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and felt perhaps that this was the first step towardstheir discharge from their sheltered hospital existence.At first the attitude of the relatives was on the whole

discouraging, and might be summarised by the remarkof one of them, " If he gets up, he’ll want to comehome." In most cases the patients had been away fromhome so long that their relatives had become accustomedto living without them, or, because of the war, no longerhad accommodation. Many .patients seem to be strandedin hospital because their homes were broken up by thewar ; they were evacuated and contact with theirfamilies was lost. ,

The main obstacle to the rehabilitation of manypatients remains the shortage of accommodation inthe homes for the elderly. The occupation of beds byrecovered patients, who could be in their own homesif domestic help were available, has been reviewed byAmulree and Sturdee (1946). Until old people can

look forward to settling in congenial surroundings aftertheir discharge from hospital, it will be difficult toarouse their desire to live a more independent life.

They are naturally disinclined to leave surroundingswhich have become familiar to them, and the staff andother patients they have come to know so well.Where new patients are admitted, it is our policy,

following that of Dr. Marjory Warren, to interview therelatives personally, and unobtrusively indicate that thestay in hospital is not likely to be permanent. This

prevents the disintegration of the family circle, whichhas occurred so much in the past, and ensures that,wherever possible, provision is made for the return ofthe patient to his own home.

THE IXTEREST OF GERIATRICS

The present high proportion of the aged sick and ofold people in the population is unprecedented. Yet it is

only recently, since institutions containing the " chronicsick " have been taken over by general hospitals, thatthe magnitude of the problem has forced itself on theattention of the medical profession as a whole. Thereis no doubt that throughout the country patients of thistype have been inadequately cared for in the past.During the war the lack of attention devoted to thisfield was perhaps understandable, for the limited numbersof hospital beds were more urgently required for theacute sick. It is apparent, however, how much can bedone for the rehabilitation even of the previously styled" bedridden " case and how much more successfullythe problem of the aged sick could be tackled bytheir earlier treatment, before the effects of prolongedimmobilisation develop.The field of research in diseases of old people is vast

and largely unexplored. Little is known even of whatis expected as normal values for the many quantitativetests that can now be applied to the body fluids and thefunctions of its various organs. For instance, Rafskyet al. (1949) have shown that in the aged thereis a rise in the &bgr;-globulin, with a low serum-albumin ;Hamburger (1948) has found a persistent falling-off ofthe daily excretion of 17-ketosteroids in both sexes afterthe menopause ; while Pedersen-Bjergaard and Tonnesen(1948) have shown that the pituitary gonadotrophicexcretion becomes maximal about the age of 70. Oncethe normals have been established, the way will beclear for investigating how the changes from the valuesof younger subjects come about, and thus some lightmight be thrown on the fundamental problems of theprocess of ageing.From the nursing point of view, it might be thought t

that geriatric work is dull. This we believe not to be so.The care and devotion the nurses have shown to these

patients is almost beyond praise. Looking after thesepeople, who often are helpless and entirely dependenton others, carries with it a sense of inner reward and

aesthetic satisfaction probably not to be found in anyother branch of nursing.

In the training of medical students a few months

spent in the geriatric wards, taking rather more thana mere passive interest, will be as valuable as similartime spent in the general wards. The future generalpractitioner will thus become better able to cope withthe problems of his aged patients, who will form a highproportion of his practice. Moreover, the clinical materialfound is often more instructive, as regards the Art ofMedicine, than that seen in the acute wards. Thestudent will have an opportunity of studying certainmaladies which in the main hospital he would veryseldom see-e.g., the late stages of disseminated sclerosis,Friedreich’s ataxy, athetosis, gout, and Paget’s disease.

Also the medical student can play a big part in therehabilitation of the untreated chronic cases ; thus hecan supervise bed exercises, and the setting up andadjustment of suspension frames : and in this wayrelieve the burden on the physiotherapists. Moreover,the student, with more time at his disposal than thehouseman, has ample opportunity for getting to knowindividual patients, and so for assisting and encouragingthem on their often rather long road to recovery.

