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about the approach to research within the Service,believing that success is most likely to be attained by acombination of workers in the field, as represented bythe flying personnel medical officers, who perform theirduties under active-service conditions and keep in touchwith the Royal Air Force institute of aviation medicine.This policy has been justified by results. When contro-versy or rivalry has developed, he has been unperturbed;for he maintains that they bud only in the garden ofgood fruits, and that lack of them is a sure sign offailure in achievement.

SELECTION TESTS FOR NURSES

OuR annotation of Jan. 12 on selection tests for nursingcandidates is described by the Nursing Times (Feb. 9)as depressing. Evidently therefore it needs to be ampli-fied. The proposal of the Royal College of Nursing thatselection tests should be introduced into the professionstrikes us as forward-looking and sound ; but we areanxious that the tests should be applied within theprofession and not used as a means of excluding candi-dates. Our annotation suggested that a simple, barelyliterate girl may sometimes have " the ability to make apatient comfortable." The Nursing Times feels that thisis setting rather a low standard of efficiency for thenurse: "what is the use of making a patient comfort-able," it asks, "if you kill him with an overdose ofmorphia or paraldehyde, because you have not the abilityto give him the correct dose ? " Not much, certainly ;but perhaps the nurse in question should not have beenentrusted with the measurement of doses : her nursingability may be of a different but equally valuable order.The country’s health services can be run by relatively

few doctors, but without great numbers of nurses it willbreak down. Nursing offers such wide variety of dutiesand interests that it should be possible to find room inthe profession both for women with first-rate intellectsand for those whose chief recommendation is a com-

petent pair of hands. This is not the moment to puteven small obstacles in the way of the girl who thinks shewants to nurse.

REACTIONS TO PENICILLIN

ONE of the remarkable features of penicillin therapyhas been the rarity of reactions, but two articles inthis issue demonstrate that troublesome reactions arenot unknown. How far these are due to impuritiesmust remain doubtful until pure penicillin is generallyobtainable. Commercial penicillin now contains some30% of impurities, whereas in the early days it contained80-90%, and increasing purification has certainly madereactions increasingly rare. Even now, however, Cormiaand others 1 have encountered reactions severe enough tonecessitate the discontinuance of penicillin therapy in0-5% of 2000 U.S. soldiers given long courses of the drug 1

for various infections. Reactions to penicillin-like those to the sulphonamides-may appear either soon afteradministration begins, where the patient is " naturally " hypersensitive or has been sensitised by a previous course iof penicillin, or some days later when the patient hasacquired sensitivity during the course of treatment ;commonly, as in the cases reported by Major Haswelland Captain Wilkinson, the reaction will then appear, tlike serum-sickness, after administration has ceased.

It seems fairly certain-though the result of skin- tests are not conclusive-that penicillin itself can produce ia contact dermatitis after protracted application. Pyle and Rattner,2 and Barker,3 described cases in doctors and orderlies who had been making up penicillin (

solutions for a long period ; patch tests with crystalline penicillin were positive in Pyle’s cases. Cormia and his

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1. Cormia, F. E., Jacobsen, L. Y., Smith, E. L. Bull. U.S. Armymed. Dep. 1945, 4, 694.

2. Pyle, H. D., Rattner, H. J. Amer. med. Ass. 1944, 125, 903.3. Barker, A. N. Lancet, 1945, i, 177.

colleagues report a case of severe urticaria and angio-neurotic oedema, leading to pulmonary oedema, beginning24 hours after the local application of penicillin ointmentin a soldier who had received two courses of parenteralpenicillin in the previous month ; these had presumablyproduced sensitivity. Of the reactions produced byintramuscular injection by far the commonest form isurticaria ; among the 209 surgical cases treated withpenicillin by Lyons 4 in 1943, urticaria, sometimes

accompanied by fever and abdominal colic, developed in5-7%. Cormia and his colleagues also mention a reactionresembling serum-sickness; also acute syncope, transientmiliaria-like eruptions, erythematovesicular eruptionsat times simulating dermatophytosis, erythema nodosum,and epididymitis. They give one example of epididymitisarising in the penicillin therapy of early secondarysyphilis and quote the 10 examples of epididymitis whichRosenberg and Arling5 encountered in 65 cases of meningo-coccal meningitis treated with penicillin. From a smallstudy with intradermal tests they conclude that fungusdiseases of the skin predispose to penicillin reactions.Lyons takes the view that urticarial reactions are so

transient that they can usually be ignored and penicillintherapy continued in spite of them ; this can hardlyapply, however, where there is a severe general reaction.Macey and Hays 11 have- obtained good results in severereactions with intravenous infusions of 50 c.cm. of 50%dextrose solution.

TWO MONTHS’ NOTICE

SINCE last July the medical press has in generaldeclined to publish advertisements giving less than fourmonths’ notice of a permanent appointment. This hasbeen done to ensure that no such post shall be filleduntil doctors serving overseas have had a chance ofapplying for it. Circumstances, however, have changedconsiderably since the four months’ rule was made : a large proportion of the possible candidates have nowbeen released, and the others are mostly more accessiblethan they were while the Japanese war was still in

progress. Inconvenience is caused to all parties by anyunnecessary delay in filling vacancies, and it is felt thatthe time has come when the period of notice requested ofemploying authorities should be reduced. The wayin which these authorities have fallen in with the viewsof the profession is much appreciated, and we are gladto inform them that advertisements will henceforwardbe accepted giving two months’ notice.

Dr. J. D. BARRIS died on Feb. 23 at St. Bartholomew’sHospital, London, to which he was consulting physician-accoucheur. He was 66 years of age.

Dr. J. G. PORTER-PHILLIPS, who died on Feb. 24 atthe age of 68, had been superintendent of the BethlemRoyal Hospital for 30 years when he retired in 1944.

4. Lyons, C. J. Amer. med. Ass. 1943, 123, 1007.5. Rosenberg, D. H., Arling, P. A. Ibid, 1944, 125, 1011.6. Macey, H. B., Hays, T. G. Nav. med. Bull. Wash. 1945, 43, 1143

SPEAKING at Bolton last week Mr. R. MacDonald Murray,a member of the council of the Pharmaceutical Society, saidthat the future health of the country demanded that alldrugs and medicines should be distributed through registeredpharmacies where there must always be a qualified chemistin charge. The chemist’s shop in his opinion was too wellestablished in the life of the community for any revolutionarychanges under a National Health Service. In industrialdistricts especially, it would remain the medicine cupboard,of the poor.

THE SCIENCE AND ART OF MEDICINE.-Sir Lionel Whitby’slecture on this topic (see Lancet, Jan. 5, p. 22), which hedelivered on Dec. 5 on his inauguration to the regius chair ofphysic in the University of Cambridge, has now been publishedby the Cambridge University Press (Pp. 24. Is. 6d.).