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These figures are sufficiently accurate to allow us todiscuss the meaning of the change. In the earlier

period one of the chief causes of the great increase inpopulation was the rise of modern medicine, bothpreventive and curative. The present age has wit-nessed another great revolution in medical treatment,and full credit should be given to the sulphonamidesand penicillin, to blood-transfusion and modern

surgical techniques. A large number of killingdiseases have been themselves disabled.Much of the ill health that plagues us is no doubt due

to fatigue and nervous strain-and no wonder. The

remedy lies in shorter hours of work and less senseof rush. " Everyone is in motion," TOCQUEVILLEsaid ; " some in quest of power, others of gain. Inthe midst of this universal tumult, this incessantconflict of jarring interests, this continual striving ofmen after fortune, where is the calm to be foundwhich is necessary for the deeper combinations ofthe intellect ? How can the mind dwell upon anysingle point when everything whirls around it, andman himself is swept and beaten onwards by theheady current that rolls all things in its course ?

"

There is need for personal as well as national peace.And perhaps men and women can learn to smoke lessand drink less alcohol, now that the war is over.

When TITMUSS demonstrated that the lower-incomegroups are relatively worse off today, and that thecauses of this widening gulf are mainly environmental,he was stating a truth that is often overlooked. The

mighty-tide of sanitary improvement which has beenflowing for two generations has not yet reached thevery poor. A good water-supply is of benefit onlywhen it can be turned on, hot or cold, inside a house ;modern drainage is a blessing only when the sanitaryfittings are not the common property of several

families ; and milk remains wholesome only when itcan be kept in a cool place. The list might bemultiplied until the evils of the slum are described inall their ghastly detail. But housing alone is not

enough. The slum is the outward expression of

poverty and ignorance. Any real effort to make ahealthy nation must provide houses, but it must alsoattack the deeper problems, of poverty by economicaction, and of ignorance by education; or it is of noavail.

Intensive Treatment of BilharziasisTHE specific treatment of human schistosomiasisdates from the independent announcements byMcDoNAGH and by CHRISTOPHERSON, in 1915 and in1917, of the lethal action of antimony on the causativeintravascular parasites. They first successfullytreated cases of blood-fluke infestation with tartar-emetic solutions given intravenously. Since thenboth potassium antimony tartrate and sodiumantimony tartrate have been extensively employed,and these drugs are today still generally held to bethe most potent available for the treatment of humanbilharziasis. The accepted maximum single dose ofeither, for an adult, has been about 2 grains ; and thisdose has been. repeated not more frequently than onalternate days, until a total of about gr. 30 of theselected drug has been reached. The full course oftreatment extended over about three weeks. Inaddition to the length of the course it has disadvan-tages which are attributable to the very toxic and

extremely irritant nature of the compounds. It isusual to begin with a small dose (gr. t) and to increaseslowly until the full dose is reached, when it is repeatedfor the requisite number of injections: With each

injection toxic side-effects, such as a feeling ofconstriction in the chest, spasmodic cough, vomiting,pains (especially in the shoulders), cramps, and some-times collapse due to a fall in blood-pressure, areencountered ; these may be severe and distressingand occur while the solution is actually being intro-duced. The solution of the drug must be freshlyprepared immediately before use, since it becomesmore toxic on standing, and it must be given withthe utmost care into the vein, without any leakagearound the site of injection, or distressingly painfulnecrosis going on to actual gangrene may result. It isthus evident that the administration of tartar emeticover some weeks is not lightly to be undertaken.The pentavalent antimonials have proved ineffec-

tive in the treatment of schistosomiasis ; and beforethe trivalent antimonial compounds were introducedthe only alternative to tartar emetic was the alkaloidemetine, which proved useful in cases where intra-venous injections could not be given, or where thepatient was highly intolerant to antimony. In 1929the organic trivalent antimony preparation, ’ Foua-din ’ (stibophen), was found to be effective in thehuman schistosomiases. This drug, which contains13% of antimony, is put up in solution in ampoules,and is non-irtitant and relatively non-toxic. It isstable in solution, and the contents of a 5 c.cm.

