Intrapleural haemorrhage is a serious complication of artificial pneumothorax (A.P.), sometimes endangering life and often leading to obliterative pleurisy and loss of the A.P. It is the purpose of this paper to discuss its causes, incidence, pathology, treatment, and effect on the A.P., on the basis of a study of the records of 37 cases in which intrapleural haemorrhage of not less than one pint (600 ml.) occurred after refilling the A.P. or after thoracoscopy at the Brompton Hospital between 1939 and 1949. INCIDENCE Six of these cases followed A.P. refills, of which approximately 180,000 were given at the hospital during the relevant period, giving an incidence of approximately one in 30,000 refills. An incidence of one haemothorax per 2,500 A.P. refills over three years was quoted by Miller and Rinkel (1947). In order to restrict the present series to cases of severe haemorrhage, only those from which at least 20 oz. of blood or " heavily blood-stained fluid " were aspirated are included. Such criteria, if applied to the cases of Miller and Rinkel, would exclude four of their cases, leaving a comparable incidence of one in 5,000 refills.The incidence of haemothorax following adhesion section at the Brompton Hospital was estimated by examining 814 patients having adhesion section between 1939 and 1949, performed by surgeons and trainees. Haemothorax requiring aspiration of at least 20 oz. (600 ml.) of blood or heavily blood-stained fluid occurred 31 times, representing an incidence of 3.9%. There were a further 39 cases in which the volume of blood aspirated was between 10 and 20 oz. (300-600 ml.), and it is probable that many smaller haemothoraces occurred.The incidence of haemothorax following thoracoscopy and adhesion section necessarily varies with the skill of the surgeon and the number of operators included in the series. Summation of the British series of Brock (1938), Edwards, Penman, and Logan (1944), Laird (1945), Watt (1947), and Wollaston (1947 gives a total of neady 2,500 operations for adhesion section: the incidence of haemothorax of variable size was 3.5 %. Similarly, the combined American series of Graham, Singer, and Ballon (1935), Newton (1940), Goorwitch (1944, and Day, Chapman, and O'Brien (1948) cover more than 8,000 operations for adhesion section: the incidence of haemothorax of variable size was 4.3%.

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Reynolds, who also has been using oxytocin by intravenous drip and recording the effects on three areas of the uterus simultaneously by means of the " strain-gauge multi-channel tokodynamometer," that his results indicate that posterior pituitary serves only to augment existing uterine motility and in certain cases results in increased activity of the middle zone of the uLtrus rather than improved

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CORRESPONDENCE MICAL JONALview of the present lack of information as to their usefulness. But it should be appreciated that the diet and water consumed by many persons has involved for a long time an intake of fluorine similar in form and quantity to that which might arise from the use of fluoride tablets in fluorine-free areas. It is suggested, therefore, that emphasis should be placed, on the pursuit of practical trials-of which so far there are few signs in Britain.-I am, etc., Didcot, Berks. J. M. FLETCHER. REFERENCES 1 Bromehead, C. N., et al., Lancet, 1943. 1, 490. 2 Weaver, R., Proc. R. Soc. Med., 1948, 41, 284. Blood, 1948, 8, 892. Retaining Patency of Veins SIR,-At the University obstetrics and gynaecological clinic in Budapest the following method is used when giving transfusions in order to ensure that the vein remains patent.The wall of the vein is gripped with fine artery forceps; a thin thread is led under the vein, and when the needle is inserted.in the vein the thread serves to fix it in position. When the transfusion is finished the wall of the vein just distal to the needle is gripped with artery forceps. The thread is cut and the needle is removed. The puncture wound in the wall of the vein can now be seen, and it is seized with a pair of fine Pdan's forceps and undertied with a very fine catgut. On removal of the distal pair of forceps the circulation commences without any bleeding from the ligatured part. The wound of the skin is closed with two or three stitches.Thrombosis rarely occurs in the ligatured vein, because the undertying secures contact of intima with intima, and the vein reacts as if the wall had been very finely sutured. Before removing the needle we inject heparin into the vein to avoid thrombosis due to injury of the vessel. On one occasion the same vein was used to give five transfusions to a patient in three days.In so far as large veins are concerned our method is not a new one, because it has been applied in surgical institutes for closing the wounds of big vessels, but it is worth considering in the case of small veins. When blood transfusions are necessary every little vein may possess vital importance, and therefore they must be treated with caution. According to our experience this method seems to fulfil the best requirements.--I am, etc., Budapest.GEORGES TARJAN. POINTS FROM LETTERS Causes of Rib FractureDr. JAMES T. HAROLD (London, S.W.5) writes: Your issue of Jan. 22 contains references to several unusual causes of rib fracture. Some years ago I encountered another unusual cause. A young female stated that she had once sustained a fractured rib. Knowing her prowess as a huntress I thought it might have been acquired through horse-riding: but this noble animal was not to blame. It transpired that after some months' estrangement from her boy friend she had met him again, was lovingly embraced, and soon after experienced what she described as " a sharp pleuritic pain in the chest." Medical opinion was nonplussed for three days, when an x-ray reveale...