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or stress. Dr. Wilson concludes that fatigue and foottrouble are—as might be expected-partly the outcomeof social factors. It is surely noteworthy and unexpected,however, that in the first group the main leisure activitywas reading ; in the second, more surburban, group themain interests were radio, reading, or the cinema. Inboth groups there were women who enjoyed communalactivities, such as those of the women’s institutes.These findings, suggestive rather than striking, might

well be followed up by wider surveys. There seems tobe good evidence that housewives neglect their ailments,forego some of their protein ration, and suffer-anyhowin the lower income-groups-from undue fatigue. Itcannot be that in every case they do these things because,as the men say when ringing pigs, they like it.

SYNCHROTRON AT THE ROYAL CANCERHOSPITAL

THE synchrotron, or to give it its correct name the

beta-synchrotron, which has now been installed in themedical physics department of the Royal Cancer Hospital,was inspected by senior officials from the Ministry ofHealth and others on July 5. With this device electronscan be accelerated to extremely high energies and cantherefore be used as a source of very penetrating Xradiation. The electrons are accelerated, not by allowingthem to move between electrodes across which a high-voltage difference is maintained, as with the usual

X-ray equipment, but by the action of a changingmagnetic field together with a special type of radio-

frequency oscillator. A beam of electrons is emittedfrom an " electron gun " inside an evacuated glass vesselheld between the poles of a large electro-magnet. Underthe action of the magnetic field the beam of electronsmoves in a circular orbit in the glass vessel, and as themagnetic field is increased and the radio-frequencyoscillator brought into action the electrons are acceleratedin their orbit. By careful design of the apparatus theelectrons may be made to move round the same circularorbit with increasing energy until they strike a targetand so produce X rays. An X-ray tube running at30 million volts would be required in order to produceX rays of the same penetration as those produced bythis synchrotron.

In the last few years it has become clear that progressin the radiation treatment of deep-seated cancer dependson being able to apply radiations of greater penetratingpower. When the first betatron was described by Kerstin the United States, it was realised that this instrumentheld great promise in the treatment of deep-seatedcancer, but that much work must be done before itcould be used with safety and precision. Now, for thefirst time, a synchrotron has been introduced into ahospital for full-time use. The apparatus installed atthe Royal Cancer Hospital is the first of two developedin this country for the Medical Research Council, whichhas borne the cost ; the second is now being installed inthe department of radiotherapeutics at the Universityof Cambridge. The -research work on these instrumentshas been done largely at the TelecommunicationsResearch Establishment, Great Malvern, which is now

part of the Atomic Energy Research Establishment ;the magnets and much of the electrical apparatus havebeen built by the English Electric Company, Stafford.The synchrotron at the Royal Cancer Hospital is

housed in a basement laboratory which is partly under-ground, so a large measure of very efficient naturalprotection is provided against the penetrating radiation.The magnet assembly from which the beam of X rayswill emerge is reasonably small, being a cylinder 4 ft. indiameter and 4 ft. high ; but there is a considerableamount of ancillary apparatus which is housed a shortdistance away. Protection of personnel is one of themain problems ; and members of the hospital’s physicsstaff have studied the subject on betatrons and similar

uev Ce8 ill Miieiica. oncio.e uiicxs in wans 5 it. tmcnhave been used as the main protection for the operator’sroom. Before the instrument can be used for clinicalwork, much physicial and biological investigation has tobe done with a view to measuring dosage and the distri-bution of the dose in the body. Owing to the particularcharacteristics of this very high energy radiation it willbe possible, using a single field, to give a dose severalcentimetres under the_skin several times as great as thatreceived by the skin, so skin tolerance should no longerbe a limiting factor in the treatment of deep-seatedneoplasms. Clearly, however, it will be necessary firstto learn precisely the distribution of dose in a mediumsimilar to the body, since otherwise great damage mightunwittingly be done in clinical use.The synchrotron provides no fundamentally new

method of treatment, but it is a technical developmentthat promises help in one of the most baffling conditionswith which medical science has to deal.

