REMARKS ON KALA-AZAR IN THE KassatA AND Buve Nie Districts OF THE SuDAN 7 BY CarTaIn L. BousrieLtp, M.A., M.D. (Cantas.), M.R.C.S., L.R.C.P., R.A.M.C.

Late attached Egyptian Army The Sudan Government caused an investigation to be made with the object of finding out if kala-azar existed or was prevalent in the above-named districts in 1909. A report was submitted to the Government in May of that year, and this article, at Dr. Andrew Balfour’s request, deals with the main points in that report.

The tour lasted from the middle of January to the middle of May, 1909, and, during that period, some 1,300 miles had to be covered, 900 of which were by camel, and, since more than half of the available working time had to be spent on general medical work, the actual time at my disposal for this investigation was quite inadequate for anything further than a rough estimation of the amount of the disease present in the various communities visited.

Those who may wish to see a fuller account are referred to the August and September numbers of the Journal of the Royal Army Medical Corps, 1910.

The accompanying table shows the towns and villages visited and the number of cases, divided into three classes : (1) Proved microscopically.

(2) Clinically certain.

(3) Highly suspicious. Only those in whom definite parasites were found are included in Class 1. The table shows that 57 proved and suspected cases were seen and points to the Blue Nile being seriously infected, for only three places were visited, viz., Sennar, Abdin and Singa, and yet ten cases were found in them.

When the report was written, 42 cases of proved kala-azar had been found in the Sudan, and of these, 15 at least had contracted the disease on the Blue Nile.

Of these 42 cases, 41 have been diagnosed since May, 1907, and have contracted the disease either on the Blue Nile or in the Kassala District.

The fact that the disease has been found mainly amongst government officials and employees calls for attention, when one remembers that they are far more under the medical eye than are the natives.

The map shows the distribution of the cases proved and suspected, and an attempt has been made to piece together all available information, so that the map is a composite one showing all known cases in these stations and does not represent the numbers seen on this tour; since its compilation, fresh cases have come to light.

There is fair evidence to support the belief that all the cases shown in the Sudan area (dotted tint) were imported.

Thus it seems probable that, as in India, the disease tends to cling to river banks, but it is to be noted that in none of these places off the rivers was I able to stay longer Extent of tour Distribution along river banks