Surgeons Of Nepal Research Articles

Knowledge of novel coronavirus disease (COVID-19) among dental surgeons of Nepal: a nationwide study

BackgroundCOVID-19 is an emerging respiratory disease caused by a novel coronavirus. There is not much evidence assessing the knowledge of dental surgeons regarding COVID-19. This study was conducted to assess the knowledge of COVID-19 among dental surgeons of Nepal.MethodsA web-based cross-sectional study was conducted among registered dental surgeons of Nepal. Ethical approval was obtained. Consent was taken, and knowledge on COVID-19 was assessed via a pre-tested structured questionnaire using Google form. The form was emailed to the participants. Descriptive analysis was performed using frequency, percentage, median and inter-quartile range. Man-Whitney test and Kruskal-Wallis tests were carried out to see the difference in knowledge score. P-value < 0.05 was considered statistically significant.ResultsTotal 227 dental surgeons responded to the questionnaire (male: 46.4%; female: 53.7%). Almost two-third (65.2%) of the respondents were B.D.S. (Bachelor of Dental Surgery) graduates. Only 29.1% worked in the government hospitals. 17.6% were currently involved in COVID-19 management. Of the participants, 87.7% knew about the condition of the requirement of Personal Protective Equipment (PPE) but only 29.1% could correctly answer the framed question for PPE. The median knowledge score calculated was 14.0 (8.0–18.0). The bivariate analysis showed a statistically significant difference in knowledge score among the age group ≥30 years and < 30 years (p = 0.013); M.D.S. (Master of Dental Surgery) graduate and B.D.S. graduate (0.041); dental surgeons of government healthcare facilities and other healthcare facilities (p < 0.001); dental surgeons of COVID-19 centers and non-COVID-19 centers (0.002).ConclusionThe dental surgeons of Nepal have a good knowledge of COVID-19, and they can be utilized for assisting in the management of COVID-19 cases in Nepal.

Burnout In Orthopaedic and Trauma Surgeons of Nepal

Background: Burnout is a syndrome, which consists of detachment from patients and colleagues, emotional tiredness and lack of achievements in personal life. Freudenberger HJ coined the term “burnout” in the 1970s and categorized into three categories namely depersonalization, emotional exhaustion, and personal achievement. Since then there has been a lot of research on the effects of stress, work or emotion, on behavior and in professional life. Surgeons are particularly exposed to burnout and more common than in the general population and have been found that burnout in the orthopaedic surgeon is more than in any other specialty. There is a high level of dissatisfaction in orthopedic surgeons in Nepal, who are emotionally harassed and tired of lack of achievements. There was research on burnout and over orthopedic surgeons in different countries but there was no research on burnout and no studies were conducted in orthopedic surgeons of Nepal. Therefore, this study was conducted to evaluate the burnout level of orthopaedic surgeons in Nepal.&#x0D; Methods: An observational transverse contacted survey among Nepalese orthopaedic and trauma surgeons by voluntary sample technique was conducted in Kathmandu Nepal between September 2018 - August 2019; using a self-administered questionnaire in digital as well as the printed form that was based on the Maslach Burnout Inventory. Demographic and occupational data were also collected.&#x0D; Results: Out of all contacted surgeons, 34 responded. The mean age was 35 and all were male. Almost everyone showed a high level of emotional exhaustion (94%), depersonalization (100%) and only 32% showed a high level of personal achievement.&#x0D; Conclusion: Burnout syndrome is consisting of depersonalization, emotional exhaustion, and personal achievements and showed a frightening level of emotional exhaustion, depersonalization and a satisfactory level of personal achievements.

