33

Evidently suicide had been committed by a right-handedman, who wandered along the road in search of help when hefound the wound was not immediately fatal. After the

- external bleeding ceased he travelled 300 yards. Not a dropof blood could be found on the road he must have travelled.

KALA-AZAR IN ASSAM.

IN a supplement to the last annual report of the Sanitary’Commissioner of the now divided province of Eastern Bengaland Assam there is published a short but interesting paper’by Captain W. L. Harnett, I.M.S., civil surgeon, Kamrup,on the prevalence of kala-azar during recent years in theRangiya circle situated in his district. The inquiry and-report were made in continuation of a similar investigationrespecting the disease in the Golaghat subdivision, but thepresent inquiry was conducted apparently on less ambitiouslines, being practically limited to ascertaining which of thevillages in the circle were infected, the extent of the infec-tion, and probable date of the first appearance of the maladyin each village. Captain Harnett supervised the work andprepared the report, but the actual investigation on the spotwas made by temporary Sub-assistant Surgeon PurushuttamDas Navis, who began his duties early in 1912. The

implicated area lies north of Rangiya in the Kamrup- district and in the neighbourhood of the main road to

Bhutan. The inhabitants of the locality commonlytake up temporary employment during the cold monthsof each year as tea-garden coolies in the gardens of the

Darrang district or in more distant parts of the province,returning to their villages in the hot weather to cultivate’’their own land. These people attribute the existence of i’kala-azar in their midst to infection contracted while work-

ing in the tea gardens and brought back by returningvillagers to the Rangiya circle. During the course of the- inquiry 67 villages were visited and 14 of them were found- to be infected. The population of the affected area is notstated, and house-to-house visits for the discovery of casesdo not appear to have been made. It was assumed at the

beginning of the investigation that the clinical recognitionof the disease presented little difficulty, and for this reason’it was not thought necessary to make microscopical examina-’tions ; but Captain Harnett in his visits for supervision of-the work satisfied himself that the cases diagnosed by thesub-assistant surgeon were actually instances of kala-azar

infection. It was elicited that during the past 11 years,82 deaths had been attributed to the malady in the 14infected villages, and that at the present time 26 personswere suffering from the disease. This area may thereforebe regarded as a focus of kala-azar infection. The informa-’tion obtained is valuable and interesting, but in some

respects it is disappointing as it throws little light.upon etiological or epidemiological points. CaptainHarnett himself, in his concluding remarks, frankly- admits that the report is lacking in various respects, and heexpresses regret that the sub-assistant surgeon who madethe local inquiries failed entirely to realise the importantbearing which some of the missing details would have hadupon the points that he was instructed to try to elicit. In

THE LANCET of Sept. 28th last year we drew attention tosome of the important epidemiological considerations asso-ciated with Indian kala-azar and to the persistence of themalady in the province of Assam, especially in the tea-growingdistricts. In three of these-namely, Nowgong, Darrang,and Kamrup-from 1891 to 1911 the deaths of no fewerthan 152,000 persons were ascribed to this terrible, and asyet incurable, disease. The comings and goings of the tea-garden coolies afford, apparently, opportunities for thediffusion of the disease not only throughout Assam, but toother parts of India. While local inquiries furnish useful

and interesting information, they do not go far enough tothrow light on the still unsolved problems for which solutionis urgently needed. This end will best be secured by com-prehensive investigations on a large scale and covering awide area, conducted by the trained etiologists and expertepidemiologists who are to be found in the ranks of theIndian Medical Service.

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THE BRITISH JOURNAL OF SURGERY.

Up to the present no attempt has been made to issue inthis country a journal exclusively devoted to surgery, thoughin several other countries surgical journals of one kind oranother have existed for some years. At last Messrs. John

Wright, of Bristol, have decided to bring out the BritishJoecrnal of S1trgery. A very strong editorial committee hasbeen formed, including some of the best-known names insurgery in the British Isles, and Mr. E. W. Hey Groves is to

act as editorial secretary. We welcome the appearance ofthe first number; it consists of 152 pages, it is quartoform, and it is well printed on good paper. So muchfor the appearance of the journal. As to its contentsan equally favourable verdict may be given ; it containsa number of valuable papers, every one of which is

of great interest, and where needed illustrations have

freely been provided. A short introduction from the Pre-sident of the Royal College of Surgeons of England, SirRickman Godlee. sets forth the aim of those who are e

responsible for the new venture, and this is followed by avery good photogravure of Lord Lister, with a brief apprecia-tion of his work for British surgery. Dr. David Newmanhas written a paper on Renal Varix and Hypersemiaas Causes of Symptomless Renal Hasmaturia, illustrated withseveral coloured drawings. Mr. D’Arcy Power has a paperin which he urges the need for earlier operations in cases ofgall-stones; the paper is based on 90 cases, and we must

subscribe to the conclusions at which he arrives. Mr. Albert

Carless describes a case of a boy who had two dermoid cystsin the mid-line of the perineum. The two cysts communi-cated, and from the hinder of the two swellings there ranbackwards a narrow, hollow channel as far as the anal

margin. The two photographs show the condition very

clearly. Mr. W. Sampson Handley draws attention to anoperation devised by the late Sir H. T. Butlin for reducingthe size of the tongue when it is too large forthe mouth or when its lateral margin shows dangerousor annoying irritability from the teeth. The operationconsists in removing a wedge-shaped piece from the marginof the tongue, and a case is described in which the resultwas very satisfactory. Mr. G. E. Gask has contributed anaccount of a case in which he grafted a piece of the fibulainto the space formed by the removal of a chondro-sarcomafrom the humerus of a boy. Mr. H. Morriston Davies hasexamined over 400 specimens of the first costal cartilage inrelation to whether the condition has any connexion with

tuberculosis, and he comes to the conclusion that neither

abnormal shortness nor ossification in the first costal

cartilage predisposes to apical pulmonary tuberculosis, andfrom this and from other considerations he finds the

evidence against the probability of the operation for thedivision of the first costal cartilage in cases of apicaltuberculosis producing any material improvement. Mr.

Robert Jones and Mr. S. Alwyn Smith (Winnipeg)have written an interesting paper on Rupture of

the Crucial Ligaments of the Knee and on Frac-

tures of the Spine of the Tibia. Mr. Robert E. Kellyhas quite a timely article on Intra-tracheal Anaesthesia,and Dr. Francis E. Shipway discusses clearly the advan-tages and disadvantages of recent methods of anses-

thesia. These papers should be of great value to many