56. GENERAL ROUTINE WORK 



Chickenpox (Gidri Kasib. Borgool). — Is occasionally seen. 



Dem/ue (Abul Ruknb). — Not recorded, with the exception of one epidemic at 

 Wady Haifa. Culex fatigans, said by Dr. Graham' to be the intermediate host of 

 the protozoon, is common. 



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



Cerebrospinal Fever. — Occui's 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 

 pui'e culture, but efforts to inoculate rabbits and a monkey, ind 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 ai"e, 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 Typhusick). — 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 Siidan 



Tabercidosis (tsil, daran) 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 \\ariations in tempera- 

 ture are not starthng 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 Der\dshes 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 tiU they are masses of ulceration 

 and necrosis. True, they make use of tureba, a native preparation of mercui-y 

 found locally, and they even fashion cones for fumigation with it, but their 

 ti'eatment is not conducted on sound principles and is probably more hannful 

 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 

 underetand how fi-equently they are themselves to blanie 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 



' Journal of Tropical Medicine, July Ist, 1903 



