KALA-AZAK COJIJIISSION lid 



As regards faiiiily distribution thu disease would appear to differ from that seen 

 in India. 



Ill only one case was there any history of infection of the second member of a family. 



The question as to whether the disease is curable is of the utmost importance and, '* Kala-azar 



. ., , . curable? 



wliether a permanent cure is possible or not, is a moot point. 



The following four cases which we have seen, are of interest, as they were reported 

 as positive last year by Captain Bousfield. 



Saleh Mohammed has been seen three times since last November, and on each occasion 

 has been fit and well. On the first occasion on which he was seen both spleen and 

 liver puncture proved negative. 



The patient suggested to us that he should come again next day for further punctures 

 as he said that since he had been first punctured, six months before, he had had no sign of 

 fever, and this he attributed to the puncture. 



Shawish Tisama was seen in February, 1910, about ten months since he was diagnosed 

 kala-azar. He was fit and well. Spleen puncture was negative for Leishman-Donovan 

 bodies. 



Eamadan Someet, a boy about ten, seen at Gallabat a year after original diagnosis 

 was made. He was tit and well with no fever, and sjaleen barely palpable. 



Ali Abdel Kader. This case was diagnosed as suspicious by Captain Bousfield. 

 When seen by us he had fever, enlarged spleen, and leucopenia. Leishman-Donovan 

 bodies were present in the peripheral blood. He was treated with tincture of senega and, 

 after three months' treatment, fever had ceased and parasites had disappeared from the 

 peripheral blood. After six months' treatment the spleen was not palpable. 



The treatment Avhich these cases had was as follows: — 



The first had a short course of quinine, apparently about 25 grains a day, for five days. 



The second was treated first with regular doses of quinine and since November 

 has been taking tincture of senega regularly. 



The third was treated with quinine for a period of some months. 



The fourth was treated entirely with tincture of senega for 5 months. None of these 

 cases, as far as I could find out, had had any suppurative focus, or anything wrong with 

 them which would tend to create a leucocytosis, since they were diagnosed kala-azar. 



Are these four cases of spontaneous cure of the disease ; is the disease simply dormant 

 in their systems in some form of which we know nothing, or is spleen puncture of therapeutic 

 value in some instances? 



I have frequently heard natives say that spleen puncture, even in cases of malarial 

 splenomegaly, has improved their condition and reduced the siie of the spleen. 



A point of considerable interest, which was noted during the tour west of Singa, -^ focus of 

 was the enormous number of cases of bilharziosis. 



All the villages lying on Khor Um Esh would appear to be more or less infected. 



This khor, which has a shallow, ill-defined bed, runs in a north-easterly direction 

 for about 20 miles and joins the Blue Nile at Abu Shoka. During the rains it is 

 always full and is fed by many subsidiary khors, of a similar nature to the main khor, 

 which drain a large area. During the dry season the people dig wells in the bed of the 

 khor, getting water about 30 feet from the surface. 



In the greater percentage of cases seen, children, chiefly boys, from 5 to 15 years 

 of age, were infected, though both men and women also suffer from the disease. 



Patients complain of " Bouul Har " or scalding urine. Microscopic examination of 

 the urine showed numbers of bilharzia ova. 



bilharziosis 



