university institutes associated with the special hospitals, the continuing inertia is damaging and may even prove disastrous; and they have no effective means THE LANCET of pressing their claim. The trouble is that the objectives of Ministry and of university are essentially dissimilar. LONDON 22 JANUARY 1966 Whereas the Ministry is preoccupied with administering a routine service and providing much-needed district hospitals, the university is-or should be-preoccupied with obtaining the physical and human resources for Study in Inertia and research. Some months ago we suggested MANY of London’s small and scattered special hos- teaching that the extent of facilities for undergraduate medical pitals are out of date and inadequate for both their education should be controlled, not by the Ministry, but clinical and their teaching responsibilities. When, in by the University Grants Committee. The argument 1962, a Government committee, convened jointly by the for transfer of control over facilities for postgraduate Ministry of Health and the University Grants Committee, education is no less strong. The staffs of London’s under the chairmanship of Sir GEORGE PICKERING, special hospitals are peculiarly competent to train recommended1 that many of these hospitals be rebuilt in graduates from home and overseas; but this cannot be two groups-namely, Holborn and Chelsea-hopes ran done on the cheap, and in the end it may not be done at high. Now, three years and some hundreds of com- all if the present drift is allowed to continue under the mittee hours later, these hopes are dimmed. The aegis of a Ministry whose gaze is fixed elsewhere. Holborn plan has apparently been shelved; and the best that can be expected for the Chelsea plan is that the site will be partially cleared in 1969 for a start on phase 1, in which St. John’s, St. Mark’s, and St. Peter’s Hospitals Lvsosomes and Tissue Breakdown are to be brought together. In phase 2, which may be IN 1955 DE DuvE and his colleagues3 showed that completed in twenty years, the Brompton, National liver cells have lysosomes-small organelles containing Heart, and Marsden Hospitals will complete the group. can break down many different which If the tardiness in making any start causes concern, hydrolytic enzymes kinds of macromolecules under slightly acidic conditions. equal concern must be aroused by the choice for the Among the enzymes in lysosomes are cathepsins (profirst phase of a dermatological hospital, a hospital for diseases of the rectum (one which does not even offer a teases), deoxyribonuclease, ribonuclease, (3-glucuroniand acid phosphatase. It has since become clear full gastroenterological service), and a urological dase, that lysosomes are present in many other cell types, hospital. This choice has been made, not because possibly in all but mature erythrocytes. The lysosomes propinquity is likely to benefit these three, but because in different cells: the granules of the different types the existing three hospital buildings are particularly vary of blood leucocytes, for example, all contain the enzymes outdated or ill sited. In other words, expediency is characteristic lysosomes, but they also have distinctive triumphing over reason. Nor is this all. Despite constituents, of such as the basic protein of eosinophil excellent designing, the 19 acres which is all that can be 4 The properties of lysosomes and their found for phases 1 and 2 together is clearly too small an granules. in immune reactions and disease have lately behaviour area: even in phase 1 not all the resident staff will be been reviewed by WEISSMANN.5 accommodated on the site. The lytic potentialities of lysosomal enzymes and their Such a slow and unpromising start is not inevitable. release under certain conditions suggested that they The responsibility for planning and building hospitals might be responsible for cell necrosis in damaged or rests with the Ministry of Health, which seems to be tissues. - -There is little doubt that release of incapable of bold and imaginative thinking. In London, autolysing amounts of lysosomal enzymes into the cytoplasm sites are scarce; and they are expensive-notably at the large can kill cells. When leucocytes are exposed to bacterial centre. On the other hand, existing hospitals, both at the toxins such as streptolysin S, their granules are disrupted centre and beyond, occupy land uneconomically. A and the cells are rapidly killed.These experiments are commercial undertaking, faced with the Ministry’s not definitive, however, because the bacterial toxins problems, might be expected to remove from the centre alsoquite increase permeability of other membranes, including those hospitals which do not need to be there as emerthe cell membrane, and it is possible that this contributes gency or district institutions. London’s land hunger is their toxicity. When the lysosomes of cultured cells such that, even well beyond the centre, suitable new sites to are damaged after uptake of vital dyes and exposure to are difficult to obtain; but within a 6-mile radius many light, the cells degenerate, and it is reasonably hospital buildings occupy land wastefully. If these were visible certain that this is due to intracellular release of lysosomal torn down and replaced by modern buildings, which 2. Lancet, 1965, ii, 327. used the land fully, the cost would be very largely offset 3. De Duve, C., Pressman, B. C., Gianetto, R., Wattiaux, R., Appelmans, F. Biochem. J. 1955, 60, 604. by the profit on the sale of the central sites. Yet what 4. Archer, G. T., Hirsch, J. G.J. exp. Med. 1963, 118, 277. 5. Weissmann, G. New Engl. I. Med. 1965 273, 1084, 1143. has the Ministry done in this direction ? Virtually 6. De Duve, C., Beaufay, H. Biochem. J. 1959, 73, 610. To the
Rep. publ. Hlth. med. Subj., Lond. 1962, no. 106. See Lancet, 1962, ii, 541.
7. Van Lancker, J. L., Holtzer, R. L. Am.J. Path. 1959, 35, 563. 8. Hirsch, J. G., Bernheimer, A. W., Weissmann, G. J. exp. Med. 118, 223.