102 
KALA-AZAK IN THE ANGLO-EGYPTIAN SUDAN 
Detail of cases 
Dogs and 
kala-azar 
The {|uestion 
of diagnosis 
Frequent 
paucity of the 
parasite 
barracks, but apparently no further cases occurred among the remaining twenty soldiers of 
the Works Department living in this building. 
A much more interesting and significant series is as follows ;— 
1. Nafr. Mohd. Ibrahim Osman, Medical Corps, while stationed at Mafaza, lived in a 
grass hut which formed part of the “Police Huts” in the Zaptea Compound. He fell sick 
in July, 190(5, and was relieved some time afterwards, leaving for Kassala in November or 
December, 1906. 
2. Two Arab policemen, from the Blue Nile district, lived in Mafaza during 
May, 1907, presumably occupying the police huts. Both these men subse(iuently died of 
kala-azar. 
3. An Arab policeman, from Kassala, Idris Adam, had lived in the Mafaza police 
huts from January, 1907, to January, 1908. He died of kala-azar in Kassala. 
4. It should 1)6 noted also that a Wakil Ombashi, of the Medical Corps (Case II., 
Boustield) passed three days at Mafaza in May, 1907, and is stated to have lived with 
the resident Medical Corps Tumergi, who, no douljt, occupied the same police hut as that 
of his predecessor, lljrahim Osman. This Wakil Ombashi was found to be suffei'ing from 
kala-azar in 1907 ; and, in my opinion, contracted the disease at Mafaza. In view of the 
2 )resent ignorance of the life-history of the Leishman-Donovan body, it is inqiossible to 
calculate the ^irobability of a house remaining infected, or to judge how long the infection 
may last. 
Assuming the bed-bug to be the alternative host, it is 2 )ossible that the infectivity may 
last through more than one generation, as occurs with the spirillum of Eelapsing Fever.' 
Or, on the other hand, the observation of M. Nicollo,- that dogs are std)jeet to the disease, 
taken with the domestic habits of these animals, may, perha 2 )s, ex 2 )lain the occurrence of a 
series of cases, arising at long intervals, in the same building. 
At any rate, the j)oliee huts at Mafaza would seem to have a fair claim to bo considered 
infected during 1906-1907. 
Bed-bugs, sent for classification to the Gordon College from the districts where 
kala-azar has occurred, are re^jorted to l)e, in all i)robal)ility, the (JimeM Icctulariiu. 
DlAdNOt^IS. The disease has been so ably descriljed," that it is sujjerfluous to rejjeat 
the ^joints which enable a diagnosis to be made; but the following brief descri^Jtion may 
assist laymen to recognise cases in their districts :— 
Kala-azar is a continuous fever, sometimes lasting for many months, accomjranied by 
enlargement of the sjjleen and liver, and, finally, by great loss of strength. The feet and 
legs often swell, and the skin of the face may show dark jrignientation. It is resistant to 
quinine, and has a much greater tendency to kill its victim than has chronic malaria. 
Any cases found to resemble the above should be sus^Jected and the nearest doctor 
informed. 
Of course, to the doctor no case can be considered as definitely diagnosed until the 
Leishman-Donovan body has been found; but this leads me to a 2 )oiut, brought out clearly 
by the a 2 ) 2 )ended cases, that tlie failure to find the ^Jarasite, even on several attemp)ts, does 
not finally exclude the disease. In some of the cases recorded, the jjarasites have been 
most difficult to find. In this connection, I may say tliat 1 searched tlirough very many 
slides sent me by Ca^rtain F. F. Carroll from his case at Khartoum, without success, and 
only found, at last, one grouj) of Leishman-Donovan Ijodies. The same i^oint was noted by 
' Dutton ;uul Todd. Koch, rUh' loading article, Jlrlflsk Medicnl Journal, Fcl>ruary :34th, 19l>G. 
Nicolle, C. La Sonainc Midicale, April ’24th, 19U8. 
® llogcrti, L., I.M.S. Milroy Lectures, 19u7. See aho Review Supplement to this Report. 
