15

ANKYLOSTOMIASIS.

This disease is endemic in Dongola, Haifa, and to a limited extend in certain areas of Kordofan and the Fung Provinces. Systematic treatment throughout Dongola Province was commenced in 1924, and since then a notable decrease in

the incidence has been noted. The matter is one of some importance, as the native of Dongola goes all over the Sudan to work and is apt to carry his diseases with him.

It is interesting to note that ankylostomiasis has not up to the present established itself in the irrigated area of the Blue Nile Province, in spite of the fact that the dampness of the irrigated soil and the increased density of the population are factors likely to favour the spread of this disease.

ANTHRAX.

An outbreak of human anthrax occurred in July at Gebel Kindermah in the Nuba Mountains. 23 cases were reported with 8 deaths. Gebel Kindermah is near Tira-el-Akhdar, where 7 human cases occurred in 1917 and 30 human cases in 1925. In 1925 the human outbreak was preceded by an outbreak among cattle, but no outbreak among cattle has been reported in this area during the years 1927 and 1928.

BUHARZIASIS.

Methodical work has been continued with a view to diminishing the incidence and spread of this disease. Especial efforts have been made to render the anti mollusc and propaganda side of the work more effective, while combining it with the treatment of infected persons; thus at the same time attacking the disease in its human and its mollusc hosts and endeavouring to prevent its

transmission from the one to the other.

The essential object of this work is to prevent the Gezirah irrigated area becoming infected. It is difficult to over-rate the importance to the future of the Sudan of preventing the infection of this area.

The measures taken to prevent the infection of the irrigated area are : —

(i) Quarantine at Wadi-Half a of labour imported from Egypt.

(ii) Quarantine at Kosti and El-Dueim on the White Nile, of immigrants entering the Gezirah from Kordofan and the west.

These immigrants are chiefly from Wadai, and from British and French West Africa.

(iii) Anti-bilharzial work in the principal endemic areas in the Sudan.

(iv) Enforcement of regulations to prevent bathing in canals, and urination and defaecation into canals in the Gezirah irrigated area.

(v) Destruction of snails in the distributary canals during the non-watering season.

(vi) Treatment of all infected cases that can be found in the irrigated area.

It is clear that no two or three of these lines of action would be sufficient in themselves to prevent the infection of this area, but it remains to be seen if, by the combination of all these methods of defence, it will be possible to save it from becoming permanently infected. It is possible also that further investiga¬ tion in the Sudan and elsewhere may furnish us with more effectual methods of combating the spread of infection.