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further increase difficulties of women in some parts ofthe country in obtaining an abortion with the NHS".

In view of the powerful medical opposition andthe lack of support amongst the general public (ina recent survey, only 18% of women of childbear-ing age felt that abortion was morally wrong and84% felt that single women who choose to haveabortions had the right to make such a decision),2how is it that such restrictive legislation continuesto make progress in Parliament? It is because

repeated Bills have been presented, not as plans tomake abortion illegal and difficult, but as measuresto correct "abuses" in the working of the 1967 Act.In an attempt to make a positive contributionDame JOSEPHINE BARNES wrote3 on May 30, onbehalf of the 2000-strong Doctors in Defence of the1967 Abortion Act, to the Secretary of State, MrDAVID ENNALS, and Mr ENNALS’s reply was re-markably full. As regards abuses the Minister sup-ported the Joint Consultants’ Committee who hadattacked the Benyon Bill as "attempting to dealwith a problem that has ceased to exist".4 In fact,the Minister said, "grave abuse of the Abortion Act... has been eliminated". He also said that "far toolittle attention has been paid to the improvementsthat have been made to the working of the Act".Mr ENNALS made it clear that he, and presumablyhis officials at the D.H.S.S., thoroughly opposedthe Benyon Bill, and he pointed out the effectivepowers that the Department were already exercis-ing, under current legislation (since 1969, 19 nurs-ing homes have had approval withdrawn and 23agencies have been black-listed).The major failing in the implementation of the

Abortion Act has been recognised by the SelectCommittee itself-namely, the extreme regionalvariations in the availability of abortion under theNational Health Service. The Benyon Bill will donothing to help women in Birmingham and Liver-pool. In such places, where the work of theNational Health Service has to be supplemented bynon-profit-making charities, these same charitiesare the main likely victims of the Bill. Doctors whowere in practice in 1967 will remember the profes-sion’s lack of enthusiasm about the prospect of

legalised abortion. But many of the doctors nowmost energetic in defence of the Act were amongstthe majority who originally expressed strong reser-vations : nine years’ experience of the working ofthe Abortion Act has convinced them that thismeasure relieves their patients of much suffering.Practical experience of the Act, coupled with readi-ness to face facts as they exist, and not as onewould wish them to exist, has resulted in a remark-

2. Part 2 of a survey on "Sex and the single British girl" published in the June,1977, issue of Honey, as a result of a survey conducted for them by theSchlackman Research Organisation.

3. Letter to Mr David Ennals from Dame Josephine Barnes on behalf of theDoctors in Defence of the 1967 Abortion Act, May 30, 1977.

4. Letter from Mr David Ennals to Dame Josephine Barnes, June 18, 1977.

able shift of opinion. The medical profession,which very largely opposed the original 1967 Abor-tion Act, now speaks with an almost united voicein its defence. Unfortunately, Members of Parlia-ment have not yet shared in this conversion.

OX EYES AND IMMUNOSURVEILLANCE

SOME years ago, Prehn’ remarked on the cyclic popu-larity of the notion of immunosurveillance againsttumours in man. At present a period of euphoric beliefin the notion is giving way to disenchantment. Themagical cytotoxic T lymphocyte and its side-kick thekiller K cell are losing ground to the macrophage, whoseactivities against tumour cells are envisaged as largelynon-specific and therefore not immunological. Im-

munotherapy with agents such as B.c.G. alive and Cor-ynebacterium parvum dead still has its enthusiastic

adherents, but the rationale for their use is increasinglyto stimulate the phagocytes rather than to provoke aspecific antitumour immune response. Levamisole is

employed in cancer because it is believed to vitalise aweakened anti-tumour immune response but the evi-dence in relation to autochthonous tumours is not com-

