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have a system of family allowances for their staffs ;and teachers on retirement receive pensions throughthe Federated Superannuation System for Universities.

PENICILLIN INHALATION FOR POSTOPERATIVE

COMPLICATIONSTHE inhalation of penicillin aerosol produces effective

penicillin levels in the sputum, and its value is undisputedin pulmonary disease associated with sensitive organ-isms.! The place of this therapy in the treatment ofpostoperative pulmonary complications is not so certain.It is generally believed that collapse of the lung afteroperation derives mainly from mechanical and physio-logical disturbances of respiration brought about by theoperation itself and by the anaesthetic. Subsequentinvasion by bacteria is probable, and in certain circum-stances-for example, in old age or with toxaemia orpre-existing lung disease-bronchopneumonia may ensue.The influence of penicillin inhalation in preventing

this bacterial invasion has been investigated by Taplinand his colleagues. 2 They found that most post-operative pulmonary infections are caused by organismsalready present in the respiratory tract before operation,and that nearly all the organisms normally residing in thetract are sensitive to penicillin or streptomycin. Thoughnot impressed by the aerosol method, they believe thatthese drugs can be effectively inhaled in the micro-pulverised (" micronised ") form, the powder having aparticle size of about 1 µ. In this powder the vehicle isdextrose, which may act as an expectorant since, whenfirst dissolved, it forms a hypertonic solution. Thetreatment is apparently well tolerated by patients, whoquickly learn how to inhale the powder properly and toavoid coughing. Penicillin and streptomycin assays ofperipheral pulmonary tissue from patients who hadundergone thoracotomy showed that the powder pene-trates to the terminals of the bronchial tree ; and Taplinand his associates suggest that this form of inhalationtherapy should be started some time before operation,so as to reduce or eliminate the bacterial population inthe upper respiratory tract.A few weeks ago Holborow and Spriggs 3 reported in

these columns that nebulised penicillin did not signifi-cantly reduce the incidence of chest complications.Thus it seems to be agreed that penicillin aerosol is

disappointing. Micropulverised powder containing peni-cillin and streptomycin seems more promising ; perhapswith it the treatment of the ubiquitous postoperative" chest " will be taken one step further.

THE DENTIST’S EARNINGS

THE Spens Committee on the remuneration of dentiststhought that an efficient single-handed dentist working33 chairside hours a week should be able to earn a netincome of 91600 a year at the 1939 value of money.A general medical practitioner on a comparable standardof full but not unusually heavy work would, they thought,command .El 800, the difference being justifiable becausethe doctor would have less leisure and less time entirelyoff duty. If 20% is added for betterment, the Spensincome of n600 becomes £1920 ; and if the practiceexpenses of a dentist are reckoned at 52% he will requirea gross income of about £4000. The Ministry of Healthaccepted £3800 as a reasonable figure for the grossearnings of a dentist working 33 chairside hours, andrecognising that for many dentists the volume of workmakes longer hours necessary it sees no reason why anadditional 91000 should not be earned, making £4800in all. But it is well known that some dentists in the

1. Mutch, N., Rewell, R. E. Lancet, 1945, i, 650. Humphrey,J. H., Joules, H. Ibid, 1946, i, 221.

2. Taplin, G. V., Cohen, S. H., Mahoney, E. B. J. Amer. med. Ass.1948; 138, 4.

3. Holborow, E. J., Spriggs, E. A. Lancet, Oct. 30, p. 688.

National Health Service are in fact earning far largerincomes, particularly in industrial areas, where grosstakings at the rate of E7000-8000 are said to be notuncommon ; indeed here and there the rate is as highas £12,000 a year. Accordingly the Ministry has decidedthat from the start of next year gross annual earningsbeyond E4800 by dentists in the service will be reducedby half. The relatively high incomes are attributablenot only to long hours of work, but also to scales of feeswhich have proved more generous in practice than wasexpected. A thorough review of the scales is to -beundertaken. Meanwhile officials of the dental organisa-tions have protested that an investigation, with the dentalprofession participating, should precede any change;and that the change now announced will discouragedentists from working the longer hours required bythe public need. It yet remains to be shown howthe general medical practitioner is. to obtain theadvantage in remuneration to which the SpensCommittee thought he was entitled.

THE MEDRESCO HEARING-AID

OVER 3000 of the hearing-aids designed by the electro-acoustics committee of the Medical Research Council 1

have so far been distributed through the National HealthService. An efficient and quite powerful valve-amplify-ing aid of the portable type, the Medresco is about themost powerful instrument for its size at present manu-factured. The microphone and valve circuit are housedin a small plastic container, while the batteries are in aseparate leather pack-a little bulky because the batteriesare designed to give a long service. The two batteries,high-tension and low-tension, have different shapes ofplug fitting so that no mistake is possible in connectingthe wires. As ear-piece the patient can choose betweena crystal insert and a telephone : the former is the moreefficient and can readily be attached to a plastic meatalmould which is made in several sizes. The volume-control has a good range but is somewhat clumsily built.The instrument as a whole naturally lacks the finish andsome of the refinement of the best commercial aids ofthis type, but -it is easy to use and is robust enough tostand up well to wear and tear.

THE KING’S HEALTH

The following bulletin was issued from BuckinghamPalace last Monday: The King’s general health continues to be good, and he

devotes a considerable proportion of his time to the conductof affairs of State.The process of restoration of the arterial circulation to

the feet is proceeding slowly, and since the bulletin of Nov. 29a further small but encouraging improvement has occurred.

In order to secure the rest and the warm environmentwhich are indispensable for the re-establishment of thecirculation, his Majesty is remaining in his apartments andspends most of the time in bed.

MAURICE CASSIDYTHOMAS DUNHILLJ. R. LEARMONTHMORTON SMARTJOHN WEIR.

Dr. ARTHUR ROBINSON, emeritus professor of anatomyin the University of Edinburgh, died at Eastbourne onDec. 3, at the age of 86.

Dr. F. B. PARSONS, physician to Addenbrooke’sHospital, Cambridge, died in London on Dec. 4, at theage of 46.

We also regret to announce the death on Dec. 4 ofSir EDWARD , STEWART, K.B.E., M.D., a former vice-chairman of the British Red Cross Society. He was inhis 92nd year.

1. Lancet, 1947, ii, 801.