140 KKMAnKS ON KALA-AZAR 



Smears were made from tlie spleen, liver, kidneys, and mesenteric glands, and a few 

 structures were found which were extremely like Leishman-Donovan bodies {vide Plate IX., 

 figs. 1-17). 



It is impossible to say definitely what tliesc an-, u^ lilm^ only were made, and it 

 was quite impossible to attemjit any cultures. 



Very few bodies, scattered here and there, could be found in the films, and iu the 

 kidney films only one was found after prolonged search. 



All that can be said is that these structures have a striking resenil)laiice to knla-azar 

 parasites, and work should be carried out on dogs in the Sudan. 



2. The second dog, though very wasted, showed no structures similar to the 

 Leishman bodies, but many lilariaj were found in the liver and spleen smears ; tiiis dog 

 was a vagrant. 



I wish to thank all who most kindly assisted me in my investigations, and to record 

 that every help and courtesy was afl'orded me by the English and Egyptian officials and 

 the medical oflBcers, amongst whom I would specially thank El Sagh, Mohammed Etf, 

 .\li Niklawi, Sudan Medical Department, who gave me much assistance and information 

 and kindly sent me several detailed reports on the cases at Singa. 

 '*'*=°"'" The following is a brief summarv of the recommendations suggested to condiat the 



raendations for 



pr.-vemion disease :• 



1. Burning of infected huts, angareebs, etc. 



'2. Isolation of acute cases, and compulsory isolation villages for chronic cases. 



3. Special quarters to be allotted to Abyssinians in towns and villages. 



4. Careful medical examination of Abyssinians before enlistment into the army or 

 police, or before employment as servants to officials. 



5. That all officials in the infected districts who have to visit villages be supplied 

 with tents, and that all possess small camp-chairs. 



6. Avoidance of native angareebs by officials, their servants and police. 



7. A course of instruction to officers of the Military and Civil Medical Departments 

 on this disease, especially with regard to its pathology and microscopical diagnosis. 



8. Until our knowledge of the ti-ansmission of the disease is more definite, it 

 ■would be wise for officials not to keep dogs. 



9. That all the angareebs used by the soldiers and police be placed, uncovered, 

 exposed to the sun from early morn to sundown. My belief is that one day's exposure 

 to the tropical sun of summer would destroy all the bugs, even those within the crevices. 



This requires a series of experiments ; in the one instance in which I tried it 

 I could find no live bugs after one day's exposure, though there were many to be found 

 previously. 



10. The invaliding from the army and police of tliose who are weak and wasted 

 and have enlarged livers and spleens, with subsequent supervision. 



13. The most effective way of getting rid of bugs from woodwork and crevices in 

 walls, etc., is to play the flame from a painter's lamp direct, and subsequently apply a thick 

 wash of lime. *' 



14. Further investigation of the disease, especially up the Blue Nile. 



This has already been done by the Second Commission sent by the Sudan Government 

 in 1909, and its report will no doubt add very greatly to our knowledge of the extent, 

 distribution, pathology, etc., of this disease in the Sudan. 



That the acute epidemic type as well as the sporadic type exists in the Sudan is now 

 well established, and several of the most acute virulent cases did not raise in mv mind tlie 