pelling. The increased tumour incidence associated withvarious congenital or acquired immunodeficiencies iswithout doubt a consistent observation but the interpre-tation that it results solely from relaxation of immuno-surveillance is now regarded with more doubt. Thus weare passing through a phase of perplexity such as isfamiliar to the academic biologist but which can be verygalling to the more pragmatic clinician who wishesto base his fight against cancer on a firm theoreticalfoundation.The sleeper in this business could be the oncogenic

viruses. In laboratory and domestic animals viral associ-ation or viral aetiology has been proven for a wide var-iety of tumours. This is not to say that there is any greatvirtue in the notion of a virus as the one and only causeof a particular tumour, but some tumours indubitablyexhibit antigenic surface characteristics which are codedfor by their contained viruses. It would be most surpris-ing if this were not so in man. All we need is the evi-dence. The situation is rather like that foreseen byGauss, who said, "I have had my results for some time:all I need to know is how to arrive at them". In cats ithas proved possible, on the basis of a knowledge of theexistence of leukaemogenic viruses, prophylactically3 ortherapeutically4 to vaccinate against leukaemias. Simi-larly, Marek’s disease in chickens has been prevented byvaccination with an attenuated virus.’ The argumentcontinues, and a paper on successful treatment of ocularsquamous-cell carcinomas in cattle6 adds grist to themill.

van Kampen and his colleagues in 1973 reported that

1. Prehn, R. T. in Immune Surveillance (edited by R. T. Smith and M. Landy);p. 462. New York, 1970.

2. Amery, W. K. Cancer Treatment Reps, 1976, 60, 217.3. Jarrett, W., et al. Int. J. Cancer, 1975, 16, 134.4. de Noronha, F., et al. Nature, 1977, 267, 54.5. Biggs, P. M. Br. J. Cancer 1975, 31, suppl. 2, p. 152.6. Spradbrow, P. B., Wilson, B. E., Hoffman, D., Kelly, W. R., Francis, J. Vet.

Rec. 1977, 100, 376.7. van Kampen, K. R., Crop, W. E., et al. Am J. Obstet. Gynec. 1973, 4, 569.

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one intramuscular injection in cattle of a saline extractof a fresh ocular carcinoma into an animal bearing anocular carcinoma could lead to regression of the tumour.Spradbrow and his colleagues6 now present a more

extensive series of results which confirm and extend thisearlier finding. 39 of 46 eye tumours in 36 Hereford cat-tle and one Jersey regressed, and in a few instances dis-appeared, after a single intramuscular injection of aphenol extract of comparable tumours. The regressionwas associated with massive infiltration with large lym-phocytes, plasma cells, and macrophages, and Spadbrowet al. assume that they have been practising immuno-therapy. There are snags recorded. In several animalsgiven multiple rather than single injections tumourgrowth was enhanced, not diminished. In one or twocattle which had bilateral tumours of disparate size thesmaller tumour regressed but not the larger. Onetumour regressed spontaneously. No evidence is offeredof the existence of the cytotoxic antibodies or lympho-cytes which seem to delight the hearts of immunologists.No evidence is offered of the effect of rechallenge withtumour after successful treatment with extract. Theobvious trick of using injection of extracts as an adjunctto surgery does not seem to have been tried. The infer-ence is that all tumours are similar, since the principalextract injected was derived from a pool of tumours. Ifthese results are reproducible, they may indicate a viralaetiology. For all these questions which are so far unan-swered, the success of the treatment is a happy finding.But the gap between these experiments and those pos-sible in man remains considerable. Firstly, the Herefordcow in Australia may be a special case, with no humanparallel. Sunlight was probably an aEtiological factor inthe induction of the tumours in the eye as it is in certainhuman squamous-cell carcinomas of the skin (but notthe eye). Secondly, the disease is common in cattle. His-topathologically comparable tumours in man are morerare-thus, those that do occur may have a differentaEtiology. However, in man basal-cell carcinoma of theskin is curable and keratoacanthoma, which can histo-pathologically be confused with frank carcinoma, oftenregresses spontaneously. So perhaps these eye lesions inHereford cattle do have something to tell us not onlyabout how to treat cancer but also about immunosur-veillance.

