KALA-AZAE COMMISSION 147 



The question of the disease being endemic or epidemic is most important. Epidemic 



From all the information obtainable, undoubtedly the weight of evidence is in favour "''Endemic? 

 of the disease having been present in the country for many years. 



Also it apparently used to be much more prevalent in certain districts than at 

 present, though in no case could I get any information of its occurrence in true 

 epidemic form. 



Certainly, in some instances, there would appear to have been small epidemic 

 outbreaks of the disease, f.</. the village of Tama. It is difficult to say whether these 

 outbreaks are premonitory of a severe epidemic or merely the last epidemic flicker of 

 a disease which is becoming endemic. In other words, that the epidemic has left 

 behind a sporadic affection. 



The latter seems to be tlie more likely solution under the circumstances. 



As regards transmission, the accepted theory, at present, is that the vector is t'iinex Mi-thod of 

 rdtiuidafii!-, yet this bug has never been found in any of the infected areas of the Sudan. ransmission 



The native information on the subject would favour an intestinal infection and the 

 possibility of this mode of infection should not be lost sight of. This subject will be 

 fully dealt with in the pathological report {vide payes 157-172). 



The possibility of infection from animals must also be considered. The tiikh of 

 natives generally hold at night, all or nearly all the following animals : goats, sheep, hens, 

 pigeons and perhaps a litter of puppies, in addition to three or four human beings. No 

 animals suffering from disease were noticed in the houses of any of the patients. 



In several villages I heard of and saw outbreaks of spirochsetosis amongst the fowls of 

 the natives. Also outbreaks of Ahniiil had killed off nearly all the goats of some villages. 



This is a disease apparently affecting the lungs and is very rajjidly fatal. I myself 

 saw no animals actually suffering from this condition.' 



The procedure on finding a case of kala-azar was as follows : — I'locedurc 



The parents of the patient were told that he was suffering from " Simeih," and the '^" ""^'"S 

 advantage of transferring the case to Singa for treatment was pointed out, especially Kala-azar 

 as, according to their views, the patient was bound to die, whereas if sent to Singa 

 there was the possibility of prolonging life. They were told that the tnkl, together 

 with the angareeh, hinsJi, etc., occupied by the patient, would be burnt and ample 

 compensation given for what was destroyed. In no case was there the least difficulty 

 in carrying out this procedure, the parents being only too glad to grasp the possibility 

 of saving their child's life. 



When the patient had been removed to hospital, the tukl, etc., was burnt under 

 personal supervision and a certificate given to the owner for the compensation, which 

 he drew at the nearest Markaz. 



Spleen puncture was performed in every case which was at all suspicious and in Spleen 

 many otliers in which splenomegaly was the only symptom. punctuie 



No difficulty was met with in making sjjleen punctures. The skin, having been 

 washed with soap and water, was then thoroughly rubbed with methylated spirits and 

 painted with tincture of iodine. After the needle was withdrawn, a piece of cotton wool 

 soaked in collodiuin was placed over the puncture. 



A 2 c.c. all-glass syringe, with a fine needle, was used in every case. The needle 

 was introduced just below the costal margin in every case but one, in which, owing to 

 the small size of the spleen, the needle was inserted in the intercostal space. 



' This is iufuctioiis pleuro-pncnmouia. — A.B. 



