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Epidemic louse-borne relapsing fever first appeared in French West Africa in 1921. It spread freely throughout French and British West Africa, extended to the Tchad area and Wadai, and finally appeared in Darfur in September

1926. The loss of life was at first very heavy, and in the Zalingei district in the autumn of 1926, 10,000 deaths were estimated to have occurred out of a population of 45,000 persons.

Considerable anxiety was felt, lest it should spread to Kordofan and thence to the Gezirah irrigated area. Had it effected an entry into this thickly populated area, the incidence of the disease would have been very heavy and the cotton cultivation would have been seriously interfered with.

Every effort was made to pi event the eastwards spread of the epidemic, but the people and the country alike presented many difficulties. The country had only recently been occupied and the people were still aloof and suspicious, communications were bad and some of the country mountainous and very difficult. The people chiefly affected—the Fur—were timid, drunken, and very dirty.

As primary measures, quarantine posts were established on the roads leading eastwards, widespread delousing operations and widespread treatment

were carried out in the epidemic areas, and as a result the first impetus of the epidemic was checked. Smaller epidemics, however, continued to occur all over the province, and before the disease could be got under control roads had to be made, motor transport to all parts of the province established, and the confidence of the sheikhs and leaders in the necessary medical and health measures had to be won. In this, to a greater extent than in epidemics occurring in more closely administered and longer occupied areas, the anti-epidemic measures had to be carried out by the administrative officials, and it was largely due to their efforts that the epidemic was at first confined to one province aDd

finally brought under complete control.

SMALL POX.

Epidemics of small pox occurred in Darfur, Kordofan, Nuba Mountains, Blue Nile, Bed Sea, Kassala, White Nile and Berber Provinces.

Darfur. Small pox broke out in Dar Masalit, the westernmost district of Darfur, in December 1927, where it was earned by immigrants from Wadai. It spread to Zalingei district in February 1928 and to Nyala district in May. In the course of the year 1,942 cases were reported with 357 deaths. It is probable that many cases remained unreported. The heaviest incidence was in Zalingei district where 1,312 cases were reported. By the end of the year the epidemic was still not under control.

It is difficult under the conditions of distance, transport and temperature to preserve the activity of vaccine in its journey from railhead in Kordofon to the remote districts of Darfur and the epidemic broke out among a largely

unvaccinated population. Fortunately many of the staff and much of the organisation that had been built up to deal with the relapsing fever epidemic remained, and was used to deal with this epidemic; moreover the people had to some extent learnt the benefits derived from medical interference and the in¬ conveniences resulting from disobedience. Had it not been for these two factors the incidence of the disease on the population of this remote province would have been far heavier.

Steps are being taken, by the establishment of dispensaries at important centres in Darfur, to build up a medical organisation which will win the confidence of the people in medical work and medical administration.