Dr. John Smith, as long ago as 1666 pointed out thepath physicians should follow in this type of work :

’’ Let None give over their patients, when they come tobe burdened with the infirmities of Age, as though they werealtogether uncapable of having any good done unto them ;for, as this will argue great weakness and ignorance in thePhysician, so it is exceeding cruelty to the patient ; for, asthe slothful in his work is brother to a great waster, so thosethat are negligent to their Ancient Friends, are very near ofkin to those inhumane Barbarians, who with great pompand alacrity both kill and devour them, thinking therebythey perform a most charitable office in delivering them fromthose incurable maladies, which will for ever render themmiserable." °’

King Solomon’s Portraiture of Old Age.

We wish to acknowledge our great appreciation of theenthusiastic guidance with which Lord Amulree has encouragedboth our work in the wards and the preparation of this paper.We are further greatly indebted to Miss B. L. Robertson,the almoner, and Miss C. G. Miles, the occupational therapist,for many suggestions.

REFERENCES

Affleck, J. W. (1947) Lancet, i, 355.Amulree, Lord, Sturdee, E. L. (1946) Brit. med. J. i, 617.British Medical Association Report (1947) Care and Treatment of

the Elderly. London.Fishberg, A. M. (1940) Heart Failure. Philadelphia.Hamburger, C. (1948) Acta endocrinol. 1, 19.Howell, T. H. (1944) Old Age. London.Lister, W. A. (1949) Lancet, i, 719.Lovibond, J. L. (1949) Brit. med. J. i, 833.Nascher, I. L. (1919) Geriatrics. London.Pedersen-Bjergaard, K., Tonnesen, M. (1948) Acta endocrinol. 1, 38.Rafsky, H. A., Newman, B., Krieger, C. I. (1949) Amer. J. med. Sci.

217, 206.Sheldon, J. H. (1948) The Social Medicine of Old Age. London.Smith, J. (1666) King Solomon’s Portraiture of Old Age. London.Thomson, A. P. (1949) Lumleian lectures, Royal College of

Physicians, See Lancet, April 16, p. 657.

L’AFFAIRE LYSENKO

FROM A CORRESPONDENT

" An intense struggle is raging in the field of biologytoday between the progressive and the reactionary, betweenthe old and the new, between materialism and idealism.In this struggle the progressive scientific ideology of theSoviet Union stands opposed to the putrid ideology of thecapitalist world. The struggle that is going on in the fieldof biology is a reflection of the acute intense class struggle."-POLYAKOV.THE English translation of the verbatim report of

the proceedings of the Lenin Academy of AgriculturalSciences of the U.S.S.R. in the session which lasted from

1. The Situation in Biological Science. Moscow, 1949. Distributedin Great Britain by Collet’s Foreign Department, 67, GreatRussell Street, London, W.C.1. Pp. 631. 9s. 6d.

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July 31 to Aug. 7, 1948, reveals three main factorscontributing to this dispute. The need to re-establishRussian agriculture after the damage done by the warled to experiments on an enormous scale, in whichRussian breeders of animals and plants have apparentlyachieved great successes. Having produced new anduseful varieties, they feel that they know far more aboutvariation and its causes than do the geneticists, whomthey accuse - of spinning theories without practicalachievement. The second factor is xenophobia, directedparticularly- towards the U.S.A., where much of the morerecent work on genetics has been done by the Morganists.The third factor is the belief that an immortal germ-plasm savours of religion.2 These three independentfactors converge on genetics as on a target, and theyare aided by the fact that communism denies the importanceof pedigree or race, placing all men on a common level.Denial of the existence of genes 3 logically leads to the viewthat variation is due to external influences acting onthe somatic cells, and that the scion affects the heredityof the stock on which it is grafted. The quarrel is thusbetween academic research into genetics and practicalagricultural research, combined with the difference ofopinion about the mechanism of heredity, the Michurin-ists supporting the theory of the inheritance of acquiredcharacters.

