-acid content of the aqueous humour of inflamed eyes was presumably caused by dilution with exudate from the relatively vitamin-poor plasma. The 1. Bourne, G. H. Lancet, 1942, ii, 661. Proto, M. Ann. ital. Chir. 1936, 15, 31. Galloway, N. M., Garry, R. C., Hitchin, A. D. Brit. J. Nutr. 1948, 2, 228. 4. Saitta, S. Scr. biol. Castaldi, 1929, 4, 301. 5. Boyd, T. A. S. Brit. J. Ophthal. 1955, 39, 204. 6. Muller, H. K., Buschke, W. Arch. Augenheilk. 1934, 108, 368. 2. 3.
operation. CEREBRAL ANGIOMATA
arteriovenous communication ; the tortuous and dilated vessels around this, which form the specta,cular part of the visible lesion, are not the cause of the shunt, nor are they associated congenital defects of structure: they are the consequences of the fistula and occur wherever there is such a fistula. Holman 10 too, concluded from his work on experimental arteriovenous fistulae that, whenever there was a significant leak and a large deviation of blood, the veins and the artery became tortuous and dilated ; but the reason for this is obscure. Holman further showed that the vascular dilatation was not permanent but disappeared if the leak was controlled, whereas excision of redundant vessels without control of the leak was followed by dilatation of further veins. So in surgical treatment the essential step is to interrupt the anastomosis-not to excise the lesion or block entering vessels. Potter’s clinical observations are perhaps of greater immediate importance. With cerebral angiomata the risk of serious cerebral injury is always present, but his figures suggest that complications come early or not at all ; that haemorrhage, though very common (4 cases out of 5) occurs at a younger age than does haemorrhage from berry aneurysms, and is much more benign ; and that the risk of serious epilepsy or mental damage is slight. About 1 in 10 of the patients show mental impairment, sometimes as premature ageing. Finally Potter’s useful contribution draws attention to the possibilities of radiotherapy. THE U.S.S.R. RETURNS TO W.H.O. ON July 8 Mr. Kumykin announced in Geneva that his government now proposes to take an active part in the work of the World Health Organisation, to take up membership of the International Bureau of Education, and to contribute 2 million roubles to the United Nations children’s fund in the form of services and equipment for maternity and child centres. This decision will be warmly welcomed by all who regretted the withdrawal of the Soviet Union from W.H.O. in 1949. Dr. F. H. K. GREEN, principal medical officer on the headquarters staff of the Medical Research Council since 1949, has been appointed scientific secretary to the trustees of the will of the late Sir Henry Wellcome (the Wellcome Trust) from Oct. 1. 7. Kinsey, V. E. Amer. J. Ophthal. 1950, 33, 257. 8. Purcell, E. F., Lerner, L. H., Kinsey, V. E. Arch. Ophthal., Chicago, 1954, 51, 1. 9. Potter, J. M. Ann. R. Coll. Surg. Engl. 1955, 16, 227. 10. Holman, E. Arteriovenous Aneurysms. New York, 1937. 11. See Lancet, 1949, i, 355.
SPECIAL
NUCLEAR An
Appeal
following statement was issued in London last Saturday by Lord Russell on behalf of his seven co-signatories, including the late Professor Einstein:: IN the tragic situation which confronts humanity,
feel that scientists should assemble in conference have arisen as a result of the of mass destruction, and to discuss a resolution in the spirit of the appended draft. We are speaking on this occasion, not as members of this or that nation, continent, or creed, but as human beings, members of the species Man, whose continued existence is in doubt.
we
appraise the perils that development of weapons
to
The world is full of conflicts ; and, overshadowing all minor conflicts, the titanic struggle between Communism and anti-Communism. Almost everybody who is politically conscious has strong feelings about one or more of these issues ; and we want you, if you can, to set aside such feelings and consider yourselves only as members of a biological species which has had a remarkable history, and whose disappearance none of us can desire. We shall try to say no single word which should appeal to one group rather than to another. All, equally, are in peril, and, if the peril is understood, there is hope that they may collectively avert it.
