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soon be incalculable. Many will be grateful, therefore,to a member of our profession, Prof. ALEXANDERHADDOW, both for his plain statement of the risks nowdeveloping and for his proposals for meeting them.1The events in the Pacific, he says, bring to an end thenotion that the area of danger can have any butrelative meaning, and he goes on to speak of thesubtler menaces arising from the liberation of radio-active products. " We approach," he thinks, " thetime when future risks must be envisaged on a

terrestial scale, with more than a hint of new kinds ofcatastrophe from increased physical incalculability " ;and this opinion has since been given further pointby the announcement 2 that there is now no obstacleto making

" the most dreaded weapon of all "-acobalt bomb which on explosion is transformed intoa radioactive cloud that will travel thousands of miles,destroying all life in its path.

" The solution," Professor HADDOW continues, " is onefor statecraft and not for science as such. Yet the issueis so universal, and the Governments of the world are socompromised in their attitudes towards it, that we mustdespair whether there exists in fact either the mechanismor the will.... If all solution is beyond the present means,the question must be raised whether the representativesof world science itself, imbued by some sense of humaneresponsibility, can assist in the judgment."

" While the crisis is unlikely to be affected by theendeavour of any single individual today, such would notnecessarily be so were the issue transferred, under thesegis of the United Nations, to a concilium of worldscience, representing especially physics, chemistry,biology, and medicine, representative also of theirnationalities, yet supranational in outlook, of an authoritytranscending that of the politician, and with an unim-peachable primary loyalty to humanity as a whole.From such a body, and possibly from such a body alone,might we expect a factual appraisal and an advocacy ofpolicy of such overwhelming weight as to commend itselfto the whole of the civilized world."

" International relations is clearly not a disciplinesusceptible to the scientific method, yet it could perhapsbe affected by the outlook of science, and some approxi-mation made towards an analysis of the contemporarysituation, more objective than those monumentaltravesties to which, from one side or the other, we aresufficiently accustomed."

Three months ago we suggested that in facing thisfurther year of peril the chief need was to keep asense of proportion. That need remains ; but a senseof proportion is not maintained by pretending thatvery big things are really quite small. In the dis-cussions.of the past few weeks some have argued thatan unnecessary fuss is being made about a weaponwhich is only the latest in a long series of lethal

developments in the art of warfare-from the bowand arrow to the bacterial toxin. To this the answeris that in this process of development there are certainprofoundly significant points, of which one was theagreement to the mass bombing of cities, another wasthe first use of atomic fission for the same purpose,and a third is the possibility that we are moving fromthe indiscriminate to the incalculable. At any such

point a pause for thought is proper ; and before weteach ourselves to regard the hydrogen bomb as alegitimate means of protecting our civilisation weshould consider what effect such protection is havingon the civilisation itself. Man often kills the thingshe loves ; and if by civilisation we mean freedom ofspeech and belief, a good conscience towards others,

1. Times, March 30, 1954, p. 7.2. Ibid, April 8, 1954, p. 5.

and a respect for human life and personality, we mayfind that it is being sacrificed in its own defence. Thereare indeed already signs of our acquiring a barbarityof thought that makes us unfit to be its defenders.The moralists say that if an end can be reached only

by evil means, that end must itself be evil; and fewof us can have any real doubts about the wrongness of

wiping out a city or a nation with a bomb. On theother hand the mere existence of this invention is notnecessarily an evil, and it may even prove our salvationif it induces the leaders on both sides to consider

objectively whether the differences between us reallyjustify and necessitate the continuance of an unde-clared war carrying such risks for everybody. Atpresent both sides are strong in armaments butnevertheless afraid ; and the reason for their fear islargely that neither ceases for a moment its efforts toundermine the position of the other. Is it too muchto ask that, as a first step towards the return of humanrelations, both should call a truce to this aggressivepropaganda ? Profoundly though we may disapproveof the Eastern regimes, we should remember thattheir citizens think they have reasons for no less

disapproval of the West; and in trying to preserve asense of proportion we should not forget that half thenations of the Free World were once our own enemies,either because we hated their tyrannies or becausethey hated ours. If by curbing our fears and restrain-ing our threats we can avert a conflict which will ruinboth worlds, the two different civilisations may beable to live side by side and eventually absorb whatis best in each other. On a historical view suchcoalescence of rival groups is very far from beingimpossible ; and its attainment must be the aim of allwho recognise that, for survival, all men must cometo regard themselves as members of a single group-in which homicide, by any method, is forbidden.

1. Tattersall, W. H. Lancet, April 3, 1954, p. 730.2. Prevention of Tuberculosis. Circular H.M.(54)30.

Detection of Tuberculous ContactsBURIED beneath the mortality-rate and the noti-

fication-rate lies the epidemic pattern of tuberculosis,as secret and tenuous as the mycelium of a mushroom-bed. Neither rate gives a reliable map of its rami-fications : the deaths have fallen fast in the lastfive years, the notifications hardly at all, as Dr.TATTERSALL has pointed out in our correspondencecolumns ; indeed in Scotland in 1953 they were slightlyhigher than in 1952. Nevertheless, the greater theproportion of cases detected, the more informativethe notification-rate will become. The situation is

complicated by the fact that patients with advanceddisease are now living longer and perhaps adding tothe risk to other people. Our greater success in makingthe tuberculous sputum-negative may not offset thisas much as we hope if, as Dr. STEWART and Dr. VANZwANENBERG suggest in their letter this week,we cannot rely on bacteriology in determining theinfectiousness of a particular patient. As things stand,it is still very hard to assess either prevalence orrisks. But our lack of a perfect map need not preventour doing much more than we are doing to containthis disease.A memorandum from the Ministry of Health,2

designed to help medical officers of health to review

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their own programmes of control, rightly insists thatthe chief cause of primary infection is close contactof a susceptible subject with an infected person.Spread from other causes-from inhalation of infecteddust, for instance-is nothing like so important.The first job of the preventive team, then, is to findevery infected person and notify him. Notification of

