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which the pin could either be raised or lowered. Fromthat period the shape of the trephine has practicallyremained unaltered, although the saw has passedthrough many modifications. Examples of theinstruments mentioned, illustrating the origin anddevelopment of the trepan and trephine from ancienttimes, may be seen in the Historical Section of theMuseum at the Royal College of Surgeons of England,to which an excellent guide1 has just been issued.

SPLENO-MEDULLARY LEUKÆMIA.

THE occasional association of spleno-medullaryleukaemia with trauma has been noticed ’from timeto time, and the injury has been regarded as animportant aetiological feature by more than one writer.Dr. S. C. Lewsen records a new case on p. 288 of thisissue and quotes a large number of other cases fromliterature. To these may be added one just reportedby Dr. Annelise Wittgenstein.2The patient, a railwayman of 42, had never been ill until

one day he fell on the ground and one of his mates trippedover him; The only apparent result was a slight effusion ofblood from the leg. He remained at home for a month.Soon after the injury he started to complain of pain in thefoot and loss of appetite, with heavy day sweats. Hesuffered from general debility and lost weight. Neverthe-less, he continued to work ’under regular medical super-vision for the next four mouths, during which time the causeof his poor condition remained undiagnosed. He died eightmonths after his injury, and the blood counts made inhospital admitted no doubt of the diagnosis of myelogenousleukaemia, the only unusual feature of the case being thenormal size of the spleen. The number of red cells and the Ihaemoglobin index were greatly reduced, the figures being1,600,000 and 35 per cent. respectively. The leucocyteincrease, as is usual in the acute condition, was moderate, thecolmt giving only 20,000.

It proved impossible to ascertain whether thepatient had substained a blow in the region of thespleen, but Wittgenstein thinks that a severe shaking,especially if combined with contusion of the abdomenand the long bones, may be enough to lead to leuksemiain predisposed persons. He thinks that the cause is tobe sought in exogenous influences of toxic, mechanical,or infectious origin. The reference to " predisposedpersons " seems to bring this author nearly into linewith those who believe that trauma does no more thanreveal a pre-existent disease. This opinion is verywidely held. Prof. Salvatore Diez,3 for instance,who lately collected 30 cases of a supposed association,

Icame to the conclusion that they afforded no proofthat leukaemia could originate from a blow.

FIRST-AID IN ELECTRICAL ACCIDENTS.

IT cannot be too widely known that electric shockhardly ever causes death outright. Dr. D. Pometta,principal medical officer of the Swiss AccidentInsurance Institute, has recently given a usefulresume 4 of the various methods of treatment whichwill probably save the victim’s life if applied promptlyand patiently. Such measures should be as familiaras the first-aid treatment of the common forms ofpoisoning, and the practitioner living in a districtwhere accidents of this kind are particularly likely tohappen will do well to have his apparatus packed ina special case ready to take up at a moment’s notice.He should put aside all other work to answer the callto an electrical accident immediatelv, and should beprepared to stay by the patient for several hours.As soon as the victim has been removed from thedanger zone, his mouth should be freed from dirt andany other obstacle to respiration, such as artificial

1 Guide to the Surgical Instruments and Objects in the HistoricalSeries, with their History and Development. By C. J. S. Thompson,M.B.E., hon. Curator of the Historical Section of the Museum.With a foreword by the Conservator, Sir Arthur Keith, M.D.,F.R.C.S., F.R.S. London : Printed for the College and sold by Taylor and Francis, Red Lion Court, Fleet-street. 1929. Pp. 92.2s. 6d.

2 Med. Klin., 1930, i., 22.3 See THE LANCET, 1927, ii., 562.

4 Schweiz med. Woch., 1930, iv., 82.

teeth, and clothing should be removed from the upper-part of the body, preferably cut off to save time. Heshould be kept warm with blankets and hot-water-bottles or heated bricks, but zealous assistants mustbe warned of the danger of causing burns. The face-and chest may be splashed with water, the limbs andcardiac region may be massaged, and cardiac andrespiratory stimulants such as lobeline may be givensubcutaneously ; but none of these secondaryrequirements must delay or interrupt artificialrespiration-the essential treatment-for more thana few seconds. While pointing out that prompt andcorrect application is more important than the choiceof any special form of artificial respiration, Pometta.prefers the Sylvester method. Here he is in a

minority, for most authorities agree with Prof.S. Jellinek5 in recommending Schafer’s. He regards.

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manual methods as better than mechanical, but saysthat apparatus may be useful to replace assistantswhen everyone is tired out. Carbon dioxide is avaluable respiratory stimulant, and can be given froma soda-water syphon when no cylinder is available.The syphon is half emptied and a rubber tube isattached to its nozzle ; it is then inverted and thefluid is blown out of the glass tube. Gas is admittedto the patient’s air passages through one nostril,while artificial respiration is maintained continuously.Unless the patient’s other injuries are so severe thathe cannot possibly be alive, respiration must becontinued for at least five hours, and the absence of-the sounds of heart or respiration or of the cornealreflex are no indication that he is dead.

Sir Thomas Legge, who retired from the position ofSenior Medical Inspector of Factories in 1926, has.joined the staff of the Trades Union Congress as.

adviser to the Social Insurance Department on thehealth of workers as affected by conditions arising outof their employment. His work will lie primarilyin the prevention of industrial disease and disability,.and he will continue by pen and word of mouth tokeep the trade-union movement informed on theproblems of health in industry. There is undoubtedlya still untapped source of study and research in thesickness records of the big trade-unions in thiscountry.

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INDEX TO " THE LANCET," VOL. II., 1929.

THE Index and Title-page to Vol. II., 1929, whichwas completed with the issue of Dec. 28th, isnow ready. A copy will be sent gratis to sub-scribers on receipt of a postcard addressed to theManager of THE LANCET, 7, Adam-street, Adelphi.W.C. 2. Subscribers who have not already indicatedtheir desire to receive Indexes regularly as publishedshould do so now. _______

5 See THE LANCET, 1927, ii., 1001 ; 1928, ii., 314.

DONCASTER ROYAL INFIRMARY.-The report for theyear ending Sept.. 30th, 1929, shows that 1805 patients wereadmitted, who stayed for an average of 25-13 days, as com-pared with 23-4 days in the preceding year. New out-patients numbered 7143, an increase of 745 : there were3786 casualty cases and the attendances and treatments inthe massage department were 27,416. A supply of radiumto the value of 3000 has been given by Mr. William Nuttall.During the year Dr. H. J. Clarke, who has since died, cele-brated his fifthieth year of general practice in Doncaster andwas presented by his colleagues with a piece of plate. Dr.Clarke handed over to the hospital the balance of the Presen-tation Fund, amounting to .875, with the proviso that theincome should be used for the purchase of a medal to beawarded annually to the best nurse of the year. The well-arranged and informative report sets out that the cost perbed was 2129 8s. 9d., a reduction of 12s. 5d. The cost perin-patient was 98 16s. 10d., and per day 7s. 0. ; out-patients cost 9s. 6d. The first block of the new Infirmary,containing 150 beds, with accommodation for 85 nurses andmaids and the usual accessories, is approaching completion.The Doncaster Collieries Association has contributed£ 10.000 towards the cost.