ampoule can be injected intramuscularly or intra-

venously without undue inconvenience to the recipient,and the dose can be repeated at shorter intervals thanconsidered advisable with tartar-emetic solutions.In this issue MILLS records his treatment of Schisto-soma hcematobium infestations in West Africans with

stibophen (B.r.) and with Anthiomaline ’ (M.&B.),a lithium salt of antimony. Each drug was givenintramuscularly for six days each week over a periodof a fortnight. Such courses have been successfullyemployed by many workers, and MILLS records 42cures in the 46 cases he treated and was able ade-

quately to observe for a reasonable period afterwards.Some months ago ALVES 1 in a preliminary note

reported the successful treatment of a few cases ofschistosomiasis with full doses of sodium antimonytartrate frequently repeated within a period of onlytwo days. Now he and BLAiR record in detail thesimilar treatment of 100 cases of S. hcematobittm andS.mansoni infections in natives of Southern Rhodesia.Their therapeutic results are excellent, and theabsence of toxic side-effects, with a proper techniqueof injection, is remarkable. What is even more

striking is the dramatic shortening of the periodnecessary for adequate curative treatment, with itsbearing on the mass treatment of the populations ofthe schistosomiasis endemic and hyperendemic areas.Mass treatment of any large community is compli-cated not only by the number of skilled personnelrequired, and the amount of energy, time, and moneythat must be expended, but by the reluctance of theaverage person to continue any long course of treat-ment to the end. This characteristic is not confinedto the backward peasant inhabitants of Africa andAsia but is daily seen in their more educated

1. Alves, W. S. Afr. med. J. 1945, 19, 171.

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Caucasian brethren. A successful two-day course ofintensive treatment for a chronic and uncomfortabledisease may well appeal to a primitive populationand can the more readily be enforced where compul-sion is necessary. If only from this aspect the resultsof ALVES and BLAIR are an important contribution tothe welfare of the native inhabitants of the schisto-somiasis endemic areas throughout Africa and Asia.

Clinician and ScientistTHE regius chair of physic in the ancient University

of Cambridge was founded in 1540. For four cen-turies it has been held by a succession of physicians.Some, such as WINTERTON and WARD, were pre-eminently scholars. Some, such as GLISSON, wereoriginal investigators. Almost all were men whose

training and whose life-work were in the practice ofmedicine ; they were, in the modern term, clinicians.In the twenty-second appointment to the office thisold tradition has been broken. Sir LIONEL WHITBYis but an occasional visitor to the bedside; his practice,tastes, training, and original work have been in thescientific, rather than in the clinical field. It is not

surprising then that he devoted his inaugural addresson Dec. 5 to the familiar but baffiing task of describingthe relation of the science to the art of medicine.!He had no difficulty in impressing his hearers withthe immense contribution of medically useful know-ledge that science has made. His apt review of

chemotherapy, stretching from the empirical dis-coveries of quinine, mercury, and antiscorbutics,through EHRLicH’s dogged search for the " magicbullets " that his scientific imagination believed mustexist, down to the modern stories of the sulphona-mides and penicillin, was a reminder of the speed atwhich human intellectual activity is altering mansrelation to his environment ; yet it dealt with onlyone limited field of scientific inquiry in relation tomedicine. Beyond its contribution of useful know-ledge, however, science can influence the practice ofmedicine by affecting the physician’s way of thinkingin his daily approach to patients and clinical problems.How far it does so, how much further it ought to doso, and what are the hindrances ; these are thedifficult questions.Anyone familiar with the atmosphere of our teach-