We have to learn to think in a new way. We have to learn to ask ourselves, not what steps can be taken to give military victory to whatever group we prefer, for there are no longer such steps ; the question we have to ask ourselves is : what steps can be taken to prevent a military contest of which the issue must be disastrous to all parties ? The general public, and even many men in position of authority, have not realised what would be involved in a war with nuclear bombs. The general public still thinks in terms of the obliteration of cities. It is understood that the new bombs are more powerful than the old, and that, while one A-bomb could obliterate Hiroshima, one H-bomb could obliterate the largest cities, such as
London, New York, and Moscow. No doubt in an H-bomb war great cities would be obliterated. But this is one of the minor disasters that would have to be faced. If everybody in London, New York, and Moscow were exterminated the world might, in the course of a few centuries, recover from the blow. But we now know, especially since the Bikini test, that nuclear bombs can gradually spread destruction over a very much wider area than had been supposed. It is stated on very good authority that a bomb can now be manufactured which will be 2500 times as powerful as that which destroyed Hiroshima. Such a bomb, if exploded near the ground or under water, sends radioactive particles into the upper air. They sink gradually and reach the surface of the earth in the form of a deadly dust or rain. It was this dust which infected the Japanese fishermen and their catch of fish.
No-one knows how widely such lethal radioactive be diffused, but the best authorities are
particles might
saying
quite possibly put
that
a
war
WAR
to Scientists and the Public
The
unanimous in
131
ARTICLES
with H-bombs
might
end to the human race. It is feared that if many H-bombs are used there will be universal death-sudden only for the minority, but for the majority a slow torture of disease and disintegration. an
Many warnings have been uttered by eminent men of science and by authorities in military strategy. None of them will say that the worst results are .certain. What they do say is that these results are possible, and
no-one can
have not
be
sure
that
they will
not be realised.
yet found that the views of experts
on
We this
question depend in any degree upon their politics or prejudices. They depend only, so far as our researches have revealed, upon the extent of the particular expert’s knowledge. We have found that the men who know most are the most gloomy. Here, then, is the problem which we present to you, stark and dreadful, and inescapable : shall we put an end to the human race : or shall mankind renounce war ?People will not face this alternative because it is so difficult to abolish war. The abolition of war will demand distasteful limitations But what perhaps impedes of national sovereignty. understanding of the situation more than anything else is that the term " mankind " feels vague and abstract. People scarcely realise in imagination that the danger is to themselves and their children and their grandchildren, and not only to a dimly apprehended humanity. They can scarcely bring themselves to grasp that they, individually, and those whom they love are in imminent danger of perishing agonisingly. And so they hope that perhaps war may be allowed to continue provided modern weapons are prohibited. This hope is illusory. Whatever agreements not to use H-bombs had been reached in time of peace they would no longer be considered binding in time of war, and both sides would set to work to manufacture H-bombs as soon as war broke out ; for, if one side manufactured the bombs and the other did not, the side that manufactured them would inevitably be victorious. Although an agreement to renounce nuclear weapons as part of a general reduction of armaments * would not afford an ultimate solution, it would serve certain important purposes. First : any agreement between East and West is to the good in so far as it tends to diminish tension. Second : the abolition of thermonuclear weapons, if each side believed that the other had carried it out sincerely, would lessen the fear of a sudden attack in the style of Pearl Harbour, which at present keeps both sides in a state of nervous apprehension. We should therefore welcome such an agreement, though only as a first step. Most of us are not neutral in feeling ; but, as human beings, we have to remember that, if the issues between East and West are to be decided in any manner that can give any possible satisfaction to anybody, whether Communist or anti-Communist, whether Asian or European or American, whether White or Black, then these issues must not be decided by war. We should wish this to be understood, both in the East and in the West. There lies before us, if we choose, continual progress in happiness, knowledge, and wisdom. Shall we, instead, choose death, because we cannot forget out quarrels ? We appeal, as human beings, to human beings : Remember your humanity, and forget the rest. If you can do so, the way lies open to a new paradise ; if you cannot, there lies before you the risk of universal death. We invite this congress, and through it the scientists of the world and the general public, to subscribe to the following resolution : In view of the fact that in any future world war nuclear weapons will certainly be employed, and that such weapons threaten the continued existence of *Professor Muller makes the reservation that this be taken to mean " a concomitant balanced reduction of all armaments."