Trotting down the memory lane

Born on 1962 at Kamaladi, Kathmandu, Prof Ishwar Lohani completed School Leaving Certificate from St. Xavier’s School. Lalitpur. followed by Senior Cambridge ‘O’ Level from Cambridge University 1980 and Proficiency Certificate Level from Amrit Science Campus. 1984.&#x0D; He did B. Muse. (Sangeet Prabhakar) in Tabala from Kalanidhi Sangit Manavidyalaya under Prayag Sangit Samiti, Allahabad. 1983.&#x0D; He completed M.B.B.S Degree from Madurai Medical College under Madurai Kamaraj University, Madurai, Tamilnadu, India. 1991 and MS General Surgery from PGIMER, Chandigarh, India. 1994.&#x0D; After completion of M.Ch. Plastic Surgery from PGIMER, Chandigarh, India in 1997, he worked initially as a Senior Medical Officer for few months and later as Senior Resident in the Dept. of Surgery, Chandigarh Medical College. He completed fellowship in Plastic Surgery as PSEF International fellow from University of Southern California, Los Angeles and California Pacific Medical Center, San Francisco May 2001 to Feb 2002 under Dr. Randy Sherman and Dr. Bryant Toth. He later did fellowship in Plastic Surgery through the Scottish Foundation for Surgery in Nepal at St. John’s Hospital, Livingstone and Canniesburn Hospital Glasgow, England from Jan 17, 2003 to Feb 28, 2003 under Dr. Auf Quaba and Dr. David Soutar.&#x0D; Presently working as Professor and Head of Department, Dept. of Plastic Surgery and Burns at the T.U. Teaching Hospital, Maharajgunj, Kathmandu, Nepal. He has been involved in the training of MBBS, MS (General Surgery) and MCh Plastic surgery graduates at the Maharajgung Medical Campus.&#x0D; He served as the President of the International College of Surgeons (ICS) Nepal Section; General Secretary of Association of Plastic Surgeons of Nepal (APSON). He has been member of Society of Surgeons of Nepal since 1996 and has contributed a lot in the activities of the society. He has presented in numerous National and International conferences and has numerous publications in international and national journals as well. He served as the Chief Editor of the Journal of Society of Surgeons of Nepal 2008 – 2014.

Magnetic resonance imaging findings in patients with low backache

Introduction: Low backache is commonly experienced by adults at some time during their lives. Though it is caused by degenerative changes, spinal stenosis, neoplasm, infection and trauma, lumbar disc degeneration is the most commonly diagnosed abnormalities associated. As Magnetic Resonance Imaging (MRI) is non invasive imaging technique with excellent spatial and contrast resolution, it has become the investigation of choice in evaluation of patients with low back pain. This study was designed to determine the patterns of degenerative disc disease on MRI in patients with low backache.Methods: A retrospective hospital based study was done by reviewing MRI report of 202 patients who underwent MRI of lumbar spine for complaint of chronic low back pain, radicular pain, neurogenic claudication or various other symptoms and signs suggestive of lumbar degenerative disc disease from January 2014 till June 2014. The patients having MRI findings of acute spinal infection, recent trauma, tumors, spinal dysraphism and metabolic conditions were excluded from the study.Results: Out of the 202 patients included in the study, 116 patients (57.4%) were male and 86 patients (42.6%) were female. The mean age of the study population was 44.26 ±15.61 (13-83) years. Multiple contiguous level disc disease was the most common type of involvement which was noted in 109 (54%) patients. Grade 4 lumbar disc degeneration (graded as per classification given by Pfirrmann et al) was noted in 65.3% (132) cases followed by Grade 2 in 25.2%(51) cases and Grade 1in 5.5% (11) cases. The most common involvement was observed at L4-L5 level (76.7%) and L5-S1 levels (55.9%) followed by L3-L4 (30.6%) in decreasing order of frequency. The most common category was disc bulge note in 46.5% (94) of cases. Nerve root compression was observed in 56% (114) of the total cases. Nerve root compromise was also noted most frequently compressing L5 nerve (28.23% of cases). Annular tear was observed in 14.4% (29) of cases and among them 20% (6) of cases had torn at two intervertebral discs. It is most frequently noted involving L4-L5 intervertebral disc (72.5% of cases), followed by L5-S1 (24.2% of cases).Conclusion: Disc generation is most common at L4-L5 level with multiple contiguous involvement of grade 4. Annular tear though not common can occur and is also common at L4-L5 level.Journal of Society of Surgeons of Nepal, 2015; 18 (2)

