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of 0’5 to 1 mg. it provokes, after an interval of6 2 to 8 minutes, contractions which, recorded

by the intra-uterine bag method, prove to beidentical in mode of onset and general characterwith those produced by active liquid extracts ofergot. It may also be given by intramuscularinjection, when a dose of 0’25 to 0’5 mg. producesstrong uterine action in 3t to 4! minutes. Intwo patients who received intravenous injectionsstrong response followed doses of 0’05 and 0’1

mg. in 110 seconds and 65 seconds respectivelv.It is of interest that the tracing shown of theeffect of one of these intravenous injections wasmade by a new method of recording uterine con-tractions which makes use of an apparatus torecord the changes in uterine shape felt throughthe abdominal wall. This method, which has theobvious merits of simplicity and of the avoidanceof the need to insert a foreign body into a uterus,has proved useful in exploratory experiments,but is not so accurate or so dependable as theintra-uterine bag. It is satisfactory to learn

(private communication) that no signs of pyrexiahave been attributable to its insertion among the

puerperal patients cooperating in these tests.The importance of the isolation of ergometrine

requires no emphasis. Its pharmacology is beingstudied by Sir HENRY DALE, F.R.S., and Dr.G. I. BROWN, and doubtless their report willlead to re-examination of the problem of pre-paring extracts of ergot for clinical use. Itwill be remembered that at the present time

ergot preparations are assayed and standardisedin terms of their total alkaloidal content reckonedas ergotoxine. Now the main activity of oral

preparations has been shown to depend uponthe presence of an ingredient for which thistest is not specific. Up to the present the onlycriterion of the presence of ergometrine is itscharacteristic action, after oral administration, onthe human puerperal uterus ; its action on isolated

strips of the resting uterus of animals is masked bythat of the other alkaloids, and the difficulties ofrecording contractions of the uterus of a puerperalanimal after oral administration of the drug maywell prove insuperable. Clearly large scale applica-tions of this new knowledge must await the successof attempts to devise a method of determining theproperties of ergometrine in official and other

preparations, and so put the assay of ergot extractson a satisfactory basis in relation to their clinicalefficiency.

ANNOTATIONS

ŒSTRIN AND PARTURITION

THE function of oestrin during pregnancy has longbeen a matter of discussion. CEstrin exists in the bodyduring this time in large quantities, yet the stateof the reproductive organs is such that it cannotexert its normal action. Furthermore, experimentson animals have shown that the administration ofadditional cestrin can interfere with pregnancy andmay produce abortion. These experiments, in con-junction with the fact that the rate of oestrin excretionreaches a high value by full term, have naturallygiven rise to theories which invoke this substanceas one of the factors concerned in normal parturition.The obvious flaw in such theories is the difficulty ofexplaining away the oestrin which is produced pre-viously. Why should it act so powerfully just at term,and yet have no influence in the preceding months whenit is present in quantities only slightly smaller’? The

paper by Mr. Cohen, Dr. Marrian, and Dr. Watson,which appears on another page, throws new light onthis problem. They point out previous sources oferror in the quantitative estimation of cestrin excretedby the pregnant woman, and show conclusivelythat this oestrin is in a physiologically inactive form.Not until the last week or ten days of pregnancy isactive cestrin excreted in any quantity, and normallabour is accompanied by an enormous increase inthe active, and a decrease in the inactive, compound.As the Toronto workers point out, any theoriesfounded on these facts must for the moment be

speculative, but it is tempting to suppose that activecestrin is in some way necessary for parturition,and that during pregnancy the oestrin-producingtissues are becoming more and more active with this.end in view. Possibly the cestrin they produce isuseless, or possibly it would be harmful to the

organism ; at any rate it is converted into an inactiveform and excreted until the critical time approaches,and then the process of inactivation is stopped and

the body is flooded with active material. Othertheories could easily be made to fit the facts, butwhatever the explanation may be the new workmakes it fairly clear that oestrin has a function

during parturition which it is prevented from

exercising in the preceding months of pregnancy.

