REMARKS ON KALA-AZAR 131 day, probably recognising the malarial paroxysms while failing to recognise the fever on the intermediate days.

The average age of those affected was about 18 years, the eldest being about 40 and Age, sex and the youngest about 6. These figures are only approximate, as the ages had of course to "°° be judged on appearance and medical examination.

Nineteen out of the twenty-two were males, the three females being extremely ill, and, in fact, manifestly moribund, when seen.

This great preponderance of males over females only illustrates the difficulty a doctor experiences in seeing the female population of a Mohammedan community; in all probability the two sexes are attacked equally.

The attached table gives the nationality :— Nationality Kala-azar | Suspected Total Arab ads -s 3 ihe 13 20 33 Sudani af mS &. 23, 5 i 6 Mixed origin ave “we sis 2 8 10 Egyptian ... ue ue ate 2 1 3 Abyssinian ... es ane Ma — 3 3 Turk i 8 a Re _ 2 2 It is also worthy of note that four Englishmen have been reported as contracting the disease in the Sudan.

The preponderance of Arabs is but natural, considering that they greatly exceed the other types in number in the districts visited.

From a study of the death-rate statistics in the main stations visited it would appear that the death-rate is rising considerably in Singa, Gallabat and Mafaza, especially in the first-named town. The fallacies are that the populations of these towns vary greatly, often year by year, and, further, every year probably sees an improvement in registration.

The actual figures for Singa are for 1907, 224; for 1908, 361; and till the end of March 1909 (¢.e. 3 months), 109. I believe the death-rate at Singa is increasing in a greater ratio than is the population; it is to be noted that 109 deaths were registered up to the end of March, and if this be kept up for the three remaining quarters, then the total for 1909 will be 436. The death-rate is usually greater in the latter half—i.e. during the rains and Death-rate subsequent fever period—than in the first half of the year, so that probably this total will be exceeded and the death-rate will have more than doubled in three years.

The onset was either by short attacks of fever, frequently repeated, or by a serious continuous attack.

Personal observations on the type of fever were of too short duration to be of any value, but it was noted that the chronic cases seldom had any fever or only a rise to 99° F. at night; most of the cases seen within a few days of death had a normal or subnormal temperature.

Wasting was marked, especially in the chronic and very acute cases (vide Figs. 32, 33a, and 34). Many of the subacute type showed but slight signs of emaciation, and this renders the diagnosis more difficult, since it is not easy to determine whether some Arabs,