NERVE-ENDINGS OF THE NIPPLE

THE nipple, like a one-note man in an orchestra,appears unobtrusively, gets ready, and, having only asmall part to play, is hardly recognised to have a partat all. Nevertheless, the nipple is more than a passiveconnecting link. It is an organ with positive physiologicalactivity peculiar to itself. Cathcart and his colleagues 1in Glasgow have stimulated thought on the subject bydescribing nerve structures in the nipple and drawingattention to its profuse innervation, both somatic andsympathetic. The nerve-endings which they havedemonstrated by modern methods of staining conformin the main to the perceived sensory responses of thenipple. The foremost of these, pain, is presumablytransmitted by the free endings which abound. Lighttouch is not felt on the surface and no nerve-endingswere found of the types shown by Woollard and hisco-workers to be concerned in its perception. Morethan a light touch on the nipple is recognised either bythe deeper layers or by structures deep to the nipple.It is not surprising therefore that lamellated corpusclesof the Pacini type were only found behind the nipple.Heat and cold are keenly felt by the nipple ; Krauseend-bulbs were seen in it but no clearly recognisedRuffini endings to register warmth.There must also be sensory responses peculiar to the

nipple or to its adjacent tissues, though they are notclearly felt in consciousness. Their anatomical basis is .

still elusive and their separate existences uncertain.

Among these is the one evoking posterior pituitarysecretion, which leads in the full breast to the processrecognised as the draught. The sensory receptors forthis are thought to lie in or behind the nipple ratherthan within the mammary gland proper. Stimulationof the nipple itself or of the skin very near to it is

apparently the specific stimulus here, though secondarilythe reflex can become conditioned to many stimuli.Then there is the response to touch in the neighbourhoodof the nipple which produces contraction of smoothmuscle beneath the areola. This in turn makes thenipple stand out and the areola pucker. Although onemay latinise the description and speak of erection ofthe nipple the word gives a false idea of the process,which is akin to that which makes goose flesh anddoes not appear to be vascular in nature. The contractionof the areolar muscle makes a knob of a ilaccid nippleso that on contact the baby’s cheek feels the nipple.It also provides a device like a cherry on the end of awide soft stalk which the baby’s mouth can draw in.Next there must be some nervous response to sucklingwhich maintains the secretion of milk, for in animalssecretion fails after denervation unless maintained bvsuckling at another intact nipple. Despite the traditional

1. Cathcart, E. P., Gairus, F. W., Garven, H. S. D. Trans. roy.Soc. Edinb. 1948, 61, 699.

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view it probably does not arise from the fullness oremptiness of the mammary gland. How far this processwhich calls out the formation of milk is linked withthe posterior-pituitary evoking one is unknown.

There is some evidence of sphincter action within thehuman nipple and sphincteric tissue has been describedthere. Now Cathcart et al. report finding a new typeof neurofibrillar network, with an outline suggestingan oak leaf, ending in it. A comprehensive account ofthe histology of the nipple, which these workers hopesoon to give, should add considerably to our knowledgeof the responses to stimulation of the nipple, but it isessential that structural work of this kind should becorrelated wherever possible with function.

THE N.H.S.

FOR inquirers at home and abroad the Ministry ofHealth and the Central Office of Information have

produced a brief and readable account of the NationalHealth Service.1 This points out that the N.H.S. andthe related social interprises require " large resourceswhich can be made available only by the determinedefforts of a people paying its way by its work " ; but itargues that, considering everything, the service has atleast been launched with remarkable smoothness.

" All big social changes start with a certain amount ofuncertainty, until people get used to the new way of doingthings ; and this Service cannot be comprehensive in thefullest sense until the country is farther along the road toprosperity and a rising standard of life. The public has stillto learn how to use the new facilities properly and eco-nomically ; and those who are actually running the Servicehave to get used to new conditions and changing needs.But if the various professions really join forces with thelaymen in the organisation described in this booklet, theycan carry out a progressive new deal in medical care whichwill redound to the benefit of all."

