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mental attitude to his disorder, and encouraged tocontinue in some form of employment for as long aspossible. His ability to cope with his symptoms is

largely determined by psychological factors, and thesuperimposed affective disorders can often be over-come by attention to the details of his general life.Whether these patients should be encouraged to mixwith one another is questionable ; in what is typically aslowly progressive disorder the disadvantages of suchsociety may heavily outweigh its benefits.The action of hyoscine in lessening parkinsonian

rigidity, first noticed, it is said, by GNAUCK in 1882,is shared by all the solanaceous drugs. Unfortunatelytheir mode of action is as yet unknown. Preparationsof hyoscine or stramonium are usually preferredto atropine or hyoscyamus because the latter havea longer-lasting effect on accommodation. Specialpreparations made from Bulgarian belladonna seemto have been convincingly shown to possess no

advantages over active pharmacopaeial preparations.12Patients with paralysis agitans, being older, toleratesuch drugs much less readily than postencephalitics, inmany of whom the dosage can with advantage bepushed far beyond pharmacopceial limits. Paresisof accommodation (causing dimness of vision) anddryness of the mouth can be reduced with eserineeye-drops, special lenses, and the addition of pilo-carpine nitrate; but dizziness, headache, mentalconfusion, diarrhoea, and urinary retention are toxicsymptoms which indicate that the limits of tolerancehave been passed. Amphetamine in suitable dosage willsometimes diminish rigidity, check oculogyric crises,and improve the mental state, though its effects arerarely striking. It is more important to ensure

sufficient sleep, and for this barbiturates are oftencalled for. ]In the last two years much has been heardof an entirely new compound, ’ Parpanit,’ a substanceclosely related to antispasmodics such as’ Transentin ’and ’ Dolantin ’ ; it has an atropine-like action,though we do not know how it works in parkinsonism.DuNHAM and EDWARDS, 1 after a careful assessmentof its value, concluded that its activity and side-effects are somewhat similar to those of the solanaceousdrugs. The new preparation may help when olderremedies are not well tolerated, but in most cases

nothing would be gained by abandoning thesolanaceous drugs. More recently RYAN and SPURWAYWOOD 14 have reported favourably on ’ Benadryl’ inparkinsonism. They treated some 40 cases with50 mg. three to four times daily, and none showedany toxic effects apart from sleepiness in the first

fortnight, though 2 patients had taken such dosesfor over eighteen months. Rigidity was consistentlyimproved and muscular cramps rapidly abolished,though tremor and oculogyric crises responded poorly.They remark that benadryl, though effective whengiven alone, can be used in conjunction with solan-aceous preparations. A correspondent last week

reported less happy experience ; but it seems at leastthat the anti-histamine drugs deserve an extensivetrial, in this disease.

Surgical relief of tremor, which often does not respondwell to medical measures, has been considered. Thevarious procedures have been discussed by BUCV,1512. Alcock, N. S., Carmichael, E. A. Quart. J. Med. 1938, 7, 565.

Hill, D. Lancet, 1938, ii, 1048. 13. Dunham, W. F., Edwards, C. H. Lancet, 1948, ii, 724.14. Ryan, G. M. S., Spurway Wood, J. Ibid, Feb. 12, p. 258.15. Bucy, P. C. Res. publ. Ass. nerv. ment. Dis. 1942, 21, 551.

KLEMME, 16 and others. In brief Bucy, recommendedextirpation of the precentral cortex, including bothareas 4 and 6 of Brodmann, though he was reluctantto attack the " arm area " of the dominant cortex,because a complete though temporary expressiveaphasia resulted. MEYERS 17 found removal of the headof the caudate nucleus beneficial, and section of thelateral pyramidal tract in the cervical cord, as

described by PUTNAM,18 reduced tremor considerablywithout producing much weakness in the limbs. Thislast procedure has the advantage of avoiding corticalextirpation with all its attendant risks. But sevenyears have elapsed since this- report was published,and it seems that most neurosurgeons on both sidesof the Atlantic do not regard the procedures withmuch enthusiasm. None of them is entirely satis-

factory, and since in general they are only suitablefor. young patients with a disabling tremor largelyconfined to one side, it is fair to say that surgerystill cannot benefit most cases.

It is too early to claim that great advances in thetreatment of parkinsonism are being made. We arestill ignorant of how the older remedies, act, and wemay not get much further until we learn more aboutthe disorders of function which characterise these

complaints. The author of the Disabilities’ articleof Feb. 26 remarked that the ease with which tremorcan be turned on and off by, a dose of a solanaceousmixture provides an opportunity for studying themechanism of tremor. It rests with us to make the

position clear to patients with parkinsonism, so asto save them needless disappointment; but a greatdeal can be done for them by studying the details oftheir management.

1899-1949IN its fifty years of life the School of Tropical Medicine

opened by MANSON in 1899 has gained world-widerenown ; and the annual report for 1948 of this schooland. of the London School of Hygiene, with which it isnow conjoined, says that of 289 students who have

completed courses in tropical medicine since the latewar, - 157 came from twenty-nine countries outsideBritain. Of recent years’the schools of tropical medicinehave been joined in their endeavours by powerful groupssuch as the World Health Organisation ; but in welcomingthis access of strength Prof. GEORGE MACDONALD warnsus that the school, to sustain its reputation for indepen-dent work, must continue to cultivate its own field.Prof. J. M. MACKINTOSH, the dean, points to the needfor still greater effort in the prevention of disease andthe promotion of health in the tropics. There is, hesays, room for fresh scrutiny of the school’s work, sincethe peoples of tropical lands stand on the threshold ofan " era of cultural and material development in whichtheir own sons and daughters will play a leading part."This point is taken up by Prof. B. S. PLATT, whoobserves :

" Whilst members of societies as highly developedas our own have derived immense benefits from theresults of the work of scientists, the majority of thepeoples of the world, particularly those in tropicalcountries... have for the most part benefited to.only a small extent ; indeed the results of progress ’have sometimes been detrimental to their health andwell-being." .

The rest of the report shows that this rueful thoughtis also in the minds of others who are planning for thenext fifty years. ’,’

16. Klemme, R. M. Ibid, p. 596.17. Meyers, R. Ibid, p. 602.18. Putnam, T. J. Ibid, p. 666.