SANITARY NOTES. KHARTOUM 
89 
(Kala-azar), Leprosy, Malaria (locally aoquii'ecl), Malta Fever, Measles, Plague, Pneumonia, 
Eelapsing Fever, Smallpox, Trypanosomiasis, Typhus Fever, Whooping Cough. 
Of these, the following have been present since 1904 ;— 
Cerebro-spinal Fever (one case only until May and June of this year, when three 
cases occurred). Chicken-pox, Dengue (one case only—imported). Diphtheria, Dysentery, 
Erysipelas, Enteric Fever (rare, some cases amongst British troops). Hydrophobia (one case 
only). Leprosy, Malaria, Measles, Pneumonia, Smallpox (one case only). Trypanosomiasis 
(one case only, imported). Whooping Cough. 
So much has been written aliout those diseases under their appropriate headings in the 
Eeview that little need here be said. The reason so many were made notifiable was to enable 
one to become acquainted with the forms of infectious disease which occurred. 
As regards chicken-pox, I would point out the great desirability of chocking this disease at 
first, whenever possible. Although rarely fatal, it causes some suffering and may entail much 
annoyance and some expense to the parents of patients, while it may also interfere with 
education. Furthermore, if chicken-pox be prevalent, initial cases of smallpox may easily be 
missed, and before things can be remedied an epidemic of variola may lead one to regret that 
more rigid measures were not adopted in the case of varicella. 
The question of dysentery requires more detailed consideration, for it is intimately 
concerned with the question of conservancy, and it is interesting to note the effect that 
the change in the latter has had upon the incidence of the former. Unfortunately, my detailed 
statistics on this point were destroyed by fire, but I take the following passages from the 
IM. 0. H. repoi’t for 1907. Amongst the Egyptian military there were 96 cases of dysentery 
notified from October, 1906, to the end of September, 1907. Of these, the great majority 
occurred amongst Egyptians, and it is quite certain that some of the cases notified were not 
dysentery at all. Bilharzial disease of the rectum is very apt to be mistaken for dysentery in 
the absence of microscopic examination of the faeces. Although there were four battalions in 
Khartoum, in addition to the Medical Corps, Works Department, and Stores and Supplies 
Department men; and only Artillery, small Eailway and Stores Department staff, and one 
battalion in Khartoum North; no less than 49 of these 96 cases occurred in Khartoum North, 
where the old conservancy method still persisted. Moreover, when we come to consider the 
monthly incidence table, we find that, in the case of the Khartoum units, with the exception of 
the third battalion, which had four cases in August, most of the dysentery cases occurred prior 
to May, about which time the effect, if any, of the new system should have been becoming 
evident. Turning to the units at Khartoum North, we find that the largest number of cases 
amongst the Artillery occurred in July, and amongst the first battalion there were more eases 
in the summer than at other seasons. While these statistics are interesting, one must not 
make too much of them, because, after all, the number of cases is small, and doubtless other 
factors have to be taken into consideration. At the same time, I believe the faulty conservancy 
methods in vogue accounted in large measure for the small epidemic which occurred during 
the wet summer of 1906, when there were in all 134 cases—24 being civil, 107 Egyptian 
military, and 3 amongst the British regiments. Now the summer of 1907 was even wetter 
than that of 1906, but a radical change had been made in the collection and disposal of excreta, 
and during the year 1907 the total number of cases notified was 104, of which 6 were civil, 96 
Egyptian military (already analysed), and 2 imported. During the present sanitary year, 
which ends in September, there had been notified, amongst a greatly increased population, 
up to the end of July, only 35 cases, of which 25 were civil, 8 were Egyptian military, and 
2 were imported. My contention has always been that dysentery cases are most apt to crop up 
in places where there is much fouling of the soil, as in the neighbourhood of prisons and 
barracks; and it would certainly seem to be borne out by these figures, for a very marked 
Dysentery in 
Khartoum 