According to the Michurinists, as Lysenko and hiscolleagues call themselves, changes in heredity are theresult of changes in the soma due to altered metabolism ;hence changes in heredity, the acquisition of newcharacters, and their transmission are always due toenvironment. Lysenko 4 defined heredity as" the effect of the concentration of the action of environmentalconditions assimilated by the organism in a series of precedinggenerations.... Heredity is a property not only of the chromo-somes but also of every living thing, every cell and everyparticle of the body. For heredity is determined by thespecific type of metabolism. You need but change the typeof the metabolism in the living body to bring about a changein heredity."

Speaker after speaker described new useful varietiesof animals and plants and claimed that the variationhad been directed by man. Isayev quoted the proud wordsof Michurin engraved on his monument : " Man can andmust create new breeds of plants better than Nature."The main argument against genetics, however, was

political. Thus Eichfeld spoke of the geneticists as havingno direct connexion with production :

’ ‘ This puts them in a privileged position ; they areworking for themselves as private gentlemen. ’ ... Further,they have at their disposal the overwhelming majority of thechairs in the biological faculties.... All the more regrettableis it that nowadays so many .of our biologists laud andextol not progressive scientists, our fellow-countrymen, butrepresentatives of reactionary idealistic trends in scienceabroad.’’

Shaumyan said :The theory of genes is reactionary to the core, for it is

bound to lower the role of Soviet man ; this theory wantsto make us bend the knee to nature; it tries to convertSoviet man into a passive appendage of nature, a placidcontemplator of nature who humbly waits for gifts andfavours from her. The principles underlying the Michurin-Lysenko theory are precisely the opposite. This theoryraises man to a position of eminence he never attainedbefore, makes him the real master and commander ofnature, and indicates Soviet man’s place and part in thebold resolute refashioning of nature."

2. "A mystical, mythical, and actually non-material gene "

(Perov); " Genetics drags us towards mysticism, it is thestraight road to clericalism" (Demidov): " Nobody will beled astray by the Morganists’ false analogies between theinvisible atom and the invisible gene. Far closer would be theanalogy between the invisible gene and the invisible spirit "(Prezent).

3. "The gene is an utter fiction, however much you, ComradeRapoport, may assert that it is a particle of matter. Theelectron microscope will not save you. You may see under anelectron microscope whatever minute particles you like, butthey will still be nothing but particles of a chromosome, andyou will never see a gene, for there is no such thing, no morethan there is a vital force " (Kostryukova).

4. Lysenko’s opening speech has been reviewed by R. B. Gold-schmidt (Science, 1949, 109, 219).

Chekmenev claimed :" Our science is the most advanced, most progressive

science in the world. This is because it is based on dialecticalmaterialism, on the scientific revolutionary theory ofMarx-Engels-Lenin-Stalin. The aim of the fruitful activityof our scientists is to serve the people, our Soviet State.Therein lies the enormous advantage possessed by ourscience over that of any capitalist State, where it servesthe mercenary interests of private profiteers, and is themeans of enriching the exploiting classes and oppressingthe working people.... There is no such thing as non-partisan science.... Michurin biology is a science based onParty principles and cannot permit of a conciliatoryattitude to reactionary biology."On the third day of the session Rapoport spoke for

genetics and pointed out that contending theories wereuseful for discovering the truth : " any restriction ofopportunity or excessive severity towards theory wouldhave been prejudicial to the interests of science." Heenumerated practical achievements based on the theoryof genes, and argued that Lysenko was inconsistent,because selection was incompatible with Larmarckism.Michurin had used selection in all his works and hadrepeatedly urged young scientists to study genetics ;Lenin had taught them that it was their duty toassimilate all that had been done abroad.On the fifth day of the session Zavadovsky said that

he was at variance with Lysenko on a number of points,but was " an ardent adherent of the Michurin trend."Alikhanian, the third speaker against Lysenko, pointedout that, if a scientist made reactionary statements, itdid not follow that any scientific fact discovered by himshould be discredited. The gene had objective reality ;it was a material unit in a living cell :

" The attacks on the view that genes exist remind me ofthe earlier denials of the existence of the atom. Though theatom itself has never been seen, no-one doubts its existence

today. So it is with the chromosome. There were scientistswho vigorously denied the reality of the chromosomes."

