Peter Pitt, The Scalpel and the Kukri: A Surgeon and his Family's Adventures among the Gurkhas (Dunmow, UK: Peter Pitt, 2005) ISBN 0-95-520590-5. 248 + xix pp. Health& History • 10/1 • 2008 161 Major Peter Pitt was a surgeon at the British Military Hospital (BMH) in Dharanin East Nepal between 1966 and 1968, having previously served as a military surgeon in Nigeria. The BMH, which was situated thirtymiles from Nepal's borderwith India, opened in 1960 to look after the Gurkhasoldiers serving in the recruiting depots, those on leave and the British staff and their families. Although referred to in the book as being relatively small, the BMH with approximately seventy beds was not small by Nepalese standards, because at this time Nepal had very limited hospital services and indeed outside the main centres still has. With its high level of resources compared with government services, the BMH- not surprisingly- also treated the surrounding population and retired Gurkha soldiers and their families, who often travelled considerable distances over difficult terrainto obtain treatment. PeterPitt'sexperiences asasurgeon- which areinterspersed with the family's life during these two years- provide the basis for the book, which is divided into multiple short chapters grouped together in themes. Together they provide a rich snapshot of his time in Nepal. The strength of the book lies in the detailed descriptions of some of his cases thatvividly portray the poverty and hardship of the lives of most Nepalese people and the challenges Pitt faced in his work. These included the relentlessness of always being on call, making wrong decisions or the very serious state in which patients often turned up at the hospital. Many arrived hours or days after an accident or becoming sick orhadalreadyconsulted otherpractitioners.Small boys falling out of trees kept him busy in the mango season, but he required a wide range of expertise to deal with the many common and rareor difficult cases. Despite the compassion and good intentions of the staff, many patients must have found the military hospital a strangeplace. Pitt describes his own surprise on his arrivalat finding thatunlike its surroundingsthe base was 'an oasis of order and cleanliness' (p. 27). As he comments, he is not an authorityon Nepal, but at times he provides tantalising glimpses into broader issues such as noting local resistance to the hospital in the early years and accusations of the British 162 BOOKREVIEWS employing Nepalese nurses for immoral purposes (p. 50). The Scalpel and The Kukri is Pitt's second book- to 'complete my narrative'(p. 13)- about his and his family's life in Nepal; it very much follows the same format as A Surgeon in Nepal (London: John Murray, 1970). An epilogue, however, records the drama near the end of British presence in Dharan, when in 1988 a powerful earthquakerocked the region and the hospital became a majorcentre for relief efforts. As in the earlier book, the realistic and detailed illustrations by George Douglas from Darjeeling are a highlight. An extensive glossary also aids the non-medical reader. Although the style is at times abrupt, the book will appeal to readers who would like to know more about medical practice and living in a country such as Nepal or who themselves have lived and worked in similar situations, whether in the 1960s or more recently. 1 smiled in recognition as I readabout the luggage and the tape recorderon the family's arrival in Nepal. SUSAN HEYDON UNIVERSITY OF OTAGO Joseph Melling and Bill Forsythe, The Politics of Madness: The State, Insanity and Society in England, 1845-1914 (London and New York: Routledge, 2006). ISBN10: 0-415-30174-2; ISBN13: 978-0-415-30174-9. Hardback, 278pp. A substantial cache of primary source data from more than one psychiatric institution forms the basis of this study of insanity in England between the 1840s and the beginning of World War I. Placed within a wider historiographical context, the institutional records from the Devon County Pauper Lunatic Asylum at Exminster, records of patient admissions to a smaller, fee-paying institution, Wonford House, and the patient admissions for two borough asylums in Devon, allow Melling and Forsythe to undertake a study of the 'politics...