1051LEADING ARTICLES

2Ist-Century Man

THE LANCETLONDON: : SATURDAY, JUNE, 30, 1956

FOR many years the public of the Western countrieshas been warned about next century. Science, theprophets have said, will destroy man. He will beannihilated by atomic bombs (the products of unregen-erate science), or be herded in ant-like societies whoserulers (thanks to science) can spy on him by television,influence him by waves, or steal his brain and replaceit with their own.-projects all curiously familiar to amedical listener. More respectably, man will simplystarve through overpopulation, caused by our follyin extending medical care to our poor relations, orbecome half-witted through failure to propagate anintellectual aristocracy. While there is time, let himturn back ; let him abandon science and revert tocommon sense, the tribal deities, and the past.Our generation, certainly, is qualified to recognise

danger. It has seen what can be done by a HITLER,and it still lives in the knowledge that a handful ofpsychopaths could bring human history to an end.But in recognising danger we need not lose our senseof proportion ; and we should know by this time thatthe forces most likely to translate such threats intoreality are, first, paranoid fear, and secondly a con-viction that the future holds nothing for us. Warningswe may need, but the prediction of doom throughscience should be seen as mostly nonsense, and itsgoblins as part of a psychoneurotic, if not psychotic,fauna. The dangers to humanity are, as always,grave ; but at no time has man been better placed todeal with them. The true defence is not to turn backto anything but to turn forward-not less knowledgeand freedom but more. This is a task which medicineand science cannot afford to neglect. The faster the

change in our societies, the greater the need to foreseeand prepare.

In a " speculative projection " of 21st-century manlately published by the California Institute of Tech-nology,l it is impressive to find the writers unanimousin. repudiating the " starvationist

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theory of futurehistory. The world’s population is increasing and willcontinue to do so ; but if the newcomers are not fedthe reason will not lie in the inability of technology tofeed them. According to the California workers, irriga-tion and reclaiming of marginal land, and the controlof insect pests, would in themselves suffice to raise foodoutput by nearly half. Beyond that lie the possibilitiesof new crops, the substitution of synthetics and ofmicroorganisms for animal foods, and the harvestingof the sea, where nine-tenths of the world’s photo-synthesis takes place : ’‘ what we need," said one

participant, " is to breed a sea-going pig." Work onsuch lines is already in progress (some will have seenthe " mechanical cow " built by N. W. PIRIE and hisco-workers at Rothamsted) ; and, though the appealof food research to governments is less than that ofdestructive undertakings, it goes on, and may gofaster. For the California scientists, the limiting factorof this expansion is the availability of skilled men :

1. See New York Times, May 21, 1956.

in the initial stages of technological revolution, thenumber of man-hours per calorie or per kilowatt-hourmay fall; but it is now climbing back to, and evenbeyond, its old level, with the difference that the newkind of labour requires aptitudes and training of a veryhigh order in a very large number of people. Here theproblems are medical as well as technical ; for psycho-logical stress among scientists, research men, andskilled technicians is already clinically evident, andthere would be further strains in a society which had noplace for the stupid. But shortage of skilled cadres-important though it may be-is not the limitingfactor that we should ourselves put first. If the worldis not fed when technology could feed it, or healedwhen medicine could heal it, the reasons are mostlikely, we should say, to lie in the form of humansocieties and the prejudices and interests they harbour.In other words, they are political.

It is easy at this point to turn away, remarking that" science has no place in politics." But the fact remainsthat the two major political issues of the world todayare both of them largely issues of science-the firstbeing the extension of high living standards to all

nations, while the second is the tendency for socialorganisation to become a vehicle for national andpersonal aggression. If these issues are to be dealtwith by scientific causal analysis-in.stead of by thecombination of dogma and vested interest which hashitherto been customary-the medical scientist cannotopt out of them. Whether the approach of socialpsychology is less vitiated by personal and culturalprejudice and bias than that of "politics" as we

understand it, only time can show : admittedly thediscipline of science does not always succeed in con-trolling the scientist’s judgments against the pull of hisprejudices. But it is clear that ways and meansbetter than those of the present can and must befound.One part of the political future of man is already

