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features of depression we shall come to any full

understanding of this common disorder, profit maybe expected from a study of the ways in whichinstinctual forces are at work in it and how they arefused together in its various forms.

A REMEDY FOR MYASTHENIA

LAST June Dr. Mary Walker, of St. Alfege’s Hos-pital, described in our correspondence columns theremarkable effect of physostigmine upon a patientwith myasthenia gravis. A fortnight ago she wasable to show two cases to the clinical section of theRoyal Society of Medicine which illustrated therelief of myasthenic symptoms by prostigmin, an

analogue of physostigmine at present issued as a

proprietary preparation. These cases aroused greatinterest, as well they might; for the relief obtainedis unprecedented in this disease. In our presentissue Dr. Blake Pritchard, with due acknowledgmentto Dr. Walker’s lead, records observations chieflymade at University College Hospital, upon seven

cases of myasthenia gravis, all of which respondedto treatment with prostigmin, given in conjunctionwith atropine. The response, unfortunately, is nomore than transient; the recovery lasts but a fewhours. Moreover, it has yet to be learnt whetherfrequent injection of the drug does more good thanharm to sufferers from this disorder. On the otherhand, if temporary, the recovery is nevertheless

extraordinarily complete, and Dr. Pritchard’s myo-grams suggest that it is physiological, not accidental.In other words, prostigmin seems to repair themechanism damaged by the disease, and this findingshould lead us nearer to an understanding of thecause of myasthenia gravis if not to its cure. If itis true as seems probable-that stimuli are con-

veyed to muscles by the liberation of acetylcholineat the nerve-endings, then it is rational to supposethat in myasthenia there is some fault which preventsacetylcholine being formed in sufficient quantity ordestroys it too rapidly. The fact that prostigmincan correct this fault-probably by delaying destruc-tion of acetylcholine at the motor nerve-endings-isexcellent evidence that the site of the trouble is themyoneural junction. What relation, if any, thisbears to other observed changes, such as those inthe thymus gland, is still unexplained.

MILK-BORNE EPIDEMICS

TYPHOID fever has been largely mastered in thiscountry, but only at the price of eternal vigilance.It still looms large in America, where indeed it

presents a definite problem, and those larger areaswhich are well organised keep regular records of allknown typhoid carriers and endeavour to checkand control their movements. Despite this manyof the milk-borne epidemics are demonstrably due tocarriers, a fact which is being brought home to thecountry by the work of the Dairy Research Bureau,whose recent bulletin gives particulars of the milk-borne epidemics reported in U.S.A. during the year1933. They are summarised thus :-

Epidemics. Cases. Deaths.Typhoidfever ...... 25 .... 229 .... 26

Paratyphoid fever 1 .... 17.... 0

Diphtheria ...... 2.... 19.... 3

Septic sore throat .... 7 .... 515.... 6Scarlet fever 3.... 238 .... 4Milk sickness 2.... 10.... 1Udder cocci .. 2.... 250 .... 0

42 1278 39

Analysis of the 25 typhoid epidemics shows that13 of them were due to infection from a typhoid

carrier and a further three from cases of typhoidfever. The paratyphoid was spread from a case ofthis disease infecting the milk-supply. The epidemicsof septic sore-throat were large and it is a fact ofno little interest that such outbreaks are spread bymilk year by year in America, while they occur

rarely in Great Britain. Up to about 25 years agoone or two were reported in this country each year;outbreaks then ceased except for the extensive oneat Brighton and Hove in 1930-31. This peculiarityof distribution has never been explained. Of theU.S.A. outbreaks the two most extensive were atChilton (Wisconsin), with 1945 inhabitants and250 cases, and at Luzerne and Hadley (New YorkState), still smaller villages with 179 cases ; in eachinstance there were two deaths. One of the mostextensive outbreaks in the series was in CumberlandCounty (Tennessee), where 248 cases were attributedto hsemolytic staphylococci in the udder of two cows.More particulars of this outbreak would be of interest.Apparently it was of acute food poisoning typedue to the enterococcus toxin, thus linking it withother outbreaks of staphylococcus food poisoning.Two of the outbreaks, one of typhoid fever and one ofmilk poisoning, were spread by Grade A raw milk.In every instance the milk consumed was raw milk(in two cases cream) unpasteurised. This is linked upwith the fact that in 30 of these 42 epidemics thepopulation of the place was less than 10,000. Everystudent of public health in U.S.A. knows that theorganisation in the large cities is usually at a highlevel, in the small towns and rural areas often rudi-mentary. Pasteurisation is almost universal in thecities, incomplete and partial outside them. Diseaseis spread by milk only in areas which do not enforcepasteurisation.

ON Feb. 28th and March 5th Dr. E. H. R. Harrieswill deliver the Milroy lectures at the Royal Collegeof Physicians. He has chosen as his subject infectionand its control in children’s wards. The lectures willbegin at 5 P.M.

CONGRESS OF INTERNATIONAL SOCIETY OF SURGERY.This society is to hold its tenth congress in Egypt fromDec. 30th, 1935, to Jan. 4th, 1936, the dates having beenslightly altered from those previously announced. Themain subjects of discussion will be the surgery of theparathyroids, the surgery of the lumbar sympathetic,the surgery of the colon (cancer excepted) and the surgicalcomplications of bilharziasis. The congress begins witha reception by the municipality of Alexandria on Dec. 30th,and the members hold their first scientific session in Cairoon the following day. During the week there will be

receptions by the president (Prof. A. von Eiselsberg,of Vienna) and by the president of council, and dinnersby invitation of the Ministry of Public Instruction andby the Egyptian surgeons. It is hoped that there willalso be a reception at the Royal Palace. Among thosewho are opening discussions are Prof. Archibald Young,and Prof. G. Grey Turner, the British delegate, who maybe addressed at the British Post-Graduate Medical School,Ducane-road, Hammersmith, London, W.12. Prof. GreyTurner reminds potential members of the conferencethat many of the staff of the University of Cairo are

British ; furthermore a large proportion of the medicalprofession in Egypt have qualifications obtained in thiscountry and nearly all speak English. Travel arrange-ments are in the hands of Messrs. Thos. Cook and Sons(head office : Berkeley-street, W. 1.) who are prepared toissue itineraries and provide other information. The

secretary-general is Dr. L. Mayer, 72, rue de la Loi, Brussels.