280 8ANITAHY NOTKS 



It will 1)0 lit onco apparent tliat the amount of enteric fuvor has been triHin^. 

 l)<iiil)tluss tliis is in part iluo to a favourable year so far as climatic conditions go. Although 

 during tlie summer months the usual high temperatures obtained, the rainfall was less than 

 usual and there was a notable diminution in the number of severe dust storms. At the 

 same time, one must not overlook the fact that the town, with the exception of Khartoum 

 North, has been in possession of a pure water-supply, albeit up to the present the 

 distribution of the water in certain localities has left a great deal to be desired. One 

 cannot, of course, expect to draw any conclusions from such small figures, but some may 

 tiiul it interesting to speculate upon them, and for such 1 would contrast the marked 

 Diminution in diminution in the dysentery returns with the establishment of many more small incinerators 

 ysentcry ^vhich now serve the native villages to the south of the town, and serve them well. 



Last year there were 50 cases locally acquired, this year there have only been 15, 

 and one knows for certain that two of these were not true dysentery but were induced 

 by faulty dietetic habits. (Evidence of Senior Medical Officer, British Troops.) Other 

 causes which may in some measure have aided the reduction of these two diseases are 

 an improvement in scavenging arrangements, the treatment of zibla heaps to prevent 

 tlies breeding out in them, and a more careful cleansing of the conservancy buckets. 



jVforeover, we are now at pains, so far as dysentery is concerned, to distinguish 

 imported and relapse cases and to subtract them from the total, as such cases are not, 

 as a rule, due to local faulty conditions. At least we can say that the local conditions 

 ■were not favourable to the spread of either of these diseases. 



The malaria cases have already been commented upon, and the number is a matter 

 for regret but may perhaps serve a useful purpose as a warning and reminder. Happily 

 none of the cases proved fatal. It is, of course, practically impossible to prevent cases due 

 to infected anophelines being brought into the town by steamers or boats. Such cases are 

 happily rare, but they do occur and increase our returns. 



As regards other diseases, it will be noticed that the spread of cerebro-spinal fever, 



measles and diphtheria was checked — an interesting example I hope of what can be done by 



Relapsing fever modern sanitary methods. Eelapsing fever figures for the first time. The original cases 



s'h"^ ^f '"h ^ came from Egypt and the locally-acquired cases apparently derived infection from 



first time clothes licc. The small epidemic was studied in the laboratories and some evidence 



advanced to show that the spirochete of Egyptian relapsing fever is a specific entity. 



This is confirmatory of work done in Egypt and Algiers. In the latter country the 



causal spirochaste is recognised as a new species and named .S'^. herbera. It is possibly 



the etiological factor in all the spirochaetosis epidemics of Northern Africa. 



Two cases of Malta fever, apparently locally acquired, fall to be recorded. In one the 

 source of infection could not be traced, but the diagnosis was confirmed by laboratory 

 methods. The other was a case of laboratory infection (i-ide pw/e 220) . 



Fortunately, there is no evidence that, apart from imported cases, kala-azar exists 

 in Khartoum. Until we are certain of the vector in this disease it will not be possible 

 to account for this apparent immunity. 



Phlebotomus fever, carried by the so-called " sand-fly," really a moth fly, the tiny 

 irritating insect which haunts verandahs, has been made notifiable. In all probability 

 it occurs at certain seasons. 



Vital Statistics 



Thanks to the Assistant Director, Sudan Medical Department, I am able for the first 

 time in the history of the town to present some figures regarding the births and deaths 

 which have occurred amongst the civil population. So far as the deaths are concerned, 



