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HOW TO GROW HEPATITIS VIRUSES?

Enders, who has done so much to extend our knowledgeof animal viruses by propagating them in cell cultures, hasnow demonstrated the efficacy of a novel method of induc-ing viruses to grow in otherwise non-susceptible cells; andhe suggested that it may be applicable to the growth ofthe viruses of infectious and serum hepatitis.l Cells areknown to have specific receptors for virus to which theyare susceptible. Holland 2 demonstrated that infectiousviral R.N.A. could circumvent the lack of receptors andinduce a single cycle of infection-first achieved by infect-ing chick embryo cells with poliovirus R.N.A. Manymyxo-like viruses produce giant cells or syncytia whengrown in cultured cells 3 and a cell-fusion factor has beendescribed in measles distinguishable from other virus

properties. One striking effect of the cell-fusion capacityof myxoviruses is the production of heterokaryons ofmouse and human cells and chick and human cells byHarris and his colleagues.4-6 Enders employed Harris’stechnique with ultraviolet-irradiated Sendai virus andshowed that if cell fusion took place in the presence ofpoliovirus then viral replication could be demonstrated inchick embryo cells and in a line of hamster embryo cells. 7In these experiments poliovirus multiplication was

subsequently demonstrated by titration in susceptiblecells; but after prolonged culture of poliovirus-infectedSendai-fused hamster embryo cells there were fewer cellsand earlier degeneration of the cultures than control cellsnot infected with poliovirus-which might provide analternative sign of multiplication. If the difficulty withgrowing hepatitis viruses is due to failure to get the virusinto cells this new technique may be very useful. Zucker-man and his colleagues 8 have shown that human liver cellscan be grown in culture, but so far, despite the usefulnessof these cells for toxicity studies, no success has beenreported in propagating hepatitis viruses in them. Failure

might possibly be due to inability of virus to gain entranceinto the cells when they are cultured in vitro, and the newtechnique described by Enders may offer a chance to getvirus into the cells. Since these cells seem to be of hepaticorigin, a reasonable hope is that if a virus entered the cellsit would then produce recognisable cytopathic effects.

DOCTORS IN INDUSTRY

THE Minister of Labour’s Industrial Health AdvisoryCommittee has, during the past year, invited the commentsof interested bodies on its report on the AppointedFactory Doctor Service,9 " as a preliminary to consideringthe Government’s attitude ". The industrial healthcommittee of the Royal College of Physicians, in an

admirably succinct reponse 10 to this invitation, has

1. Enders, J. F., Holloway, A., Grogan, E. A. Proc. natn. Acad. Sci.U.S.A. 1967, 57, 637.

2. Holland, J. J., McLaren, L. C., Syverton, J. T. J. exp. Med. 1959,110, 65.

3. Kohn, A. Virology, 1965, 26, 228.4. Harris, H., Watkins, J. F. Nature, Lond. 1965, 205, 640.5. Harris, H. ibid. 206, 583.6. See Lancet, 1966, ii, 119.7. Diamandopoulos, G. T., Enders, J. F. Am. J. Path. 1966, 49, 397.8. Zuckerman, A. J , Tsiquaye, K. N., Fulton, F. Br. J. exp. Path. 1967,

48, 20.9 See Lancet, 1966, i, 915.

10. The Appointed Factory Doctor Service. Report of the Royal College ofPhysicians Industrial Health Committee. April, 1967.

recognised that although the proposals in the report werenot directed towards establishing a national occupational-health service, they present an opportunity both for

setting up the nucleus of such a service and for ending thepresent isolation of doctors working in occupationalmedicine from the mainstream of medicine. The com-

mittee believes that the slow development of occupationalmedicine has been largely due to its attachment to the

Factory Inspectorate of the Ministry of Labour, and it

proposes the transfer of the present medical inspectors tothe Ministry of Health and Department of Health forScotland, making them part of the new service with thesame type of duties as the so-called " A " doctor, who,like them, will have the title of medical adviser.The medical advisers must have access to laboratories,

radiological services, and certain physiological tests, andthe committee believes that these should be provided bythe National Health Service or be chargeable to it. This isin line with its general plea for integration of the proposednew service with the National Health Service, whichwould also simplify the problems of recruitment andremuneration of part-time doctors working in it. Initialand refresher courses for the medical advisers will have tobe developed, for they will have to be specialists, and acareer structure with the opportunity of reaching con-sultant status must be created. The adoption of theseproposals would remove many of the well-founded doubtsabout the practicability and effectiveness of the serviceenvisaged in the original report. In some quarters theywill be regarded as too radical, and, as such, resisted. Butwe lag behind most of the advanced countries in the statusofficially accorded to occupational medicine and in thefailure of our official thinking to see it in the context ofcommunity health care. Attachment to an outmodednarrow concept of inspection as part of the enforcement ofminimal environmental standards has been mainlyresponsible for this. If new legislation is contemplated-and there seems to be little immediate prospect of this-the comments of the Royal College of Physicians will haveto be very thoroughly considered.

THE SEAT-BELT SYNDROME

ALL new cars in this country must by law be fitted withsafety-belts. Since a passenger who is thrown from hiscar is twice as likely to be seriously injured as one whoremains in it, from now on (if only we can persuadepeople to wear their belts) the number of injuries causedby ejection should fall. There is some evidence, however,that we shall be seeing more of the seat-belt syndrome-a group of injuries in which the forces of sudden decelera-tion tear the mesenteries and their blood-vessels and

perforate the bowel. Some 20 cases have now been

reported. Blumenberg 2 writes of an Army sergeant inOkinawa who was wearing a lap type of belt and who wasthrown against the side of the door. After treatment offacial injuries, he was discharged from hospital. Three

days after the accident he began to have abdominal dis-comfort and difficulty in passing flatus. An X-ray of theabdomen showed free air under the diaphragm. At opera-tion a linear tear of the mesosigmoid extended to the root,and four inches of the sigmoid colon itself was detachedfrom its mesentery. A small perforation had been sealedby small bowel and omentum. The patient recovered

1. See Lancet, 1966, i, 699.2. Blumenberg, R. M. Ann. Surg. 1967, 165, 637.