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tons of heroin, and 6-0 tons of cocaine might be heldto represent the world’s annual requirements. Alaborious and elaborate analysis, recently completedby the secretariat of the League and based on thestatistical returns from the various manufacturingand consuming countries has resulted in yieldinguniformly lower figures than those vouchsafed bythe Health Section. The secretariat’s figures are

8! tons of morphine " as such," about half a ton ofheroin, and 5 tons, or rather less, of cocaine. The

figure for morphine is given for " morphine as such "because there is also to be brought into account themorphine used for conversion into codeine, morphineesters, and ethers, which have not hitherto beenclassed as " dangerous drugs," as well as into dioninand apomorphine. If morphine so utilised is to beincluded the secretariat puts the annual requirementat 31! tons for all purposes, although the actualmanufacture of morphine in 1929 amounted to 592tons, and it is estimated that not less than 100 tonsof morphine in all its forms passed into illicit traffic.As regards raw opium the League’s secretariat gives375 tons as the annual world requirement for legitimatepurposes ; there is, however, also the opium preparedfor smoking, of which some 600 tons are annuallyexported,’for which India is responsible to the extentof 66 per cent. Lastly there is the opium consumedin British India, which amounts to 200 or 250 tons ayear. ------

THE HISTORY OF THE AMPUTATING KNIFE.

THE historical section of the Museum of the RoyalCollege of Surgeons has received many additional Ipossessions during the past twelve months, some ofwhich are described in the annual report of theMuseum. Of these, not the least interesting to surgeonsand students are the specimens illustrating the historyof the amputating knife, which show the manychanges that the blade of this instrument has under-gone during the past thousand years. The series,arranged chronologically, begins appropriately witha replica of a Roman scalpel or cutting knife thatwas found with other surgical instruments at Pompeii ;for the first description of the amputation of a limbis that given by Celsus (A.D. 30). This is followedby the model of an amputating knife described byAlbucasis, with a long straight blade terminating ina sharp point, called by him a

" knife-rasor," whichwas employed in the tenth century. Next is a modelmade from a drawing in the manuscript work on"

Chirurgery," written by John Wryghtson, an

English surgeon, in 1350. The blade of this instru-ment is short and at the extremity is curved slightlyinwards. A century later, as shown in the next

specimen, the form of the blade was completelychanged and is curved backward with the cuttingedge on the outside instead of the inside of the curve.In 1578, Ambroise Pare, in his " Chirurgie," describedtwo knives that he used when amputating, one ofwhich he calls an incision knife and the other a" crooked knife for dismembering," the blade ofwhich is crescent-shaped with the cutting edge onthe inside. The amputating knife described byanother famous French surgeon, Guillemeau, in 1594,has a broad blade curved only at the extremity and issimilar in shape to Wryghtson’s knife of the fourteenthcentury. The knife described by Fabricius Hildanusin 1646, of which a model is shown, differs widelyfrom its predecessors. It has a heavy blade shapedlike a scimitar with the cutting edge on the outsideof the curve. But this innovation apparently didnot last long, for in 1665 Scultetus describes the

amputating knives used in his time as having a

crescent-shaped blade and figures a " crooked knife,wherewith," he says, " the flesh is to be cut in so faras the bone which must be saw’d off."

Early in the eighteenth century Sharp introducedhis amputating knife with a curved blade which wassometimes made with a double edge, and later Perret’sstill more crescent-shaped blade with a periostealelevator came into use in France about 1772. From1760 to 1775 the curved blade of varying shape wasfavoured and it was in general use until 1788, whenLoder advocated a knife with an almost straightblade which he had found to be effective. Fromabout this period, the straight-bladed and relativelysmall amputating knife began to replace the stronglycurved instruments used by Sharp and other surgeonsin the earlier part of the eighteenth century. BenjaminBell figures a straight knife in his " System of

Surgery " in 1788, and Savigny in 1798 illustrates aknife with a blade intermediate between Bell’s andPerret’s, which shows that the straight type wasgaining in favour. Savigny points out that " careshould be taken in the construction of this instrumentthat the back is not thicker than is absolutelynecessary to give and support the required firmness ofthe edge, otherwise it becomes unwieldly in itsmanagement." Sir Astley Cooper, however, appearsto have preferred the broad back, for his amputatingknife, shown in the series, has a very thick backwith the sides of the blade much smoothed along itsborders, but the blade is straight. Lisfranc, whoobserved that he preferred straight knives for

amputation, taught that " when a knife is requiredfor the forearm or leg, the cutting edges should beextended to the insertion of the blade into the handle."He therefore had his knives made with long slenderblades with double edges. In 1846 Robert Listonestablished the long straight blade in favour, andthis type has remained almost unchanged. Hisknives, which he had made in various sizes, sometimesmeasured over a foot long in the blade alone and were

finished with a dagger point, the backs beingsharpened for the last two inches. The cutting edgewas almost straight till it curved upward near thefree end to meet the back. In his " PracticalSurgery" he thus explains his reason for the longslender blade : " The form and size of the instrumentought always to be in proportion to the extent of theproposed incisions as regards both their length anddepth. If an extensive incision is necessary, an

instrument presenting sufficient length of edge mustbe employed so that the parts may be separatedsmoothly and quickly." Although his knives hadwooden handles, Liston always insisted that thehandle of a surgical knife should be perfectly smoothand polished, so it could be effectively cleansed, andthis idea was adopted by Lister.

This series serves to illustrate the interestingfact that in re-establishing the advantage of the

long straight blade, Liston was but reviving a typethat had been used by the Arabian surgeons of thetenth century.

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INDEX TO "THE LANCET,"VOL. I., 1931.

THE Index and Title-page to Vol. 1., 1931, whichwas completed with the issue of June 27th, is nowready. A copy will be sent gratis to subscriberson receipt of a post-card addressed to the Managerof THE LANCET, 7, Adam-street, Adelphi, W.C.2.Subscribers who have not already indicated theirdesire to receive Indexes regularly as published shoulddo so now..