Autologous blood patching in the management of broncho-pleural fistula in spontaneous pneumothorax

Introduction: Autologous blood patching (ABP) has been described as a modality of treatment of bronchopleural fistulas (BPF). The success rates have varied chiefly because the numbers studied have been small and the populations inhomogeneous. We conducted this study to determine the success rate in patients with BPF of spontaneous onset.Methods: All patients with spontaneous pneumothorax with no evidence of pleural infection and in whom the air leak did not subside despite 48 hours of conservative management were included These patients underwent one to three episodes of blood patching in 50ml aliquots. Demographic profile, smoking status, success rate and complications were recorded and compared.Results: Between July 2011 and January 2014, seventy-six patients underwent ABP. The overall success rate of ABP was 58%. Twenty one were successful in first attempt (27.6%), a further 12/55 (22%) in the second and 11/43 (25%) in third attempt. The success rates did not differ significantly with etiology of spontaneous pneumothorax (P = 0.706); smoking status (P value = 0.958); duration of air leak prior to ABP (P= 0.149) and presence of residual pneumothorax after chest tube insertion (P= 0.176). Seven complications (3 pleural infections, 1 surgical emphysema, 1 expansion of pneumothorax and 2 recurrence) occurred. Infectious complications occurred in patients who received two or more instillations of blood.Conclusion: ABP achieved a modest success rates in our experience. Two or more attempts may be necessary to attain a successful result but one has to be mindful of the possibility of infection.Journal of Society of Surgeons of Nepal, 2015; 18 (2)

Clinical profile and early outcome of arteriovenous fistula creation for haemodialysis: Integrated activity in a general surgery unit

Introduction: A functioning arteriovenous fistula (AVF) is essential for maintenance hemodialysis (HD) in a patient with chronic renal failure. This study explores the creation of AVF as an integral activity in a general surgical unit by a general surgeon.Methods: This is a hospital based cross sectional study done at Patan Hospital patients who underwent creation of AVF from January 2015 to June 2015 were included in the study. Patient demographic and clinical data were documented. Outcome and complications of AVF surgery were obtained over a 6 months period from the time of vascular access creation.Results: Thirty-seven patients were operated in the study period with a mean age of 35.44 years and M: F ratio of 2.7:1. There were 3 immediate and 3 delayed failure with 81.81% (n=27) patency rate at 6 months follow up. The maturation time was 3-7weeks (mean +/- SD of 4.83 +/- 1.053). Complication occurred in 4 patients, namely arm edema (n=3) and haematoma (n=1).Conclusion: The creation of AVF for HD performed in a general surgery unit is a safe procedure with satisfactory outcome and acceptable level of complications. Journal of Society of Surgeons of Nepal, 2015; 18 (2), Page: 2-5

Tuberculous pseudotumor of fibular head

Tuberculous osteomyelitis of long tubular bone is uncommon, the reported incidence is about 2-3 %. Tuberculous osteomyelitis of fibular head is very rare and it mimics neoplasm. Here we report a case of a 28 year old male presenting with unremitting right knee pain with swelling around fibular head with knee radiography showing lytic lesion of proximal fibula,excisional biopsy was done and histopathological report confirmed it as tuberculous osteomyelitis. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 33-35