ANNOTATIONS
cells.
The
retrogressive changes are but they are less obvious. It appears that all these crucial chemical and morphological comparisons have been made on long-grafted tumours, which probably means that there has been considerable selection from the original -tumour-cell population, with the result that the most rapidly growing elements have predominated. It might be valuable to know how the cells of primary malignant tumours compare with those that are conditional or dependent on the one hand, and with both normal embryonic and adult cells on the other. G. C. Easty and E. J. Ambrose have made a start, and they find that the methionine content of aestrogen-induced, dependent kidney tumours of hamsters is considerably less than that of normal kidney.
aqueous humour of non-inflamed aphakic eyes has indeed the same vitamin-C content as that of normal eyes.7 8 The reduced levels found in Boyd’s experiment may therefore be no more than an indication that the inflammation resulting from the lens extraction was more persistent than that resulting from the sham operation. It is at least as justifiable to attribute the observed delay in healing to the persistent inflammation as to the difference in ascorbic-acid levels. That is to say, delay in healing and reduction in the vitamin concentration are not necessarily causally related, as Boyd suggests, but both may be the result of the greater degree of inflammation induced by the true as compared with the sham
VITAMIN C AND HEALING Bourne1 has suggested that the formation of collagen in healing wounds is unlikely to be influenced by supplements of vitamin C if the diet is already adequate. The failure of local applications of the vitamin to increase the rate of healing in well-nourished laboratory animals accords with this view.23 . Since contrary findings have
OuR knowledge of cerebral vascular disorders is Potter 9 has broken new pathetically incomplete. in of his ground study angiomatous lesions, other than neoplasms. Perhaps his most important conclusion is that in all of these the essential abnormality is an
malignant
to be found in
same
embryonic cells,
been reported-by Saitta,4for example-the problem has been reinvestigated. In order to vary the local concentration of the vitamin in healing wounds, Boyd5 has made use of the considerable reduction in the ascorbic-acid content of the aqueous humour that follows extraction of the lens.6 In a trial series of 10 guineapigs he found that the mean concentration of ascorbic acid in the aqueous humour fell from 22-16 mg. per 100 ml. to 11-60 mg. per 100 ml.-a highly significant difference. For his main experiment he used 20 guineapigs in which the lens had been removed from the left eye, and the right eye had been subjected to a similar but sham operation. Ten days later a standard injury of each cornea was produced by an electrically heated wire loop. Healing of this injury was then assessed by watching the gradual disappearance of fluorescence from the injured site when it was viewed in ultraviolet light after the local application of fluorescein. Owing to the frequent relapses, especially on the aphakic side, healing was not regarded as complete until fluorescence was absent on four consecutive occasions. The mean of the healing time so determined was 17-3 days for the aphakic eyes and 10.8 days for the shamoperated controls. The ascorbic acid in the cornea and in the aqueous humour one week after completion of healing was significantly less in the aphakic than in the control eyes. Boyd rightly emphasises that even in the aphakic eyes the mean corneal ascorbic-acid level of 32-09 mg. per 100 g. was many times higher than in normal connective tissue ; yet healing was delayed compared with the control eyes, which had a mean corneal ascorbic-acid content of 47-29 mg. per 100 g. It is, however, questionable whether the difference in the rate of healing was in fact due to this difference in the local concentration of the vitamin. The amount of trauma suffered by the control eye was indubitably less, and probably much less, than that suffered by the eye undergoing extraction of the lens. The observed difference in the ascorbic-acid levels of aqueous humour and cornea of the two eyes was most’ probably the result of different degrees of injury. The fall in ascorbic-acid content of the aqueous humour of inflamed eyes was presumably caused by dilution with exudate from the relatively vitamin-poor plasma. The 1. Bourne, G. H. Lancet, 1942, ii, 661. Proto, M. Ann. ital. Chir. 1936, 15, 31. Galloway, N. M., Garry, R. C., Hitchin, A. D. Brit. J. Nutr. 1948, 2, 228. 4. Saitta, S. Scr. biol. Castaldi, 1929, 4, 301. 5. Boyd, T. A. S. Brit. J. Ophthal. 1955, 39, 204. 6. Muller, H. K., Buschke, W. Arch. Augenheilk. 1934, 108, 368. 2. 3.
