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charged down from the hills on the 40,000 Persians anddrove them into the sea. At the third invasion, underDairius’s son Xerxes, the Persian troops were crippledin a sea fight and had to retreat on foot. Starving andthirsty, ’they’ ate grass and drank polluted water ;thousands ’died of dysentery, and as a result of this

epidemic Persian aggression in Europe was finallydestroyed."

,

Many other famous epidemics have changed thecourse of history : for example, the destructive outbreakof smallpox which heralded the decline of Athens ; themalaria brought back by’the ill-fated expedition againstEgypt,’ to remain indigenous in the regions round Athensto thisday; the plague which forced the Gauls to retreatfrom Rome, leaving the -Capitol still untaken; theinfections (possibly malaria and dysentery) which

undermined Hannibal’s invading Carthaginians ; andthe pestilence (smallpox again) which killed Marcus’Aurelius in Vienna,- and so wasted the power of Romethat it became prey to the barbarians. Professor Wynn,who plans to follow this fascinating study down tomodern times, suggested that though the primarycause of the fall of civilisations must be sought in the’

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minds ’’ and:, - hearts of men, yet bacteria and virusesare still man’s greatest foes, and civilisation is constantlythreatened by them as well as by war. If today ourminds and hearts are -as bad as ever, at least our

epidemiology and hygiene are much better : we maysurvive, and even repent.

AUREOMYCIN: A VERSATILE ANTIBIOTIC

AUREOMYCIN, a new antibiotic which can be givenby mouth,l is active against many of the rickettsise,certain viruses, and many gram-negative and gram-positive organisms. Preliminary reports indicate - thatamong rickettsial diseases in which it is effective areRocky Mountain spotted fever, Q fever, typhus, andrickettsial pox (a relatively new disease of which therehas lately been an outbreak in New York). Experi-mental. work has shown that it is potent against thepsittacosis virus ; and some cases of primary atypicalpneumonia seem to’have responded very favourably toits administration. There is reason to hope that inbrucellosis the results with aureomycin will be betterthan with any previous treatment. Infections with the

coli-aerogenes group, particularly those affecting the

urinary tract and peritoneum, have been successfullytreated with it ; and it is now being tested with salmonella

infections, including typhoid fever.2 Moreover, since itreadily passes the blood-brain barrier it may prove usefulin some forms of meningitis.. It is active against manyof the organisms not affected by penicillin or strepto-mycin. According to Finland et al.,2 most organisms donot become resistant to it as they do to streptomycin ;and there is already evidence of its usefulness againstgram-positive organisms that have become penicillin-resistant.

In screening experiments aureomycin was found to behighly effective in the treatment of mice infected intra-cerebrally with the virus of lymphogranuloma venereum-.Impressed by these preliminary tests, Wright and hiscolleagues,3 at the Harlem Hospital, New York, usedthis substance to treat 25 patients suffering from thedisease. The cases were divided into three groups-buboes, lymphogranulomatous proctitis (with or withoutulceration), and benign cicatricial rectal structures.All of 8 patients with buboes showed a decided reductionin the size of the glands after four days’ treatment ;within forty-eight hours, only occasional elementary

1. Annotation, Lancet, 1948, ii, 618.2. Finland, M., Collins, H. S., Paine, T. F. jun. J. Amer. med. Ass.

1948, 138, 536.3. Wright, L. T., Sanders, M., Logan, M. A., Prigot, A., Hill, L. M.

Ibid, p. 408.

and inclusion bodies were seen in the buboes, and aftera week’s treatment none at all were observed. Of3 cases of proctitis each was considerably improved,tenderness and discharge disappearing within four daysand bleeding in eight. Finally, in 14 patients ’withbenign rectal stricture there was a decrease in rectalpain and in discharge and bleeding, and an increasein the stool diameter. These results are encouraging ina disease for which there has hitherto been no specifictreatment. Wright and his associates noted mild

hypochromic anaernia in all who received aureomycinparenterally. This was not severe enough for treat-ment to be stopped, and it responded to treatment withfolic acid and iron; subsequently the ansemia was shownto be largely due to the solvent used for the aureomycin.

This antibiotic also seems to be effective in a numberof ocular infections. Braley and Sanders, 4 of ColumbiaUniversity, have used it locally as a 0-5% solution,of aborate salt, in saline. Milder infections such as inclusionconjunctivitis, vernal, follicular, and influenzal con-

junctivitis, and conjunctivitis due to staphylococciand pneumococci improved within a matter of hours andcleared in one to two days. Epidemic keratoconjunctiv-itis and dendritic keratitis were more resistant, requiringprotracted local and parenteral treatment. ’ In epidemic,keratoconjunctivitis aureomycin was of ’value only whentreatment was started before the fourth day of the-disease ; with dendritic keratitis and Mooren’s ulcerresults were equivocal. No patients with trachoma weretreated, but it is thought that aureomycin should - beuseful in this condition. In the opinion of Braley ’andSanders it is at least as effective as; penicillin whenapplied locally, and it is noi-irritating to the inflamedeye.