Laparoscopic versus open appendectomy: a prospective comparative study

Introduction: Appendectomy is one of the most commonly performed surgeries usually done by conventional open method. The role of laparoscopic appendectomy is still not well defined in the literature and although widely practiced it still hasn’t gained popularity in Nepal. The aim of this study was to compare the outcomes of laparoscopic versus open appendectomy.Methods: A prospective study was carried out, between August 2013 and September 2014, involving 216 patients (93 males and 123 females) with a diagnosis of acute appendicitis based on Alvarado score of seven and above. Patients were allocated into two groups where every alternate patient was operated either open or laparoscopically. The groups were compared in terms of operative time, post operative pain, post operative complications and length of hospital stay.Results: Open appendectomy (OA) comprised of 106 patients and Laparoscopic appendectomy (LA) comprised of 110 patients. Patients’ characteristics were similar in both groups. The mean operative time in LA was 42.82±10.84 minutes and in OA 37.99±9.81 minutes (p&lt;0.86). Conversion was done in 2.8% of laparoscopic cases. Mean comparison of postoperative pain by visual analogue scale was low in LA compared to OA (P&lt;0.05). Mean post operative stay (3.19±1.26 vs 2.75±0.7, p&lt;0.01) and surgical site infection was recorded in 9 patients (8.5%) in OA group and 3 (2.5%) in LA group, with p value of 0.06.Conclusions: Laparoscopic appendectomy is feasible and safe as open procedure with less post operative pain and shorter hospital stay. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 29-32

Role of surgery in management of liver abscess

Introduction: Liver abscess is a common disease in developing world. Its treatment has evolved in last few years to become less and less invasive. Percutaneous drainage of liver abscess is a wellestablished method and probably most widely accepted as well. However, large and multiloculated abscess containing thick pus may not be suitable for such methods.Methods: All patients with liver abscess, who could not be drained or not found suitable for percutaneous drain insertion and eventually underwent surgery were included in the study.Results: Total 8 patients were treated by surgical drainage, open or laparoscopic technique. Surgical drainage was effective way of treatment for abscesses not treatable by needle aspiration or percutaneous tube drain insertion with good outcome.Conclusion: In patient of liver abscess who has large multiloculated abscess with thick pus or not suitable for percutaneous drainage, surgical treatment either laparoscopic or open can be an effective and successful. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 20-22

An institutional review of tumour biology of breast cancer in young Nepalese women

Introduction: Breast cancers in less than 40 years of age group usually present with aggressive biology and has poor prognosis. The aim of this study was to see clinic-pathological and hormone receptors of breast cancers in young women and compare with less than 40 year age group.Methods: Prospective analysis of 97 breast cancer in patients less than 40 years out of total 373 patients (26%) over a period of 8 years (2007 Jan to 2014 Dec) was carried out at the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.Result: Among the young women diagnosed with breast cancer, the mean age was 34.5±6.2 years. Mean tumour size was larger in younger women (5±2.5 vs 4.5±2.4 cm). Locally advanced disease was higher in younger patients (55% vs 47%). Lymphatic and vascular invasions were higher (63% vs 35% and 40% vs 25%). Grade II and III tumours was higher (56% vs 25%). ER, PR and HER2 positivity was detected in 46.9%, 48.9% and 28.9% respectively. Significant lower ER or PR expression (34.5% vs 54%) was seen in younger women, p=.002.Triple negative tumours (ER -ve, PR -ve and HER2 -ve) was proportionately higher in younger patients (23% vs 13.7%, p=.043).Conclusion: Young Nepali women presents one quarter of all female breast cancers, more frequently locally advanced with aggressive tumour biology like ER/PR negative and triple negative breast cancers. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 16-19

Evaluation of ‘Visual prostate symptom score’ in men with benign enlargement of prostate in a tertiary care center in midwestern Nepal

