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pregnancy and lactation. A genetic predisposition to low levelsof certain antibodies in the mother would be reflected by lowlevels in the fetus and neonate, thus weakening the first line ofimmunological defence to infection or hypersensitivity in theinfant respiratory tract. This notion is supported by the in-creased frequency of S.LD.S. in bottle-fed babies and by thepeak incidence ofs.LD.s. at 3-6 months ofage.7

Tissue Typing Laboratory,Royal Melbourne Hospital,and Department of Surgery,University of Melbourne,Victoria 3050, Australia B. D. TAIT

Pathology Department,Royal Childrens’ Hospital,Melbourne A. L. WILLIAMS

Department of Medicine,University of Melbourne J. D. MATHEWS

Hæmatology Department,Royal Melbourne Hospital D. C. COWLING

HLA AND MYCOSIS FUNGOIDES

SIR,-We have determined the HLA antigens of 15 patientswith histologically proven mycosis fungoides. This condition isconsidered to be a slowly evolving T-cell neoplasm’ with

mainly cutaneous involvement. Our patients were in the earlystage of the disease with lesions of the plaque variety. Therewere 7 males and 8 females, with a mean age of 56 years.

Tissue typing was done by microcytotoxicity on peripheral-blood lymphocytes, using a panel of 92 antisera and a modifi-cation of the method of Kissmeyer-Nielsen and Kjerbye.2 3 The

following HLA antigens were sought: of the A series, 1, 2, 3,9,10,11, 28, 29, W25, W16, W30, W31, and W32, and of theB series, 5, 7, 8, 12, 13, 14, 18, 27, W15, W16, W17, W21,W22, W35, W37, and W40. For most specificities, at least twoantisera were used, and for many, three or more were used.The control population consisted of 342 random healthy indi-viduals from the same region of the west of Scotland as thepatients. ,

Disturbances of expected HLA antigen frequency were

observed:

HLA Patients (15) Controls (342)(%) (%)

Al S3.3 40.3A29 6.6 4.6AW30 6-6 2.8AW31 20 3.4AW32 20 4.1 1

"AW19"* 53.3 11.9B8 46.6 30.7

*Includes A29, W30, W31, and Us’32.

The high frequency of B8, in association with Al and otherfirst-series antigens was striking. In addition we noticed a veryunusual increase in the antigens of the "W19" group ofA-series antigens (A29, AW30, AW31, and AW32). Theexpected increase in Al with raised frequency of B8 (due tolinkage disequilibrium) is also present.These observations correlate with findings in other disease

states in which T-cell function is believed to be abnormal (e.g.,myasthenia gravis4 5). The abnormally high frequency of W19specificities is not due to an association with B8 in these

patients, and remains unexplained. We intend to extend ourstudies to a larger group of patients, doing more detailed

1. Lutzner, M., Edelson, R., Shein, T., Green, I., Kirkpatrick, C., Ahmed, A.Ann. intern. Med 1975, 83, 534.

2 Kissmeyer-Nielsen, F., Kjerbye, K. E. in Histocompatibility Testing 1967, p.381. Copenhagen, 1967.

3. Dick, H. M., Crichton, W B., Ferguson-Smith, M A, Izatt, M. M. in Histo-compatibility Testing 1972; p. 63. Copenhagen, 1972.

4. Behan, P O., Simpson, J. A., Dick, H. Lancet, 1973, ii, 1033, 1220.5. Simpson, J. A. Ann. N. Y. Acad Sci. 1966, 135, 506

analysis of the expression of other cell-surface antigens, includ-ing possible immune-associated antigens. In addition we intendto correlate these observations with the reported low levels ofcirculating E and EAC rosette-forming cells in mycosis fun-goides, and with the finding of a subgroup of patients withraised levels of IgE.b6 7

University Department of Dermatology,Western Infirmary,Glasgow RONA MACKIE

University Department of Bacteriology,Royal Infirmary,Glasgow HEATHER M. DICK

University Department of Bacteriology andImmunology,Western Infirmary,Glasgow MARIA B. DE SOUSA