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Unlike streptomycin aureomycin is ’wirtually non-toxic in therapeutic doses ; the only side-effects so farobserved are occasional nausea and some pain oninjection,- which will no doubt disappear’ with theelimination of impurities. It will almost certainlyearn a place alongside penicillin and streptomycin.

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NEW YEAR HONOURS

IT seems only yesterday that Sir John Boyd Orr,of the Rowett Institute, was speaking his persuasivewords in World of Plenty. But the intervening yearshave given him vast new audiences who have understoodfor the first time the practical importance of the scienceof nutrition, both for themselves and for the nations.His earnestness and his exposition have released a greatconstructive force that will go on acting whatever hehimself may now do ; but it is entirely right that heshould have the permanent place among our legislatorswhich a peerage now gives him. Another man who, inhis own less conspicuous way, -has done a great dal toapply scientific knowledge to everyday life is Sir WilsonJameson, now appointed G.B.E. Medicine is fortunateboth in the wisdom and in the loyalty of its senior

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representative in the Civil Service during a decade ofunparalleled difficulty, and fuller knowledge of his servicewill deepen the respect in which he is held on all sides.Sir William Gilliatt’s K.c.v.o., though it commemoratesa happy event, has been earned in many years ofvaluable work. Of the new knights, Prof. Henry Cohenis well known as a clinician and as the principal authorof the B.M.A.’s report last year on medical education ;and he has lately assumed a major professional responsi-bility as -vice-chairman of the Central Health ServicesCouncil. He combines common sense with uncommondistinction of mind. Mr. H. E. Griffiths, who alsoreceives a knighthood, is a surgeon whose originalinterest in industrial injuries has widened into long anddevoted advocacy of btter reablement. Prof. Sydney

4. Braley, A. E., Sanders, M. Ibid, p. 426.

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Smith, third of the medical knights, is an adopted butcherished son of Edinburgh who has won enviable

reputations as professor of forensic medicine, as dean ofthe medical school, as acting principal of the university,and as much besides. The many other honours whichwe, are glad to record on p. 77 include a Privy Counsellor-ship for Dr. Edith Summerskill, in recognition of herexpertness as a parliamentarian.

A LITTLE NURSING ?

Two students write today to protest against theintroduction of three weeks’ nursing experience intothe medical curriculum as " a ridiculous waste of time."They hope this innovation will not spread to other

hospitals, and plead instead for " at least one forcepsdelivery." Our sympathies are often with students whenthey criticise the curriculum, but we cannot share thisview, which seems to reflect a regrettable bias given tothe doctor’s professional outlook by current training.Mr. Carruthers and Mr. Richardson feel that the student,by watching the nurses at work in the wards, can acquirea technique which he should later constantly use andteach to others-that of making people comfortable.It cannot be acquired by observation alone, or, forthat matter, by three weeks’ instruction: good nursingcomes with practice. But though three weeks will notmake the student a good nurse it will at least teach himthe rudiments and some of the difficulties of an importantside of his job. Other hospitals would do well to followthe London Hospital’s lead.

DOES SODIUM SALICYLATE CURE RHEUMATICFEVER ?

UNDER this title Reid has published an article inwhich he postulates that adequate oral administrationof sodium salicylate can really cure the diseaserheumatic fever. This assertion is based on observationof 9 adults, and of 3 children with pericarditis. Of theadults 7 were given sodium salicylate 2 g. and sodiumbicarbonate 2 g. at four-hourly intervals from 6 A.M. to10 P.M.—five doses daily-until " complete recovery asindicated by the return of the erythrocyte-sedimentationrate to normal." The other 2 adults received the sameamount of sodium salicylate but no alkali. To 2 of the3 children (aged 14, 12, and 9 years) sodium salicylate1-3 g. and sodium bicarbonate 1-3 g. were given at thesame intervals as for the adults ; the third child receivedthis dosage of sodium salicylate but no alkali. Reidgives evidence that the efficacy of salicylate treatmentdepends upon the attainment and maintenance of a

plasma-salicylate level of 30-40 mg. per 100 ml. ; healso suggests that the urinary concentration of salicylateis a satisfactory guide to the plasma concentration. Hefound the fall in the sedimentation-rate to be closelycorrelated with the plasma concentration of salicylate ;failure to respond to salicylates is attributed by him toneglect to maintain a satisfactory plasma-salicylate leveland to withdrawal of salicylates at too early a stage." The practice of giving large doses of salicylate untilfever, tachycardia, and joint pains have been relievedand then drastically reducing the dose is condemned."

