NOTES ON CURRENT TOPICS

s no less than 159 papers,'etc., from a very wide range of journals; it deals with the general, experimental and biochemical, clinical and pathological, radiological and statistical aspects of cancer, the papers reviewed being grouped in that order. The new journal will appeal to an enormously wide range of readers. It is one which by broadcasting reviews of all advances in our knowledge of the cancer Problem from every point of view, will aid very materially in forwarding the study of the problem. The multitude of medical journals is to-day overwhelming; one sometimes wishes that some international tribunal could be formed?perhaps under the xgis of the League of Nations?to decide which should discontinue publication or be burnt, and which should be fostered and officially approved. But, in a very crowded world of medical journalism, this new journal will be a beacon light to many different classes of medical workers interested in the cancer problem. The Complications of Duodenal Ulcer. By CECIL ROWNTREE, f.r.c.s., v Surgeon to the Cancer Hospital, and to the Dreadnought _ Hospital. (The Practitioner, No. 697,?Vol. CXVII, No. I,? ? July 1926.) t'Kw cases of duodenal ulcer that are untreated for any length of time escape the addition to their normal symptoms of one or other of the more serious complications, which adequately treated cases usually avoid. The only symptom of duodenal ulcer that is constant, persistent, and typical, is pain. It is true that it may vary in its character, its situation, or its periodicity, but every patient with a duodenal ulcer will at some" time or another experience pain, which may be in bouts or spasms, may disappear for weeks or months at a time, may be much better in summer than in winter, but is none the less the one symptom that takes him to the doctor. He may not state categorically that the pain comes on one and a half to two hours after meals, no matter what their nature, or that it is relieved by further food, or by one or other of the widely advertised remedies for chronic indigestion; but all these points can generally be elicited by careful inquiry. These, then, are the normal symptoms of duodenal ulcer. To what are they due? Is the pain the result of the irritation of the raw surface in the duodenum by the acid gastric juice, or is it due to spasmodic contractions of the gastric muscle induced by the presence of the ulcer? We know that in duodenal ulcer the muscular activity of the stomach is increased and that the food is unduly hurried from it, but in spite of this the .t'-rays do not show those irregular spasmodic contractions that are such a regular feature of gastric ulcer. It is easier to believe that the pain is chiefly due to the action of the gastric juice which is hurried into the duodenum before its acid content has had the opportunity of becoming neutralised. Perhaps the most dramatic feature of the disease is the small size of the lesion which produces such farreaching effects, for the ulcer is rarely much larger than the finger nail, and sometimes 110 more than a few millimeters, and yet it may convert a strong, hearty, and happy man into an ill-tempered, dyspeptic invalid. The number, variety, and severity of the complications of duodenal ulcer seem out of all proportion to the insignificance of the primary lesion and it is difficult to find a satisfactory method of classification. Perhaps the most simple is to divide them into the acute and the