As might be expected, much is made of the need tochange a state of affairs in which the hospitals wereowned by " some 2000 separate, and often jealous andconflicting, local public or voluntary authorities " :

" new

forms of organisation were required to rescue the healthof the people from what Lord Horder called the maze,the unwieldiness, the overlap, the uneconomy, the lackof integration of our health services.’ " On the otherhand, it is recognised that it would be wrong for medicalneeds to be met everywhere in the same way : " medicinethrives on experiment and comparison of different waysof doing things ; uniformity of method or belief is itsenemy."’ Those who hold that too much attention is

being paid to curative medicine may get some comfortfrom reading that the present expenditure on the N.H.S.(which amounts to about 2s. 6d. per head per week)" can be justified only on the basis that the essentialaim of the Service, and all who work in it, must be toprevent illness." Similarly, proper emphasis is laid onmedical care in the home as contrasted with care in

hospital: the pamphlet says that " for nearly everybodythe family doctor is the pivot of the whole scheme apartfrom dental treatment," and describes how fuller use ofthe home (or district) nurse, of home-help services, andof sickroom equipment provided by local authorities willprevent unnecessary admissions to hospital.At a time when capital expenditure must be kept to

a minimum, and only the most urgent schemes for theextension or repair of hospitals can be permitted, thebuilding of comprehensive health centres " on anyscale " is considered impossible. We are also told once

again that " more study is also needed of the kinds ofcentres most worth trying out before any large-scaleexperiments are launched." However, it is encouragingto hear that " the building and testing of health centresin action, in different forms and circumstances, in largetowns and small, in suburbs and country areas, is a task

1. H.M Stationery Office. 1949. Pp. 36. 6d.

for the next few years." This leads up to the strikingunderstatement that " during that time a great many,perhaps most, family doctors will continue to practiseoutside health centres." Similarly irritating is theremark that in the old days " the family doctor, workingsingle-handed or in a small partnership, usually had toomuch to do because he had too many patients, insufficienthelp, and insufficient equipment, and he was unableexcept with great difficulty to keep up to date or to enjoyreasonable leisure." Little attempt is made to explainhow the coming of the N.H.S. has improved the con.ditions for general practice or arrested their deterioration,The pamphlet does not go far below the surface, and

the light in which it describes the N.H.S. is naturallyrosy. Nevertheless, like the Ministry, we hope that itwill be read by

" those who are workers in the Service,without whose understanding and whole-hearted effort itcannot succeed." Any description of the service whichbrings us back to its main objects is useful at the presenttime, reminding us that more is at stake than termsof service.

A FIVE-YEAR PLAN

Six years ago Lord Nuffield endowed .the NuffieldFoundation with £ 10 million and urged them to get onwith the job of promoting the health and well-being ofmankind. The first year was spent quietly makingplans, and by the end of their first active quinquenniumfrom their total income of -E2/ million the foundationhave given away ;E2/ million in grants. To give usefullyis a responsible and exacting task, but the foundationhave known how to be at once discriminating and bold,and their grants range from £100,000 for the Universityof London’s chair of child health to E1500 to enable theMedical Research Society to purchase Clinical Science inmemory of Sir Thomas Lewis.

In their fourth report 1 the foundation, besides givingan account of their stewardship, also deal with theirplans for the future. In continuing to further the healthand well-being of mankind they hope to help in thediscovery of new knowledge especially in biology andsocial studies-sciences which they feel have been latelysomewhat overshadowed by the more fashionable physicsand economics. They are also anxious to encourage theapplication of existing knowledge to everyday things,especially by joint effort, among groups of experts.Through the National Corporation for the Care of OldPeople the foundation look forward to continuing theirwork on behalf of the old, especially the arrangementsfor the care of the semi-sick who at present tend to beneglected because of the gap between the hospitalauthorities and the local authorities. From their ownresources and as trustees of the Oliver Bird Fund theywill also continue to support research into chronicrheumatism.

In the last twenty years research has become increas-ingly expensive. Today the man in the small semi-private laboratory is at best grievously handicapped.To achieve his utmost he may need access to facilitieswhich can only be provided by the Government, a univer-sity, or a large commercial firm. But this does notmean that the private patron should go out of business.As the foundation point out, he has the urgent task ofseeing that " creative minorities " get a first hearingand a chance of wider support. In their budget forthe next five years the foundation have therefore once’more made provisions for fellowships and training grantswhich will help the unique individual and projectto get their chance.

Prof. HILDA LLOYD has been elected president of theRoyal College of Obstetricians and Gynaecologists insuccession to Sir William Gilliatt. She will assume

office in October.

1. Obtainable from 12, Mecklenburgh Square, London, W.C.1.