A PROFESSOR EMIGRATES

SIR,-My chief mentor, the late Sir James Learmonth, usedto say that to prolong a correspondence in the columns of evensuch a journal as The Lancet did harm rather than good. How-ever, Professor Brumfitt and his colleagues (May 15, p. 1072)make such a cogent case and throw out such a direct challengethat I can easily rationalise away any reluctance and reply. Indoing so, and in case I am regarded as indulging in specialpleading, may I say that I share their financial state both pro-fessionally and personally; particularly in regard to the second,I am still at the same lowly merit level as they are, havingfailed to advance from where I was thirteen years ago when Ileft this country to hold a chair in Australia.What I was trying to say by my remark that we should be

"in there pitching" had no relation to salaries or conditions ofservice. Money, as one of my favourite novelists has said, is noteverything, but it buys nearly everything. Unfortunately, it isthe second clause in that aphorism that seems to have come todominate nearly all our thinking. Nevertheless, those of uswho took up academic medicine must have felt that other

things were more important than gold. Though these are in-deed hard times for us all, we cannot deny that we are still ator very near the top of the salary bracket of all professionalworkers. True, we as academics have through a combinationof self-neglect and maladroitness fallen behind relative to ourpeers (e.g., the Civil Service); but this does not detract fromthe fact that we are still comparatively well placed. What is farmore important is that if one chooses an academic career onemust face the fact that one is expected to do everything one’snon-academic colleagues do and much more besides for the samesalary, as Professor Brumfitt and his colleagues have indi-cated. This is the academic’s doom, but of course with it comecertain advantages which I need not detail but which are oftenpointed out to us by our N.H.S. counterparts.

No, what I meant was that those whose commitment was toacademic medicine in its broadest sense are still in a positionto give some leadership; one direction that this can take in ourincreasingly materialistic world is leadership in values. Cur-rently all debate seems to be centred on terms and conditionsof service rather than the quality-and, it should be added,the quantity-of service that should be provided. What I ampleading for is that academic clinicians should put quality firstand use their potential influence and undoubted intellectualpowers to this end rather than join the majority in primarilydeploring the circumstances in which we find ourselves. Profes-sor Brumfitt and his colleagues may find this hopelessly out-dated idealism but I sincerely believe that, unless we are pre-pared to provide much more of the lead in ideas and, almost

6 Zachiariae, H., Ellegaard, J, Grunnet, T., Søgaard, H., Thulin, H. Actadern-vener. Stockh 1975, 55, 466.

7. MacKie, R., Sless, F. R , Cochran, R., de Sousa, M. Br J. Derm 1976, 96,173.

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as importantly, in terms of self-confidence within the profes-sion, then the N.H.S. really is beyond recall.

Surgical Unit,St Mary’s Hospital,London W2 HUGH DUDLEY

SIR,—White I have considerable sympathy for ProfessorBrumfitt and his colleagues who have decided to stay with onlyone C-grade merit award between them and indeed for myselfwith my salary increments frozen halfway up the consultantscale, I find a total inability to make my way through theadministrative maze far more oppressive.The structure which now runs (down) the Health Service is

such that there are infinite possibilities for complete inaction.The only policy decisions ever made are nebulous ones such asthe improvement of geriatric or mental health services. Thesein no way make any contribution towards an improvement ofgeriatric or mental health services, but they do provideammunition for refusals to make any other improvements. Allpractical decisions are left either to our administrators or todoctors in committee. The administrative game of endlessbuck-passing from district to area to region, up, down, andsideways is so sickeningly familiar that the heart fails at thethought of it, but when we ourselves are organised into com-mittees we become equally useless. We set up subcommitteesand working-parties to look into problems and make impos-sible decisions about medical priorities, and when the most per-suasive speaker has eventually won the day our recommenda-tions pass back through the committee to the administratorswho tell us there are no funds available anyway.

As a profession we are being sidetracked into a fight aboutthe wrong issues. The response to the B.M.A. questionnaireshowed that most consultants are not sufficiently concerned totake a stand about private practice in the Health Service.

