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stressing. Dictatorship always starts by detailed criticism of theUniversities and then by control of their affairs."

The views of Lord Butler, who has seen more of thegame than most, must command attention. But there is

another side to the coin. In his memorandum Lord James,a former High Master of Manchester Grammar School, andnow vice-chancellor of the University of York, wrote:

" The growth of public expenditure on the universities makesit quite inevitable, in my view, that Parliament should bereassured that the large sums which it now votes are spent withproper economy. This confidence is particularly necessary ifthose sums are to be substantially increased, as I believe thatthey should be. Even if we contend that the existence of theU.G.C. and other controls makes such a reassurance super-fluous, Parliament will still want it. I believe that any attemptto resist such an examination, or to appear to shelter behindthe U.G.C., can only give the impression that the universitieshave something to hide, and ultimately weaken both theirclaims and the authority of the U.G.C. There is growing incertain quarters a distrust of the universities as secretive and

extravagant, which if it develops can do nothing but harm.Actually, I believe that they are more economical and carefullycontrolled than some other sectors even of the public economy,and it is possible that lessons might be learned from them ...But this has not only got to be true; it must be seen to be trueby Parliament and the public generally. A growing publicinterest in universities is inevitable. In so far as that interest is

knowledgeable, it can only work to the advantage of theuniversities."

Lord James is surely right. The present system, farfrom sustaining Lord Butler’s " free democracy ",negates it by largely obscuring from public scrutiny anddebate an outstandingly important object of nationaleffort and national expenditure.

IN AND OUT

AMONG the provisions of the Mental Health Act, 1959,which were criticised during its Parliamentary progresswere the automatic discharge of patients after prescribedperiods of absence without leave or of extended leave andlack of real supervision after discharge. It was pointedout that these provisions might allow patients to be dis-charged before their treatment was complete and increasethe risk of criminal behaviour by mentally disorderedpersons. That at least some of these fears were justified isclear from the Lord Chief Justice’s comment on twocases in which patients had committed violent crimes withina few months of discharge from hospital (see p. 285).For the protection of the public Lord Parker suggests

that courts should make wider use of section 65 of theAct, which restricts a patient’s discharge from a hospitalorder. Because prognosis is often uncertain, he feels thatit would usually be safer to make the restriction orderunlimited in point of time. But from the doctor’s pointof view, a restriction order brings difficulties of its own,for it is not confined to discharge, and restricts other

aspects of the patient’s freedom while he is in hospital.For instance, a patient subject to a restriction order can-not be allowed out of hospital, alone or accompanied,without the permission of the Home Secretary. Thiscondition makes it difficult to follow a normal programmeof reablement in an open psychiatric hospital which istrying to fulfil a therapeutic rather than a custodial role.This difficulty is intensified for the mentally subnormalpatient, who is unable to understand why he cannotshare outside activities like the other patients. As aresult, he often becomes disgruntled and absents himself

without permission, with the risk that he will repeat thekind of behaviour which led to his appearance before thecourt.

It is questionable whether a patient whose behaviourjustifies a restriction order should ever be sent to an openpsychiatric hospital rather than to one of the specialsecurity hospitals. There all patients are under the samegeneral restrictions, and the patient can lead a muchfuller life within its confines than in an open hospital wherethe staff are trying to keep him under constant supervision.A different, but related, problem is raised by the com-

ments of the recorder at Poole quarter sessions on the

expulsion of a patient from the Henderson Hospital afteronly two weeks " not because he was cured, but becausehe has offended against the regulations of the hospital ".The patient, an ex-borstal boy, due to inherit E40,000when he was forty-eight, provided that he was not sen-tenced meanwhile to imprisonment for a two-year periodor more, had been placed on probation in 1965 for threeyears by the Court of Criminal Appeal on condition thathe entered a psychiatric hospital for six months. Since

leaving hospital he had been fined E65 for damaging pro-perty. He appeared before the Poole quarter sessionsbecause of his breach of probation. Henderson Hospitalhas justifiably earned a high reputation for its treatmentof the most difficult patients by permissive methodswithin a fine therapeutic community. Patients and staff

join in deciding whether a patient is suitable to beadmitted and to remain in the hospital. If the result ofthese decisions should mean that a patient who wishes toremain in hospital is forced to leave, and so breach theconditions of his probation, it would seem desirable thatarrangements should be made for his transfer to another

hospital. Clearly the circumstances of the Poole casewere unusual, but the balance between the uncooperativepatient’s right of asylum and hospital’s responsibility

’ , towards its other patients must often be delicate.

RUBELLA VACCINES

AT least four rubella vaccines have been developed andgiven limited trials in man. The best known is that

described by P. D. Parkman and H. M. Mayer,’ andfurther developments were discussed at a meeting in

Washington in November. This vaccine was developed byserial passage of rubella virus in kidney cells of the vervetmonkey and after 77 passages (H.P.v. 77) it shows alteredproperties. First, it produces striking cytopathic effects inR.K.13 cells. Second, it evokes more interferon than thevirulent parental virus. Third, the H.P.V. 77 strain does notproduce viraemia in monkeys and only irregular excretionof virus in low titre from the throat, whereas the early-passage virus produces virsemia in 43% of monkeys andregular shedding of virus in the throat. Moreover, theH.P.v. 77 strain unlike the virulent virus does not spread tomonkeys caged with infected animals.The vaccine at a dose of 10,000 T.C.D.5o subcutaneously

has been found to stimulate antibodies regularly inchildren. There was no spread of virus to 49 contacts,whereas naturally infected children in the same en-

vironment transmitted virus to all of 10 susceptible con-tact children. A few of the children, however, were foundto excrete virus from the throat after vaccination, and thefear must remain that when many thousands of vaccinatedchildren have been examined the occasional spread of

1. See Lancet, 1966, ii, 1061.