415

channel, which on several occasions had threatened the

patient with asphyxia, an additional operation was done.The trachea was split vertically, and both margins werethen attached to the sternocleidomastoid muscle, whichwas freed by incision at the same time. This gavethe trachea a good lateral support. In order to cover

the large anterior gap, a flap of skin, periosteum,and bone taken from the sternum was implanted so

that the epithelial surface faced the trachea, the rawsurface being outwards, and the skin was sutured over

it. The patient can now breathe very well through hernew trachea, without stridor, and has not again beenthreatened with asphyxia. The transplanted bone is easilypalpable under the skin of the neck and the x rays showit equally well. A similar method has been employedseveral times in urethroplasty for urethral stricture, no boneflap, of course, being used.

THE PARASITE OF KALA AZAR.

FOR many years kala azar in India defied all attempts toelucidate its etiology, and as it came to be regarded merely I

as a manifestation of "malarial eachexia " very little was of (

done to grapple with it except by anti-malarial measures grewhich proved quite valueless. But the new light which sev

Leishman threw upon the nature of the malady by his dis- thi:

covery of the protozoal parasite with which his name and At

that of Donovan have been associated, completely altered the wh

position, and soon a number of earnest Anglo-Indian workers Cr<

were engaged in investigations upon the disease. Among W:

those who have greatly contributed to the advance in exi

knowledge of kala azar the name of Rogers stands out Bu

prominently. More recently Captain W. S. Patton, I.M.S., of

was charged by the Indian Government with the special duty Mj

of investigating the development of the Leishman-Donovan isE

parasite, and his reports have been published from time to pItime in the Scientific Memoirs of the Officers of the m.

Medical and Sanitary Departments of the Government of T]

India. Captain Patton’s last official report dealt with the arassociation of the disease with the blood-sucking Indian m

bed bug, Cimex rotundatits, which had been suspected tt

by Rogers to be the transmitter of the malady to M

man. In a recent issue of the German journal A-rehiv a

fiir Protistenkunde, Captain Patton published an article on hi

another similar parasite found in the intestinal tract of the li

Lygaeid bug, the structure and life cycle of this parasite w

being almost identical with those of the Leishman-Donovan a

body ; and in January of the present year he read a paper IE

in London before the Society of Tropical Medicine and o

Hygiene, published in THE LANCET of Jan. 30th, in which n

he gave the gist of his own research work and summarised vour knowledge of the parasite of kala azar. From this s

paper it appears that after due consideration of the many i

difficulties which have hitherto surrounded the classification "I

of the parasite, he has arrived at the conclusion, adopting asuggestion formerly put forward by Rogers, that the kalaazar parasite is a herpetomonad and should in future beknown as Herpetomonas donovoni. Its life cycle is made upof three stages-pre-flagellate, flagellate, and post-flagellate.The flagellate stage is found in the midgut of the Indianbed bug, the post-flagellate in the rectum of the adult host,where the parasites become encysted and are finally passedout in the fseces and are liable to be ingested by the larvaeor nymphs of the insect. In blood-sucking insects like thebug infected with these flagellates the cysts are not

ingested by the adults, since these feed exclusively on

blood. It is conjectured that the parasite, in order

to reach man, must revert to its non-flagellate stageand that this change is most likely to take placesomewhere in the neighbourhood of the biting part of the

bug. It has been proved that Indian bed bugs becomeinfected by feeding on the blood of kala azar patients, andthough further experiments on animals may be necessary toprove the precise way in which an infected bug infects ahealthy human subject there can, we think, be little doubtas to its ability to do so. These investigations do not seemto us to have received in this country the recognition which,in our opinion, they merit; but it is a matter for congratula-tion that through them it has been already possible to applyappropriate preventive measures for stopping the spread ofthe disease. We hear from India that very promisingresults have followed the burning down of bug-infestedhovels and the removal of populations from infected villagesto fresh sites free from any trace of the bloodthirsty Indianbed bug. By the scientific work of the experts whom we havenamed above much of the protracted suffering from blacksickness " has already been prevented and many lives havein consequence been saved.

THE RESEARCH DEFENCE SOCIETY.

THE letter from Mr. Stephen Paget which appears at p. 421of our present issue gives an interesting account of the pro-gress of this society. Commencing with a membership ofseven (a number which has a history of beneficence as old asthis world) it has now reached a membership of over 2000.At the inaugural meeting, an account of the proceedings ofwhich we published in THE LANCET of June 27th, 1908, LordCromer was in the chair and Sir Thomas Barlow, Mr.

Walter Long (to whom this country owes the practicalextinction of hydrophobia), Lord Robert Cecil, and Mr. H. T.Butlin spoke, and it is greatly owing to the dignified advocacyof those speakers that the society has grown as it has done.Mr. Paget gives a list of pamphlets and other literatureissued by the society. These pamphlets put forth in

plain language the benefits which have accrued to

mankind as the results of experiments on animals.

, The wonderful diminution in both the incidence of,i and the mortality from, diphtheria, yellow fever,t malaria, and Malta fever since the discovery of antitoxin,l the transmitting mosquito agent, and the micrococcus

) Melitensis is known to all our readers and must convince

any sensible layman who is open to conviction. As to those

1 honest, if wrong-headed, persons who believe that no human3 life should be bought by an experiment upon an animal3 we can only leave them to time for cure. It is the

1 antivivisectionist who suppresses facts, who distorts know-r ledge, and who is wholly inconsistent to whom a perusal1 of the Research Defence Society’s literature may be recom-h mended. Some of them are clever men and women who,d whatever they may do as an organised society, would, we areLs sure, as individuals not wish to be either dishonest or

y ignorant. The Research Defence Society is doing a goodn work and deserves public and medical support.a -

THE RETARDING INFLUENCE OF SODIUMBICARBONATE ON PANCREATIN.

PEPTONISING powders are used to a large extent for pre-digesting milk in cases where difficulty is experienced indigesting cow’s milk. They are usually composed of onepart of pancreatin mixed with four parts of sodium bi-carbonate with or without the addition of sugar of milk.

It has recently been shown by Mr. C. E. Vanderkleed andMr. L. H. Bernegan 1 that these proportions are unsuitableowing to the retarding influence of excessive quantities ofsodium bicarbonate on the amylolytic power of pan-creatin. They prepared mixtures of these substances in

various proportions, containing from 20 to 80 per cent.

1 Druggists Circular, January, 1909, p. 16.