Distribution of Tropical Diseases in Africa. 451 
Albert Nyanza, also in Central Unyoro, in the Shuli district, 
to the south-east of Dufli, and in Uganda, in the Kahura 
district. 
With regard to the effect of malaria upon Europeans and 
Egyptians, one notices marked differences; and here the 
personal equation comes notably into play. Some suffer 
very little from malaria, others suffer from severe remittents 
and from what some call bilious remittents and black water 
fever. On the whole Europeans suffer less from anything 
more than an occasional attack of typical intermittent fever 
than do the Egyptians, Inactivity, severe marches in the 
sun or by moonlight, and fatigue, are the predisposing causes 
of attacks of fever in Europeans. In all the old Egyptian 
stations which I have visited, the Egyptian troops and 
officials suffered excessively from malaria. It was very 
fatal, or if not fatal, it induced such marked debility that 
they were greatly incapacitated for ordinary employment. 
I found that the “spleen test” was very useful in ascertain- 
ing approximately the salubrity of a district. The Bahr-el- 
Ghazel district is, owing to its very abundant water-supply 
and its many swampy areas, excessively malarious. The 
country to the north of the Bahr-el-Arab is comparatively 
exempt. 
I pass on now to deal briefly with the subject of enteric 
fever. At Khartoum it is endemic, and no wonder, when 
one considers the filthy condition and want of all sanitary 
precautions in that town, and the quagmire into which it is 
yearly transformed at high Nile. After the inundation of 
the Nile the disease spreads all over the so-called island of 
Meroé. In all the districts I have mentioned above, as also 
in Kordofan, I met with cases of enteric fever, but they 
varied in frequency, not so much with the character of the 
country or the climatology, as with the habits and customs 
of the natives, and their sanitary surroundings. The disease 
was most frequently seen in the larger settlements in the 
Bahr-el-Ghazel districts. There, where the slave-dealers 
were in the habit of crowding together thousands of slaves, 
the filthy condition of the places can be well imagined, and 
it was in these hotbeds of disease that I saw most cases of 
