134 X.—PUBLIC HEALTH.

In 1915 a reorganisation of the medical work of the Soudan was carried out with the creation under its own director of an independent Civil Medical Department which had previously been under the control of the Principal Medical Officer, Egyptian army.

A new system of registration of births and deaths has been instituted, which has resulted in a considerable increase in the number of registrations.

The following is a table of registration for the five years:— 19U.

Births,. Deaths 16,645 12.450 1915. 1916. 1917. 1918, 12,318 16,065 15,303 9,587 14,078 9,172 18,935 14,452 These figures do not approach completeness or accuracy, as may be shown by the fact that the estimates of population from other sources give a total of over 4,000,000 as against 3,400,000 in 1914; but the system of registration does not obtain at all in the southern Soudan.

Seven outbreaks of cerebro spinal meningitis occurred in 1914 and 1915 with a heavy mortality.

As regards small pox, the Northern Soudan is fairly efficiently protected by vaccination. Small outbreaks occurred in Khartoum and Omdurman in 1917, but were soon controlled. Vaccinating tours are apanged as far as possible during the winter months, but have had to be curtailed owing to shortage of staff. Considerable success has recently been obtained in vaccinating among nomad arabs, who had previously been strongly opposed to it. _ _ Small pox was prevalent in certain districts in 1919, principally Mongalla, and later the Upper Nile province. There were a few cases in Omdurman and Khartoum North during the summer.

In 1918 the Sleeping Sickness Commission was considered to have completed the duties for which it was appointed, and its advisory functions were taken over by the Central Sanitary Board, the executive work being continued by the Principal Medical Officer of the ‘Egyptian army.

In the Yei River district of the Mongalla province about 175 patients, who had been three years free from symptoms, were discharged as cured.

In the last year progress has been made in the infected areas dealt with, and no new areas of 'human trypanosomi infection have been discovered. The Principal Medical Officer of the Egyptian army has forwarded me the reports of Captains Spence and Simson, R.A.M.C., on their several districts, and I fully endorse his tribute to the patient steady work which these two officers and their Egyptian and Syrian staff are doing.

The influenza epidemic made its appearance in the Soudan in September 1918. It became very general throughout the Soudan, with a considerable mortality. The district which suffered the most appears to have been Berber province, north of Khartoum. It reached its most virulent stage in February 1919, and died away in April and May.

It is not possible to give more than an approximate estimate of the extent of the outbreak and consequent mortality. The Senior Medical Officer, Kassala, estimated 1,600 cases out of a population of 6,000 in Gedaref alone; thirty-five deaths from the disease were notified. The death-rate of all cases admitted to hospital was about 6 per cent. Malaria on the whole was not severe except at Makwar in the Sennar province, where the'Blue Nile dam is to be constructed.

Much work is being done in continuing the antimony treatment of bilharzia, first fully investigated and developed by Dr. J. B. Christopherson, the Director of the Khartoum and Omdurman Civil Hospitals.

Dr. E. S. Crispin, the Director of the Medical Department, reports that considerable difficulty is still experienced in respect of both staff and hospital requirements. Advertisements for medical inspectors produced few replies and there has been a similar difficulty in obtaining Syrian and Egyptian staff.

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