Introduction: Quantification of lower urinary tract symptoms (LUTS) in patients with benign enlargement of prostate (BEP) is required to initiate and regulate treatment. Among many, International Prostate Symptom Score (IPSS) is standard though it is time consuming and difficult to understand by many patients. A recent Visual Prostate Symptom Score (VPSS) which is presumed to be simpler and well understood by patients with lower educational status has been in use.Methods: This is a prospective observational study conducted in Nepalgunj Medical College, Nepalgunj. In a total of 79 patients, 25 patients of LUTS because of other causes were excluded and 54 patients clinically diagnosed with BEP were enrolled for the study over a period of one year. Symptom evaluation was done in all with both IPSS and VPSS and uroflowmetry parameters were also recorded. The IPSS and VPSS were compared with each other and also with uroflowmetry parameters.Results: Mean age of the patients was 67 years and mean prostate volume was 48 gm. The patients who mostly were farmers had median eighth grade of education. Fourteen were illiterates and 40 were literate patients. Significant number of patients required assistance of a medical personnel to complete IPSS (p= &lt;0.001) including those in literate group as well (p= &lt;0.001). Time taken to complete VPSS was significantly less (p= 0.019). Total IPSS correlated with total VPSS ((r= +0.36; p=0.007). There was negative and significant correlation of VPSS with uroflowmeter parameters while IPSS failed to do so.Conclusion: VPSS is an easy and reliable tool to assess symptom severity in cases of BEP presenting with LUTS. It has the added advantage of utility in assessment of LUTS in patients with lower educational status. Moreover, the patients take shorter time to complete the questionnaire. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 6-10

The First Oration of the Nepal Orthopaedic Association Challenges of an Orthopaedic Surgeon in Nepal

DOI: http://dx.doi.org/10.3126/noaj.v1i1.8125 Nepal Orthopaedic Association Journal Vol.1(1) 2010

Phacoemulsification surgery by a nationally-trained cataract surgeon of Nepal

A one month phacoemulsification training course had been implemented by the Nepal Netra Jyoti Sangh (NNJS) in collaboration with Association for Ophthalmic Cooperation to Asia, Japan (AOCA). To evaluate the visual outcomes of phacoemulsification surgery by a nationally trained surgeon in Nepal. A retrospective study of patients that underwent phacoemulsification with foldable intraocular lens implantation during a period of 18 months was carried out. Cases that had a six-week follow-up period were included. Effective phaco time (EPT), intra-operative and postoperative complications were noted. Uncorrected visual acuity (UCVA) at day 1 and best corrected visual acuity (BCVA) at week 6 were noted. The data were analyzed using SPSS 11.5. A total of172 patients that had completed a 6 week follow-up evaluation were included in the study. The mean age of patients was 57.12±10.19 years. The mean effective phaco time (EPT) was 9.74±7.41 seconds. Posterior capsule rupture (PCR) with vitreous loss occurred in 2 eyes (1.2%), Descemet's membrane detachment in 1 eye (0.6%), capsulorhexis extension in 1 eye (0.6%) and wound site thermal injury (WSTI) occurred in 3 eyes (1.7%). Postoperative complications were mild to moderate striate keratopathy (9/ 172), corneal edema (1/172), corneal epithelial defect (1/172) and uveitis (1/172). At 6 weeks post-operatively, 165 eyes (95.9%) had a BCVA better than 6/18 and 7 eyes (4.1%) had a BCVA of 6/18 to 6/60. Patients undergoing phacoemulsification had a good visual outcome as a result of the procedure performed by cataract surgeon trained from AOCA/NNJS national phacoemulsification training program of Nepal.

Ruth Watson FRCS: Surgeon in Nepal

In 1971, I was sent by the British Council to Nepal to teach and to operate. There, in the little town of Pokhra, I met the most extraordinary woman surgeon that I have ever encountered before or since. Her name was Ruth Watson. She was a slimly built, smiling young woman, dressed in a Nepalese sari and speaking to her staff in fluent Nepalese. She had arrived in Pokhra 20 years before, at the age of 25, and established a hospital there. Initially it was constructed out of matting, but this was soon replaced with corrugated iron Nissen huts. Because the metal walls shone in the blazing Nepalese sunshine the hospital came to be called the 'Shining Hospital' by the patients, and the name stuck. It served an enormous population from the far flung villages--mostly poor peasant farmers and their families. By the time of my visit, there were about 50 beds, a small operating theatre and a single-bedded labour ward.Ruth told me that she had once delivered two sets of twins synchronously on that one bed!

