90 
SANITARY NOTES. KHARTOUM 
Water supply 
and intestinal 
complaints 
The Hlue Nile 
supply and 
enteric fever 
improvement has taken place in the case of the Egyptian soldiery. Some of this, however, is 
due to greater care in diagnosis. It is noteworthy that in 1900 the outbreak terminated with 
the rains. I am of opinion that but little of the dysentery occurring in Khartoum is, strictly 
speaking, water-borne, but that it is chiefly due to the fouling of food and drink by infected 
dust, and this view is supported by the facts I have recorded, and by a consideration of other 
statistics available — for instance, the returns of monthly incidence of infectious disease. 
This is a question which also concerns enteric fever, and I pass to a brief consideration of 
that disease in its epidemiological aspects, as met with in Khartoum. My remarks 
regarding it apply more or less to dysentery as well. 
It has been stated that one need look no further than the present water supply of the 
town to account for the presence of cases of diarrhoea, dysentery and typhoid fever in it during 
1907. Now it is easy to make such a statement, but quite another thing to prove it true, and if 
it is erroneous it is likely to do hai’in by limiting the sanitary outlook and tending to confine 
preventive measures to one source of evil. No one denies that the present water supply is a 
possible source of danger, but that it is an actual source remains to be proved. All the 
evidence goes to show that it is not the chief factor in causing these diseases, or, at least, that 
it has not been so in the past. Take the year in (juestion — 1907. We find there were 8 cases 
of dysentery amongst the civilian population, 2 of which were imported ; and 15 cases of 
enteric fever, of which 5 acquired infection outside Kliartoum. Thus, during one year, amongst 
a population of, say, 25,000 people, there were 6 cases of dysentery and 10 of enteric fever, and 
yet we are informed that the general water supply was to blame! Even supposing a good 
many cases were not notified at all, the numbers do not point to the drinking-water as a cause. 
But it may be held that these cases should not be considered with reference to the whole 
population, hut only with reference to those susceptible to attack by sucb diseases, presumably 
a population numbering about 3000. It is true this would be a fairer computation, at least as 
regards the 10 enteric cases, but we find that 2 of these oocuri'ed amongst soldiers at the 
British Barracks, where the drinking water, even though taken from the river above the town, 
is carefully boiled, while some of the other cases were natives, and so outside the 3000 
susceptibles. As regards dysentery, it has yet to be proved that the native is not susceptible. 
The disease is not uncommon in Egypt, and Egyptian soldiers in the Sudan are certainly 
liable to be attacked. We know that the native of India suffers heavily from this disease and 
his suiTOundings and mode of life do not differ markedly from those of the native of the Sudan. 
As a matter of fact, most of our dysentery notifications refer to native cases, and, as I say, there 
is nothing to show that dysentery is chiefly water-borne, and much to indicate that, in the past, 
it has been due to infected dust gaining access to food and drink. 
It is further asserted that it is the rise of the river, sweeping a foul foreshore, which is to 
blame. If tbis were so, one would expect that mo.st of the cases would occur late in .lune and 
during July and August. As regards enteric fever, such has not been the case in the past. 
Taking the present sanitary year, we find that in November, December and July, respectively, 
one case occui'red; there were two in May and four in June. As regards the cases in June, 
two of which at least acquired infection in May, there is little doubt that infection was derived 
from Nile water, for the river was very low, and in places practically stagnant. It was no 
longer self-purifying to any extent. In other years the greatest number of enteric cases has 
usually occurred in October, when tlie Nile is running full. Owing to the loss of my statistics, 
I am unable to present figures in detail, but the facts are as stated, and there is nothing to show 
that the river supply is the chief source of infection. At the same time, it should be abolished 
as soon as possible and a satisfactory supply substituted for it. 
Taking the dysentery cases for the present sanitary year, it is instructive to find that they 
have been fairly equally distributed throughout the past ten months, the greatest number (four) 