He quoted Lysenko’s writings in 1947 admitting thechromosome’s part in the transmission of heredity, andasked him :

" If, as you most properly put it, changes in the chromo-some produce changes in character, why then not investigatethe mechanism and the nature of the changes produced inthe chromosome so as to be able to control them ? Whyshould the statement of Lysenko that the various morpho-logical characters of a chromosome often, and even always,bring about changes in character’ be considered correct,while the conception of the heterogeneity of the chromo-some, the qualitative dissimilarity of its various parts,and of the significance of the chromosome numbers in thedevelopment of character (polyploidy) be denounced asdownright idealism by Mitin ?

"

To counterbalance the evidence of useful agriculturalvariations produced by the Michurinists, Alikhaniandescribed what the geneticists had done in the same way.Polyakov denied that Lysenko could cause what

variations he wished ; Lysenko could only alter theenvironment to enable organisms to flourish exceedingly,and then select from the resultant variations.

Zhukovsky also supported genetics, basing his argu-ment on the alternation of generations in plants and onthe reduction of chromosomes in animals, which could bewatched by microscopy. Kostryukova,3 he said, haddenied the existence of the gene because no-one had seenone ; but the existence of viruses was denied for a longtime, and now we could see them. Viruses propagatedwithout being alive and caused unusual phenomena inthe host’s cells. Catalysers also produced complexbiological phenomena. Therefore why could not thegene ? Zhukovsky challenged Lysenko to issue a com-prehensive manual on how to train plants to vary inaccordance with agricultural requirements.

_

On the eighth and last day of the session Lysenkorevealed that the Central Committee of the CommunistParty had approved his opening speech. The sessioncame to an end with recantations from Zhukovsky,Alikhanian, and Polyakov. But in his original speechAlikhanian had said : " One thing is clear : facts cannot

1020

be disregarded." And Rapoport had said : " Truthemerges from conflict."

Let us hope that it does. Meanwhile, if we feel anydoubts about genes we can study the photographsillustrating Darlington’s recent article on geneticparticles. 5 _________.

REMUNERATION OF MEDICAL LABORATORY

TECHNICIANS

ON April 20 the appropriate technical council of theWhitley Councils for the Health Services agreed tothe following salaries for medical laboratory techniciansemployed in the National Health Service in England,Wales, and Scotland.

Student and junior ec/MMcaN.—From £ 110 at 16 yearsof age to E299 at 25 years and over. On passing the inter-

5. Darlington, C. D. Endeavour, 1949, 8, 51.

mediate examination of the Institute of Medical LaboratoryTechnology (or equivalent qualification) or the Inter. B.so.,salary to be increased by :í:13 per annum at any point on thescale. If no examinations passed, salary to be increased to:í:312 at age 30.

Technicians (who must hold associateship of LM.L.T. or

equivalent).—370-Elo-S435. On gaining F.I.M.L.T. (orequivalent) salary to be increased by n5 at any point on thescale. -

Senior technician (who must hold F.I.M.L.T. or equivalentand be in charge of a laboratory or a separate department).-L450-:í:20-:í:530.

Chief technician (who must be in full charge of laboratoryservices, or a specialised laboratory of unusual size and

importance or a central reference or research laboratory).—E530-E20-650.

In the Metropolitan Police Area all scales will besubject to London weighting on the following basis:16-20, JE10 ; 21-25, ;E20 ; 26 and over, je30.