.every case discovered, indeed, is an essential contri-bution to prevention which all clinicians, in or outof hospital, ought to make. For only when a case hasbeen notified can the M.o.H. set about finding outwhere the patient got his infection and whether hehas infected others. The Ministry thinks that if asmuch effort were put into tracing sources and contactsof tuberculosis as is put into tracing sources of typhoidor contacts of smallpox, we should make faster

progress. Contacts should not only be examined :they should be kept under observation for a time tosee whether they are incubating the disease, or whether,in common with the index case, they are exposed toa source of infection not yet detected. Children,adolescents, and young adults naturally need theclosest supervision ; and all tuberculin-negativecontacts, of whatever age, should be given whateverprotection B.C.G. vaccination confers. Local healthauthorities are now at liberty to give this vaccine tochildren about to leave school, and the Ministry haspublished a circular 3 and memorandum 4 on thesubject.In tracing sources of infection, skin tests can be very

useful, and they could be applied much more widelythan at present to investigate the family contacts ofan infected child, and so to trace the person by whomhe was infected, or even the source of infected milk.Surveys of the family contacts of tuberculin-positiveschool entrants have yielded a high proportion ofinfected adults ; and the Ministry thinks that furtherstudies of this kind would be valuable. Skin testingat other ages may also be informative : thus whena child seen at a chest clinic is found to have a primaryinfection or adult-type tuberculosis, the skin testingof his class and teachers at school may reveal anunknown case in another child or an adult. Indeed,skin tests could be used, STEWART and VAN

ZWANENBERG believe, to map the incidence ofinfection in various age-groups, and in different

schools, throughout the country. This would giveus a picture of the black spots, and, as the years go by,a measure by which to judge the success or failureof our attempts to control the disease. In areas

where not all milk is pasteurised the discovery of ahigh proportion of tuberculin-positive children mayreinforce a campaign to get rid of bovine infection.Repeated radiographic examination of school staffseems a reasonable precaution, and one to which noteacher ought to object-though it is not alwayseasy to be enthusiastic about an investigation whenone’s livelihood depends on the result. The Ministryfavours the selective use of mass radiography ratherthan the examination and re-examination of largegroups. Patients referred by their general practi-tioners, and patients attending hospital, give a

relatively high yield of positive findings, and it isoften useful to radiograph the work group of a patientnewly diagnosed at a chest clinic. Similarly the

3. Circular 22/53.4. Memorandum 324/B.C.G.

appearance of several cases in one village is a goodargument for a survey of the whole population byradiography and skin testing. The Ministry alsoholds that all pregnant women should be radio--

graphed as part of routine antenatal care.In short it believes that the M.o.H., the chest

physician, the family doctor, and the mass-radiographyunit, working together and consulting often, can applythe traditional methods of epidemiology, and thenewer techniques of radiology and skin testing, tothe detection of the epidemic pattern of tuberculosisin their area. It is particularly important, the memo-randum adds, that the general practitioner should befully informed about what is going on ; for withouthis support the campaign cannot succeed : andindeed its complete success depends on the activecollaboration of everyone concerned in the detectivework.

The Sardinian CampaignIN 1945, when the destructive consumption of war

mercifully ceased, the Allied nations diverted theirgeared-up production and surplus stores to beneficentuses under the direction of UNRRA ; in addition., theUnited States provided dollars to aid recovery in

Europe under E.R.P. In the Italian sphere the firstcall on these materials and funds was for emergencywork, such as controlling malaria and other epidemicdiseases. But members of the UNRRA mission wereanxious to invest some of the funds in work of lastingvalue. Dr. F. L. SOPER, of the Rockefeller Foundation,proposed a mosquito eradication campaign; andSardinia was chosen because, being an island, it is arelatively isolated unit and because it was the mostmalarious part of Italy. Members of the RockefellerInternational Health Division had behind themsuccessful eradication campaigns in Brazil and Egypt.They had established that, at least in some circum-stances, extensive and vigorous eradication workcould obviate the trouble and expense of routinecontrol measures. With this background, it wasintended to plunge directly into a similar campaign inSardinia, relying on administrative experience gainedin earlier schemes and on existing knowledge of theSardinian malaria vector, Anopheles labranchice.In October, 1945, UNRRA agreed in principle to the

project, which was to be carried out jointly by theItalian government, UNRRA, and the RockefellerFoundation (which supplied technical staff and extrafunds). A special agency known as ERLAAS (EnteRegionale per la Lotta Anti-Anofelica in Sardegna)was set up to conduct the campaign. Delays inassembling staff and equipment deferred the start oferadication work until early in 1947 ; but this wasno misfortune, since it gave time for a survey of theisland by a malariologist and an entomologist. By1947 it was realised that this campaign, aimed at theextermination of indigenous mosquitoes, would bemuch more difficult than the earlier campaigns,which had dealt with mosquitoes intruding into newterritory. Furthermore, the Brazilian schemes hadattacked highly domestic strains of mosquitoes whichwere never found breeding far from man ; whereasA. labranchice, though a man-biter, will readilybreed in remote places and feed on wild animals. Tooffset these difficulties, there was the new weapon of