ing hospitals must recognise that the clinician’s habitof thought and that of the laboratory worker are notalike. Sometimes they differ so much that discussionbetween them becomes futile and antipathy is engen-dered. The laboratory worker loses patience withthe clinician’s ignorance and unwillingness to learn,his woolly-mindedness and credulity. The clinicianconcedes the laboratory worker’s precision, but isirked by his narrow outlook and hint of intellectualsuperiority. Yet both, for generations, have beentrained in the same scientific laboratories, of chemistryand physics, anatomy and physiology. Why is itthat, twenty or thirty years later, they cannot talkthe same scientific language The answer is that theydo not appreciate the limitations, as well as the

possibilities, of the application of scientific thinkingto clinical medicine. The scientist asks his questions,plans and performs his experiments, and may or maynot get his answers ; if he does not solve his problem,he postpones it, or abandons it, disappointed but notdiscredited ; new knowledge or new technique may1. The address will be published by the Cambridge University Press

bring the solution later on, or perhaps it was notworth solving. To the clinician, on the other hand,every patient is an urgent problem ; none can beabandoned or postponed. Some decision must be ‘

taken and acted on, however. scanty the knowledgeon which it can be based. Being obliged, so often,to act without precise indications of how to act

readily blunts the logic of all but the sharpest intel-lects. This common experience is an explanation,though it need not be taken as an excuse, for impre-cision in the clinical mind. A second and morefundamental difference in ways of thinking arisesout of the infinite variety of patients and the problems sthey present. WHITBY recognised this in saying," it is true that medicine will never be an exact science,because the normal variations in individuals havesuch a wide range that automatic and mechanicaltreatment is prohibited." The scientist seeks

generalisations, at all stages, from the simpleclassifications of natural history to the comprehensive" laws of nature " ; his experiment gives him nosatisfaction unless he knows he can repeat it andobtain an identical result. The physician’s goal is therestoration or preservation of the individual’s health,and every success is satisfying although it may be

unique ; with him the generalisations are a meansbut not an end. We cannot therefore expect or

desire that clinician and scientist should think alongidentical lines or talk quite the same language. Butthat need not imply antagonism. WHITBY was rightand opportune in saying again that " the welding ofart and science will make for good medicine." Itmust come through a mutual recognition, by clinicianand scientist, of the differences in their backgroundand in the nature of their tasks, and a mutual respectfor the contribution each can make to the problems ofinnumerable bedsides.

"

New Year HonoursTHE first major list of honours to be issued since the

end of the war is concerned almost entirely with con-tributions to victory. No such list can include morethan a representative sample of the many men and womenwho have shown exceptional ability, endurance, or

devotion : for every person honoured in war, there mustbe twenty, fifty, or a hundred equally deserving in theirown way. But the fact that relatively few are chosenneed not and should not reduce our pleasure at theirrecognition. It is in fact a great pleasure to see amongthe new knights the names of so many men long honouredby their colleagues-among the surgeons Fairbank,Gordon-Taylor, Max Page, W. H. Ogilvie, StanfordCade, and Henry Wade ; among the physicians A. M. H.Gray, R. A. Rowlands, A. W. Stott, and C. P. Symonds;and a bacteriologist of the distinction of Paul Fildes.The outstanding success of Sir Alexander Hood as

director-general of Army Medical Services brings himpromotion to G.B.E., while other administrators raisedto knighthood include J. B. Hance, director-general ofthe Indian Medical Service, and R. B. Ainsworth, directorof medical services of the Red Cross Joint War Organisa-tion. Outside the strict confines of medicine we are

glad to note that Prof. A. V. Hill, F.R.S., becomes a

Companion of Honour. In the hospital world LordSouthwood, chairman of Great Ormond Street Hospital,is created a viscount, and Mr. Philip Inman, chairman ofCharing Cross Hospital, becomes a baron. A supplement-ary list will be published shortly. Meanwhile, at thebeginning of a New Year of better hopes, all of us willgratefully congratulate those members of our professionnamed on p. 30.