being influenced by science in a sense opposite to thatprophesied by the pessimists. In the past, societieswhich drew their dynamic from rigid ideologies andconformities were not seriously hampered by them inimposing themselves on the world and their neigh-bours. In some respects these " armoured cultures "were at an advantage : they lost their art, their litera-ture, and their capacity for enjoyment, but not theircompetitive efficiency. But once scientific technologycomes to be the chief qualification which enables asociety to compete, this situation is likely to change.In such a world ideologies have immediate andevident consequences : relativity may be a philo-sophical concept, but if it is an erroneous one we mustalter the design of our electronic equipment. Thus a

society may have to choose between " bourgeoisgenetics and no beef, or between ’’ communistic "economics and no production. Moreover, the continuedcompetitive efficiency of a neotechnic culture will

depend on the attitudes of the men it produces-theirreceptivity, spontaneity, capacity for social action,and lack of biases-and these will be continuouslyexposed to practical tests. When the most biaseddictator of the future sets his most fanatical henchmento build up a supersonic air force, they will still beunable to train pilots without at the same time trainingand employing psychologists whose studies of humanbehaviour will call the dictator’s mental state in

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question, and engineers who, if their machines are toleave the ground, will be unable to accept the dogmathat 2=3. However much we allow, as we must,for the human power of double-think, which affectsscientists as much as (some would say more than)their fellows, the continued growth of analytical andpurposive study of Nature must give rise to more

analytical and purposive study of ourselves, of society,and of the pretensions of would-be leaders or rulers.

21st-century man will have his own troubles. Hemay look back at ours as an age of inequality andideology, in which societies still delegated authorityto essentially aggressive or prohibitive people ; as the

age in which it became possible first to control diseaseand hunger and then (by applying the same methodsof thought) to control the antisocial, irrational, andincoordinate sides of human conduct which obstructedthe application of knowledge ; and possibly as thegolden age of science in general. Since the exponentialprogress of knowledge can hardly go on indefinitelywithout some pause, our grandsons may spend the 21stcentury in drawing breath, and in allowing civilisationto catch up with the practical and intellectual pro-gress made in the time of strife and excitement which

preceded it. But if they read our literature, they willhave less respect for the Jeremiahs and the Jonahs whoforetold judgment than for the Ezras who urged theircontemporaries to rebuild the Temple.

1. Brit. med. J. Feb. 25, 1956, p. 413.2. Lorber, J., Hart, C. B. S., Farmer Pauline, Muggleton, P. W.

Tubercle, Lond. 1956, 37, 187.3. Gernez-Rieux, C., Gervois, M., Ramon, P., Tacquet, A. Rev.

Tuberc., Paris. 1951, 15, 1154.4. Rosenthal, S. R. Amer. Rev. Tuberc. 1951, 64, 698.5. Kudrjavcevová, A. J. Rozhl. Tuberk. 1954, 14, 348.6. Ebina, T., Kobayashi, T., Kato, K. Proc. imp. Acad., Japan.

1946, 22, 269.7. Ebina, T., Ito, T., Yakuwa, E., Ito, K., Takowe, Y., Ebiner, A.,

Umeta, Y. Acta tuberc. scand. 1954, 29, 279.8. Obayashi, Y. In W.H.O. Monograph Series, no. 28. Geneva, 1955.

British B.C.G.THE rather tentative official support for B.C.G.

in this country in the past few years has been fortifiedby a statistically unassailable experiment 1 ; and,although the vaccine cannot yet be freely used,there are signs that control is being relaxed. So farall the B.C.G. vaccine routinely used in this countryhas been imported. But the first report of a BritishB.C.G., a freeze-dried vaccine, has now appeared.2 2Freeze-dried vaccine, if it is as consistently potentas the liquid products, has obvious advantages.It can be kept for many months at room-temperaturewithout serious loss of potency, so that each batchcan be fully tested before it is released. Instead of

having to be ordered in advance and used withouta delay, the freeze-dried product can be kept in storeand is promptly available-an obvious advantageto those who use it infrequently and in small quantities.Freeze-dried vaccines have been manufactured andtested in many countries, notably in France,3 theUnited States, 4 Russia, 5 and Japan.6 The extensiveJapanese experience of its manufacture has recentlybeen reviewed by OBAYASHI in a W.H.O. monograph. sThe new British vaccine was produced in the Glaxo

laboratories and, after detailed bacteriological andanimal tests, two batches were put to clinical trial.LORBER and his colleagues 2 vaccinated 276 newborninfants. After six weeks 88% of those vaccinated withone batch and 77% of those vaccinated with the othergave a positive tuberculin skin reaction. But twelve

