Remarks on 



KaLA-AZAR IX THE KaSSALA AND BlUE NiLE DISTRICTS 



OF THE Sudan 



BY 



Captain L. Bousfield, M.A., M.D. (Cantab.), M.R.C.S., L.R.C.P.. R.A.M.C. 



Late attached Egyptian Army 



The Sudan Government caused an investigation to be made with the object of 

 finding out if kala-azar existed or was prevalent in the above-named districts in 1909. 

 A report was submitted to the Government in May of that year, and this article, at 

 Dr. Andrew Balfour's request, deals with the main points in that report. 



The tour lasted from the middle of January to the middle of May, 1909, and, during Extent of tour 

 that period, some 1,300 miles had to be covered, 900 of which were by camel, and, since 

 more than half of the available working time had to be spent on general medical work, 

 the actual time at my disposal for this investigation was quite inadequate for anything 

 further than a rough estimation of the amount of the disease present in the various 

 communities visited. 



Those who may wish to see a fuller account are referred to the August and 

 September numbers of the Journal of the Royal Army Medical Corps, 1910. 



The accompanying table shows the towns and villages visited and the number of 

 cases, divided into three classes : 



(1) Proved microscopically. 



(2) Clinically certain. 



(3) Highly suspicious. 



Only those in whom definite parasites were found are included in Class 1. 



The table shows that 57 proved and suspected cases were seen and points to 

 the Blue Nile being seriously infected, for only three places were visited, viz., Sennar, 

 Abdin and Singa, and yet ten cases were found in them. 



When the report was written, 42 cases of proved kala-azar had been found in the 

 Sudan, and of these, 15 at least had contracted the disease on the Blue Nile. 



Of these 42 cases, 41 have been diagnosed since May, 1907, and have contracted 

 the disease either on the Blue Nile or in the Kassala District. 



The fact that the disease has been found mainly amongst government oflBcials and 

 employees calls for attention, when one remembers that they are far more under the 

 medical eye than are the natives. 



The map shows the distribution of the cases proved and suspected, and an attempt Distribution 

 has been made to piece together all available information, so that the map is a ^°"g"^<='" 

 composite one showing all known cases in these stations and does not represent the 

 numbers seen on this tour ; since its compilation, fresh cases have come to light. 



There is fair evidence to support the belief that all the cases shown in the Sudan 

 area (dotted tint) wei-e imported. 



Thus it seems probable that, as in India, the disease tends to cling to river banks, but 

 it is to be noted that in none of these places off the rivers was I able to stay longer 



