388 allot equitably the available foodstuffs, and con- tiont of the filterable virus requires a very special cluding : " We make appeal to the conscience of technique,t of which McNee and his colleagues do the men of enemy peoples in whose breast the notI seem to have taken full advantage, as Edward sense of responsibility before the tribunal of Hort,7 whose pioneer work in this connexion is history is not stifled." unique,1 pointed out, and it is quite possible that all these investigations may eventually be merged THE RECENT INCIDENCE OF SMALL-POX. into a single life-history. Until such a consumma- tion is attained we can but place on record such SMALL-POX has recently appeared in different findingsf as those of Dr. Coles without, for the of Britain. that there were parts We understand amoment,I attempting to evaluate them. few cases in Scotland ’towards the close of last year, 8 cases being notified in Aberdeen, and 1, which was probably infected in Aberdeen, in Fochabers in THE RESTORATION OF SERBIAN LIBRARIES. Elginshire. Since the beginning of the year 29 WHAT Serbia has suffered in destruction of in The disease cases have been notified . human1 life and property during the last four years in in occurred January the following sanitaryccan never be accurately stated, but in one direction 3 :-Metropolitan of Battersea, thet loss is precisely known and very detrimental to cases; of St. Pancras, 4 cases ;thet resumption of normal intellectual life. Serbian urban of in the of Benfieldside, libraries1 and printing presses seem to have been a 5 Durham, cases ; Lower Bebington , specialg object of enemy attentions, their efforts Cheshire, 3 cases; of Bootle, 7 cases ;tto destroy the monuments of Serbia’s ancient Rowley Regis, Staffordshire, 1 case; ,civilisation( and the future means of culture and 1 case. The following districts were affected ineducationE in that being extremely thorough. February:-Urban district of Wisbech, Isle of Ely, Ther library contained in the University of Belgrade 2 3 cases; Hartlepool, cases; of.was destroyed, together with the University itself, Flaxton, N. of Yorks, 1 case. There has duringi. the bombardment of that ; the library thus been a wide topographical distribution of the of( the monastery of Dechani was pillaged; and we disease, although nothing as yet like epidemic may] add to the list the library of Nish, the scien- prevalence. Since a large proportion, especially oftifici library of Alexinatz, the theological library the younger section of the community, is now of( Prizren, and those of Sloplje and Kragujevatz. unprotected by vaccination, the recurrence ofSerbia’sf heroism has defeated the military purposes small-pox will demand vigilance on the part of of( her enemies, but she will be largely dependent the health authorities of this country. upon1 her Allies for help in the re-establishment of her literary needs. In another column of this issue SPIROCHÆTES IN TRENCH FEVER. Lord Crewe makes an appeal on Serbia’s behalf for books of every kind, old or new. Many people in IT is just three years since McNee, Brunt, and this country will respond generously to Lord Renshaw proved the infectivity of the blood in Crewe’s appeal from a pure desire to help an unfor- cases of trench fever. One year later, Riemer tunate ally, and it may not unfairly be pointed out described scanty spirocheates in direct blood films that their gifts will promote the study of our from cases of Volhynian fever, which is undoubtedly language and literature in a country where it has the same disease. Later, in 1917, Nankivell and hitherto been little known. The secretary of the Sundell observed and recorded spirocheetes in the organisation for the restoration of Serbian Libraries, urine of trench fever cases. The American Com- which is being promoted by the Royal Society of mission, under Strong, proclaimed that the virus of Literature, is Miss Waring, 2, Bloomsbury-square, trench fever is filterable, and a very recent paper London, W.C. ____ by Sir John and his colleagues seems to confirm this. Arkwright and Duncan demonstrated RADIUM TREATMENT OF EPITHELIOMA OF THE the constant presence, after a suitable time, of LOWER LIP. bodies (Rickettsia bodies) in the and minute gut THERE is considerable diversity of opinion as to excreta of lice fed upon trench fever patients. the value of radium in the treatment of the These bodies were not found in healthy lice fed different forms of malignant tumour. Some upon healthy men, and their presence was correlated enthusiastic advocates of the to the virulence of the febrile attack. In this issue therapeutic pro- of radium contend that it is of use in Dr. A. C. Coles describes scanty spirochaetea found perties almost any form of superficial malignant tumour in the blood of trench fever ’ patients purposely or at of the disease. The more con- infected at The characters of the any stage Hampstead. spiro- servative, however, hold that, while radium is of chætes on the whole with those described agree decided value in the treatment of certain Riemer in 1917 and also, but to a lesser extent, by cancerous its of is limited, with those of Nankivell. Perhaps the most striking growths, scope utility and, on the whole, its main value lies in its employ- common feature is the looping and intertwining to ment as an adjunct to surgery. Epithelioma of which Riemer refers very Nankivell distinctly.l the lower is a form of cancer did not remark this on the other lip which, perhaps, feature, and, best lends itself to treatment radium. described a end to his by hand, tapering spirochaete, In the International Jou,rnal for whereas Dr. Coles finds that his never of Surgery spirochæte December, 1918, Dr. of Toronto, The as to whether these various George Elliott, tapers. question discusses at some the radium treatment of have common length findings any ground appears partly of the lower and the of such solved the of the Rickettsia bodies epithelioma lip origin by possibility growths. That chronic irritation from of filterable size, and also by the very pipe-smoking being pertinent is a or even an cause he is fact to which Coles that frequent exciting alludes-namely, Noguchi inclined to and statistics from the found that the spirochæte of Weil’s disease will doubt, Depart- ment of the Registrar-General of Ontario were pass through a Berkefeld V filter. The investiga- quoted in support of this view. Recently in one 1 See THE LANCET, 1917, i., 347. year in the of Ontario the figures relating 389

