Observations on Kala-azau in Kassala I’uovinoe 
BY 
L. r.0USFiELi., M.A., M.D. (Cantab.), M.K.G.S., 1,.U.C.P. (J.ono,), iCA.M.C. 
Itimbashi, Egyptian Medical Corps, S.i\I.t)., Kassala 
yiuce August, 1907, eight cases of this disease have been definitely diagnosed in the 
province, and all have terminated fatally, while thirteen other oases, extremely suspicious, 
have come under my observation or to my knowledge, of whom nine are already dead. 
It is almost impossihle to give any trustworthy idea of the prevalence of the disease, as 
the towns and villages are far distant one from another, usually being visited but once 
a year by a doctor, and then only for a day or two. 
Thus cases positively diagnosed have only been found at Kassala (7) and Mafaza (1), 
and prolonged observations on cases have only been carried out at Kassala and Gedaref, 
namely, where doctors were present. 
However, the positive diagnosis of eight cases presents a serious picture when one 
remembers the fact that for every native admitted there are five or more who do not seek 
medical assistance. 
It is a matter of extreme difficulty to trace the history and movements of the patients. 
Indeed, in some cases it is almost hopeless, for many have no fixed abode, are often admitted 
very ill, have no friends to speak for them, and, further, talk in various dialects. Thus 
of all the cases it has only been possible to find out definite abodes and house contacts in 
six out of a total of twenty-one, and even in these six cases sometimes the residence in a 
tukl (hut) or hosh (compound) was only for a few weeks. 
Of the co-inhabitants I have had an opportunity of examining, I have found none 
suffering from the disease or presenting signs of ill-health suggestive of kala-azar, and in 
the few instances where I have been able to search the dwellings I have been unable to find 
bed-bugs. 
However, I believe bed-bugs exist in every town and village of Kassala, and, personally, 
know of their existence in Kassala, Gedaref, Gallabat, Mafaza, Tomat, Sofi, and Turkelein. 
Specimens from the first three towns were sent to Dr. Balfour for examination, and 
Mr. H. King has identified them as Gimex lectularius. 
Dogs are very common everywhere, but, unfortunately, this possible source of infection 
was not studied, since the observations on the liability of dogs^ transmitting the disease 
were not then known to me. 
To study the disease properly in this province, one specially appointed is required, who 
has all his time at his command for making lengthy observations and carrying out the 
difficult but important work of tracing these cases to their source in the various places. 
The disease is apparently new or but recently recognised, for following Dr. Neave’s case 
in 1904, the next one observed was by Captain Cummins in May, 1907, and in this province, 
though a case was suspected early in June, 1907, it was not until the tliird splenic puncture 
(August 30th) that Leishman-Donovan parasites were found, and since that date seven 
other oases have been definitely diagnosed. 
The very great importance of recognising the appearance of this disease in a new 
country is such that 1 a])])end two tables, “ .V ” of those cases definitely diagnosed by the 
discovery of the parasites, and “ B” of those extremely supicious of kala-azar, but where 
the parasites were not found. 
^ Nicolle, (J., La Semainc Medicah', March 11th, IDUH, aud MM. Ch. Nicolle et Ch. Comte, La Scmainc 
Midicah\ April 22ud, 1908. 
Number of 
cases 
Bed-bugs in 
Kassala 
Province 
Historical 
