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cult and unsatisfactory home backgrounds. Quite apartfrom the question of how well the schools could cope withsuch boys and girls-without undergoing a sea-change-there is the obvious question of how desirable it would beto concentrate them in large numbers as State-supportedpupils in fee-paying schools.As for the broader academic range which the Com-

mission expects integrating schools to accept, here againthe difficulties bristle. The schools are for the most parttoo small to be comprehensive. So the Commission com-promised by saying they should be semi-comprehensiveand take pupils capable of attempting the Certificate ofSecondary Education if they cannot manage G.c.E. at 0level. This would mean going down a little below the

half-way mark. But while this would neither satisfy thefull-blooded comprehensive-school believers, nor yet theleading public schools which are selective grammarschools with large and powerful sixth forms, it managesto combine some of the worst of both worlds. If half the

places are taken over for non-fee-payers, the remainderof the places which are still offered to fee-payers mightbe expected to become more selective than ever. Becauseof the increase of fees caused by the proposed fiscal

changes, the fee-payers will be more restricted than everto the well-to-do classes. As the Commission admits, aschool in which the non-fee-payers included all the lessable as well as the less rich, while the fee-payers werericher and brighter than ever, would be a disaster andanything but integrated.For the rest, the Commission has humane things to

say about the internal organisation of schools-againstbeating by boys, fagging, authoritarian discipline; infavour of weekly boarding, co-education, social service.But the general impression which Sir John Newsom andhis colleagues convey is of reasonable people who foundthemselves pushed further and further into a doctrinairecul-de-sac. This is certainly not the last word about thepublic schools and independent education.

BIOMEDICAL RESEARCH AND THE M.R.C.

THE Medical Research Council’s report for 1967-68 1

notes, among other events, the imminent closing of SirHarold Himsworth’s long and fruitful secretaryship. Itincludes a message from him on Future Trends in Bio-medical Research, written for the Council for ScientificPolicy. Therein, he foresees a continuing move towardsmore research in basic biology; and he points out how theM.R.C. is spending its money in a way that reflects thischange in emphasis. Six years ago, the Council spent El 1on the evaluation of normal function for every El it gaveto direct investigations on sick people: today the ratio isabout 3: 2. But biomedical research, to realise its promise,needs to be assured of more resources: " in respect ofmanpower the biomedical field will be relatively wellplaced ", but Sir Harold is less confident about financialsupport.The Council set up four new units during the year and

agreed to two more, balancing the six units which havebeen disbanded. Notably, Oxbridge’s two gains, immuno-chemistry (Prof. R. R. Porter) and molecular pharmacology(Prof. A. S. V. Burgen), accord with a basic-sciences1. Medical Research Council Annual Report 1967-68. H.M. Stationery

Office, 1968. Pp. 356. 31s. The 75-page section on Some Aspects ofMedical Research will be published as a separate booklet.

research policy. Expenditure on research groups, at

E481,000, was E22.000 less than for 1966-67, but this is anatural result of the principle on which this ten-year-oldscheme is operated. Successful projects were alwaysintended to be taken over by the host university, and 1967fitted in well with the University Grants Committeequinquennium. During the year seventeen groups weretransferred, and this was accompanied by a correspondingreduction in the grant-in-aid. The M.R.C. has always setgreat store by its short-term research-grants scheme but,surprisingly perhaps, the number and value of applicationsfor these grants is declining, though the number of grant-holders (1210 in 1967-68) seems buoyant, for the timebeing at least. Fund-hungry research-workers might liketo know how the future of this system is envisaged. Ifthis falling-off in interest proves permanent, does theCouncil intend to lower its standards to keep the numbersup or, more likely, go on applying high standards to adwindling number of applications-or even re-examinethe whole idea ?

HÆMOLYTIC-URÆMIC SYNDROME

EARLY reports of the association of haemolytic anaemiawith acute renal disease came from Hensley and Dacieet al.2, and the title hamolytisch-uramische Syndromewas proposed by Gasser et awl. Many further cases havesince been described and they have lately been reviewedby Dacie.4 The syndrome arises in three main forms: anacute illness affecting infants and young children; anillness with more diverse clinical features, mainly affect-ing adults; and as a feature of some cases of rapidly pro-gressing malignant hypertension or renal failure associatedwith childbirth. The association is commoner in children

(particularly infants) than in adults. In all three forms theperipheral blood changes are similar: the characteristicburr cells were first described by Schwartz and Motto 5as

" a peculiar red cell measuring 7’5[L or less in diameter

and having one or more large spiny projections along itsperiphery ". These cells are associated with triangularcells termed pyknocytes by Tuffy et al.,6 the whole appear-ance being likened to red-cell fragmentation (schisto-cytosis). Thrombocytopenia often accompanies the

haemolytic anaemia. Fragmentation of red cells with vary-ing degrees of haemolytic ansemia and sometimes thrombo-cytopenia may occur unassociated with renal disease,particularly in vascular disorders such as haemangioma,in structural abnormalities of the heart, and after cardiacsurgery. Including these cases, the whole syndrome hasbeen called microangiopathic haemolytic anxmia.The renal lesions in the haemolytic-uraemic syndrome

are varied, but Shinton et al.’ found that thrombi in theglomerular tufts and areas of cortical necrosis were

common. Fibrinoid necrosis and intraluminal thrombi aresometimes seen in the afferent arterioles. In children thevascular changes are usually confined to the kidney, butin adults they are not unusual in other organs, particularly1. Hensley, W. J. Aust. Ann. Med. 1952, 1, 180.2. Dacie, J. V., Mollison, P. L., Richardson, N., Selwyn, J. G., Shapiro, L.

Q. Jl Med. 1953, 22, 79.3. Gasser, C., Gautier, E., Steck, A., Siebenmann, R. E., Oechslin, R.

Schweiz. med. Wschr. 1955, 85, 905.4. Dacie, J. V. The Hæmolytic Anæmias, part III. London, 1967.5. Schwartz, S. O., Motto, S. A. Am. J. med. Sci. 1949, 218, 563.6. Tuffy, P., Brown, A. K., Zuelzer, W. W. Am. J. Dis. Child. 1959, 98,

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7. Shinton, N. K., Galpine, J. F., Kendall, A. C., Williams, H. P.Archs Dis. Childh. 1964, 39, 455.