286 



SANITARY NOTES 



Various 

 conditions 

 relurncd as 

 Dysentery 



I understand from Dr. Crispin that a certain number of these cases, especially those 

 in outlyin^^ villages, were diagnosed by native sanitary barbers, whose instructions are 

 to record the most prominent symptom at the time of death. This explains the inclusion 

 of such terms as " diarrhoea " and "fever" which are symptoms, not diseases. In view 

 of the notification returns for communicable diseases, the presence of 20 fatal cases of 

 dysentery provides room for reflection, but one knows that there is no class of disease 

 in the Sudan in which so many mistakes in diagnosis are made as that in which blood in 

 the stools is a prominent symptom. 



I have seen haemorrhoids, tubercular ulceration of the bowel, simple enteritis, bilharzia 

 of the rectum and several other conditions, returned as dysentery, and it is probable that not 

 one-half of the cases under discussion were either true bacillary or amoebic dysentery. 

 Moreover, several of them may have been imported or relapse cases. At the same time, one 

 cannot but admit that this table with its entries of diarrhcEa,' fever and dysentery, throws 

 some doubt on the official dysentery returns, and that there were, probably, as indeed 

 I have indicated, considerably more dysentery cases than were notified. Even so, however, 

 there is no reason to alter the statement made on page 280. The oflBcial notifications from year 

 to year give, beyond any doubt, a fair idea of the amount of communicable disease present 

 in the town and certainly the death returns indicate that the health of the commuuitj- is at 

 present satisfactory and will, I trust, lead to an increased support of those sanitary 

 measures on which so much depends. One has no wish to claim too much for sanitation, 

 and we must remember the character of the population, the climate, the comparative 

 isolation of the city and everything having a bearing on the question. The very presence, 

 however, of diseases like malaria, dysentery and enteric surely indicates that, given faulty 

 conditions, they will speedily increase and that it is essential to combat them in every 

 possible way. Water-supply, milk-supply, improper food, disposal of excreta, waste waters 

 and refuse ; mosquitoes, flies and dust, all demand careful attention, as do possible carrier 

 cases and imperfect housing conditions. 

 Liability of ^^g regards the last point, observe the part tuberculosis plays in the table, accounting 



to Tuberculosis directly for 58 deaths and indirectly probably for many more, as there can be little doubt 

 that some of the cases of so-called diarrhoea, fever and dysentery were in reality tuberculous 

 in nature. The Sudanese are specially susceptible to the bacillus of tubercle and time and 

 again I have seen obscure febrile cases turn out to be general tubei-culosis. I believe the 

 prevalence of this disease is due in large measure to the exclusion of light and air from their 

 primitive and over-crowded dwellings, to their filthy habit of expectoration, and to some 

 extent also to the nature of their dietary. It is, perhaps, noteworthy that nearly all the 

 deaths occurred amongst adults, some proof of the accuracy of the hypothesis advanced, for 

 tuberculosis in children is believed to be largely due to infection through the intestinal 

 tract. 



The last table is that for Khartoum North. It is very unsatisfactory from a statistical 

 standpoint and hardly worth including. 



Of the 116 deaths, it will be seen that only 30 have the cause of death stated. 

 The remaining 86 have been returned as either intestinal diseases or fevers — terms 

 which, under the conditions obtaining at Khartoum North, mean next to nothing. The 

 medical officer reports that they were not seen until after death had occurred. By 

 presenting such a table, however, and drawing attention to the great value of reliable 

 statistics and the need for improvement a useful purpose is served. To me the tables 



• In this connection, sec a very nble and suggestive paper by Dr. G. D. Maynnrd, of Pretoria, entitled 

 "Acstivnl Diarrhoeas of Sonth Africi." Transvaal .'fedical Journal, September, 1910. 



