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in the interests of historical accuracy. One thingleads to another, and in these days it is alwaysdangerous to say who did or did not first " describe "or

" discover " anything, unless the thing describedor discovered is precisely formulated.May I be permitted to add, with reference to

Dr. Gordon’s -further expressions of opinion in thecourse of his letter, that the microscopic agglutinationtest for variola elaborated by my colleague Dr. Amieswould seem to me more scientifically founded froman immunological point of view than the macroscopicflocculation test with virus extracts, in that theformer represents a simple and uncomplicated reactionbetween the elementary bodies of variola and theserum of the small-pox patient. In my opinion nopains should be spared to render the reagents employedin serological work with viruses the simplest andpurest possible. The effective study of elementarybodies requires a lengthy apprenticeship and is in

my view indispensable for any real advance in ourknowledge of the biological nature of viruses.

I am, Sir, yours faithfully,J. C. G. LEDINGHAM.

Lister Institute, London, June 29th.

ACHLORHYDRIA IN PYLORIC CARCINOMA

AN EARLY REFERENCE

To the Editor of THE LANCET

SIR,-Dr. J. Douglas Robertson has given us, in

your last issue, some valuable observations on thedevelopment of achlorhydria in obstructive carcinomaof the pylorus. His conclusion that this is causedby the attendant gastritis must almost certainly becorrect.As a matter of historical interest and evidence of

the early attention devoted to the pathologicalchemistry of the stomach by a physician of theGuy’s school, I would refer him to papers by GoldingBird, in the London Medical Gazette, 1841-42, pp. 391and 426. With the very laborious methods of

quantitative analysis then available Golding Bird

clearly demonstrated a steady decline in the

percentage of hydrochloric acid in obstructive pyloriccarcinoma, and also the simultaneous rise in the organicacids. He assumes, however, that the disappearanceof the natural acid was due to failing vital powers.

I am, Sir, yours faithfully, .

Wimpole-street, W., June 29th. JOHN A. RYLE.

FRACTURES OF THE CALCANEUS

To the Editor of THE LANCET

SiR,-May I congratulate Mr. D. C. Corry on hispaper on fractures of. the calcaneus involving the

subastragaloid, appearing in your issue of June 22nd.I agree with him that it is essential to obtain move-ments of the subastragaloid and mid-tarsal jointsin order to ensure a foot free from pain. The followingcase is of interest :-

In November, 1933, a postman reported at hospitalwith a history of a fall off a ladder 15 feet high on to his leftheel 11 weeks previously. He had been in bed for tendays following the injury and had tried to return to work8 weeks after the accident, but had found the foot sopainful that this was impossible. On examination, move-ments at the ankle-joint, subastragaloid, and mid-tarsal

joints were all markedly limited and painful on forcingthem. There was also much periarticular thickeninginvolving the ankle and tarsal joints. The foot was heldin a pronounced valgus position. The X ray films showed afracture of the calcaneus extending into the subastragaloidjoint with shortening and widening of the bone. Impactionhad taken place between the fragments and there was agood deal of overlapping. At first sight the above case

presented as grave an outlook as possible, and a subastraga-loid arthrodesis was considered. With two manipulationsunder an anaesthetic and regular treatment consisting offaradic contractions and movements, the patient wasable to carry out his work as a postman at the end of32 months with the aid of a valgus insole. After 15 monthsof work he reports that the foot is still free from pain andthe movements good, but it occasionally aches at thechange of weather.

Pain in these cases is often described as being dueto an arthritis in the subastragaloid joint. But ifmovement is obtained in this joint with freeing ofthe soft structures over the tarsal joints, a perfectlyuseful foot can often be obtained. Subastragaloidarthrodesis requires a patient to lie up for 4-8 months,and even after that period the foot may be painfulunless the soft structures around the tarsal joints aretreated. I am, Sir, yours faithfully,

Wimpote-street, W., June 29th. W. ELDON TUCKER.

LIGATURE OF SPLENIC ARTERY FORADVANCED SPLENIC ANEMIA

To the Editor of THE LANCET

Sin,—I have read with great interest in your issueof April 20th the article on this subject by Mr. R.Burns-Watson. The operation of ligature of the splenicartery was referred to by J. W. McNee in his Lett-somian Lectures of 1931 (Brit. Med. Jour., 1931, i., 413)as likely to be of value in several types of splenicenlargement. I had an opportunity of discussingthis question with Dr. McNee during the centenarymeeting of the B.M.A. in London, and at that

meeting I read a paper on Splenectomy with specialreference to Splenomegalies in the Tropics. Inthis paper, published in the Indian Medical Gazette,of January, 1933, stated that ligature of the splenicartery had been successfully performed on previousoccasions and urged that this manceuvre was worthyof more extensive trial, particularly in India, wheresplenomegalies of the splenic anaemia type are byno means uncommon. Splenectomy is a very severeoperation for such cases when extensive adhesionsare present.

I have had no opportunity for performing this

operation myself, as my present duties are mainlyadministrative, but I had hoped that other surgeonsin India would be tempted to try this alternativeand simpler procedure. Ligature of the splenicartery is not always easy, as it may be difficult toseparate the artery from the greatly engorged veins,and ligature of the whole pedicle though easierwould probably be more risky. Complications are

also to be considered, and among these portalthrombosis is a serious possibility. It is gratifyingto note that a surgeon in New Zealand has providedanother example of the successful result of splenicligature, and this time for an advanced case of so-called splenic anaemia.

In the Indian Medical Gazette of May, 1935, anarticle appears on Splenectomy for Tropical Spleno-megally by A. N. Palit. Ten cases were operated on witha successful result in nine. But the more severe caseswere apparently avoided, as ascites, signs suggestingcirrhosis, fixed immobile spleen, and so forth, are

mentioned as contra-indications. It is just in thesetypes of enlarged spleen that splenic ligature maybe of value, while such cases if left to themselvesusually terminate fatally. Will some surgeon inIndia provide us with more evidence as to the valueof splenic ligature in these cases of the splenic anaemiatype, which can only be removed by splenectomywith a high mortality risk. Reference is made in