Reconstruction

SOCIAL MEDICINE IN THE UNIVERSITIES

THOMAS MCKEOWNM.D. Birm., D.Phil. Oxfd, Ph.D. McGillPROFESSOR OF SOCIAL MEDICINE IN THE

UNIVERSITY OF BIRMINGHAM

Two conferences on social medicine were arranged atOxford during April by the Nuffield Foundation, at therequest of the medical subcommittee of the UniversityGrants Committee, which " has had under considerationrecently the provision made in medical schools for

teaching and research in social medicine." No doubtit was the hope of its organisers, as well as of thoseattending, that the conferences would provide a state-ment of past achievement, or of plausible intention forthe future, which would satisfy a critical observer thatthe provisions already made in the universities are

justified and merit favourable consideration of theirextension. Moreover, the answer which the request ofthe University Grants Committee invited will laterhave to be given to many other people who take thepresent claims for social medicine on trust and reservejudgment on its future.Though no direct answer emerged at Oxford, the

conferences at least disposed of the confusion betweentwo common grounds for criticism which in part explainsthe ambiguity of much of recent comment on this subject.It is necessary to remind ourselves that, for many yearsbefore the first chair of social medicine was established,far-sighted people had hoped to see an increased emphasison social and preventive teaching in medicine. Theyhad anticipated that a few clinical teachers wouldinterest themselves, and that their interest would spreadto their colleagues. To a limited extent this has happened,and American clinicians, such as Means in medicine atHarvard, and Harvey in surgery at Yale, are examplesof such initiative which have their parallel in this country.We should recognise that this work proceeded in theorbit of clinical medicine, without assistance from

departments of preventive or social medicine.The creation of whole-time departments of social

medicine in several universities entirely changed the

position. Naturally these departments inherited respon-sibility for public-health teaching, to which inevitablywas added a special role in relation to the changedattitude to clinical teaching. But what we are now calledon to consider is not only whether clinicians can reason-ably be asked to extend the range of their interest butalso the grounds upon which an appeal can be madeto the universities for support for full-time departments.A satisfactory answer for the one will not do for the

other, and we may put these issues in perspective byconsidering more carefully the two lines of criticism towhich they give rise.

TWO CRITICISMS

The first is the criticism of the practising clinician,who considers that, however worthy the intentions ofhis colleagues, their preoccupation with the social back-ground of illness is mistaken. He does not question thatsometimes the social environment is related to the origin,development, or spread of illness, or that social com-

plications may result from illness ; nor does he questionthat these matters are so important that someone

must make it his business to deal with them. What hedoes question is the suggestion that it is his business,or that of a sufficient proportion of his students to

justify its inclusion in his teaching.It is important to distinguish this criticism from

the one which follows. The clinician who hesitates toraise the sights of his teaching is rarely passing a judg-ment on the claims of social medicine as an academic

department. He is usually quick to admit that he doesnot know what these claims are, and modestly reservesjudgment on them.The second criticism is that of the full-time university

teacher. The laboratory and the clinical research workersagree that no academic department fulfills its obligationsunless it contributes to research as well as to teaching.In their opinion, a subject which justifies the creationof chairs in many universities must demonstrate a fieldof inquiry with promise of a contribution to medicalknowledge which will not suffer by comparison withphysiology or medicine. It is in this light that theyexamine the claims of social medicine, and unlike theclinical teacher pass no judgment on its teaching.The first of these criticisms is entirely reasonable and

fully merits a considered reply. But from the point ofview of the full-time department it is the less serious ofthe two, and since it need not disturb the academic statusof social medicine it will not be discussed here. To putthe claim at its lowest, no-one questions that the tradi-tional public-health course still has a place in teaching,though to many people its solid if undramatic achievementmust recently appear to have taken on a greatdeal of water. Even if unchanged this course could

reasonably be considered the teaching complement ofa development justified by its fruitful research.The second criticism is more serious and requires an

immediate answer. It is difficult at this time for newdepartments, of which the oldest has been active foronly a few years, to show the published results whichwould be the best vindication of their claims. None theless, it is entirely reasonable to expect them to provide