weeks after vaccination the proportions of "con-vertors " had risen to 96% and 92%. This delayin the appearance of the sensitivity produced byfreeze-dried vaccine was also noted by EBINA et al.The vaccination lesions were small and in only 8infants were there palpably enlarged axillary lymph-nodes. None had any detectable general disturbanceof health. The vaccine was kept at room-temperatureduring the fourteen weeks of the trial. There was no

important change in the vaccine during this periodand counts of viable cells were of the same order asat the start of the investigation. LORBER et al.believe that this particular British freeze-dried vaccinewould not be suitable for vaccination of contacts ;for it may be desirable in contacts to induce tuber-culin skin sensitivity as quickly as possible with theleast risk of failure. This is, however, not a seriousdeficiency ; for most of the vaccine required in thiscountry will probably be needed for routine vaccina-tion of those not especially exposed to infection.

1. Lightwood, R. C. Proc. R. Soc. Med. 1952, 45, 401.2. Fanconi, G., Girardet, P., Schlesinger, B., Butler, N., Black, J.

Helv. pœdiat. acta, 1952, 7, 335.3. Lightwood, R. C. Arch. Dis. Childh. 1952, 27, 302.4. Payne, W. W. Ibid.5. Creery, R. D. G. Lancet, 1953, ii, 17.6. Harris, L. C. Arch. Dis. Childh. 1954, 29, 232.7. Ferguson, A. W., McGowan, G. K. Lancet, 1954, i, 1272.8. Lowe, K. G., Henderson, J. L., Park, W. W., McGreal, D. A.

Ibid, 1954, ii, 101.9. Creery, R. D. G., Neill. D. W. Ibid, p. 110.

10. Dawson, I. M. P., Craig, W. S., Perera, F. J. C. Arch. Dis.Childh. 1954, 29, 475.

11. MuCance, R. A. Macy Conference on Metabolic Interrelations.New York, 1954 ; vol. 5, p. 245.

12. Russell, A., Young, W. F. Proc. R. Soc. Med. 1954, 47, 1036.13. Hallman, N. Helv. pœdiat. acta, 1955, 10, 119.14. Stapleton, T., Evans, I. W. J. Ibid, p. 149.15. Bonham Carter, R. E., Dent, C. E., Fowler, D. I., Harper, C. M.

Arch. Dis. Childh. 1955, 30, 399.16. Schlesinger, B. E., Butler, N. R., Black, J. A. Brit. med. J.

1956, i, 127.17. Lancet, 1954, ii, 127.18. Ibid, 1955, ii, 1327.19. Morgan, H. G., Mitchell, R. G., Stowers, J. M., Thomson, J.

Ibid, June 16, 1956, p. 925.20. Macdonald, W. B., Stapleton, T. Acta. pœdiat., Stockh. 1955,

44, 559.21. Fanconi, G., Spahr, A. Helv. pœdiat. acta, 1955, 10, 156.

Hypercalcæmia in InfancySINCE the benign and severe 2 types of idiopathic

hypercalcsemia in infancy were first described, manycases have been recorded,3-16 and we have from timeto time discussed these developmentsP 18 Theclinical pattern is well defined : anorexia, vomiting,constipation, and failure to thrive, with raised serum-calcium and blood-urea levels. The outlook in the

simple group is generally good, although there havebeen occasional deaths ; but in the severe type,with physical and mental retardation, patchy osteo-sclerosis, renal failure, and hypertension, recovery isoften incomplete and death is not rare. In a recentissue Dr. MORGAN and his colleagues 19 described15 cases seen in Dundee during a period of two yearsand they gave a detailed account of metabolic studiesin 2 hypercalcsemic infants. Their conclusions confirmprevious reports of high calcium retention,8 11 15 20and the beneficial effects of low-calcium diet and ofcortisone,9 21 which, they found, increased the faecalcalcium. Dr. MORGAN and his associates do notfavour the use of calcium-chelating agents, such asdisodium ethylenediamine-tetracetic acid (E.D.T.A.),because of the gastro-intestinal irritation they produce.Like most of those who have studied this syndrome,they feel that the most likely cause is an over-actionof vitamin D. Dr. LIGHTWOOD and his colleagues inthe paediatric unit at St. Mary’s Hospital, London,