operation. CEREBRAL ANGIOMATA
arteriovenous communication ; the tortuous and dilated vessels around this, which form the specta,cular part of the visible lesion, are not the cause of the shunt, nor are they associated congenital defects of structure: they are the consequences of the fistula and occur wherever there is such a fistula. Holman 10 too, concluded from his work on experimental arteriovenous fistulae that, whenever there was a significant leak and a large deviation of blood, the veins and the artery became tortuous and dilated ; but the reason for this is obscure. Holman further showed that the vascular dilatation was not permanent but disappeared if the leak was controlled, whereas excision of redundant vessels without control of the leak was followed by dilatation of further veins. So in surgical treatment the essential step is to interrupt the anastomosis-not to excise the lesion or block entering vessels. Potter’s clinical observations are perhaps of greater immediate importance. With cerebral angiomata the risk of serious cerebral injury is always present, but his figures suggest that complications come early or not at all ; that haemorrhage, though very common (4 cases out of 5) occurs at a younger age than does haemorrhage from berry aneurysms, and is much more benign ; and that the risk of serious epilepsy or mental damage is slight. About 1 in 10 of the patients show mental impairment, sometimes as premature ageing. Finally Potter’s useful contribution draws attention to the possibilities of radiotherapy. THE U.S.S.R. RETURNS TO W.H.O. ON July 8 Mr. Kumykin announced in Geneva that his government now proposes to take an active part in the work of the World Health Organisation, to take up membership of the International Bureau of Education, and to contribute 2 million roubles to the United Nations children’s fund in the form of services and equipment for maternity and child centres. This decision will be warmly welcomed by all who regretted the withdrawal of the Soviet Union from W.H.O. in 1949. Dr. F. H. K. GREEN, principal medical officer on the headquarters staff of the Medical Research Council since 1949, has been appointed scientific secretary to the trustees of the will of the late Sir Henry Wellcome (the Wellcome Trust) from Oct. 1. 7. Kinsey, V. E. Amer. J. Ophthal. 1950, 33, 257. 8. Purcell, E. F., Lerner, L. H., Kinsey, V. E. Arch. Ophthal., Chicago, 1954, 51, 1. 9. Potter, J. M. Ann. R. Coll. Surg. Engl. 1955, 16, 227. 10. Holman, E. Arteriovenous Aneurysms. New York, 1937. 11. See Lancet, 1949, i, 355.
SPECIAL
NUCLEAR An
Appeal
following statement was issued in London last Saturday by Lord Russell on behalf of his seven co-signatories, including the late Professor Einstein:: IN the tragic situation which confronts humanity,
feel that scientists should assemble in conference have arisen as a result of the of mass destruction, and to discuss a resolution in the spirit of the appended draft. We are speaking on this occasion, not as members of this or that nation, continent, or creed, but as human beings, members of the species Man, whose continued existence is in doubt.
we
appraise the perils that development of weapons
to
The world is full of conflicts ; and, overshadowing all minor conflicts, the titanic struggle between Communism and anti-Communism. Almost everybody who is politically conscious has strong feelings about one or more of these issues ; and we want you, if you can, to set aside such feelings and consider yourselves only as members of a biological species which has had a remarkable history, and whose disappearance none of us can desire. We shall try to say no single word which should appeal to one group rather than to another. All, equally, are in peril, and, if the peril is understood, there is hope that they may collectively avert it.