The Politics of Madness: The State, Insanity and Society in England, 1845-1914 by Joseph Melling, Bill Forsythe

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' of mental breakdown in the period. Their themes in specific chapters include the administration of lunacy; treatment and care; admissions; community and family; gender and domesticity; patient backgrounds and class; and the patient experience. Health& History • 10/1 • 2008 163 In a final chapter the authors reflect on the 'remaking' of the institutional landscape in the twentieth century. This is an impressive volume, not least because it seeks to address a range of issues in one over-arching narrative of asylums and their social, political and cultural context. The authors introduce the complex debates surrounding the now extensive scholarship in the field of the asylum studies in a compact but detailed argument which situates their study. In seeking to understand the institution's role during the period, they set out to question previous assumptions, both scholarly and general, about a range of issues. In particular,the authors appear concerned to challenge leading scholar in the field, Andrew Scull, whose work is critiqued throughout the book. Here, Melling and Forsythe disagree that institutions imposed 'a hegemonic model of treatment'in specific places, and suggest instead that'the identities of class, gender andethnicity (or race) were negotiated via the rules of the asylum' (p. 6). Australian and New Zealand readers of this book will find much to interest them, and many useful points of comparison with colonial psychiatric institutions in the same period. For instance, no Poor Law operated in the colonies, but as Melling and Forsythe suggest, the English institutions were progressively adopting what might be called a mixed-economy of asylum care over the nineteenth century; some families of inmates of public asylums were able to pay a small amount towards their maintenance, as happened in the colonies. A chapterabout patient 'journeys' to the institutions in Devon also comments on migration, family networks and social change, and allows the authors to examine the demographic data in their extensive sample of cases. A similar approach to colonial patient populations is overdue. How friends and families coped with institutional committal is the subject of another chapter, and it too offers much to the scholarly field in different partsof the world. One of the key shifts in the literature around the histories of institutional committal has been a focus on patients and their 'experiences,' insofaras these can be discovered. Inthis volume, which draws heavily upon statistical methods and provides rich insights into large...

The Scalpel and the Kukri: A Surgeon and His Family's Adventures among the Gurkhas by Peter Pitt

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...

Surgeon in Nepal. By Peter Pitt. 8½ × 5½ in. Pp. 225+vi. IIIustrated. 1970. London: John Murray (Publishers) Ltd. £2.50

Journal Article Surgeon in Nepal. By Peter Pitt. 8½ × 5½ in. Pp. 225+vi. IIIustrated. 1970. London: John Murray (Publishers) Ltd. £2.50 Get access Surgeon in Nepal. By PeterPitt. 8½ × 5½ in. Pp. 225+vi. IIIustrated. 1970. London: John Murray (Publishers) Ltd.£2.50 British Journal of Surgery, Volume 58, Issue 8, August 1971, Page 638, https://doi.org/10.1002/bjs.1800580838 Published: 07 December 2005

Book Reviews : Surgeon in Nepal. By PETER PITT (London, John Murray, 1970), viii, 225 pp. £2.50. The Siege of the Peking Legations: A Diary by Lancelot Giles. Edited, with Introduction 'Chinese Anti-Foreignism and the Boxer Uprising' by L. R. MARCHANT (Perth, University of Western Australia Press, 1970). xxvii + 212 pp

Book Reviews : Surgeon in Nepal. By PETER PITT (London, John Murray, 1970), viii, 225 pp. £2.50. The Siege of the Peking Legations: A Diary by Lancelot Giles. Edited, with Introduction 'Chinese Anti-Foreignism and the Boxer Uprising' by L. R. MARCHANT (Perth, University of Western Australia Press, 1970). xxvii + 212 pp

Surgeon in Nepal

Surgeon in Nepal

Surgeon in Nepal.

Surgeon in Nepal.