725

would increase any risk of unemployment for them..Since many women have expensive dependants, and manymen have none, this habit among employers is only avery blunt instrument of social justice. Yet it is wielded

occasionally even in the professions, where the custom ofequal pay for equal work has sometimes been known todeprive women of appointments for which they were fit.We do not regret that custom, but it is insufficient byitself. As the commission point out, our present familyallowances and income-tax rebates are insufficient; andwe doubt if any effort to make remuneration equitablewill get far without the inclusion of larger allowances fordependants.

SYNTHETIC PENICILLIN

THE recent announcement in the press that penicillinG (i) has been synthesised in America, though accuratein fact, may have been misleading in emphasis, for theyield is very small.During the war penicillins F and G (i and 11) were

obtained in traces by synthetic processes which wereworked out simultaneously in Oxford and in the Mercklaboratories in New Jersey, U.S.A. Secrecy had to bemaintained at the time, but a joint monograph is shortlyto be published. It was clear in the early stages of theseinvestiga,tions that the antibacterial product obtainedwas penicillin, but more evidence on this point wasgathered by workers at Cornell University, who alsoobtained the product in a high degree of purity. Du

Vigneaud and his colleagues 1 of the Cornell biochemicaldepartment have now described the synthesis of penicillinG, by the interaction of d-penicillamine and 2-benzyl-4-metboxymethylene-5 (4)-oxazolone. There seems to beno likelihood that a way will be found of increasing theyield, and indeed the chances of any other reasonablycheap penicillin synthesis being developed are- remote.On the other hand, the work done by British andAmerican chemists may well lead to the prepa,ration ofnew " unnatural" penicillin compounds whieh-may have alittle something that the natural products haven’t got.

1942: THE TIDE TURNS

THE coincidence of the celebration of the fourthanniversary of El Alamein and the publication of theRegistrar-General’s report on 1942 1 had a certain signi-ficance, for 1942 marked the turn of the tide in the medicalas well as the military sense. 1940 and 1941 were marked

by all the vital statistical indications of the effects onnational health of the strains of total war. Mortalityfrom pulmonary tuberculosis, respiratory diseases, andcerebrospinal fever had risen considerably above theirpre-war levels ; the downward trends of infant andmaternal mortality had been halted, and there was arise in the civilian death-rate. Some of this mortalitywas due either directly to the air-raids, which caused22,215 deaths in 1940 and 19,543 in 1941, or indirectlyto the rise in infectious diseases resulting from thecongested living and working conditions and poor dietinevitable at the time.The recovery in our military fortunes which 1942

brought was associated with a striking improvementin the statistical measures of national health. The mostsensitive indices of well-being-infant mortality and

pulmonary tuberculosis death-rates-fell to record lowlevels of 51 per 1000 related live births and 542 deathsper million of the civilian population at all ages. Epi-demic diseases, such as whooping-cough, measles, andscarlet fever, all had low mortality levels ; cerebrospinalfever caused only 1143 deaths compared with the 2459deaths of 1940. These results were at least partly the1. Du Vigneaud, V., Carpenter, F. H., Holley, R. W., Livermore,

A. H., Rachele, J. R. Science, Nov. 8, 1946, p. 431.1. Registrar-General’s Statistical Review of England and Wales

for 1942. Tables : part I : medical. Pp. 319. H.M. StationeryOffice. 5s.

result of the less harassing conditions of life suggestedby the fall in the number of air-raid deaths to 3891,most of which occurred in the " Baedeker " raids onBath, Exeter, and Norwich. The achievement forthe ’first time of a death roll from diphtheria below2000, however, can be fairly attributed to the Ministryof Health’s immunisation campaign. A curious featureof these annual reports on the war years is the progressivedecline, noted also in the first world war, in the numberof suicides ; from a pre-war annual average of 5000,the toll fell to 3416 in 1942.The Comparative Mortality Index, which takes 1938

as a base line of 1-000 in the standardisation for age, wasintroduced in the 1941 report 2 ; in that for 1942 it takesits place as a regular feature. From 1938 the trend incivilian mortality is clearly indicated by the C.M.1.

Similarly the ratio of male to female mortality shows thedisproportionate rise in mortality among the men of thecivil population.

- C’.M.7. Male-femate ratio

1938 ...... 1-000 ...... 1-343

1939 ... -" .. 1.022 ...... 1-339

1940...... 1-171 ...... 1-382

1941...... 1-070 ...... 1-406

1942 ...... 0-942 ...... 1.416

The Registrar-General’s report for 1945 is in prepara-tion, and we may look forward to a resumption of thecomplete and up-to-date reports of pre-war practice. -

ON THE STAFF

AT some hospitals junior honoraries are not

distinguished from their seniors except, possibly, by an" assistant " before their titles. At many others thedistinction is one not only of name but also of privilege :the assistant may, for example, be expected to see alloutpatients, and may have under his personal chargeonly a few beds, the number depending on his principal’sliberality. This practice is blessed by the years ; but, asa correspondent indicated some months ago,3 it is onethat would best be abandoned. The division of duties isindefensible ; work in the outpatient department no lessthan in the wards requires all the skill a unit can com-inand; and there is much in favour of the care of thepatient, after admission, being in the hands of the doctorwho first examined him as an outpatient.

> The assistant honorary, who, in any case, shares anequal weight of responsibility with others on the staff,should be rewarded at least by official recognition in theallocation of beds. St. Peter’s Hospital for Stone, London,have now announced that the title of assistant surgeonis to be discarded there; all the honorary surgicalstaff will be called honorary surgeons and will control anequal number of beds, except perhaps for some slightadvantage to one or two of the most senior. Juniorhonoraries elsewhere will hope that this example isnot lost on other hospitals.

THE SCOTTISH BILL

THE Bill providing for a comprehensive medicalservice for Scotland was -published last week. Thoughthe scheme as a whole follows the English model, thereare several interesting variations. For example, the

provision, equipment, staffing, and maintenance of,health centres will be the duty of the central healthdepartment, and though the Secretary of State isempowered to delegate this function to local healthauthorities he is, it is stated, unlikely to exercise this

power widely in the early years of the new service. Themain differences between the Scottish Bill and the EnglishAct are described in our parliamentary columns.

2. See Lancet, Sept. 28, p. 469.3. Lancet, 1945, ii, 350.