Recommendations for prevention 140 REMARKS ON KALA-AZAR’ Smears were made from the spleen, liver, kidneys, and mesenteric glands, and a few structures were found which were extremely like Leishman-Donovan bodies (vide Plate IX., figs. 1-17).

It is impossible to say definitely what these are, as films only were made, and it was quite impossible to attempt any cultures.

Very few bodies, scattered here and there, could be found in the films, and in the kidney films only one was found after prolonged search.

All that can be said is that these structures have a striking resemblance to kala-azar parasites, and work should be carried out on dogs in the Sudan.

2. The second dog, though very wasted, showed no structures similar to the Leishman bodies, but many filaris were found in the liver and spleen smears; this dog was @ vagrant.

I wish to thank all who most kindly assisted me in my investigations, and to record that every help and courtesy was afforded me by the English and Egyptian officials and the medical officers, amongst whom I would specially thank El Sagh, Mohammed Eff, Ali Niklawi, Sudan Medical Department, who gave me much assistance and information and kindly sent me several detailed reports on the cases at Singa.

The following is a brief summary of the recommendations suggested to combat the disease :— 1. Burning of infected huts, angareebs, etc.

2. Isolation of acute cases, and compulsory isolation villages for chronic cases.

3. Special quarters to be allotted to Abyssinians in towns and villages.

4. Careful medical examination of Abyssinians before enlistment into the army or police, or before employment as servants to officials.

5. That all officials in the infected districts who have to visit villages be supplied with tents, and that all possess small camp-chairs.

6. Avoidance of native angareebs by officials, their servants and police.

7. A course of instruction to officers of the Military and Civil Medical Departments on this disease, especially with regard to its pathology and microscopical diagnosis.

8. Until our knowledge of the transmission of the disease is more definite, it would be wise for officials not to keep dogs.

9. That all the angareebs used by the soldiers and police be placed, uncovered, exposed to the sun from early morn to sundown. My belief is that one day’s exposure to the tropical sun of summer would destroy all the bugs, even those within the crevices.

This requires a series of experiments; in the one instance in which I tried it I could find no live bugs after one day’s exposure, though there were many to be found previously.

10. The invaliding from the army and police of those who are weak and wasted and have enlarged livers and spleens, with subsequent supervision.

13. The most effective way of getting rid of bugs from woodwork and crevices in walls, etc., is to play the flame from a painter’s lamp direct, and subsequently apply a thick wash of lime.

14. Further investigation of the disease, especially up the Blue Nile. This has already been done by the Second Commission sent by the Sudan Government in 1909, and its report will no doubt add very greatly, to our knowledge of the extent, distribution, pathology, etc., of this disease in the Sudan.

That the acute epidemic type as well as the sporadic type exists in the Sudan is now well established, and several of the most acute virulent cases did not raise in my mind the