KEMAKKS OX KALA-AZAE 129 



both having greatly enlarged spleens ; proof of their deaths in Khartoum I was not able to 

 obtain. The marmiton (cook's boy) also died of fever in the same year. All apparently 

 occupied the same quarters. 



(2) At Mafaza, between August, 1907, and April, 1909, amongst those occupying the 

 police lines, eight died of this disease, while another policeman, the sub-mamour and his 



two servants almost certainly died from this cause. Associated 



(3) At Abdin, two brothers were found, one with definite kala-azar, while the other '^^^^ 

 had been ill for two years with fever and had a spleen reaching to the umbilicus. 



There was practically no time to study the important question as to how the disease is 

 transmitted, but the following facts were forcibly impressed upon one. 



(a) Bed-bugs are extremely common : qi;ite 75 per cent, of the native angareebs 

 harbour them ; 



(ft) Angareebs in places away from the river banks seem to harbour bugs just as 

 frequently as those in places situated on the rivers. 



The following facts, with reference to the presence or absence of bugs in angareebs, 

 were ascertained in 20 cases of kala-azar : — 



(1) Live bed-bugs found in eight instances ; 



(2) Eecently deposited eggs, but no live bed-bugs found in four instances ; 



(3) No signs of bugs or their eggs in four instances ; 



(4) In the case of those who did not use angareebs, or had not used them in the 

 place where seen, bed-bugs were found in four instances. 



All the bugs examined were believed to be Cimex lectularius, owing to their presenting 

 distinctly flattened or concave edges on the dorsal aspect of the pro-thorax. 



Oimex roiundatus has, I believe, at present never been identiiied in the Sudan.' The 

 disease in the Sudan certainly seems to spread, in some cases, through the members of a Bed-bugs 

 household or community, and this suggests that it may be conveyed by the bed-bug. 

 Against this view, however, is the striking fact that in the Sudan, as in India, the 

 disease appears to cling to river banks, and yet bed-bugs are equally common in places on 

 and away from the river and infected persons must frequently be visiting these places off 

 the river. 



The popular belief, which I have often heard expressed, that angareebs strung with 

 strips of hide do not harbour bugs is quite fallacious, as many such angareebs w-ere seen 

 teeming with these pests. In view of the possibility of the disease being carried from 

 domestic animals to human beings, the animals kept in the tuMs or hooshei^ of those 

 suffering from kala-azar were noted, but in no instance were animals, evidently ill, 

 discovered. The domestic animals seen were donkeys, sheep, goats, dogs and chickens. 



Trade, habits, and food seemed in no way connected with the transmission of the 

 disease, but it still has to be determined whether river water, or the eating of fish, may 

 not be a means of conveying the disease in the Sudan, a possibility in view of the tendency 

 of the disease to cling to river-side villages and the frequent initial intestinal disturbance. 



The disease runs in many cases a very severe and rapid course, and of those diagnosed •^'""'■■al lype 



often severe 



on this tour, eight were known to be already dead in June, 1909. The average duration g^^d rapid 

 of the illness, according to the statements of the various patients, who, how-ever, are not 

 by any means entirely to be relied upon, was twenty-one-and-a-half weeks, while five 

 terminated fatally in thirteen weeks. Nine cases gave a history of illness of less than 

 three mouths, while five more stated the disease had lasted five months or less. The 

 most rapid case was that of a woman aged about 18, at Kassala ; she and her husband were 

 ' It has uow beeu found iu the Red Sea Proviace and the Lado district. — A.B. 



