130 



REMARKS ON KALA-AZAH 



Is the disease 

 a recent iniro- 

 duction into 

 the Sudan ? 



Incidence by 

 months 



most dutiiiite in thoir assertions that shu had Ijuoa ill only twenty days before admission 

 to hospital where she died six days later. 



Another case, a boy at Abdin, declared most definitely he had only been ill 15 days, 

 and had not previously had fever. He was evidently very ill indeed, but probably the 

 history was faulty as his spleen nearlj' readied the umbilicus ; his peripheral blood 

 showed Leishman parasites. 



Chronic cases were seldom seen; three, however, gave histories of five years (Lueisa), 

 three years (Abdin), and two years (Abu Galud) respectively. 



The following points make one inclined to the view that the disease may be a new 

 arrival amongst a previously uninfected people : (1) The virulent character ; (2) the 

 comparatively few chronic cases observed (this, in my opinion, is a very suggestive fact) ; 

 (3) the epidemic character the disease has assumed at Mafaza and Sennar; (4) the 

 absence of history of a past epidemic, though this is naturally extremely difficult to 

 determine owing to the ever-present malaria after the rainy season both near and away 

 from the rivers ; (5) the failure of medical recognition, though it nmst be kept in mind 

 that the disease has been but comparatively recently separated from malaria and many 

 medical men are still ignorant about this malady. 



No information was obtained as to the incubation period of the disease, though much 

 attention was paid to this point. 



The only case that in any way threw light on this point suggested 16-18 days as 

 the incubation period. 



The incidence of the disease appears to favour the months of July, December, and 

 January, which correspond to the commencement of the cool and rainy season and the 

 few months following the end of that season. It is often quite impossible to obtain definite 

 information from a native about the date of onset, but the following table gives the 

 approximate months of onset of all the cases, proved or suspected, that I have been 

 able to follow : — 



KAT.A-A/.AU CASKS 



vcd 



Jaauary 

 February 

 March 

 April 



June 



July 



August 



September . . . 



October 



November ... 



December 



A point to be carefully remembered in the Sudan is that it is quite common for a 

 kala-azar patient to have had malaria and to give a history of fever every alternate 



