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adequate level for Staph. aureU8 and some strains of

Strep. faecalís. A dose of 200,000 units six-hourly wouldprobably be lethal to most gram-positive organisms andabout 50% of gram-negative bacilli. There is, however,wide individual variation in the levels obtained, andfurther work is required on this subject.Another field for inquiry is the use of penicillin in the

prevention of urinary infections. If the drug will preventurethritis and ascending infection due to the indwellingcatheter, one of the urologist’s main difficulties will beovercome. Preliminary reports are encouraging.New advances bring new problems. Thus, in specialist

surgical units, where there are many similar cases, thereis a danger of a penicillin -resistant strain being spreadround by cross-infection unless the strictest precautionsare taken ; this must be borne in mind in urologicalw.ards. Another danger is that the removal of staphylo-,cocci from an infected area may lead to an increase in

gram-negative contaminants. This may not greatlymatter in surface wounds, but a heavy infection withinsensitive proteus or Ps. pyocyanea might be seriousin the urinary tract. It must also be remembered thatin many urinary infections relapse will be inevitableunless the mechanical efficiency of the tract is restoredby surgery.

OF NOT SMOKING

THE cost of tobacco imports this year is estimatedat ;E50 million-a full JE15 million more than the totalfor consumer goods andonly £ 10 million less than theanticipated expenditure on machinery and equipment.Much of this tobacco comes from the United States ;and the Government are said to have decided that, toconserve our dollar resources, the amount must bereduced. American growers are so confident of this cutthat they have already scaled down their productionplans.

If the cut were made, it could be argued that, tobaccobeing non-essential, ordinary private trade might beleft to take its course, with the demand constantlyexceeding the supply. Again, the tax might be increaseduntil the demand came down to the level of the supply;here the objection is that any further imposition mightmake of smoking a pastime only for the rich. Again,rationing could be introduced, as on the Continent- solution that would at least have the merit of tendingto provide equal shares for all. Finally, what was lostfrom America might be made good by purchases from"

soft-currency " countries ; and Greece is said to have

been marked as the’ source best able to’make good thedencit.

It is not easy to gauge the priority which tobaccomay justifiably be given. With essentials, such as food,our requirements can be assessed within narrow limits ;while the morale value of luxuries, such as films, can alsobe judged with fair accuracy. Unfortunately, there isno yardstick for the measurement of tobacco’s virtues.Hitherto authority has pandered to the growing nationaltaste for a, smoke ; all through the war the country hadas much, or almost as much, as it demanded ; and thereis little doubt that any restriction now would be violentlyopposed. Tobacco is, in fact, commonly regarded as anessential comfort, though why it should occupy thisplace in our affections is not clear. Plainly, smoking hasnot, as some have supposed, simply a symbolic value ;for the chewing of gum, though better than none, is a

poor substitute. Nor is its effect wholly explained byits pharmacological action. It seems likely that thecomfort it brings is derived, as with alcohol, from acomplex of conditions which defy rational analysis.Empirically, there is no doubt of its capacity to allayanxiety; the enhanced demand during the war wasprobably related less to increased spending-power thanto the troubled times. Fora great many people smokinghas become a means of keeping a mild psychiatric

disability within bounds, and we must face the fact thatany sudden or drastic reduction in supplies of tobaccowould cause a sharp rise in the.incidence of overt anxiety.

LIGUE INTERNATIONALE CONTRE LE

RHUMATISME

THrs body has been reconstituted, under the presi-dency of Dr. Ralph Pemberton, of Philadelphia, and hasbeen subdivided into a European Ligue and an AmericanLigue. A European congress will be held in Copenhagennext September and an international congress in theUnited States in 1949. The British branch of the Ligue isrepresented by the scientific advisory committee of theEmpire Rheumatism Council, with Dr. W. S. C. Copemanas chairman and national representative, Dr. G. D.

Kersley as treasurer, and Dr. Oswald Savage as secretary.New members will be welcome, and particulars may behad from the organising secretary, Empire RheumatismCouncil, Tavistock House North, Tavistock Square,London, W.C.l.

SMALLPOX

IN the Grimsby outbreak, where infection occurredin a lodging-house for seamen and farm labourers,the number of cases up to March 11 was 15, and 6 ofthese patients have died. All secondary cases haveoccurred in the direct line of contact. At least 8 contactsin this outbreak are still at large and remain unidentified.A case of semiconfluent smallpox has now been reported

in a man of 66 years, a resident member of the staff ofthe Empire Memorial Hostel for Seamen, in CommercialRoad, Stepney. No direct connexion with the Grimsbycases has been established. This man sickened - onMarch 3, and was removed to Mile End Hospital (L.C.C.)on the 5th. He remained there until the 9th, when hewas removed to a smallpox hospital. The Ministryof Health recommends that people who visited theseamen’s hostel between March 2 and 6 should be undercareful surveillance until March 20, and any person who hasvisited the hostel since Feb. 14 should be medicallyexamined. The source of the infection in Stepney hasnot yet been identified, and it is assumed that an abortiveor ambulant case-probably a woman-is still at large.

Several cases of smallpox have lately been reported inParis, and the outbreak is expected to spread.

RELEASE OF DOCTORS FROM SERVICES

THE Central Medical War Committee have beeninformed that the release of medical officers in class Awill be as follows :

Royal Navy.-April, group 60 ; May and June, group 61.Army.-General-duty Aledical Officers: April, group 57 ;

May, group 58 ; June, group 59. Specialist April 1-20,group 45 ; April 21-May 11, group 46 ; May 12-25, group 47 ;May 26-June 4, group 48 ; June 5-15, group 49 ; June 16-30,group 50.

Royal Air Force.-April, group 58.

WE regret to report that Dr. B. A. MCSwINEY, F.R.S.,dean of the medical school and professor of physiologyat St. Thomas’s Hospital, died on March 8 at the age of 52.

WE have also to record the death of Dr. Louis COBBETT,a former professor of pathology in the University ofSheffield and lecturer ’in pathology in the Universityof Cambridge, who died on March 10. Since his retire-ment in 1929 Dr. Cobbett had continued his work onthe bacteriology of tuberculosis. He was 85 yearsof age.

THE INDEX and title-page to Vol. II, 1946, which wascompleted with THE LANCET of Dec. 28, is publishedwith our present issue. A copy will be sent gratis tosubscribers on receipt of a postcard addressed to theManager of THE LANCET, 7, Adam Street, Adelphi,W.C.2. Subscribers who have not already indicatedtheir desire to receive indexes regularly as publishedshould do so now.