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the working mother ? You state that "at 40 women areready to go back to work "; but at that time a woman’sparents and those of her husband begin to fail and to needhelp, her husband may want more comfort, and soon themarried daughters will require assistance. Do not tell methat these tasks should be taken over by the social-securitypersonnel-a district nurse for half an hour and a home helpfor one hour a day are very poor substitutes for a daughter, awife, or a mother in case of illness. Again, you say that" Only 20% of doctors in Britain (compared with 75% inU.S.S.R.) are women "; but it is clearly misleading to selectas a model this single feature of an authoritarian systemwhere everything is closely interconnected. The statisticsof this country should be considered, which show how manyof the girls who study Medicine, never practise. The policyof some medical schools of limiting the number of girlentrants should be judged from this angle.

If, as you believe desirable, working women in all tradesand professions come to make the best possible use of theirabilities, the women of the future will have an institu-tionalised childhood and an institutionalised old age, and inbetween a working-life of rush, and nerve-racking strain,trying to fit two full-time professions into a 16-hoursworking dav.

RAHEL LIEBESCHUETZ.

EXPERIMENTAL MYASTHENIA GRAVIS

Sir have followed with interest the work on theattempted production of myasthenia gravis in animals byinjecting them with thymic or muscle extract in Freund’scomplete adjuvant. Dr. Vetters and his colleagues (July 5,p. 28), who were unable to demonstrate the production of anexperimental myasthenia, raise an important point whichDr. Kalden and Dr. Irvine (Sept. 20, p.638) have failed toanswer.

Vetters et al. question the validity of the thymitis, which,as I understand it, is essential for the production of theexperimental disease. The thymitis is diagnosed histologic-ally by observing a dense aggregation of lymphocytesaround Hassall’s corpuscles in the medulla. Goldstein et al.have described these findings in several papers.I-4

I submit that what is described as thymitis is in fact a1. Goldstein, G., Whittingham, S. Lancet, 1966, ii, 315.2. Goldstein, G., Whittingham, S. Clin. exp. Immunol. 1967, 2, 257.3. Oppenheim, T. J., Goldstein, G. Nature, Lond. 1969, 222, 192.4. Goldstein, G., Strauss, A. J. L., Pickeral, S. Clin. exp. Immunol.

1969, 4, 3.

Fig. 1-Normal guineapig thymus with prominent aggregationof lymphocytes around Hassall’s corpuscles in the medulla.

(Hsematoxylin and eosin; x 100.)

Fig. 2-Higher-power view of medulla showing cuff of lympho-cytes around Hassall’s corpuscle.(Haematoxylin and eosin; x 225.)

normal finding, which I have observed on many occasions inthe thymus gland of normal outbred guineapigs (figs. 1 and2). These illustrations are representative of many othernormal thymus glands. They are almost identical to fig. 2bin Goldstein’s recent paper,4 which is said to show thymitis.

I do not feel competent to judge the validity of theelectromyographic data, but I would suggest that whatGoldstein and his associates, and Kalden and Irvine, calla thymitis may be seen in the thymus of normal guineapigs.

It would be unfortunate if a crucial pathological role wasascribed to the thymus in this experimental system, uponthe demonstration of a histological appearance which canbe readily observed in the normal guineapig thymus.

J. N. WEBB.

University Departmentof Pathology,Edinburgh.

TREATMENT OF TETANUS

SIR,-The modern treatment of tetanus outlined byDr. Cole and Dr. Youngman 5 is too expensive to be

adopted in developing countries where the disease is amajor problem. The following is an analysis of the tetanuscases admitted during the 2-year period between Sept.,1967, and Aug., 1969, to the children’s department of thishospital, classified as of grade 2-3 severity by the criteriaof Cole and Youngman.

Apart from general nursing care, antibiotics, and atten-tion to local hygiene and nutrition, the standard manage-ment of these has been with chlorpromazine (2-4 mg. perkg.) given intramuscularly together with paraldehyde (0-2ml. per kg.), and 50,000 units of tetanus antitoxin intra-muscularly 15-20 minutes after the chlorpromazine andparaldehyde. We have encountered no allergic reactionswhen this order has been carefully adopted. 3 further

daily doses of 5000 units of antitoxin were given afteradmission. Spasms were controlled with diazepam(’ Valium ’), 1-2 mg. every 4-6 hours alternating withintramuscular paraldehyde until 48 hours after cessation.

5. Cole, L., Youngman, H. Lancet, 1969, i, 1017.