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an escape of cerebro-spinal fluid, in one case duringoperation and in the other a few hours later.In face of this emergency Mr. CAIRNS suggeststhat the upper aspect of the cribriform plate shouldbe exposed by an immediate transfrontal operationand the tear in the dura closed by suture or by agraft of fascia lata. He concludes that in fracturesof the frontal sinus and cribriform plate there isserious risk of intracranial infection, not onlyimmediately but also later when any new infectionof the nasal passages may break through barriers

weakened by previous injury. The indicationsfor urgent surgical intervention are clear in casesof injury to the dura during intranasal operation,and in cases of delayed cerebro-spinal rhinorrhoeaand aerocele following trauma. In the acute

stage of such injuries the desirability of immediateoperation has not yet been fully established, andgreater accuracy of diagnosis of the site of injuryis necessary before immediate operation, with itsrisk of aggravating the shock already present, canbe justified.

ANNOTATIONS

ABYSSINIAN REFUGEES IN KENYA

THE arrival of nearly 8000 Abyssinian refugees inKenya has thrown a strain upon the medical depart-ment of the colony. A large number of these unfor-tunate people had made long treks and were in amiserable, famine-stricken condition. There were

many women and children, including young infants,among the refugees and the area into which theyhad migrated was an almost waterless desert. The

geographical position made transport and supplyextremely difficult. The medical men hurried tothe district found that some of the parties weresuffering from small-pox, others had enteric, and therewere many cases of febrile illness which could onlyat the time be diagnosed as P.U.O. Dysentery wasalmost universal and nearly every immigrant wasinfested with lice. The immediate necessities of foodand water were supplied and the vaccination anddelousing of the refugees were undertaken. At theearliest opportunity a concentration camp has beendeveloped with adequate water-supply and facilitiesfor the transport of food. The medical staff is

supported by sanitary officers and a large numberof trained African hospital orderlies, and accommoda-tion for 200-300 patients in hospital has been provided.The difficulties in arranging a satisfactory sanitarysystem for such a horde of primitive people are

evident, and the progress of the concentration campwill be watched with interest. It may be mentionedthat this camp is the largest centre of population inKenya with the exception of its two chief towns,Nairobi and Mombasa.

A NEW REMEDY FOR KALA-AZAR

THE evolution of organic compounds of antimonyproceeds apace : fresh combinations are continuallybeing prepared and tested in the hope of finding oneless toxic and more effective than the last. TheChinese Medical Journal for September contains asymposium on the latest candidate, Solustibosan(S.D.T. 561), which forms a stable clear colourlesssolution of pentavalent antimony hexonate. Struthersand Lin 1 of Tsinan, writing on the clinical applica-tion, state that the doses are comparable to those ofNeostibosan ; 2 c.cm. of solustibosan is approxi-mately equal to 0.1 g. of neostibosan, which contains 42 mg. of antimony. On the first day 2 c.cm. wasgiven and afterwards 6 c.cm. on alternate days.Injections are usually given intravenously, althoughthe drug is isotonic and may be administered intra- :muscularly as well. Between January, 1936, andMarch, 1937, 29 patients were treated and thoughconclusions can only be tentative it seemed clear that

1 Struthers, E. B., and Lin, L. C., Chin. med. J. September,1937, p. 335.

solustibosan will cure kala-azar in the great majority ofcases. They conclude that it has comparativelylow toxicity, and its stability on exposure to air isan advantage. Yates 2 who has treated 82 cases atthe Hope Hospital, Hwai Yuan, has nothing but goodto say about it, but points out that the globulin testremains positive for some months after cure. H. Weese3of the I.G. Farbenindustrie, Elberfeld, says that amouse survives after subcutaneous injection of43 c.cm. (860 mg. stibium) per kg. weight (i.e., nearly5 per cent. of the total body-weight) which meansthat the mouse tolerates 25 per cent. more antimonyin the form of solustibosan than of neostibosan.

Finally Kikuth and Schmidt contribute to thiscollection of papers an interesting historical accountof the discovery of this new and efficient compound.

HEALTH UNDER THE "EL"

AN account of a localised health campaign inaugu-rated in 1932 as part of an important movement inNew York State financed by the Milbank MemorialFund has topical interest. The object of the move-ment was " to demonstrate by cooperation withthree typical communities embracing a populationof half a million people, whether, by intensiveapplication of known health measures the extentof sickness in the United States can be further andmaterially diminished and mortality-rates furtherand substantially reduced, and whether or not suchpractical results can be achieved in a relatively shortperiod of time and at a per capita cost which com-munities will willingly bear." The three communitiesselected were Cattaraugus County, a rural area,Syracuse, a medium-sized city, and the Bellevue-Yorkville district of New York, a typical Americanmetropolitan area. In the two former areas thedemonstrations began in 1923, and an excellentdescription of the work carried on in each has alreadybeen given by Dr. C. E. A. Winslow in books entitled" Health on the Farm and in the Village " (1931) and" A City Set on a Hill " (1934). Since the Bellevue-Yorkville demonstration required longer preparationit was not begun till 1926 ; its varied activitiesare now described by Dr. Winslow and Mr. S. Zimand. I)For the benefit of the reader who knows not New

York it may be explained that the " El " is theelevated railway, and that the Bellevue-Yorkvilledistrict lies under the shadow of the lines of the" El " that run above Fourth and Third Avenueson the east side of the city. The chief objects of thedemonstration were to interest the district in the

2 Yates, T. M., Ibid, p. 339.3 Weese, H., Ibid, p. 421.

4 Kikuth, W., and Schmidt, H., Ibid, p. 425.5 Health under the El. By C. E. A. Winslow and S. Zimand.

New York and London : Harper and Brothers. 1937. Pp. 203.$2.25.