We have to learn to think in a new way. We have to learn to ask ourselves, not what steps can be taken to give military victory to whatever group we prefer, for there are no longer such steps ; the question we have to ask ourselves is : what steps can be taken to prevent a military contest of which the issue must be disastrous to all parties ? The general public, and even many men in position of authority, have not realised what would be involved in a war with nuclear bombs. The general public still thinks in terms of the obliteration of cities. It is understood that the new bombs are more powerful than the old, and that, while one A-bomb could obliterate Hiroshima, one H-bomb could obliterate the largest cities, such as
London, New York, and Moscow. No doubt in an H-bomb war great cities would be obliterated. But this is one of the minor disasters that would have to be faced. If everybody in London, New York, and Moscow were exterminated the world might, in the course of a few centuries, recover from the blow. But we now know, especially since the Bikini test, that nuclear bombs can gradually spread destruction over a very much wider area than had been supposed. It is stated on very good authority that a bomb can now be manufactured which will be 2500 times as powerful as that which destroyed Hiroshima. Such a bomb, if exploded near the ground or under water, sends radioactive particles into the upper air. They sink gradually and reach the surface of the earth in the form of a deadly dust or rain. It was this dust which infected the Japanese fishermen and their catch of fish.
No-one knows how widely such lethal radioactive be diffused, but the best authorities are
particles might
saying
quite possibly put
that
a
war
WAR
to Scientists and the Public
The
unanimous in
131
ARTICLES
with H-bombs
might
end to the human race. It is feared that if many H-bombs are used there will be universal death-sudden only for the minority, but for the majority a slow torture of disease and disintegration. an
Many warnings have been uttered by eminent men of science and by authorities in military strategy. None of them will say that the worst results are .certain. What they do say is that these results are possible, and
no-one can
have not
be
sure
that
they will
not be realised.
yet found that the views of experts
on
We this
question depend in any degree upon their politics or prejudices. They depend only, so far as our researches have revealed, upon the extent of the particular expert’s knowledge. We have found that the men who know most are the most gloomy. Here, then, is the problem which we present to you, stark and dreadful, and inescapable : shall we put an end to the human race : or shall mankind renounce war ?People will not face this alternative because it is so difficult to abolish war. The abolition of war will demand distasteful limitations But what perhaps impedes of national sovereignty. understanding of the situation more than anything else is that the term " mankind " feels vague and abstract. People scarcely realise in imagination that the danger is to themselves and their children and their grandchildren, and not only to a dimly apprehended humanity. They can scarcely bring themselves to grasp that they, individually, and those whom they love are in imminent danger of perishing agonisingly. And so they hope that perhaps war may be allowed to continue provided modern weapons are prohibited. This hope is illusory. Whatever agreements not to use H-bombs had been reached in time of peace they would no longer be considered binding in time of war, and both sides would set to work to manufacture H-bombs as soon as war broke out ; for, if one side manufactured the bombs and the other did not, the side that manufactured them would inevitably be victorious. Although an agreement to renounce nuclear weapons as part of a general reduction of armaments * would not afford an ultimate solution, it would serve certain important purposes. First : any agreement between East and West is to the good in so far as it tends to diminish tension. Second : the abolition of thermonuclear weapons, if each side believed that the other had carried it out sincerely, would lessen the fear of a sudden attack in the style of Pearl Harbour, which at present keeps both sides in a state of nervous apprehension. We should therefore welcome such an agreement, though only as a first step. Most of us are not neutral in feeling ; but, as human beings, we have to remember that, if the issues between East and West are to be decided in any manner that can give any possible satisfaction to anybody, whether Communist or anti-Communist, whether Asian or European or American, whether White or Black, then these issues must not be decided by war. We should wish this to be understood, both in the East and in the West. There lies before us, if we choose, continual progress in happiness, knowledge, and wisdom. Shall we, instead, choose death, because we cannot forget out quarrels ? We appeal, as human beings, to human beings : Remember your humanity, and forget the rest. If you can do so, the way lies open to a new paradise ; if you cannot, there lies before you the risk of universal death. We invite this congress, and through it the scientists of the world and the general public, to subscribe to the following resolution : In view of the fact that in any future world war nuclear weapons will certainly be employed, and that such weapons threaten the continued existence of *Professor Muller makes the reservation that this be taken to mean " a concomitant balanced reduction of all armaments."