to deaths from cancer in all situations extremes has been gaining ground in recent years thus tabulated: Cancer and other malignantwereand has found frequent expression in the literature. tumours of the buccal cavity, 94; of the is to the effect that actual obstruction of the and liver, 631; of the peritoneum, intestines,stomach andpyloricIt orifice by the hypertrophied muscular band rectum, 263; of the female genital organs, 177; of isE comparatively rare and that spasm is the deter- the breast, 126; of the skin, 26 ; of other organs mining factor. If the hypertrophy is slight there and organs not specified, 489. Of a total of 1806 is a good chance of success by medical treatment classified deaths cancer of the buccal cavity and alone, but when it is considerable surgery offers the of the skin is the only form that can be con- only chance of success. If this view be accepted nected with smoking. Dr. Elliott points out it becomes a matter of great importance to decide that when from this total of 120 are eliminated when an operation is needed and the optimum those in other situations than the lower lip time at which it should be performed. One of the it will be readily appreciated upon what meagre reasons which have led the physician to hesitate grounds cancer of the lower lip is regarded before resorting to surgery has been his unwilling- as being associated with pipe-smoking. He holds ness to subject so small and feeble an infant, and that for this form of epithelioma radium is the one so lacking in resistance, to the shock insepar- treatment par excellence. From the cosmetic I able from a severe operation. Speed and a standpoint alone it possesses the obvious advan- minimum of exposure and manipulation are very tages that there is little or no scarring; it causes desirable if shock, hitherto the commonest cause scarcely any pain; it appeals to the patient, who is of surgical failure in this condition, is to be avoided usually terrified at the idea of operation; and the or reduced. These desiderata would appear to be result of treatment, so far as can be judged at attained in the operation devised by Rammstedt, present, seems to be permanent. Statistics one frequently employed in the United States, but obtained direct from the Deputy Registrar-General hitherto little known in this country. It con- of Ontario, Colonel J. W. S. McCullough, show that sists in the simple division of the hypertrophic there has been a marked increase in the number muscular band by an incision in the long axis of the of deaths from cancer and other malignant pylorus transverse to the muscular fibres without tumours in nearly all situations, especially in interfering with the mucous membrane and without the skin, whereas deaths from cancer and other closing the gap so formed by sutures. The whole malignant tumours of the buccal cavity have only operation, including the initial incision of the increased by three. Dr. Elliott attributes the abdominal wall and its subsequent closure, occupies increase of mortality from malignant growths of only from five to seven minutes, and very little the skin to the fact that treatment is postponed manipulation is required. Another advantage is until the condition is so serious that nothing is of that the normal condition of the alimentary canal any avail. Radium to be successful must be em- is restored. At a recemt meeting of the Medical ployed early, and, for obvious reasons, the treat- Society of London, a report of which is included ment must have a wider range than the clinical in this issue, Mr. R. A. Ramsay described in detail distribution of the lesion. Early diagnosis is this operation as he had performed it on three essential and there is little doubt that in occasions. Although few in number they illustrate some superficial cases of malignant growths, the reasonableness of the procedure and serve to and especially, perhaps, of epithelioma of the bring the operation to the notice of physicians and lower lip, radium treatment is indicated. Dr. surgeons on this side of the Atlantic. Mr. Tyrrell Elliott, in his paper, mentions several cases of Gray, whose experience had been greater, said that epithelioma treated successfully by radium. In his it was quite in accord with the general conclusions opinion the most important detail of treatment is arrived at, and the opinion of these two finds, the careful regulation of the dosage, the correct- perhaps, its greatest support in the work of ness of which must depend upon the judgment of W. A. Downes, of New York, who, by substituting each individual administrator. He considers that Rammstedt’s operation for gastro - enterostomy physiological chemistry may some day solve the reduced the mortality for the surgical treatment of problem of cancer, and suggests, as has been done this condition at his hands from 43 to 24 per cent. before, that this disease may be due to an aberrant metabolic process in the chemical constituents of the cell. SENSATION AND THE CEREBRAL CORTEX. ____

SURGICAL TREATMENT IN HYPERTROPHIC A RECENT number of Brain contains a further STENOSIS OF THE PYLORUS. contribution by Dr. Henry Head to the subject which he has made peculiarly his own-that of ALTHOUGH it is now many years since hyper-sensation in its different phases at each and all of stenosis of the was first trophic pylorus described,the various levels of the central nervous system.1 opinions have ever been at variance whether the He] has taken the opportunity of restating and condition should be treated medical or by bysuccinctly£ summarising the results of previous means. has been surgical Dogmatism rife, butinvestigations on sensation as it manifests itself the remains undecided. Whilst question somein lesions of the peripheral nerves and spinal cord. authorities themselves as convinced that r express The war has provided numerous chances of minute no proved case ever gets well by medical measuresEexamination of cortical and subcortical cases where alone, others do not resort to surgical treatment atthet lesion is small and localised on the main that without it the is less. all, believing mortality sensoryE pathways or centres, and Dr. Head is thus This of view no due divergence is, doubt, largely toable to provide a remarkably complete review of for the successes of varying nomenclature, treat- tthe whole subject, which on both theoretical and ment medical means are the by regarded by practicalI sides is deserving of close attention. In extremists of the other school as of examples faultythet lower levels of the nervous system affection and of confusion between diagnosis, congenitalof( certain sensory tracts produces strictly limited hypertrophic stenosis of the pylorus and mere pyloric spasm. A view intermediate between these two 1 THE LANCET, 1918, ii., 657.