Although our salaries are ludicrously small when comparedwith those of doctors in other countries, so are most profes-sional salaries. We now live in a poor country. While we grum-ble about these things, the cuts in Government spending on theHealth Service are leading to a rapid deterioration in all

aspects of patient care. The only way that savings could use-fully be made in the Health Service is by rationalising half theadministration out of existence. For the rest, unless we getmore, not less, spending on a consistent policy-not districtgeneral hospitals today, nucleus hospitals tomorrow, spin theideas fast enough and centrifugal force will prevent any ofthem from spilling out-we shall be left with a Health Serviceso impoverished in all its resources that there will be nothinguseful for any of us to do, even if we decide not to emigrate.Department of Pathology,North Middlesex Hospital,London N18 1QX EVA LESTER

SIR,—It is not clear to me what are the points which Profes-sor Brumfitt and his colleagues are trying to make, except tosay they want more money and less work.

I am writing from a holiday address and must quote frommemory, but I do not think that anything I say will be wideof the mark.The professors appear to be complaming that their salaries

are no greater than those of full-time consultants. In one of theearlier Review Body reports the point was made that theN.H.S. salary scales had been responsible for raising thesalaries of medical academics, and that in turn had raised allacademic salaries. The D.H.S.S., they say, is not prepared topay them for domiciliary visits, but laboratory consultantsmust do very few domiciliary visits; in 25 years I did not doone. They do not say that the university does not pay N.H.S.staff for teaching. They admit that they can direct fees fromprivate patients into a pool for their researches (or to go on aforeign trip?), but full-time consultants cannot do this.

They make a point which surprises me: "Our departmentshave no established technicians, biochemists or other non-me-dical personnel supported from university funds". I know ofno other academic department in the field of laboratory medi-cine which has no ancillary staff. I had quite a number. TheUniversity Grants Committee sends money to universities, andI do not think it is guilty of sending more support to one uni-versity or college than to another. The figures showing whereU.G.C. money goes are published annually and the book canbe obtained from H.M. Stationery Office. The U.G.C. does notcommand the university how to disburse the money; indeeduniversities insist upon this degree of freedom. If, therefore,Professor Brumfitt and his colleagues have no supporting staffthis is a matter between them and their university or college.

All that the professors are saying is that those who earnmore than average salary are getting it in the neck becausethey are regarded as plutocrats by our society. This is a generalissue which affects professors and consultants alike and thosewho have senior appointments in industry.

Before the war the U.G.C. money was ;2 million; it is now550 million. There has been some inflation (? x 7) and uni-versities have expanded, but those two combined do not, Ithink, match up to a multiplying factor of 270. Where does themoney go? Do we spend it wisely and carefully?3 Dean Terrace,Edinburgh EH4 1ND SCOTT THOMSON

SIR,-We write in support of our distinguished colleagues atthe Royal Free Hospital (May 15, p. 1072). We too perfonnthe role of clinical consultants in addition to our academicduties but with no extra income from private practice, over-time (a privilege extended to our junior staff), or domiciliaryvisits. Our salary has been frozen by Government decree, yetwe find that our senior registrars and lecturers can earn morethan us by working no longer hours, and newly appointedyoung consultants are, with generous incremental allowances,starting at the level we have reached after four years in thegrade.

If your meritorious correspondents from the Royal FreeHospital can command but one C award between them, whatelse can Professor Dudley (April 10, p. 795) suggest to stopthose of us in clinical academic medicine from following Pro-fessor McLachlan’s example (March 27, p. 685)?

Departments of Medicine and Surgery,Welsh National School of Medicine,Cardiff, and Llandough Hospital,Penarth, South Glamorgan

P. M. SMITHJ. L. CRAVEN

CIGARETTE SALES

SIR,—Mr Daube (May 15, p. 1082) challenges my earlierstatement that the Americans have been more successful thanourselves in giving up cigarettes. This statement was made inthe context of my leaning over backwards in an effort not toascribe to dietary change their improved coronary mortality inrecent years, compared with our own worsening mortality,However, since he has challenged the comparison, may I justsay that I obtained my information from the most up-to-date source’ I had to hand, and that the information it pro-vides still seems to me the most relevant? The latest figures it

provides for the U.S.A. are in respect of 1973; and I shall followMr Daube’s practice of giving the change in figures over aneleven-year period. But I shall cite what are, I suggest, the rele-vaitt figures-i.e., not the figures for total number of

cigarettes manufactured and sold by each country, but thosefor adult per-caput consumption in the two countries. They

1. Tobacco Consumption in Various countries. Tobacco Research Council,London, 1975.