150 KALA-AZAK COMMISSION 



The children all complained of frequent micturition and irritation of the bladder; 

 some cases I saw jiass(>d larfjf clots of pui'c i)lood and a very small quantity of uiine with 

 them. 



Others undnuhtedly, from their symi)toiiis, had infection of the rectum as well, and 

 were passinj,' hlood and nmcus. 



Several women whom 1 saw suffering; Imiii this disease also complumcd of renal 

 and ovarian pains, which may have meant an infection of these organs also. 



'I'lic heavy infection of this definite area with hilharzia is of exceeding interest as, 

 up to the present, only isolated cases of hilharziosis in Sudanese and Arabs have been 

 recorded, and so far as I know no definite infected area has been reported. Samples 

 of watei' were taken froMj the wells of IJillet Howeires, in wiiich at least two-thirds 

 of the boys appear to be infected. 



The examination of the water sliowed eonsideralile deposit, cliietiy earth and sand, 

 with some vegetable debris. Flagellated and ciliated bodies were present in considerable 

 numbers.* 



R K (.■ O M M K. M) A T 1 O N S 



Kecommenda- 1 That a special-service 15ritish Medical Officer witii a knowledge of kala-azar 



be appointed to Sennar Province for the further investigation of this disease. That he 

 be given full power of isolating cases and contacts as he may think fit. 



2. That he make further experiments to determine, if possible, the mode of infection. 

 We think that, owing to the wide-spread distribution of tiie cases and the absence of 

 epidemics, animal experiments, which we have found to be easy and piaeticable, promise 

 the best results. 



3. All Medical OHicers serving in infected districts should be thoroughly cognisant 

 of the clinical features of the disease and instructed in making proper peripheral blood 

 films, which they should send to some competent authority for examination. 



4. In infected areas all sanitary barbers who have iu)t been as yet instructed in 

 the symptoms of the disease, should lie instructed therein without delay. 



.'j. They should be ordered to leport all suspicious cases to the Medical Otficei- of 

 their district, and, as an incentive to the discovery of all cases, they should be given a 

 reward of I'.T. '25 for every positive case reported. 



(J. Ollicials and employees of the Government suffering from fever should not neglect 

 such attacks, especially if persistent, but consult a Medical Ollicer. It is possible that 

 kala-azar in its early stages is a curable disease. 



7. -Ml ollicers, employees, etc., sliimld taki' jiio[)li\ lactic <loses of (iiiiniiiu during 

 the Kliiirif. 



H. Owing to the, as yet, uncertain method of transmission of the disease, preventive 

 measures of a general sanitary natine should lie generally carried out. 



(o) Personal cleanliness and house cleanliness are of importance. Should tlie 



disease be carried from person to person neglect of this fact is dangerous. 



(/() Especial attention should be given to absolute cleanliness of kitchens, 



cooking and table utensils and food. Water should be filtered or boiled. 



(/•) Cleanliness of villages is essential, and we would suggest that Sheikhs be held 



responsible for this, .\ dirty and insanitary village might be the starting point of an 



epidemic. 



• KiKniiry sluiwwl that iiifuctiiui in all i>rol>al)ility was a<N|uircd through the skiu (.nviiij; to the haliit of 

 inddliiiir nliout in the- infu'-tcd |>ool» formed rouud the welU. — .V.B. 