ALCOHOL AND HYPERTENSION

Two papers from Glasgow p. 111 and p. 114 suggestthat tests of hepatocellular function are disturbed in asubstantial proportion of hypertensives and that alcoholabuse may be responsible. In isolation, these observa-tions could have several explanations. However, it is

becoming apparent that there is a link between alcoholingestion and hypertension which may be of both theor-etical and practical interest. Klatsky et al.I investigatedthe drinking habits of 83 947 subjects by questionnaire.Both systolic and diastolic pressures were higher in thosewho drank alcoholic beverages and, in general, the

height of both pressures was related to the number of

1. Klatsky, A. L., Friedman, G. D., Siegelaub, A. B., Gerard, M. J. New Engl.J. Med. 1977, 296, 1194.

alcoholic drinks consumed. The first anxiety about suchstudies is that the consumption of alcohol might reflectsome other factor which is more directly related to

raised blood-pressure. For instance, if excessive alcoholintake were associated with obesity this might explainthe observed relationship. However, when subjects inthe Californian study were grouped according to theiradiposity the relationship between blood-pressure anddrinking was also independent of age, sex, race, smok-ing, coffee consumption, and educational attainment: inview of the last observation, it seems unlikely that theupper social classes drank more and were also predis-posed to high blood-pressure. Indeed blood-pressuretended to be lower in college-educated subjects. TheFramingham study2 also recorded a significant relation-ship between alcohol intake and systolic pressure, and inanother study hypertension was 2.3 times greater inproblem drinkers than in matched controls. In addition,the Registrar General’s occupational mortality figuresshow that the highest death-rates from hypertension andstroke occur in those socio-economic groups which havethe highest death-rate from cirrhosis of the liver.4

It is still possible that some overlooked factoraccounts for this association, although this seems de-creasingly likely. In addition, the evidence from morta-lity data and hypertension clinics suggests that theraised blood-pressure is a sustained phenomenon ofclinical importance rather than an acute effect of alcoholingestion. Whilst the Glasgow studies are concernedwith liver dysfunction, the Californian work shows thata blood-pressure rise occurs with the intake of alcohol inquantities well short of that which would be expected tocause liver disease: it seems therefore that liver damageis not an essential prerequisite and this makes alcohol’in-duced hypercorticism (mentioned by Dr Ramsay on p.114) an unlikely mechanism. The Californian workersinvoke an old concept which is having something of anew life-"stress". They wonder whether stress is res-ponsible in their subjects for both increased alcohol in-take and raised blood-pressure. Perhaps we could takethis further: could the distinct personality characteris-tics that have been described in some hypertensive indi-viduals5 also predispose to alcohol ingestion? As weremarked a few weeks ago6 students of hypertension,usually trained in the "hard" sciences, are havingtoventure on unfamiliar waters.

HYPOPHOSPHATÆMIA

IN critically ill patients the manifestations of meta-bolic abnormalities are easily misascribed to other fac-tors such as sepsis. One has to be continually aware ofthe possibility of mineral and vitamin deficiencies insuch patients, so that the appropriate tests are done

promptly and the deficiencies forestalled or made good.Hypophosphatxmia in its most severe and acute form iscommon in patients being fed intravenously with con-centrated dextrose solutions, especially in those who are

2. Kannel, W. B., Sorlie, P. Hypertension in Framingham: Epidemiology andControl of Hypertension (edited by O. Paul); p. 553. New York, 1974.

3. D’Alonzo, C. A., Pell, S. J. occup. Med. 1968, 10, 344.4. Mathews, J. D. Clin. Sci. mol. Med. 1976, 51, 661s.5. Esler, M., Julius, S., Zweifler, A., Randall, O., Harburg, E., Gardiner, H.,

de Quattro, V. New Engl. J. Med. 1977, 296, 405.6. Lancet, 1977, i, 1088.