BRITISH SOCIAL HYGIENE COUNCIL

NVE publish this week a brief but forcible appealfrom Lord Horder and a group of authoritativesignatories for pecuniary support in furtherance ofthe objects of the British Social Hygiene Council.The letter is so explanatory of the reasons whythe Council should receive hearty endorsement fromthe medical profession that further words in its

support would be redundant, while the theme requiresno embellishment. The Council was instituted inits first shape to deal with terrible evils-evils whichleapt to the eye, but produced too little practicalimpression ; and, what was worse, then menace wasgrowing incalculably. By the vigorous cooperationof laymen and doctors the immediate situation wasmet and greatly remedied. But as the work went onits logical scope became revealed to those in theconduct of the Council’s affairs; its efforts becamewidespread and from time to time we have referredto the imperial significance of many of its achieve-ments. But the work that has been done has notreceived the recognition that it has merited, althoughregular publication of both the objects and perfor-mances of the Council has taken place, and itsliterature has been frequent and convincing. Thisis a bad time, as Lord Horder and his co-signatoriesadmit, for launching an appeal to public benevolence-but with the far-reaching claims of charity everytime is, and will be, a bad one. We wish to claimfor the British Social Hygiene Council the sympathyand encouragement of the medical profession for thereasons set out in the appeal. And if any one ofthese reasons is more forcible than the others it is

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that the Council recognises the supreme claim ofour young people, who have the right to find theworld in which they have to make their way, a

wholesome one, and the right to expect protectionfrom gross but remediable dangers.

THE ELECTROCARDIOGRAM IN DIPHTHERIA

IN a study of electrocardiographic changes in 13 fataland 194 non-fatal cases of diphtheria, Andersen 1confirms the findings of previous observers. Patients

dying in the first 15 days of the disease may showevidence of myocarditis in the first five days ; butsuch changes are rarely conspicuous. Since the workof Warthin 2 and Schwentker and Noel 3 this "early"myocarditis has been attributed to degenerativechanges dependent upon the general toxaemia. It isto this, rather than to damage of such specific struc-tures of the heart, that death is due in this stage.After the fifth day the electrocardiographic changesare more striking, and death seems to depend directlyupon the cardiovascular damage ; this " late "myocarditis is ascribed to reactive and regenerativechanges, and all parts of the curve may show changes.The signs of myocarditis are often overshadowed inthe electrocardiogram by evidence of conductivelesions, notably intraventricular block, bundle-branchblock, and complete heart-block. The more severethe case, the more obvious the changes. Completerecovery from all types of lesions is recorded, butdamage may still be detectable when the patientleaves hospital and even as long as eight years after-wards. Although there is much agreement betweenelectrocardiographic and clinical signs, the formerusually precede the latter, and changes in the curvesmay demonstrate lesions which cannot be discoveredby other means. The most important lesion whichmay be missed clinically is complete heart-blockassociated with a raised ventricular rate.

A STUDY OF MIGRAINE

THE multiplicity of remedies advocated for thetreatment of migraine may only serve to indicate ourlack of knowledge of the nature of this common andincapacitating complaint. Certain it is that as yet wehave no one specific line of treatment uniformlysuccessful in all cases. It may also suggest thatmigraine has not one cause but many causes, andthere have been many ingenious attempts to dividecases of migraine into various clinical types, thoughfew deny a common constitutional or hereditarytendency. A recent study by Prof. P. Vallery-Radotand Dr. J. Hamburger 4 reviews much of the originalwork on migraine in the light of their own experience.They divide their patients, according to the apparentcause, into five categories : (1) endocrine, especiallymenstrual migraine ; (2) digestive migraine ;(3) biliary migraine ; (4) anaphylactic or allergicmigraine; (5) migraine of local origin with cervicalneuralgia, and painful fibrositic nodules-trea,tmentbeing suitably adjusted according to the type of case.In the menstrual type extract of corpus luteum,12 injections immediately preceding the period, hasgiven satisfaction if continued for several months.Digestive migraine, which appears to follow particulararticles of food, is sometimes amenable to dieteticmeasures; Marcel Labbe has had success with a

