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devoted to their mentally handicapped children. They knowthat these children have potentialities not perhaps fully appre-ciated by the general public.As time goes on it is being proved that mentally handi-

capped children, including mongols, have a future in thisworld. Most assuredly they can play some part in the lifeof the community. Evidence of this is to be found in thesociety’s voluntary centres for all ages, and in our workcentre for the mentally handicapped over-16s, where out-side contract work is being done and the girls and boysare receiving payment (though small) for doing a usefuljob of work.People must learn to appreciate the fact that the birth

of a mentally handicapped child into a family, tragicthough it is, does not mean the end of their world-thereis a future. We say tell the parents as soon as you know

definitely, but take time to explain the points mentionedin my letter of Jan. 20. We feel that doctors will agreewith thiq !If’ntimf’nt

T. A. FORTUNEChairman,

Scottish Society for Mentally Handicapped Children.Glasgow.

DRUGS FROM ABROAD

G. F. TROBRIDGEN. P. W. LITTLER.

Hawkmoor Chest Hospital,Bovey Tracey, Devon.

Sin,—Now that we have exhausted our stocks ofreliable antibiotics and other drugs, we find that ourpatients are being given imported drugs in accordancewith Ministry of Health directive.We have no knowledge of the firms supplying these drugs and

therefore no means of judging the reliability of the productsthey supply. Have they the means, as have the reputable Britishpharmaceutical companies, of controlling quality and potency ofproduct and, when new toxic effects are noted, of helping thepractitioner ?This is surely the beginning of the end for the British

pharmaceutical industry, since no managing director will beprepared to put money into developing new products only tohave them stolen from him just as they are beginning to pay.Having stifled pharmaceutical progress how is medicine to

progress ?We feel this fundamental change in policy has come without

its full implications being realised. Is it still too late to recoverthe situation ?

CRISIS IN NURSING

P. D. NUTTALL.

SiR,—The fears that " many (hospitals) will be freed touse nursing auxiliaries instead, and stop training studentnurses " is a reality that may be closer than Dr. RitchieRussell (Feb. 17) thinks. In England and Wales there are54,000 student nurses (whose numbers are decreasing)and 50,000 nursing auxiliaries (whose numbers are

rising).The lines of demarcation between the work of nursing

auxiliaries, enrolled nurses, and student nurses are soblurred that the only fact that emerges clearly is theoverall responsibility, both clinical and administrative,of the trained nurses in charge of wards.

It is imperative that the army of untrained workers be givena short in-service training course; for, although these womenmay be excellent material for training for the Roll, the pastprejudice of both nursing and medical professions against" assistant " nurses, together with the economic policy of theNurses and Midwives Whitley Council, has prevented themfrom taking this training. " The pupil nurse must wait forseven years to catch up with the nursing auxiliary who oftendoes quite complicated nursing " (Times, Feb. 1). Thiseconomic disincentive should be rectified at once.

Nursing is unlikely to obtain more than its present share ofschool-leavers (and probably even less with the ImmigrationBill) and so it becomes even more imperative that those who dobecome student nurses should go on to registration. There willbe plenty of posts of ward managerial responsibility in Mr.Powell’s new hospitals.The British nursing system must remain rooted in apprentice-

ship-but must this method be administered as inefficiently asit is at present, when 40 out of 100 fail to qualify ? We needfewer student nurses, of a higher calibre, and in-service trainingfor the army of untrained auxiliaries. We urgently need anincrease in the tiny numbers of enrolled nurses.

I entirely agree with Dr. Ritchie Russell that we need farmore experimentation in training schemes-but this is not atask for the Royal College of Nursing.

Nursing is basically simple, consisting of the trained execu-tion of a number of humble tasks with compassion. Ward

management needs additional skills.Goodmayes, P D NEssex. P. D. NUTTALL.

LOSS OF TISSUE-SPECIFIC AUTOANTIGENSIN THYROID TUMOURS

SIR,-With reference to the paper by Dr. Goudie andDr. McCallum (Feb. 17) I should like to mention that,although it is perhaps inadvisable to include necropsytissue in this type of experiment, their results agree withthe evidence presented elsewhere that the cytotoxicfactor is a circulating autoantibody which is closelyassociated if not identical with humoral thyroid-specificcomplement-fixing antigen. I

The most interesting feature in their paper, however, istheir interpretation of the known variation in antigenic contentof thyroid glands showing different pathological changes. Thepoor concentration of autoantigen in non-toxic adenomata andin carcinomata, together with the observation that an adenomawithout significant round-cell infiltration may occur in themidst of an otherwise typical Hashimoto goitre, are believedto be " remarkably consistent with the simple immunologicaltheory of loss of tissue-specific autoantigen in tumour

formation " as proposed by Green.2 However, there is surelyanother equally acceptable explanation for these findings, andit is founded on the observation of Trotter and Belyavin 3 thatthe thyroidal content of complement-fixing antigen is pro-portional to the functional state of the tissue. There is a

similar correlation between the susceptibility of trypsinisedthyroid cells to the action of cytotoxic factor and the functionalstate of the tissue of origin.l Thus the cells of hyperplasticthyroid tissue (whether the hyperplasia is generalised through-out the gland or localised in a toxic adenoma) are rich in theircontent of intracellular antigen, while the cells of hypo-functioning tissue such as may be found in a non-toxic adenomaor in a thyroid carcinoma have little or none of this antigen.It therefore seems that the lack of antigen in the thyroidtumours studied by Goudie and McCallum could be merelya reflection of the impaired function of these tumours and maynot necessarily be of primary importance in their pathogenesis.The occurrence of colloid adenomata in the centre of other-

wise typical Hashimoto’s disease can likewise be readilyexplained without reference to Green’s hypothesis bymaking the assumption that Hashimoto’s disease may be

superimposed upon a previously normal gland or upon onethat has been the site of some earlier lesion. A preliminaryelectronmicroscopic study of Hashimoto’s disease has shownthat the infiltrating lymphocytes (presumably carrying cell-bound antibody) come into very intimate contact with thethyroid epithelial cells and that the morphology of theseepithelial cells is such as to suggest that they possess a very1. Irvine, W. J. 2nd Clark Fellowship Lecture, Edinburgh, 1961 (to be

published).2. Green, H. N. Brit. med. J. 1954, ii, 1374.3. Trotter, W. R., Belyavin, G. in Advances in Thyroid Research; p. 138.

Oxford, 1961.