KALA-AZAli IN THE ANGLO-EGYPTIAN SUDAN 
101 
Kaili, in Southern Seunar, No microscopic examination was possible in his case, owing to 
lack of appliances. 
At about the same time, Dr. MacTier Pirrie, of the Gordon College, who had contracted 
a chronic fever while working in Southern Sennar, was found to be suffering from kala-azar 
by Dr. Gullaud, of Edinburgh, and Major Marshall, I.M.S., through whose kindness I am 
able to append short notes of the case, which has been more fully reported elsewhere by them.' 
Previous to receiving my communication. Captain L. Bousfield had suspected two 
cases, coming to his notice at Kassala, to be kala-azar; and he was shortly able to confirm 
his suspicion by finding the Leishman-Douovan bodies in the splenic blood. He at once set 
to work to investigate the disease in Kassala district, the results of his investigation being 
appended in a separate report (see pucje 107). 
I will now proceed to discuss, as briefly as possible, some of the points which appear to 
me to merit attention in the series of cases under discussion. 
DISTBIBUTIOX. With a single exception all the cases hitherto described in the 
Sudan have arisen in the vicinity of the Abyssinian frontier, or on the Blue Nile and its 
tributaries—rivers which rise in Abyssinia. It is possible that other cases exist in other 
parts of the Sudan, in view of the presence of the disease along the North African coast ; 
but it is remarkable that none have hitlierto been described. The sudden discovery of a 
considerable number of cases, all traced to the Abyssinian border or its vicinity, gives colour 
to the suggestion that the Sudan owes this disease to cases imported from Abyssinia. The 
high proportion of cases actually occurring among Abyssinians, taken in conjunction with 
the recent increase in trade and communication between that country and the Sudan, 
strengthens this probability, while the very slow growth of this communication during the 
early days of the Anglo-Egyptiau regime may perhaps account for the previous rarity of 
the disease in the Sudan. 
Unless this theory is groundless, a considerable increase of the disease in the Sudan 
may be anticipated in the future. 
The work of Major Leonard Rogers, I.M.S., and Captain Patton, I.M.S., goes far to 
demonstrate that the bed-bug is the agent by which kala-azar is transmitted from man to 
man. These insects are very common, both in the Sudan and Egypt, so that, given a certain 
number of imported cases suffering from the disease, there would seem to be a decided 
danger of its spreading in both countries. 
With the exception of those described by Dr. L. Phillips, no cases have come to light in 
Egypt, although this country has been the field of investigation by many pathologists for 
many years; so there seems no doubt that it is extremely rare. This question will be dealt 
with more fully under the heading of Differential Diagnosis. I am permitted, through the 
kindness of Dr. Bitter, Pathologist to the Egyptian Sanitary Department, to refer to his 
recent observation of Leishman-Donovan bodies in a case of chronic ulcei'S in an Egyptian, 
which he intends to report elsewhere. This discovery is in line with the finding of these 
bodies in “ Delhi Sore,” and the accepted opinion would appear to be, that the organism 
producing these cutaneous lesions, though morphologically similar to that of kala-azar, is 
essentially different in nature; so that Dr. Bitter’s discovery does not demonstrate tlie 
presence of kala-azar in Egypt. 
HOUSE INFECTTOX. I have not had an opportunity of going into the question of 
house infection on tlie spot, but the matter is discussed by Captain L. Bousfield in his paper. 
The two cases in Egyptian soldiers from Senga, arose in men occupying the same 
Distribution 
of kala-azar 
in the Sudan 
Its rarity in 
Egypt 
House 
infection 
‘ Lancet, August 15th, 1908. 
