56 GENERAL ROUTINE WORK Chickenpox ( Gidri Kasib. Borgool).—Is occasionally seen.

Dengue (Abul Bukub).—Not recorded, with the exception of one epidemic at Wady Haifa. Culex fatigans, said by Dr. Graham1 to be the intermediate host of the protozoon, is common.

Plague ( Tahun).—No record of this disease.

Cerebrospinal Fever.—Occurs sporadically and in epidemics. Some forty deaths in the last outbreak at Omdurman in 1899. I have seen one typical case along with Captain Ensor in a Sudanese. We isolated a small diplococcus from the cerebro-spinal fluid obtained by lumbar puncture during life. It was secured in pure culture, but efforts to inoculate rabbits and a monkey, via their nasal cavities, proved ineffectual. A rabbit received 1 cc. of a broth culture subcutaneously. Beyond slight fever no illness resulted. The cultural and staining characteristics, such as they are, were positive, and we have little doubt the organism was the Diplococcus intracellularis meningitidis of Weichselbaum. The disease did not spread, every precaution being taken.

Typhus (Humma Typliusick).—Was once supposed to be common. It is said the Mahdi died of it. His fatal disease was, however, probably cerebro¬ spinal fever, and typhus is only doubtfully present, if at all.

(2) Other Diseases common to all climates which are frequent in the Sudan Tuberculosis (sildaran) and syphilis (zhurri, halug) are common. Their ravages are terrible, especially on the integumentary and loco-motory systems of those affected. The reason for the tubercle bacillus system finding suitable pabulum has been mentioned, but it must not be supposed that the climate of the Sudan favours its existence. The reverse is true, at least during the winter months (November to March) when the air is very dry and pure, and the variations in tempera¬ ture are not startling or excessive, although the nights are always cool. Occasional high winds and blowing sand form the only drawbacks.

Syphilis in the Sudan is a loathsome scourge. In the time of the Dervishes it was considered rather an honour to have acquired infection. A lad was not a man till he had developed a chancre. The results of this ignorant and pernicious regime are deplorable. Patients do not visit the hospitals till they are masses of ulceration and necrosis. True, they make use of tureba, a native preparation of mercury found locally, and they even fashion cones for fumigation with it, but their treatment is not conducted on sound principles and is probably more harmful than beneficial. Education, combined with proper sanitary measures, is the only remedy. The Sudanese are fond of their children, and if they could be made to understand how frequently they are themselves to blame for the pitiable condition of their offspring, be taught the dangers and crippling effects of the unchecked . disease, and be instructed how to avoid acquiring it and how much can be done by 1 Journal of Tropical Medicine, July 1st, 1903