vegetarian diet, but Vallery-Radot has seen more

from restricting special foods and reduction in starch

1 Andersen, M. S.: Acta Med. Scand., 1934, lxxxiv., 253.2 Warthin, A. S.: Jour. Infect. Dis., 1924, xxxv., 32.

3 Schwentker, F. F., and Noel, W. W.: Bull. Johns HopkinsHosp., 1929, xlv., 276.

4 Les Migraines. Paris : Masson et Cie. Pp. 232. Fr.45.

and fats. In biliary migraine the authors chooserepeated biliary drainage, although other workers havehad results with salines and bile salts by mouth. In

allergic migraine some patients respond to non-specificdesensitisation, or to peptone in half-gramme dosesbefore meals given over long periods. Finally, casesassociated with tender fibrositic nodules in the softtissues around the neck and skull may be relieved bymassage, ionisation, or other physical measures. Inthe main these are the principles accepted by mostclinicians elsewhere, but they will derive instructionfrom the authors’ discussion of the diagnostic diffi-culties in separating clinical types, and of the manypossible variations in dietetic or drug treatment.The book has an abundant bibliography.

THE BLINDING WORM OF GUATEMALA

THE complete story of the pathological lesions ofthe eye, induced by the embryos of Onchocercacaecutiens, the so-called " blinding worm " of Guate-mala, is set out in a volume which forms a notableaddition to the splendid series of monographs issuedfrom the department of tropical medicine of HarvardUniversity, under the leadership of Prof. R. P. Strong.Records are supplied of the investigations made inGuatemala during part of the years 1931 and 1932,together with a subsequent study in the laboratoriesof the department of tropical medicine at Harvard, ofthe pathological material, parasites and insectscollected in Guatemala, as well as in other centreswhere onchocerciasis prevails. Prof. Strong discussesthe more important features of the work of the

expedition in Guatemala and the success of the publichealth measures for the eradication of the disease, andProf. Sandground writes a critical analysis of the

genus onchocerca. An entomological study of thesimuliidae by Dr. Bequaert, and an epidemiologicalstudy of onchocerciasis in Guatemala by Dr. Ochoacomplete the work.

Onchocerciasis in Guatemala is confined to threedistricts in which a high grade of coffee is grown;there the climate is temperate and the altitudeapproximately 2500-5000 ft. In all the endemicareas the three species of simulium which transmitthe disease-S. metallicum, S. callidum and S. ochraceum-are found in abundance. Over 98 per cent. of allcases of onchocerciasis occur in the prevailing Indianpopulation. In Guatemala the tumours produced bythe adult worms-Onchocerca cepcM’eK.?—occur mostlyin the scalp or in the region of the head, whereas inWest Africa the patients with this disease tend to havethe lesions on the body. The microfilariae, or embryos,are more numerous in the skin in the vicinity of thetumour than in the skin at more remote places. Thetumours themselves are small, measuring 6-20 mm.in diameter, and a few only 1-2 mm. The most

important pathological studies here set out concernthe eye, and have been collected from investigationsof 11 eyes removed at operation. In every case themicrofilarim were demonstrated in sections both instained and in unstained preparations ; unfortunatelythey tend to congregate in the tissues of the eye,possibly because they are phototropic. In the cornea

1 Onchocerciasis, with special reference to the CentralAmerican form of the disease. In four parts : I., by Richard P.Strong, Ph.B., M.D., S.D., professor of tropical medicine,Harvard University Medical School; II., by Jack H. Sand-ground, D.Sc., assistant professor of tropical helminthology atthe school; . III., by Joseph C. Bequacrt, Ph.D., assistantprofessor of entomology at the school; IV., by Miguel M.Ochoa, M.D., parasitologist, Salubridad Publica, Guatemala.Contributions from the Department of Tropical Medicine andthe Institute for Tropical Biology and Medicine, No. VI.Cambridge, U.S.A. : Harvard University Press. London :Humphrey Milford, Oxford University Press. 1934. Pp. 234.21s.