This is a valuable contribution to an ever-vital

problem. But the series is small ; and it is perhaps riskyto base conelusions upon a study principally of adults, fora first attack of rheumatic fever after the age of 20seldom causes permanent damage to the heart. (Thiscriticism can also be levelled against some Americanreports, such as those of Coburn 2 and Manchester,3 inwhich a curative action is claimed for salicylates.) ’Thethird criticism is that no mention is made of any follow-up.

1. Reid, J. Quart. J. Med. 1948, 17, 139.2. Coburn, A. F. Bull. Johns Hopk. Hosp. 1943, 73, 435.3. Manchester, R. C. J. Amer. med. Ass. 1946, 131, 209.

The criterion of cure in this series-the sedimentation-rate-was also used by Coburn. Yet there is still nogood evidence that the effect of salicylates in loweringthe sedimentation-rate implies a parallel beneficial actionon the rheumatic process. Rapoport and Guest 4 foundin 15 patients with a raised sedimentation-rate, of whomonly 4 had rheumatic fever, that the administration ofsalicylate caused a fall in the sedimentation-rate ; and

Homburger 5 reported a similar finding in patients withcarcinomatosis. The most relevant contribution, how-ever, is that of Harris.6 Using full doses of salicylate(at least 1 grain per pound body-weight) he found that,of 6 patients with pulmonary tuberculosis and 4 withrheumatoid arthritis, 8 showed a fall in the sedimentation-rate of the order observed in patients with rheumaticfever under such treatment. In a further series of 6children with rheumatic fever, chosen because (a) theyhad leucocytosis, (b) the white-cell count was not affectedby salicylate, and (e) there were no manifestations ofsalicylate toxicity, he found that although the sedimenta-tion-rate fell to normal the white-cell count still reflectedcontinuing activity and there was no definite indicationof clinical improvement. Cautiously Harris concludes :" It is very doubtful that massive salicylate therapysuppresses the inflammatory reaction of the rheumaticpatient or that the lowering of the E.s.R. in rheumaticpatients so treated has the significance attributed to itby Coburn."The history of salicylates in the treatment of rheumatic

fever since they were first introduced for this purpose byMaclagan in 1876, does not suggest that they cure thisdisease. They have been used so widely and for so longthat it is hard to believe that if they had a curative actionthis would not have been recognised long ago. There

certainly would not have been reports, such as those ofMiller,’ Ehrstrom and Wahlberg,8 and Master andRomanoff,9 suggesting that the outcome of rheumaticfever in children is alike whether or not salicylates aregiven. Ehrstrom and Wahlberg’s conclusions were basedupon a series of 51,111 cases, while Miller’s were basedupon 1907 patients treated with salicylates and 1600who received no salicylates. Even .the argument thatthe earlier workers did not use large enough doses isnot valid ; as long ago as 1903 Lees 10 suggested dosesup to gr. 300 daily, while in 1906 Clarke 11 was givinggr. 240 daily. Recent work indicates that this is morethan enough to maintain the optimum plasma-salicylatelevel. Maggioni 12 has shown that in children the

optimum level can be maintained with a dose of gr. 1-1-5per pound body-weight (0,12-0,18 g. per kg.).

THE KING’S HEALTH

LAST Monday the following bulletin was issued fromBuckingham Palace : .

Since the bulletin of Dec. 13, 1948, the King has madeuninterrupted progress. His general health is entirelysatisfactory. On both right and left sides the arterial circula-tion in the legs and feet is improving slowly. It is not yetsufficient to allow more than strictly limited activity whenHis Majesty leaves London to continue his convalescence inthe country.

MAURICE CASSIDYTHOMAS DUNHILL

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HORACE EVANS -J. R. LEARMONTHJ. PATERSON ROSSMORTON SMARTJOHN WEIR.

4. Rapoport, S., Guest, G. M. Proc. Soc. exp. Biol., N.Y. 1946,61, 43.

5. Homburger, F. Amer. J. med. Sci. 1946, 211, 346.6. Harris, T. N. Ibid, 1947, 213, 482.7. Miller, J. L. J. Amer. med. Ass. 1914, 63, 1107.8. Ehrstrom, R., Wahlberg, J. Acta med. scand. 1923, 58, 350.9. Master. A. M., Romanoff, A. J. Amer. med. Ass. 1932, 98, 1978,

10. Lees, D. B. Brit. med. J. 1903. ii, 1318.11. Clarke, T. W. Amer. J. med. Sci. 1906, 132, 429.12. Maggioni, G. F. Arch. Dis. Childh. 1948, 23, 40.