65 () 3. The persistence of the influenza epidemic of 1918 into the first two months of 1919. 4. A severe and fatal epidemic of malaria at Derr Markaz, Assouan Moudiria. 5. An increase in the mortality rate of most of the important infectious diseases caused presumably by non-reporting of cases due to the disturbed internal conditions in the spring and early summer. In this respect it may be noted that the mortality rate of typhus fever cases was 32'8 per cent, in 1919, compared with 264 per cent, in 1918. BmaUfooo.

The number of smallpox cases recorded in 1919 is the largest during the last ten years. As soon as the unusually large incidence of cases was noticed early in the year a vaccination campaign was at once begun, but most unfortunately, owing to the disturbances and interruption of communications, this campaign was stopped. It is also quite certain that the number of cases reported in March, April and May was much below the real number of cases occurring. In June, however, as conditions became more normal, the notification and discovery of cases improved, and has remained at its usual standard since. As soon as possible the general vaccination campaign was reopened. The number of persons revaccinated during the year was 2,500,000, The campaign is still being carried out, and at the time of writing this report (May 1920) over 6 million people have been vaccinated. In the course of the work many concealed cases of disease were discovered in villages by the vaccinating gangs, Ine total number of cases of smallpox found and reported was 7,895; of this number 1,926 died, giving a mortality rate of 2t’39 per cent.

Malaria.

A severe and fatal epidemic of malaria occurred in Derr Markaz—the most southerly markaz of Egypt—inhabited by a poor population living on the narrow strips of cultivation on each side of the Nile. The increase in the death-rate was remarked in the autumn, and blood films examined in the central laboratory in Cairo revealed positive malaria. Many of the blood films were taken from women, and as it i.s well known that Bcrberine women seldom travel away from their own villages, the suspicion was strengthened that there existed a local and fatal epidemic. A divisional inspector, detailed to investigate and rejjort, confirmed the diagnosis, and found the whole of the markaz south of Derr town infected, with a heavy death-rate. Another English inspector was at once despatched with a full medical staff, and an active anti-malaria campaign was started. The sick were hospitalised and treated, quinine was distributed throughout the infected districts, arrowroot and milk supplied, and breeding places of mosquitoes searched for, located, and anti-mosquito measures put into force. The area infected extended roughly to 106 kilom. of the river, and included seventeen districts, none of which e.scaped infection. In certain places so many of the inhabitants were incapacitated that work stopped in the fields, and at one place, Ibrim, even the dead lay unburied in the houses for two or three days, owing to absence of able-bodied people to bury them. Although it was suspected that the disease had been imported by servants or Labour Corps men returning from Palestine or the Soudan, no evidence could be elicited to prove this.

Mosquito breeding was found to be taking place in irrigation wells, a few birkas, and in zeers in houses. Unused wells were covered in, used wells were stocked with fish, birkas were filled in or drained oil into the river. A passenger control station was instituted at Shellal, where travellers from Derr to Egypt were medically examined, their addresses taken and sent to the medical oflicer at the place of destination with instructions that if necessary such persons were to be treated free of charge.

The various sub-committees appointed by the Anti-Malaria Commission continued their work, though considerable delay on account of the disorders in the spring was reported. The commission had at its disposal the sum of £E. 21,000 for the year, and this sum was spent as follows :— • £E. In Cairo and districts ... In the canal zone In the principal Moudirieh towns ... In the Oases 5,000 1,739 10,161 2,100 A sum of £E. 1,000 was set aside for a survey of the mosquitoes’ of Egypt. The work was practically completed at the end of .the year, and the results will be'published by the Commission.'

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