Corrigenda

[This corrects the article DOI: 10.2471/BLT.16.189894.].

place of malaria in the treatment of G.P.!. ? .
A.-There is no reason why pyretotherapy with T.A.B. vaccine should not be used in the treatment of G.P.I., but it is far less likely to be successful than artificially induced malaria. Many forms of artificially induced hyperpyrexia have been tried in this disease, but none has produced results comparable with those obtained by malarial infection, except those methods which raise the patient's temperature by physical means-e.g., the Kettering hypertherm and similar cabinets. In this connexion it should be stressed that the induction of hyperpyrexia is potentially dangerous, and should be undertaken only by one skilled in the procedure and with optimum nursing and other facilities available.
Treatment of Peptic Ulcer Q.-May I have information on the treatment of duodenal ulcer ? Do you know of any book which deals with the medical treattnent of the peptic ulcers, particularly with post-ulcer diet ? All the books murmur vaguiely about pure6es, etc., btit none seems to give real practical help.
A.-The Sippy treatment of peptic ulcer by diet and alkalis is still the standard method. Modifications chiefly concern precautions against avitaminosis and alkalosis and efforts to deal with the nocturnal secretion of acid. The drawbacks of alkalis are compensatory secretion of acid and the production of alkalosis; formation of CO, is not a disadvantage. After-secretion of acid is most likely to occur after strong alkalis such as sodium bicarbonate, magnesium oxide or carbonate, and calcium carbonate. These substances are also likely to produce alkalosis if used in excessive dosage. On the other hand, they are cheap and they relieve pain more effectively than the newer alkalis, such as magnesium trisilicate and aluminium hydroxide. The nocturnal secretion of acid can be neutralized by the continuous-drip method, whereby a stomach tube is passed and alkalis, such as aluminium hydroxide gel or a mixture of milk and sodium bicarbonate, are allowed to drip continuously into the stomach throughout the night. Alternatively, the patient may be roused for feeds at 12, 2, and 4 a.m. Aluminium hydroxide has no advantage over magnesium trisilicate, except in the form of aluminium hydroxide gel for continuous intubation.
Evidence of the value of alkalis in the treatment of experimental ulcers in animals is quite convincing. If the gastric juice can be continually neutralized so that the acidity never exceeds pH 3.5, pepsin is inactivated and ulcers heal. The difficulty is to maintain this continuous neutrality in the human stomach. Clinical gastro-enterologists have been impressed by the importance of emotional tension in the genesis of ulcer symptoms and the relief secured by rest in bed without alkalis. They therefore tend to be more interested in psychological management and sedation than in the use of alkalis. For similar reasons regularity, frequency, and adequacy of feeds are considered more important than the exact composition of the diet. In fact many diet schedules are inadequate in calories and quite needlessly complicated. Finally, as there are possibly more than a million patients with peptic ulceration in this country at the present time, treatment must be ambulant in the great majority of cases. For all these reasons treatment by diet and alkalis tends to be less strict than in the past. Details of diet will be found in standard textbooks such as Hutchison's -Food amid the Principles of Dietetics or McLester's Nutrition anid Diet in Health and Disease. The homogenized or strained foods supplied for special diets and infant feeding by the large canning firms are now available again at most chemists' and are useful for purees. Half an hour with an intelligent dietitian will give more help on post-ulcer diets, particularly under wartime conditions, than a much longer time spent in a medical library.

INCOME TAX
Depreciation of Furniture, etc. J. R, has been informed by the inspector of taxes that depreciation is not an admissible deduction for income-tax purposes, but that he can claim "wear and tear allowance" or "cost of renewals." The inspector suggests that as the cost and date of purchase of each item must be known for the purpose of the wear and tear allowance J. R. may find it preferable to claim renewals. *** The wear and tear allowance is " such deduction . . as the Commissioners . . . may consider just and reasonable as representing the diminished value by reason of wear and tear during the year." No rule is laid down as to the method of estimating the " diminished value," but the common practice is to start from the cost of the particular asset and write it down by an appropriate percentage year by year. One proviso of the section limits the final allowance in respect of the asset by reference to the amount of its cost less any sum received for it on sale. For that purpose the inspector is entitled to know the amount of the cost of each item on which wear and tear allowance is claimed, even if the Commissioners having jurisdiction in the matter are willing to depart from the normal basis of estimating " value." Purchase of Practice M. Y. wishes to buy a practice, obtaining a loan on terms which provide for repayments of principal out of income. Will she have to pay tax on the profits before deducting the amount of the repayment of loan? *** Yes. Such repayments are clearly payments on "capital" account and cannot be deducted in calculating " income." In fact they represent savings in a particular form, and there is no more legal ground for deducting them in calculating income-tax liability than there would be in the case of repayment of a building society loan or even voluntary savings for investment.

LETTERS, NOTES, ETC. Primary Cancer in Accessory Sinus
Dr. THOMAS LINDSAY, F.R.C.S.Ed., writes from St. Lawrence's L.C.C. Hospital, Caterham, Surrey: Many years ago I reported a case of ? primary carcinoma of the heart. At that time I think it was Duncan Fitzwilliams who asked if the accessory sinuses hadbeen examined, and they had not. The other day a case occurred which at first sight looked like a primary carcinoma of the liver. The liver was very large and riddled with growths. On further investigation the primary growth was found in the maxillary antrum.
Device for Filling Blood Sedimentation Tubes Capt. M. D. DESHMUKH, R.A.M.C., writes from Harihar: Having read in the Journal of May 5 (p. 632) Dr. M. M. Conran's description of a device for filling blood sedimentation tubes I went round to our clinical side-room to show it to the medical officer, Capt. Gian Singh, I.A.M.C., who is in charge of the laboratory investigations. He showed me the method he was following, and it certainly appears to be very much simpler. It is as follows: Attach a well-fitting rubber teat to the upper end of the blood sedimentation tube and fill it like a pipette up to just above the zero mark. Put the lower end lightly on the rubber pad and adjust the level to the zero mark by pressure on the rubber teat, letting out the slight excess of blood; then press the lower end firmly, remove the rubber teat, and fix the clip.
Management and Treatment of Tuberculosis and Venereal Disease, Dr. J. L. WHITWORTH (Melbourne) writes: The report that the Central Hospital, Melbourne, requires several doctors and that this hospital and these doctors are to be engaged on tuberculosis and venereal disease mainly calls for some comment. It will be obvious even to the layman that the concentration of this infective material in the heart of a big city is unwise and unnecessary. That these diseases should be treated " in the great open spaces " should be a foregone conclusion. Further, the expense entailed and the inconvenience caused in trying to manage these diseases under conditions so opposed to the public health would be unreasonable; ihe aseptic technique would require to be almost fanatical; the risks of infection to doctors and nurses and staff unfair; and the end-results problematical, in spite of the superior skill and attention that would be given, perhaps to the disadvantage and detriment of medical

Corrigenda
The last line of Dr. Owen-Flood's letter in the Journal of Aug. 18-(p. 241) should refer to " minor epileptics " not " mental epileptics." By a mishap at the printers the first line in col. 2 immediately under Table V in Capt. Degen's article on " Sequelae of Cerebrospinal Meningitis" last week was transposed to the foot of col 1.